A/N: Hey! Welcome to my Derek-doesn't-die AU. As always, I really appreciate any kudos and encourage any and all comments. Although I'm cross-posting (so half of the book is going to posted in a couple days), feel free to comment as if each one was coming out one at a time :) I can promise pain, but also joy (occasionally) . There is a happy ending, I promise.
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A painfully familiar face turns up in the ER of Grey Sloan Memorial hospital with life-threatening injuries.
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Derek Shepherd's wife once told him that organ damage was much like death. But worse. She explained her point of view rather bluntly. Though they were similar in some ways, organ damage hurt more. Organ damage went on forever, it hurt for life. Consistently. Death ended; the hurt faded.
He disagreed.
Death was irreparable. There was no coming back from the dead; no magic drug or procedure that could make someone proclaimed dead spring back to life like there was for most other things in medicine. Most organs could be transplanted, if not, replaced by a machine. Hearts could go on bypass; colostomy bags could be placed and kidneys could be filtrated with dialysis. Organ damage could be treated but dead was dead. Dead would always be dead. Asystole. Empty lungs. Stationary heart. Blown pupils. Dead.
There was a chance with damage to the organs. The bones. The muscles. The tissues. The tendons. The body. Organ damage was not irreparable. Most of the time. That was the one thing that made his rebuttal hesitate. Sometimes it meant sacrificing a part of a patient's life. The three- or four-days patient had to come in for dialysis or the thousands of dollars that getting a coronary artery bypass surgery cost. The time and work it took to regain full range of motion from a broken wrist or the wait for the gastrocnemius fascia to heal after being gashed through with a scalpel. But that was time and that was money.
He supposed it was the thing about him that his mother always used to say. Black and white. Death was worse. Full stop. No more comments.
Although, he could see her point: long, drawn out pain did hurt. But so did death. It hurt to die and it hurt the people around said passed person. Their friends, siblings, parents, children, grandparents, colleges. Organ damage didn't do that. No one held a funeral in a gloomy church, standing in the rain with a black umbrella as they cried over a grave when his mother's kidney decided enough was enough and gave up. But he did when his father was shot and killed.
It was like acute and chronic pain.
One was quick. The other lasted forever.
One was dying upon impact when a truck slammed into the side of your unsuspecting car, sending it rolling down the road. The other was having to deal with the altered life you were left with when your eyes crept open to a shattered windshield. The closest thing to death that wasn't...well, death.
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"Bailey, Edwards we've got a trauma incoming, ETA one minute." Meredith informed the pair as she headed in the direction of the fresh air, at least a slight relief from the congesting heat of the room. The sun may have been dazzling, but at least the air would be cold.
"Doctor Bailey- I need you for a consult. It's an emergency." A man interfered before she even had a chance to open her mouth to answer Meredith's request. "It will only take a second though."
"Right. Grey, I'll meet you out there. Edwards, finish these sutures for me." She instructed as she took the chart from the man that had appeared besides them, flicking through the scans as she walked with him. Meredith nodded, reaching for a trauma grown as her face met the air of the outside world.
She was right. The air that brushed against her skin from the light breeze was cold, but soft against her skin as it was concealed by the Tuscan yellow of her trauma gown. A perfect balance of climate that made her sigh with satisfaction. It wasn't often that Meredith Grey felt her life was perfect. Half-decent in fact. It was riddled with complexity, a string of events that she wasn't even sure she could decipher anymore. But she was smiling today. So happy in fact, that she was one of those people. The ones who felt they could smile as much as they wanted, every day, all day, because they lived on some kind of fantasy high of pure joy and contentment.
She allowed herself to breathe for a moment in the calmness and tranquillity of the open space. The sharp intake of air was soothing, therapeutic even. As much as the sun was appreciated by her and most others, the ER easily got boxed up and stuffy so it was nice to take in the crisp air of mid-spring. The winter was well behind them now and pollen season was just settling into its new place, ready to take plenty of victims of allergy-induced ailments. She sniffed a little. Perhaps it was already on the way to her.
