Summary: Mari considers the ER. Derek offers coffee. The Grey sisters suck at communicating.
chapter nine: liminal space
Mari passes a tall janitor mopping one of the open trauma rooms, left trashed and bloody, and he looks up, reading her newness in her ironed clothes, and straight-edge, and says, very matter-of-factly. "People die here you know."
That's how she enters the ER.
She slides out of a nurse's way, toes curling in her running shoes, and tries to block out some of the noise. Squeaky shoes against linoleum, impatient demands, coughing, sneezing, wheezing, heart monitors, and curtain rings rattling against metal, drawers being yanked open, doctors relying orders, nurses coordinating, calm down ma'am, and it shouldn't be long now, and we're waiting on tests, and when did that start?
There was less sound, less static, less immediate concern, in a lab, in a morgue. An easier test of cleverness, when you had time to be methodical. Less places to trip and trip up.
She had turned down an emergency internship in med school, ignored the sage advice. Start in trauma, start in muck, and gruel, and too-much and all-at-once, to the point where you can't think about anything but getting through it, and somehow this miraculous transformation was meant to take place.
Caterpillar to butterfly. Composure under pressure, hardwired in.
She didn't think she needed it. Thought her childhood had given her enough.
Only, now, without mentorship, or guidance, or much of any aid, she realizes she can't command like House, like her mother, like her ex-boyfriend even, who gave her a lifeline by bluffing through a lawsuit about a broken employment contract that might not even be broken. She's been weighed, and found wanting. Missing some tangible, distinguishing mark, when she tried to explain the situation with Dr. Bearden and was admonished. She hoped to bring her case to the Chief for correction, and found he was dodging her steps. She went to HR and the hospital counsel for advice and was condescended to and waved away. Three tries, each unwilling to consider her. Three strikes, and out.
Dr. Doug Ross, Head of the ER, looks through her résumé, balanced on a chart of a child with a chest cold, and whistles lowly.
"You came to the wrong hospital." he tries to hand it back and raises his brows when she doesn't take it. "Look. You've never worked an ER, and this isn't the place to learn emergency medicine. Trust me."
Slowly, skeptically, she asks, "at a Trauma One hospital?"
He gives her a sardonic look. "Where emergency physicians have to run everything by surgery. You lookin' forward to waiting for approval on every assessment, every diagnosis, every test?"
She flounders.
Dr. Ross smiles, closed mouth, and wry, like he's beaten his head against that wall so many times it's lost meaning. "Even the nurses here," he waves the back of his hand around, turning his attention to the inbox/outbox of messages "aren't truly trained in emergence care. Like all the ER resources, they're floaters from the surgical department." He clicks his tongue. "Now we have 20 surgical interns to deal with. You know how many interns the ER got?"
"One."
"That's right."
Mari presses her arms behind her back, locking her wrists. She can't keep changing course, by telling him never mind. Not now that she's seen where her experience is deficient and how to correct it. "I'm only asking for a rotation." She can put up with all of that, for a rotation. Surely. "You might need help fending off the twenty surgical interns when they pilfer through traumas and neglect the true drudgery."
Dr. Ross pauses in sorting through his messages, eyebrows twitching at a word like drudgery.
Mari presses closer. If there's only one intern on the ER side, then there's unfortunate slack that will need to be picked up. Patients passed over because their concerns aren't surgical, their needs not prioritized as immediate. She's trained in assessments, even if not emergency care. She has some advantage still.
Dr. Ross listens to her pitch, there in the ER, her résumé still in hand only because she wouldn't take it back.
"Alright, alright, let me look at this thing," and this time he gives it actual consideration.
If she professes to speak multiple languages on her résumé – none particularly useful to him, besides Spanish, as most of the non-English speakers who come in are from South Asia - then why not test her on a language she'll actually need to know.
"Thoracostomy tube?"
"Chest tube."
"Lac?"
"Laceration."
"Ambo?"
"Ambulance."
"ABG?"
"Arterial blood gas reading."
"Chem-7?"
"Blood urea nitrogen, serum chloride, CO2, creatinine, glucose, potassium, sodium."
It's not secret, that this is an interview, impromptu and in full view. When he doesn't stump her with the routine, others join in.
Doug Ross married a charge nurse, so he knows nurses are much harder, and cannier on judging the young interviewee doctors, than he could ever be.
She handles it… well enough as they lose her in ER specific slang and nurses' shorthand, stay away from the mnemonic devices every fresh-from-med-school graduate still has memorized.
Mari licks her teeth, after the twelfth wrong answer, eyes narrowed but slightly unfocused, like she's running through textbooks in her mind as she asks for another one.
He sits back against the admin desk, until he thinks if he doesn't make the call, she'll stay chatting with the nurses, turning it so it seems like she's the one testing them, prompting them for more and more.
