I apologize for the long wait for an update! This chapter ended up being way longer than I ever intended it to be (I think it's the longest chapter I've ever written!) but I think it will be worth the wait! It's pretty heavy; there's a lot of angst and heartbreak, which I think is a nice change from all the bright and shiny we've been seeing these last three chapters (not that I don't like bright and shiny!). With reference to the timeline, it says it takes place sometime after 2x06, but that basically means anytime between 2x06 and 2x13, which is where they work together on Thanksgiving, and she sort of comes to terms with his choosing Addison.

For the OR scenes in this chapter, again, I am not a doctor, so if there are any mistakes, I apologize! Like in chapter 2, though, the medicine isn't really the focus here, so while I did some research, I didn't go out of my way to make sure it was 100% accurate.

The next chapter should be up soon-ish, but I won't make any promises. It will be a happier chapter, though!

In the meantime, don't hesitate to leave me a review!

Maybe I love you

Maybe I just like the sound

But if you disappear

You'll still hear when my heart hits the ground

We'll never know

What it's like to be free

How can you solve

What can't but should be

There's no explanation

Only what we cannot change

So we'll leave how we met

With nothing the same

Holding Us Back – Katie Herzig

"And right here, this is a seven-hour craniotomy. You held the clamp the entire time. Never flinched. That's when I knew you were going to be an incredible surgeon."

Listening to him say this, hearing the unwavering seriousness in his voice makes me smile, but I can't help but feel the excitement of the moment fading slightly. It was definitely an interesting surgery, and it was a great experience for both of us as surgeons, but it wasn't one of the greatest surgeries I ever scrubbed in on. In fact, it was probably the most torturous. It was not too long after Addison showed up and Derek decided that he was going to try and stick his marriage out, making him the last person that I would want to spend seven hours stuck in an OR with…

S2, sometime after E6 – Into You Like A Train

I had experienced many forms of rejection in my life. When you grew up with parents like mine, feeling unwanted or in the way was something that occurred often. You got used to being rejected, you understood that you weren't wanted, and the easiest thing to do was stay out from underfoot. If you were like me—tired of being inconspicuous and making sure to stay out of the way—you rebelled. You went out of your way to be underfoot, you drank, and you partied; you did everything in your power to tarnish your mother's spotless reputation. It led to some pretty spectacular arguments, but it was a good way to vent all of that frustration at being rejected all your life.

Derek's rejection, however, was something different altogether. Maybe it was because I had never dreamed that he would reject me. Sure, Addison was his wife, but after all of the moments we had had together, it never entered my head that he would pick her. So when he did, when he came out with lines like, We've been married eleven years, and, I have to give it a chance, it was shocking. In the moment, I felt numb, empty, hearing the words Derek was saying, but not making any sense of them. After, when I was alone, everything seemed to catch up to me, and it was terrible. It made me sick, not physically, but emotionally. Thinking about him, remembering all those times we had together, seeing him at work, made me nauseous, and heartsick.

I had never been one of those people who believed that a broken heart could kill you, but now I wasn't sure. I wasn't sure of anything anymore. I was in pieces, and not entirely sure how I was supposed to put myself back together again. As a result, I'd become a zombie. I went through the motions of living: I got up, I went to work, I came home, I ate, I slept, but it was all done out of habit. The days had become a meaningless blur of charts, surgeries, and sleepless nights.

I remembered Derek, though. Every single encounter, whether it was a glimpse of him rounding the corner or an awkward run-in at the nurses' station, was branded into my mind forever, and all the tequila in the world couldn't make them go away.

It had been almost a month since that night, the night that the whole hospital—maybe even the whole city—remembered as the night the train to Vancouver derailed, and that I remembered as the night Derek broke my heart, though broken might not be the most accurate description: he didn't break my heart, he cut it out completely. There was nothing left but a huge, gaping hole in my chest. I was surprised that I was still alive.

"We should have a girl's night."

It was Monday morning, a rainy, dull Monday—typical for Seattle; we'd had four of such mornings last week—and we were all in the locker room—late, as usual, though Bailey seemed to be cutting us more and more slack—getting changed.

Cristina glared at Izzie from across the bench. It was obvious she thought this suggestion was a terrible one. "A girl's night?" she repeated scathingly.

"Yeah," Izzie replied, choosing to ignore Cristina's disapproving tone. "You know order in, watch a movie, have lots to drink...It's exactly the kind of thing we need right now." I couldn't help but notice her pointed glance was directed at me. And suddenly I understood: this girl's night thing wasn't about us getting together and having fun. It was about me. This was Izzie's way of trying to cheer me up. And, right now, getting drunk—people like Cristina and I couldn't have a girl's night without enough tequila to make you forget it all the next morning—sounded like a great idea. "That sounds great, Iz." I tried—and failed—to muster some more enthusiasm into my voice.

