Disclaimer: don't own anything.

Derek lay with his arm resting on his forehead, counting sheep unsuccessfully until he sighed deeply and sat up in his bed. It was still early, too early, especially on his day off, especially when he could hear his mother in the kitchen.

She'd been at it since the day before when he had finally confided in her. She had insisted that he book an appointment with Olivia right away and had only slightly relented when he had told her about her family.

Now, he had an appointment with his oncologist at Seattle Presbyterian this noon.

His oncologist.

Maybe if he tried hard enough, he could pretend that none of this was real.

Derek slowly moved to retrieve his t-shirt from the floor when a throbbing pain moved down his arm, originating from his shoulder, almost rendering him immobile. He sat back down, breathing heavily as the pain ebbed, only to flare up again when he tried to move his arm.

Breathe in. Breathe out.

One. Two. Three.

He began with his little finger, flexing it then extending it.

Relatively no pain. Good.

He did the same with the rest of his fingers before moving on to his arm, again flexing it and then extending it.

Mild. Nothing he couldn't handle.

Repeated the action a couple of times before finally moving on to his shoulder.

Breathe in. Breathe out.

He was a board-certified pain specialist, he could do this. This was nothing, nothing at all.

Derek took a deep breath, an attempt to calm his racing heart as he slowly abducted his arm.

Breathe in. Breathe out.

So far, so good.

One. Two. Thre- And then it was back, knocking the wind out of him.

It started off as a tingling sensation, pins and needles but the further his arm moved from his torso, the more the pain blazed.

If the pain had started as pins and needles, Derek was almost certain it could now be classified as hammers and saws.

He clenched his sweatpants, pushing his head down, willing himself to control his breathing as a ringing overtook his ears.

He shuffled away from his bed and toward the bathroom, in his daze knocking down the picture by his bed, a cracking sound emanating from it.

No pain meds. Just..just no pain meds.

He chanted in his head, standing in front of the mirror as he took in his haggard appearance, his red-rimmed eyes, his shaking arm.

I...I don't need any pain meds.

He knew what this was, he knew exactly what this was and honestly? whoever said that knowledge is power was a total fucking moron because knowing, knowing made it so much harder.

Derek clutched the sides of the sink tightly, intently staring at the mirror before closing his eyes, his breaths uneven as he slowly twisted his hand to fetch two white pills and gulped them down with shaking hands.

No pain meds. No pain meds.

A wave of nausea washed over him, forcing him to back away from the mirror and to retreat into his bedroom.

No pain meds. No pain meds. No more pain meds. No more pain meds. No more pain meds.

He knew exactly what this was.

Referred pain.

Referred pain in his right shoulder caused due to the tumour, presumably, pressing on thediaphragm.

The tip of the iceberg.

Just referred pain.

Whoever said that knowledge was power was an utter fucking moron because if this- if just this made his chest feel on fire then, then Derek Shepherd was screwed.

Because this, this was just the beginning.

He knew exactly what was going on with his body and knowing was soso much harder.

"Hey. Good morning. Breakfast?", his mother looked up from her crossword puzzle as he entered the kitchen.

"Ah, yes. I'll just grab the-", Derek turned around to face his mother, his hand still atop the open refrigerator door.

"Where's all the milk?", he asked her, eyebrows creased.

"There's no milk."

"No, there should be. I bought some yesterday, enough for both of us."

He raised his eyebrows, arms outstretched as he waited for her answer.

"I read that...dairy products should be..avoided."

He looked at her perplexed, still unable to come to terms with what she'd done.

"In liver cancer.", she finished.

Ah, well that made sense.

"You threw out the milk?"

"I didn't throw it out, Derek", she muttered, rolling her eyes. "I gave it away. The lamb chops, too."

"Mom."

"Yeah. Alcohol. Dairy products. Red meat. All of these should be avoided. And you know I read on the internet that there is something called a keto diet, if I'm not wrong. In this one, you majorly eat fats and it is essentially a no-carb diet. It sounds..good and apparently, it's good for you.", she rambled on, completely ignoring his disapproving glare. "I mean... I might even try it with you! It helps lose weight. You don't need that, though."

"Ma, Ma-"

"You've...you've lost so much weight, dear. I..I mean."

"Mom! Listen to me. Stop.", he said, leaning on the counter, arms crossed. "Stop this. All of this is just some crap you found on the internet. Next, you'll tell me to do yoga or to go to the church. I mean you're...you're not-"

"Not what? A doctor?"

"That's not what I was saying, Ma.", he replied softly.

"I..just meant-", he began and a simple glance in his mother's direction, her dark eyes fierce, arms on her hips, and he raised his hands in simple surrender.

