Thursday morning Teddy scrubbed in for her biggest surgery of the day, a double bypass and valve replacement on Ian Riggs. She had seen Annie and Josh in Ian's room when she did rounds.

"Liard," Teddy said to Cassidy, "you need to be on the top of your game. The patient today is Nathan's brother and Josh's father."

"Where are Josh and Annie," Cassidy asked.

"Residents lounge," Teddy guessed, "they're both banned from the OR floor until it's over, no OR floor, no gallery. Which intern did you bring with you?"

"Grewal," Cassidy replied.

"Grewal," Teddy said, "your main job today will be to update the family. The son and the brother are both surgeons, be clear and direct in your communication. Nathan Riggs the brother is a cardio attending here, his fiancee Meghan Hunt is a trauma surgeon. The patient's son is a second year surgical resident Josh Riggs, Josh will be with my daughter Grace Altman also a second year."

"So the rumors are true," Grewal asked, "that an attending has her kid here to do their residency."

"Grace was here as an intern a couple months before I took the position here," Teddy said, "her and I both being here wasn't planned. You'll find Grace and Josh easily enough. He's in jeans and a black t-shirt and she has her hair in a french braid, she's wearing a bright pink top today with jeans. Try the resident's lounge or the second year locker room for them. Nathan has a blue button down on and jeans, Meghan has red hair and is wearing blue today."

"I'm on family communication," Grewal asked, "I've only been here a week."

"You are," Teddy said, "and this is a VIP patient so you need to be perfect. Can I trust you to do that?"

"Yes mam," Grewal replied. The young woman was slightly afraid of Teddy, she had heard Teddy's reputation and history. She knew the woman was supposed to be brilliant and talented and that she had a long military history. The rumor among the interns was that the attending Dr. Altman had a soft spot for the second year residents and would back and fight for them for reasons none of the interns knew. Now Pryia Grewal had the answer to why the taller Altman liked the second year residents, her daughter is one of them.

Teddy stepped into the OR and saw Owen smiling from the gallery surrounded by Annie and Josh's friends. She could see several cell phones out and knew they would be texting updates to Annie or Josh.

Teddy began the surgery and cracked the chest, the moment she was in she realized that things were much worse then they had been on the scans.

"Hunt," Teddy called through the intercom , "I need you to scrub in and we may need Pierce."

"On my way," Owen called. He ran from the gallery to the scrub room and quickly joined Teddy in the OR.

"This is worse then I thought," Teddy said, "some one needs to tell Nathan. These vessel are too thin and the walls of the heart are like paper. I don't know how much I can do."

"You've done it before," Owen said, "you patched with something."

"A pericardial patch could work but its a long shot," Teddy said, "it may be my only shot."

"We have to try it for Josh and Nathan," Owen said.

"Nathan said his brother was a heavy drug user but I don't think even Nathan knows how bad it is. Look at this he's done so much damage I don't know what we can do and his tox screen in pre-op shows there's a high level in his blood even though he said he hasn't used in a month but I don't believe it," Teddy said, "we'll need medical detox for him after this."

"What other options do we have," Owen asked.

"Whatever I do today is a temporary fix," Teddy said, "this heart is so damaged I need to call a transplant panel for tomorrow. I want him on the list with A1 status."

"Can we do that," Owen asked.

"I can try," Teddy said, "it will make him sober up and maybe connect with Josh."

"Then we have to do it," Owen said, "do what we can today, what about an LVAD?"

"Then he's in the hospital until a suitable organ can be found," Teddy said, "I want to talk more to his doctor in Portland before I go that route. Let's do what we can. It will restore the function and quality of life somewhat. I need more tests to decide if it's an LVAD or transplant but he's open on the table and I have to do something. Closing him will kill him."

"Do what you can," Owen said.

"Edwards," Teddy commanded, "call down to the pharmacy for as much bovine pericardium as you can get. Warren get this man on bypass."

"Someone call Nathan and Josh Riggs," Owen said, "I want them updated on the situation and both cross matched for blood transfusions. If they can give we need them now."

In the gallery Richard went to the intercom, "Hunt, I'll talk to the family. Is Grace with Josh?"