Both Cristina and Izzie stared at me. Neither of them had thought that I would go for this. They both had been prepared to persuade and dissuade me.

"How about tonight?" The oblivion couldn't come soon enough for me. I was tired of feeling broken. I was tired of feeling, period.

Again, they both stared at me.

"Uh, sure." Izzie was the first to recover, hastily plastering a smile on her face.

"Yeah," Cristina chimed in, previous disapproval forgotten.

"Can I come?" George asked, struggling into his lab coat. "Since I, you know, live with you and all?"

Alex snorted. "It's a girl's night, Bambi. Why would you want to get drunk with a bunch of chicks?"

"So that he can get laid," Cristina shot back, eyes narrowing. Her hatred of Alex far outweighed her dislike of George.

"As if any of you would sleep with him," Alex retorted.

"Shut up, Alex," Izzie snapped.

"Oh, just come. All of you." I was tired of listening to them bicker and tiptoe around me like I was going to shatter at any minute. I was already broken. That wasn't going to change.

"I'm not going to a girl's night." Alex's expression said he clearly fancied himself above girl's nights.

"It's not a girl's night," I snapped. God, they could all be so childish sometimes. It was just one of many things that made me yearn for Derek even more.

"It's not?" Izzie's brow furrowed in confusion.

"It's not," Cristina clarified. As usual, she was the first one to adapt. "It's like a Bailey's interns thing."

"Oh. Well, okay then," Izzie said. She clearly didn't understand what had just gone on, but she was willing to go with it.

There was an awkward silence, mercifully broken by the arrival of Bailey. "What are you all sitting around for? Rounds! Now!" she barked.

We all slunk out of the room with a chorus of "Sorry Dr Bailey"s.

Thankfully, Derek was absent during rounds. The last thing I needed were his big, sad eyes boring into mine. I didn't need his pity. I'd gotten the message loud and clear. He chose Addison. She was his wife, and he still loved her. Once again, I'd been rejected.

It shouldn't have been surprising. He was a rich, charismatic, highly successful, world-renowned neurosurgeon, who had people flying from all around the world so that he could cut their heads open. I was a virtual nobody. A first-year intern. Bottom of the surgical food chain. The only thing that made me slightly famous was my mother's legacy, but if people found out what she thought of me and my desire to follow in her footsteps, any good impression they had of me would fade pretty quickly. I should have known that it was all about the chase; that it was the fact that I was forbidden fruit and that our relationship was against all the rules that made him want to pursue me. He wanted me because he couldn't have me. And then, when his Isabella Rosellini-esque wife showed up, he went back to her. She was beautiful, rich, and successful, exactly like him. They were a perfect match.

"O'Malley, you're with Burke. Stevens, you're with Dr Montgomery-Shepherd. Yang, you're with me. Grey, pit. Karev, scut." Bailey doled out assignments with a disinterested air; she obviously had better things to be doing with her time. I couldn't help but notice that nobody had been assigned to Derek's service, and wondered briefly if that was done on purpose.

"Seriously?" Alex cried. "That's the third time this week!"

Bailey just raised her eyebrows. "You got a problem, Karev? 'Cause I can see to it that you're doing scut for the rest of your intern year."

Alex shot her a dark look, but headed off without any further argument. Bailey glanced around as if daring anyone else to argue with her, but no one did. We all knew better than to mess with the Nazi. Besides, the only other person who might have complained about their assignment was me—the pit was right up there on the 'assignments interns hate' list, especially seeing as our trauma department was a little lacking—but I was actually grateful. The pit was busy, and even though it wasn't always the most interesting work and most of the cases weren't surgical, it was a place where I would be constantly at work without needing to worry about running into Derek.

"Well, what are you all waiting for? Move!"

George scuttled off, Izzie following close behind, but not before they both shot furtive looks in my direction. I bit back the urge to yell at them. They didn't need to worry about me. I wasn't fine, but that was something I'd gotten used to.

Cristina, mercifully, didn't try to see if I was all right. The look she sent me was one of gloating: You're in the pit while I'm scrubbing in on cool surgeries. I didn't want to tell her I was actually fine with working in the pit; it was a sure-fire indication that I was anything but fine—though I was pretty sure she'd already figured out as much.

"Are you sure you want to do this girl's night thing?" she asked, Bailey having drifted out of earshot to gather some patient charts at the nurses' station. "I mean, Izzie will totally go all out with this. It's going to be torture."

