When Derek woke up again 30 minutes later, he had a headache the size of Russia. He sat up wearily, rubbing his eyes. He could hear the chatter of people outside and stood up only to fall back from the dizziness that suddenly hit him. He tried again and managed so he walked outside after grabbing a bottle of water from the refrigerator. The bright sun hit his face as soon as he stepped outside blinding his tired eyes. He walked around the side of the house to the patio area where everyone was sitting and chatting.
"Hey Derek." Meredith said smiling and getting up to grab his arm.
"Hi."
Meredith helped him sit down and she stood behind him rubbing his tense shoulders.
"Daddy?" Kai said running over to him and jumping onto him.
"Be careful Kai." Meredith said in a warning tone.
"It's okay."
"Daddy, can you make pancakes now?"
"Okay."
Derek ushered Kai off his lap and stood up, grabbing the chair to stop himself from collapsing.
"Are you sure your okay to do this?"
"No, not at all but I can't not do it."
"Let me help."
"Okay."
Orva and Robyn ran into the kitchen giggling and Kai followed shortly behind. Meredith went and explained to their guests and then ran into the kitchen where Derek and the children were. Derek was tying aprons on each child then on himself.
"Robyn can you go get the flour?" Derek said grabbing hold of the counter suddenly.
"Der?"
"Dizzy, I'm fine." Derek snapped. "Sorry."
Robyn went back with the flour and placed it on the counter.
"Orva can you get the eggs? Kai can you get the sugar? And Robyn can you get the milk?"
"Okay."
"Kay Daddy."
"Okay."
A few minutes later, Derek was using the little strength he had left to mix the thick mixture. The room was spinning.
"Derek, your not okay."
"I just... just need to sit down a minute."
"Okay, good."
Meredith grabbed his arm and guided him towards the couch. He made a sound sort of like, "Ungh," and then he toppled.
She'd seen that happen any number of times with people who donated blood without eating a big enough meal beforehand. They thought they were fine, stood up in a rush, and wham. Down they went. She stepped forward more on instinct than anything else, arms outstretched. She hooked her arms underneath his as he flailed. She fell onto the couch with him more than sat, and she rolled off his willowy frame as soon as they'd landed. She swallowed, still catching up with the situation.
"Shh," She said to the kids, who ran outside terrified. A few seconds later his sisters and Cristina ran in the door and stood by the doorway.
Meredith blinked and rolled back toward Derek. His lips were the color of chalk. His eyes rested half-closed, and he wasn't seeing, but he wasn't all the way out, at least. She patted his face, and he blinked a bit like his eyelids had been attached to his eyeballs with slowly drying glue.
"Derek," She said.
His hand twitched. She slapped his cheek a bit harder.
"Derek, wake up."
"M'okay," He slurred.
"You fainted," She said.
She ran her fingers through his hair. He blinked again, but he still didn't look like he was perceiving that much.
"Derek? Derek, are you awake?"
He made a noise that wasn't exactly coherent. She stroked his face. She didn't want to leave him, but she doubted she would get very far just by smacking him.
"I'll be right back," She said, and she ran to the kitchen, careful to keep him in her line of sight as long as possible, just in case he did something like faint all the way.
She needed orange juice or something else sugary. She pulled open the fridge, only to be delighted by what she saw. Apple juice. one of his sisters must have bought it when grocery shopping. She grabbed the jug and poured Derek a glass. She ran back to Derek with her hand cupped over the top of the glass to keep the sticky juice from spilling too much. She helped him hold the glass.
"I haven't eaten," He said in a wispy, disturbed voice.
"In days," She said. "I know. It's okay."
Meredith sat down on the couch next to him and he rested his head on her shoulder. She held his hand tightly.
"Are you still dizzy?"
"The room is...spinning at 100mph."
"So yes, very."
"Do you have a blood pressure cuff?" Cristina asked walking towards him.
"Yes?"
"I want to take his BP."
"Okay, it's in the medical draw, you know where that is."
She snuggled into his arms. He wrapped her in his embrace, and he didn't say a word. But he trembled. She felt it against her skin like the flutter of a leaf. His whole body.
"Derek, are you okay?"
"I'm fine," he said.
"Because you seem sort of like you might faint again."
"I think I-"
Before Derek could even finish the sentence he passed out again but onto Meredith. He slid onto Meredith's lap from her shoulder. Last time he was only half-fainted but this time he had fully fainted onto Meredith.
"Derek!" She shouted.
Cristina ran back from the kitchen and attached the cuff to his still arm.
"80/50 it's low Mer that's why he's fainted."
"Derek, wake up, you need to wake up." Meredith said slapping his face gently.
Cristina went and got a glass of water from the kitchen. She went back to Derek and splashed water on his face.
"Hmmm..." He said incoherently.
"Derek can you hear me?"
"Hmmmm..."
Meredith grabbed the glass of juice and put it to his pasty lips. He weakly took a few sips. Meredith rubbed the small of his back gently.
"Your okay Der." She reassured.
After a few minutes, his colour had darkened slightly and he wasn't shaking anymore. He had drunk the entire apple juice which made his BP go up slightly.
