Too Close Part 2

The dictionary defines grief as keen mental suffering or distress over affliction or loss; sharp sorrow; painful regret.

As surgeons, as scientists, we're taught to learn from and rely on books, on definitions, on definitive.

But in life, strict definitions rarely apply. In life, grief can look like a lot of things that bear little resemblance to sharp sorrow. Grief may be a thing we all have in common, but it looks different on everyone.

Meredith just stood there on the front porch after putting her kids to bed. It has been a long day. She didn't hear Amelia coming toward her. So she flinched when she heard footsteps near her. She turned around and recognized her sister in law walking over to her, quietly.

"Thanks." Amelia suddenly said as she appeared next to Meredith who stared into the sky.

It was almost dark, both women were standing on the front porch and stared in the darkness. For a while, no one said anything. They just stood there, each of them had a cup of coffee in their hand.

Meredith shot a side glance at her sister in law.

"For what?" She asked then.

"For giving me the phone. For letting me hear the message. I needed that, hearing his voice again." Amelia said, referring to the voicemail message Derek left on Meredith's phone. Meredith smiled warmly, embracing the feeling of being finally at home. "He loves us." Meredith suddenly said.

"Even though he will be back … he thought he would come back. He had no idea how this would turn out. I should have come with him. Maybe then …" She shook her head. She had her people here, even with Derek dead, she knew she survived it. "It was the least I could do." She replied.

"I am … It wasn't right to yell at you like that." Amelia said, referring to the supply closet confrontation. "It was, Amelia. It was." Meredith cut her off. She understood where her sister in law was coming from.

"You need these answers in order to move on and live your life and so on. In this moment I was not thinking straight. But when I signed those papers, I wasn't myself. I was not myself, not the conscious me you know. I was in shock."

"Who wouldn't be?" Amelia interjected silently. Meredith nodded and continued: "I've seen his chart. I demanded that they hand me the chart so that I can see for myself what they did. They never did a head CT although he had a head laceration." Meredith bit her lip, it was hard to talk about those things but at some point they would have to talk about it. Amelia's lip trembled.

I miss you, Derek.

So much that it hurts every time I think of you ...

Why did you have to leave so soon ...

I know you haven't had much choice in that matter but that doesn't change the fact that I miss you horribly.

Every day, every minute ... I just have to believe there is something like heaven so we can meet again.

There just has to be ...

And you're waiting for me. 'Wait for me'.

I will, Derek.

I will.

"Even after all these months, I still think he comes around the next corner. I never thought I'd have to do it without him. He was always there, he showed me what real love is like." Meredith said, looking away and she was trying to recall happy memories of her and Derek. A time where they had no problems, where they were happy – why did this accident kill him? Why him? The universe is seriously fucked up, as if it was mocking her, screwing with her.

Amelia's thoughts were about Derek and why they didn't do a scan.

She would have done one, as precaution if they patient had a head lac. Stupid podunk hospital. "Not doing a head CT when the patient presents with a head lac. That's pretty irresponsible." Amelia said.

"Maybe then he could have been saved."

Maybe ...

"If they had thought about doing a head CT. That's like med school 101." She shook her head.

"Can you believe this? If they had caught it in time, he wouldn't have been dead right now. Ellis would have had a daddy that was here. It's something that could have been prevented, his death could have been prevented." Meredith nodded as realization hit Amelia.

"I do not have time for coffee. I do not have time for meetings. I don't... My job is not to make you feel better about me. My job is to make my patients get better. Do you know what can happen in the hour or two I would be wasting with you?

An hour or two matters!

They matter to me. They should matter to you.

They matter to my patients. If I leave and my patient dies, it's not me who will suffer, it is his mother, his sisters, his friends, his wife, and they will hate me.

With everything inside them, they will hate me and you and everyone here because they won't understand why he is gone, why people always leave, why everyone you give a crap about walks away or is ripped from your world without warning, without reason, in convenience stores and plane crashes and podunk hospitals with podunk doctors who don't do what they are supposed to do, which is save people!" Amelia freaked out on Richard who was just trying to help.

All the nurses and other staff were looking at what happened.

"I understand why you left when you left." Amelia said.

Meredith's head shot up as she looked at the neurosurgeon. She looked at the neurosurgeon before responding to that statement. Amelia looked at her, keeping on a straight face and not letting on what she was really feeling.