I sighed, not wanting to go through this again. I didn't understand how much clearer I had to make it. "It's not a girl's night. We're all just going to hang out at the house and get really drunk."

Cristina frowned, concerned. We'd been doing entirely too much drinking in the last month for her not to be. "Meredith—"

"I don't have all day, Yang! You too, Grey! Get going." Bailey glowered at us, shoving a stack of charts into Cristina's arms. She looked like she was of half a mind to argue with Bailey, but I wasn't. Seeing my chance, I didn't hesitate to flee, Cristina's worried gaze following me all the way down the hall.

The pit was quiet, a rarity. Most people would be glad to have some time off, but I had been counting on a busy day to keep my mind from wandering. Derek had a nasty habit of invading my thoughts like a particularly violent disease, so I'd been doing everything in my power to fore him out, hence the excessive working, the strange men, and the copious amounts of tequila. When I was at home, it was okay if I was unable to prevent the invasion, but it wasn't something that I could afford to have happening at work. It was bad enough that we worked in the same hospital and that I had the potential of running into the real Derek every time I turned the corner. I didn't need him in my head, too.

By noon—after having dealt with a broken arm, a man with a child with a migraine, and a forehead laceration caused by a rogue tree branch—I was more than ready for an escape. The slow trickle of people coming in the ER doors had stopped for now, and I was pretty sure that the doctors and nurses here were more than capable of dealing with whatever minor casualties might come in over the next half-hour while I headed down to the cafeteria and got a sandwich. Still, I couldn't afford to leave without making sure.

"I'm going to grab something to eat," I said quietly to Tyler, as he approached the desk with a stack of paperwork.

He nodded absently. "Okay. You want to grab me a KitKat while you're at it?"

"Um, sure." While Tyler was one of the few nurses that I had actually gotten to know over the last two months, I didn't really know him well. Nurses and surgical interns weren't normally really chummy. It was no secret that the nurses all sort of hated us. "Don't worry about paying me back," I added hastily, as Tyler searched the pockets of his scrubs for change.

He looked up at me, surprised, and then smiled. "Thanks."

I offered a feeble smile of my own. It had been so long since I'd even tried to smile that I wasn't even sure I remembered how. "No problem."

I'd barely made it three feet from the desk when another one of the nurses called, "Dr Grey!"

Resisting the urge to throttle her, I turned, hoping that my face didn't look as murderous as I felt. "Yes?"

"We've got an MVA coming in. The first ambulance is three minutes out." She looked at me expectantly, obviously thinking I was going to leap into action. Did she think I was a resident or something? I was an intern. I'd barely been working here two months. This was my first rotation in the ER without a resident to supervise me. I had no idea what I was supposed to be doing. I glanced nervously at Tyler, who just shrugged.

"Um, page Dr Bailey. And get a couple of trauma rooms ready. Do we know the ages of the victims?"

The nurse shook her head. Ok. So there was no need to be paging pediatrics just yet. "Well, then just page Dr Bailey." I took a deep breath. You can do this, Grey. Dr Bailey will be here any minute, and then you can take over. "And page Dr Marshall," she added as a hasty afterthought. He was in charge of the ER today, and had gone down to the cafeteria to get some lunch. He'd be able to take over for her. He'd know what to do.

The phone at the desk rang again, and Tyler pounced on it. He listened for a few minutes, nodded, and then hung up. "That was the paramedics," he said to me. "The first ambulance is two minutes out, and the patient has severe head trauma."

My heart sank. So much for avoiding Derek today. "Page Dr Shepherd. And get me a trauma gown."

I couldn't believe this. I had been successful in avoiding Derek for the last few weeks, and on the one day where I had an assignment that I knew would keep me far from the endless blue eyes of one charming neurosurgeon, there had to be a trauma that required his attention. One that I was forced to assist on, too. I was never going to feel relieved when I got assigned to the pit again.

Why couldn't today have been a busy day? Why couldn't there have been a million and one other patients who needed my attention, the way there normally were, so that I would be too busy to get roped into working with Derek? Did fate really hate me that much?

Fate doesn't hate you, Meredith. It's just the way it is. You work in a hospital. I work in a hospital. We were bound to run into each other sometime.

I clenched my teeth, trying to ignore Derek's voice in the back of my mind. I'd been hearing it all the time ever since that night when he finally told me he was picking her. I'd taken to calling him my Derek, because he was just like the old Derek, the one that had chased after me for weeks until he finally wore me down. He didn't bother me too much at work anymore, coming out mostly when I was at home, and really only staying away when I was in the comforting embrace of tequila.