"I'm okay." He whispered.
"You need to sleep."
"No, pancakes."
"Derek! You have just fainted twice in 20 minutes, you need to rest."
"Can't I just sit at the island and watch you and the kids?"
"Fine but then you are sleeping this afternoon."
"Thank you."
Meredith slowly helped Derek up, gripping hold of him and they slowly walked to the kitchen island. His hands were shaking like mad. She went to the refrigerator and poured him another glass of apple juice and passed it to him. As soon as he picked it up, the juice spilled. Meredith sat next to him and helped him hold the glass. He sipped weakly at it while she brushed her fingers through his hair. Color seeped back into his face finally. Cristina rummaged around in a cupboard, dropping packets on the floor.
"Ah-ha." She said loudly.
"What?" Meredith asked.
"Your secret stash of junk food. Here you need to eat this." She said pushing a Mars bar and packet of salt chips in front of him.
"I'm not hungry." He whispered.
"I know Der but if you don't eat then your going to faint again, your BP is low you need to drink loads and have some sugar and salt." Meredith said rubbing his back.
With struggle, he opened the packet of chips and half-heartedly ate it.
"I'm sorry Mer."
"You don't need to apologise, your hurting more than you have in years."
"I know."
He finished the bag of chips and opened the candy bar. The kids walked into the house and looked at their sickly looking father.
"Do you want to finish off pancakes?" Asked Meredith.
"Is Daddy sick like Nona?"
Meredith looked at Derek who looked destroyed at the comment.
"No, I'm not sick like Nona. I'm sick because Nona is gone, I'm really sad like you guys."
"I sad too."
Derek's phone buzzed in his back pocket,
"It's the hospital, let me go take it."
"Okay."
Derek stood up and slowly walked into the bedroom.
"Pancakes?"
"Yes!"
30 minutes later, the kids were eating their pancakes and Derek hadn't re-emerged from the bedroom.
"Auntie Cristina is going to look after you for a minute."
"Okay Mommy."
Meredith crept into the room. She could see him buried in the covers, his head facing the window. She walked up to the bed and sat down behind him. The unhindered shiver of his muscles and the tightness of his tendons spoke of fear. She pulled his wrist into her hand and felt along the center for his pulse. Racing. He made a deep noise as he swallowed.
This looked sort of like the precursor to a panic attack, or maybe an ongoing one. Panic and anxiety tended to cause a positive feedback loop by begetting more panic and anxiety. She frowned.
"It's okay," She whispered as she stroked him. "Can you sit up?"
One moment, he'd been lying on the bed in a defensive, semi-fetal curl, buried under blankets. The next, she inhaled at the force of his embrace as he wrapped his arms around her body and pushed his face against the warmth of her neck. The blankets rustled as they fell away from his shaky torso. His frozen hands chilled her through the back of her shirt. He panted. Chuffs of air fell against her skin, and for minutes, he didn't speak at all. She wasn't sure what to do. He'd clutched her as though she were some sort of teddy bear.
"It's okay," she said.
"I don't feel very well," He whispered.
"I know," she said. She stroked his back.
"It's okay. You're okay. You're okay, Derek. You need to take deep breaths." She forced herself to take her own advice. Feeding his own anxiety with hers wouldn't do anything but exacerbate everything.
"I'm sorry," He said against her skin.
"Why?"
He sat back and wiped the tears from his eyes.
"The hospital called."
"I know, what did they want?"
"They want me to go in now, they...they think I...I have cancer."
"What?"
Derek stood up and started pacing up and down the room as he did when he was nervous.
"They...they want to do a biopsy and spinal tap in 45 minutes."
"Who rang you?"
"Dr James Whan."
"He's head of Oncology Derek, that's good."
"I suppose."
"We need to head off."
"I don't want to go."
"I know, where do you have to go?"
"His office on the 5th floor."
"Do you want me to tell them?"
"No, just say I have a follow up at the hospital."
"Okay, you get yourself ready and I'll go talk to them."
"Thank you Mer."
"Love you."
"Love you."
Meredith left the room and wanted to cry but she had to stay strong. In typical Seattle weather it had started to rain so everyone was inside again.
"Hey." Nancy smiled.
"Derek has an emergency follow up appointment at the hospital, is it okay if you can look after the kids, we're going to be gone a while." Meredith said looking at everybody.
Lexie, Cristina and Alex had gone so it was just his sisters and they kids again.
"Yes of course, everything okay?"
"Yes just checking on the stitches and they're hoping to remove them."
"Okay good."
Derek walked out of the bedroom after changing his shirt and he put a pair of jeans on.
"You ready?"
"Just need a bottle of water." He said flatly.
"Okay."
Derek went into the fridge and got a cold bottle of water out. He put a pair of sneakers on and a hoodie. Meredith put on her boots and a trench coat on.
"Bye." Derek said walking out into the rain straight to the car.
"Bye."
As soon as he got to the hospital, Dr Whan introduced himself and explained the test he was having done. Next, Jackson removed his stitches but he didn't know about cancer. He was taken into the procedure room and they waited for Dr Whan.
