Chapter 31: Surgery? Gender Reveal?
Much to Callie's dismay, the Nursing Supervisor would not schedule an additional nurse for an upcoming surgery without Owen's approval. Tired of trying to remember to find Owen and obtain his signature, Torres had assigned Jo the task of watching for Hunt. Jo was growing increasingly bored as she waited in the Main Lobby. She was frustrated that Hunt wasn't returning her calls or texts. She saw a couple of her friends hanging out by the main desk and decided to catch up with them. The conversation went from funny ER stories to boyfriends to hairstyles.
Seemingly out of nowhere, Bailey stopped at the counter. "Ladies, is the hospital this slow? Because I've got all sorts of work you could do if you have time to chat about hair and makeup tips." Bailey asked with a warning tone.
One of Jo's friends grinned uncomfortably and excused herself quickly. The desk clerk they had been chatting with looked back at her computer and began typing.
"Wilson?" Bailey stated flatly.
"Actually, Dr. Bailey, I'm doing exactly what I've been assigned to do," Jo smiled sweetly.
Bailey glared at Jo in disbelief, "We have a beautician training program here now?"
"Dr. Torres asked me to watch for Dr. Hunt. Long story," Jo explained.
"Hmm," Bailey expressed as she walked away. "You better not be standing around talking about hair next time I see you, Wilson."
Coming up behind Jo and surprising her with a kiss on the cheek, Alex asked, "What is that all about? Are you on her list?"
"Torres asked me to wait here for Hunt to get his signature on something and Bailey walked up and heard me chatting about hairstyles. Whatever," Jo offered.
"He just walked in – better do your job," Alex grinned and chuckled as he pointed the top of his head toward the door.
Owen came bumbling into the hospital with Bronwyn on his hip and Oliver's hand in his. Upon seeing Owen's face, Jo took in a quick breath. She had never seen the Chief look so ragged, exhausted, and stressed. Before asking for Torres' favor, Jo thought it best to offer to help first.
"Good morning, Dr. Hunt. Can I help you out? Your hands are full," Jo greeted him with a smile. Without a word, Owen handed her a bag that contained Bronwyn's snacks, toys, and change of clothes, then he steered Oliver to Jo's hand and handed Bronwyn to her.
Owen glanced at the clock over the desk and told her, "I'm late for Amelia's ultrasound. Can you watch them? Just for half an hour? I'm sorry to ask, but…" Owen fretted.
"No problem at all, Chief," Jo smiled broadly. "Can you sign this for Dr. Torres? She needs it right away."
Owen signed the paper against Jo's back without reading it. "There you go. Kids, be good for Dr. Wilson." Owen kissed each of the children and absent-mindedly kissed Jo on the lips. Jo's eyes widened as she glanced over to Alex who shrugged and chuckled. Owen took off running at full speed.
Bronwyn was giggling hysterically, "Why did my daddy kiss you? You're not one of his kids!"
"I… I'm really not sure," Jo uttered in amused confusion.
Alex approached and picked Bronwyn up. She squealed in delight when Alex held her high in the air. "How's my favorite three-year-old and why are you wearing that hat?" he asked her.
"It's been a hell of a freakin' morning," she remarked as she shook her head seriously.
Completely losing his composure, Alex laughed and advised, "Those aren't words you should use, Bronwyn."
Letting out a giant sigh, Bronwyn shrugged her shoulders and offered, "That's what Daddy keeps saying, huh, Ollie?"
Oliver looked up at Alex and Jo and nodded. Alex knelt down and started analyzing Oliver's giant bruise and scrapes. "Man, did you get in a fight or something?"
"Finley did it," Bronwyn announced as she climbed onto the floor and grasped Jo's hand.
"Yeah?" Alex asked, maintaining his gaze on Oliver. Alex gently touched Oliver's chin and cheek.
Oliver stood there in resignation, Owen had already analyzed everything, and Oliver pretty much expected some other doctor would do likewise once they arrived at the hospital. "Finley punched me, but the thcrapes are becauthe I fell on the driveway later."
Alex gritted his teeth and opened his lips wide, "Do this."
"Like thith?" Oliver confirmed as Alex looked at his teeth briefly.
"Did your brother knock your tooth out too?" Alex asked.
"Nope. That justh happened," Oliver explained.
Bronwyn pulled on Jo's lab coat and whispered as Jo knelt, "Now he talks funny." Jo smiled and put her index finger over her lips.
Alex saw that some of the scrapes needed tending. "How about if Dr. Wilson and I take you downstairs to clean all that up?" Oliver agreed and the four were on their way to the Pit.
Meanwhile, Owen burst into Annalisa's exam room just as the two women decided they couldn't wait any longer. He was out of breath as he approached Amelia's side and kissed her, "I'm so sorry."
"Life happens, right?" Amelia smirked. "What took you so long?"
