Alex was as strong as he put out to be but he had a weakness, his family. He had an awful upbringing, abusive alcoholic drug taking father and an abused schizophrenic mother. His father would beat his mother black and blue but as soon as he got old enough to repay the favour he left. Alex had to be the father to his 2 sisters and the husband to his mom at only age 14. He couldn't have friends, girlfriends or even go out because of his mother. Alex had to bathe her, dress her, cook for her, give her her meds and do everything. He also had to look after his 2 younger siblings and do the same tasks for them. Once he had enough he had to get his mother committed and that meant that him and his siblings had to go into care.

That morning he got a phone call from his sister's social worker which was bad enough without knowing what he was going to say.

"Hi Alex, can you sit down for me?" The man asked sombrely.

"Yes what's going on?"

"It's your sister Alex."

His heart began racing and his palms started to clam up.

"Amber? What is wrong with Amber?" He stuttered.

"There was an accident last night. She was in a car and it crashed around a telegraph pole."

"Which hospital is she at I will book a plane ticket now." He panicked.

"Alex, she didn't make it. I'm so sorry." The social work said.

"Amber." He whispered tears running down his face.

"I have to go now to talk to your brother, I'm sorry Alex."

"Bye." He said.

At this point Alex was sobbing with his head in his hands and shoulders shaking every time a sob took over his body. Meredith burst into the room hearing the sobs and went straight over to the bed Alex was sat on.

"Alex, what happened?"

"Amber..." He gasped,

"She's dead." He sobbed.

"Oh my god Alex!" She said pulling him in to hug him.

He didn't know what to do, go to work or not? At least if he went to work he could keep his mind off it and keep busy. That's what your supposed to do anyway. He sat back up 10 minutes later and stood up feeling very dizzy and nauseous but he shrugged it off thinking it was just from the grief or shock.

"Alex?" Meredith asked.

"Yeah." He said being away in some distant place.

"What are you doing?"

"Work."

"Wait what?"

"I have to work I need to keep busy and I have a huge case with Robbins today anyway that I can't miss."

"But..."

"I know, you can tell Robbins if that makes you feel better but I have to work."

Alex walked out of the room to see April and Lexie waiting outside the bathroom for Derek to finish. Meredith followed out shortly after.

"No Alex, you need to go to the back of the queue." Lexie said.

Derek opened the door and Alex went straight in and locked the door behind him.

"What is his problem?" Lexie asked harshly.

"Derek come here, just guys be quiet."

"What's up?"

"He is like that because his sister died last night. Her husband has just called him about it, cut him some slack. He is still going into work though but just don't tell anyone

"Oh my god!"

"I know just don't tell him you know." Meredith said before walking away with Derek.

Alex was getting ready in the bathroom trying to get rid of his red puffy eyes but it wasn't working. He looked like a red panda bear, his eyes were bloodshot, his face pale and his hair messy. He brushed his teeth and hair then walked out of the bathroom. Alex saw April and Lexie looking at him sympathetically but he just ignored them. He was a fourth -year resident so couldn't afford to take time off especially now with the boards only in a year. He went back into his room and got changed into some clothes. It was only 6am but his shift started at 7am. Once ready Alex walked out of the room and Meredith met him at the top of the stairs.

"I'm taking you to work today your not allowed to drive in this state."

"I'm fine Mer."

"Nice try but your not."

"Hmmm..."

They both walked downstairs into the kitchen, Derek was already cooking and the smell made Alex's stomach churn.

"Hi Alex do you want something to eat?" Derek asked trying to conceal his concern for his friend.

"No thanks not hungry."

"You need to eat something."

"I'm sure Meredith has told you anyways but I'm not up to eating at the moment." He said emotionlessly.

"She has, I am truly sorry Alex."

Alex walked over and got some water from the tap and then placed it on the counter. He then rummaged through the medication to find some anti-nausea meds to try ease his bubbling stomach.

"Alex?"

"What?"

"Anti-nausea meds?" Meredith asked.

"I just feel a bit sick, it's just as a precaution."

"Are you sure you should be working?"

