A/N: Usual disclaimers. I am not a medical professional. All my info for this story has come from the show or the internet. Sorry to be late again, but this one is extra long so hopefully it makes up for it a little. For the purposes of this story, which does parallel season 8 somewhat, I have elected not to use the cheating plot line in reference to Owen and Cristina. The end of this chapter is sad. There are moments of levity, but fair warning. Anyway, here is Chapter 12. I hope you like it, and I really appreciate hearing your thoughts. Next week, look for Chapter 13 which will include the 5th year boards! As always thank you for reading, from the bottom of my heart.


Alex sat slouched in April's office, haphazardly adding the finishing touches to his fellowship application. It was due by the end of the week, and both April and Meredith had been after him to get it finished on time. Boards and fellowship interviews were rapidly approaching and Alex knew he needed to turn in the best application possible. He wanted to stay at Seattle Grace Mercy West. Though the hospital had declined a little bit in terms of ranking over the years of his residency, it was still a great place for a career. And Robbins liked him. And he liked Seattle, now more than ever. He had a reason to want to stay in Seattle now too. April, who was also applying to Seattle Grace.

And of course, she had already finished her attending fellowship application, as had Meredith. And even freakin' Avery, apparently. But Alex was close to being done. And it wasn't like he was wasting time, jerking around. He was looking into cutting edge cancer stuff. For Marcello. Not that he'd found much. Nor did the family seem very interested in trying experimental stuff. Which he kind of understood, but Alex still didn't want to give up. Marcello had been getting worse and worse. He and his family had made the decision to move him to hospice care if he stabilized enough for transport. Cancer sucks.

Cristina sat at April's desk, quietly snacking on a box of raisins, pouring over her own fellowship paperwork. Recrossing his leg, Alex eyed his friend closely and raised his eyebrows. She hadn't finished her application either, and so was spending her lunch hour in much the same position as him. He never thought she'd be one to put things off, though he did know that things in Cristina's personal life weren't great. Not that he'd been able to figure out a way to talk to her about it. Some friend he was.

It was just weird. Alex was never really good at talking about that kind of crap with his friends before his whole relationship with April. But now he wanted to, because she was his friend and... Especially since Cristina had been acting more and more closed off. Even to Meredith. Cristina had been there for him before and Alex wanted to be there for her now. He just needed to figure out a way to get things going.

"Cristina?" Alex ventured.

"What?" she snapped. Before Alex could reply they were interrupted by the sounds of people coming down the hallway.

Alex and Cristina both looked up from their applications as the door to April's office flung open and Jackson practically zipped into the room and sat down next to Alex on the far side of the couch. He crouched down and peered through the blinds of the office window.

Cristina made eye contact with Alex as he smirked and they both shook their heads.

The door opened again, much less abruptly and April casually limped in, with the aid of her recently acquired cane, gripped her left hand. She'd been using it almost daily for the past two weeks, save for two especially rainy days, and she seemed a lot more comfortable with it than she had ever been with her crutch. She still had aches and pains of course, but somehow the cane seemed less of a 'thing' for her compared to before. April told him it felt less visible than a crutch. And somehow that made a huge difference.

Heading over to her desk with a faint smile on her lips, April didn't look at Jackson. Instead she leaned over Cristina and opened her snack drawer, pulling out a bag of trail mix. As she moved to sit on the couch next to Alex, she calmly teased, "Jackson, you can't hide from your mother forever."

"I can try!" Avery replied, still crouching down and peering through the blinds. Alex saw Cristina roll her eyes. "She's trying to set me up with this junior urologist."

"Or she is trying to show one of her most promising residents a hospital with potential urology fellowship opportunities."

"My mother? The meddler? Yeah, right. You are such a groupie."

"Okay, well, even if she is trying to set you up, maybe Dr. Keaton is nice. And it's not like she asked your mom to do it. You might have a good time. It's just showing her around. And your mother is a great mentor, no matter what you say."

"Yeah, yeah," Jackson moaned.

As the two friends bickered, April rolled her eyes and grabbed a handful of trail mix. She carefully sorted the contents in the palm of her hand, peanuts with peanuts. Almonds with almonds. Raisins with raisins. M&M's with M&M's. Each taking up their own small corner of April's palm. Freakin' weird, but Alex had learned that April did a lot of little things that he thought were odd; like occasionally eating pizza slices crust first, or shopping in a particular planned way.

She said that it was a way of saving the best for last. Her favorite part of pizza wasn't the crust, and she would rather shop for baking supplies than cleaning ones. But she'd always get the cleaning stuff first. And April's favorite part of trail mix was actually the M&M's. But she'd eat them last, and she said that she'd done the sorting since childhood. Alex didn't really get the whole delayed gratification thing. In food or in life.

The logic seemed flawed. If he was going to bother with sorting the crap (which was highly unlikely), he would damn well go for the parts he liked best first . Maybe it was because of his childhood in foster care, but Alex saw no guarantee that what you'd saved for last would still be there if you waited, and no guarantee that you'd still want it even if it was still there. For food or life. But it was just one of those things he didn't get about April, and no longer felt annoyed by.

If April wanted to wait to eat her freakin' M&M's, let her wait to eat them. And reach over and snag a few snacks yourself. Alex did, swiping couple of raisins from her open palm.

"Hey!" she said leaning back and playfully covering her palm with her other hand.

Tossing the swiped raisins into his mouth and chewing loudly, Alex leaned forward and made a face at her.

"You can't share?" he teased.

"You can't ask?"

"Damn it!" Jackson gasped and pulled a flowery pillow from behind his back on the couch. He lowered his shoulders even more and held the soft object in front of his face.

"Lame hiding spot, dude," Alex mumbled as he filled out more of his application. The door opened again, and a confident Catherine Avery glided in, followed by a younger doctor chick.

Jackson groaned and lowered the pillow, his lips forming into a tight lipped smile, "Hey Mom."

