Derek was so relieved to enter the quiet of his apartment when he arrived back in Seattle. He loved his family, but the loudness and craziness was not what he wanted right now. All he wanted to do was to study the previous 12 clinical trial surgeries and see if he could figure out why all the patients had died. He was lucky to even be able to do the 13th one. He had received a letter saying he had to stop the trial at the end of the year because no one had survived. Thankfully, he was able to find a 13th person who he could fit in before December 31st.
"Hey Babe, I wanted to let you know I made it home safe. What are you up to?" he asked as he called Addison.
"I am trying to relax in the tub, but your sons seem to be having a wrestling match at the moment." Addison exclaimed. This caused Derek to chuckle. He couldn't wait to have wrestling matches with his boys! It was one of his favorite memories with his dad.
"Well, as much as I would love to talk, I need to get some sleep. I have my final clinical trial patient in the morning." he yawned. The line was quiet for a minute.
"Derek, are you ok?" Addison asked. Derek rubbed his eyes. He could barely stay awake and really did NOT want to have this conversation with Addison. He knew she had been worried about him lately, and in all honesty, he had been a little off. But who wouldn't be with the amount of death he had been around lately?
"I told you. I am fine." Derek responded, a little harsher than he meant. He heard her intake of breath that meant her feelings were hurt. "I'm sorry, Addie. I know you are concerned. I am just tired and stressed, but I will be ok. I really do need to get some sleep. I will call you tomorrow. I love you." He hung up the phone as he heard her say she loved him too.
After he was off the phone, he dropped his luggage on the floor of the bedroom and collapsed on his bed. Soon he was fast asleep.
Derek entered the hospital early the next morning and went straight to his office. He looked at the file on his desk. Dawn Bartlett. That was the name of the patient he was operating on. His last patient with the clinical trial. She was 39. The mom of 3 teenagers. She was only diagnosed with her tumor 6 months ago. Maybe she would be his Christmas miracle.
Derek met with Dawn and her family around 7:00. They all knew it was an extreme longshot for her to actually survive the surgery. Derek couldn't watch her say goodbye to her husband and kids. It was too painful.
He walked out of the room and headed straight for the OR. As he was scrubbing, Meredith entered the scrub room.
"Hey. How was your Christmas?" she asks pleasantly as she began to scrub. It had been strange to her at first working so closely over the past few months on the clinical trial, but now, it felt like they had truly moved past their history. They weren't exactly friends, but it was nice to be able to talk again.
"It was chaotic, but fun. How was your Christmas/" Derek asked. He wasn't paying much attention to the conversation as he was running through the surgery in his head.
"I worked." Meredith shrugged. She looked at Derek suspiciously. She could tell his mind was somewhere else.
"Now remember, as we inject the cocktail into the tumor, we HAVE to be completely in sync. Just like we practiced." Derek said as he suddenly turned to look at Meredith.
"I know, Derek. We've got this." Meredith said, a little taken aback at his harshness. They walked into the OR together and began the surgery.
An hour later, Meredith and Derek were staring at each other in disbelief. Dawn didn't stroke out when they injected the cocktail into the tumor. She was alive still!
"Did it really just work?!" Derek thought to himself. "Addie had always said the time between Christmas and New Years was the most magical time of the year. Maybe she was right!"
"Um, Dr. Shepherd. What do we do next?" Meredith asked, drawing Derek out of his trance.
"We take the patient to the ICU and monitor her very closely." Derek said, trying his best to maintain decorum and not shout with joy.
He immediately called Addison as soon as he was done scrubbing. Oh how he wished she was here! He was happy to find she was spending time with Savvy. He knew Addison really missed her friend! While he was on the phone with her, his pager went off. 911 to the ER.
Derek took off running as soon as he was off with Addison. He nearly collided with his wife's OB, Dr. Leslie Rahar as he entered the ER.
"Dr. Shepherd. Where are you going in such a hurry?" Dr. Rahar asked.