"You do?" Meredith asked back, surprised that Amelia understood why she left after the funeral and so. His presence was everything, remainders of his existence … they were all here – haunting her. Meredith looked at her sister in law. There were so many things she didn't know about her. And that Amelia didn't know about her. Amelia nodded. But before she had the chance to continue, both of their pagers beeped loudly.

Meredith flinched at the mere sound.

"Apparently, we have to get back to work."

Both surgeons reached for their pagers. "Chances are this is some major accident that'll take forever. I'll get the kids." Meredith said and went upstairs. She didn't like the fact that the kids will spend the night in daycare or more, the rest of the night. Amelia just nodded. When they arrived at the hospital, there were dozens of patients and more to come.

"Holy mother of …" Amelia exclaimed.

"This is going to be a long, long night." Meredith stated. "I think you're about right." Before Meredith knew what was happening to her, she was called over to a patient that was being wheeled in.

"34 year old male, crashed his car into a pole. Closed head injury. Increased intracranial pressure, GCS is 6. He was hypotensive en route." The paramedic stated the facts.

„Clear a trauma bay right now." Meredith ordered.

"Are there any residents available?" She asked a nurse that was passing by. "No, Wilson is with Torres and Edwards is busy with teaching her new interns how not to kill a patient." Meredith just nodded, a simple yes or no would have been enough. "Make sure CT is on standby. If there's a bleed or something and I need to go in, I want the OR prepped and ready the minute I know what we're dealing with." Meredith commanded.

"Of course, doctor." The nurse quickly replied and contacted OR. Meredith was in the trauma room, trying to stabilize the patient, but she couldn't get his blood pressure up.

"Is there any ID on him, if yes, can you please inform the family?" She added.

„We need to consult general. His abdomen is rigid. Page Dr. Bailey, I am going to need all the help I can possibly get. And then get him to CT." Meredith constructed, while testing the patient's pupil reaction. Before the doctors could do anything the patient started crashing. The heartbeat became more and more irregular and monitor signaled with a rapid and erratically tone that the patient had gone into ventricular fibrillation. "Damn it." She muttered, before shouting.

"I need a crash cart now."

A nurse immediately responded. She handed the paddles over to Meredith.

„Charge to 200. Clear."

She shocked the patient once, but he didn't respond, neither to the first round of ACLS drugs or to the shock. "Charge again." Meredith pressed the paddles to the patient's chest. "Clear." The next shock sent the patient's body flying upwards and back on the gurney. After three rounds they were able to revive him. "We really need to get a CT done. Okay, move."They released the brakes and were on their way down to CT.

Dr. Miranda Bailey waited for them in CT.

"What do we have?" She asked as Meredith entered the viewing room. "MVC, he suffered traumatic brain injury and possible abdominal injuries, that´s why we paged you. We are still waiting for the images to come up." Meredith answered. After a while the images were up. "Damn, he's suffered major trauma to his abdomen. Grade IV liver lac." Bailey said.

"Well, that's not all. What can you see, Dr. Grey?" Amelia directed to Meredith, who studied the monitor carefully, before answering: "Epidural hematoma."

"Well, then let's get him to an OR, before he bleeds out."

In this moment, Amelia was paged for another consult. "Page me if there are any complications. I go in as soon as possible. Now I have an open skull fracture to get to. I have OR 5 if you need me." Amelia rushed away. Meredith had a bad feeling about waiting with the head surgery.

It's what they did with Derek and that ended fatal.

The surgeons rushed the patient to the OR, but there weren´t any ORs. "How come there is no OR available. I have an emergency craniotomy or my patient will die." Meredith was furious, once again she was acting Medusa-like. The nurse stuttered helplessly: "I can´t do anything about it."

Meredith rolled her eyes in agitation.

"Well, bump any non-emergent patients. Clear the OR rotation now and maybe someone just started operating. Maybe they can close up until further notice. I don´t care, just get me a damn OR." The nurse nodded and reached for the phone. "That seemed to work. What is the surgical plan?" Dr. Bailey commented.

"We're starting with the liver lac." Meredith said in reply.

The nurse interrupted with a "OR 2 is ready for you guys." "Okay, let's go. You've heard her, we got an OR."

They rushed the patient into surgery.

It isn't just death we have to grieve.

It's life.

It's loss.

It's change.

And when we wonder why it has to suck so much sometimes, has to hurt so bad. The thing we gotta try to remember is that it can turn on a dime. That's how you stay alive. When it hurts so much you can't breathe, that's how you survive.