"Hey baby," The senior Dr. Avery said, smiling broadly. "I know you've been trying to avoid me."

"I haven't been-"Jackon lied.

"That's okay, Jackson," Catherine said rolling her eyes. "I wasn't looking for you anyway. I needed to find this one here. Let me see you!" She held out her hands toward April and wiggled her fingers. "Girl! I'm so happy to see you looking so well!"

Alex was vaguely disturbed by the way that the senior Dr. Avery's eyes drifted to him, and up and down his body, as she said those last words. Like she meant, 'so well' in broader terms than April's recovery. Like she knew they'd...surely not.

Then again, April and Jackson's mom were apparently 'facebook friends'. And as soon as they'd agreed to try this whole 'relationship thing', they'd also ended up doing the whole 'is in a relationship with' thing on the site. So, at the very least, Catherine Avery probably knew about the fact that they were dating. The rest was easily inferred. Alex wasn't really a big facebook user himself, but Amber had been after him lately to use it. April used it to keep in touch with her family and friends back in Ohio.

When she'd updated her status to 'in a relationship with Alex Karev', it had made quite the stir. A flurry of people 'liked' it or whatever. Which felt a little weird, but he guessed that's just how social media worked. He figured it was better to be 'liked'.

Then Alex had gotten messages from two of April's sisters within minutes and a friend request from the third. Which proved to him that Kepner women were all a little crazy, not just April. The message from Kimmie had been polite and kind enough, expressing a hope that they might meet sometime in the future, if he ever came back to Ohio with April. Libby, the oldest sister if he wasn't getting it confused, had sent him a message with a very different 'don't mess with my sister or you'll have hell to pay' kind of tone.

Alice had just straight up requested to be friends with the simple message: "You're pretty much the first boyfriend my sister's ever told us about, and I am really excited for her, so I'm gonna keep facebook tabs on you. Fact, this is. Less creepy to facebook stalk if we're friends, but it'll happen either way. Also, I post many funny memes, so there is something in it for you if you accept."

Alex laughed out loud when he'd read the message on his phone and had accepted her request right then and there. At least she was honest. And it wasn't like he posted much to the facebook that much anyway. What would Alice see? So, now Alex was facebook friends with someone in April's family. Which made him feel good.

Which was weird. Because it was just the internet. Whatever. And Alice did post some funny shit.

April stood up and Dr. Avery pulled her into a tight embrace. "Honey, Jackson told me everything that happened, with the earthquake and everything. I was very worried about you. But look at you now, just persevering. Dr. Hunt told me you are almost caught up on your surgical hours already. So proud."

April's smiling face was barely visible over Catherine Avery's shoulders. She stammered, "I-I don't know what to say. Thank you."

When they pulled apart Dr. Avery gestured to her companion and said, "This is Dr. Mara Keaton, one of my best 5th year residents. This is Dr. April Kepner, Dr. Cristina Yang, and Dr. Alex Karev. And of course my son, Jackson. Some of the finest Seattle Grace Mercy West has to offer. Even if one of them insists on specializing in plastics."

Jackson rolled his eyes fondly at his mother, and rose from the couch, shaking the dark haired woman's hand. Alex and Cristina both murmured greetings and April grinned.

"Pleased to meet you all," Dr. Keaton added, in a faintly british accent. "Seattle Grace certainly seems like an interesting place to work." Her eyes settled briefly on Jackson and then darted to the floor. Uh, huh. Alex smirked. Suck it up, Avery. She thinks you're hot.

Turning back to April, Catharine asked, "Honey, do you have time to get lunch? I have a bladder transplant at 4:15, but I'd love to catch up."

Alex cleared his throat as he felt her eyes drift to him again. Catch up. Catch up. Old Doc Avery was certainly going to talk with his girlfriend about more than her leg injury. For crying out loud. People acted like their relationship was this totally out of left field thing. And maybe it was. Whatever. Stranger crap had happened right?

April seemed oblivious and replied, "Absolutely! Of course. I've actually been working since last night, so my shift is over. So...yes! I'd love that. We could get lunch now, um, i-if you have the time."

"Oh, of course! ABSOLUTELY! If you have time? I do hope you have the time," Avery mocked in a high pitched voice.

April rolled her eyes, "Shut up, Jackson!"

"Groupie," Jackson murmured glancing to Alex. He could only chuckle and give the other resident a small nod. April scrunched up her nose and squinted at them. She couldn't deny it though. She totally did have a tendency to idolize authority figures and act all over eager in front of them.

Catherine Avery seemed pleased with the plan and she somehow convinced Jackson to give Dr. Keaton a tour of Seattle Grace while she ate with April. Alex didn't get why Avery bitched and moaned so much. Keaton was hot. And british. Seriously, who cared if your mom introduced you? Avery needed to lighten up. Why complain over getting to spend the afternoon with a hot chick?

If Alex was single...well Mara wouldn't have really been his type. And it was hard to imagine being single again. Because he now realized that most of his recent single life, Alex had spent being miserable. Miserable. And he worried that Cristina, one of his best friends was miserable now.

When the bickering group finally left, the room felt so much quieter. It was just Alex and Cristina again. Alone. Back to where they'd started. He sighed and looked up from the couch, watching his old friend carefully. Her pen was still and, although she was staring at her application on the desk, her gaze seemed to be miles away. Alex felt bad. He needed to do something for her.

"Counselling still isn't working out, is it?"

So maybe he didn't have much tact. But Alex had to start somewhere.

Cristina seemed less than thrilled about his segway into the conversation, "You're asking me about this now?"

"Well," Alex shrugged. "Yeah. I'm, uh, here for you or whatever. If you want to talk about it."

"It's none of your business. I don't want to talk about it."

"I know, I get it...I just-" He shrugged. "I know its a crap deal. And I know you haven't...Mer is worried. You're stressed. Boards are coming up...I am worried."

Cristina made eye contact with him after a long moment. She sighed put down her pen and leaned back in the desk chair.

