Chapter 48: An Abscess and A Surprise Birth

Baby B: Born at 34 weeks

January 25

Amelia woke up in recovery. Her head felt heavy, foggy, and confused. Her parched mouth felt as if she'd eaten a desert full of sand, and the sand seemed to have scratched her throat from end to end. Her stomach, likely weighed down by all the sand she'd eaten, was nauseous and rumbling. She moaned and groaned in an attempt to call for help.

"Hi, Dr. Shepherd-Hunt. It's nice to see you awake," an unfamiliar nurse who looked like Cinderella smiled as she began to take Amelia's vitals. Once she had her readings, the nurse patted Amelia's hand and whispered, "I'll be right back, doctor."

Amelia's eyebrows lowered as she attempted to speak. She knew she was in recovery, but she didn't understand why. She moved her hand down to her baby bump. She discovered a large wet dressing and recoiled in pain as she palpated it. Drifting back and forth between sleep and flawed awareness, Amelia tried to make sense of her situation.

The nice nurse returned and swabbed her mouth, explaining lovingly, "You're not quite ready for liquids, honey. This will help a little." Wishing for water, Amelia noticed that each attempt to cough caused horrible pain in her throat and in her abdomen. Amelia held out the bloodied hand that had discovered the dressing, hoping the nurse could help. Then she patted her ring finger, attempting to ask for her husband. People, their faces, and the room warped in and out of focus as it tilted up and down as well as forward and backward. Time seemed nebulous and amorphous.

"Hey…" Owen cooed as he greeted his groggy wife. He was dressed in scrubs, a surgical robe, a scrub cap, and a mask. Immediately, he began changing her dressing and lightly cleaning off her hand. "You need to avoid touching that, Mia," he advised mildly. He reached down and caressed Amelia's head, asking, "Do you know where you are?" She nodded. When she attempted to speak, Owen shushed her. He said gently, "You're intubated, Aims. Don't try to talk."

He pulled up a chair and sat down next to Amelia's bed. He stroked her arm and asked a series of questions. Each inquiry was met with a nod or a shake of her head. "Do you know why you're here?" Amelia shook her head slowly. "Do you know what day it is?" Amelia shook her head slowly. "Do you know who I am?" She smiled and nodded. Owen quipped with a smile, "Well, that's a relief."

"Can you squeeze my hand?" Amelia attempted to position four of her fingers but each one seemed as if it had its own agenda. "Let's try something else," Owen suggested kindly with a forced smirk. Medically, he was concerned about her slow recovery from the anesthetic, but he was trying not to show that. He paused as a look of concern washed over his eyes and asked, "Do you have any pain?" Amelia nodded and put her hand where her baby bump used to bulge and where she wasn't supposed to touch. She tried to contort her face in a way that could communicate the intensity of pain.

Sounding like an adult from a Charlie Brown special, Owen evenly gave orders to Cinderella. He turned to look at Amelia, gently and slowly explaining, "Aims, you're just waking up from surgery. You had a C-section and our little girl was born. Addie also had to go in and address that abscess." She thought she understood him correctly, but his words were warped and slow. He'd said something about a C and a little girl.

Owen chuckled as his eyes glossed with tears, "She's beautiful. Karev's working with her, she's in good hands. You're not going to believe this, but she doesn't look like an Asha." Amelia tried to smile but wasn't sure if she pulled it off. She knew what he had just said was funny, but she wasn't sure why it was funny. Owen reached up and traced the smile on her lips.

Amelia stretched her head and neck just a few degrees toward her left side and closed her eyes. Falling back to sleep in a second, Amelia re-entered her dream world where her dad held her hand and Derek had an arm around her. Her father and brother continued to reassure her that she was going to wake up and that there was no reason to panic. Amelia, on the other hand, insisted that she was certain she was dying.