Because arguing with his mother had always been futile.

"Yes so I decided that I would make some eggs, however you want them. Omelette, scrambled-"

"I can make my own omelette."

She scampered to remove a pan from the cabinet, completely dismissing him. She rose up on her toes, a hand clutching her back, a grimace on her face.

"Ma, I'll get it for you."

"Oh no, I've got it.", Derek hastily reached across her to retrieve the pan, essentially engaging in a tussle with his mother.

The pain in his shoulder had receded to a dull ache yet he hesitated to stretch his arm, hesitated right when he was tugging the pan from his mother's hands, causing it to fall to the ground.

"Shit. Are you okay?", he whispered, exasperated.

His mother paused for a moment, staring at him closely. "Yes, dear I'm fine. Are you?"

"Yeah...yeah of course. I'll just be...in the living room and yes, omelette sounds good. Thanks, Ma.", he mumbled, moving out the kitchen.

He couldn't let the pain affect him; couldn't let the fear of the pain affect what he did everyday. He needed to work harder; he needed to work through the pain.

He had, objectively, experienced worse pain and he sure as hell, wouldn't let a little bit of referred pain affect his life.

Just...no more pain meds.

He would figure it out. He would.

He had to- before noon.

"Dr Turner will be with you in just a minute", the nurse muttered, ushering them inside Olivia's office. He'd been here once before, right after he'd ended up in the ER a few days ago.

The nurse, Betty, was chatting with his mother as her pager buzzed, propelling her out and into the hallway while his mother slowly turned towards him with a small smile and he returned it in earnest, never taking his eyes off the collection of graphic tumours on the cream coloured wall.

Derek had loved tumours, especially the intricately wound complex ones, he had loved the adrenaline that had come with solving it like encoding a centuries-old cryptic message; loved the fact that it compelled him to be better everytime. He had loved the high that came with it but also the blatant joy he saw on the faces of his patients, their families; the idea that something that seemed invincible could be taken down, could be defeated.

He would never admit it to anyone but Derek Shepherd was a man who thrived on validation.

And solving inoperable tumours had helped him, as much as it had helped his patients.

Would he ever be able to stomach inoperable tumours again? After this?

Would he even get a chance to?

"Hi. Sorry, I got stuck with a patient.", Olivia entered the office in her blood-red scrubs, her coat's lapel upturned with her scrub cap half hanging out the pocket.

"Uh, really sorry about this."

"It's..fine, Liv. You could have called us later; it really wasn't a big deal."

"No..no, I wanted to do this as soon as I could."

"Right, yeah. Well, this is-"

"Mrs Shepherd. It's very nice to finally meet you.", his doctor shook his mother's hand, a strained smile on her face.

"You too, dear and please, call me Carolyn."

"Please, both of you. Take a seat."

"Okay, so I'm assuming Derek told you", she began, "But I'll just brief you once." she paused for a beat, looking him over before rearranging the stack of papers on her desk, presumably, his scans.

"Derek has something called Hepatocellular Carcinoma, stage C. It is a form of liver cancer, as you know. The..good part is that it hasn't spread to anywhere else but the problem..is that the tumour is large, large enough that surgery is not an option."

"So..so what are the options? Chemotherapy? Radiation?"

"That is what I wanted to discuss today. Our options.", her gaze flicked to him for a second before she continued, "Right, so let's begin with those."

"Hi. Hi, I'm sorry, please continue.", Miranda whispered, shutting the door behind her, a grey suit jacket hanging off her arm.

"Miranda"

"Chief", he gave her a slight nod as she took a seat on the couch on his left.

The tumour was inoperable but she was his surgeon, nonetheless.

"As the first line of treatment, my recommendation is that we go for TACE.", Olivia turned her attention towards his mother as he ran his fingers over the rough edge of her mahogany table, over and over again, his gaze fixed to the mindless task.

"TACE is transarterial chemoembolization. This is a procedure where we insert a catheter up the patient's thigh to inject certain drugs into the arteries supplying the tumour, which will then block these arteries thereby essentially-"

"Killing the tumour", Carolyn Shepherd finished.

"Yes, exactly. Actually, I would prefer it if we went with DEB-TACE. It is a newer, improved version of this procedure with significantly fewer side effects. But, it is finally, your choice, Derek."

"Right, yeah. Um..I..whatever you think is fine is fine with me", he mumbled, his hand inside the pocket of his trousers, clenching the pen, clenching it hard enough that the tip pierced his skin.

He made sure he didn't flinch as he did so yet, he could feel his mother's resolute stare.