"She is," Teddy called, "wherever he goes she can go with him today he needs her."

Richard found Annie and Josh sitting with Nathan and Meghan in a deserted waiting room. Richard noticed how much like a family the four looked.

"Nathan, Josh," Richard said, "I have some news can I have a seat?"

Josh looked up, "Dr Webber what's happening?"

"We should wait for Gloria," Nathan said, "she just stepped out for a smoke."

"We don't have time to wait unfortunately," Richard said, "Nathan Ian listed you and Josh as his medical power of attorney."

"We'll go get coffee," Meghan said, standing. Annie took her cue and stood as well.

"Stay," Josh said, grabbing Annie's hand. He needed Annie, she was the only thing holding him together.

Annie sat back down and squeezed his hand.

"Meg," Nathan whispered.

Meghan returned to her seat and put her arm around Nathan.

Richard began, "when Teddy opened up Ian's chest the damage was far more extensive than the scans showed. She has had Owen scrub in with her."

"He's not cardio, we need Pierce," Nathan said.

"She's been called," Richard said, "the walls of the heart have been severely weakened by substance abuse. Teddy doesn't know if she has enough healthy tissue to work with. She's going to attempt to use bovine pericardium to do an extensive repair. She may need to use an LVAD and her initial response is to put him forward to the transplant board."

"Do it ex vivio," Nathan said, "Pierce and I did it. Grey assisted. She had Christina Yang from Klausman on speaker phone. Yang had done one with Teddy."

"Do not call Christina," Annie said , "mama will not talk to her about that surgery. That was the night Henry died on Christina's table."

"You know about that," Richard said.

"I do there's not much we don't talk about," Annie said, "mama won't be able to focus on this if you bring Christina into it at all."

"We won't Grace," Richard said, "we have three options right now for Ian. Teddy can do the repairs as best as she can using the bovine tissue, we can place an LVAD and put him in the transplant list or she can close and we provide monitoring and with in a few months palliative care."

"I want her to try," Josh said, "uncle Nathan what do you think?"

"I think she should try," Nathan said, "I'm giving Teddy my permission to act as she sees fit. Her and Owen are in there and know what they see. They have my permission to do what is best for Ian."

"Tell her to do what she thinks is his best shot for recovery," Josh said.

"I need you both to say it," Richard said.

"Dr Altman has my permission to act as she sees fit," Nathan said.

"Dr Altman has my permission to act as she sees fit," Josh echoed.

He knew what giving that meant, there was a chance his dad wouldn't come off Teddy's table.

Richard replied, "thank you I'll go let Teddy know and will update you when I know more."

"Thank you Richard," Nathan said.

"I'm sorry," Richard said, "I really am. Addiction is a horrible disease."

"Thank you dr Webber," Josh said.

As Richard walked away Annie pulled Josh into a hug.

He began to cry against her shoulder.

"Your okay," Annie said, "I'm right here and I'm not going anywhere."

"It's my dad," Josh said, "I thought this might finally be my chance with him."

"I know love, I know," Annie whispered, "we have to trust mama and uncle Owen. She never gives up on a patient and she'll fight 100% harder because it's your dad. It will be okay."

Annie held Josh for a few more minutes while he cried.

Annie whispered, "why don't we go sit in mama's office for a while. Go somewhere quiet."

Josh just nodded against her shoulder.

Annie stood and took his hand to lead him away.

"We're going for a walk," Annie said, "our phones are on."

"We're going to find Gloria and take her to my office," Meghan said, "come see us when you're ready."

"We will," Annie said, "I have my pager as well."

"Good," Meghan said, "if we hear anything we'll update you."

"Thanks auntie meg," Josh said.

The four hugged before going their separate ways.

Meghan texted Annie.

Meghan, "where are you going?"

Annie, "getting tea or coffee from residents lounge then sitting in mama's office. Josh needs quiet and away from people."

Meghan, "you can get in?"

Annie, "I have access on my fob. She gave it to me. She knows we might sit there."

Meghan, "Josh has Nathan's office as well. We're going to take Gloria to mine."

Annie, "tell me if anything changes."

Meghan, "this will be hours minimum 8-10. Make sure you both eat and drink."

