It was a wasteland. How formidable, to see what used to be home, and know it's what was meant to happen. April Kepner, standing before the ranch house her father and mother had died in. Trembling with the phone in her hand she knows she made the right call for when weighing out the life of her parents to that of the tiny humans it's easy to see which one fits.

Arizona rocks silently nearby as she hugs her legs to her chest and sobs.

The smoke billows and ash flows like snow in the wind.

"Let's go." Gruffs Kepner, "We're still playing the game."

How they need each other. How, in this story, the cosmic balance keeps them sane.

The two of them shuffle grudgingly towards the van, step inside, and pull the doors shut. The voice starts up on the radio, "Congratulations Dr. Kepner, Dr. Robbins. Put the car in gear and head south down the highway until I give you further instructions."

Kepner obeys. What else can you do when Jigsaw demands something. So many lives are at steak and these two have been selected for the game of a lifetime.

With a gash on her brow, a busted lip and a black and blue arm, Kepner sighs to pull herself together. It's going to be a long night.

Miles away, below the streets of storm ridden Seattle, through rusted pipes that leak onto moss covered walls, into the grates of drain pipes, past rats feasting on creatures much larger than them, out into a wide round room we find a man dangling from the ceiling. Fair warning dear friends, I am not Shanda Rhymes. I'm someone much more terrifying. If you hated her for Derek you're going to hate me for Karev.

Season 11- season 12- rough estimate as to where we are at in her story but keep in mind the story is mine. So I have my own terms.

Terms like this one. Where metal cuts sores into his wrists and his eyes droop with chloroform sleep. In and out in a haze he thinks of her, of Jo. Her eyes, the way she smirks at him when she's disappointed, how annoying she can be. When at last he pulls himself out into consciousness his first thought is, 'Why is she not with me?'

Those eyes of his find a grate, one covering a window, a dingy plastic tarp crumpling between the two. If they're underground what's behind that window? Panning over he finds an analogue clock he figures is dead because all three of the hands stay on the 12 unmoving.

He's naked apart from his red and white checkered boxers and sweat drips down his abdomen. Those plump, solid, hairy pecks shiver with every breath. Mouth parts he screams, "Hello!" of course who's he speaking to? "HELLO!" why would anyone call out when in this situation? "HELLO? Is anyone out there!" It's like broadcasting that your ready for death.

I suppose it's the drive for progress in a surgeon. That which makes them so eager for communication. Steady hands, steady mind, aware of all the options. Nothing is... steady here... in fact it's sturdily uncomfortable.

As he pulls against his restraints they rattle. The dark silver glint of the room lacks an OR's gleam. The swaying yellow lights are stained and he doesn't even realize that he's bleeding from the neck. The neck, where in lies, behind two flaps of skin, so roughly stitched together, a key. The door swings open and in limps an older gentleman.

This gentleman is refined. Salty pepper hair, missing an eye, hard pointy chin, and the frame of someone familiar. If Karev wasn't still in a haze from the drugs he might have been able to point out who this man was. You and I know, but he only sees shadows.

He holds out a silver box in his hands, "You recognize this?" a gruff voice the stranger has.

"Fuck you!" Karev cries, "What do you want!"

The older gentleman only shakes his head, presses a button, and drops a casset between the teeth in the box that just opened. A zipping noise echoes throughout the chamber and another button goes in with a click.

"Hello Alex." Says a deep snarl, "I want to play a game. The man before you is one you know. He is playing his own game but I assure you he is not the enemy. In fact you are a bit of importance to him. Your survival might just save his life."

Alex grips the chains and attempts to pull himself up with a nasty groan.

"You're responsible for the death of a little boy. Anthony Jacobs, as the surgeon on his case it was your responsibility to keep him alive. Your love live cost you greatly. To check the scans would have been no issue but you wanted to prove a point. Today you're to be put to the test. If you die today it will not only be you who slips to the other side but the residents, interns, and attendings who helped you kill that boy. When Dr. Sloan crosses behind you to pull the lever the indent in the floor will open and you'll have sixty seconds to retrieve the key I've so sloppily stapled into your neck and unchain yourself before you're lowered into the gears which will eat you like a wood-chipper. Be careful. Those chains are woven that tightly you might slip in anyway. Live or Die Dr. Karev, it's up to you." There's static and the tape dies.

Alex pulls against the restraints, "It was an accident! I didn't mean to!" voice dropping to a whimper and thrashing sease, "I never meant to kill him."

His eyes find the gentleman before him still standing in the shadows, "Step into the light."

Mark Sloan limps into view.

Alex starts to laugh, "Holy fuck. I'm in Hell. This is God's way of punishing me for the life I lived."

"Shut the fuck up." Sneers Sloan, "This isn't Hell. It's the abandoned underground water plant. You're not dead. Someone's angry and that someone, at this moment has a lot of power. Now either we play or I move on without you."