By remembering that one day, somehow, impossibly, you won't feel this way. It won't hurt this much. Grief comes in its own time for everyone, in its own way.

So the best we can do, the best anyone can do, is try for honesty.

Meredith and Bailey were scrubbing in on the same patient. Meredith was lost in thoughts and Bailey saw that.

"Grey." She said her name. When Meredith didn't react, she repeated it a bit louder. This time, Meredith flinched. "Grey, are you okay?" She asked. Meredith only nodded before entering the operating room. The patient was already under general anesthesia.

Meanwhile, Bailey entered the OR, saying: "Let's save this man's life today, shall we, Grey?" Bailey said.

Meredith ordered: "Scalpel." She was making the first incision. The patient went briefly unstable in the middle of surgery. "What the hell is going on?" Bailey asked as the patient was bradying down and the blood pressure went up. His heartbeat was only in the forties and falling.

This was not good.

Meredith knew Amelia had inserted a device that is measuring the intracranial pressure that was now going through the roof which was bad.

"I think the ICP's through the roof. Check the pupils. If blown, page Shepherd right now." Meredith called out as she stared intently at the monitor. Her heart was beating in her chest.

Bailey looked up in realization.

"Crap."

This is not supposed to be happening.

Not today of all days.

"That's what …" Meredith stopped mid-sentence. Her saying this won't help this patient. She hoped Amelia would be here soon. She wanted to spare the family the fate she suffered. "Where is she? I paged the minutes ago." Meredith was getting impatient. The patient was at risk of herniating and then dying.

Where the hell is Amelia?

Where the freaking hell is Amelia Shepherd? She is supposed to be coming to the 'rescue'.

Meredith had her paged her minutes ago. "With every minute we wait we risk more and more brain damage. Maybe he'll end up …" Meredith exhaled deeply before continuing.

"… braindead. So page Amelia Shepherd again."

Dr. Bailey watched the facial movements of her colleague. It was obvious that she tried to regain the much needed distance. This was reminding her of what she went through with Derek. "Right away, doctor." The nurse said and did it. But Amelia did not answer her page, not even after a few minutes passed. This was not good. They were squandering time, valuable time that can decide whether a patient lived or died. "Call OR 5, see if you can reach her." But after the nurse hang up, she said: "Shepherd's not available. She is busy with her skull fracture patient." Meredith sighed before asking for Shadow Shepherd. "Is Shadow Shepherd available?"

"Nelson isn't either. So what do …"

"… we want to do in order to prevent his brain from herniating." Meredith completed. Bailey looked at her. "I can do it." Meredith suddenly said. She could, actually. Derek had taught her well. She believed she could do this and save this patient's life. He deserved that shot.

"Grey, we have to wait for neurosurgery. That is protocol." Bailey said.

"I know that the whole waiting thing makes you crazy but we have no choice. It's protocol, hospital policies." "You won't go by telling me about hospital policies, Bailey. You are not a 'by the book' – person, you are a 'do what's right' – person. In fact, you know this is the best shot. Let's give him the best shot. He deserves it. He deserved it."

He deserved the best shot.

But he never got it.

Bailey looked at her former intern in confusion. "You were talking in past tense." She stated.

"Are you okay? Emotions can cloud judgment." Meredith gaped at her for a moment. "No, I am okay, I don't lack judgment. But this patient is not. His intracranial pressure is rising with the very second. I can change that by doing crash burr holes. Maybe that'll give us time to figure out what to do. It's also possibly we'll have to opt for a craniotomy. Fact is when we do nothing, this patient will die. Maybe he won't code but his brain will die and then he is dead although he isn't."

Meredith continued to stare at the numbers.

The normal ICP is between 5 - 15 mmHg. And not as high as this.

"You're talking about …"

Miranda was fairly sure Meredith was talking about the neurosurgeon, her Derek, who has lost his life after saving four people in a car wreck and ending up in a second accident. The universe is really ironic that way.

"I am. But this has nothing to do with this. My medical instincts are telling me that we have to do something – before this patient dies." Bailey didn't respond. Part of her knew that the doctor was right but she couldn't bring herself over to cave. Meredith had no intention of giving up. That patient's life depended on her. This was like the doctor who should have fought harder to make her superior get a head CT but gave in – signing Derek's death sentence by doing that.

Meredith wouldn't let that happen to that guy.

She would make sure of that.

