A bit of filler looking at Annie and Nathan working together. I can see Nathan being a good teacher for Annie, strong cardio but not Teddy and someone Annie will be confident being herself with.
A couple weeks after the avalanche Annie was prepping for a solo peds case. Her cardio attending she was comfortable with but she had never been allowed to fly solo with Alex before. Alex was demanding of his residents and this was rare for him to let a resident take the case from start to finish. Annie had done the procedure under Nathan's guidance on a few adult patients. She knew Alex and Nathan often didn't see eye to eye in the OR, while she had worked extensively with both of them she hadn't worked with them together, much less flown solo.
"Mini Altman, how is our patient doing, " Alex asked.
"Vitals are stable, sats are great, he's cheerful and positive," Annie replied, "mom is anxious."
"What's your plan," Alex said.
"I was just going to my locker to get Anatomy Jane and the skills lab for a heart model," Annie replied, "
"Why," Alex asked.
"I always do," Annie replied, "show the child what we're going to do."
"Every case," Alex clarfied.
"Every time," Annie replied.
"Even a simple valve replacement," Nathan asked.
"It's not simple when you're five," Annie said, "it's scary. So I show them and let them play with the models. When I had tubes in my ears as a kid my mom read me a story about it that made it less scary. I'd like to make some about the common cardiac procedures we do on kids."
"Do it and there's your bid for chief resident," Alex said, "I brought kids from Africa, Grey did two different studies, Yang was well Yang but April won it and she overhauled check lists things that made patients safer and more comfortable."
"I won't get chief resident," Annie said.
"Why not," Nathan asked.
"Same reason Josh won't be considered," Annie replied, "we have family on staff. Josh has a better shot than I do. It wouldn't be considered politically not with mama and uncle Owen."
"You don't know," Nathan said, "you're a good surgeon."
"Let's go check on Luke," Annie said, "I already did pre rounds on him."
"Go get your toys," Nathan directed, "and meet us upstairs."
Annie ran to the skills lab and her locker to gather what she needed. Meeting her attendings out side of the patients room she took point on meeting with the family.
"Dr Grace," the mother asked, "have you done this before?"
"I have in adults," Annie replied.
"Dr. Altman is a resident," Nathan explained, "she's done five with excellent outcomes under my supervision."
"Who is doing the surgery," the mother asked.
"Dr. Altman will be," Nathan said, "I will be supervising and there to guide her if she needs it. I have confidence in her work."
"I will be there working on your son's abdominal problems while Dr. Altman is fixing his heart," Alex said.
"How will she fix my heart," Luke asked.
"I brought in a couple things to show you," Annie said, bringing the heart model and anatomy Jane doll out from behind her back.
"That's an ugly barbie," Luke said.
"I know she's funny looking. This is anatomy jane, she's really good for helping you see what's going on when we do surgery. If I take off the stomach you can see all of the organs inside. This is what inside your body looks like. When I do your surgery I'm going to open your chest up and use a special saw to open your ribs."
"A saw," Luke asked.
"A special bone saw not what your dad would use to cut through wood," Annie said.
"Can I see one," Luke asked.
"I can ask," Annie replied, "we don't usually get to bring surgical tools out of the OR. When I open up your ribs I can work on your heart."
"How do you work on my heart," Luke asked.
Annie passed the little boy the heart model ,"this is what your heart looks like."
She explained how she would fix his heart and put everything back together. The little boy and his mother appeared to relax as Annie explained the process and showed it to them on anatomy jane from start to finish.
Returning to the locker room to put her doll away Annie ran into Bailey.
"Is that Anatomy Jane," Bailey asked.
"It is," Annie replied, "I was using her to show a five year old how we would do his surgery."
"When did you get one of those," Bailey asked.
"The summer I was 19. The staff here sent a care package with Christina Yang to mama and I the summer I was in the hospital. Jane was in there," Annie said, "mama and uncle Owen used her to explain what the surgeon did to me."
"I forgot about that," Bailey said, "you've kept her all these years?"
"She went to med school with me," Annie smiled, "she lives in my locker now."
"You keep anatomy Jane in your locker," Bailey asked.
"It's great for working with kids," Annie replied, "and I run through surgeries on her. It lets me think it through physically."
"Does your mama know," Bailey asked.
"She does," Annie said, "I'm a dancer I learned to think with my whole body."
"Why surgery," Bailey asked, "beyond your mother. From all accounts you were a professional level dancer you could have done that."
