Chapter 2- Breaking the Routine Can Have Consequences

Over the years, Derek Shepherd's body had become used to a certain routine. Usually, no matter what was going on in his life, his body knew to get up at six in the morning for a jog, after which there was a shower and then a trip to the local coffee shop to satisfy both his caffeine and town gossip fix. After a bagel and coffee and finding out what his patients were talking about for the day, he could get ready for work. Every day was the exact same and after eighteen years, he didn't even need an alarm clock anymore. His body just knew that this was the routine and had him up and about by six.

There were a few exceptions and interruptions that he had learned to deal with. His predecessor at the Oakbrook Falls Medical Center had been a stickler about keeping the house call alive and it meant that he had trained Derek to do the same. While he saw the majority of his patients during office hours, it wasn't exactly unheard of for him to get a call in the middle of the night for Mr. Cascio, whose wife swore his drinking had nothing to do with his nearly biweekly falls, or an emergency Sunday night call for Jason Whitlock, who only got tummy aches on school nights. This summer he had been called for twisted ankles, poison ivy, concussions, and one birth when a couple newly moved to the tiny town had seriously misjudged the distance to the nearest hospital. He sat with the dying, coached new parents through the first few weeks of infancy, and sometimes just sat and talked to anyone who felt lonely. And he loved every minute of it.

But he hadn't received any calls the night before and his nightly routine had gone exactly as planned. He had closed the office at seven, heated up some leftovers, and had gotten some reading done until he had forced himself to go to bed at eleven. Usually, he fell asleep at around one and then started it all over again. It was why he was so confused now as he rolled over in bed, his eye catching the clock on his bedside table. It was nearly eight, his cell phone was ringing, and for a minute, a paralyzing panic spread throughout his body.

He was late. He wouldn't be able to jog today, he wouldn't be able to go to the coffee shop, and he was pretty sure his day was completely ruined. He had no idea why he had slept in and he hated it. His routine was everything to him and it took him a full minute to bring his body back to the bed, to fill his starved lungs with air as he opened his eyes. "It's okay," he whispered as his room came back into focus. "It's okay. You're okay." And it would be okay, as long as he closed the office at six today and got a run in before dinner. The interruptions in his life, in his routine, had led to him creating a back up routine and he had to believe that would be enough as he breathed in slowly and let it out.

His cell phone was still ringing and he ran his shaking hands through his unruly curls as he sat up in bed. His parents had a routine too, and part of their routine was to check in on him. It had been going on for eighteen years now and he really didn't think they had ever missed a day. It had once annoyed him, but he had come to accept that this was their way with dealing with what had happened, and he wasn't going to begrudge them their own way of healing. Even if he had moved on and was happy, it probably wasn't as easy for his parents. He got it and today he even found himself feeling relieved about the predicability of the phone call. "Hey, Dad," he answered his phone.

"Hey, bud," Dad replied over the sound of what sounded like a stampede but what was probably a large herd of grandkids running around the house. He didn't think a day went by when there weren't grandkids all over the Shepherd house and Derek knew his parents lived for it. "Did I wake you?"

"Yeah, but it's fine," Derek sighed, running his hand over the stubble on his cheeks.

"It's kind of late for you," Dad said carefully. "Late night calls?"

"No, the calls are usually pretty quiet during the summer," Derek replied, trying to pretend that he didn't hear his mom asking if everything was okay.

"So you just…slept in?"

"I got to sleep kind of late last night," Derek lied because it really hadn't been late. He really had no idea why he had slept in, but he knew where his parents' minds were going and he refused to let them go there. "But I'm good, Dad. I'm getting ready for work and I'll go for my run tonight."

"Okay…" Dad drew out the word as the sounds of three or four kids screaming filled Derek's ears.

"Did you and Ma move into a zoo?" He asked, swinging his legs to the floor and stretching before he got up.

"No," Dad chuckled fondly. "Em and Soph decided they wanted a night out last night, so we got the eight kids. It's been a fun morning here in the Shepherd household. Your ma is making Mickey Mouse pancakes and Cam has decided he wants to be a chef one day so we have a bit of a mess going."

"Poor Ma," Derek laughed.

"She lives for it," Dad stated. "How was your day yesterday?"