Normally, I didn't mind. I knew it probably wasn't helping me in my futile quest to get over Derek, but it was nice to have some small piece of him with me still, even if it was a figment of my imagination. Now, however, wasn't a good time. I couldn't have my Derek's voice in my head while I was trying to have formulate coherent sentences in the presence of real Derek, who was going to be worrying about me and asking probing questions about how I was getting on without him.

I wished he wouldn't. He wasn't supposed to be hovering all the time trying to see if I was okay because it made it a hell of a lot harder for me to try and figure out how I was supposed to put myself back together again. I needed a clean break, not one with jagged edges that stabbed at me every day. And Derek, damn him, wasn't letting that happen.

"What have we got?" Derek's voice pierced the confusion of my thoughts. The words were so achingly familiar—how many times I'd heard him say them in the last two months I had no idea—and his voice was one I had been yearning for, but right now, I just wished he would leave. I'd told him that hating him was the most exhausting thing I'd ever done, but the truth was, missing him was worse. Hating him for failing to mention he was married was easy compared to trying to figure out how to live without him, or dealing with the knowledge that he hadn't picked me. I wasn't surprised—given the option between Addison and me, Addison was the obvious choice—but I had thought—okay, maybe more like hoped—that he might have felt something similar to what I was feeling. The knowledge that he didn't—or at least that his duty to his wife was more precedent—was excruciating, and maddening. I wasn't sure if I hated him for breaking my heart, or admired him for his loyalty.

Tyler—thank God—leapt right to the task of giving Derek the required information, allowing me to flee unnoticed out the doors to wait for the ambulance. The air—chilly for early November—hit me in a rush, stinging my cheeks and bringing tears to my eyes, which didn't help the ones I was trying so desperately to fight.

I'd thought I could handle this. Sure, I'd been doing my best to avoid Derek for the last month, and hadn't said anything to him beyond a few perfunctory words, but I'd believed I would be able to handle actual interaction with him. I'd thought that I'd be ready for this, but the sound of his voice made me want to cry. Who are you kidding, Meredith, the voice of reason in my brain snapped. You can't handle him. You're a mess.

Frustrated at myself for my lack of control, I shoved my arms into the sleeves of the trauma gown I'd been given, fingers fumbling with the ties at the back. Several futile attempts at tying a single bow only made things worse; I could feel the tears of frustration threatening to spill down my cheeks as I cursed my trembling fingers.

"Here."

His voice was soft, caring, as his gentle, steady fingers replaced mine, only making me want to cry more. He shouldn't be so nice to me. He shouldn't act like he still cared. In fact, it would be better if he didn't care at all. I'd rather be some fling to try and get over his wife cheating on him with his best friend than something more meaningful. It was easier to get over.

He tied the knot in silence, fingers lingering against the back of my neck before falling to his sides. The rational part of me was screaming at him to stop, but the larger part of me had missed his touch for too long to protest. He was close behind me I could feel his breath on the back of my neck.

Something could very have come of that moment, but neither of us would ever know what because the ambulance cam screaming into the yard. Derek sprang into action, moving swiftly to the meet it as if nothing had happened, but I couldn't move. I couldn't think, or breathe, or feel anything other than the gaping absence Derek had left behind him. It was just too much. I couldn't do this.

The paramedics were getting out and the opening the back, and the gurney was being unloaded, and Derek was saying things, and I couldn't move. The rational part of me—reduced to next to nothing—knew that I should be there, helping, getting the patient into the ER, but I couldn't. It was like I'd been turned to stone. I was stuck in the past, the memory of Derek behind me running through my head in an endless loop.

"Meredith?"

Derek and two paramedics were rushing towards me, pushing the gurney. I could see the concern filling those endless blue eyes, which only made things worse. He couldn't do this to me; he couldn't cast me aside and then worry about me and be kind and expect me to survive. Every time I started to deal with this, to get myself sort-of held together, he swooped in with his gentle concern and fathomless eyes and shattered everything again.

"Dr Grey?"

It was Tyler this time, his concern masked slightly under professionalism. He was worried, but he wasn't going to press it. "Are you all right?"

I nodded, trying to swallow the lump in my throat. "Fine." I'd used the word so much lately it had lost all meaning. "How's the patient?"

He grimaced. Something about his expression set off alarm bells in my head. "Severe head trauma. Looks like he's going to need surgery. Dr Shepherd's already taken him up..."

"And he needs someone to assist," I groaned shoving my hair out of my face.

Tyler nodded, apologetically. "There isn't time to call anyone else. Otherwise I would, believe me."