"Oh, sorry. I was paged 911." Derek responded as he went to the nurses' station to find out his assignment.
"Me too." Dr. Rahar explained as she followed him to the nurses' station.
"Both of you are needed in bay 1. There is a pregnant woman who fainted in the shower and hit her head." the head nurse informed them. Both of them headed over to evaluate the patient.
"Leona Ryans, the patient is 28. She hasn't regained consciousness but is stable. Fetus is 34 weeks gestation. Fetal heartbeat is a little low, but steady." George rattled off. Both Derek and Dr. Rahar examined the patient.
"Get a head CT and page me as soon as the results are in." Derek instructed as he signed off on the chart.
"Keep a close eye on the fetal monitor. If there are any changes, page me immediately." Dr. Rahar told Lexie. She looked over at Derek, who had a worried expression on his face and kept glancing at the clock.
"Dr. Shepherd, what is wrong?" she asked with concern. She had never seen the man so rattled. Derek looked up at Dr. Rahar and gave her a weak smile.
"Oh, nothing. It's just, the woman's husband was gone when this happened." he said vaguely.
"And you are worried about Addison being in New York." Dr. Rahar nodded in understanding. "Derek, it is extremely unusual to faint in pregnancy like this." she continued as she placed a comforting hand on Derek's arm. She knew he wasn't thinking like a doctor, but as a husband and father. "Why don't you just call her?"
"No, no. I don't want to worry her. She is out with her best friend. If I call, it will just stress her out." Derek exclaimed, straightening up. He pushed the fears down and walked out of the room. Dr. Rahar shook her head. Sometimes the husbands were more frustrating to work with than the hormonal, pregnant wives!
Derek made his way up to the ICU to check on Dawn. Her vitals were still holding strong, but she wasn't awake yet. He knew it would most likely be a long time before she woke up. If she woke up. He shook his head to try and get rid of the negative thoughts. His pager then went off informing him the CT results were ready for Leona.
Derek met Dr. Rahar to go over the results. "Dammit!" Derek exclaimed in frustration. "She has an aneurysm. I was hoping to avoid surgery. Has the patient regained consciousness?" he asked George..
"Yes. She is with her husband in room 524." George informed him.
"Alright. We need to go talk to them." Derek directed to Dr. Rahar. Now he really wished his wife was here. If he had to operate on a pregnant woman, he would much prefer to do so with Addison. Then again, with her being pregnant, maybe it would distract him more.
The two doctors entered Leona's room and saw a tall man with dark hair staring out the window while the patient slept. He turned when he heard the door open.
"Please tell me you are the doctors who know what is going on with my wife! I have been getting told nothing since I have gotten here." Cedric Ryans said in frustration. Derek was immediately put off by the man's attitude. What did he think they were doing? Having a tea party instead of working? Dr. Rahar noticed the anger flash across Derek's face and was surprised. She had never known Derek to react so easily to impatient family members. It happened pretty much every day. One of the hazards of the job.
"We just received the CT results. I apologize for it taking so long." Dr. Rahar said sweetly before Derek could say something. He glanced at her and did his best to control his frustration. In reality, the CT results had been rushed. Leona had been moved to the head of the line, and it hadn't taken very long at all.
"Your wife has an aneurysm in her brain that is going to require surgery." Derek explained as he pulled up the CT scan on the computer screen. It was then Derek noticed Leona was waking up.
"Hello, Leona. I am Dr. Shepherd. Do you remember what happened?" he asked, turning his attention away from the husband.
"Um,yeah, I, uh, I think so." she said in a confused tone. "I fainted, correct?" she asked her husband in confirmation.
"Yes." Cedric said in a strained voice. Derek noticed the anguish and guilt cross the man's face and began to soften towards him. He knew if Addison was the one in the bed, he would feel the same as Cedric did.
"We need to do surgery right away. If we don't, the aneurysm could burst and well, that could be catastrophic." Derek explained.