"Really good. I finally convinced Mr. Calloway to start taking his insulin regularly. Oh, and Sarabeth and Dan finally got a positive pregnancy test. She's six weeks and I think Dan's going to hand out fliers announcing it." His parents didn't know his patients like he did, but these phone calls usually involved him filling in his parents on his life as a small town doctor. Each of his patients' successes felt really big to him, and he loved being apart of their ups and downs. "Today I'm actually volunteering at the summer camp to talk first aid."

"Well, make sure you tell them the story of you putting a hook through your hand," Dad laughed.

"I'll probably leave that out, Dad," Derek rolled his eyes. "Oh, and you want to hear something kind of crazy?"

"Go for it, buddy."

"The first baby I ever delivered in Oakbrook Falls is starting his senior year of high school in September," Derek reported proudly. He could still remember the day he had delivered Jamie Hughes clearly. He had been scared and alone for the first time, Dr. Shetland had been in Manhattan, and Mrs. Hughes had gone into labor at the grocery store and demanded not to be taken an hour out to the bigger hospital in Syracuse. Jamie had been her fourth kid and after about twenty minutes of pushing, Derek had held the tiny baby in his arms, letting his loud cry wash over him.

"That is kind of crazy, bud," Dad agreed after a second and Derek couldn't help but wonder about the pause. Logically, he knew his parents were busy with the grandkids and Dad was probably being climbed on, but that panic that had risen briefly earlier made him wonder about the pause and what it could possibly mean. "You know, your ma and I were thinking about coming out to visit in a couple weeks. What do you have going on?"

"Nothing yet, just getting ready for the school year to start. Is Ma wanting to do more antiquing or are you wanting to try one of the trails again?"

"Please don't say the 'a' word to your mother," Dad groaned. "I think we just want to visit you. It's been a bit since we've seen you."

"You guys were here two months ago," Derek pointed out, trying to ignore the short sting of guilt that moved through him. He was about four hours away from his parents' home in Long Island but rarely made it home. His sisters and Mark tried to make it every week, but he hated driving down, hated the busy roads and the unpredictability of the traffic. It threw everything off and his parents seemed to understand that. But they were getting older and he probably needed to let himself break his routine to spend a weekend with them at some point, instead of forcing them to come up.

"If you lived closer, we'd see you every week," Dad stated. "And we love Oakbrook Falls."

"I know, Dad," he sighed heavily. "I…I can try to make it down a little more. I don't…but I can try. Especially before winter."

"Well…your ma would be thrilled to have you," Dad said slowly. "We'll figure it out."

"I mean it, Dad. You guys can stay in Long Island and I'll come stay at the house for a weekend," Derek promised softly.

"That sounds great," Dad said just as Derek heard a bunch of kids screaming and laughing. "Okay, bud, I know you need to start getting ready for the day and I need to try to control these little monsters."

"I really do need to see if I can make it to the coffee shop," Derek agreed. "Tell Ma I love her and I'm really doing okay."

"Why wouldn't you be okay?" Dad countered. "And she loves you, too. So do I for that matter."

"I love you, too, Dad," Derek grinned before ending the call and throwing his phone on the bed. This was just how things had been for eighteen years. His parents worried but pretended they didn't and he acted like he didn't know why. They had thought Oakbrook Falls would be a phase, a place he would go to get his mind back on the right track, but instead he had fallen in love with the predictability of the small town and how safe everything felt. He was a local now, which had only taken about a decade. At first, the people who had survived the town's ups and downs had looked at him with suspicion but Dr. Shetland had told him to be patient and to build trust. And over the years, their looks had turned into genuine smiles and delivered apple pies. They liked that he would sit with them for an hour, listening to their problems or getting excited about pictures of grandkids. He was one of them and after Dr. Shetland had died of pancreatic cancer and left Derek the practice, the town had proudly claimed him as theirs.

And in that time, the town had helped him get his head back on track and figure out what he needed to heal after everything. He had found it on a particularly bad day, and had immediately loved everything about it. As a twenty-seven year old, he had felt like he had finally found where he was meant to be, where he could he happy. Now, at forty-five, he didn't think he could ever leave, even as the town changed with each passing year. As more and more young couples gave up on city life, Oakbrook Falls expanded and shifted just a little. It was still a small town and he still felt like he knew most people, but every summer, a new group of families moved in with their young kids, dreaming of the kind of stability that Derek had found.