"We're still in therapy. To answer your question. We're still in it, and we spend every session arguing over the same thing. Then we go to work and we act like there is nothing happening. And then we go home and we don't talk. Or we yell. It's a real party."

"That's lame," Alex said quietly. He stayed quiet and still, afraid that Cristina would bolt or lock down if he so much as moved. She stayed silent for a long time, and he was afraid that those few words would be all she was willing to share.

"And I can't see a way forward," Cristina concluded, her previously stoic expression cracking slightly, as the corners of her lips twitched. "Not with both of us being happy. I guess sometimes loving someone just isn't enough."

Alex sighed. Maybe she had a point, "I loved Izzie. I really loved her. It didn't seem to make a difference."

Cristina snorted, "Well, lover boy, you're one to talk. Things have turned around for you haven't they?"

It was true. Crazy but true. Usually out of their little friend group, Alex was the one whose personal life was full of the most crap. Lately things had turned around for him though, with April. Because he was happy, and he could see himself loving her. Maybe he already did. He was still cautious because of his past, but Alex could see it. Circumstances had turned around for Owen and Cristina too. But not in a good way.

With a humorless laugh, Cristina continued, "And I thought I knew him. I thought Owen knew me. I thought that he...he knew me, and he understood me, and loved me. Because I have never been anything but clear about who I am. What I care about. What I want in life."

Alex carefully set down his paperwork and ran his open palms down his legs. The root of the whole conflict between Owen and Cristina was her abortion. And he could see why Cristina had chosen to be so closed off from everyone. Especially Meredith. Because Mer had had a miscarriage, and spent a year trying to get pregnant again. Then, she'd worked hard to adopt Zola, and even that had almost not worked out. Her best friend had tried desperately to have a child, and nearly failed, while Cristina had had the chance to have one, but chosen not too. Their friendship was tight, but Alex understood why Cristina might have decided not to talk about it.

"And he expects me to change my mind. Grow up. Because everybody wants kids," she said, sneering and waving her fingers making air quotes. She seemed to be on a roll. Alex figured she needed to get some of it off her chest. "No, actually some grown up people don't wanna have babies. I don't. I've never been unclear about that have I? Not everyone wants to grow a friggin' baby. I'm not-I'm me. Surgery...I am a surgeon. A great cardiothoracic surgeon. I don't want to be a mother. That isn't me. I shouldn't have to change."

"No," Alex agreed.

He'd known for years about Cristina's desire not to become a parent. Alex understood it, and it made sense, and Yang had never pussyfooted around the issue. And he had to think that Owen must have known too. before they got married. But on the other side, he could understand a little bit of the thing from Hunt's perspective.

Sometimes you didn't realize you wanted something until you'd lost it. Or almost lost it. Alex understood that all too well. Maybe Owen didn't realize what he wanted until it was almost a reality.

"But, I guess...he shouldn't have to change either," Cristina continued, closing her eyes and shaking her head. "If what he really wants in life is to be a father. If he wants someone to pop out kids for him. I love him though. But I can't see a way forward."

Alex winced and scratched the side of his neck with one hand. He'd never been good at this emotional crap. He almost regretted pushing Cristina to open up. He didn't know what to say. Because Alex didn't really have any solutions. Most of the time life works out way different than you'd imagined. Different than you'd want it. A sucky but true fact of life. Look at Webber's wife and the alzheimer's. Robbins ending up co-parenting Sloan's kid. April and her leg...wait.

"Maybe...you'll both need to change. You both gotta..." Alex paused, gesturing vaguely as he searched for just the right words. "Re-frame how you picture your lives or something."

"I am not having baby to save my marriage," Cristina snapped angrily.

"I didn't say that! That's not what I meant..." Alex placated. "Hold on, just listen. Hear me out: Look at the Chief and Mrs. Webber. Ellis Grey, the alcohol, the work. All those years and all that crap it took for him to realize he wanted to be with her or whatever. And how does it end? She gets freakin' alzheimer's and can't remember who she is half the time, let alone that he picked her. Is that how either of them imagined spending their golden years? No. But Webber is making the best of it. He's not working as much anymore, he's spending what time he can with her."

Maybe he wasn't making that much sense, because Alex could tell Cristina was getting frustrated with him. She stood up and shoved her application roughly into a folder and made for the door. Damn it.

"Or Robbins," Alex tried again, "You think she pictured her life being forever connected to Mark Sloan? I don't know much about it, but probably not. She wasn't exactly his biggest fan before. But...she loves Callie, and she adores Sophia, and so she's going with it. She can be happy even if this is different than what she thought she'd get."

Cristina was flush with the couch now, reaching for the door handle, when Alex realized he needed to pull out his big gun, so to speak. The real way he'd come to some insight on this whole thing. At least, he thought it might help. Maybe it was crap.

He continued, "And April? You should have seen her when Torres told her about her leg. She never dreamed she'd have a knee replacement, or scars, or pins. I mean, just to maintain that stuff, April is gonna need more surgery periodically throughout her life. And it'll hurt. She knows that. Faces that. But when Torres first told her, she flipped out. She freaked because she thought she couldn't have the exact life she wanted. And she can't. In a lot of ways, she can't. I mean, it's never gonna be the same. April was never an athlete, but now she told me she misses jogging. Running. Stuff like that. The point is, her life's going to be different. And at first, she thought different would be bad. owen...he's freaking out because he thinks different is bad."

Alex paused, eying Cristina cautiously. She wouldn't look at him and she stood completely still. She hadn't pulled open the door though.

"But different doesn't have to be bad," he added, trying desperately to explain to Cristina how he thought she could approach a 'way forward with Owen'. "April sees that now. Because...all that crap with her leg? Huge part of the reason we got together. And we're different than what she thought she'd have, but it's not bad. We're happy. I think she is happy. And she still do stuff. Maybe she can't jog, but April can still walk. Hike in the park. And see stuff."

