Arizona is just leaving the OR when she runs into Maggie Pierce.
"Dr Robbins, I was just looking for you," Maggie says with a smile.
"Can you walk with me? I have a patient in pre-op that I need to check on," Arizona says untying her mask and gown and stuffing them into the bin.
"Oh, yes but it's about a consult so maybe I should wait and we can talk later," Maggie suggests.
"Just send me the case notes and I'll review them this afternoon," Arizona offers, sounding tired and a little distracted. She stops just outside the door before taking a deep breath and barreling through it.
Maggie pauses outside the door and listens as the surgeon transforms from exhausted to exhilarated and positive. She smiles appreciatively knowing what it takes to do that for patients.
Continuing down the hall she runs into her sister.
"Hey, Meredith I can't take the kids tonight, I have a new peds case," Maggie informs her.
"Okay, well that's fine. I was planning to get off on time tonight. Thanks for your help this week though," Meredith replies.
"Happy to be part of the village," Maggie quips before giving her a quick hug and heading back to her office.
Arizona groans, she was trying to focus on the consult from Pierce, but Alex has been texting her for the last half hour bitching about the clinic supervisor. She stopped responding ten minutes ago after DeLuca dropped off her salad, but now her phone is buzzing again. Setting her fork down, she touches the phone to check to read the message and is surprised to see that it is a message from Callie, opening it, she is greeted by a photo of her daughter. Smiling brightly, she saves the photo as her new screensaver, contemplating calling to thank her ex, but is interrupted by a knock at the door.
"Come in," she calls over her shoulder.
"I'm sorry to interrupt, but have you had a chance to review that case yet?" Maggie asks stepping into the office.
"I'm reading it right now," Arizona replies motioning for the other surgeon to sit down.
"Is that lunch or dinner?" Maggie teases noting that it's almost 4 pm.
"Time will tell," Arizona quips back with a soft smile and a flash of dimples. Then turning back to the case file, she remarks, "So the mother has Hypertrophic Cardiomyopathy."
"Yes, and since HCM is genetic, I wanted you to evaluate the fetus for any signs of it," Maggie explains.
"Hmm, did she do any genetic testing before the pregnancy?" Arizona questions.
"No, and she wasn't aware of the HCM prior to her pregnancy. And before you ask, this is her first child, so no siblings to test," Maggie answers.
"Well, you've certainly done your research," Arizona murmurs as she continues to review the case. "Let's schedule a 3D ultrasound for the baby as soon as possible."
"Finish eating and I'll get everything set up, is it okay if I sit in on the ultrasound?" Maggie asks.
"Of course, you should. If we are lucky, we'll get to see what HCM looks like as it's forming in-vitro," Arizona points out.
"Uh, have you seen it before?" Maggie inquires curiously.
"Not yet," Arizona says taking another bite of her salad.
Maggie marvels at the calm fetal specialist. "Sorry, it's just that you seem really calm about this. I would be researching like crazy if I was faced with a diagnosis that I wasn't familiar with," she says uncritically.
"Dr Pierce, fetal medicine is relatively new. But I learned from the best and just because I haven't seen it before, doesn't mean I can't fix it," the blonde informs her confidently.
"I get that, but you, you're new to fetal medicine how can you be so confident?" Maggie blurts out.
"Dr Pierce, I know that we haven't really worked together before, but you need to trust that I know what I'm doing," Arizona pushes back, just a bit annoyed. "I didn't get triple board certified by accident, I've worked very hard to get where I am."
"Oh no, Dr Robbins. I am not questioning your skill or training," Maggie says hoping to lighten things up. "It's impressive. You are impressive," she adds seriously before standing up to leave.
Arizona frowns, she may have overreacted and now she wonders if she should apologize.
Worried about getting off on the wrong foot, "I'll just go set up and I'll meet you in the patient's room," Maggie mutters before leaving quickly.
The elevator opens and Amelia steps in and eyes Maggie curiously.
"How's your day going?" She asks before punching the button for her floor.
"It's good, long. But good. I have a consult with Robbins, my patient has a congenital heart defect and she's in her second trimester," Maggie explains.
"Oh, so you might be spending some quality time with Dr McDimples," Amelia teases.
"Dr McDimples? I've not heard anyone call her that," Maggie retorts uncomfortable.