It was just the magic of Oakbrook Falls and Derek loved it. There was town gossip every morning at the coffee shop but none of it was mean-spirited. No one ever wanted to know how he had ended up there, but he knew they were at least a little thrilled that he had carried on Dr. Shetland's title of most eligible bachelor in the town. Some people called it the town doctor's curse, but Derek also knew that Dr. Shetland had been beyond happy with his partner, Jack, in the end. The fact was, Derek just felt like the tiny town was perfect and he never felt overwhelmed when he was walking around. This was home.

He showered quickly, probably faster than he usually did, and then after getting dressed for the day, walked out of his little cabin that he had bought sixteen years ago, and started down the street towards the coffee shop. He still felt a little off about his morning but it was going to be okay. He was going to get his coffee, open the office for a couple of hours, and then his routine would shift for a bit as he spent his afternoon with kids to teach them all about first aid. Today was just a weird day and he didn't think there was any reason for his dad to sound so concerned. Weird days happened and he knew that tonight was going to help him get it all back on track.

"Dr. Shepherd!" Mr. Potter called to him as he walked into the coffee shop. It was a small space that served very simple coffee, though there had recently been some upset when they had decided to introduce flavored lattes. The tables and chairs were all mismatched, there were pictures of the falls all over the walls, and a TV in the corner that played Yankees games in season. It was one of Derek's favorite spots in the whole town and usually the one that calmed his brain.

"Derek, Chris," he corrected, just like he did every day as he walked up to the owner. Chris Potter was seventy-two but still acted like he was fifty, though he had started to slow down since his wife, Amy, had died the year before. He was waiting for one of his kids to take over the coffee shop, and Derek had his money on his daughter, Tegan, who had been coming for a lot of short trips to Oakbrook Falls in the last couple of months, her kids and husband in tow.

"Derek," Chris laughed, shaking his head. "I was starting to think we weren't going to see you this morning."

"You give me my caffeine fix, Chris," Derek pointed out as he put a couple dollars down on the counter. "And I have to harass you about coming in to check your pacemaker."

"The ticker is doing fine," Chris shrugged. "Black or are you leaving room for milk today?"

'Black," Derek replied. "And while I appreciate that you think your heart is doing great, I'd rather know for sure before I have to tell Tegan you're not taking care of yourself."

"Ah, but I know you can't do that," Chris smirked at him before sliding a large mug towards him. At the nameless coffee shop, no one was allowed to just take a coffee to go. Chris wanted his customers to sit for a bit and talk before their days got going and it was how Derek usually ended up getting bombarded by everyone in town. "Doctor-patient confidentiality."

"I don't know who told you about that but I'm not afraid of you," Derek shook his head. "Just make an appointment, okay? Twenty minutes and then I'll leave you alone for the rest of the year."

"Remind me next time your parents come into town to have a talk with them about you respecting your elders," Chris shook his head slowly before handing Derek his bagel. "Dr. Shetland used to harass my old man, too, you know."

"Oh, I remember. Your dad was my first patient ever and he was probably more stubborn than you," Derek smiled. "You're going to call and make the appointment today?"

"What will you do if I don't?"

"Make it for you and show up at your house the next time Tegan is in town," Derek shrugged.

"You're a pain in the ass, Doc," Chris laughed, his green eyes sparkling as he wiped his hand over his white beard. "Fine. I'll call today."

"Thank you, Chris," Derek smiled at his friend before turning to sit at his favorite table in the back corner, his back against the wall as he watched the rest of the coffee shop. Chris had put a plaque up earlier in the year declaring it the Doc's table and Derek appreciated it, if only because it could throw off the routine if someone else took the seat.

"Derek!" Dan White walked up to him quickly, like a man on the mission. Dan and his wife, Sarabeth, had moved to Oakbrook Falls two years earlier, and in that time, had struggled to get pregnant. They had seen a fertility specialist in the city, who had told them there was nothing wrong, and Derek had finally told them to relax and stop worrying so much about it. Now, Sarabeth was pregnant and Dan looked like he was on the verge of a freak out.

"Morning, Dan," Derek nodded to him. "Is everything okay?"

"I…tell me about morning sickness," Dan stated as he sat down in front of Derek, blocking the view of the door. Derek shifted sightly until he could see around Dan's shoulder and then took a deep breath.