The pain was so much worse then than it ever had been. He hadn't been sure he could have been in more than he had been previously but he was. The tests were hell. Even with his wife clinging to his side, holding his hand through everything, even now, it didn't make the pain more bearable. He had finally found something Meredith couldn't make go away. And now he could only wish he hadn't.
His body burned with every movement he made. The Lumbar procedure, which he had always told patients was uncomfortable, forced him to hunch over, the pain in his back so severe he could barely breathe. The pain in his hips from the bone marrow aspiration and biopsy made walking next to impossible, and even sitting down hurt him.
Meredith just kept clinging to his hand. She had smiled and talked to him gently through it all, talked to him as if this was all routine, as if this was nothing to her and he was still just the strong, energetic man she had fallen in love with. Which was amazing. He hadn't known what to expect from her with this but she was being amazing. Even thought right now he was in complete pain, he loved that.
Derek was sat in Dr Whan's office, he was in agony but he refused any meds, he knew his head had to be clear to hear the news. Meredith sat next to him holding his hand. Dr Whan's walked in, slamming the door behind him.
"I've heard your refusing pain medication." He said sitting down.
"My head needs...to be clear."
"Okay but your going to need it tonight and tomorrow, it will be excruciating."
"Okay, so?"
"Dr Shepherd, you definitely have a sub type of acute mylegoeneous leukemia known as acute promyelocytic leukemia."
"Okay," Meredith breathed, squeezing Derek's hand as he gasped lightly.
"Essentially, you have an excess of immature cells and a deficiency in the mature cells," Dr Whan explained. "It's not a common diagnosis, but it is good news for us."
"Good?" Meredith asked.
"APL is the most treatable form of AML," Dr. Whan nodded.
He didn't know what to say so he stayed silent. Trapped in his thoughts so Meredith had to speak for him.
"Okay."
"We have caught it early so it is far more treatable. We start chemo on Tuesday, it's Thursday today. You have exceptional chances Derek."
"Derek, that's good, really good." Meredith said placing her hand on his shoulder.
Derek slightly nodded before returning to his deathly silence.
"Your going to be in the hospital for 6 weeks, the entire time of your first round then if you require a second round that can be administered from outpatient."
"6 weeks?" Meredith asked shocked.
"Yes, we don't know how his body will react to the chemo so if you are at the hospital we are prepared for whatever happens."
"Erm...what are his chances?"
"I try not to let my patients and family talk about topics such as that but because you are doctors then you will most likely know. 7 and a half out of every 10 get full remission, you have around a 75% chance of survival, compared to some cancers your odds are amazing."
"That's amazing Derek." Meredith said looking at him.
He was lost in his dark thoughts, Meredith knew this was going to be extremely hard on him, mentally and physically. She also knew how dark Derek could become and she was worried about that happening again.
"Your okay to go but I suggest that you use a wheelchair, your body is already using a lot of energy, you don't want to be wasting it. I have some Demerol for you, it will make you very drowsy but the pain will go, let me go get you a wheelchair."
"Thank you Dr Whan."
"Call me James."
"Thank you James."
James left the room to get a chair and Meredith turned to face him, he was trembling like a leaf and he was sheet white.
"You can beat this Derek, I know you can, we all know you can."
"The funeral...Sunday has to be the day."
"We can talk about that when we get back home."
She held onto his hand as Dr Whan came back through the door.
"Here you go." He said before helping Derek in.
"I will see you 7am Tuesday morning then."
"Bye."
Meredith wheeled him out of the room towards the elevators.
"What time is it?"
"5pm why?"
"Can you take me to conference room 2b?"
"Yes, why?"
"It doesn't matter."
2 minutes later, they arrived outside the room where all the board members were along with the heads of departments and Bailey. He stood up shakily and knocked on the door. Meredith grabbed hold of him around his waist and his hand. He walked in the room to see everyone staring at him.
"Dr Shepherd?" Bailey asked.
"I need some time off, 6 months minimum." He said looking down at his feet.
"6 months?" Cristina asked shocked.
"I do too." Meredith said smiling at him.
"No you don't Mer."
"I do."
"Can someone tell us why?" The head board director said impatiently.
"I...I have acute promyelocytic leukemia...I start chemo on...Tuesday."
"Oh my god." Callie whispered looking at him.
"I'm sorry Dr Shepherd."
"Pain." He whispered to Meredith.
"We have to go, sorry." Meredith said before walking out of the room and helping Derek sit back down.
Derek looked destroyed, he had cancer, he was still grieving and now the job he had been working for for years he can't do. They arrived at the car and Meredith helped him in before taking the wheelchair back.
"Your in loads of pain, take the Demerol."
"No...head clear...telling sisters...and kids."
"Okay, stubborn ass."
Derek chuckled a little bit before falling to sleep. Meredith wanted to fall apart but she couldn't. She had to be strong. Just looking over at him asleep in the passenger seat, he already looked sick but then he was going to get worse. Weight loss, huge bruises, hair loss and infections. Great. Just Great.