"It's fine," I mumbled, brushing past him. It wasn't, but there wasn't anything else I could say. I'd just have to hope I could keep it together for another few hours.

I'd never thought there would be a day that I would dread going into surgery, and certainly not in my intern year. Today, however, all I could think about as that elevator climbed higher was how I wished I were doing anything else. According to Tyler, the head trauma was pretty serious, so we were looking at four or five hours minimum. Add in Derek Shepherd, and you have the perfect recipe for torture. I would almost have been glad if the victim had been a pregnant woman; despite the awkwardness that situation would present, at least Addison would be there to offer a distraction.

By the time I stepped out of the elevator, I had a plan: I had to pretend I didn't care. I had to be professional, if only to protect myself. If I have him nothing to work with—no longing looks, lost expressions, or casual flirting—than he'd be forced to treat me with the same degree of professionalism. So as long as I pretended he was just another doctor and not the guy I'd opened my heart to only to have it smashed, we'd be fine.

You shouldn't be doing this, my Derek said quietly. You deserve better than this, Meredith.

I closed my eyes briefly, willing him to disappear. He was right: pretending not to care about Derek, pretending that I was fine and not barely hanging on by a thread was going to be the hardest thing I had ever done, and it wasn't going to be made any easier with him lurking in the back of my mind all the time.

Telling myself I was going to be professional and actually doing it in the face of the man I thought I was going to spend the rest of my life with are two completely different things, however, something that occurred to me as I shouldered open the door t the scrub room. How many times had I told myself I was going to be fine at work, only to see Derek and freeze up? Who was I kidding? I couldn't do this. I couldn't stand here and make small talk—or any talk for that matter—without making it painfully apparent just how much I wasn't over Derek. I'd thought that avoiding him completely would make things easier for me, and while it provided temporary relief, it made it so much harder when we actually came face-to-face.

I wanted to run. I wanted to turn and run as fast as my legs would carry me in the opposite direction. I could go now. Quietly, while I still had the chance. Derek wasn't here yet. I could get out, get my things, and leave. I could move to another city—surely there was another program that would take someone with records like mine—and never have to look at Derek Shepherd or his wife again. I'd be able to start fresh, focus on the medicine, and not let myself get distracted by chatty, dreamy attendings. I deserved better than this. I owed it to myself to get out while I still could. The Chief would understand: it wasn't like he didn't know what was going on; the whole damn hospital knew.

Mind made up, I crossed the room to the door. I had to get out of here while I still had the chance. Not pausing for a moment to think about the possible consequences of what I was about to do—like the fact that Derek might not be able to operate without my assistance—I opened the door, and ran smack into Derek.

"Meredith?"

I froze, unable to ignore the knife twisting in my gut. Those deep, blue eyes locked with mine, full of sadness and surprise and concern, and I knew I was screwed. There was no way I could run from that hypnotizing gaze—I'd tried, unsuccessfully several times.

"I, uh..." I knew I was supposed to explain what I was doing here, to tell him that I was the intern assisting on the surgery, but the words escaped me. My mind was reeling, rendering it impossible to try and think straight, let alone string together a sentence. Words, both Derek's and mine, chased themselves around my head in dizzying circles. Pick me. Choose me. Love me. We've been married eleven years. You're choosing her, aren't you? She's my wife. Pick me. Eleven years is a long time. I can't just throw that away. Choose me. I owe it to our marriage...Love me. Meredith, I'm so sorry.

"Meredith?" Derek's hands gripped my arms gently. His touch brought back memories of long evenings and lazy mornings in bed, wrapped in each other's embrace, and made my heart ache with longing. He had to stop doing this. He had to stop making me feel this way, making me remember these things, because it was killing me. Literally. "Are you...?"

Suddenly realizing how this looked to anyone who might be passing by, I hastily disentangled myself from Derek's grip and turned away from him, heading towards the sink. "I'm assisting you on the surgery." I was surprised at how cool and detached my voice sounded, given my inner turmoil. Judging by the look on Derek's face, he was equally surprised, whether because of my tone or the news that we would be spending hours in surgery together, I didn't know.

He swallowed. "Oh." His choked tone of voice did not escape my notice, which only made things worse. He wasn't supposed to be suffering. He was supposed to be happy. He didn't choose me. He chose Addison. He was supposed to want Addison. He wasn't supposed to be with her and still want me. That wasn't how it worked. If he'd wanted me, than why had he chosen her? He didn't strike me as the type to be a martyr.

"Tyler told me that the case was pretty serious and there wasn't time to get anyone else," I continued, making it perfectly clear that this wasn't something I had chosen. I didn't want to spend another moment in the OR with him any more than he did.