Alex realized he was rambling, but found that he was unable to help himself. Maybe it was a habit he picked up from April. Or something. Still, he wanted to explain to Cristina, "We walked in Magnussen last weekend. Saw some frogs, and a crane...When you don't go so fast, you actually see stuff you'd never have seen if you were running. Yeah, her leg makes life different. Different doesn't have to be bad! Doesn't have to be less. You gotta find ways that it can be good, better even. Find ways you can still do what you want. Owen just needs to see that this life, a life with you, can still be good. Different from the one he sees with kids, but still good. Maybe you could show him. Show him it can still be a great life."

Cristina still hadn't so much as twitched. She continued to stand frozen in place, with her hand on the door handle, starting with a furrowed brow at the poster on the back of the door in front of her. One of April's, with those 'motivational' quotes she liked so freakin' much. In bold white letters on top of an image of Gandhi; "Be the change you want to see". Alex leaned forward a little and watched his friend closely, wondering if he'd blown it all. Stupid emotional crap. Whatever. He'd tried. Years ago he wouldn't have even bothered.

Alex had just started to straighten his pile of application papers when Cristina slowly sat down next to him on the couch. She remained quiet until she finally whispered, "How? How can I show him that? He wants to be a father. He wants to have a child. A life with me means that can't happen. Which means different is bad."

That was a good question. The heart of the problem really. Alex blinked, "Um, maybe not. I think you gotta figure out why Owen wants to be a father. What that means to him. What's important about it or whatever..."

Cristina raised her eyebrows. Alex supposed it was probably a little hard for her to see. Hard to get into someone else's perspective, especially when she didn't even want kids at all herself.

Leaning back thoughtfully, Alex said, "Owen doesn't strike me as the kind of guy who is all about flesh and blood. Like 'I need progeny' type of crap. You popping out a kid. He'd have...he'd have loved your kid if you'd had it, but if you guys ever adopted too, I don't think I can see him loving that kid any differently. Right?"

"I don't see where you are going with this."

"So, he's not about having a kid to sow his seed," Alex had seen those kind of Dads in peds before. They were often the kind of absentee types, who'd have a really hard time dealing when their kid was sick or not perfect. Because the kid was in a way an extension of their own ego. He didn't know Owen well, but Alex didn't think Hunt was like that.

"And if he's not that kind of guy, then...I think what Owen really wants is to love a kid. Teach 'em stuff about life and crap. Whatever. About being a good person and all that. It's about making a difference in a kid's life. I think that is being a Dad to him."

"That's what he feels like he'll lose," Cristina murmured. "If our life is different."

"But," Alex said holding up a hand. "That doesn't exactly have to be true. You can love a kid, teach a kid; make a difference in their life without being their parent. Owen could still find that-have that, in a life with you."

He thought of his own childhood. Alex had had a few teachers and coaches that made him think he could make it. People who weren't his parents, but who cared for him. Who made him think he could escape Iowa. Finish college. And Med School. Become a doctor. A surgeon even. If he'd had more encouragement like that, more people like that, maybe he wouldn't have had to spent so much time in his life being a total ass.

"Think about it: I know you are Zola and Sophia's godmother. I know you don't hate kids, but you don't exactly go out of your way to spend extra time around them. You see them when you see them, and whatever. But what if you re-framed your idea of being a godparent? Make Owen a part of it. Change the role that you think kids will play in your life. Really step up. What if you and Owen did something with them, like...often? You could both be really active in both their lives. Go to their little league games and stuff. Take them...camping or whatever...just- be there for them."

"They're too young to camp. And I don't like watching sports."

"Whatever! Do something else! It doesn't freakin' matter. I'm just saying, try being active in their lives."

"Wouldn't it make Owen bitter? Doing all of it for kids that aren't ours?"

"Probably," Alex conceded, shrugging his shoulders. "Definitely, at first. But, like I said, you both have to change a little. Let some of your old plans go. Compromise. And I don't know. What other choice is there? Neither of you wants a divorce. You gotta try something."

Cristina nodded, contemplating. After a while, she turned to face Alex and smirked, "Evil Spawn, Kepner has turned you into a regular Dr. Phil."

God, he hoped not. But he had been surprising himself lately. Only the other day he'd caught himself folding his laundry. Actually folding. That had to be in some part because of his girlfriend, because who really cared if your socks were folded together? Alex didn't. But he'd folded. So, maybe April really was making him change.

Not that much though. Surely. Alex snorted. Well, so what? He seemed to have helped his friend.

"Only for you," he teased.

"But I don't know, Alex."

"Just talk to him about it. See what Hunt thinks. If it's a crap idea, it's a crap idea."

Cristina looked like she was about to say something else, but her words were cut off by the sound of his ringing buzzer. Glancing back to her apologetically, Alex looked down and his heart sank. It was from peds. He was already on his feet and halfway through the door, when said hastily, "I gotta go!"

Marcello Conti, 911. Damn it.


April twisted the coffee cup on the table in front of her, carefully spinning it clockwise and then counterclockwise in equal measures. She smiled broadly. Her lunch with Catherine Avery really was the perfect way to end things before she headed back home. Her shift had been pretty long and, though April was happy to have done two procedures, she was even happier to unwind.

The senior Dr. Avery was always entertaining, even if she could be a little forward, and very brash. April admired her career, but also her personality a little bit. Because she just said things to people. Things that April would probably never work up the nerve to say. She'd been working on getting better at the whole assertiveness thing, but she was pretty sure that people like Catherine Avery, Dr. Bailey, and Alex were at a higher level. One which April didn't think she'd ever reach.

"Honey, I hope that you know how glad I am that you and Jackson are so close. You're a good friend," Dr. Avery said seemingly out of the blue considering that they'd just been talking about baking recipes. April turned around, following the older doctor's gaze, and saw that Jackson and Mara Keaton had entered the cafeteria and were chatting rather intensely at a secluded table.

