=1= Baltimore, Johns Hopkins Hospital
At this point, Meredith and Jackson had about four months left of their training at Hopkins. They had ticked off four fifth of their surgery bucket list items, and were well on their way to finish their accelerated residency. This meant a couple things. First, the two residents were facing two big exams, the former being the oral board certification exams for both of their specialties, and the latter being their final performance assessment imposed by the trial directors. The final performance assessment was a novel hands-on evaluation process. It embodied in the form of this class' five trial participants functioning independently as attendings for four months in their respective departments. All five participants had ample solo surgery experience by this point. However, in this challenge, they no longer had their mentors peeking over their shoulders in the operating room, ensuring the quality of their work, or the opportunity of being assigned cases. These four months, they needed to prove their training had enabled them to function as mature physicians in a high-stress environment independently. They needed to prove they could run their own service. Their performance were evaluated on several dimensions, the most important two being surgery outcome, and patient satisfaction. The five participants had traded in their lighter coloured residents' scrubs for the dark forest green scrubs for attendings.
The approaching of the end of their residency also meant they needed to start considering fellowship programs. Meredith and Jackson's meteoric rise to the top of their fields undoubtably attracted a lot of attention. Ever since their returned from the middle east, there had been non-stop flowers arrangements, baskets full of fruits, baked goods, assortments of jams and cheeses, fancy chocolates, expensive liquors, and even gourmet dog treats covering nurses station in the plastics, ENT, general, paediatric and neurosurgery wards. The vigorous courting had also manifested in waves of visitors at the hospital. Many fellowship program directors wanted to woo the pair so eagerly they were willing to fly to Hopkins instead of letting candidates going to them usually. They also gleefully took the advantage
of the 4-months assessment period. The hospital's board granted them special privilege to witness their future hire dealing with attending-level challenges firsthand. Jake and Collier joked that Helen, McCale, and Siever had the easiest job as mentors because they didn't need to pull any strings to set any interviews up for their students. Given the time limitation, the pair didn't say yes to meetings with all the program directors that wanted to recruit them. Instead, they each had a list of promising programs they set their eyes on based on their mentors' suggestions and insider information they acquired from year of working in the field, and the resident duo only spoke to directors from those programs.
When the two of them were not in interview or surgery, they studied for their upcoming oral boards. This year, neurosurgery and plastic surgery board certification were scheduled three months from now, while the paediatric surgery and ENT board exam were at the month end. In the short time frame they had to prepare, the pair spent every second of their free time in the library making their own book to study based on their own case records, categorized by exam topics. After getting a full picture of what they would be working with, Meredith went ahead and broke down each of their cases using the infamous Harrington study method. Clarissa had brought it up on the call that all the Harrington children of her generation had a specific study method, suitable from MCAT all the way to board exams, inherited from their parents, and further tweaked to perfection by Ellis. A week later, Meredith received a parcel of well-loved notebooks and study cards in the mail from Philidelphia. Just like any other thing her mother did, the method was indeed extraordinary. Its unique organization allowed in-depth learning even during the small pockets of spare time they had at the hospital. All in a sudden, the pair found they had gotten through their own book in half of the time they allocated originally. After they were confident they had everything drilled in their minds, they took turns to question each other until they were blue in the face. At the end of the month, when they received the email announcing their successful certification as paediatric and an ENT surgeons, the pair knew the method had worked wonders in such a short time.
Something Meredith hadn't expected to receive, was a letter from Seattle. Keith Collier handed it to her a day after her first board certification exam. Meredith took the white envelope in her hands and cautiously inspected it. The minute she saw the return address was left blank, she had a gnawing suspicion of who it might be from despite not recognizing the hand writing. She certainly wasn't expecting letters from her friends, seeing they all still talk with her weekly on the phone. George wasn't supposed to be back for another four months. Plus, they would have sent the letter to her apartment instead of the hospital anyways. As she was deep in thought, Jackson appeared beside her, holding out a cup of coffee just the way she liked it. Meredith put the letter down and took the cup instead. She sighed contently when she inhaled the rich aroma as the pair walked towards the vacant skills lab.
"Shepherd sent it?" Jackson questioned as he eyed the envelope carefully.
"Yup. Can you screen it for me? Just tell me the important things and filter out any personal crap I don't need to know?" Meredith requested, passing over the envelope.
"Sure." Jackson agreed, tearing open the envelope and dug out two pieces of paper. The first piece of note seemed pretty beat up, nearly fulling apart at the seams where it was folded multiple times. The other piece of paper seemed rather crisp and new. He quickly opened and scanned through the first note, which he found out to be heavily marked with different colours of pens, snorting intermittently as he read. "This is the script for the eloquent apology he was supposed to deliver for his past deeds when he cornered you last time in the scrub room." Jackson rolled his eyes sarcastically. Upon hearing it, Meredith scrunched her face in annoyance. Then he quickly proceeded to the next sheet. This time, his eyes widened and his eyebrows shot up.
"What is it, Jackie?" Meredith prodded, seeing his unusual expression.
"Webber is an alcoholic and he relapsed." Jackson said in a disbelieving tone, "Shepherd found out and reported him to the board behind his back. That's how he climbed the ladder to chief."
"What!" Meredith gasped.
"Do you want to hear me sounding out his apology for lying, and I quote, 'being a backstabbing bastard while he should have been a better friend and a supporter' to Webber?" Jackson asked as he continued going through the letter with his eyebrows raised.
"Wow. Did he say why?" Meredith asked curiously.
"First, he really wanted the job and saw it as the right next step to his career. Second, he still harboured resentment towards him for bringing Addison out there and not stopping you leaving. And third, Webber's alcoholism really influenced him to make ill decisions as the chief. So he needed to do the right thing, even though now he admits his approach was wrong." Jackson concluded as he folded the note back up after he was done reading, "He also promised to leave you alone until you initiate contact." He snorted, "It's nice of him finally listening to what you said. But let's see if he can follow through with actions. Wouldn't be the first time if he can't though."
=2= Seattle Grace Mercy West Hospital
"Derek," Mark stormed into his best friend's office after a gluteal liposuction, "What is this thing that I heard about you attending therapy?"
"Did Addison tell you?" Derek's head snapped up at Mark's question, his sapphire eyes narrowing at him.
"You told Addison and not me?!" Mark questioned incredulously as he slumped down on the leather couch, "To answer your question, no. I saw you sneaking into Kathrine Wyatt's office yesterday. Isn't she a shrink?"
