Annie and Josh had spent wonderful few days on Whidbey island. They had had dinner with the family the night before to celebrate but hadn't seen their friends yet. Annie was looking forward to seeing Jenna, Julia and Cassidy, she had texted them a picture of her left hand with a cryptic message.
Checking their assignments Annie and Josh got changed into scrubs and made their way to the wards they were needed on. Annie stepped out of the elevator onto the peds floor. She was starting two weeks in peds with Alex Karev. Peds had become a favorite of Annie's. She liked helping kids feel better and teaching them about their bodies. She liked that connecting with kids sometimes meant reading a story, coloring, playing LEGO or make believe. She could do fairy dust and magic with the preschoolers and the latest Disney channel hits or YouTube trend with the older kids. Parents weren't always sold on the petite resident who looked 19 instead of 26, until they saw her with their child and heard her speak.
At the nurses station Julia grabbed Annie by the arm.
"Grace Altman what the hell was with that text last night ," Julia asked, "your hand and the words 'he asked'. He asked what?"
Annie replied, "you missed a small detail. Which hand was it? And what piece of jewelry am I wearing in it?"
"Your left," Julia said, "new jewelry."
Annie laughed,"my fiancé and I will tell everyone together at lunch. The cafeteria at 12:30?"
Julia shouted, "holy shit! Josh proposed? When? What did you say?"
"Yes, Friday and yes," Annie said.
"Show me," Julia said.
Annie put her coffee down and showed her friend her left hand.
"Grace this is amazing," Julia squealed, "Josh has good taste. Congratulations,"
"Thanks. We're really excited," Annie said, "your the first outside of the family to know."
Arizona joined the residents, "what are you celebrating?"
"Mini Altman and Riggs Jr are engaged," Julia blurted
"Josh proposed and I said yes," Annie said.
"Let's see," Arizona said.
Annie showed Arizona her ring.
"It's beautiful Grace," Arizona said, "congratulations."
Arizona hugged the resident she had watched grow from a shy undergraduate into a confident young doctor. Arizona remembered the first time Teddy had brought Annie into the hospital as a shy girl of 19 and then how they slowly rebuilt Annie's trust in people over the next year before she went to medical school. The young doctor standing in front of her was smart and driven; but she hadn't lost any of her sweetness or empathy.
"Thank you," Annie said.
"Does your mama know," Arizona asked.
"We had a family dinner last night e," Annie said, "she's excited. Josh and I going to take our time to plan the wedding."
Arizona smiles, "I'm happy for you and Josh. Congratulations."
"Thank you Dr Robbins," Annie said.
"Get to rounds," Arizona said.
"We're going," Julia said.
Arizona texted Teddy.
Arizona, "congratulations mama Altman."
Teddy, "who told you?"
Arizona, "I saw your daughter. She was telling Julia Young."
Teddy, "she's excited. Annie and Josh are meant to be."
Arizona, "I know her better than him. I've never seen her smile like that."
Teddy, "she's beyond excited."
Arizona, "how do you feel about it?"
Teddy, "I'm happy for her. I knew it was coming for a few weeks. Josh came almost a month ago to ask for our blessing. He wanted to do it right. They want to take their time wedding planning so there's no rush."
Arizona, "will you do an engagement party for them?"
Teddy, "we had a family dinner last night. They don't want a huge deal made. I'll do something small for close friends and family but not a whole surgical staff thing. I do know part of my gift for her wedding day already. It's part of that silly rhyme."
Arizona, "What?"
Teddy, "something old from the rhyme. I have a pair of pearl earrings that were my moms she gave them to me when I finished medical school. I was saving them for a special milestone for Annie or Allison. My mom was there when Annie was born. It was my mom that put Annie in my arms to say goodbye. My grandma gave my mom the pearls on her wedding day. I have other jewelry I can save for Allison that was my moms."
Arizona, "that's perfect. Annie is sentimental like that."
Teddy, "she is. I worry she'll miss Leslie in all of this. You want your mom at your wedding."
Arizona, "she has her mama, auntie Meghan and Evelyn."
Teddy, "she does."
Annie walked into her first patient's room and read over the chart one last time.
"Atlman, " Alex commanded, "persent."