Shaking her head April said, "I told him Dr. Keaton was probably nice. I told him you weren't just setting him up."

"I most certainly was!" Dr. Avery replied, eyes twinkling. "I thought they might get along. Why not see how they do spending time with each other?"

April's eyes widened and she looked back down to her hands, "Oh, then I guess...that's...that's fine."

Catherine only laughed, and added, "That's just how I am, April. I always have stir the pot. I just can't resist. Sometimes my meddling works, you know! Maybe not always for Jackson, but there are a few happy couples back at the Brigham who I could take credit for introducing. But anyway. And what about for yourself? Getting along with uh, who is it? Dr. Karev, yes? I'd never have pegged him as your type. How is that been for you? Because you look like you're a lot less...tense."

Her mouth opened as April struggled to reply. She knew what Dr. Avery was really fishing for. She thought April had been tense before. Wound up. Because she had waited such a long to have sex. And maybe that had been true. But you don't ask about it in public.

That's the thing. Catherine Avery just said things to people! Even right in public. She'd done it before to April the last time she came to Seattle. In the OR! So embarrassing.

Shrugging, she finally managed to reply, "It's been-It's really good. Alex is great. I mean, he might come off as a bit of a jerk, but deep down he's...I can't complain."

April shifted uncomfortably as a broad smile spread across the older doctor's face, and her eyes gleamed, "I see. That's good. You've had sex with a man."

"I never said-It's not that obvious..."

"Honey, I have an eye for these things. Good for you. It's helping you be a better doctor. It'll help you pass boards."

April gulped, and looked down to her hands. Awkward. Before she could steer the topic of conversation to something that wouldn't make her blush, April's phone buzzed. Her eyebrows knitted together as she read the message on the cell's screen. He wanted her to come up to peds. The message was a little cryptic, but April suspected that it had to do with Marcello. The teen was the only patient of Alex's that she had any real familiarity or connection with. And Alex had been working to save this kid with a higher than usual intensity, even for him.

"Speaking of Alex," she said looking back up at Dr. Avery. "I've got to run upstairs and help him with a pediatric consult."

They both rose from the table and quickly hugged. Catherine pursed her lips and laughed, "Oh, you don't have to make excuses to me, April. Get some girl. I've got my bladder transplant anyway."

The other woman elegantly walked away, leaving a flabbergasted April behind. Dr. Avery really didn't think April was leaving just to-that Alex had paged her because he wanted to...?

Well, she know that people did it. Had sex. In the hospital. Hell, she'd almost done it herself in an on call room with Alex all those months ago.

But that hadn't been a very good idea. And since they'd started dating, April and Alex had never slept together in the hospital. Or anywhere but her room actually. April didn't think she wanted to. Certainly not right now. Not in the hospital. She really hoped Alex didn't want to. Then again, his text message was a little cryptic. Suddenly, April felt nervous. What if he did?

Alex was typically pretty direct about most things. That sort of thing especially. He usually just rolled over and kissed her and said something simple like "Wanna screw?" If April wanted to, they did, and if not, they slept. Simple. Fairly low stress for all parties involved. Not always the most romantic, but April didn't really mind. She never felt like Alex was pressing her to do anything she didn't want to. And he could be romantic in other ways.

Sighing, April lifted her cane and limped to the elevators pressing the button that would take her upstairs to the pediatric ward. She was probably just freaked out because of Jackson's mom. Because if she'd gotten this text on any other day, or at any other time, April would have assumed that it was about Marcello. So, she decided to assume that now. To trust her gut.

The doors opened and April exited the elevator, scanning the peds lobby area for Alex. She caught sight of him near the nurses station. One look at the expression on his face and April knew that her first instinct had been correct. This had to be about a patient. It had to be about Marcello.

As soon as Alex saw April, he rushed to her side, grabbing her elbow and urgently leading her down a hallway, speaking quickly, "April you've done a Kimberland procedure once before haven't you? With Hunt? Back when there was that accident at the Boeing factory? For that guy with swelling that impaired his breathing? His lungs had fluid and erosion yes?""

"Uh, yeah," April said, thinking back, and trying not to stumble.

Months before the earthquake there had been a major industrial accident at the Boeing factory near Renton. Six traumas had come to Seattle Grace, and one of them had died. She'd worked on a man with lung and swelling issues, and Hunt had taught her to perform a somewhat new and controversial procedure. It had saved the patient though. But April didn't quite see why Alex wanted to know about it.

"Alex? What's going on?"

"The patient made it, right?" His grip on her elbow was tight enough that April could tell how involved Alex really was.

"Yes, but-"

"I've read some stuff about alternative applications of the Kimberland, like on cancer cases for instance. It relieves pressure on the lungs. Marcello's tumor is-"

"But Alex, that's just one study! I've read about it too. It's not even finished yet! Kimberland is a trauma procedure for acute injuries caused by an external factor. A tumor is different and-"

"Whatever, it's been done! You know how to do it. You're Chief Resident. Robbins likes you. The oncologist will listen to you. Come on."

"But-"

"Marcello's tumor is eroding the walls in his lungs. The results are not dissimilar to swelling!"

April shook her head, "I'm not Marcello's physician. I'm not familiar enough with his case to advocate for any procedure, let alone one that's risky and isn't known for success in cancer cases! There is an appropriate chain of protocol to follow for situations like this."

Alex glowered and looked at her pleadingly, "I don't give a damn about any stupid protocols. His condition is deteriorating. His family is driving up from Yakima! That's 3 hours away. They need to get here. They should be here. Marcello needs a few more hours!"

April didn't have time to reply, as Alex suddenly opened the door to a conference room and thrust her inside. Dr. Robbins and an Oncology fellow, Dr. Khanbo both looked up as they entered the room and Alex shut the door behind him.

Arizona looked sad and tilted her head to one side, "Karev-"

"She's done one before. A Kimberland procedure. I told you. Her and Hunt. Back for the Boeing case," Alex said. "It's been tested on a trial basis with cancer patients with lung distress!"