"Yup." Derek nodded, "You were the one that talked me into calling Addison. I did that a couple weeks ago. And she just put me on the phone with Violet, the psychiatrist at her practice, after she heard me ask her for what I should do. Violet suggested I did indeed have a lot of unprocessed trauma and anger from my father's passing, the break down of my first marriage and when I botched Jen's surgery." Derek sighed, looking down at his hands, "Violet recommended Dr. Wyatt, and I've been seeing her every week since."
"You talked to Violet about Mr. Shepherd? You never talk about him! You didn't even talk to me about him!" Mark sat up from the couch immediately in shock.
"Yeah, I let it slip that day. It was when we had William Dunn, the serial killer on death-row in our hospital." Derek admitted, shrugging. "I was really angry and outraged. And she caught onto it. I had to start somewhere. Might as well open something I've pent up since I was 12." Seeing his best friend's fixated expression of shock, Derek chuckled, "What, is it that unbelievable that I'm attending therapy?"
Mark nearly shouted, "Yes! You never even like to admit you are wrong! And now you're going all out with a therapist."
Derek leaned back in his chair, raking his hair and letting out another long sigh, "That just cemented myself as the arrogant asshole who thinks the world revolves around him."
"Didn't you just describe every surgeon alive?" Mark replied with a chuckle.
Derek brushed his joke aside and continued rather seriously, "I've apologized to Addison for placing my career over my marriage in New York, and for still pursuing Meredith while I promised her to give our marriage another try."
"Wow, you're serious about this." Mark leaned forward and observed Derek intently.
"You bet I am." Derek pursed his lips into a thin line, pausing a little before dropping the bomb, "I'm resigning as chief of surgery in two weeks."
"Wait, why? Isn't this what you've always wanted?" Mark sprung up from the couch, and paced in front of Derek's desk.
"I thought I wanted this job. And I backstabbed Richard to get here. But I've been hating my life more and more everyday since I became chief. Sure it feels nice to get drunk on the power, but I'm stuck in this office all day, mingling with the board and media, tending to piles of paper work and budgetary reports, and half of the hospital hates me. I'm lucky if I get to step into an O.R. once a month, Mark. It's not what I want." Derek said seriously while tapping the pile of paper in front of him.
"What are you going to do after you're not chief anymore? You have a new head of neurosurgery. You can't go back to your old job." Mark asked, still processing Derek's big news.
"Oliver Mocco gave me his two week notice this morning. I'll go back to being Richard's head of neurosurgery once he is reinstated." Derek waved a piece of paper in front of Mark.
"Wait, your head of neuro is already quitting? He's only been here for what, eight months? You got a pretty high turnover rate, Shep." Mark said half jokingly.
"That's not funny. You know what's actually funny, Mark? Oliver Mocco is quitting to go be an attending at Hopkins." Derek huffed sarcastically. "He left his department head post in my hospital to go to a place he would probably never make head with Helen Crawford and Thomas Koracick over him. Yet he was still more interested in the institution that cultivated the youngest Harper Avery Award Winner."
"Are you jealous, Derek?" Mark asked disbelievingly.
"Yes, I am! Because there is no words that can describe how much I want to do the same! But I can't! Because of my responsibility to this hospital and my promise to leave Meredith the hell alone." Derek rubbed his face frustratedly, "I need to give Richard his job back, this is the first step to my redemption, the first step to my freedom."
"Now while you're on your journey to redeem yourself. Tell me are you sure you don't want to casually date to just, um, let out some steam?" Mark whistled playfully. "I know that Mercy Wester you hired back, what was her name again? Ah, yes, Kepner has the hots for you."He finished his sentence with a mischievous smirk.
"Mark!" Derek admonished him. "I've gone on five blind dates ever since your arrival. And I've been marched around like the most eligible bachelor of the month after the divorce thanks to you! None of them worked out! Can you not take a hint? I don't have eyes for others and I certainly am not engaging in another relationship with my underling. How are you trying to demolish my progress while you were the one that pushed me to change in the first place?"
Mark clapped his hands and stood up to exit the chief's office with a satisfactory grin, "Relax, it was a test. Glad to see you finally pulling your head from your ass, Shep. Keep it up!"
=3= Baltimore, Johns Hopkins Hospital
Meredith was waiting in front of the ambulance bay for her patients to pull up, a rare sight to be seen given she no longer worked down in the E.R., except a couple occasions when Simmons asked her to run it. But this case was special to her. Ten months ago, she helped brith a pair of conjoined twins, Abigail and Micaela, in the head of fetal surgery, Vivian Carlsmith's O.R. through an ex utero intrapartum therapy delivery at 30 weeks of gestation. She was the paediatric surgeon assigned to care and monitor the twins while they were in the NICU after their delivery. Today, the twins were back for their separation surgery. A couple minutes later, a large specially built hospital transportation van stopped, and a couple with a custom made double width stroller stepped out. Meredith rushed forward to hug the parents, Liliya Miroshnik and Anatoliy Bachinskly, who she had grown close to during their stay in the hospital. After greeting the adults, Meredith then crouched down to coo at the baby girls sleeping peacefully.
Abigail and Micaela were craniopagus twins, meaning they were joined at the skull, soft tissue, and brain, specifically, the fusion of their anterosuperior skulls and interdigitization of brain parenchyma, a rare anomaly occurring only once in about 2.5 million birth. The twins' case was further complicated by a shared segment of the horizontal superior sagittal sinus with exchange of venous blood. The nature of their anatomy meant the focus of the surgery was on separation of brain matter and the web of entangled cranial vessels and subsequent skull reconstruction. Consequentially, Meredith and Jackson were selected as the primary physician for each part. In addition, Meredith functioned as the coordinator for the entire project, and the point of contact with the family given their strong bond and the parents' immense trust. Ever since the delivery, the two residents had spent countless hours developing an intricate continuous plan leading up to the final separation. They tracked the twins' growth through MRIs and CT scans. They input the scans into a computer to generate the latest 3D model of their heads and brains for visualization and calculation. Six months ago, they made the decision to operate when the twins were nine months old, strong enough to endure the surgery and make a fast recovery given superior brain plasticity in babies, but not too long that they risk the twins growing more shared blood vessels. Around the same time, Meredith performed a strip craniectomy to disconnect the fused portions of the skulls to place the external distraction device to increase the working distance between the twins and passively generate separation over several weeks. Five months ago, an external soft-tissue constriction device was initiated to decrease shared circumference from 40 cm to 28 cm. Three months ago, Jackson inserted the custom made subcutaneous tissue expander onto the twins' head before they head off to the Middle East, which was then slowly inflated with saline to promote the growth of new skin on their head, ensuring both twins would have enough scalp to close the wound after the surgery.