Annie, "we need to worry about Josh. I'm okay."

Meghan, "you worry about Josh I'll take care of Nathan and Gloria."

Annie, "I will. I'm worried about him. I know they're not close but that's his dad."

Meghan, "it was always a complicated relationship. Nathan and Josh's grandparents used to take care of him. I used to see them a lot when Josh was younger and I was in school or a resident."

Annie, "I know. He used to talk about you and Nathan a lot. Your his family the way I have mama and Uncle Owen."

Meghan, "is Teddy okay to do this? You said something that makes me wonder. Something with her first husband."

Annie, "she will be. She has uncle Owen. She compartmentalizes when she needs to. If she needs to she'll talk to Owen. It's not my story to tell. She doesn't talk about Henry often and only with me. I just needed to make sure that Christina Yang wasn't called."

In the OR Teddy directed, "we're going to do this ex vivo."

Owen asked, "are you sure."

"Owen who is the cardio person here," Teddy asked, "you've seen me do this a few times. I've done it in this OR. I can do this. I need you to be my second set of hands. We're looking at 9-10 hours here. I need music and to do this."

"Okay," Owen said, "tell me where to start."

"We need to get the heart out and into ice as fast as we can," Teddy said, "once we do that the clock starts and we have to move. "

"He's on bypass," Stephanie Edwards said.

Teddy began to remove the heart as the tissue she needed was brought up. Teddy pushed away thoughts of the last time she had done one here.

It was nearly midnight when Teddy and Owen scrubbed out after sending Ian up to the ICU. together they walked to the waiting area and saw Josh half asleep with his head on Annie's shoulder and Meghan gently running her hand down Nathan's arm. They approached the family and sat down.

"Mama," Annie whispered, "how did it go."

"Long sweetheart," Teddy said, "can you wake Josh?"

"Josh," Annie said, kissing his forehead, "mama is here they're done."

Josh sat up, "Teddy, how's dad."

Nathan asked, "Teddy tell us what happened."

"Ian is in the ICU and critical," Teddy said, "the next few hours are crucial. I'm going to stay with him overnight."

"What happened Teddy," asked Nathan.

Teddy explained the procedure.

"Were you successful," Gloria asked.

"It was more extensive than we thought but he is alive," Teddy said, "he's critical and the cardiac intensive care unit. I will take you up there soon. Recovery will not be easy. If he makes it through the next 48 hours I foresee a good recovery. He will need to do a full medical detox and remain sober. Further drug use will undo everything I just did."

"Mom," Josh said, "you have to do that with dad. Do it to live. Stay sober together. This is do or die time literaly."

"Gloria we can help you and Ian find treatment," Meghan said, "we have ways to get you there and get it covered. Let us help you."

"It never works," Gloria said.

"It has to this time," Teddy said, "I've rebuilt Ians heart and repaired the damage to his aorta. Owen was able to repair some damage to his diaphragm. We did everything we could."

"Thank you Teddy," Josh said, "Owen."

"Your welcome Josh," Teddy said.

"Why don't all of you go get some rest," Owen said.

"I want to see dad," Josh said.

"Go splash some water on your face and we'll go," Teddy said.

"Gloria, do you want to see Ian," asked Nathan.

"I do," Gloria said.

"I'll take you to him," Teddy said.

Teddy led the way to the cardiac ICU. She paused outside Ian's room.

"Mrs. Riggs," Teddy said, "your husband is still intubated. There are machines that are breathing for him and helping to keep his heart beating at the speed I want it to. He is hooked up to a lot of monitors and IVs."

"Mom do you want me to go in with you," Josh asked.

"Please," Gloria said.

"Ask me what any of the machines do," Josh said.

Josh led his mom into the ICU cubicle.

Annie turned to Teddy, "is it really going to be okay?"

"I don't know sweetheart," Teddy admitted, "it was 1000 times worse than the scans showed. I don't know how that heart was still beating on its own. It's a miracle he made it to my table. How's Josh?"

"Stressed, exhausted, scared," Annie said, "that's his dad."

"I know," Teddy said, "it's hard to see a parent in this position."

"He cried today," Annie said.