Olivia cleared her throat and wrote something on her notepad, "Okay so I'd like to go forward with the DEB-TACE. The second approach will be Sorafenib- a drug that is widely used in the treatment of liver cancer. We'll start off with 400 mg per day before the TACE and then move it up to 800 my per day post it. TACE along with Sorafenib has shown some very good results so the standard method would be that we go ahead with a month of a daily dose of Sorafenib and then after some scans go through with the procedure. We might need to repeat the TACE considering the tumour is invading both lobes of the liver so possibly a month or two after the first, we will repeat the procedure."

"Next, I'd like to talk about your pain management."

Derek looked up, his anguished blue eyes meeting her softer, warmer brown ones.

"On a scale of 1-10, how bad is your pain right now."

"A 2"

"Okay", he watched Olivia take a deep breath as she looked down to her notepad again. "And daily how bad is it? A range if you can."

"Stays under 4", he made sure that his eyes never left hers as he said this, eliciting a tired sigh from his friend.

"Right so I'll prescribe some NSAIDs to you. Acetaminophen is also an option. I'll leave it up to you."

"Right so do either you have any questions for me?"

"Yes, yes. I.. I wanted to ask about the diet..you know what he can have and what he can't", his mom whispered.

"Ma."

"No, no that's a great question, Mrs Shepherd", Olivia replied with a smile. "No alcohol. Preferably no dairy products as well. No red meat. No products with added sugar or ones with too much salt. Absolutely no undercooked fish and seafood. And...there is this diet called the ketogenic diet which is known to be beneficial. I'll refer you to the dietician and she will help out."

"Right. Thank you, Doctor Turner. I..actually had another question."

"Of course."

"I wanted to ask...why."

"I'm sorry..I don't quite understand."

Ma, please, don't. Don't do this.

Derek closed his eyes and gulped soundlessly as his mother continued, "I mean why..why did this happen? I mean I'm no doctor but if I'm not wrong liver cancer usually happens in alcoholics and my son isn't one. So how did this happen is, I suppose, what I want to know."

"Mrs Shepherd...yes, you're right that it occurs primarily in alcoholics or those suffering from hepatitis but sometimes it just...happens."

He saw his mother struggle with the answer, about to question her further when Miranda spoke up, "Derek..I mapped his genome a few years ago; when we did Zola's and..we had found that he was at high risk for liver cancer.", Bailey moved from her place on the couch towards them as she continued, "It's not a certainty; high risk doesn't mean that you will get it but..but it's something."

"Thank you, Miranda.", her voice quivering as she looked at his chief.

"Right, so that's it? We can head out now?", he slapped his hands on his thighs, wincing slightly.

"Thank you, dear.", they stood up as did Olivia.

"Actually I'd like to talk to Derek for a second."

"Oh, we'll be in the cafeteria", she posed it as a question directed at him and began to move out the door with Bailey, giving Olivia a small smile.

Derek lifted his eyebrows at her as soon as the two had departed.

"The pain."

He should have known.

"Is it really under a four?."

"Yes."

She combed her fingers through her long dark hair anxiously, "Doctors make the worst patients, after all."

"Look, I'm fine with the NSAIDs. I took two this morning and the pain was fine after."

"It became a 2. What was it before you took them?"

"A 4."

At least a 6.

"Right. Fine. I still think that you should consider taking opioids-"

"No. Absolutely not.", he barked, lips pursed.

Olivia sighed deeply before conceding. "Fine. As your doctor and as your friend, this remains my advice to you."

"Understood. I won't be taking it."

He turned to leave her office when she put her hand on his arm", This will work, Derek."

He paused, his arm still in her hold and met her determined gaze and spoke before he could stop himself, "You know you don't have to do this with me, right? Give me false hopes about the prognosis and make me channel in my inner fighter or whatever. I know the odds, I know everything, Doctor Turner.", she removed her hand from his arm so quickly as if it had burned her skin., "Like I know where I stand on the BCLC scale and I know that in the revised scale I stand at.. C2 if I'm not wrong and the fact that the average survival time for patients with C2 tumour treated with TACE was what? Two.. twenty-four days, I think. That is, if the TACE works. So yeah, in the best case scenario I have about...7 months to live", he laughed humourlessly. "Don't you think you should have led with that?"

He stormed out of her office, leaving her standing in the middle, his heart beating rapidly in his neck, the wound in his palm throbbing uncharacteristically.

Derek watched his mother meticulously weave the needles through the thick indigo yarn, her back to him.

"Are you going to say something? Or just stand there?", she said, her head still bowed, hands still moving gracefully.

"I...", he shifted on his feet, hands in his pockets. His mother turned around, eyebrows raised and he slowly moved to stand in front of her.