As the final separation surgery day approached, Meredith and Jackson had nailed down their portion of the surgery plan with 2 other surgeons sharing their specialty, Helen and Tom for Mer, and Siever and Dr. Fakhry for Jackson. In addition, Dr. Collier had remodelled one of his O.R.s to accommodate the 25-person surgical team, including a fleet of scrub nurses and paediatric anesthesiologists to monitor the twins' vital life functions, maintain their safety, and intervene any sudden and dangerous complications through out the operation. All personnel in the O.R. were split into 2 teams, those wearing orange scrub caps cared for Micaela, and those wearing purple kept an eye on for Abigail while Meredith and Jackson donned green scrub caps as team captains. All equipment and instruments were also labeled with orange and purple tape to be easily distinguishable.
After she admitted the twins for their surgery, Meredith rushed to the conference room for the last meeting with their surgical team. They were supposed to undergo the last dry run of the surgery before the actual separation day tomorrow. During the meeting, Meredith reviewed the detailed surgical plan and timeline, wrote down the abbreviated version on a poster sized paper and taped it onto the wall of the O.R. together with a family portrait of the twins to remind the team what was at stake.
Later that night, during the rehearsal, they had a small hiccup on their fourth turn over. The entire procedure required the twins to be turned for a total of five times, many times lifting them head over heels, while avoiding equipment entanglement and physical impact. Meredith rubbed the space between her eyebrows tiredly when the scrub nurses rearranged the equipment one more time as the resolution to avoid banging one of the twins on her heart monitor.
"Nervous?" Jackson asked beside her.
"About the biggest and most complicated surgery I've lead? Ha, I'm not nervous at all." Meredith chuckled humourlessly, she lowered her voice to a whisper. "You know the fellowship program directors from Boston Children's, CHOP, SickKids, Tulane, UCLA, and Mount Sinai and New York Presbyterian get here today? They would all be judging us from that gallery. If we get to end out residency on a high note or not all depends on tomorrow, Jackie."
Jackson sighed, "I know." He lowered his head plant a chaste kiss on the top of Meredith's hair for comfort. "We can do this."
After executing the procedure without a hitch several times more, the final rehearsal came to an end. At this point, it was safe to say the surgery was very much choreographed as a ballet, with everybody knowing their role at any given time.
The next day, after their parents said a tearful goodbye, the twins were wheeled into the O.R. with breathing tube inserted for a marathon surgery, predicted to last anywhere from 24 to 48 hours. The procedure began with the lead paediatric anesthesiologist putting both girls under, a particularly complicated balancing act given their shared blood supply. After confirming both twins' vitals were stable, Jackson began the first incision to remove the tissue expander. Then, the neurosurgery team was rotated in to begin the painstaking and meticulous task or dividing veins and brains. When they proceeded to the post important step, the fistula ligation, which involved clipping and dividing the large connection shared between the babies, Meredith made an unwelcome discovery.
"Damn it." She hissed, "The fistula is completely covered by the dura. I can't see a thing from this angle." She paused, contemplating the next step while feeling the prickle of the hair at her neck because of everyone's expectant gaze. She soon made up her mind, "We're going to cut into the dura for visualization."
"Dr. Harrington, are you sure? The dura wraps around major cerebral arteries. You just elevated the level of sophistication of this surgery ten fold!" One of Jackson's intern monitoring the progress of the surgery couldn't help but cut in nervously.
Meredith looked up, her unwavering gaze conveyed her confidence, "Yes, I know the complexity of what I'm doing! But this is the only way if we want to proceed. I'm putting them on cardio-pulmonary bypass and hypothermic circulatory arrest to avoid stroke and massive haemorrhage. Page cardio and you go tell Dr. Avery that plastics and ENT have to be postponed for at least five hours while we slide around the vessels." She reached out her left hand for the instrument, "Fifteen blade."
Everyone in the gallery held their breath as they watched the three neurosurgeons carve into the dura with precise, cautious movements. The moment the monitor displayed the clean field of the exposed fistula, all audience let out a collective sigh of relief. Without a moment of hesitation, the neurosurgeons quickly moved forward to clip and dissect the fistula. Then, they managed to separate the first hemisphere without complications in less than 4 hours. The separation of the second hemisphere, the contralateral hemisphere however, was far more complex because of the uneven distribution of sagittal sinus between the girls. They ended up dividing the venous anatomical structure that one twin received a considerably larger share of the sagittal sinus, while reconstructing the other twin's deeper venous system with a pericardial patch, allowing continued venous drainage to compensate for the loss of a large chunk of the shared sinus. After that, they resumed perfusion and rewarming to wean both twins off cardiopulmonary bypass. Fortunately, there was no cerebral edema nor bleeding, and hemostasis was quickly established.
Fifteen hours after the twins were put under, Meredith announced proudly, "Cranial separation achieved!" The twins were now separate, and the two operating tables were swiftly rolled apart, providing better access for the surgical teams to each child. Attendants in both the gallery and the O.R. applauded the neurosurgery team enthusiastically as they exited the O.R. and the plastics team entered the stage for cranium reconstruction with titanium and mesh. As Meredith passed by Jackson, she bumped his shoulder playfully in camaraderie.
After Meredith scrubbed out, she sank down onto the floor with her head between her legs. There were so many moments in the O.R. the procedure could have gone horribly wrong and she could have lost both twins. It took her a good fifteen minutes to calm her heaving and recover from the stress and adrenaline rush. After her breathing was stabilized and her flushed expression had ceased, she walked out into the terrace where the twin's parents were holding vigil with supporting family and friends for an update. She then went back into the O.R. to see the remaining of the surgery through.
Another ten hours later, Jackson concluded the procedure when he tied off the last suture on Micaela's scalp. With an overwhelming sense of relief and pride, the gallery above broke into a roaring applause while the surgical staff hugged and congratulated each other for their herculean efforts that lead to the success of such an ambitious and precarious surgery. Meredith playfully curtsied to their audience in and shared a victorious dance with Jackson. They knew they had proved themselves under scrutinization once again. They collaborated well with senior attendings while maintaining their authority in the O.R., not being undermined or outshined by their mentors.