She felt her ears perk up to the sound of the approaching ambulance, the forte howl of the siren flooding her eardrums. She didn't know anything about the patient contained within the metal box. Normally, she could have at least prepared herself for the arrival by considering possible injuries from the situation that had put the person in the ambulance, but not this time. She had no name, age, gender, cause of injury or the ailments themselves. Nothing. Not a single thing. She pulled the blue gloves over her hands as she saw the familiar colours of the vehicle pull into view.
The ambulance pulled up in front of her. She stood still until she heard the hum of its engine drop away and the vehicle silenced, sat ungrudgingly in constant with the now perfectly quiet world.
Meredith took that as her cue to move forward and greet the paramedics. Not wasting a second, one of them made a grasp for the handle of the back of the ambulance, the other divulging as much information as they knew as he ripped open the door.
"John Doe, late 40s, broadsided by a semi-truck- "The paramedic started.
That was a few more pieces of information than she knew than she did when the ambulance first came into sight. Male. Anywhere in the region of forty-eight to fifty, maybe a dash either way. Probably in an awful lot of pain, providing he was even conscious. Broadsidings almost always meant broken bones and surgeries, especially if the point of impact was on the patient's side. She nodded to the three key pieces of information, the paramedic pausing as she helped her colleague roll out the man plastered to his stretcher, only for Meredith to stop, her hands still outstretched like they had been when she first intended to help.
No.
No.
No.
No, no, no, no, no, no, no, no, no.
She was sure the woman was still talking but Meredith wasn't listening. She felt her throat swallow involuntary and a stab to her chest that she had only ever experienced a couple of times in her life. The stench of blood – his blood – clogged her sinuses and she couldn't help it as she dropped her mouth open to take easier breathes. At least that way she was absorbing a little less of the smell. She could taste it too. As if the stench was so thick that it diffused through the air to the tip of her tongue. She almost gagged. Almost.
The paramedic's words turned from well-structured sentences to muddled, disjuncted words. Something about blunt force trauma. Something about oxygen levels. Something about C-spine. Something about tachycardia. Something about Hypovolemia.
She closed her eyes and she was sure she could still smell the fresh air and hear the distant bustle of the ER and taste the lingering tang of strawberries on her lips from breakfast. Her most perfect breakfast. Kids by her side. Husband by her side. The whole world was on her side. It was a picture-perfect scene that she could scarcely even attempt to imagine in her wildest dreams. However dark and twisty she was, she wasn't quite sure she would ever be able to imagine the scene that lay out in front of her in her wildest dreams either. Correction, darkest nightmares.
Then again, it's the nightmares that always seemed to become reality.
Bailey rushed over from the depths of the ER to the fast-approaching gurney as her standard protocol for both others and herself instructed her to do. Rule 2. When I run, you run. Meredith had learnt that on her first day as an intern. And she herself, had taught it to her interns. It wasn't for the extra exercise or the fun of it. It was because every second counts. Whether it's waiting another minute before taking someone to the OR or taking five too many seconds to search for a vein, those precious ticks of the clock were the difference between a doctor waking out the room with a smile, overbearing gratitude trailing your tracks from each family member who had to sit through the long painful silence of the waiting room, and a sigh, a throw of your scrub cap and a slow, trudging descent to the room where an expect family stands, waiting for the news to brighten up their broken day that you know won't come out of your mouth.
She didn't feel her mind giving her legs a request to move. But the world was moving and her feet were breaking contact with the floor before settling back down, her body nearing the ER with every footstep before she could stop and question anything she wanted to. Anything she needed to.
"What have we got?" Bailey called to Meredith as she approached with the group at the OR doors, not noticing the emptiness that hung over her.
"John Doe, late forties. Broadsided by a semi-truck – multiple rolls. Blunt force trauma to the head, chest and abdomen as well as from the left side impact. Tachycardic. Numerous query as well as obvious fractures. Positive LOC on scene, initial GCS of 3, now 10, been drifting in and out significantly since pickup but total loss of speech skills. Both pupils are equal and reactive but an intracranial bleed seems likely." The first paramedic announced, pulling the gurney forward a little.