Owen looked at his watch and advised the nurse, "Page anesthesiology and Dr. Montgomery. She's too groggy and her BP is too low for this point in post-op." Sitting at her bedside and rubbing her arm, Owen closed his eyes slowly and took slow deep breaths. When the nurse paged him to come to recovery a few minutes prior, he'd stepped away from his newest daughter who looked just like her mama. Sitting here, he almost began to wonder if he'd ever speak to that mama again. The doctor in him said he was being ridiculous; of course, she would be fine. The over-protective husband in him trembled in fear. His gut reactions from both roles haunted him because, without a doubt, something was not right.

The anesthesiologist entered the room and Owen shared his observations. The doctor ordered neostigmine and a warming blanket, then asked about Amelia's glucose and sodium levels. He ordered Owen to step aside and let them work.

Cinderella pushed neostigmine into Amelia's IV. A CNA stood behind her with an armful of warm blankets. Each blanket was placed on top of Amelia except for one that was rolled up and placed around her shoulders and head like an outline. As he stood in the periphery, Owen heard that her glucose and sodium levels were within an acceptable range.

As the nurse, assistant, and doctor tended to Amelia, Addison entered Recovery. As she gowned up and masked, she took the lead and questioned with a combination of concern and anger, "What's going on?" She placed a hand on Owen's shoulder and whispered that he should step out,

"Addie, she's in pain. I changed her dressing and it was soaked. Something isn't right," Owen shared. Addison nodded then headed to Amelia's bed.

The anesthesiologist shared with Addie, "Delayed emergence. We just pushed neostigmine and began warming her up."

Addison smirked as she caught Owen's glance and shared, "The baby is with Karev in the NICU, Owen. Why don't you head up there?" Addison began barking orders and called for an immediate transport out of recovery.

Owen, feeling ignored and dismissed, called out, "You haven't addressed her pain. She's hurting at her surgical site. This isn't just delayed emergence."

Addison did not make eye contact with Owen. She heard him yelling something, but she was trying to focus on her mental checklist, "Has anyone tried a quick neuro exam? How are her pupils?" Everyone shook their heads. Obviously frustrated, Addison lifted Amelia's eyelids one by one and declared with relief, "Pupils are equal and reactive." Looking up, Addie saw Owen still standing in the room. She leaned over to the nurse and ordered, "Please get him out of here now."

"What's her pulse ox? I need a chem panel and a CBC stat. What's the last BP?" Addison demanded. Before receiving all the answers to her questions, Addison stepped on the brakes by the bed's wheels and began pushing the bed toward the door. "She needs a warmer room, people. Keeping her down here in the cold is only going to create an uphill battle." Grab some more warm blankets and change out the top layers while we're moving." She mumbled aloud but to herself, "Even being in the hallway would be better than this walk-in freezer."

"Addison!" Owen bellowed as he blocked the bed from moving further. "Dammit, look at the right side of the bed, people!"

"We don't have time for every little issue, Owen, you know that," Addison admonished.

More roughly than he intended, Owen grabbed Addison's arm and guided her to the other side of the bed where blood was dripping off the blankets. Owen stepped in and took over leadership as he called out to the nurses about replacing the warm blankets slowly and steadily. He lifted the blankets above her surgical site and threw the bloodied layers on top of Amelia's other side, hampering the nurses' efforts but discovering the source of the bleed. When Owen placed Addison's hands firmly on top of the area, Addison mumbled, "Holy hell." Then called out, "Page General Surgery. Have them meet us in Labor & Delivery. Do not let them send Grey – she's family."

The anesthesiologist answered back, "Dr. Montgomery, with all due respect, she should be in the ICU. We need equipment at the ready." Addison knew he was right, she just didn't want to admit to herself that Amelia's condition was that serious. She pursed her lips and nodded, correcting her order, "Gen Surg to ICU not L&D."

Amelia blinked her eyes several times and slowly turned her hand, so it brushed Addison's leg. "Hey, Amy," Addison said as she moved her face closer to Amelia's. Amelia's eyes closed quickly. Addie rubbed her cheek. "Honey, I'm right here. We're moving you to a warmer room. Owen's right here. I'm here. We've got you, Amy."