"Uh, it is," Derek said quietly, coming to the sink beside me to scrub in. "He's got a severe subdural hematoma, and possibly several other bleeders. I didn't have time for a CT, so I'm not exactly sure what's up there. It'll be a long surgery, though," he added, glancing sideways at me as if he expected me to bolt. God knew I wanted to, but there was no backing out now. Besides, running would only give him what he wanted. I was fine. Or at least it was imperative that everyone thought I was. Especially him.

"I know."

I finished scrubbing in as quickly as I could and left the room, eager to get to work so that I would have something to think about other than Derek. These next ours would be so much easier if I could keep my mind focused on the surgery and not the man performing it.

Derek seemed to be thinking along the same lines; when he entered, it was as if I wasn't there. He got gowned and took his position at the patient's head without saying anything, taking a moment to collect himself and assess the patient one last time, probably preparing an entrance strategy. It wasn't until he was ready to begin that he spoke.

"Are you sure you want to do this?"

His voice was so quiet that no one but myself could hear. I knew he wasn't asking in a professional context; he and I both knew I was more than capable of toughing this out. He seemed to be wondering whether or not I could do this with him.

"I'm fine," I replied quickly, avoiding his gaze. I wasn't going to sacrifice a learning opportunity to save my heart. It was already shattered beyond repair, and another few hours with Derek wasn't going to make it any better, but it wasn't going to make it any worse, either.

"Well, then. It's a beautiful day to save lives. Let's get started."

My hand started to cramp up three hours into the surgery. It was the longest surgery I'd scrubbed in on yet, and Derek was nowhere near finished. My sole responsibility was to hold the clamp, allowing him to fix the bleeders and damaged tissues. If the clamp slipped, the bleeding would be more than Derek could control.

I tried to ignore it at first. If I just pretended I couldn't feel anything, maybe it would go away. Muscle cramps didn't last forever. I turned my attention instead to Derek's work, trying to focus on what his hands were doing instead of my own.

I could always switch hands. My left hand wasn't nearly as dominant as my right, but it steady, and I wouldn't be using it for long. I'd just hold it until my right hand uncramped, and then I'd switch back. Nobody would ever have to know.

My conscience was prodding me to say something, though. The responsible thing to do was to let Derek know that I was going to be switching hands, to avoid the worst-case scenario. The surgery junky, on the other hand, argued that any sign of weakness could get me removed from the case. This may have been the most painful, awkward surgery I'd ever assisted on, but it was also one of the most intense, and I didn't really want to throw that away. Though, the rational part of me countered, if I didn't say anything and Derek found out, I'd probably be thrown out of the OR and not let back in for another week.

"Dr Shepherd?" Rational me trumped surgical junky me in this situation.

"Yes, Dr Grey?" His tone was distracted. Clinical. We seemed to have fallen into a routine for the last thee hours: be impersonal and professional towards each other. Had the rumour mill at Seattle Grace not been what it was, nobody probably would have known that anything had happened between us.

"I'm going to have switch hands."

Derek glanced up from his work briefly, the first time he had made eye contact with me since entering the OR. My heart clenched as our eyes locked, and I could see something more than cool professionalism lurking in his eyes. "What?"

"My hand. It's cramping up, so I'm going to switch hands," I said calmly, fixing my gaze firmly on the patient's exposed brain. It was a great way to forget about all my inner turmoil.

"Oh." He seemed surprised by my statement. "That's fine, Dr Grey. Just be careful."

"Of course, Dr Shepherd." I hated calling him that. Before, Dr Shepherd had been a defence mechanism, a way of deflecting inappropriate advances, or it had been used in affection, to tease him. Now, I had to use it anytime I addressed him, because Derek was too familiar a way to address your boss. It just felt wrong. My tongue was itching to call him Derek, to say his name again and again, but I couldn't. Not anymore. He had burned those bridges when he chose his wife.

Carefully, as so not to move the clamp and cause to patient to bleed out, I replaced my right hand with my left, relishing in the ability to stretch out the cramped muscles. The digits in my hand were stiff and sore from being clenched in the same position for so long, and I was now beginning to realize exactly how gruelling surgery could be. It wasn't always going to be easy and exciting.

"You know, I'm impressed," Derek said conversationally, not looking up from his work. "Some more suction here, please, Bokey."

My free hand, which had been clenching and unclenching in an effort to stretch out the cramped muscles, froze. This wasn't professional conversation. We were now entering dangerous territory, territory neither of us should be entering if we didn't want to get hurt. "Impressed?"

Derek nodded. "Most interns would have said nothing, or asked to be excused from the surgery, or even panicked. You just stayed calm, came up with a solution, and let me know ahead of time that you were going to move. That's very impressive."