"Leo, two years and 4 month old male, exposed to opioids and methamphetamines," Annie began, "heart murmur detected and waiting for a cardio consult, there's also an intestinal blockage. Receiving TPN. No family contact. He's on his own according to the chart."
"Follow up with cardio and he's your patient today," Alex said, "you need to get him stabilized enough for us to repair the gastric issues. All your doing today is this patient. Get to know him."
"I've got it," Annie said, "he looks about the size of a one year old. Do we know anything about milestones?"
"Nothing," Alex said, "mom OD on Saturday and didn't make it."
"I'll contact the social worker," Annie said.
"Do that then get him stabilized for surgery and a cardio consult," Alex said.
They finished rounds and Annie returned to Leo's room.
"Hi little Leo," Annie said, "I'm Dr. Grace. We're going to get you feeling better. I know you're scared and hurting and not feeling good. We're going to take good care of you I promise. Let me pick you up and see if we can get you cleaned up. You'll feel better when you're all clean."
Annie gently picked the little boy up out of the crib and held him against herself , "you're hardly bigger than my baby sister. Okay Little man we're going to get you a clean diaper and some clean clothes. Does a bath sound good?"
Annie gave Leo a bath as gently as she would have Allison. She hummed and sang the same soft lullabies she used with her sister. Arizona watched from a distance.
"Grace," Arizona said as Annie exited the little boys room.
"Dr. Robbins," Annie said, "my patient just fell asleep so I was going to check on my cardio consult for him."
"I've watched you with him," Arizona said, "have you considered peds?"
"It's on my list," Annie said, "I still enjoy cardio but I love being with the kids. The little things that make them feel better and make the hospital less scary for them."
"You could do both," Arizona said, "your cardio fellowship is 2 years and your peds is a year. You can do both if you wanted."
"I'm only a second year," Annie said, "it's a long way off."
"It is," Arizona said, "never too early to think of what you like and see where you fit."
"I'll consider it," Annie said, "today Leo reminds me a bit of Allison. He's 11 months older but no heavier and not much taller. He loved his bath."
"He probably needed that bath," Arizona said.
"I know it's not surgical but he's going to be easier to treat if he's clean and comfortable," Annie said, "and he's all alone in the world. No kid should be alone in the hospital. It was a little bit of comfort I could give him."
"They shouldn't be alone," Arizona agreed.
"I should check on my cardio consult for this little guy," Annie said.
Annie paged down to cardio again and when she didn't get a response half an hour later texted Teddy.
Annie, "Is cardio really backed up today?"
Teddy, "no why?"
Annie, "we've been paging for a consult for a 2 year old."
Teddy, "I'll head up room number?"
Annie, "6238."
Teddy came up to the peds floor and met Annie outside of the room.
"Dr. Altman the patient is 2years 4 months, opioid and amphetamine exposures, high levels of both in his blood, gastric issues and blockage in his large bowel. There's a heart murmur I can't figure out what I'm hearing. The rhythm on the monitor isn't one I've seen before. I've ordered an EKG, CT and CT angio," Annie said.
"What else do I need to know," Teddy asked.
"He's underweight and malnourished, no bigger than Allison," Annie said, "severe diaper rash. I gave him a bath, we read a story and now he's asleep. Karev said he's my only paiten until the family is found. I'm with him around the clock."
"Are you a babysitter or surgeon," Teddy asked.
"He needs someone to hold him and show him he's safe," Annie said, "it's what you would want if it was Ali."
"It's the right thing to do," Teddy said, "is CPS involved."
"I called," Annie said, "until then Leo is a baby who needs care."
"Leo," Teddy said, " a little lion."
"He's a cute kid now that he's clean," Annie said, "red curls, big blue eyes, freckles."
"Let's go see him," Teddy said.
They entered the room and Teddy looked at the little boy in the crib.
"Hi Leo," Teddy said, "I'm Dr. Altman, I'm going to help the other Dr. Altman make you feel better. Can I listen to your chest?"
Teddy gently opened his pajama top and listened to his heart.
"Annie come listen to this," Teddy said, "what do you hear?"
"The rhythm is wrong," Annie said, "there's a lag time then two sounds close together and it's sloppy the sounds slur together."
"Get an EKG and a CT," Teddy said, "I want all the tests you can."