"What about my baby? Is the surgery safe for him?" Leona asked as she placed her hands over her baby bump. Derek swallowed, finding it hard not to bring back images of Addison in a hospital bed just a few months ago after getting hit in the head. She too covered her baby bump as if to protect their boys.
"I will be there to monitor your daughter the entire time. Should a problem arise, we will deliver her. She is 34 weeks along. If she is delivered, she should be just fine." Dr. Rahar explained quickly when she saw Leona start to protest.
After further explaining the procedure and risks to the couple, Derek and Leslie exit the room.
"Derek, I know this case is hitting you very close to home. Would you like someone else to handle it?" Dr. Rahar asked cautiously.
"No, I am fine." Derek retorted. "I will let you know when the surgery is scheduled. It will probably be first thing in the morning." Derek walked down the hall to his office without looking back.
When he entered, he collapsed on his couch. It had been an emotional roller coaster of a day. He looked at his phone and realized he had missed a call from Addison. It was too late for him to call her back without possibly waking her up. Instead he chose to send her a text saying "Good night. I love you." He purposely said nothing about Leona's case. He didn't want to stress her out.
Derek chose to sleep in his office that night. He wanted to be close incase either Dawn or Leona had an emergency. Thankfully, neither did. Derek slept fitfully most of the night. He kept having dreams that Addison was the one heading into surgery the next morning. Around 5:00, he decided to get up and began to stretch. Sleeping on the couch was not the most comfortable. "I guess I am not as young as I used to be." he laughed as he heard his joints cracking as he stood up.
After making his way to the attending's lounge, showering and changing into fresh scrubs, Derek checked his phone. It was 6:00 for him so that meant 9:00 for Addie. He had some time before Leona's surgery, so he decided to call his wife. Again, no answer.
"Hey, Babe. Just wanted to say good morning. I am heading into a surgery that will take most of the day. I'll talk with you later. Love you." he said to Addison's voicemail.
Derek then decided to go check on Dawn. He had been receiving regular vital check reports, but still wanted to look in on her. As he approached her room, he found her husband and oldest daughter.
"Good morning Dr. Shepherd. You are up early." Justin Bartlett greeted him with a small smile. "How is my wife doing?"
"Her vitals are doing really well, but as you know she hasn't woken up yet. We won't know much until she regains consciousness." Derek answered as he gave Dawn a check-up.
"When will that be?" 17 year old Zoe piped in. Derek looked over at the blonde headed girl. She was so young to be dealing with something so ominous as losing her mother.
"I don't know." Derek said tenderly. "As I mentioned yesterday. She is the only person to even survive the surgery. This is new territory for everyone. It could still be awhile."
"Or it could be never." Zoe said sadly as she sat on the couch putting her head in her arms. Derek didn't know what to say. The teenager was saying what neither of the men wanted to voice. They didn't know if Dawn would wake up. Or what kind of condition she would be in if she did. It gutted Derek to see the affects this was having on the young girl. He couldn't even imagine how the other two children were handling this at ages 13 and 15!
"I have to go to another surgery now." Derek said after a few minutes. "This will take awhile, but I will come back by and check on all of you when I am done."
Derek exited the room and headed to the OR. He knew he should stop by Leona's room before the surgery, but he didn't have the energy to deal with another family at the moment. He kept remembering his dreams from the night before.
"Good Morning Dr. Shepherd" Lexie said as she bounced into the scrub room. She was very excited to be scrubbing in on the surgery. She didn't notice the sullen mood Derek was in. When he didn't respond, she just assumed he was concentrating on the surgery ahead.
A few hours later, Derek began to breathe a little easier. Everything so far had gone smoothly. All of the sudden, Leona's stats started going haywire. Her heartbeat stopped.
"What the hell happened?!" Derek yelled as he backed off the patient so Dr. Rahar and Lexie could perform CPR. After several shocks, her heartbeat still wasn't back. The baby's heartbeat was also dangerously low.