"Oh, well ask Meredith about it some time, it was her intern class that named the attending, Derek was Dr McDreamy, Mark Sloan was Dr McSteamy and I'm not sure when or why, but Robbins earned Dr McDimples at some point," Amelia replies her blue eyes twinkling at the memory.
"Well she does have amazing dimples, so I can understand it," Maggie says reluctantly.
"Oh this is going to be fun," Amelia quips rubbing her hands together as the elevator doors open. "Have a good night and don't do anything I wouldn't do," she adds as the doors close.
Rolling her eyes, Maggie blushes slightly, thankful that the doors are closing and no one heard that remark.
"Michelle and Jon, this is Dr Robbins. She is the fetal medicine specialist here at Sloan-Grey," Maggie says introducing the blonde surgeon.
Arizona steps forward and shakes both of their hands. "I'm sure that Dr Pierce has explained why I am here, but I'd just like to remind you HCM is typically diagnosed by genetic testing, it's not real common to diagnose it in vitro, but it can be done. Since you are at 20 weeks and the heart is the first organ to develop, we may be able to determine if the fetus has HCM today," Arizona explains carefully and confidently. "Now we're going to do a 3D ultrasound to get a good look, if you don't want to know the gender of the baby, you might want to turn away," she adds with a grin that causes both parents to exchange nervous looks.
"We've agreed to wait until birth," Jon says nervously, looking over at Michelle for confirmation.
"Okay, then I'll just turn the screen away from you both," Arizona replies flashing another smile at them.
Maggie stands right behind her, wanting to see everything and the blonde gives her a curious look before turning the machine on and preparing to begin.
The blonde surgeon chatters along mentioning key development benchmarks as she sees them. Pausing carefully to record screenshots, but never long enough to alarm the two nervous parents. After a few moment, she puts the wand down and steps up to face them both.
"The next part of the exam is going to be me closely examining your baby. I need to focus, so I won't talk as much, but that doesn't mean that anything is wrong, it just means that I am gathering all the information that I can to make an accurate diagnosis. Just do me a favor and relax as much as you can, okay?" Arizona states confidently, waiting for each to acknowledge her question with a nod.
"Um, if you have any questions for me, I'd be happy to answer them while Dr Robbins is finishing up," Maggie says moving around to stand in front of the screen.
"You mentioned that Michelle might need surgery to repair her heart, is that the same procedure that the baby would need? Would you do them at the same time?" Jon asks.
"Right now, Michelle doesn't need surgery and we don't know if the baby has inherited the defect, so let's not get ahead of ourselves," Maggie replies stealing a glance at the blonde for reassurance.
"In vitro cardiac thoracic surgery occurs infrequently, most cases can wait until the baby is born to correct the defect," Arizona pipes up, still staring intently at the screen.
"But it's possible or you wouldn't be here," Michelle points out.
"It is possible, but not likely," Arizona counters. "And not all surgical consults result in surgery," she adds looking up from the screen to reassure the couple.
"How often do you consult and not operate?" Jon asks suddenly.
Arizona looks down, she was hoping that they wouldn't ask that question. "Slightly less than 60 percent of my cases are surgical," she replies setting the wand down.
"Six out of ten end up having surgery," Michelle repeats.
"Yes, but that isn't reflective of your case, many of those cases are not genetic defects," she adds to reassure them. "Now, I need to go review my findings and I need the both of you to promise me that you're not going to get worked up over this. I am one of the best Fetal surgeons in the country and I learned fetal medicine from the best, so you're in good hands here at Sloan-Grey," Arizona says confidently as the tech disconnects the machine and wheels it away.
"We'll be back in an hour or so," Maggie adds. "I'll send the nurse in to check on you in twenty minutes," she says before following the blonde out of the room.
"That was so intense," Maggie exclaims falling back against the wall, before seeing the worried look on the blonde's face.
"It's only going to get worse," Arizona replies with a sigh, before heading into the consult room to review the scans.
Maggie follows her inside. "You were so confident in there. You said that she wouldn't need surgery," she questions.
"Not exactly, I said that not all surgical consults result in surgery," Arizona points out.
"Back up. What did you find?" Maggie asks leaning against the desk and watching the blonde put the scan up on the large screen.
Grabbing the pointer, Arizona traces the 3D image of the heart, "This is the right side of the heart."
"It looks normal," Maggie notes.