April felt out of place. She hovered, wide-eyed and silent by the door. Alex was obviously desperate to do something for Marcello's case, but she really didn't think doing yet another surgical procedure was the solution. He was so very sick, and his cancer had not responded to any of his treatments this time. Kid's like Marcello were a major part of why April had not chosen to specialize in any type of neonatal or pediatric surgery. It was just way too sad. Not that trauma surgery was much better, but at least then you were usually dealing with acute injuries that had a direct cause and effect. Not unexplained chronic diseases in children.

And of course, Marcello's treatment wasn't April's decision anyway. She cared for Marcello a lot, having gotten to know him over the past few months, but at the end of the day, she wasn't actually on the teenagers care team. It was Robbins, Alex, and Khanbo who had to choose what path to take.

It looked like Robbins and Khanbo were thinking making a decision that Alex didn't agree with and so he'd brought her in. April was surprised that he'd called for her actually.

Khanbo shook her head, "I'm not unfamiliar with the study Dr. Karev. But the patients they used were not end stage, and nowhere near as frail as Marcello. I'm sorry, I just don't see him as a candidate."

"The tumor is putting too much strain on Marcello's lungs! He'll be dead in a matter of hours if we don't do anything," Alex countered. "The parents aren't going to be able to make it. He'll die alone!"

Khanbo sighed, "That's regrettable, but even if we did do the surgery, it's likely that he would die on the table before his family arrived anyway."

"At least then we'd be freakin' doing something!"

Robbins walked to Alex's side and reached a hand to his shoulder, "We've done a lot Alex. And that iso-chemotherapy treatment you found gave him a few more weeks. The Conti's and Marcello knew that we are nearing the end. That's why they wanted to move him to hospice if his condition stabilized. They wanted no more extraordinary means. We can't go against that directive. We can't try one more thing. We'll supplement his oxygen and hope that it buys enough time."

April gulped and blinked rapidly, trying to control her reactions. This was too sad. It wasn't fair. Children shouldn't die. They should all get the chance to grow up.

"It won't," Alex muttered. "He's not gonna make it till they get here."

"No," Khanbo agreed. "But it's what we can do."

"It's sucks. This is a terrible situation, but sometimes this is what happens," Arizona continued.

He pulled away and crossed his arms shaking his head, "We can't fail him on this. I know his parents needed to keep working to keep their insurance. But the fact of the matter is that Marcello has been alone for most of his time here. Away from the people that care about him. He can't die that way."

Robbins shook her head, "He won't be alone, we can have nurses-"

"Freakin' nurses! They're overworked as it is! And he'll try to be brave, and say he doesn't need them and send them away and-"

"I think you are wrong, Dr. Karev," Khanbo said softly moving slightly closer to Alex, and tapping on the chart in her hands.

"What?"

"Marcello's parents haven't been able to stay with Marcello as much as they would like, but I would not say that he has spent his entire time in this hospital alone. He has had people who care about him with him often," the other doctor lifted one hand and gestured to Alex and April.

"You've done an excellent job of that Dr. Karev. I can't tell you how much Marcello talks about you and friends during my examination. Those visits, helping you study...that all made a huge difference in his life. Even now."

Robbins agreed, "You did a good job with this case, Alex. You could stay with him, if you want to. I can shift your other cases, until..."

Alex shifted his jaw, and April watched a haunted expression fall across this case. Something about Marcello really hit home for Alex. Thinking about it, April thought it made some sense. the teen was a feisty kind of kid, whose life circumstances had forced him to look out for himself. Not unlike Alex himself. And Alex's ex-wife had almost died of cancer. There were enough similarities that it was easy to see how he'd gotten so wrapped up in this case. More so than for a normal case, even for another cancer case. She'd looked into some stuff after the whole Amber hitchhiking thing had happened. April had been curious to understand Alex better, like why he could stay for hours on end with patients in their rooms, or why he could have done the same for her, yet he'd only spent a weekend in Iowa when Aaron tried to kill Amber.

Though she was no psychologist, April guessed, based on her research, that the traumatic experiences of his childhood had made Alex prone to transference. It meant that he unconsciously redirected intense feelings and emotions to similar circumstances or relationships in his own life, as a way of avoiding actually facing whatever the situation was in his own life. It seemed the only explanation for why Alex could go above and beyond in his job as a doctor for some patients, and yet had not been able to deal with his own family until very recently.

Not that April would ever tell Alex that this is what she thought he did. One, he'd freak out and think she was crazy for looking into stuff like this. About him. And two, he'd never even accept that there was a possibility he had transference. He was generally distrustful psychology, and so she thought it was more productive for her to just encourage him to further engage with his family, as he had been doing since Amber came to Seattle. And, some transference wasn't necessarily a bad thing. His intense connection to his patients was part of the reason why April thought Alex was such a good pediatric surgeon. He just needed to keep things in balance.

When Alex didn't reply to Arizona's suggestion, she thought that maybe this was too hard for Alex. Whatever was causing him to pull so much for this case, might also be causing him to freeze up when it came to staying with the dying child.

So April spoke up, "Uh, Dr. Robbins? My shift ended about half an hour ago. I haven't had the chance to change or head home yet. I know Marcello almost as well as Alex does. I...I can stay with him. Then all the burden wouldn't just be on Alex and the nurses. And I think having someone there that he knows at least a little will be important to the parents. Better than no one he knows at all."

"April," Arizona said quietly. "I know you're not on this case, you don't have to-"

"It's okay," April replied quickly. "I don't Marcello to be alone either." Her voice wavered on those last words and she swallowed. She knew how much comfort it had given her to know that Alex was there, in the collapsed building with her, for her own near death experience. If she had died, April would at least have had some comfort in knowing she wasn't alone.