"I have to get the baby out NOW!" Dr. Rahar yelled. She immediately flew through an emergency C-Section. Soon an impossibly tiny little girl was pulled out of her mother and not making a sound. Once the baby was out, Derek resumed compressions on Leona. Once he heard the cry from the incubator on the other side of the room. He let out a small sigh of relief. His relief was short lived; however, as 20 minutes later, Leona's heart had still not restarted.
"Dr. Shepherd, it is time to call it." Dr. Rahar yelled at him. He wouldn't listen to her. "Dr. Shepherd! Derek! Take your hands off the patient!" she commanded him. Derek threw his hands up, looked at her in despair and walked out of the room.
After scrubbing out, he blindly walked through the halls to his office, ignoring everyone. He vaguely heard someone yelling after him but didn't care. He grabbed his keys and left the hospital.
Once Derek was back in his apartment, he completely lost control. He yelled in anger as he threw the closest thing to him, a flower vase. It crashed on the floor, broken shards going everywhere. The sound jolted Derek enough to make him realize he had just broken Addison's favorite vase. He went to the fridge, grabbed a case of beer, and drank himself into oblivion.
Derek awoke the next morning from his phone going off. "What the hell?" he yelled as he looked at the offending device. Addison was calling him. He couldn't face her. How was he supposed to tell her he let ANOTHER person die?! And this one was a pregnant woman!
It wasn't long before his hangover caught up with him and he was losing the contents of his stomach. Once he was able to stand again, Derek looked around the apartment. Beer cans and glass were everywhere.
"Great. Another failure." Derek grunted. His phone started to ring then. He looked at the caller id. It was Addison. He couldn't talk to her now. She left a message, which he deleted without listening to. He sent a quick reply saying "In surgery. Will talk later." After that, he proceeded to drink himself into oblivion again.
Sometime in the middle of the night, Derek woke up from his drunken stupor and looked around the growing number of beer cans. He knew he couldn't continue to do this in the apartment he had so many good memories in with Addison. Then it dawned on him. The trailer. Addison hated the trailer. She wouldn't care what he did there. He grabbed some clothes, threw them in a bag, and left.
For the next couple of days, he drank almost non-stop while he was conscious. He wanted to numb the pain, the guilt. 30 people had died on his operating table in the last 3 months. 15 had survived. He felt like a murderer. Deep down he knew that almost all of the cases had been hail mary cases. That the patients were basically on their deathbeds anyway. But his logical brain was no longer in control. He now had a small understanding of why Amy used drugs. While he wouldn't go that far, he kind of got it. It was about numbing the pain. Quieting the thoughts.
Mark and Lexie were getting ready for a New Year's Eve party when his phone rang. "That's odd. Why is Addison calling?" Mark asked as he looked at his screen.
"Addie?" he asked, confused
"Mark, what is going on with Derek? I haven't heard from him in 2 days!" Addison exclaimed. Mark was stunned. He had been so wrapped up with Lexie, he hadn't even noticed the last time he saw Derek.
He walked over the Shepherd's apartment and started banging on the door. No answer. Not that unusual. Mark fished out his key and entered the apartment. He stopped dead in his tracks. What the hell? The place was trashed!
"Uh, Addie, he, uh, isn't here. Look. Let me make some calls, and I will find him." Mark said quickly and hung up the phone.
"What the hell?" Lexie exclaimed as she walked in behind Mark to see what was taking so long. "Where is Derek?" she asked.
"That is the question of the hour." Mark said angrily coming out of the bedroom where he had been looking for his friend. "He isn't answering his phone and the hospital hasn't hear from him since he apparently left angry 2 days ago."
"Maybe Meredith knows where he is." Lexie voiced. She noticed the stricken look on Mark's face. "I don't mean because they are sleeping together. I mean because they were working on the clinical trial together. Maybe something happened." she backtracked.
"That's actually not a bad idea. Can you call her?" Mark said, trying to calm down. Lexie quickly called Meredith and got the answers they were looking for.
"Well, Meredith didn't know but George did." Lexie said as she got off the phone. She relayed the story to Mark about what happened with Leona's surgery. "From George's description and from the state of the apartment, I would say he has gone off somewhere and doesn't want to be found." Lexie finished.