"I can have someone run you through orientation, before 2nd shift," he decides, pulling her out of her narrowed focus. It might be a nurse; it might be an ER resident. It's a reality of who's available. A surgical resident might commandeer her for themself, have her run scut like one the interns.
He meant what he said, about this not being the place to learn emergency medicine. The tone of the ER is let surgical have its way first, and handle what's in its wake. Everyone who's actually trained in emergency assessment and trauma, is on the way out. Him included.
"First shift will be 48 hours by the way." He waits for that twitch of dismayed agreement everyone has, before smiling ironically. "Welcome to the ER."
(212-555-4247): I'm doing follow up w katie bryce soon
(212-555-4247): you know technically youre on this case. you could join me
She remembers Louis going to metaphorical war with the cell phone store when they assigned him a 646 number, because he didn't want to be grouped in with the plebs of not-true New Yorkers, newly moved to the city. A 212 number was old New York, established Manhattanite. The kind of New Yorker that didn't leave 'the' city for anywhere further than the Hamptons.
She's debating still, if it's worth it to head to the house, to eat something properly nourishing, and take a nap, before she needs to come back, sort out paperwork, and start her delayed shift, when the text messages distract her.
Mari: technically I don't work here
(212-555-4247): don't tell me you were pretending to be a doctor. Its very convincing
Mari: real doctor. Guy sold me a diploma and everything
Mari: this is just a strangely run hospital
She inputs his contact into her phone. No honorific, so Derek Shepherd, could as easily be Derek, from the bar, or Derek, a colleague.
Derek Shepherd: Explain over coffee?
She shouldn't. She has a 48-shift stating in 5 hours.
Mari: Where?
At the third floor, east wing coffee cart, she catches Derek being handed two coffee cups.
He's in royal blue scrubs, again, or still, with his white lab coat thrown over them.
Now that she's seen the ER, and walked the hospital, she knows the color coordinated hierarchy. Royal blue for attendings. Light blue for surgical residents and interns, and scrub nurses only when they're in the OR. Green for medicine. Pink for OB and GYN, brown for nurses everywhere else.
She slides her hands down her tan A-line skirt, and wonders if she looks neutral, or disjointed, with everyone but the coffee attendant in scrubs.
"How do you take it?" Derek asks, passing her one of the waxed paper cups with a greeting smile.
Mari glances down at the black, steaming liquid, feeling the scorch of it against her fingers. "Reluctantly?"
He's in the middle of shaking out a sugar packet when his eyebrows jump. "You don't like coffee?" he asks, aghast. One sugar is smoothly poured in without spilling a granulate and then dispersed with a wooden stirrer, each motion easy, like he's done it a thousand times while he's shaking his head at her.
Whisky neat, but he sugar in his coffee. Interesting.
"The aroma is nice," she concedes fake-begrudgingly. "And the caffeine."
She's never developed an actual palate for it, but it's an old nurse's wisdom, that hot coffee is the best way to keep from getting sick, when working in a hospital. Better than tea, but she wonders if that's just preference.
Derek throws the stick into the trash with a distracted twist of the wrist, while both of them move out of the way for the next person to be handed their order. He notices she didn't add anything to her cup. "You don't like it, but you drink it black?"
"Coffee has antioxidants. Sugar on the other hand," she gestures to his cup "is a primary-risk factor in every study not funded by a food company, and coffee creamer has thickening agents, and artificial sweeteners, and machine lubricants, that are begging for spiked blood sugar and gut issues."
A short Asian doctor behind Derek glares at her as he grabs a handful of coffee creamer. "No," he says aloud. "She's not going to ruin coffee for me. Not today."
Derek brows crinkle. "You know this," he gestures between them "might be a deal breaker."
"For you or for me?"
"Oh, I seem to be accruing deal breakers from you. I'm a surgeon. I like coffee. You're too attracted to me."
A woman behind him, tall and pretty and brunette, turns to watch him. Mari catches it while taking the smallest sip of her hot coffee, feeling the steam burn like a blush.
"But no," he continues musingly "I meant for me. Coffee happens to also be my favorite ice cream flavor."
"Well, that's that then," she raises her coffee cup to her quirked eyebrow, saluting farewell.
Derek's lips lift, one corner higher than the other. "Why say yes then?" he wonders, daring.
He said he wouldn't ask her on a date. That he would wait for her to make the first move, given her misgivings.
But he texted her in the 3-day window since she gave him her number, and there's a social connotation there, about showing interest.
She bites the corner of her lip, shaking her head to avoid looking into those damnable blue eyes. "I didn't say yes because of the coffee."
"Okay." When she peeks over at his expression, he's smiling.
Derek tilts his chin towards the bridge to the other wing, the light bright and white. "Come on, I want to show you my favorite spot."