"It's completely normal and will probably go away in about six weeks," he replied, taking a long sip of his coffee. "We only need to be concerned if she's having more than four vomiting episodes a day, and if she starts to lose weight."

"Oh," Dan nodded slowly. "What if she throws up at night instead of the morning?"

"According to my four sisters, the man who decided to name it morning sickness should be executed in some particularly creative ways," he laughed. "It's normal, Dan. Sarabeth is looking great. If you want to help her, ask Chris if he has any ginger or peppermint tea. It might settle her stomach."

"Okay, yeah, I can do that," Dan nodded slowly. "Sorry, Doc, I know you aren't working yet but…"

"But you're a worried husband and dad and you know I don't keep hours," Derek assured him. "Call me anytime and you know I'll talk."

"Thanks, Derek," Dan shook his hand. "I'm pretty sure Sara is going to ask you to be her doctor for this pregnancy but…well, you don't have privileges anywhere, do you?"

"I don't," Derek shook his head. "But I know some obstetricians who help me out here. I'd be happy to help you guys out and send you to someone you can trust when the time comes."

"I...seriously, thank you," Dan grinned at him before standing up and walking away. It was one of the perks of being a small town doctor: there wasn't much Derek didn't do. Dr. Shetland had taught him not to worry about specialties or to push people out just because it wasn't something he knew a lot about. It mean that he was an obstetrician, pediatrician, cardiologist, neurologist, gastroenterologist, and everything in between and it always kept him on his toes. He had learned a lot over the last eighteen years and he hated to send any of his patients to New York City or Syracuse before he had exhausted all of his options.

The worst thing was when he couldn't help. Dr. Shetland had warned him about that feeling, and Derek had felt it numerous times: the gnawing dread replaced by a terrifying helplessness that left him cold. But nothing has been worse than Chris's wife when he had had to send her to New York for a full breast cancer work up, only to find out it was terminal. Derek still sometimes woke up in a cold sweat when he remembered Chris's middle of the night call, because he needed to understand. Sometimes he wondered how the older man was dealing with being a widower, but he was too terrified to ask. It was stupid, but Derek wasn't sure he had any right to coach anyone through the rocky waves of grief.

"Dr. Thepherd!" A little voice yelled and Derek looked up just in time to catch the sturdy five year old boy who came barreling towards him. Ryan Mueller was small for his age but rambunctious and Derek wasn't sure he had ever walked anywhere in his life, just ran.

"There's my favorite explorer," Derek grinned as he lifted the little boy into the chair next to him. Ryan immediately laughed, revealing a gap in his mouth, and Derek raised his eyebrows. "Ry, did you lose a tooth?"

"Huh Huh," Ryan nodded eagerly, sticking his tongue through the gap. "Gueth how."

"How?" Derek asked.

"Fell off my bike," Ryan laughed.

"You're kind of a mess, little guy," Derek shook his head, shifting to take a closer look at the scratch on the little boy's chin. "Were you wearing a helmet?"

"Yeah," Ryan shrugged. "It wath tho cool!"

"Ryan, Dr. Shepherd is eating," Diana Mueller shook her redhead as she walked up to the table. "I'm so sorry, Derek. He ran off before I could stop him."

"It's fine, Diana," Derek assured her. "I see we had another Ryan the Explorer mishap."

"I feel like that's my life in a nutshell," she laughed. "Ron says if he had known a boy would be so much work, he would have prayed for a girl."

"Next time my parents are in town, ask them if four girls or two boys were harder," Derek shook his head as he watched Ryan line up the sugar packets.

"Dr. Thepherd," Ryan started, "can I play baseball?"

"Sure," Derek nodded. "After you get your cast off."

"Tomorrow?"

"Definitely not tomorrow, explorer," Derek shook his head as he smiled up at Diane. "Maybe next week. Did you get a lot of signatures?"

"Yeah!" Ryan held out his green casted arm that was filled with signatures and designs. He had fallen climbing a tree earlier in the summer and had refused to cry the entire time Derek had set it. The little five year old got into trouble without even trying and Derek couldn't help but admit that the little boy who wanted to be a world explorer was his favorite.

"Wow!" He gasped. "You got hundreds!"

"I know," Ryan grinned. "But I wanna play baseball."

"You will," he assured him. "Maybe you'll play baseball and be an explorer."