Bailey's eyes took a second to take in the man. She could group patients quite easily; it was something that came with experience. Some patients, unless they had some horrendous internal bleeding hiding and refusing to present itself, she could pretty much confirm with a brush of her eyes that they would be okay. Perhaps they would need some time to recover, but, eventually, they'd be fine. Some she could tell would be a challenge. That they'd need surgery, some time in the ICU and a longer recovery. But some...some physically hurt her. It hurt her to think about what it would be like for the next of kin and people related to the person that would have to deal with one of two endings. The first was death and grief. The second was a half-life. One where the patient was so badly that they'd never be the same again.
That was this man, judging by the crimson smudged around his head and the appearance of his leg. And that was just what she could see. The list she had been presented by the man only added to her visual evidence.
Category 3. Massive trauma. Life-ending or life-changing trauma.
"Derek-" Meredith muttered, the name barely escaping her throat, never mind her lips.
"Suspected haemorrhaging of the abdo, it's significantly distended: hypovolemia. C-spine secured on scene in case of probable cord damage. Grade 0 response in the right leg, left is NT. Some neurovascular concerns about the left open tib/fib fracture but a pulse was found when we last checked approximately two minutes ago. Medial left knee dislocation had to be reduced in the field due to lack of blood-flow." Her male partner continued, neither his ears nor anyone else's in the groups picking Meredith's attempt. Bailey nodded as she gestured for assistance from the group that had assembled around the man on the stretcher.
"Derek." Meredith tried again, her volume creeping up just enough for Bailey to notice something exiting her lips but not the content of the word.
"Grey?" She questioned, any hints of the classic Bailey berating that she had received for the majority of her life rejected and replaced by genuine, heartfelt concern. She took another look at the broken man on the gurney, recognition still not flashing across her face as Meredith expected it to. Or that she would have expected it to. But there was no one home anymore. A juxtaposing compound of deep, profound thought and complete utter absentmindedness. The group fell silent as all eyes fell the blonde woman in scrubs as the word crept from her lips for the last time.
"Derek-" She muttered through a grappling exhale that threatened to let out more air than it had let in.
Bailey blinked heavily, her eyebrows creasing as she examined the woman before turning back to the man on the gurney.
All those things that the woman had said was about the John Doe. The irregular heart rhythm, broken bones, alarming state of consciousness, suspected mass haemorrhaging in both his brain and belly, the concerns over his c-spine and ever-weakening pulse of his dorsalis pedis. They weren't about John Doe at all. They were about Derek Shepherd. Her friend, her colleague, and the husband of the broken woman in front of her.
"Find Hunt, find Torres, find Webber. Find everyone you damn well need to that can ensure that this man lives!" She demanded almost violently, a spark in her voice that Meredith wasn't sure she'd ever heard before, and she'd heard Bailey at her worst. The paramedic nodded, pulling the gurney away from her and Meredith and disappearing behind the doors of Trauma Bay 1.
She turned back to Meredith to find her eyes unfocused and dazed in the direction of the room as she inhaled and exhaled to an unnatural rhythm. "Meredith? He's going to be okay. I am going to do everything I possibly can, okay? We are going to do everything we can, I promise." She vowed, pausing as she failed to even acknowledge her voice. "Meredith, can you hear me?"
She didn't respond in any way other than the hand that reached out to the shorter woman, grasping onto her forearm. "Bailey," She breathed after a second. "I- I'm gonna faint."
Bailey's eyes couldn't help but widen at those words, escaping from the blood constricting grip of her forearm and instead grabbing at the whole of her body, feeling the precise moment it went limp in her arms.
.
"Hey you, don't look at me like that." Bailey requested- no, commanded, purposefully giving a reassuring smile as she entered his view. Her voice was so broken, but she at least tried to shove some strength into her tone. She wanted to touch him. To let physical touch reassure him that it was all going to be okay. But his neck was still engulfed by a C-collar, his forehead upwards was wrapped in blood-soaked gauze and a mask engulfed his nose and mouth. There was nowhere to touch him. Nowhere that wasn't covered in dried, crackling blood or still hadn't been cleared for fractures yet. "You know we don't let people die here Shepherd. Okay?"