"Yes I need to." Alex said gipping slightly.

Meredith glared at him and ate her slice of toast quickly. After a few minutes, Alex, Meredith and Derek were walking out of the front door towards Derek's black Porsche. Alex was becoming more and more nauseous by the second. He didn't even know if he could make it to the hospital without throwing up in Derek's prized car.

After 10 minutes they were driving down a small lane where no one else was and Alex felt a gurgling sensation.

"Stop the car!" He shouted.

Derek abruptly stopped the car at the side of the road. Alex quickly ran out towards the trees and doubled over his aching stomach. He threw up and Meredith ran out to help him. She rubbed circles up and down his back to try comfort her clearly hurting friend. This was the other side of him that many people don't see unless they're close like Meredith was.

"Sorry." Alex said gasping for air.

"Don't apologise, you are hurting more than you are putting on and this is how your grief shows."

Alex leant forward and threw up once again. Derek was sat waiting anxiously in the car. Once he finished Meredith ran back to the car to try find a bottle of water.

"Is he okay?" Derek asked.

"No he shouldn't be working today, he looks awful and he must feel so bad. He can't stop throwing up and he's lost his sister."

Meredith found the bottle of water and quickly opened it to give to Alex.

"Small sips."

Alex managed to keep it down which was good and he felt marginally better.

"Do you think you can get in the car now?"

"Yes."

Meredith helped Alex back into the car because he was so unsteady on his feet. Meredith helped Alex sit down in the back and he went to sit down next to him.

"Your okay Alex." Meredith reassured him.

Meredith placed her hand on his and smiled at him. He was exhausted and just fell asleep in the back of Derek's car.

Meredith woke him up when they arrived at the hospital. His face had drained to a new shade of pale which worried Meredith a lot.

"Alex, we are at the hospital." She said gently stroking his arm.

He slowly woke up feeling like death warmed up and he wasn't even sure if he should've been at work. Derek went and opened Meredith's door to help them out. Alex opened his door and stood up on his weak legs. He grabbed hold of the car to balance himself. Meredith went around to his side of the car and grabbed his arm.

"I am going to go onto Arizona's service today so I can stay with you." Meredith said.

You could tell how weak Alex was because he didn't argue with her. Meredith helped Alex walk all the way to the residents lounge so they could change in there. Jackson, Cristina and Bailey were already in there and they all looked confused when they saw 'Evil spawn' looking so weak and Meredith practically holding him up.

"What the hell?"

"Bailey can I talk to you outside please?"

"Yes of course."

Meredith quickly went and sat Alex down on the couch and he fell straight back. Mer walked outside and met a concerned looking Bailey.

"So?"

"Alex's sister passed away last night in an accident and he only found out this morning. Most people grief through crying and depression but Alex doesn't. He becomes ill and quiet, he threw up 3 times on the way here but he insists on coming in. Is it okay if I a, on Robbins service today to look after him?"

"Oh my god of course I'love go tell her." Bailey said before walking away.

When Meredith walked back in Alex had is head in the trash can throwing up violently. Jackson and Cristina was stood in shock while Derek who had just come in to give Meredith her bag was rubbing his back for him, Meredith ran over and Derek moved out of the way for her.

"Your okay Alex, don't worry."

He sat back and tears were streaming down his deathly white face from his red puffy eyes.

"If you put on your scrubs you can get out of these clothes because you have sick down them." Meredith said.

"Okay." He sighed.

Meredith went over to his cubby to get his scrubs.She whispered to Cristina and Jackson,

"His sister passed away last night this is his way he grieves."

"Oh my god."

"Poor thing." Cristina said, Meredith didn't know if she was being sarcastic or not.

Meredith collected his scrubs and went back over to him. She passed him the scrubs and went to get herself changed. Once she had gotten changed she went over to see how Alex was doing, he had finished getting changed and was sitting back against the couch again. Meredith sat down next to him and hugged him. Normally Alex would pull away and make some comment but today he hugged her back weakly. Robbins ran into the room, panic plastered all over her face. She ran straight over to Alex and crouched down in front of him.