The twins were rolled out in two separate gurneys for the first time into the PICU and remained in pharmacologically induced comas for several days to speed up the healing process. Because of clinical and electrographic evidence of seizures in both twins initially, they received multiple anti epileptic agents that were subsequently discontinued gradually over the course of the next few weeks. After medical and neurologic stabilization, both patients exhibited no more postoperative complications, and were discharged to inpatient rehabilitation a month after separation. At the two-month post-op check up, both twins presented with significant developmental gains without neurological deficits, declaring the surgery a complete and total success. The multidisciplinary team soon pushed to have their case report published on the Annuals of Surgery.
Upon the news of their successful dissemination, they received a consultation request from Boise Memorial Hospital in Idaho for a similar case of craniopagus twins separation. Johns Hopkins surgeons agreed to assist when they saw the anatomical resemblance to their twins. After communication with Boise, Meredith learned that their original collaborator was SGMW given the geological proximity, and the joint effort was initially spearheaded by Dr. Oliver Mocco, the previous head of neurosurgery there. However, the switch made sense, seeing the lead surgeon just transferred to Hopkins and the Hopkins neurosurgery and plastics department had more advanced technology and relevant experience to help with this particular type of congenital defect. Meredith and Jackson pitched in for the planning of the surgery, but the collaboration was eventually scheduled to be executed by Dr. Mocco and his team of choice in six months.
=4= New York, Park Hyatt Hotel, a month later
Jackson dragged a disheveled Meredith out of the backseat of his car. She was covered in cold sweat, her complexion was white, and her clothes were rumpled after the three hour car ride into the city from Baltimore. She was wearing a mask, had a puke bucket in one hand, and an IV bag in the other. She caught a nasty stomach bug from one of her paediatric patients the day before her neurosurgery oral exam, and she had been experiencing symptoms including nausea, stomach cramps and a low-grade fever ever since. Jackson pumped her full of IV fluids to counteract the dehydration from her non-stop hurling. But Meredith couldn't be put on prescription strength anti-nausea medication because antihistamines caused drowsiness, dizziness and decreased mental alertness while none of the OTC drugs managed to relieve her vomiting. Helen had tried to talk her to sit this one out to no avail. She also offered to phone the examiners, who were likely to be her contacts in the New York neurosurgery circle to keep an eye on Meredith's physical condition, but her student also denied that, citing she didn't want any special treatment for the one of the most defining exams in her medical career.
Jackson got the tan ironed suit and a big packed bag from the trunk of the SUV and put an arm around Meredith's lower back to support her unsteady figure staggering into the hotel lobby after handing his car key to the valet. Jackson booked a room at the exam venue so Meredith could get cleaned up before her exam.
A couple floors down from their room, Derek Shepherd walked into Room 2118 in his suit and tie and his brief case. He was beckoned to substitute for the original examiner who came down with the stomach flu by his chief at NY presbyterian. He had resigned from the chief surgeon position at SGMW a week ago. He still had some loose ends he needed to tie off, but he was officially liberated from the burden of that post. Derek was currently visiting his family in New York, using his many accumulated days off from the past year. He greeted his co-examiners in the room, the elder Dr. Stowe from New York Presbyterian, one of his attending when his was an intern, and Dr. Reynolds, a female neurosurgeon he had worked with when he operated at Mount Sinai. He didn't keep in touch with either of them when he moved, so they spent the little time they had before the exam making small talk and catching up. Twenty minutes later, the contestant knocked on the door. Derek called out to let him or her in, and what greeted him was an IV pole on wheels and Meredith connected to it under a surgical mask.
Meredith stopped and scanned the room upon her entry. Her emerald eyes automatically trekked to meet the sapphire ones of Derek Shepherd and she was physically frozen to the spot. All in a sudden, she felt the urge to cry in this moment of extreme vulnerability. She had been putting up a strong front since yesterday. Seeing how worried and anxious Helen, Jake and Jackson were, she pushed her own feelings down. But now, his presence felt like the last straw, and she felt the dam breaking. She started feeling the distress brought by her sickness and the fear and pressure to perform for the exam. The whirling emotions nearly wiped out her resolve completely. She wanted to break down, preferably in his arms.
Dr. Stowe cleared his throat loudly when he failed to see the resident presenting herself. Meredith snapped out of the reverie. She clasped a hand over her mask, squeezed her eyes shut to suppress the tears forming in her eyes, and took a few deep breath to regained her self-control. I can do it, she chanted to herself, I got over the biggest set back in both my personal and professional life alone, on my own two feet, I can get over a viral gastroenteritis and get my board certification alone. Derek watched her silently. Seeing her distraught always hurt him to the core, and this time was no different. He wished he could help her more than anything in the world right now. But somehow, he was completely helpless because of the promise he made to Meredith.
Meredith detangled her IV tube and walked forward with the most convincing confident smile she could muster at this moment. She greeted the three examiners politely, "I'm so sorry, doctors. I caught the stomach flu while working on the paediatric floor yesterday. But I'm determined to walk out of here a certified neurosurgeon, so please excuse my actions. They might seem a little weird normally, but this is extraordinary circumstances." Derek nodded, consenting her to proceed. Under the examiners' amused gaze, she put on a pair of surgical gloves, and pulled out three masks from her suitcase in case they would want protection against her virus. Next, she took out two microphones and a speaker. She set one microphone on the coffee table for the examiners to use, then put the other mic and the speaker onto the chair she was supposed to seat in. She dragged her suitcase and the chair to the furthest corner of the room from the examiners and set the speaker in the middle of the carpeted floor, hooked it up to the outlet and adjusted its volume on her way there. After her preparation, she retreated into her corner and sat down. "Doctors," She spoke into the microphone, "I'm ready."
Derek picked up the folder sitting on the coffee table and began reading the welcome speech and the rules. "Dr. Harrington-Grey, welcome to the American Board of Neurological Surgery Certifying Examination. It is comprised of three sessions, each 45 minutes in length, 10 minutes break in between. One session consists of five questions focused on general neurosurgery. To pass the test, you must pass two of the three sessions. You may fail a session and still pass, but examiners are not permitted to indicate whether you passed or failed each section. You will be rated on your ability to diagnose, manage treatment, handle the unexpected. Basically, the strength of your constitution in crisis. Now let's begin."
He flipped open her file and scanned through the selected 15 cases. He checked out her case reports on the trial residency website before, but seeing the details, he must admit he was impressed. He himself didn't get to lead half of these surgeries until he was well into his time as an attending. Dr. Reynolds coughed, reminding him to start. Derek forced down his personal feelings aside to behave like a cold, hardened professional he was asked to be. He started questioning, "62 year-old female, unhelmeted bicyclist, admitted through the E.R. after she fell off and hit the concrete payment. Presented with visible head trauma, positive LOC, G.C.S of 13, abrasions and smbgaleal hematoma on the right posterior scalp and no significant medical history. Your approach?"