His lip quavered under the mask. He was trying. He was trying to speak.
"Okay. You're going to be okay." Bailey confirmed after a second, as if he had agreed with her. She thought he did. The tension in his face relaxed just a touch and his eyes softened.
"Persistent hypotension after two litres of Saline." Owen sighed, his eyes shooting up to observe the drip for a second, hoping that perhaps a malfunction in their delivery could explain the unyieldingly low blood pressure. It couldn't. It was the massive blood loss that was causing it. That was the only viable reason.
Bailey pulled herself out of her attempts of reassurance with a mental head shake. She could do this. She didn't need to babysit him. She needed for him to be okay and to do that, she needed to do her job. At least he looked a fraction less terrified now. "Pulse is still thready at 130." Bailey noted.
"He's got a right haemothorax and I really don't like the look of this head lac."
"He had a positive LOC on scene and his GCS is at 10." She added, considering the possibility Owen had suggested through his opinion of the bandaged laceration to his head.
"We'll need to prep for intubation, secure his airway." Owen returned to the statement, knowing he needed at least one kind of surgery, if not, multiple.
"I got a flail chest, 36 French tube." Bailey demanded to an intern, holding her hand out for the catheter. "I'm sorry Derek, this is gonna hurt, but it's gonna help, okay? It's gonna make you better, I promise." She warned as she drew the scalpel to him just before the feeling of the tube breaking into his side sent him desperately gasping for air. She wasn't even sure he had heard her warning.
"Ortho consult?" Callie announced as she entered Trauma room 1 in her standard happy mood, unaware of how many of her friend's worlds had just been crushed. "Ouch." She stated at the sight of the man, severely unaware of the piercing looks of her fellow doctors as she waltzed into the room as if it was just another set of broken bones.
"Callie." Called Owen's voice from the man's side, softly but serious.
"What?" she inquired, her smile fading quickly at his tone then, as their eyes met, the look on his face. Before either of them had a chance to question the other's reactions, the once strict metronomic tempo of beeps surged further into tachycardia. He was losing blood. And fast. The room bustled once more and the tempo of footsteps increased tenfold, the noise levels turning up a couple notches to the right too.
"Definite hypovolemia, let's make sure to keep him warm." Owen announced to the room of swarming doctors. "Is the Trauma panel back yet, CBCs?" He inquired, frowning as no one in the room nodded their head nor called out a positive answer.
"Don't worry about paging neuro, I told Amelia I was on the way to an acute trauma and she said she'll be right behind me, she just needed to talk to an intern quickly." Callie explained, stepping into the room to examine the man's obvious left leg open fracture but still stood too far away from the man lying, outstretched on the table to recognize him as one of her best friends. Owen looked up at her, eyes wide as his face drained any colour he had left. Callie pondered the man's features for a second, eyes not catching onto the look of the trauma surgeons face. He looked…familiar.
"Torres, the patient-" He tried, only to be cut off by Callie.
She internally sighed at the state of the patient's mangled foot, following it upwards to examine a swollen, relocated knee.
"What happened to this guy? Was he like..." She interrupted, only to pause as she looked up at the sound of the seal breaking on the door.
The room fell silent at the person who entered, Dr Torres left feeling like she was missing out on something everyone else knew.
"Thought you'd need a neuro consult." She explained nervously as she received stares from every surgeon, doctor and nurse in the room.
"We are all fine here." Owen responded quickly, his voice staying steady as much as he felt the temptation to let it tense and shudder as it begged to do. He didn't let a second beat between them because of his fear that she would step forward and see who the patient was.
Callie, now much closer to the man as she untied the pelvic binding, looked up to him at his dismissal. That was an outrageous suggestion. The man clearly needed a neuro consult. She looked over to him to confirm the decision before she shouted out her opinion only to find herself swallowing deeply. She found the source of the room's silence. The room's shock. The room's stares at Amelia Shepherd. The room's general worried atmosphere.
The room was aware that the patient was Derek Shepherd and now, she was too.