"Can I?" Ryan gasped.

"I don't see why not."

"Cool!' The little boy grinned as he reached out to high five Derek.

"Come on, Ry," Diana shook her head as she leaned over to pick up the sugar packets. "Dr. Shepherd probably wants to finish his breakfast and get to work."

"Nah, he'th my friend, Mommy," Ryan frowned as he watched his mom clean up. "Right, Dr. Thepherd?"

"Right, but your mom is right that I have to go to work," Derek grinned at him. "What if some other kid breaks his arm trying to find a secret wizarding world and I'm not there to help him?"

"Oh…that would be no good."

"Exactly, so I'll see you later," he nodded, ruffling the little boy's hair. "I think when you get your cast off, you deserve a lollipop and a sticker."

"Cool!" Ryan repeated before jumping off the chair and running off, his mom quickly rushing after him. Derek shook his head and looked down at his half-eaten bagel before checking his watch. He was already running too late and he hated to make today any weirder. He would get a sandwich later from the the deli so there was probably no reason to worry about finishing his bagel. Right now, he just wanted to get to work before anyone stopped him and made his morning even weirder. He just wanted to get his day back on track before it fell apart even more and made it too hard to get back to where things made sense.

He dropped his mug and plate off on the counter and then walked out of the coffee shop quickly, pausing to smile at a few people who called his name. It was sometimes weird to think about how the town had accepted him and seemed to love him so much, especially since Dr. Shetland had passed. His mentor had been born and raised in Oakbrook Falls and had been dedicated to bringing superior medical services back to the tiny town. By the time Derek had walked into his office thirty years after he had come back and asked for a job, Dr. Shetland had been known throughout the area as one of the best doctors in rural New York. He hadn't been fancy, he hadn't always even been that nice, but he had given up a lot of his own happiness so that he could change his childhood home.

When Derek had met him, the doctor had taken one look at him and his medical degree, shrugged, and told him he'd get one year to prove himself. During that year, Dr. Shetland hadn't asked him any questions or really even talked to him that much. But he had been one of the best teachers Derek had ever had, and he still found himself missing him. Over the course of the fifteen years they had worked together, the doctor had become someone Derek felt like he could talk to and while he had never told him about what had happened, Dr. Shetland had apparently understood and was supportive. There was a slight possibility that the old man had been his only friend in Oakbrook Falls and it had made saying goodbye even harder.

Sometimes though, it barely felt like he had. Dr. Shetland had left him the practice and enough money to pay off the last of his student debt and sometimes Derek found himself talking to the old man's picture, telling him about their patients or just trying to figure out a rough case. It had actually been the hardest routine Derek had ever had to break, the morning coffee with his mentor or the evening beers. Keeping him alive through the practice and talking to his picture felt like holding onto that routine, even just a little bit. It felt better than saying goodbye forever.

"Good morning, Derek," his nurse, Patricia, called out to him as she opened the office door.

"Good morning, Patty," he smiled at her brightly colored scrubs. "Sorry, I'm late."

"Ten minutes never hurt anyone," Patty laughed and Derek fought the urge to wince as his chest tightened and his mind tried to go somewhere else. He was fine. He was at work and his routine was coming back on track. "Though I'll tell you, Sandy was worried sick about the fact she didn't see you running this morning. She's already called three times to make sure you were still alive. Apparently doctors in this town don't have much luck. Never mind that Dave lived to be eighty-two."

"Remind me to stop by her house later and double check her medication levels," Derek shook his head, following his nurse inside.

"Can do," Patty nodded as Derek smiled at Dr. Shetland's picture and then walked back towards his office, past the waiting room with the kid's toys in a giant toy box and a stack of magazines that he really needed to remember to update. "By the way, you'll never guess who just called and made an appointment."

"If you tell me it's Chris Potter, Sandy might have reason to worry about my health," Derek smiled at her, putting his bag down on his organized desk.

"He said you harassed him this morning at the coffee shop about his ticker and he's trying to figure out where young people like you get off on bossing him," Patty laughed. "But he made an appointment for tomorrow at five."

"I did harass him and I threatened to call his daughter, too," Derek shrugged. "Have we gotten the labs back on Mrs. Ramirez?"

"Not that I've seen so far this morning but that lab always puts us on the backburner. I'll call and harass them for you."