"You look like you did when I caught you and Mark burying your sister's walkman."

He awkwardly took a seat beside her on the couch, a half-smile gracing his face, "She was just so..crazy about it."

"Oh, I remember vividly.", she muttered, returning to her knitting.

"What..what are you making?"

"It's going to be a scarf. It's for your sister."

"Oh. That's..that's great."

"Hmm. Are you going to say what you're here to say?"

"Right.", he rubbed his palms on his pants, fixating his gaze on the door to his room. "I...I wanted to apologise for this morning.", Derek slightly moved towards her as her actions slowly ceased, still looking away. "I shouldn't have..talked to you like that. I didn't..I didn't mean it, Ma."

"No, you shouldn't have. Look at me, Derek."

"I've...I've been doing that a lot lately; saying things I don't mean, awful, hurtful things to the last people I want to hurt..and I just.. I just-", Derek shook his head, resigned, his blue eyes darkening when he felt a hand softly squeeze his knee forcing him to look up.

"You recognise what you did was wrong. That's good but that's not enough, son. Did you apologize to...all these people you hurt?"

You...you mean nothing to me, nothing.

All of this is just some crap you found on the internet.

Give me false hopes about the prognosis and make me channel in my inner fighter or whatever.

"Not everyone, no", he replied feebly.

"Like with Doctor Turner today." Derek looked up suddenly at her answer, unable to keep the surprise off his face.

"You...you heard us?"

His mother simply nodded, lips pursed.

"How..how much did you hear?"

"I heard enough. I heard enough."

"Ma", he sighed, an agonising pang moving through his body, a pain he didn't recognise, a pain he was certain had nothing to do with the tumour.

They sat in silence for a while, Derek terrified of his own voice, too scared to even move.

"Derek Christopher Shepherd.", she mumbled, taking his hands in her warmer, softer one's. She traced the calluses on his palms with her fingertips gently before lifting her hand to grab his face, lightly stroking his cheek, her wet, anguished eyes clashing with his. "Do you remember when you first started on the hockey team?"

"Yeah.", he replied, startled.

"It was your junior year, if I'm not wrong. You were so happy when you made it, ready to take on the world; I..distinctly remember the sparkle in your eyes, the delight; I haven't seen that in a while, haven't seen you that happy for the past few years.", she paused, a faraway look in her eyes as she sniffled, "I think everyone who knew you remembers that-but what they don't know, possibly never will is the fight. The hours you put in, for years; the way you practised early in the morning, before everyone else; the way you shot pucks after pucks for years and the heartbreak when you just weren't tall enough or strong enough or big enough. I remember how you hurt...I remember your anger too."

"But you never stopped fighting; you never stopped. You weren't tall or big enough so you became fast, faster than anyone else, so fast that soon you became indispensable to the team. Because you kept on fighting, every step of the way, you continued to fight. I've... I've never seen you not fight, Derek. Until now."

"Ma, I-"

"No, let me finish. I know these last four years have been hard on you, so very hard but I never... never expected you to give up, Derek. You've never cared about the odds or what people say and now..you're just waiting, waiting for...", she gulped loudly, her hand tightly clutching the front of his button-down while she raised the other to wipe the tears falling down her cheeks.

His breathing picked up as he watched his mother, hands on her shoulder.

Looking at her, he realised that he'd never seen her unkempt before, had never seen her in disarray, fumbling and fidgeting.

Until now.

Even when their father had died, she hadn't cried, had not broken down; at least not in front of them, never in front of her children.

The rational part of him understood that Carolyn Shepherd had grieved for her husband, that she still did but for twelve-year-old Derek, his mother was invincible, immensely strong, unbreakable - their driving force.

She had always looked ahead, always helped them move forward.

"I need you to fight. Promise me you'll fight, Derek.", she whisper-yelled, a frazzled look in her eyes, her cheeks still inadvertently wet, her hands haphazardly gesturing and pointing.

Derek Shepherd had never seen his mother unkempt before, had never seen her fall apart, had never truly believed that she was fallible.

Until now.

Until she sat in front of him, begging, pleading her son to fight. Begging him to fight.

"Promise me, Derek. Promise me.", she chanted, her voice breaking at his name.

untilnowuntilnowuntilnow

"Ma, Ma. I promise. I promise, Ma. I..swear to you. I will. I will fight... until I can't, till I can't. I promise you, Ma.", Derek held her face in his hands, pressed a kiss to her forehead and wrapped his arms around her tightly.

Held her, held onto her so tight that they were both trembling, until her chants and his promises bled into one, until Derek was convinced that he had broken some part of her but that he had also started to mend it.

A/N: hey. There you go

tell me what you guys think about it :)