Silence beat on in the room, no one quite sure what to say. Callie drew her eyes away from him after a second. She wasn't surprised she didn't recognize him. Even if it wasn't for the mask that was yet to be replaced by the endotracheal tube and ventilator covering half of his face, the lack of the once establish colour to his face and darkening blood that littered his face told her that she could be forgiven for overlooking her relationship to the patient in her first glance.
"Actually Dr Shepherd, I've got a guy who sustained a nasty wrist fracture from a fall and I wanted to check it wasn't neuro related. The fall, that is." Callie requested as the rest of the room remained deadly quiet. The only sound protruding from the room continued droning on at a tachycardic tempo, a series of beeps that the woman at the door noted as odd, but didn't question. She knew they all knew what they were doing.
Amelia nodded and headed out the door, followed by Callie. She turned to give Owen a nervous but sympathetic look before leaving with the oblivious woman.
.
"Are you alright Callie?" Amelia questioned as they walked around the ER, noting the lack of her customary smile. Callie had no idea what she was going to do. Or what she was going to say. Or anything really.
"Oh yeah, I'm fine. Sofia kept me up last night, that's all." She lied, continuing to lead the woman in circles, literally and metaphorically, noting the mostly unoccupied beds. It had all been so calm, so peaceful. She had even had time for a proper lunch and to visit Sofia, who she found drawing a cute but rather odd-looking dog, complementing it convincingly and taking it proudly as a gift nevertheless.
She had one major trauma since the start of her shift, seven hours earlier. One. It was such a calm day. Surgeons often became rather ravenous beasts in the hunt for a good surgery to scrub in on or an eccentric case to question everything they ever thought they knew about medicine, but some days were a good kind of peaceful. It was a much-needed silence after short sleeps and long shifts, especially in the heat which at this point, was tantamount to a midsummer climate.
"Do you actually know where you're going?" Amelia questioned, finally having enough of walking past the same patients three times.
Callie paused and looked to her. She couldn't lie to her any longer. "Something…Amelia, something happened."
.
"Shepherd, I need you try and speak for me again, okay?" Hunt requested, pulling the mask from his face for just a second.
Derek blinked heavily as he swallowed before his tongue hit against the back of his teeth sluggishly in an attempt to speak. It was a confused kind of movement, like his tongue was paralyzed in his mouth, and his vocal cords didn't shift.
He shook his head, placing the mask back over him. He pulled out a pen light as he spoke to observe their constriction. "We need a head CT. He's got to have a brain bleed. Pupils aren't asymmetrical but there's nothing else that could be causing these kinds of neurological symptoms. We could still get a blown pupil. Then it might be too late." Owen observed.
Bailey puckered her lips as she pondered the suggestion. "Agreed but his other injuries are significant too, if left untreated, it's highly possible he could-" She stopped. The word caught in her throat. She couldn't bear to see someone she knew, never mind someone she worked with every day, in this kind of situation. In the kind of situation where the word 'die' needed to be said. He could die. And the word wasn't any kind of exaggeration. A quick flash to his monitors could tell an intern, a first-year med student even, that the patient was already dying. His heart rate was well into tachycardia and his blood pressure was only tanking with each second that passed, despite the rapid transfuser shoving blood as desperately as possible into him. "We need a neuro consult to be sure but his pressures steady and he's stable enough for a CT." Bailey concluded, deciding there was no other way of knowing which one would kill him first.
"She's the only one on call." Owen sighed, patting his forehead with his forearm in place of running a hand through his hair, his fingertips drenched in the patient's blood. Derek's blood.
"You mean-" Bailey breathed, the next inhale not quite making it to her lungs. It held itself in her throat instead.
"Amelia. Amelia is the only neurosurgeon above residency working today…but I can't let her-" He paused, rephrasing. "I can't make her operate on her own brother."
As much as he knew it would shatter Amelia – how much it would shatter anyone come to that – if he told her that her brother had died in the room next door from a brain bleed and no one paged her as a neuro consult, never mind as his sibling, then he wasn't sure she could survive through it. He knew she was strong. But how she would be able to take this scenario was beyond his own comprehension.
But no one else was on call. No one else was near enough to get to the hospital in time, never mind get changed and scrubbed. Not before the patient died.
Not before Derek Shepherd died.