Meredith cleared her throat, pressed a hand on her abdomen to suppress the bile rising to her throat due to nerves. She knew this case inside and out, she could do this as long as she manage to choke out her first word. After a pause, she rasped out, "First, I would check the trauma ABCs, to make sure her airway, breathing and c-spine are secured. Then, I would do a primary physical exam to get the full extend her injury, then do a neurological exam to see her reaction to light, pain, how she controlled her limbs, if she could follow commands, and verbal response."
"You found out her level of consciousness is declining to monosyllabic response." Derek replied.
"My differential diagnosis is a traumatic brain injury that led to a brain bleed. I would order a non-contrast CT of her head and the cervical spine. I would get a CBC, a chem-7, coaggs and put her on a heart monitor."
"On the head CT, you found a large acute subdural hematoma in the left side of the brain with a midline shift and mass effect and a non-displaced linear skull fracture on the right."
"I would intubate her and bring her to the O.R. for an emergency decompressive craniectomy to evacuate the clot."
"How would you proceed in the O.R.? Be as specific as you can be."
"Well, the patient is placed on the table with a towel rolled up on her right side, with her head gently turned to the right side for better exposure for the left side of her skull. Her head is secured in a three-pin Mayfield skull clamp. I make sure she had been administer pre-op antibiotics, and her hemostasis, BP and ICP are monitored by the anesthesia team. Her hair had been shaved, so I would make a curvilinear incision behind her ear. I then drill three pilot holes into her skull, then use a craniotomy to remove a large bone flap, about 14 centimeters long. I would then slice through the dura, to expose the clot. And then evacuate it with irrigation and suction. If the brain is swelling, then I would sew the bone flap onto the patient's abdomen to keep it viable until the swelling subside enough to allow for a cranioplasty."
"So after the surgery, your patient is back in the ICU, but you've notice her ICP was still high."
"I would prescribe mannitol, set her PCO2 to above 25, and give her hypertonic saline."
"None of that work."
"Then in that case I'm suspecting there is a re-bleed at the surgical site, or the skull fracture on the right side of her brain started bleeding. I would confirm with a post-op CT."
"The post-op CT revealed a subdural hematoma on the right side with right to left midline shift."
"I would bring her back into the O.R. to evacuate the clot on the right side." Meredith crossed her legs, "After the surgery, she will be taken for a repeat CT to confirm clearance. She should be closely monitored to keep her ICP below 15, and a neurological exam will be performed every 2 hours after she wake up. She should also be put on anti-epileptic medication, that would conclude my treatment."
"OK. Moving on to the next scenario."
The minute the first session was concluded, Meredith dashed into the bathroom to hurl into the toilet. The hurling soon turned into dry heaving after she depleted the little content she had in her stomach. At the five minute mark, she walked out of the stall to step in front of the mirror to check her appearance. Her tanned suit was still nice and crips, without a trace of a wrinkle given she had took it off the first thing as she stepped out of the exam room. The front of her hair was a little damp from the sweat on her forehead. Her face was still pale as a sheet of paper, and she could taste blood in her mouth. But she flipped her hair so it parted differently to give her more volume. When she put on the mask after she brushed her teeth and wiped her face, nothing seemed wrong. Even her emerald eyes were brighter with sheen because of the layer of tears in them. She sighed, straightened her blouse one more time before heading back into the exam room.
The rest of the sessions went by quickly as Meredith managed to distract herself by focusing on the questions. She had somehow convinced her body to only feel the nausea when she excused herself into the bathroom. Throughout the questions, she focused on Dr. Reynolds' kind brown eyes across the room, finding strength as they resembled those of her mentors. Six hours later, a drained Meredith barely managed to walk out of the hotel room on her own two feet. Luckily, Jackson was able to meet her in the elevator bank. He quickly grabbed the suitcase from her and supported her as they stepped into the elevator car.
"How did it go?" Jackson asked.
"I think I kicked the board's ass despite Derek being my lead examiner." Meredith broke out into a small grin.
"What?!" Jackson exclaimed in shock.
"He was good today. Acted like a complete stranger, wasn't affectionate, or worried, and didn't try to offer me any favour. Even though he tried to do the hole stolen glances and loaded exchanges thing first, but it's much better now." Meredith said, "Exactly how I wanted him to behave in this setting."
Later that night, when she woke up from her 6 hour long nap feeling much better, she got the email declaring her passing the board exam, meaning that she could now put both F.A.C.S (Fellow of American College of Surgeons), and F.A.A.N.S (Fellow of the American Association of Neurological Surgeons) as part of her title. A week later, Jackson also passed his plastics board certification exam with ease. The change in their status, from residents to double board certified surgeons triggered their phones being blown up by calls from fellowship programs around the country amending their offer to better attract the pair. After endless time discussing their offers with their mentors, Jackson settled on the joint fellowship in facial plastic and reconstructive surgery offered by New York Presbyterian and Sloan Kettering Memorial Institute. It was the perfect program for him, where he get to work with cancer patients, taking their tumour out, and help with subsequent reconstructive surgery to restore normalcy, the ideal combination of his two specialties. Not to mention New York was THE destination to practice plastic surgery. Meredith decided on pursuing double fellowship in paediatric neurosurgery and paediatric hepato-pancreatico-biliary surgery at Boston Children's Hospital. She was more than hesitant to move first. She had everything she needed in Baltimore. Her friends, family, a job she loved, and colleagues that adored her and nurtured her. It was where she picked up all the pieces and became whole and healed. However, both her mentors and her review officer agreed that if there was one part of Meredith's training that need to be strengthened, it would be paediatric neurosurgery. She had many cases in both paediatric surgery and neurosurgery, and she had tapped in the water of paediatric neurosurgery a couple times because of her patients' young age, but she never received systematic training where her two specialty crossed. To be fair, there weren't exactly someone to teach her, given both her mentors didn't focus on paediatric cases, and Johns Hopkins didn't exactly have the strongest department. She was finally convinced to leave when Helen brought up the fact she needed to call Children's Hospital of Philadelphia for consult while working on the conjoined twins separation case.