"This is the left side," Arizona says putting up another scan beside the first one.
"Oh god," Maggie gasps. "It's enlarged," she exclaims.
"Yes, because it's been overcompensating for the smaller right side," Arizona informs her.
"Wait, the right side isn't underdeveloped," Maggie argues.
"It's fully developed but it's undersized," Arizona corrects her.
"I don't understand, she's at twenty weeks, according to the development chart..." Maggie begins to counter argue.
"She's not at twenty weeks, she's at twenty-four weeks," Arizona interrupts. "So now you see the problem?"
The Cardio Chief pauses and continues to focus on the scans. She has a few ideas, but fetal cardiology isn't her specialty. "Okay I see it, but what is it, it doesn't look like HCM," Maggie says finally.
"It's not HCM, which is good. And right now since the both sides of the heart share the ductus arteriosus, it is possible that in a few weeks, this will even out and by the time the baby is born, it won't be an issue," Arizona explains.
"Oh my god, you had me so worried," Maggie says relieved, smiling she turns to look at the blonde who is still frowning. "Wait, you don't think that's what is going to happen do you?" She asks.
"No, I don't. I think that this is going to get worse and the ductus arteriosus is going to rupture," Arizona replies dropping her head into her hands.
"What are the options?" Maggie asks pulling out the chair beside the blonde and sitting down.
"I'm not sure. I need to run a few more tests," she says softly. "Would you mind just giving me a few minutes?"
"Uh sure, I can do that. Do you want me to talk to them?" Maggie asks, although she really isn't sure what to say.
"I'll talk to them, I just can't do it right now. I need to go over this again, maybe I'm wrong," the blonde says hopefully.
"I have a feeling that you are wrong about as often as I am," Maggie says dropping a hand on her shoulder before turning to leave.
"Dr Pierce, I just checked on Mr and Mrs Elliot, why didn't you tell me about the consult?" Edwards asks, she hasn't been the lead cardio resident for long, but still she should be kept apprised of all consults.
"How did it go with Riggs today?" Maggie asks instead of answering her question.
"It went fine. The transplant team is just finishing up, I appreciate getting to assist on that, but I did a Maternal medicine rotation, I'd like to follow this case," Edwards presses.
"Okay, well if you want to follow the case, then we'll be meeting with the parents to review Dr Robbins findings, I'll page you," Maggie says pulling her own phone out to read the incoming message.
"Where's Robbins now? Can I at least look at the scans before we go in?" Edwards questions eagerly.
"She's in there, but don't bother her. She's working on the diagnosis," Pierce cautions.
Edwards knows Robbins pretty well, and knows how to work with her. Disregarding Pierce's concern, the resident turns slips into the consult room, closing the door quietly behind her.
Robbins looks up, surprised to see Edwards, but then remembering that she's assigned to Cardio now.
"I just wanted to get caught up on the Elliot case," Edwards says pausing to look over the screen closely.
Arizona doesn't reply, she just keeps looking through the scans.
Stephanie turns around and stands behind her curious about the diagnosis, but knowing enough not to ask questions yet.
"You're hovering," Arizona huffs turning her head slightly to catch the intern's eye.
"Sorry, I was just wanting to see the scans, I haven't seen a case like this before," Edwards says eying the screen.
"Neither have I," Arizona admits with another frown.
"Oh," Edwards mutters to herself.
"Do me a favor and head to the library and pull these two case files from the Johns Hopkins database, email them to me and print them out. We're going to need to do some comparison research before we can put a surgical plan together," Robbins says writing out the information quickly and handing it to the resident. "Don't hand this off to an intern, I need you to do it, so it's done correctly," she adds firmly.
"Yes Dr Robbins, I'll do it myself," Edwards replies taking the paper and heading out the door.
On her way to the library she runs into Murphy.
"Hey, my girlfriend's flight just landed and we're going to Joe's later, come by and meet her?" Murphy asks hopefully.
"Maybe, I just got an interesting case with Pierce and Robbins," Edwards answers.
"Fetal cardiothoracic?" Murphy asks suddenly quite interested.
"Back off, it's bad enough that I lost my spot in neuro to Blake and then you took it before I could get it back, no way that you're getting in on this, besides rumor has it that you're banned from Robbins' service," Edwards snaps before slipping into the library to get away from her.