"Karev, go home." She said.

"I...I can't...so have to be here...and we have Emily's surgery...to do." He stuttered.

"Alex I am so sorry for your loss, I know how much Amber meant to you." Robbins said placing her hand on his.

He smiled weakly and wiped a few tears from his eyes.

"If you are going to work do you want start?" Robbins asked.

"Yes." Alex said standing up.

"Are you on my service today Grey?"

"Yes if that's okay, I want to stay with Alex to make sure he is okay."

"Yes that's fine, good idea."

They all stood up and Meredith grabbed hold of Alex's arm. They all walked slowly out of the Resident's lounge towards the elevator. Alex let go of Meredith's arm and walked on his own towards the elevator. It dinged and Owen, Bailey, Teddy and Cristina were stood in there. Alex walked in and slumped against the elevator wall and closed his eyes for a second, all eyes darted towards the young surgeon.

"How are you Alex?" Owen asked oblivious to the situation.

"Well my sister is dead and I have spent the entire morning throwing up so I am absolutely amazing." He said coldly.

"Oh I didn't know Alex, I'm so sorry."

The elevator went to an awkward silence until the doors opened once again and Alex walked out with Arizona and Meredith. Alex was swaying side to side as he walked down the corridor towards Emily Geldart's room. He had been working with her for a few months to try fix her stomach issue so she could eat again without any pain. Alex stopped outside her room and held onto the door frame, Meredith went over and held his arm.

"Are you sure that your ready? You've gone super pale again."

"Yes."

Alex took a deep breath and opened the door. Emily was sat in her bed with her dads next to her smiling from ear to ear.

"Dr Karev, Dr Robbins!" She laughed.

Alex had frozen at the door and Arizona went forward to greet her. The way that Emily smiled and greeted them devastated him because the last time he properly saw his sister was when he was 10 and that was exactly how she sounded. Freddie one of her dad's was talking about her surgery and her other dad Seb looked over at Alex with confusion all over his face.

"Dr Karev?" Seb asked.

Everyone stared at Alex until Meredith went over to him,

"Alex, can you hear me?" Meredith whispered in his ear.

He was lost deep in his thoughts, that scared him, he knew what he was capable of. Alex felt a hand move from his head all the way down to the tips of his fingers. He quickly snapped out of his thoughts,

"Ummm...yes sorry." Alex stuttered.

"Is he okay Dr Robbins?"

"He and Dr Grey are just going to go for a walk now while we discuss this little ray of sunshine's plan." Arizona said.

Meredith tugged at Alex's arm and he sighed. They walked out of the door and Meredith held onto his arm tightly as she could tell he was becoming dizzy.

"Alex do you want to maybe sit down for a minute?"

"No, Mer I think I'm going to puke." He said almost gagging.

Meredith quickly looked for a nearby bathroom but she couldn't find one but the attending's lounge was down the hall. Meredith quickly dragged Alex to the lounge and Derek, Teddy, Richard and Owen were sat in there.

"Meredith, Alex?" Richard asked shocked.

Neither of them replied and just went straight over to the bin next to the couch where Owen was sat. Alex sat down and leant straight forward towards the trash can and very violently expelled the contents of his stomach. Meredith once again gently rubbed his back and everyone else just stared in complete and utter shock.

"Alex, you're okay." Meredith reassured.

"Do you want me to get him a glass of water?" Owen asked.

"Yes please."

Owen quickly ran out of the room as Alex leant back on Meredith's arm. He had tears gushing down his face, for the grief, the pain, the embarrassment. Owen ran back into the room with a small plastic cup of water and passed it to Meredith with a tissue. She wiped his face for him and passed him the cup of water.

"Small sips."

He managed to keep the fluids down which was good but he was shaking and looked so deathly.

"Tired Mer." He whispered.

"I know." She whispered back.

"Is it okay if he can maybe just have rest in here before his surgery?" She asked.

"Yes take all the time you need." Chief Owen said.

"Just rest I'll wake you up before the surgery."