"I do it. I do the craniotomy. I learned from the best. I can manage a simple craniotomy on my own." Meredith said, knowing exactly what she wanted to do. Bailey's face showed surprise. She was bewildered by the young doctor's decision.

"Are you sure this is a good idea?" She asked. Meredith didn't answer.

"You know what the alternative is? Waiting an hour and a half for the neurosurgeon and then it's too late and the family has to decide whether to unplug him or ship him off to a long-term care facility … I want to spare them that fate. Let me try. I learned from Derek, spent most of my residency in neurosurgery." Meredith could do this. She was the only one available."Webber said that that's how we get things done at night. So go with it. Maybe I'll even have to do a trauma flap. But I am confident I am able to do this. Amelia's stuck in surgery and so is Nelson, the other neuro guy."

Aka Shadow Shepherd.

The really crappy thing, the very worst part of grief is that you can't control it.

The best we can do is try to let ourselves feel it when it comes. And let it go when we can. The very worst part is that the minute you think you're past it, it starts all over again. And always, every time, it takes your breath away.

There are five stages of grief.

"What procedure are we going to do?" Dr. Bailey asks, interrupting the nagging silence. Meredith was a competent and qualified surgeon but her specialty was general surgery not neurosurgery. She'd left neuro as a result of swapping a placebo with the actual drug for the Chief's wife.

Okay then it's easy. We just don't work together. I am leaving neuro. This is my consequence.

Everyone in the OR was quiet.

They know the importance of being quiet. Their patient's life could depend on it.

"Craniotomy is what I am gonna do. Are you finished up with treating the abdominal bleeders 'cause if that is the case you can assist me." Meredith replied, taking her place by the head of the patient, preparing to open him up.

She closed her eyes for a moment before starting. She inhaled and exhaled slowly.

She opened her up and removed her skull flap. Surgical evacuation constitutes definitive treatment of this condition. Craniotomy is followed by evacuation of the hematoma, coagulation of bleeding sites, and inspection of the Dura. The Dura is then tented to the bone and, occasionally, epidural drains are employed for as long as 24 hours. Craniotomy is the surgical removal of part of the bone from the skull to expose the brain. Specialized tools are used to remove the section of bone called the bone flap.

She wished Derek was here, looking over her shoulder, assuring her everything'll be alright.

The bone flap is temporarily removed, then replaced after the brain surgery has been performed.

She was about to localize the bleeder in order to evacuate it. An hour into the surgery Meredith enforcedly performed, the patient's condition suddenly changes abruptly. His condition took yet another dive downwards. Meredith had barely started to evacuate the hemorrhage when the patient suddenly began to get unstable again.

Meredith's heart beats hollowly in her chest, she is barely able to keep herself together. When the surgeon hears the alarming sound of the cardiac monitor indicating irregularities in her patient's heartbeat, she looks up, her eyes fixating on the monitor that was beeping irregularly.

"Her ICP has reached incrasingly high levels." Meredith exclaimed, her voice scared and terrified.

"So what do you do?" Bailey asked. Meredith turned all her attention toward the patient, she was racking her brain for some solution that wouldn't just kill the patient.

"Grey, time is running out. You need to tell us what to do. You're the lead surgeon on this case which means you're the one who is supposed to te ..."

"Will everyone just shut up?!" Meredith interrupted whoever was speaking. "I need to think and this is not helping."

"I knew this surgery was a mistake." Meredith just ignored that comment. There was no time for self doubt.

These seconds decide. Every single person in this OR knew this.

"Push of mannitol. It reduce the pressure ... hopefully." Meredith ordered, she stayed calm even under this amount of stress and it wasn't even her specialty. "... and prevent of further swelling." Bailey finished the sentence for her. Meredith looked over to the general surgeon, before she focused back on the surgical field. There was an open brain in front of her. This was not the time to get distracted by anything. Mannitol is effective because it do not cross the blood-brain barrier (much), and thereby draws cerebrospinal fluid out of the cranium and fluid out of the injured brain, reducing pressure and further injury.

Luckily, the mannitol really helped. After a while the patient's vital signs stabilized and even the intracranial pressure went back to a normal range. Meredith breathed a sigh of relief.

"You did it, Grey." Bailey smiled under her scrub cap.

In this moment, someone entered the OR, Meredith didn't bother to look up. "Meredith?" A voice asked. "What ..." She continued, baffled by what she was looking at. Meredith now did look up and in Amelia Shepherd's face. "They've told me you need me in this OR ..." She said.