=5= Baltimore, the Bygone Restaurant
A week later, Keith Collier took the 5 residents in the first class of accelerated residency program out to dinner at the ritzy rooftop restaurant by the harbour to celebrate all of their successful board certification. Amongst the rest of the 5 residents, 2 cardiothoracic surgeons passed their boards three months ago, while the remaining orthopaedic surgeon was certified around the same time as Jackson. It was the first time Meredith and Jackson really interacted with their colleague outside a hospital setting, and it felt nice to connect personally. When they were seated chitchatting under the flickering harbour light after they finished their food, Kieth Collier presented them with five delicately wrapped gift boxes. They opened the box with the card on which their name was written in Copperplate script, and found a crisp new Johns Hopkins Hospital lab coat with their name, and their latest certification stitched above the pocket. Meredith ran her fingertips on the embroidery repeatedly as she recalled her first day at Hopkins, wide eyed, scared, excited, and looking for an asylum with a broken heart. But she ended up finding the best things in her life there, a family, a blossoming career, a home, and most importantly, herself and her worth. She clutched the piece of fabric recording her journey tightly in her hands, and shot her Uncle K a watery smile.
Keith Collier tapped a fork lightly against his champagne flute, signalling he was ready to make a toast. Everyone's eyes turned to him. He raised his glass, "Everyone, congratulations on finishing your residency in a record breaking three years." He smiled warmly at his residents, scanning them one by one and added, "I am grateful for your outstanding performance over the past years. You helped make Johns Hopkins the best teaching hospital year after year. You brought spotlight, and built a legacy for it, now it is about time you build your own. I am more than proud, for you all to land yourself in the best fellowship programs in the subspecialty you choose. And I would wish you all the best of luck embarking on your new adventures. I give you this gift today to remind you of your training, your heritage, of where you came from, of how far you have come, and how much you have conquered. Hopkins always standby you, even if you're miles away. Just know that I'll welcome any of you back with open arms at any point of your career."
All five residents looked at him with tears of appreciation, and clanked their glasses together with a cheer, marking an official end to their residency.
=6= Seattle Grace Mercy West Hospital
After departing from Baltimore, Meredith spent her two months vacation between Boston, Phillidelphia, and Seattle. She went back to Boston with Jackson and Sneezy. They had agreed that it was better for the Australian Shepherd to live with her in Boston, where she could stay at the Avery mansion and roam the giant backyard everyday without a leash instead of cooped up in a Manhattan condo. During her two weeks there, she finished moving, house hunting, and setting up her new apartment with the Avery's help. She also hung out frequently with Amelia at Harvard before she had to leave for L.A. with Geraldine Ginsberg to work on Kayla Lindy's case.
After everything was arranged and settled, she was invited to join the Harringtons in Pennsylvania. Apparently, it was a family tradition for them all to take two weeks off work and gather at the Albermarle residence every year. It was the first time she saw the magnificent property filled up to the brim with so many people. She met her extended family, cousins, nephews, nieces, uncles, aunts and numerous in-laws for the first time. She was a little overwhelmed first, merely by the amount of "family" she had. But everyone was really warm, nice, welcoming and none of them seemed to despise her for having a crooked childhood. Plus, Clarissa's youngest son, Everett Harrington, who she had met last time she was here stuck by her side at all the time, helping her out by whispering the name of the relative she was talking to in her ear whenever she seemed lost or confused. In addition, she enjoyed hearing her mother's wild tales in her younger years. She even found herself dubbed the title of her nephews and nieces' favourite aunt. Though it was easily because she was the only female Harrington child in her generation, Meredith still took it as a positive sign that her cousins' kids liked her. Sometimes when her hands itched to cut, Meredith snuck out with Everett, who worked as a paediatric cardiothoracic surgery fellow at CHOP. He took her to his hospital so she could observe surgeries up in the gallery at the world-class paediatric surgery facility. By the time she left, her suitcase was filled with homemade jams, sauces, crochet socks, crochet plushies for kids at her hospital, antique medical books, and family photo albums.
She flew back to Seattle for the remaining time of her vacation. She typically spent her mornings visiting her mom at Roseridge. Ellis Grey was barely lucid at all nowadays, and spent a great deal of time in the afternoon sleeping or napping. At this point, Meredith had opted to not clarify her identity at all, but rather pretend to be whoever her mother thought she was, and have pleasant conversation about medical advancements and surgery while sharing a lunch. it was her way of making sure her mother was eating.
In the afternoon, she spent time at the house with whoever wasn't at work. Izzie attempted to teach Meredith how to bake once, only to result in her cursing Meredith out of the kitchen. She went on girls nights with Callie, Arizona, and surprisingly, Teddy and Bailey at baseball diamonds. She took Lexie running a couple times when her younger sister complained of stress and anxiety. She had dinners with her friends at the hospital cafeteria nearly everyday. The rest of the time she was alone in the house, she spent sorting through her mother's old stuff and reading her mother's journals.
This particular day, she made it into Seattle Grace Mercy West with Cristina, Alex and Lexie in the morning. George was coming home for vacation after his first tour that very day, and he was going to meet them at the hospital before he head home to his mom's. George's flight wasn't until that afternoon, so Richard ended up giving her surgical privilege, and Bailey asked her to scrub in on her kidney transplant that morning. Meredith gladly took Bailey up on the offer. She was put into a trance when she was handed the indigo attendings' scrub to change into instead of the light blue ones she was familiar with.
In the O.R., Bailey was casually chatting with her previous intern as they were waiting to receive the organ being harvested in another O.R. "So where are you headed next? Is that going to require another NDA?" She teased.
"Come on." Meredith sniggered, "I can't keep it under wraps even if I want to. Boston Children's announced my recruitment on their website the very day I accepted their offer. Huge head shot on the front page kind of announcement."
"That quickly, eh?" Bailey shot her intern an amused glance.
"Hah, what can I say, Dr. Bailey. I am the best fellow they can get, after all." Meredith stated jokingly.
"You've grown too cocky for your own good, Grey." Bailey smiled under the mask, "Seriously though, have you ever considered coming back to Seattle for your fellowship? Yang, Karev and little Grey had been talking a lot about it. Little Grey was particularly disappointed you didn't come back west."
"Hmm, they don't say." Meredith replied. She contemplated quietly for a little longer, "I guess they didn't want to sway my mind. Honestly, Seattle Grace didn't even make it to the list."
"You had a list?" Bailey looked at her pointedly, her eyebrows shooting up her forehead.
"Yeah, a bunch of promising programs that I was going to choose from. Seattle Grace wasn't one of them. You see, Grace's neurosurgery department actually isn't all that strong. Derek was the only one that carried the weight and attracted all the tougher cases. At that time he was still chief, so he was barely operating, and god forbid I am never working under him again." Meredith chaffed, "Arizona is great and amazing. I have witnessed her abilities myself at Hopkins. But she became an attending a year ago, and had only been running the department for a couple months. Plus Grace didn't exactly have a paediatric neurosurgery department." Meredith shrugged as she concluded her reasons. Behind her, the door hissed open and in stepped an intern carrying the basin with the kidney inside.