The team wheeled Amelia to a room, and Addison ordered a larger 14 gauge IV for fluids, Tramadol, and antibiotics. Freshly gloved, Addie examined the incision site and was able to temporarily stop the bleeding. "Let's optimize hemoglobin and coagulation status and get her awake."

Miranda Bailey entered the room and jumped in to assist. "What's your plan, Dr. Montgomery?" Miranda inquired.

"To have you continue to look for any external hemorrhage sites and analyze the blood draw for internal bleeding. I'm going to talk to Owen and encourage him to spend his time in the NICU," Addison declared as she ordered the anesthesiologist to continue to work on warming Amelia and waking her up.

"You got it," Bailey confirmed. "You heard her, people, let's keep moving."

Addison stepped into the hallway to provide an update to Owen, who was sitting in a formerly empty chair behind the ICU nursing desk. When he saw Addison walk through the curtain, Owen sat up and asked with hesitation, "Well?"

"Owen, she's stable. We're warming and waking her now. I'm going to have to go back in to explore for a hemorrhage. She may have internal bleeding and I was able to spot and temporarily stop an external source. We're replacing blood loss and fluids. Pain meds and antibiotics are in. When she wakes up, I'll assess mental function and confusion to discover if it's from shock or the delayed emergence. Her blood pressure is low but we're watching it carefully."

"When," Owen stated firmly and factually, "When she wakes up."

"She will wake up, Owen. She will," Addison declared without proof. "You're welcome to go in and be with her briefly, but I suggest you head up to the NICU in a bit and stay with your daughters."

"What's next?" Owen asked.

Addison explained, "Assuming we can continue to slow the bleeding, we'll wait until she's conscious and stabilize all her readings. Once we're there, I'll go back in and address the source or sources."

"How did this happen, Addison?" Owen asked sternly.

"I don't know yet, but I will find out," Addison promised. "Have you heard any updates on Twin Two?"

"Karev is with her," Owen uttered solemnly, distracted by Amelia's emergent status.

Addison held out her hand and reached toward Owen, "C'mon. Let's go check on your bride." Owen grasped her hand and let her lead him into the ICU room.

Amelia was slowly surveying the room when they entered. She was definitely awake, and Addie wanted to assess her. The anesthesiologist had extubated her and her breathing was steady. Before Addison could do or say anything, Owen rushed to Amelia's side. He smirked and said softly, "Everything is ok. Seems you're trying to grab some extra sleep before those babies start keeping you up all night."

After grinning in response, Amelia blinked several times, yawned, and closed her eyes briefly. She re-opened her eyes and looked around quizzically at all the people surrounding her.

"Where am I?" Amelia asked Owen.

Owen, the over-protective husband overruling the doctor in him, determined that she did not need to know the seriousness of her situation nor that she was in the ICU. "You're here at the hospital. You're having a little post-op bleeding and a small case of delayed emergence. Everything is going to be ok." Owen rubbed his hand from her brows to the top of her head and kissed her forehead. Grasping her hand, Owen grinned and looked in her confused eyes.

"Addie?" Amelia moaned with a hoarse and gravelly voice.

"Hi Sweetie, I'm right here," Addison assured her still wearing the highly bloodied gown she'd had on while treating Amelia.

Amelia lowered her brow and narrowed her eyes before haltingly questioning, "Is that my blood? Am I ok?"

Stepping closer and patting Amelia's arm, Addison avoided the question and responded, "It's good to hear you talking and see you awake. We're keeping an eye on you, Amy."

"Where's my baby? How is she?" Amelia inquired, perplexed yet determined to wake up and figure out her situation despite the cobwebs in her head.

Addison grinned and said, "She's in the NICU. I'll have someone get an update for you.

Amelia continued her investigation, "I had a C?"

"Yes, you had a C," Addison confirmed. "then the abscess ruptured, and we had to anesthetize you."

"Do I have sepsis?" Amelia wondered aloud.

"No signs of sepsis. There are a few stray vessels that don't want to stop bleeding, but we'll take care of those soon enough," Addison clarified. "Thanks to Owen, your bleeds were caught very early on. He saved us all a great deal of trouble."