"No, I know where he is." Mark said as it dawned on him. "He went to his damn trailer." Mark stalked out of the apartment and drove straight to Derek's land. When he got there he found a very drunk Derek.
"Your wife has been trying to call you." Mark said through gritted teeth.
"And let me guess, she called you because you are always the person she turns to." Derek said angrily.
"Well if you would answer your damn phone, she wouldn't have to call me." Mark clipped back.
"Go home Mark and leave me alone." Derek yelled as he entered the trailer and locked the door behind him.
Mark walked back to his car and called Addison on the way back to his apartment and told her where Derek was. When he got back to the apartments, he was surprised to find Lexie cleaning up the Shepherd's place.
"Lexie, you didn't have to do that!" Mark exclaimed.
"I couldn't do NOTHING, Mark. Cleaning helps calm my nerves. Did you find Derek?" she asked as she continued to clean.
"Yes, he is at the trailer and is a drunken mess." Mark said as he ran his hand through his hair. "It's bad, Lexie. I've never seen him like this. So much for a Happy New Year." he finished as he glanced up at the clock and realized it was past midnight.
"Mark, let's finish cleaning up and then go to bed. We will figure out what to do with Derek in the morning." Lexie answered as she came over and gave Mark a hug. Mark knew she was right. They needed to have the place cleaned before Addison got there. She was in for enough of a surprise when she saw Derek. She didn't need to see this mess as well.
The next morning, Mark knew he needed to stay at the apartment for when Addison arrived. He called Callie to see if she could go talk some sense into Derek. It took some convincing, but she finally agreed.
Callie couldn't believe she had agreed to go see Derek. What the hell was she supposed to say to him? She was friends with Addison, not really him. She liked Addison. Derek on the other hand lost a lot of her respect with the way he had treated both Meredith and Addison last year.
As she pulled into the clearing where the trailer was, she was shocked by what she saw. First she couldn't believe Addison used to live in that thing! Second, she couldn't believe the amount of beer cans that were thrown all over the porch.
Derek cringed when he heard a car pull up. Great. Callie was walking up to his trailer for who knows what reason! He knew she didn't like him very much. What could she possibly have to say to him?!
"It's a little early to be drinking, isn't it?" Callie asked as she approached him slowly. Derek just stared at her and kept drinking. Callie sat down in what she assumed used to be Addison's chair and an awkward silence fell over them.
"Um, so I had this case a few years ago.." Callie began. She proceeded to tell him of a case where she had accidentally prescribed the wrong medication and ended up killing the patient. "It happens to all of us, Derek."
"How do you live with it? How do you wake up every morning and live with the fact that you killed a guy?" Derek asked as tears sprang in his eyes. Callie was shocked at his raw emotion.
"Um, I, uh.."Callie stammered.
"I am not asking to be judgmental. I honestly want to know. How do you move on?" Derek cried. Callie was stone silent. She just stared off into space. Derek proceeded to hand her a beer and both fell silent.
About an hour later, both Callie and Derek looked up as another car drove in.
"Looks like they are sending in the military for us." Callie retorted as Owen got out of the car. He slowly walked up and took in the downtrodden surgeons before him.
"Hey" he said. Derek acknowledged him with a nod but Callie completely ignored him.
"Let me guess. You were sent to try and convince us to return." Derek retorted. Own shrugged his shoulders, pulled out a chair leaning against the trailer and sat didn't say anything for a while.
"I have seen a lot of death. More than you can even imagine. I am not going to talk about that." Owen said as he shuddered. "I am here to tell you that you have to accept the fact that death comes with the job. It's hard. Most of the time, the death isn't your fault. I know how many deaths you have experienced lately Shepherd. Those cases were ones no one else should touch. You shouldn't feel guilty." Owen reasoned with him.