Alex remained silent, and Khanbo nodded approvingly. Dr. Robbins solemn features held a flash of concern which dissolved. She seemed mildly impressed, "Alright Kepner, I know you're not obligated to do this, but thank you. I think I'll still shift Karev's cases. The both of you can see Marcello through this. It's gonna be a hard afternoon."

April bit her lower lip and nodded.

She could help. It was a devastating situation, but April thought she could do it. Sit with Marcello. While he...until he...

If Alex couldn't. If he couldn't alone. She could.

April could do it for Alex as much as she could for Marcello.


Alex clenched and unclenched his hand around his cell phone, as he spoke quietly in the hallway, updating the parents once again.

"Yeah, he's...he's been in and out of consciousness. That's um, not unusual when there is lung failure. Oxygen intake goes down and...yes. Yes. We do have someone with him round the clock. We'll stay until you get here."

His family was still probably about an hour out from Seattle, and with the onset of the evening rush hour, it could take even freakin' longer. Alex knew Marcello would be dead by the time they got here. It sucked. It was awful. It pissed him off.

Alex was angry at the insurance companies that forced the Conti's to keep working in order to pay for their son's care, at the expense of them being able to spend much time with him in his last few months. He was mad at Dr. Robbins and Khanbo for not being willing to try doing a Kimberland procedure, so he could maybe have a little more time. He was mad at the disease, the tumor, because Marcello was a great kid, and he was being robbed of his life.

And Alex was pissed at himself. Because he was being a chicken. He'd fought for a risky surgery. It was easier to keep fighting the inevitable, and to try to keep the teen hanging on for a few more hours.

Because it was hard to do this. To help Marcello do this. And his chest was tight and his palms sweated and he couldn't forget the feeling of holding Izzie in his arms as her own cancer killer her. At least he'd thought it was death at the time. It was awful and he couldn't face it again and none of that was Marcello's fault, so Alex was pissed. He should be stronger. Better.

But he wasn't, and right now April was the one who was really being there for Marcello. She wasn't making excuses to check stats or oxygen levels, or to update the parents. And she wasn't even his freakin' doctor. But there she was, going out of her way to help someone. He felt bad because it was really his responsibility. His job. Alex pocketed his phone and slipped back into the familiar and once inviting room. He'd spent a lot of time in that room. Eating, playing video games, studying. Now it just seemed cold, sad, and wretched.

April had lowered one handle on Marcello's bed and had her arms wrapped around him, deftly avoiding the various wires and monitors he was attached to. Alex could see unshed tears shining in her eyes, but April was holding it together. He was surprised. She was keeping it together better than him. April held Marcello leaning back on her chest, propped up a bit to hopefully aid his breathing, and he wore an oxygen mask, but his strangled breathing was becoming more and more labored. He was pretty out of it too. It was hard to tell in his moments of awareness whether Marcello knew he was dying or not, or if he would remember in the next moment of lucidity.

Making his way into the room, Alex sat down in a chair near the other side of the bed. Marcello moaned and gasped. April leaned her head to his ear and whispered, "Shh...don't worry. It's just Dr. Karev coming back in. Okay?"

The teen's eyes fluttered opened as he wheezed and shifted, feebly pulled at his oxygen mask. April stilled his movements and ran a soothing hand down his arm.

"Hey Bud," Alex said, trying to sound as normal as possible. "You gotta keep that on. For...for your breathing, alright?"

"M'kay, Dr. Karev," Marcello replied, wheezing even more. He seemed a bit more lucid than he had been.

Alex sighed, "Call me Alex, dude. She's April." They'd sort of had this conversation before on a less aware kick, and he clearly hadn't taken it in.

Behind his mask, Marcello smiled faintly, "April? Don't tell me you..." His words dissolved into a cough. He gasped and recovered slightly, "Don't tell me you...were...born in April?"

"April 23rd," she replied, gently leaning her head on top of Marcello's.

"That's lame," the boy croaked. A half smile fell on Alex's face. This was the longest and most coherent conversation Marcello had had so far. And he was still himself. Which made Alex's chest tighten just a little more.

"Hey!" April replied.

"It is a little lame," Alex agreed, joining in the tease.

"I didn't pick it. Blame my parents."

They all three laughed and sat quietly for a minute when Marcello sighed and whispered, "You...you guys don't have to stay...I know I'm...I know this is...it."

He swallowed, "I know I am dying...but I can handle it. I don't wanna...mess up your jobs."

"No," April answered firmly gently wrapping her arms close around his body. "No. I've got you. I've got you and I am going to stay. Alex is going to stay. You're not a problem for anyone."

Alex sniffed and looked to the ceiling as a lump rose in his throat.

"M'...M' kinda scared...I didn't...there a time when...my chemo...it all hurt so bad, I just wanted it to end. But now?" Marcello's wheeze gave way to tears, which made him cough. "I mean...what have I done...with my life?"

"I know," April said, shifting so that Marcello was sitting up even more, helping to relieve the coughing temporarily. "I think that it's okay to feel the way you feel. But you know what? You are a really good guy. You had a positive affect on a lot of people. Me, Alex, even Dr. Yang. Most people your age haven't figured out how to do that yet. Some people never do. But you did."

Alex has no freakin' idea how April was keeping her voice so even. He knew wouldn't be able too if he was talking at that exact moment. It was a good thing April was here. Marcello didn't need to see Alex fall apart. Maybe it was because all he could keep going back to was his memories of Izzie, and all the pain and surgery and crap that she'd gone through with her cancer. It was like his muscles had flash back. Muscle memory of something. He could remember exactly what it was like to hold her. As she 'died'. Not unlike the way April held his young friend now.

Her words seemed to calm Marcello. He slowly drifted off again.