"Bailey won't do it, there's no insurance and no parents," Annie said.
"I'll deal with Bailey," Teddy said.
The little boy began to cry and Teddy scooped him up, "hi little man. You're okay. I'm going to take care of you. You're going to be okay."
Annie ran the tests Teddy ordered.
"I'll need to do a pacemaker," Teddy said, "and he has two valves that need to be repaired or replaced, I won't know how bad it is until I'm in there. I'm bringing Karev in as my second surgeon."
Alex entered, "mini Altman, you're scrubbing in on Leo. Get him prepped."
Annie smiled it would be the first time she had scrubbed in with Teddy since her intern review almost 10 months earlier. Not working directly with Teddy had been good for Annie and Teddy's relationship. But today they would work together and both were excited.
Annie took the spot beside Teddy at the scrub sink.
"Annie ring," Teddy reminded.
"Where do I put it," Annie asked.
"I use my necklace," Teddy replied.
"On the same chain as the heart," Annie asked.
"Yes," Teddy said, she showed Annie her own necklace, "my rings go with the family charms Owen bought me for a wedding gift."
"I've never taken the heart one off," Annie said, "the clasp is tricky."
"I'll help this time," Teddy smiled, "I usually leave my rings on the chain and only put them on for special occasions."
"I want to wear it," Annie replied.
"I know," Teddy smiled, "put it on the chain at work though. You can't operate with it."
"Altman and min Altman what's taking so long," Alex asked.
"Figuring out what to do with Annie's ring," Teddy called.
"Annie's ring," Alex asked, "what resident wears a ring at work?"
"Her engagement ring," Teddy replied.
"What," Alex asked.
"Josh proposed this weekend," Annie said with a smile.
"Mini Altman and Riggs Jr," Alex said, "you're getting married."
"Yes Dr. Karev," Annie replied.
"Congratulations," Alex said, "now let's get this kid fixed up."
"Right away Dr. Karev," Annie replied.
They scrubbed in and Annie got to assist Teddy with the repairs to the small boy's heart. Owen watched from the gallery as the mother daughter team operated. Annie showed talent in cardio she was a natural and could easily follow in her mother's footsteps but he had also seen the tender way she cared for and spoke to the tiny boy on the table and thought peds might be her calling.
Annie sat with the little boy after the surgery. Around midnight Owen came up to peds.
"Annie," Owen said, "mama said you were sitting with a little patient overnight. Do you need company? I brought tea and apples."
"Thank you," Annie said, "Leo can't be left alone. This is scary for a little boy. His mom didn't make it and we can't find any family."
Owen sat on the stool opposite Annie's chair, "your doing the right thing. How's he doing?"
Annie replied, "vitals are stable. He liked scrambled eggs for dinner. He really liked his bath this morning and we need more picture books."
Owen asked, "where's the family?"
"His mom was one of the teens that ODed in the pit last weekend, mama tried but couldn't save her. The moms family can't be found in Washington, CPS is starting to look out of state. They don't know much yet so he's our patient until his family is found or he goes to a foster home," Annie said, "whatever happens he needs people to love him and teach him he's safe."
Owen asked, "is that why you stayed to sit with him?"
"The summer I was in the hospital you, mama and Chris never left me," Annie said, "I always had someone there to make sure I knew I was loved and safe. You didn't have to be there and you chose to stay to make sure I would be fine. Leo needs someone to do that for him. I can be that person, uncle Owen. I can show Leo he's safe and cared for that no one can hurt him now."
"I'll sit with you then," Owen said, "they don't need me in the pit right now. But you could use some company."
"I'm okay," Annie said, "I wouldn't mind getting my hoody from my locker though and switching to my glasses. Can you stay with him for 10?"
"Go do that," Owen said, "Leo will be fine, Josh is in the burn unit if you want to say hi. I'll page you if anything changes. I know it's been a long time since I did peds but I am a dad I can watch a sleeping child."
"Thank you," Annie said.
"Go see your fiancé," Owen said.
"I like hearing that word," Annie smiled.
"It is a good one isn't it," Owen agreed, "I love hearing mama call me her husband. That sounds right."
"I know we haven't started planning yet," Annie said, "but I want to ask you something."