Yeah, she did ask for consult hours ago.

"But it seems like you've got it under control here." She said after stepping nearer and watching Meredith's precise moves with the instruments. It was clear that she studied under Derek.

When Meredith and Bailey scrubbed out, the were greeted by an infuriated Owen Hunt. "Did I hear that correctly?" He asked, looking toward Meredith. Who looked at him. Why should she feel guilty? For saving a life? Doesn't that sound weird to you too? She saved a man's life. Why was everyone ... freaking out because of it. Yeah, liability and all ... But what the heck, the patient's alive, and stable. Not brain dead. Not like Derek. Damn it, why does everything remind her of Derek? "Why the hell are you operating on this patient's brain without informing neuro?"

"If we hadn't the patient would have ended up brain dead for sure. And I don't want to be telling that to the family if we could have done something to prevent it."

Brain dead. Like Derek.

"We did but nobody else was available. I was the only one. I am not letting this man die just because the neuro consult needed one and half hour to get here. Because time matters. It can decide whether a patient lives or dies or ends up a vegetable." Meredith defended her actions.

Should she have let the patient die while waiting for neurosurgery to answer to page instead of performing a procedure that could end up saving him - she knew how to do a simple craniotomy ...

Derek had taught her. Among other things. Medical things but not only medical things.

"It was the right decision." Amelia cut in. "She is right. She did exactly what I would have done. She was me in there." She shot Meredith a look, smiled at her almost invisibly. Meredith waited for Owen to continue his rant but instead, he just shook his head and said resignedly: "Fine. I won't do anything if Ame ... if Dr. Shepherd agrees with your approach." Amelia tried to catch his gaze but failed. Owen turned around after saying that.

Without another word, Owen left, leaving Meredith and Bailey standing there, obviously confused. "So ..." Amelia looked over to Meredith. "Now you take Derek's place and steal my surgeries?" She joked (although that it wasn't funny, it had been an emergency). "Uh, no choice." Meredith replied.

"Okay, guys, I am leaving now." Dr. Bailey saw in this a chance to disappear.

"He would have ended up like ..." She didn't finish that sentence. But the case today ... it changed her. It was like she was Derek in there. Why did she leave neuro in the first place, oh yes, the trial but ... She wanted to operate on brains.

... like Derek.

Amelia only nodded.

Her sister in law did the right thing. Both of them went toward the attendings' lounge only to be greeted by a very loud conversation.

"You kicked ass, Meredith. You saved that guy's life. Derek would have been proud."

Meredith smiled faintly.

"Oh, have you heard?" Callie said smirking idiotically. Maggie was there too, and listening to the conversation. "No, I have not. What is it I haven't heard?" Maggie wanted to know what they were talking about. "Apparently, she's been performing Shepherd's craniotomies. Bailey assisted her."

"No way?!" Maggie exclaimed. Arizona just stared at her ex-wife for her moment, then her eyes wandered toward Meredith who wanted to disappear in this second.

"She did."

Meredith stared at the orthopedic surgeon and gave her deadly stare. If looks could kill ...

"You are general surgeon." Maggie said, flabbergasted at what her sister has been doing. Saving someone's life while operating on a brain. This was so ... badass. Performing a surgery that wasn't her specialty as a lead surgeon. "How do you know how perform a craniotomy ..."

"... flawless craniotomy, I saw the whole thing as I was sitting in the gallery." Callie Torres interjected.

"Come on, Grey. You're supposed to be bragging about this."

I am not.

This just reminds me of Derek.

No, not every case can remind you of Derek. You can't get emotions get in the way of work.

"I almost went into neurosurgery, I spent most of my residency in neuro. But then I decided to go into general surgery. But this patient, I had no choice but to go in and relieve the pressure." Meredith explained.

They look different on all of us, but there are always five.

Denial. Anger. Bargaining.

Depression. Acceptance. Goodbye; Meredith Grey, Lexie Grey, Mark Sloan, Alex Karev, Izzie Stevens, Derek Shepherd, Miranda Bailey, Owen Hunt, Arizona Robbins, Callie Torres, Cristina Yang, and Richard Webber

'I understand why you left.' That were Amelia's words.

Meredith still remembered them.

It has been a long day. Amelia and Meredith had worked together on a case, a tough case but in the end everything worked out. So that was good. She would ask Amelia later about what she meant with that ...