"Basically, anything that could have gone wrong this morning did. Finley punched Ollie, threatened Bron, and snarled at me. Oliver tripped on the driveway and scraped himself up from head to toe. Bronwyn's hair is stuffed into a baseball hat because I couldn't get the snarls out. And that's just the beginning." Owen concluded by running his hand over his hair and grasping the back of his neck while taking a deep breath, "But I'm here now."
"Let's check out these babies," Annalisa announced as she placed the transducer on Amelia. "Did the two of you decide if you're finding out the genders?"
The couple looked at each other for one last confirmation and then both simultaneously answered, "Yes."
As Annalisa examined Twin One and recorded measurements and observations, she disclosed, "Twin One is a little girl." Both Amelia and Owen beamed.
"And she's looking healthy?" Owen inquired.
Without looking at him and keeping her eyes on the screen, Annalisa explained, "As far as I can see now. I'll analyze the data when we're done, and we'll confirm."
"Look how much she's grown, Owen," Amelia conveyed with wonder.
Annalisa remained focused and moved over to Twin Two. Fairly certain about what she was going to see, Annalisa braced herself and felt her stomach tighten. She was simply thankful that the baby very likely did not have anencephaly like Amelia's first child. Just to be sure, she focused first and foremost on the head and its shape and dimensions, "Baby Two has a well-developed brain, head and face."
"She's sucking her thumb!" Amelia squealed with delight. "Or he…which is it?"
"We'll get there in a minute. You want me to jump ahead to that, don't you?" Annalisa asked dryly.
"Absolutely," Amelia confirmed with conviction.
Annalisa moved the transducer to see what she could discover. "Another baby girl," Annalisa grinned widely. As the couple celebrated and kissed, Annalisa returned the transducer to the baby's neck where she had left off. She pressed on the baby in an attempt to obtain a solid view of her spine. As she suspected, Annalisa saw telltale signs of spina bifida. Her heart sank with sadness, knowing how much more complicated Amelia's pregnancy had just become.
Clearing her throat to get their attention, Annalisa softly revealed the news. "Owen and Amelia, I want to show you something." The couple, who had not watched the ultrasound since Annalisa's announcement about the gender, sobered up quickly.
Owen spoke before Amelia had a chance, "What is it?" He squeezed Amelia's hand.
"Let's take a look and I can show you," Annalisa offered as she turned the screen back on. "As her spine developed, some of her nerves formed this growth. See the bump there? That's a myelomeningocele." Amelia said the word aloud at the same time Annalisa uttered it. Amelia pursed her lips and folded her arms just below her breasts. Her breathing became more intentional as she silently attempted to keep calm.
"If you like, I can page Arizona Robbins and Alex Karev to discuss surgical options and birth timing or we can wait awhile," Annalisa offered.
Owen grabbed his chin and mumbled, "Is now ok, Mia?" Amelia nodded in agreement. As Annalisa walked slowly to the phone in the exam room to request the page, Owen pulled up a chair and lay his head on Amelia's shoulder. He forced out a question, afraid of the answer, "What's this mean, Mia?"
"In utero surgery is the best option. I can't remember the details from my training – there are certain ideal weeks for the surgery that hit before the ideal weeks for a preemie birth. I'm sure Arizona can tell us more." Amelia reached her hand over and stroked Owen's hair, whispering, "We'll have options. She'll be ok."
Annalisa returned and sat down. "They should both be here shortly. In the meantime, do you have questions for me? Otherwise, I'll step out and give you time alone."
Owen shook his head, "No questions. Thanks, Annalisa."
Amelia's lips remained pursed and tight, "Owen, we're not going to fall apart yet. We need to keep it together so we can hear the details."
Owen raised his head from her shoulder and wiped away a stray tear as he nodded and asked, "But she'll be fine?"
"Likely. There may be some paralysis. Her site is low on the spine, which is very good. Some kids have very few symptoms, some experience intestinal, kidney, or hip challenges. Right now, we're mostly in a wait and see phase," Amelia explained like a neurosurgeon on duty. "Deep breath. We're keeping it together right now, right?"
"Yeah," Owen agreed numbly as he checked his phone and saw a text message from Jo.
Torres had called Jo away from the kids, so Jo left them in Alex's care. Jo sent a text to Owen letting him know that Alex had taken over and was tending to Oliver's scrapes. When Alex's pager directed him to Annalisa's office, Alex assumed Owen was ready for the kids. Carrying Bronwyn on his shoulders and holding Oliver's hand, the trio trekked across the hospital. In order to keep unemotional, Amelia asked about the chaotic morning and caught up on all the excitement.
Annalisa's medical assistant saw Karev and the kids heading toward her. She buzzed into the exam room and asked the parents if they would like the kids to come in. They both said yes. The MA explained the basic situation to Alex on a note, so he wasn't walking in blind. In the room, Owen had moved over to Annalisa's seat and shuffled the ultrasound images away from the myelomeningocele and toward one of Twin One's face.
Alex walked in with pursed lips and a nod as the kids ran up to their parents. "Mommy!" Oliver exclaimed. Over time, the Auntie title was too much of a hassle for Oliver, so he made his own decision to call Amelia 'Mommy.' The other two followed suit.