Alex laid down with his head on Meredith's lap and almost instantly fell asleep. Mark walked in smiling until he saw his favourite resident fast asleep with sick down his light blue scrubs and his face as pale as snow.

"Shhhhh..." Derek instructed.

"What happened?"

"His sister passed away last night and when he grieves it seems like he becomes ill. Just let him rest, he is insisting on doing a surgery in a few hours." Derek continued.

"Oh my god."

Alex woke up in a cold sweat and his heart was pounding. His head was still on Meredith's lap, she was stroking his hair gently. Derek, Mark and Owen were still in the room doing their various things. Alex slowly sat up and flopped back against the couch.

"How long have I been out?" He asked.

"2 hours, the surgery is beginning in 30 minutes if you are still up for doing it."

"Yes."

"So do you want to get changed into some fresh scrubs?"

"Yes please."

"Mer, there are some pale blue scrubs in the cupboard next to the door if you want to use them." Derek said.

"Thank you."

Meredith stood up and grabbed a pair of scrubs out of the cupboard. She helped Alex up and he went into the bathroom to get changed into the fresh scrubs. Alex came out a few minutes later looking a bit better than before, his hair was neater, he was marginally less pale and he could walk a lot better.

"I have told Robbins that we are going to do the surgery so we have to go up now." Meredith said standing up.

"Okay." Alex said quietly.

They left the room and walked straight to the elevator and got in. All this was done in silence, Alex was trying to prepare for the long surgery ahead and Meredith was worrying about Alex. They left the elevator and went straight to the scrub room. They already had there scrub caps on and they put on there masks. Robbins was already in there starting of with the initial cut. Once they scrubbed, Meredith went straight in and Alex took a final deep breath before also walking in.

Scrub nurses placed gown and gloves on Alex and Meredith after taking their pagers and phones. Meredith was already at the table when Alex walked in, he took another deep breath and walked towards the table.

"Feeling any better?"

"A little."

"Good, we are going to try dissect the entire tumour from her oesophagus so she can eat. Should take maybe 3-4 hours."

"Okay."

They chatted during the surgery for 2 hours until Alex's phone began to ring.

"It's Dr Karev's." The nurse announced.

"Who is it?"

"Iowa mental health facilities."

"Ignore it."

"Okay."

It stopped ringing but almost instantly rang again.

"Answer it please." Dr Karev said.

"Is this Dr Alexander Karev?" A sad sounding nurse said.

"Yes."

"This is about your brother Aaron Karev."

"Okay is he okay?"

"No Dr."

"Aaron, what is wrong?"

The entire OR was silent with eyes plastered on Alex's depressed looking face.

"He found about your sister this morning, were they close?"

"Close until he tried to kill her." He said bluntly.

"Is it best if I just say it to you straight?"

"Yes."

"Your brother successfully committed suicide earlier today. He died almost instantly. I am so sorry Dr."

"Thank you for telling me, I have to go I am in a surgery."

"I am so sorry, bye Dr."

Alex wanted to cry but he couldn't, he just felt sick and so dizzy. The entire OR staff were looking at him sadly and silently. Everything started spinning and he grabbed hold of the OR table and Arizona grabbed his arm but it didn't work. He passed out onto the floor with a large bang.

"Alex!" Meredith screamed.

"I can't leave the patient, put him in the rescue position and get him some oxygen. Some one page Hunt, Bailey, Shepherd and Sloan now!"

Meredith put him in the rescue position and a nurse passed her an oxygen mask. She placed it on his face with the hopes it would maybe help him wake up but it didn't. Dr Shepherd and Dr Sloan ran into the room and looked at the hurting resident on the OR floor.

"What happened?" Dr Shepherd asked.

"He found out that his brother committed suicide this morning after the news of his sister, then he passed out."

"Oh my god, there is a gurney outside let's get him on there." Dr Sloan instructed.

They lifted the surprisingly light man up and took him outside to the gurney where Bailey and Hunt were waiting.

"Oh Alex." Bailey said shocked at his state.

"Trauma one is open, he has a large wound on his forehead which will need sutures."

Then the worst happened...