It was as if a huge weight had been lifted off my shoulders. He wasn't going to wade into the murky, painful waters that were our personal lives. The comment was purely professional. "Uh, thank you," I mumbled, deciding not to mention how very close I had been to not saying anything at all.

The rest of the surgery passed smoothly. The craniotomy was extensive—the patient had an excessive amount of bleeding in his brain—but there were no complications, which was a relief. With everything that was going on now, I wasn't sure I could handle any more stress. Derek, thankfully, refrained from attempting to make any more small talk. He explained a few of the finer details of the surgery and pointed out techniques that he was using. I asked a few surgery-related questions, which he answered. Other than that, he worked in silence, and I watched him, hand holding the clamp firmly in place. My Derek stayed silent, allowing me to immerse myself in what was happening in front of me, and forget about the world that existed outside the OR.

Seven hours after we walked in, Derek finished closing and stepped back from the patient with a small, satisfied smile. "Well that's it," he said, unable to keep the satisfaction out of his voice. "He should make a full recovery."

There was a moment of silence as the words set in, and then the OR burst into applause. I couldn't help from clapping politely as well. That was by far the most complicated and impressive surgery that I had ever seen—including all the procedures I had watched my mom do over the years—and, despite how much my life had sucked these last few weeks, I couldn't help feeling that unbelievable high that accompanied a successful surgery.

Derek chuckled at the applause, shaking his head. "Thank you all, but you know, I really can't take all the credit. Dr Grey here did an incredible job. Holding a clamp for seven hours without flinching is no small accomplishment."

Underneath the surgical mask, I could feel my cheeks flushing, as everyone suddenly turned to look at me, still applauding. I couldn't help notice that Derek had joined in, looking pleased. You should say thank you, my Derek chided. It's not every day that I praise interns in my OR.

And you should stay the hell out, I snapped back. This is none of your business. Besides, you shouldn't be praising me in front of everyone. It looks bad.

Not able to think of anything to say, I just ducked my head awkwardly, and fled to the scrub room. The sooner I got out of here, the better. José Cuervo was calling my name.

I'm allowed to draw attention to the things you're doing right, Meredith, my Derek continued, as the doors to the OR hissed shut behind me, cutting me off from everyone else. You shouldn't sell yourself short.

Yeah, but you can't be doing this to me, I protested. Everyone's going to think you're praising me because of what happened between us, not because I did a good job.

Oh, so this is now my fault? As I recall, you were the one who decided we were going to do this relationship thing.

Yeah, and look how that turned out.

"Are you all right, Meredith?"

I jumped, heart hammering in my chest. I'd gotten so wrapped up with the Derek in my head that I had forgotten about the real Derek.

"I'm, uh, fine," I replied hastily, turning my attention back to scrubbing my hands and trying to act as if he hadn't just scared the crap out of me.

There was a moment of tense silence as we both washed our hands. Derek was the first one to break the tension. "I'm sorry if I put you on the spot there. You really did do a great job, though."

"It's fine," I repeated, a little more firmly this time. I didn't really want to talk about it anymore.

"You're going to be a great surgeon, Meredith," he said, offering me a smile. It was a shadow of its former glory, but it was the closest thing to a real smile I had seen in weeks.

I wanted to hit Derek. He wasn't supposed to care. He wasn't supposed to be making little comments like this, personal, supportive, caring comments, when he had chosen the other woman. How was I supposed to get over him if he never stopped acting like nothing had changed?

"Meredith?" I could hear the concern in Derek's tone; feel his gaze resting on me, but I kept my eyes fixed firmly on my hands. He should know better than to bring my mother up.

"She wouldn't have been proud of me. She was never proud of me," I said quietly, shutting off the water. I didn't want to do this now. Or ever. This whole "friends" thing that Derek seemed to want was never going to work, because it would be too easy for me to pretend that Addison didn't exist. I wasn't going to be that woman, the one who went and slept with a married man. My mother's indiscretions had been the reason I didn't have a childhood. I wasn't going to do to Addison what my mother had done to my father.

"Meredith, you don't know that," Derek began gently, as if he were calming a frightened animal.

"Don't act like you knew her," I snapped, suddenly frustrated. He just didn't get it, did he? I didn't want him to be nice to me. I didn't want him to try and look out for me or encourage me. I wanted him to leave me alone. I was heartsick and exhausted and I didn't have the energy to be nice to him or pretend to be okay around him. "There wasn't anything I could have do that didn't disappoint her. So don't try and tell me she would be proud of me." And with that, I fled the scrub room.