"Thanks," Derek sighed. "If her cancer is back, I want to know as soon as possible so I can get in touch with her oncologist. She hates him but I'm not sure what else we can do."

"Well, all we can do is hope it isn't back," Patty nodded as she sat down in the chair in front of his desk. "You have three appointments this morning, including a new family just moved here from the city. Twin four year old girls."

"That should be fun," he nodded before sitting down himself and reaching for some mail that was sitting on the edge of his desk.

"Then you have camp from one to four. Rob wants to know if he can come see you after that, I told him that shouldn't be a problem," Patty recited. "That leg of his is bothering him again."

"Because he won't let it heal."

"Well, you can tell him that all day until you're blue in the face," Patty laughed. "And…well…don't kill the messenger."

"Kill the messenger?" Derek looked up at her.

"Do you remember how about two months ago, I received an invitation from Mount Sinai in the city for a symposium on pediatrics and rural medicine and you told me you'd think about it?"

"I…vaguely…" Derek admitted because it really had slipped his mind. Small things did sometimes, especially when they really didn't have a place in his life.

"Which means you've completely forgotten," Patty shook her head. "Well, Mount Sinai in the city is having a symposium on pediatrics and rural medicine and you've gotten yourself an invitation for the fourth year in the row. Dave always went but you usually throw the invitation away."

"And I didn't this time?"

"No, sir, you did not. You told me you'd think about it and lo and behold, the thing's a month away and you need to give me an answer so I can let them know."

"I…a month away,' Derek breathed as he glanced at the picture on his desk of his huge family. Mom and Dad had wanted to come to see him because he never went to see them. He tried his best now to get there for Thanksgiving and Christmas, but sometimes that was too hard. Sometimes just the thought of being there made his breath come in short gasps as he contemplated what it would mean to let go of his routine.

"Now, I think you should go," Patty said firmly. "Dave always went and it helped us more than hurt. With all these families moving to town, I don't see how it could be a bad thing for you to go. And I know Dave never bothered you about it and I never could figure out why but he's been gone now for three years and I think it's time the rest of the world started thinking of this practice as yours."

"Oh," he looked up at her as he nodded slowly. "How long is it?"

"A week."

"A week?" Derek frowned as he clenched his fists against the swell of panic. "Patty, who can take over while I'm gone for a week? The town…"

"Will be fine for one week if their doctor goes to New York, learns a bit, and sees his family," she finished for him. "We'll ask Russell to come in again. Then the whole town will magically not need any medical help for a week and I'll get a break, too."

"Because they hate Russell and say he has no bedside manner?"

"No one is wrong about that and you know it," she shrugged and then crossed her arms as she looked at him. "So are you going?"

"I…" Derek took a deep breath and ran his fingers through his hair. His parents were getting older, his dad's body would probably start to give up on the long drives one day, and it had been a long time since he had gone home. He could spend a week with them and see the nieces and nephews and his sisters. He could go out for a drink with Mark and try to act like it was no big deal. If he did that, his parents might not worry so much. "Okay. Tell them I'm coming. And I'll stay with my parents."

"Well, will you look at that? It's a miracle," Patty smiled widely.

"I'll call Russell and ask him to check in on Monday and Friday of that week," Derek nodded, choosing to ignore her comment. "But I want to see as many patients as possible before I leave."

"That's a given," she nodded.

"Anything else?" He sighed.

That's it," Patty smiled. "I'll just get everything ready for the day. Meg should be here any minute."

"Thanks, Patty."

"Of course," she shrugged and then paused by the door of the office. "Derek?"

"Yeah?" He sighed as he looked up at her.

"Your parents are going to be thrilled when you make that phone call," she pointed out. "Don't back out on them."

"I…I won't, Patty," he shook his head quickly before his nurse walked out of the room and closed the door behind her. His chest was a little tight but it was going to be okay. He was gong to visit his family in New York, he was going to spend a full week with them and that could only be a good thing. He would have to come up with a new way to keep to his routine but that was fine. He just needed to relax his clenched fists and breathe and just remember that everything would be okay. No matter what happened while he was back home, no matter how out of sync everything felt, he could find his way back to Oakbrook Falls and to his routine. Everything would be okay.

And you sit there in the rubble,

Till the rubble feels like home

That's how you learn to live alone