Alex scratches his face on the underside of his forearm, "Who the fuck brought you back to life?"

"I was never dead." He chuckles and walks around him, "Get ready... the games about to begin."

"Wait!" Calls out Karev, "Can't you rip the key out of my neck and hand it to me? I can't reach it."

Mark looks down at the circle that makes up the middle of the room. A step down from the rest of the floor with a divide down the middle. What's to keep it from falling in? What's to keep the old machinery from switching on and eating him? What's the chances of Karev's survival if he doesn't?

With a deep breath he makes the first move towards Karev. A squeak reveals that the trap doors are metal. He slowly limps across the room knowing he's running out of time. The screen on his wrist watch shows the timer is now at 45 minutes. Is Karev even worth it? A weird feeling waves over him as he examine's the victim at hand. Something about Alex in a submissive position after fighting so hard against him for the love of a girl neither of them got to keep really digs in his groin.

At last he reaches Karev, "I've become.. a bit of a wild kind of guy over the last few years." he admits, "Done a lot of weird stuff, found a lot I liked, a lot I didn't like, and yet still so much curiosity devours me."

"What's your point?" Spits Alex, "I'm dangling over a meat grinder here."

Mark thinks. Then says, "I'll help you... if you let me stick my tongue in your mouth."

Eyes widen in confusion, "What the fuck?"

Mark shrugs. Turns and starts to walk away.

"Wait." Says Karev. Hesitates. Then with a hateful snarl says, "Okay."

Thick lips. Prod slimy, and wet. Rough stubbles. Hot breath. For a second Alex even begins to fuck back with his own pink plump muscle. The smell of musk and boy odor wafts in his nose and he pulls away in discontent, "Rip this shit out of my fucking neck will you?" He growls.

Sloan nods and the next thing Alex knows two large chalice fingers are digging into flesh. His animal roar only excites Sloan. Only he's forced to pull away when an electric shock hit's his wrist from the watch, "I can't touch it." He sighs as he pulls back.

"You piece of shit." Whimpers Alex, "How the fuck am I supposed to do this?"

Mark's eyes search the room. There has to be something. Otherwise it wouldn't be a fair game. Who ever's running this must want to see more right. No sense in ending such a good story now. Then he sees it, swaying between Alex's hands. A metal pic, curved at the tip, long enough to reach the neck but not unless it's the handle is in Karev's hands. Connected in the spirals above to ensure it wont fall.

"Look up." Says Sloan.

Alex's eyes find the tool. He lets out an anxious animal noise and looks at the doctor before him, "I hope to God it's magnetic."

"Probably wont loosen until I pull the Lever." He nods, "Alright. We're going to do this. You're going to survive. When you do I'll let you punch me in the face since you let me kiss you."

Alex's rage centers in the redness of his face and he narrows his vision now determined to sock Mark in the jaw, "Let's play the fucking game."

Mark walks to the back of the room, eyes on time, "Three... Two... One." A sturdy grip and a full body weight tug pulls the lips of the door apart and when the lever locks in a socket the gears start to scream. The analogue clock on the wall's red hand starts to move and the chain holding the pic releases allowing Karev's hand to grip around the handle.

Alex fights the urge to make howling noises as he injects the tip into his own flesh and begins to work open the metal studs holding it in place. In blinding pain he pushes it in futher and feels the clink against the metal and yes, it is magnetic. All the while the spirals above inch him closer to the metal screeching teeth. With a quick, smooth, pull he slips rusted metal out from his wound and moves both hands along the shaft of the pic to bring the tip closer to his fingers, only ten seconds remain!

He grabs the key, 8. He locks in on his left wrist, 7. He braces both chains with his left hand, 6. He finds the hole, 5. Quick twist, pop of, jolt, he's still suspended, 4. A shift in his legs to throw his body weight, 3. He sways back and comes off, 2. He rolls across the concrete floor, 1. The chains are being swallowed by the gears and he's bleeding from the neck while laying in the red hot puddle.

Dr. Sloan limps over to him, throws a leg over to straddle his lap, and pulls a small white kit from the pocket in his coat. Popping it open he pulls out a needle and some thread, "I got to be sparing with this stuff." he tells the dying man, "They only gave me so much." Then leans in to fix the stitch job gushing through his fingers making them slippery. Quick work pulls skin and skin together and then, from his pocket, he unravels enough gauze to wrap around the neck twice.

Stuffing the materials back into his coat he's sent backwards by the sheer force of Karev's knuckles against his face. Impactful swing, and unsuspecting timing caused the flesh around a cheek bone to swell up black immediately.

"Damn kid." Groans Sloan.

Karev stands, "You ever bring that filthy mouth near me again, I'll cut your fucking balls off."