"I had picked medicine when I was in highschool before I even knew mama's name. I loved dancing but there's a finite time line on it. Very few make it past 30 or 35. I lost my passion for going after it professionally after my pas de deux partner was killed by a drunk driver. He was just walking his dog on the side walk when he was hit. But he was a donor so he saved a lot of lives," Annie said, "I still pick up drop in classes on days off. This is what makes me feel alive Dr. Bailey, doing this I make a difference. I had a little boy go from being terrified to being curious today. That's what makes me come in every day, put on my Mary Poppins face and go see the kids. I know I have a ton to learn but I want this and I'm ready."
"You are," Bailey agreed, "I'll be watching today."
"So is mama," Annie said, "I won't let either of you down."
"I trust you won't," Bailey said, "now go save some lives."
"Yes Dr. Bailey," Annie replied.
That afternoon Annie walked into the scrub room and scrubbed in. She took her place at the table and looked over to Nathan who nodded for her to begin.
"Ten blade," Annie said, she began to cut into her patient. As she was preparing to replace the valve she noticed something she hadn't seen before.
"Dr. Riggs can you look at this," Annie asked, "I haven't seen this before."
"Describe it for me Dr. Altman," Nathan said.
"It's whitish, hard, and has an uneven surface," Annie replied, "I think it may be a tumor."
In the gallery Teddy stood and went to lean against the window to peer directly into the OR and try to see what Annie was seeing.
"I'll take a look but you need to get a sample to pathology," Nathan said.
"I have to place the new valve, the old one is out, we can't just take a sample and close," Annie replied.
"He's on bypass, you have a moment to take the sample," Nathan directed.
Annie asked for the tools and took a sample sending it down to the lab. She replaced the valve and began to close.
"Dr Riggs am I doing a temporary closure on the ribs," Annie asked.
"Close it properly," Nathan said.
"Do you think the mass is malignant," Annie asked.
"Possibly," Nathan replied, "it wasn't a cyst."
"I got most of it out," Annie replied,"it wasn't very big."
"You'll chart it all," Nathan directed.
"I will," Annie replied.
Annie closed and scrubbed out.
"That was a good catch," Nathan said.
"I just wish I knew what it was," Annie replied.
"I've only seen something like that once before in a patient with TB," Nathan replied.
"Should I order a TB test," Annie asked.
"It can't hurt," Nathan replied, "you'll have to be monitored for it as well then."
"I had the vaccine years ago," Annie replied, "when I was 15 our church did a missions trip to Guatemala and we had to get it then."
"Did you enjoy your trip," Nathan asked.
"I liked helping people, building a clinic and a school but not the preaching part," Annie admitted.
"I'm looking at coordinating a group of residents to do a six week humanitarian trip in central america sometime next year would you be interested," Nathan asked.
"Go and actually make a difference," Annie replied, "I'm in. Do I get to operate?"
"Probably," Nathan replied, "I didn't think you would be interested."
"I'm very interested," Annie said, "I want to go help. This one would have more purpose then taking a bunch of highschool kids to volunteer in an orphanage and do some building repairs for ten days. I could actually change people's lives for the better."
"I'm going to talk it through with Bailey and Teddy but it's at least a year away to get it all done properly," Nathan said, "can I count on you as a resident to go?"
"I'm in and I'll try to get Josh," Annie said, "what attendings are interested?"
"Meg," Nathan replied, "she misses field work. The avalanche gave her a taste of that again and she wants more."
"That was something else," Annie replied, "she was in her element."
"She was. Meghan loved the speed and creativity of what she did in Iraq," Nathan said.
"Not answering to Owen," Annie laughed.
"He's relaxed over the years," Nathan said.
"They still argue," Annie pointed out, "he's more conservative in his approach then she is."
"Always has been," Nathan replied, "he could be intimidating back when I first met him. How did you deal with him right away? Or did Teddy hide you because we all knew you existed and how much she liked getting the letters from you."
"About me never from me. Mom didn't let me write until I was 19," Annie said, "he was a bit scary but not as bad as Christina. She terrified me. Mama had told me a lot about Owen from the beginning. I knew that was her best friend and she trusted him with everything. But hugging me the first time I went to nana's for dinner was a bit much."
"When did uncle Owen come up who decided that," Nathan asked.
"The summer I was 19," Annie said, "the same week I started using mama instead of Teddy. I remember waking up in the ICU and mama saying that she was there and so was uncle Owen."
"19 seems like such an arbitrary date," Nathan said.
"Drinking age in canada," Annie replied, "I guess they thought I could get drunk and write to my birth mother. I dont think that mama being my only true parent is what anyone pictured."
"What did you picture," Nathan asked.
"Once I got to know her having all three," Annie replied, "once I realized she loved me the whole time I knew she would stick around. I know Josh says your more his dad then Ian."
"I wish I could have been there more for him," Nathan admitted, "Meg and I looked into it but we were in med school. So we visited as much as we could."
"We don't think Ian and Gloria are coming to the wedding," Annie said, "they haven't replied yet and aren't returning Josh's calls."