Amelia beamed as Oliver approached and leaned up and over a bit to squeeze him, "How's my rough and tumble boy?" She grasped his chin in her hands and looked at Oliver's face, continuing, "Good thing school pictures were last week, huh?"
Oliver laughed in agreement as he told Amelia, "I mithed you thith morning. It was bad and Finley was mean."
Bronwyn piped up in her typical loud voice, "Yep. And Finley punched Ollie and he gotted this close to me and said he was gonna hurt me." Each set of words had physical movements to accompany them as Bronwyn swung her fist, leaned over, and tried to imitate Finley's face. Then, knowing it would get her attention, Bronwyn added her phrase of the day, "It was a hell of a freakin' morning, Mommy."
"Hmmm…" Amelia responded with a furrowed brow. "Apparently. Who did you learn those words from?"
Owen slightly blushed and cleared his throat, then joked, "The neighbor came over this morning and…"
"Daddy, don't be a liar. You said thems words and the s word too," Bronwyn announced.
Amelia looked over at Owen with a playful angry face, "Someone is in trouble."
"Do you want to see your new sisters?" Owen asked, changing the subject. Karev walked over too, put a hand gently on Amelia's shoulder and leaned toward the display. Amelia grasped his hand in hers. Owen let the kids sit on his lap so they could be close to the images.
Bronwyn gasped with awe and delight, "Two sisters?! That's cool."
Alex leaned down to Amelia and asked detail questions in med-speak. Amelia was thankful for the distraction. He asked, "How high is it?"
Amelia mumbled, "Low. Good placement."
"Lower body movement?" he inquired. Amelia nodded then Alex asked, "Gray matter development?"
"Appears intact and fully functioning," Amelia responded.
As she spotted her little sister sucking a thumb, Bronwyn blurted out, "She needs a binky! Look at hers, Mommy."
"Excellent," Alex assessed. Arizona and Annalisa entered the room, so Alex walked over to them. Having the kids present was not ideal, but five brilliant doctors could figure it out. Having viewed portions of the scans, Alex shared his assessment of the twins' development with his colleagues. "I'm not sure if you need me here at this point. I can take the kids and deal with that."
"They might have questions about timing the surgery and delivery and about viability," Arizona reminded him.
"You know all that. I can meet with them another time after the news has sunk in a little," Alex insisted. The other two agreed.
Alex walked over to the family and suggested, "Would you two like to come with me and see some tiny babies that are just a little bigger than your sisters? You can't touch them, but we can look." The kids eagerly agreed and went to the NICU with Alex.
As they were walking out the door, Bronwyn asked Alex, "How can they tell that the babies are sisters and not brothers?"
All remaining in the room chuckled as Arizona commented, "Ah…that's good for him."
Arizona sat down on the rolling stool and reviewed the scans briefly. She added a few more scans to the collection as she moved the transducer around. She shared, "Now this is only based on what I'm seeing at this moment. I'll need to study the scans further to gain more clarity. I agree with Annalisa, both girls are thriving and healthy. As Twin Two's spine further develops, we'll be able to determine how extensively the nerves protrude. Prognosis is hopeful. We'll watch for tethered cord and further developments. Your best option is in utero surgery. Amelia, are you familiar with the studies comparing pre- and post-birth surgeries?"
Amelia nodded, "In utero is infinitely better. That's our best option."
Nodding, Arizona added, "If you opt for surgery, 19-25 weeks gestation has shown the best results, so sometime between today and the next six weeks. The 22nd week seems to be a frequent choice, but I prefer to wait until at least 24 weeks," Arizona explained.
"Why?" Owen asked, thinking the sooner the surgery, the better. Viability wasn't even on his radar.
Taking in a slow breath, Arizona explained, "Should the surgery not unfold as planned and the baby or babies need to be delivered, 24 weeks provides a 40-70% chance of survival. The 23rd week is only 10-35% with the 22nd even lower. Every day between the 24th and 26th week provides an additional 2-3% increase in the percentages. However, if we wait beyond the 24th week for the operation, the spine has less time in utero to develop and heal from the surgery. Luckily, we're dealing with two girls – girls have a higher survival rate. Alex is available for further consultation about delivery weeks and prognosis. He shared that he was very pleased with the girls' development at this point. Of course, the longer the babies remain in the womb, the better."
Arizona paused to take stock of the couple and their states of mind. She commented gently, "Even for two successful doctors, this information becomes overwhelming to absorb." Arizona shared that she had a few journal articles she wanted to share with the couple. She also advised that they consult with one of her colleagues at UCSF who pioneered the in-utero surgery study.
Once Arizona finished speaking, silence hung in the air for a few minutes.
The first to move, Amelia leaned over to grab some Kleenex. Owen whispered, "I'll do it, Mia." He gently wiped away the gel on her belly as Amelia gazed at his face. Arizona and Annalisa nearly cried as they quietly slipped out of the room.