Bailey nodded, stepping up to the table. "Let's get started, then. Grey, show me how good you really are."
Meredith smiled, "Of course, Dr. Bailey."
After Meredith and Bailey scrubbed out of the smooth-sailing surgery, Bailey went to update the family while Meredith headed to the lobby. It was about time George got here. Expectantly, she found George waiting for her in his battle dress uniform, surrounded by Lexie, Cristina, and Alex. Meredith ran up to hug him, glad he made it home safely. Cristina ridiculed her, "Come on, you were the only one that get to see him actually in the Middle East, yet you act like you haven't see him for years!"
Meredith retorted, "Watch it! When you've been in the war zone you'd know how dangerous his job is."
George smiled at his friends bantering, finally deciding to interrupt, "Come on, let's go have lunch? I'm starving. And I'm actually craving crappy hospital food."
Cristina turned to stare at him as if he had grown two head, she finally relented, "Military didn't change you, O'Malley. Still freaky as ever."
After lunch, George and Meredith chatted at the waiting area across from the main nurses station as their friends were paged back to their jobs. In the middle of their conversation, Meredith's eyes caught a nervous looking old man with a moustache in a dark brown jacket. He was fumbling with something in his jacket pocket and he was fidgeting, shaking a little even. He turned around and quickly rushed away the minute he caught Meredith's scrutinizing gaze, so quickly that it was becoming suspicious. He seemed really disturbed, Meredith decided. She wanted to push the strange sight out of her mind, but she kept having a feeling. Almost the same type she felt the morning she held a bomb. Meredith cocked her head to the side as she was thinking. After a few seconds, as if she was struck by something, she sprung up from her seat. She turned George around, who was sitting across from her, pointed to the quickly retreating figure now at the middle of the corridor and whispered harshly, "That older gentleman in the brown jacket, does it look like he is holding a gun in his pocket?"
"Damn it." George cursed and the smile dropped from his face entirely. "The shape does look like a gun barrel. A Glock, maybe. What is he doing with a gun in a hospital?!"
"He's here to shoot. Hopkins had someone pulling a gun at an E.R. nurse a couple months back."
"So what do we do? What did you do at your hospital?" George whispered back urgently.
"How do I know! The guy was taken down by the armed guards! It's Baltimore! It's not like we have that option here!" Meredith hissed.
"Fine." George sighed, pulling out his two service weapons from the holster strapped inside his camouflage jacket. Under Meredith's incredulous gaze, he shot back, "Shut it, Mer. I was going to get them serviced and reregistered at the station today." He passed the Beretta pistol to Meredith while loading his own M1911. "You still remember how to shoot from your military training at Landstuhl, right?"
Meredith sighed, "I do." She quickly loaded the gun as well.
"Then let's hurry. He is headed to the back corridor with supply closets. It's only staff there so it could be pretty empty. If we manage to stop him there, we don't need to worry about causing public panic." George stood up and made a beeline for the suspected shooter.
"We may have to take him down. He seemed really disturbed. I'm not saying we should, but just be prepared." Meredith said quietly as she caught up with him. Her fingers pressed the side of pistol against her abdomen, keeping it hidden under her scrubs as they made it pass hospital staff.
"Yeah. Let's cross that bridge when we come to it."
When they were about to enter the back corridor, they heard two gunshots going off. The two of them quickly exchanged a worried glance, and barged through the door with their guns raised in front of them, just in time to see Alex falling to his foot at the other end of the corridor. Meredith bit back the gasp in the back of her throat and kept her gun pointed at the male figure that gunned down her friend. Soon, Meredith noticed another body, a Dr. Reed Adamson according to her lab coat lying in a pool of blood to her right.
The shooter turned at the sound of them entering, and aimed his gun at Meredith, while the two doctors kept their firearms firmly pointing back at the shooter. Standing behind George, Meredith squatted down slowly, and traced one finger down Reed's neck to check her pulse while keeping her gun and her eyes on the shooter the entire time. She felt a weak and thready pulse underneath her finger tips.
George's assertive voice rang out, "Sir, put your gun down!"
Meredith slowly rose back up on her feet, and whispered, "We have to move quickly, she is succumbing to life-threatening blood loss and Alex was just shot in the chest."
George nodded ever so slightly. His eyes darted around the room, trying to figure a way out. He whispered to Meredith in a volume so low she was straining her ear to hear even though she was literally standing right behind him. His lips barely moved, yet his plan was clearer than ever. "This corridor is illuminated by lights and lights only. You can reach the switch on the right. I'll shoot him the second the lights come off. Now move discreetly while I try to talk him down one more time." Meredith hummed quietly in response.
George spoke up again at the shooter, "Sir. Please put your weapon down. You are hurting civilians, innocent people, doctors in this hospital, doctors that help people heal. You need to stop that right now."
The older man sniffled first, but soon his expression hardened, and his eyes darkened. He barked through gritted teeth angrily, "They are not healers! They are murderers, monsters! They killed my Allison! They deserve to die!" He began shaking with rage. Meredith took this opportunity to sneak her right hand onto the wall next to her in search of the light switch slowly. Soon, she felt it. She rested her thumb on top of the switch lightly.
"I'm sure they didn't mean to do that. There is risk to every surgery—" George tried, but was quickly cut off by the man.
"No! I begged and begged to not take her off life support, to let her live. But you doctors!" His hand shook, but kept the gun pointed at Meredith nonetheless, "You decided if she live or die! Without mercy! You killed her!"
George put one arm behind his back to give Meredith the thumbs up, signalling he was done trying, and he was ready for her to pull the switch at any moment now.
Meredith tapped her foot on the floor lightly three times. She coughed softly, then counted to three in her mind, and pulled the switch down swiftly right at three. She herself quickly hit the deck as well. The space was engulfed in darkness. That very second, a gun shot rang out, followed by a thud of something falling onto the ground, and painful moans.
After their eyes adjusted to the dark, Meredith exchanged a nervous glance with George. She could see him nodding. After lowering her gun's aim to point at the blurry figure on the floor, she flipped on the lights. They found the man crouching on the floor clutching his knees, the gun knocked out of his hands.
"Oh, thank god." Meredith heaved a sigh of relief. "Keep your hands where they are!" She demanded harshly while George walked up to him and kicked the gun further away. He put his own weapon back to the holster with one hand while his other hand firmly pressed the older man's wrists onto the floor.