"That's not good," Nathan said.
"We know Josh is worried they're using again but doesn't want to go check," Annie said, "I know it's not my place to say anything but I'm worried about Josh. He won't talk about it but it bothers him."
"I'll call tonight," Nathan said, "I have a few days off next week and Faroke is away with the school band for spring break so maybe I can drive down."
"I don't think they really liked me when they came up," Annie said, "or understood Josh."
"They never understood him," Nathan said, "but they never tried either."
"I know the feeling," Annie said, "he's lucky he always had you."
"He's done well," Nathan said, "but I can't take credit for that."
"He credits you with alot," Annie said, "he says with out your encouragement he never would have applied to med school."
"He just needed a push," Nathan said, "some confidence to apply to bigger name programs."
"Mama pushed me to," Annie replied, "I thought because of the Canadian system I was restricted to UBC. She encouraged me to apply all over the place I think we did 9 or 10 applications and I had 6 interviews. It came down to staying in Vancouver or going to Boston."
"I'm glad you chose Boston," Nathan said.
"So am I," Annie replied.
They had reached the surgical waiting area and approached the patient's mother.
"Ms. Thompson we've finished your son's surgery," Annie said.
"It's Miller," the woman replied, "his father isn't around much."
"My apologies Ms. Miller," Annie replied, "we'd like to talk to you about Luke's surgery may we have a seat?"
"Sit," Ms. Miller replied.
"There were some unexpected findings when we opened up Luke's heart," Annie said, "in his heart we discovered a mass."
"A tumor," Ms. Miller asked, "does he have cancer."
"It was an unknown mass," Annie explained, "I removed it and sent it to pathology for further testing. Right now we are not going to panic. I was able to remove the entire mass and complete the valve replacement. He is in the PAC and should be transferred to peds ICU for overnight monitoring in the next hour."
"Will he be okay," Ms. Miller asked, "what do we do now?"
"Right now we are waiting for results from pathology before we proceed," Nathan said, "the good news is that Dr. Altman was able to remove the entire mass."
"Is it cancer," Ms. Miller asked.
"We don't know yet," Annie admitted, "we will have results in the next two to three days. Is there any family history of cancer we should be aware of?"
"Not on my side but Steven his father ran off when he was six months old and I don't know his family history," Ms. Miller admitted.
"If you are able to contact him and get the information I would advise doing so," Annie said. She had some suspicions, Steven and Thompson were common enough names but that was her biological father's name.
"I can try," Ms. Miller said, "I don't know if he will respond. When he left me his mother let it slip that he had abandoned his girlfriend and unborn child about 20 years earlier. All she knew was that he had a daughter somewhere who was in her early twenties. His grandmother is still involved in Luke's life."
Annie's heart dropped, she had likely just unknowingly operated on her half sibling. She had to tell Teddy, that would be the only person who could sort this out. Because if she had it would be a major ethical violation.
"Please let him know what has happened with Luke and he can contact myself or Dr. Riggs directly," Annie replied.
"What do we do now," Ms. Miller asked.
"You go see your son," Nathan said.
"How is he," Ms. Miller asked.
"He will be groggy and in pain," Annie said, "the tube is out of his throat but his throat may be dry and sore."
"How do I help him," Ms. Miller asked.
"Stay with him, read him a favourite story, sing to him, hold him," Annie suggested.
"Are you a parent Dr. Altman," Ms. Miller asked.
"I'm not. My siblings are much younger and I spend a lot of time with them," Annie said, "I was the patient a few years ago and my mother and step father never left my side that's what helped the most. There's also research that shows the things I suggested help to reduce anxiety, pain and healing times."
"Do you have family that you could call," Nathan asked.
"Luke's grandmother," Ms. Miller replied, "I'll give her a call."
They walked the anxious mother up to the peds ICU to see her son. As they left Nathan asked, "are you okay? when she talked about the father you looked a bit tense."
"I need to talk to mama," Annie replied, "Steven THompson is the name of my biological father and what she said about him having a daughter out there in her twenties."
"You think that's you," Nathan said.
"Possibly," Annie replied, "and it's a huge ethical issue if it is."
"Not really," Nathan said, "you didn't know you still don't. Annie that's a common name."
"The grandmother will recognize my last name," Annie said.
"Deal with it when you get there," Nathan advised, "you don't need to worry. It's Friday, do you have weekend plans?"
"Some wedding stuff," Annie replied, "dress shopping for mama and Ali and suits for the guys."
"Have fun," Nathan said, "let us know if you know if we can help with anything."
"Probably more the week of," Annie said, "thank you for offering."
"I'm going to get my stuff and head to my office," Nathan said, "good work today Annie."
"Thank you," Annie smiled, "see you later."