"Is he okay now," Teddy said.

"Worn out," Annie said, "we sat in your office for hours. Thank you for letting us use it."

"I thought you would need somewhere quiet," Teddy said.

"We did," Annie said, "thank you."

"Your welcome," Teddy said.

"How are you doing," Annie asked.

"Tired and I need to go check on and feed your sister," Teddy said, "I'm assigning Edwards to monitor overnight."

"I can stay," Annie offered, "Josh won't leave tonight anyway and I'm going to stay with him."

"I'll go see Allison for her 1am feed and then send her home with Owen," Teddy said.

Josh and Gloria came out of the room.

"You said he was okay," Gloria said.

"I said he was alive and in critical condition, " Teddy repeated.

"Will he live," Gloria asked.

"If he does the next 48 hours I think he will," Teddy said, "but I can't make any promises. It's up to Ian to fight now. I hear that you're concerned however my pager is going for the peds floor. I will be up there for a consultation for about an hour then I will return."

"Thank you Teddy," Josh said, "I'll sit here."

"I'm staying with Josh," Annie said.

"We're going to take Gloria home for some rest," Meghan said, "Mom has been with Faroke this whole time. Mom needs a break."

"I'll stay with Annie and Josh while Teddy is in peds," Owen said.

Annie pulled another chair into the ICU cubicle and sat holding Josh's hand. They didn't need any words. He just needed to be with her and knowing that Annie was with him made Josh feel calmer just her presence comforted him.

Owen walked towards peds with Teddy, "are you okay to go see Allison on your own?"

"I need to go feed her," Teddy said, "I have to feed her. I've left it too long between feeds. I'll feed Allison then you can take her and some new bottles home. I'll meet you in my office."

"Okay," Owen said, "I'll see you soon."

Teddy walked into the daycare and saw the staff about to warm a bottle for Allison, "I'll feed her then her dad is taking her home."

"Of course dr Altman," the teacher said.

"Hi baby girl," Teddy said holding Allison close, "did you miss me baby? Let's go to mama's office and have something to eat then daddy will take you home and I'll see you in the morning."

Teddy carried Allison to her office and settled on the couch to feed the baby. Owen slipped in and sat with them.

"The last time I did that was four or five years ago," Teddy said, "Annie had just started med school."

"I know," Owen said, "are you okay."

Teddy looked down at Allison then back at Owen, "it sounds crazy but it made me think of Henry. The night I lost him was the last time I did that."

"I know," Owen said, "that's why I stayed with you the whole time."

"I love you and I love our life but there are times I still miss him," Teddy admitted,

"You loved him," Owen said, "you had a good life with him. It doesn't bother me. We both had lives before. Teddy I love you exactly as you are, all those things made you who you are."

"I love you Owen," Teddy said, "thank you for always understanding and being there for me. I couldn't have done that today without you."

"You were amazing," Owen said, "I thought we were going to lose him so many times and you got him back every time. Others would have given up."

"I couldn't give up," Teddy said, "I could never look Josh or Nathan in the eye if I had closed. The only choice was to go until there was nothing left. I had to operate, I had to save him."

"I know," Owen said, "that's one of the things I love about you. You never give up on the people you care about."

Teddy leaned against Owen.

"How's Ali," Owen asked.

"Starving from the look of it," Teddy said, "her and I both need this."

"We could start looking at formula," Owen said.

"I want to try to make it to her birthday," Teddy said, "days like today are rare. It's better for her."

"It's an option if you want it," Owen said, "so you don't stress about it like you did today in the OR."

Teddy shook her head, "I like the time with her."

"What do you need right now," Owen asked.

"Water," Teddy said, "there's some in the fridge here and anything from my snack drawer."

Owen sighed, "you need more than a snack."

"So do you," Teddy said, "but guess what Owen."

"What," Owen asked.

"Look at the date," Teddy said.

"What," Owen asked.

"In a month we'll be married," Teddy said.

"Four more weeks," Owen said, "I love you and I can't wait to start the next part of our lives."

Owen kissed her and Teddy could tell he wanted more than a quick peck. His kiss was intense.

Teddy laughed, "um baby here Romeo. I'll see you at home tomorrow."