"Meredith!" He didn't call particularly loudly—neither of us wanted any more gossip spreading around—but it was loud enough for me to know he was going to come after me, which was the last thing I wanted. I couldn't do this anymore. I'd just spent the last seven hours being professional and making surgical small talk with Derek, and I couldn't do it anymore. I had to be alone for a bit while I dealt with the harsh reality that had been once again shoved in my face: Derek wasn't mine, and he wasn't ever going to be.

Thankfully, I didn't have to wait for the elevator. Waiting just gave Derek more time to catch me, and while I could have taken the stairs, getting caught by Derek in there was not an option, especially since the last time he caught me in there, we practically ended up having sex.

Tears blurring my vision, I stumbled into the empty elevator, pressing the button for the third floor. I leaned back against the wall, painfully aware of how often I had witnessed Derek in a similar pose, and tried very hard not to cry as the doors began to close. I had to keep it together until I was home. Then, I could cry my heart out into my pillow, and the whole hospital wouldn't know about it by rounds tomorrow.

"Hey."

My heart sank. Crap. He'd caught me after all.

"Meredith?"

I couldn't look at him. If I looked into those sad, pitying, concerned eyes, it was all over.

"Are you all right?"

Was I all right? Did he really think, after everything that had happened, that I was fine? "No," I said finally, hating how choked my voice sounded. There was no hiding the fact that I was on the verge of tears now.

"What?" He sounded genuinely confused, which made me angry. He was a highly intelligent man, so how could he not understand what something like this would do to someone like me?

"No, Derek, I'm not fine," I snapped, looking up at him. "Happy now? I'm not fine. In fact, I don't think I'll ever be fine. Not when it feels like my heart has been ripped out of my chest and dashed into a million pieces. Is that what you want to hear?"

Derek looked horrified. "No, Meredith, no. That's not at all what I want!"

"Then why the hell do you keep asking me if I'm okay?" I cried. "If you really don't want to know how I'm doing, why do you keep bringing it up?"

The question hung in the air for a few minutes. Derek, for once, seemed unsure of what to say next. "Meredith—" he began, but I wasn't ready to let him finish.

"And you want to know why I'm not fine? Because you won't leave me alone! How am I supposed to get over you when you're always there, saying things, and caring, and being...you!?"

He sighed, running a hand through his hair. "Meredith...what do you want me to say?" He looked so weary, so lost, that I felt bad for a brief moment. I wasn't the only one suffering.

But he's the one who chose, the rational part of me pointed out. He picked her.

But I'm miserable with her, Meredith. Can't you see I don't love her? my Derek protested. You're the on I want Mer.

Then why are you with her? rational me argued. Why aren't you with me?

SHUT UP! I cried. All this mental bickering was making my head hurt. I had enough on my plate as it was. I didn't need them fighting, too.

"I want you to leave me alone," I said quietly.

Do you want me to be the better man?

Yes. No. Crap.

"But—"

"You chose her, Derek. You can't have us both." As much as it pained me to push him away, as much as my heart was screaming at me to take him back, he had to hear this. This was the way it had to be. "That's not fair. It's not fair to me...and it's not fair to her, either," I added quietly.

There was a long, pained silence. I could feel the tears burning in my eyes, and I bit the inside of my lip until I tasted blood to keep them from falling. I was actually doing this. I was telling the love of my life to leave me alone, no matter how much I wanted him to stay.

Finally, Derek spoke. "You're right. It's selfish of me." His tone was quiet and resigned, tinged with bitterness. "I just..." He trailed off, blue eyes imploring me to understand what he couldn't say.

"I know," I whispered. And I did. I got it now. He was being the better guy. He was being true and honourable, and anything else wouldn't make him Derek. "You're being the better guy."

"I don't want to." The admission was quiet, and probably the closest thing I was going to get to him admitting he was trapped in a loveless marriage. Which was fine. It was hard knowing he wanted to be with me, but at least I could pretend he didn't. Saying it out loud would make it irrefutable.

"But you have to," I repeated. "You chose her."

"Meredith," he whispered, closing the distance between us. I shivered involuntarily when his hands brushed my arms. This was what I had been missing, what I had been yearning for for so long.

I knew he was going to kiss me, and even though it was what I had been dreaming of for weeks, I couldn't. It would only make all this so much harder.

"Derek," I said softly, stepping away. "We can't. It's over."

He looked for a moment like he might kiss me anyways, but the elevator doors opened and he pulled away.

"Goodbye, Meredith." He gave me one last long look before I exited the elevator. Coward that I was, I couldn't say it back to him because I didn't want to acknowledge what we both knew.

It was over.