Seeing George had gained physical control against the offender, Meredith rushed back into the hallway to call for security, two gurneys, and to check Reed and Alex's blood type. While waiting for help to arrive, she quickly checked the injury on Reed and Alex. Reed's pulse was thready and even faster, and she was unconscious. She checked the bullet wound on her head, a perforating GSW with an entry on her forehead, an exit at the top of her head, and estimated the amount of blood lost. Alex was still conscious and in shock. He responded to comands and pain very well, clearing his neurological status. Now she was only worried about his blood loss and the GSW in his chest. His breathing was becoming more and more ragged and rapid, so she was suspecting the bullet punctured his lung, causing pneumothorax and hemothorax.
As hospital staff rushed into the typically empty back corridor, Meredith rattled out orders. "Initiate a massive transfusion protocol for Dr. Adamson and prep an O.R! Order as much type specific blood as you can get. Call her family, I'm bringing her up right now for an emergency craniotomy. And put in a chest tube for Alex! His left lung is collapsing." Seeing the guards gaining control of the shooter, Meredith shouted to George, "You take care of him!"
George nodded at her and rushed to his friend's side.
In the O.R., Meredith was gloved and gowned after hastily scrubbing in. She didn't have time to take her patient for a pre-op CT to determine a bullet trajectory, so she was cutting blind. After inspecting the bullet entry wound and estimating the angle the it went in, she quickly opened Reed's skull. What she saw confirmed her suspicions, the bullet went through her right frontal lobe tip well above the skull base. It didn't fry much of the brain tissue, but it clipped a major vascular structure involving multiple arteries, resulting in rapidly expanding blood clots, causing the brain to swell. Before she could evacuate the clot, Reed coded twice. Meredith ordered to push high dosage of both atropine and epinephrine. After a total of four rounds of defibrillation, Meredith got her heart to restart again. In the end, Meredith evacuated the hematoma using her fingers because that was the fastest way. After digging out the big blood clot, Reed's ICP decreased, not enough that it was back in the normal range, but enough to confirm the bleeding ceased and the clot was evacuated. The slow recovery was expected given the extend of her injury. Meredith sewn the large bone flap she took off during the craniectomy onto Reed's abdomen until the swelling went down. During the entire process, she ignored people up in the gallery and focused on her patient on the table. After surgery, Reed was taken for a post op CT and E.E.G. The CAT scan showed reduced mid-line shift and no presence of a re-bleed, and the E.E.G. revealed normal brain activity. Having confirmed her patient was indeed not brain dead, Meredith let out all the air she didn't realize she had been holding in. She then met with the family, informed them of the good news, but warned them that she couldn't make any promise about major deficits until she woke up. With her family's consent, she quickly ordered Reed to be put in a medically induced coma to speed up the healing process.
After exiting the waiting room, she was informed by the nurse that Alex was currently in surgery, with Cristina, and Teddy fixing the penetrating GSW in his chest. Richard patted her on the shoulder for her quick actions before heading off to meet the media gathering in the ambulance bay. She comforted a distraught Izzie while George went with the police to have his statement taken. After George came back, she also gave the police her account of how everything panned out.
A couple minutes later, She had a crying Lexie in her arms. Her younger half sister was apologizing frantically to Izzie, for her part in Alex's injury. In her mumbled explanation, Meredith learned that the shooter was a grieving widower called Gary Clark, whose wife underwent tumour resection surgery for pancreatic cancer with Dr. Webber. Her surgery went just fine, but she suffered a massive stroke soon after the operation. According to her advanced directive, she was unplugged from the machines when minimal brain activity was confirmed despite her husband's vehement protest. Soon, he filed a lawsuit against the hospital and then chief, Derek Shepherd, who authorized the surgeons to honour Mrs. Clark's decision. Today, he was here to seek revenge on all the surgeons that ever worked on his wife, including Derek, Lexie, Richard, and a Dr. April Kepner. Alex and Reed Adamson were collateral damage.
Seeing Izzie's pained expression and her pleading eyes to please make Lexie stop, Meredith took Lexie to a different bench as her younger sister continued to sob. She hugged Lexie tightly, murmured in her ear that it wasn't her fault, and she didn't do anything wrong. Lexie soon laid her head on Meredith's lap while Meredith wiped her tear away and stroked her hair until the younger Grey sister calmed down. Lexie was soon summoned by police and legal. When she left, Meredith saw Derek standing in the middle of the hallway staring at her with red-rimmed eyes. His hair was disheveled like he had ran his hands though it, and his eyes were filled with unshed tears. He pressed his lips tightly together as he walked up to Meredith. "Dr. Grey, thank you for today. For taking down the shooter, and for saving Reed Adamson's life. I'm sorry—" His voice broke and he was nearly choking in the end. It was obvious to her he was consumed by the same guilt Lexie was suffering from. Meredith sighed, stood up on her tip-toe and enveloped him in a sympathetic hug. "It wasn't your fault, Derek. He did this, not you. You have nothing to be sorry for." Meredith murmured, and only felt Derek tightening his arms around her shoulder and his hot tears dampening her scrub top.
A.N.
Happy reading! Please review, like and follow!
Thank you for 200 reviews! I am so sorry for the wait. I had a writer's block, and I needed extra time to cover everything in this chapter. Please let me know what you think in reviews and please keep them coming! It's about the only thing that motivates me to keep going these days with more and more things on my hand. Please let me know if you found some of the plot repetitive, and if you think I moved too fast with Derek's progress?
I didn't write the conjoined twins separation so I could get the plane crash out of the way. I planned and researched it because I thought a surgery of this level of complexity is the right jewel to wrap up Mer and Jackson's residency at Hopkins, getting rid of the plane crash just happened to be an added bonus ;) I have heard your cries and requests of keeping our favourite resident pair together through fellowship as well, but please please tell me my decision made sense :(( And I promise you they will keep in touch and they will reunite very soon!
How did you think of the shooting? Did it make any sense or did it seem too far-fetched? When I rewatched the Sanctuary episode as I was writing this chapter, I felt like the point blank distance was nearly impossible for Reed to survive, but I later found an article from American Association of Neurological Surgeons that explained the damage to the brain was entirely dependent on the bullet trajectory, so I thought my plot line was plausible and I ran with it.
Lastly, I crossposted this story on AO3. But these are the only 2 platforms I'm posting my story on, and both are under ID-allis0917, if you see it anywhere else, it is not authorized, and please let me know. Thank you!
Love,
Allis