"I'm sorry about that, Teds," Owen said, "that was a bit more than I meant. I know Allison is here. Working with you like that. That's when I fell in love with you. Seeing you fight for your patients . That's the first thing I noticed."

"My surgical skills," Teddy laughed.

"Okay your eyes," Owen said, "and your smile caught my attention but working with you and getting to know you is what made me love you."

"I'll never forget your confidence. You knew exactly what you were doing. It was hot then you smiled at me," Teddy said. She leaned against Owen and switched Allison sides to finish eating.

"Why do you still have your scrub cap on," Owen asked.

"I forgot it was there," Teddy said.

Owen untied the bow at the back of her scrub cap and started to take the hair pins out of her bun, he slid the hair tie out allowing Teddy's hair to fall in loose curls around her shoulders. He ran his fingers through her curls.

"That feels good," Teddy said, "I like when you play with my hair."

"I know you do," Owen said, "it's so soft."

"Owen," Teddy giggled, "stop flirting with me."

"You brought up the wedding and I got excited," Owen said, "I wish I had known when I met you that this would happen. All the time the guys teased me about having a crush on you."

"What would the guys say," Teddy asked.

"Finally, Dan would be happy for us," Owen said, "he always saw us together."

Teddy smiled, "they'd say we went soft."

Owen chuckled, "married with two daughters. Probably."

"We should check in Annie and Josh before we go," Teddy said.

"Their fine," Owen said, "Annie will look after him. Meg said she was amazing all day."

"I still want to sit with them," Teddy said, "make sure they're okay. I know Josh is only her boyfriend but he's family."

"He is," Owen said, "I want to say good night before I take Allison home."

"She's almost done," Teddy said, "you'll have to move fast so she doesn't totally wake up."

Owen nodded, "why don't I say good night to Annie and Josh and you meet me at the doors with Allison when she's ready?"

Teddy agreed, "that will work. Then I can go sit with the other two."

Owen went to say good night to Annie and Josh, he found Annie asleep on Josh's shoulder, Josh was asleep as well with his head on Annie's. Owen quietly covered them with a blanket.

Owen, "teds Annie and Josh are both asleep in Ian's room."

Teddy, "they okay?"

Owen, "I covered them with a blanket but they're fine. I think they're just tired."

Teddy, "that's what she does after a big emotional day. She gets that fight flight or freeze reflex then when the adrenaline wears off she crashes hard and sleeps."

Owen, "Josh is probably just as worn out."

Teddy, "I'll sit with them anyway. I've been through watching my dad get really sick. I'll make sure he's okay."

Owen, "Annie won't leave him."

Teddy, "she won't. She loves him."

Owen, "she does."

Annie and Josh woke up in Ian's ICU room around 5am.

Teddy came from the on call room when Annie paged her.

"He's alive," Josh said.

"He made it through the night," Teddy said, "that's good. His vitals are better than they were when I brought him up. He's fighting."

"Will he make it," Josh asked.

"I can't say yet," Teddy said, "but he's fighting and we're going to use everything we have to help him."

"Thank you," Josh said, "no one else could have done what you did yesterday."

"I've done that big of a repair once before," Teddy said, "your first year of med school. That patient made it. As long as your dad fights he will. It's up to him now."

"How can I help him," asked Josh.

"Talk to him," Teddy said, "be here. He knows you're here. Take care of yourself."

"When Meg and Nathan bring Gloria back we're going to go home for showers and food," Annie said.

"Do that," Teddy said, "come back when you're ready. Make sure you both eat."

"We will," Annie said.

"Pre rounds start soon," Teddy said, "why don't you duck out. At least get clean clothes."

"I need a shower," Josh said.

"Let's go home, shower, eat and nap then we can come back," Annie said.

"I'm going home after rounds," Teddy said, "I'll be back tonight."

"We'll see you later," Josh said, "let me know if anything comes up."

"I will," Teddy promised, "go get some rest."

"Thank you mama see you later," Annie said.

"See you soon sweetheart," Teddy said, giving Annie a hug.

"Thanks again Teddy," Josh said.

"Your welcome Josh," Teddy said.