"Anything little bear," Owen said.
"No little bear at work," Annie said.
"I have mama bear, little bear and baby bear," Owen teased.
"No dad humor," Annie said, "your dad jokes are getting bad. Please save the dad jokes for at home, even the interns are noticing your bad dad jokes."
"What did you want to ask me," Owen asked.
"Do you remember before my intern exam you found me in mama's office crying," Annie asked.
"We talked about a few things that day," Owen said.
"I asked you hypothetically if when the day came you would walk me down the aisle," Annie said.
"You did and I said I'd be honored," Owen said.
"Uncle Owen in the last few years you've been an important mentor and person in my life. To a huge extent a father figure. Over the last year or so I've really started to see you as a father and not just as Allison's dad but mine in a lot of ways as well. Would you walk me down the aisle at the wedding," Annie asked.
Owen wrapped Annie in a hug, "I would be happy to Annie. You're my daughter. You've been family and very special to me since the first time mama brought you to a family dinner. Now you're my daughter, I don't make the step daughter distinction, you're one of my girls. I would be honored to walk you down the aisle."
Annie had tears in her eyes, "thank you uncle Owen."
"Any time Annie," Owen said, "have you told mama?"
"I only thought of it as we were sitting here talking," Annie said, "that's what I want and mama will understand that. She knows I see you as a dad and will be happy I asked you."
"Her and I talked about it last night," Owen said, "she thought you would ask me and I thought you would want her or Chris to do it."
"Mama gets to do all the mother of the bride things," Annie said, "she can enjoy that. Chris doesn't know yet."
"You haven't told your brother," Owen said.
"He's in the arctic on a training mission something to do with polar bears," Annie said, "I sent him a picture and a note to call me but he hasn't opened it yet. I'm not sure how he'll react."
"When Nathan proposed to Meghan both times I was a little surprised but I was happy for them. They belong together and he makes her happy. Josh makes you happy and Chris sees that," Owen said, "he'll be happy for you."
"I haven't told Leslie and Dan either," Annie said, "I don't know if I will. I doubt I'll invite them. If they can't be bothered to email me back why would I set myself up for them not to show or to create issues on my wedding day."
Owen said, "that's always your choice. Whatever happens mama and I support both of you 100%. We love you."
"I should email them in a couple weeks maybe I can tell them in my email," Annie said, "they never respond so I don't know if they read them but it makes me feel better to at least try to keep communication open."
"If you want to tell them you can," Owen said, "I'm excited for you."
"Thank you," Annie said, "are you sure you don't mind walking me down the aisle?"
"I get to walk my oldest daughter down the aisle," Owen smiled, "I want to do that Annie. I'm honoured you asked me. I will even do the father daughter dance if you want me to."
Annie replied, "thanks uncle Owen. I've seen you dance, we might have to practice. If it's okay with you I'd like to run and see my fiancé and change into clean clothes and my glasses."
"Go Annie," Owen said, "I'll watch Leo."
When Annie left Owen texted Teddy.
Owen, "Annie's patient is headed for the foster system. I know it's sooner than we thought but he's adorable. She won't leave him."
Teddy, "little Leo?"
Owen, "yes. He's a cute kid and his story is tragic."
Teddy, "let's talk when we're both home. He'll be in the hospital a few weeks. I know you want one more child."
Owen, "I've always dreamed of three."
Teddy, "I said two or three. I've had two. I won't go through another pregnancy. The girls were both hard on me in different ways. We don't even know if we could have another of our own. But I like the idea of adopting or fostering."
Owen, "let's talk about it. He's going to need a lot of care."
Teddy, "he will. There's a massive heart defect that will need 3-4 more surgeries in the next year or two and revisions as he grows. So far he's my patient for that long and Annie will work with me on him. She's showing a talent for peds cardio. Christina's published a bit about it. I may need to call her if you're okay with it."
Owen, "I have no issue with her as a colleague. If you want to call or email her I'm fine with it."
Teddy, "you want your wife to call your ex wife?"
Owen, "you're calling your former student to talk medicine."
Teddy, "it's a bit odd. But she's the best at this repair."
Owen, "treat the little boy like he's our own. What if this was Allison."
Teddy, "I'd pay to fly her out to do the repair."