"Do you think the family members care if it was my fault or not? Their loved one is still dead." Derek spat. Owen was quiet again. He recognized that Derek was not going to be reasoned with. He knew what it was like to suffer from depression. To not know which way was up. To not feel like you could breath. He knew that what Derek needed most was to know that they were there for him.
As Owen was about to say something else to Derek, a third car pulled up. Derek looked up and was shocked to see Addison getting out of her car. He couldn't look her in the eye as she walked up. Addison looked over the disarray of beer bottles round Derek. She couldn't believe what she saw. She knew Mark had told her it was bad, but she never expected this!
"Callie and Owen. I really appreciate you guys coming out here for Derek, but would you mind leaving us alone now." she asked politely. Derek recognized that she was trying to hold it together but underneath was in complete shock.
"Callie, let me give you a ride home." Owen offered since the orthopedic surgeon was a little tipsy. No one said anything else as Callie followed Owen to his car, and they drove off.
Once they were gone, Addison proceeded to sit down in the chair Callie had vacated. Derek handed her a bottle of water but still didn't say anything. The couple sat in silence for a little while before Addison turned to Derek and said, "What is going on Derek? I have been asking for weeks. Don't tell me you are fine." she said as she gestured to all the trash everywhere.
Derek looked at her and squeezed the bridge of his nose with his hand. How was he supposed to admit failure to her? He was supposed to be strong for her right now. He was supposed to be her rock. He not only had a hand in killing people lately, but he was failing his wife and children.
"Obviously I am not fine." Derek clipped at her. Addison crossed her arms and just stared at him. She knew Derek well enough to know that getting angry was his way to hide pain.
"Then tell me what is going on." she barked back. She too turned to anger to cover up pain and the sight of Derek like this terrified her! Derek stood up and threw another beer bottle down.
"What's wrong? What's wrong?" he yelled. "What is wrong is that I have killed 30 people in the past 3 months! The latest one was a pregnant woman. Even my miracle patient with the clinical trial hasn't woken up yet." he continued as he paced back and forth.
"Derek, you didn't kill those patients and you know it!" Addison exclaimed as she stood up. Derek stopped pacing and turned to look at her.
"They could have had weeks or months more with their family. I told them there was a chance. I was the only one stupid enough to try and operate. Who else is responsible for their death?!" Derek cried out. Addison walked over and stood directly in front of Derek.
"You. Are. Not. Responsible." she said slower while looking him directly in the eyes. "Those patients knew the risks. They made the decisions. Not you." she said in a more loving tone. "And Derek, what about those 15 patients you DID save. They were just as high risk. You gave 15 families their loved one back." she continued as she pulled him in for a hug. It was hard to really hug him with her giant belly starting to get in the way.
Derek started to cry really hard at that point. Addison led him inside the trailer where they laid down and she just held him. Eventually the crying stopped. Derek sat up.
"Addie, I know everything you said is true, but I don't know. It still doesn't really help." Derek tried to explain. Addison looked at him in confusion. This was not how Derek normally acted. Usually logic was the best way to get through to him.
"I don't understand." she replied. "What else is the matter.?"
"I don't know." Derek said in frustration. "Everytime I close my eyes, I see the faces of the patients who have died. Then, I remember you dying on the OR table." he choked out as the tears started up again.
It then began to click for Addison. Derek's fear had more to do with her than with the idea of having lost so many patients. With everything she had been through in the last year, Derek had been her rock. He had always been there to hold her when she was scared. He had been just as upset and scared as she was but had never really dealt with it.
"Derek, look at me." Addison commanded. "I know my brain tumor really scared you. I know you blame yourself. But it wasn't your fault. None of it was. Please hear me on this." she pleaded.
"Addie, I just don't know how I am supposed to go back into an OR again. I don't know how I am supposed to be a surgeon again." he whispered. Just then Addison's phone beeped. She looked at it and was shocked.
"Um, Derek. You might want to rethink your last statement." Addison said sternly. "You need to go to the hospital now."
"Why?" Derek asked in confusion.
"Because your miracle patient just woke up." Addison responded as she showed him a text from the Chief.