And so time slowly passed, the boy sliding in and out of consciousness, and talking briefly. Alex found it difficult to sit. Difficult to stay in the room. He did for the most part but he couldn't help himself from going to the hall and pacing to calm his nerves every now and then. Because he freakin' needed to maintain his composure for this. Alex wasn't sure how April was doing it actually. Her leg certainly must be getting stiff from the awkward position she was in on the bed. And though she was clearly on the verge of tears, no hint of it slipped into her voice. Out of all the 5th years, she was usually the one who went to pieces over stuff. Even for patients. But today she was rocking it. Calm and comforting. She was being just what Marcello needed. And Alex was grateful for that.

At some point April had started humming and singing quietly to Marcello. He'd asked her what songs she knew, and then he and Alex had teased her about her taste in music and she'd started to hum stuff she remembered. Her head was good for lyrics. For all that crap. ABBA, Elton John, Manilow. Simon and Garfunkel. Lame or not, Alex thought it helped. Marcello was breaking through less and less often and grew more and more distressed as he struggled harder to breath, and the music seemed to calm him.

Alex had stepped out side to call the parents one last time when April was in the middle of 'The Boxer', and Marcello's breathing was more labored than ever, and he'd taken a moment to breathe. He'd gone to the far end of the hall and back before slipping in to the room again. The moment he came in, he knew. He knew.

April had stopping singing the words, only humming the chorus, and rocking Marcello gently from side to side. But Alex knew. The sounds of labored breathing were absent, and somehow the place just seemed...empty. Void.

"He's gone," April said softly, her voice finally revealing the depth of her emotions.

Alex froze, taking deep shaky breaths. He remembered how it felt when Izzie's body had gone limp in his arms. In your arms, death felt different than unconsciousness. He was overcome with an onslaught of memories of Marcello. And Izzie. It felt like the world was closing in around him. And he couldn't stay. He felt he should, but...

Damn it.


She'd kept it together.

April could hold things together. She'd been okay. Mostly. She'd been okay when Marcello told her he was afraid of dying. Mostly. She'd been okay when she'd felt the life leave Marcello's body. Mostly. She'd been okay when Alex had left her alone in a room with the dead boy. Mostly. She'd been okay when Robbins and Khanbo had lead in the parents to see their dead son.

April had been okay when she'd carefully shifted the...the...him from her own arms to the arms of his mother. Mostly.

She'd kept it together when the woman had held her hands and balled on her shoulder. She'd kept it together when the father had thanked her for being there with his son.

She'd kept it together. Until she couldn't.

The tears had started to fall in the elevator. By the time she reached the 3rd floor and was walking to her office, she was sobbing. April Showers indeed.

Losing any patient was difficult, and took some toll, but Marcello? He was a hard loss. And it was different, just holing someone as they went. Usually April was in the ER or the OR, and doing a procedure when a patient passed away. Even for those she had to work hard to control herself. This was a whole knew level of sad. April made it to her office, and opened the door.

Alex already there, sitting on the far end of her green couch, with his head in his hands. She'd never seen him cry like this. He'd broken down a little when he'd told her the truth about his mom and dad, but April could see that his was even worse than that. Then he'd tried to hide the fact that he was a mess. Not now though. Now Alex glanced up and wiped his eyes with his hands as he saw her come into the room. She slumped down on the couch next to him, leaning her cane on the edge of the small table in front, and grabbing a wad of tissues from a box that sat on the table.

"April," Alex said, his voice thick with tears. "I'm sorry. I shoulda been the one to do all that. He was my patient."

"It's o-okay," April blubbered dabbing her eyes with the kleenex. She really didn't mind. She got it. About his transference. And his ex-wife and her cancer. "I-I understand. You-your...Izzie...had...c-cancer. Brings up bad memories... I g-get it. I've got your back. We...we d-din't let Marcello down...and his p-parents...they were glad someone was...with him..."

Alex turned and pulled April into an embrace, "You didn't let him down. I freakin' did. You were so great...with him and I just couldn't. I'm still sorry. I...I shouldn't be like this. After all this time. Izzie left me years ago. And she lived."

Gulping as her onslaught of tears continued April chocked out, "It's r-really okay. I had your back...and you were the-there. Marcello knew you were. I had your back."

"Huh," Alex sighed. "That's exactly why I am still sorry. You have my back. You do. You...you're here and Izzie left. And...and I shouldn't still let her crap mess my head. Not for important stuff like this. Not when you're here."

"Obvio-sly it was a big deal for you," April gasped tearfully. "And...you can still feel...I mean...it's okay if a part of you...s-still loves her enough to...f-feel so much from a m-memory."

Alex sniffed, and his arms pulled her closer, "I, uh, you say stuff like that and...I-that's why..." As he paused, and April reached to the table for more tissues. "I think that's why I-I love you April. I know it's a bad freakin' time to tell you but..."

April's heart and mind reeled with conflicting emotions, sadness for Marcello's death, and joy because of Alex's admission. As though it were an autonomic response she replied, "I love you too." She did. And she didn't need to think about it. But she would think about the fact that Alex had said it. And said it first. He loved her? She would no doubt spend hours thinking about it. Analyzing it. Re-analyzing it. But that would come later.

Right now, April was grief stricken, and all her mind could focus on was the loss of a fine young man.

"You know," Alex said. "Marcello is a reason our first date wasn't a bust. He's the reason I didn't walkout on you in the bathroom when you said it was a bad idea."

"What?"

"Yeah, he told me about feeling different because of what happened to him. He pushed away his girl, and you tried to do that...but because he told me about it I-I remembered and whatever...and we went and..."

"He was good," April's face crumbled and her sobbing increased two fold. She buried her face in Alex's chest and cried, "He was just a kid. It isn't fair."

"I know."

In the end, April and Alex ended up sort of doing something she'd vowed never to do, something she'd sort of worried about at lunch much earlier in the day. After the crying tapered off, they'd stretched out on her couch and dozed off. Before April feel completely asleep she found her mind taking a moment to realize the irony. Because April was ending up sleeping in the hospital with Alex. Just not in a way she feared.

And Alex Karev had told her he loved her. So, yeah, she was going to sleep curled up next to him in her office at the hospital. Whatever.