Owen, "then call her. Our oldest is already doting on Leo. She was singing that French Canadian lullaby she sings to Allison to him."
Teddy, "Dans mom taught her a few. She used to speak French with her grandmere. She's got a funny accent but she understands it and speaks pretty good French. That was helpful when we explored Paris."
Owen, "Paris, London where else did you two explore?"
Teddy, "it was only ever 3-4 days of her trip she'd get 10 days to come see me and we'd hang out at my place for a couple days, go somewhere new for a couple nights then she'd scrub in with me. We've done London, Paris, Zurich, Frankfurt, Nice and Edinburgh."
Owen, "Zurich? Did you go to Klausman?"
Teddy, "we did. We both got to scrub in. Annie was in fourth year at Harvard. Obviously before you came to see me. We just showed up and I pulled rank and demanded to see Christina."
Owen, "Annie asked me to walk her down the aisle at the wedding. She said she sees me as her dad."
Teddy, "I'm not surprised she asked you. What did you say?"
Owen, "I told her I would be honored. I want to do it. I even offered to do the father daughter dance. She told me I need to practice."
Teddy, "dancing is a big deal for her. I'm no better than you. Ask Meg or Riggs for pointers. Annie tells me I'm not allowed to dance outside of the house. But what do we expect from her with the years of classical training and highland she's had."
Owen," we'll both practice."
Annie found Josh in the burn unit.
Annie sat down beside Josh, "hey babe."
Josh hugged her, "where have you been all day I've missed you."
Annie said, "I have a very tiny vip patient. His name is Leo. He's two and no bigger than Allison."
Josh asked, "the drug baby?"
Annie replied, "yes. It's tragic. He's completely alone."
Josh, "I heard Karev wanted someone with him 24/7 why are you here?"
"Uncle Owen came to say hi and he's watching Leo so I could see you and get my glasses," Annie explained.
"You got Owen to watch him," Josh asked.
"He offered. We had a good talk," Annie said, "he's going to walk me down the aisle at our wedding and do the father daughter dance with me."
"That's the first decision we've made," Josh said.
Annie nodded, "I know I should have talked to you first but it's what I want. It feels right. Uncle Owen is the closest thing I have to a dad."
Josh said, "in a lot of ways he is your dad. I assumed you would ask him to walk with you. I went to talk to them before I proposed. I had originally planned to talk to Owen then Teddy was home. I've never been so afraid to talk to them in my life."
"You asked them for my hand in marriage," Annie asked, "it's not 1950."
Josh rolled his eyes, "I asked for their blessing not their permission. I wanted to make sure neither of them would kill me."
Annie giggled, "they would never kill you. You're the golden boy."
Josh laughed, "our competition is 11years old or and 17 months. Not hard for us."
"Allison is the princess," Annie said, "my sister is the family princess for sure."
"They love you," Josh said, "and Ali tried to say my name last night."
"Osh," Annie laughed, "it's cute. Nee and Osh."
"She's said nee for a while," Josh pointed out, "how's your day going?"
"Really good," Annie replied, "did you tell anyone?"
"Duncan knew I was going to," Josh admitted," so he asked and you told Robbins and Julia first thing this morning so they all know from Julia."
"My surgery on Leo was intense," Annie said, "I've never seen so much damage on such a tiny heart. Karev knows, he heard mama and I talking about what to do with my ring in the OR."
"What did you decide," Josh asked.
"It's on my necklace, the one you gave me for my birthday the first year we were together," Annie said, "I'll put it there at work and wear it at home. Did anyone say anything?"
"People are happy for us," Josh said, "they want to see you and see the ring. Why is that such a big deal?"
"The other girls want to see my ring," Annie said, "it's the first thing Julia asked after when. Not how did he ask. Could she see the ring. Because it's pretty and shiny."
"I told them to wait for you to tell the story," Josh smiled, "maybe lunch tomorrow?"
"I hope so," Annie said.
Josh's pager went off, "911 in the pit. I'm on trauma with Kepner."
Annie gave him a quick peck, "I'll be in the peds ccu 6231. See you later."
"I'll come find you," Josh replied, "love you."
"Love you too," Annie replied and walked back upstairs to sit with her tiny patient.