She can admit Seattle Grace is beautiful. The atrium and the glass bridge looking over it in particular. There are trees at least 10 feet tall inside and outside the entrance in a straight avenue in well-designed lines. Derek places the flat of his palm against her upper back and leads her in a turn to face away from the entrance, and towards the south windows where it's untampered, unmanicured trees, a blue sky, and white fluffy clouds almost swallowing up the top of an expansive mountain.
"Did I get you in trouble, taking you for the Katie Bryce case?"
Mari watches him lean against the railing, turning away from the view. It's strange to think, if all had gone well on her first day, she never would have had the time to join the Katie Bryce case. "Is that what you did, Dr. Shepherd," she teases, not looking away from the picturesque scene, "take me?"
He huffs in amusement, leaning closer to murmur, "well –"
She has to remind herself; this is not normal dating; this isn't the guy at the bar. That flirtation, and that kiss, was… reckless attraction, with a potential she'd never see him again, and wanting to feel something nice, and good, in a brand-new city.
"It wasn't you," she reassures him in a close murmur, eyes flickering away.
She considers, for half a second, about confessing how frustrating the past few days have been, how her career was circumvented, but therein lies the reality.
He's a surgeon. Even if he's not one for hospital politics, and she isn't sure he isn't, moving to Seattle to head a department, he's still a surgeon.
If she told him, and he didn't see a problem in it, in the Chief singling her out and going against her wishes, if he thought she wasn't considering the opportunity?
That nice, and good feeling, in this brand-new, uncomfortably haunted environment, will disappear on her. She'll be cured of Derek Shepherd.
Mari sips at her coffee, tasting its full, warm bitterness, and admits to herself she isn't ready to be cured yet. "It's handled now, so…there's that."
Derek pauses, before he leans back. He clears his throat. "Well, are you free to join me for Katie's post-op?"
"Do you…have any concerns?" she blinks, realizing that he was re-orienting, heading back over the line of professional, that he didn't just use it as an excuse, but is including her in Katie's post-op care.
"No," he shakes his head lightly, giving her a run-down so far. She's come off the anesthesia with limited confusion, knows her name, knows what happened.
Mari freezes, realizing...
He's a Neurosurgeon.
Head of Neuro, in his 30's, at a well-regarded metropolitan hospital, where he was obviously scouted for the position. For the past four years, she's wanted to pick the brain of a neurosurgeon, after getting tired of much-too-short academically framed questions to neurologists. She wanted someone brand new who wouldn't think the intent of her research was telling, who could hold a discussion without needing consultation.
She hates the studies done on neurodegenerative diseases like Alzheimer's and what looks like Alzheimer's, how all of it branches from the same suppositions made decades ago, and no one considers that any of it, the entire foundation of it could be wrong. Not many even question that one of the leading risk factors was lower intelligence and schooling.
She found him, and she wasn't looking, and that is the most dangerous thought she's had about Derek Shepherd so far.
Mari presses down hard on her heels, to keep herself grounded.
"What kind of cognitive tests do you prefer to use?"
"Hi Katie," Derek greets the angry teen sitting up in bed, fists closed at her knees, gauze wrapped around her bulbous head.
She's still in the open floor of post-op, with curtains half closed around the beds, and her mother and father squeezed in at her side. They both look up at Derek's arrival, tired eyed but relieved in the attention of Katie's surgeon.
Katie gives Derek a biting, sarcastic smile. "Thanks for making me completely bald. Really."
"Yeah, I know. it's the worst thing ever," he agrees, pulling out a pen light to check her pupils. "But, with the location of your – "
"Yeah, save it."
"Katie," her father warns, rubbing at his eyes.
"Have you ever heard of a bald beauty queen?"
Derek's lips twitch, amused at the shallow girl, who cared more for her hair, and her looks, and her pageant, than the consequences of brain surgery.
The nurse near Mari smiles too on her way out, a schadenfreude twist to it, as she makes deliberate eye contact with another nurse and they both suppress giggling.
Katie's burning eyes are on the nurse's back, as her parents are only focused on Derek, and Derek is split between evaluating Katie and answering the parents' questions.
Katie juts her jaw at Mari, who still stood back, daring her to mock her too.
"Maybe this is a sign that you should take a break from it. Just focus on getting better. You could start applying yourself more in school," Katie's mom reaches for her daughter's clenched hand.
Katie trembles, too weak to yank away, with only one possible outlet left to her, ready to turn on her exhausted mother, or button her lip from showing further weakness. She might do it by complaining incessantly, or not mentioning any pain or confusion at all.
"I've heard of a bald beauty queen," Mari answers Katie's earlier question, stepping further into the space until she's at the foot of Katie's bed. She briefly glances at Derek, wondering it's okay with him. He tilts his head, lips curled in closed-mouth agreement. Mari loosens her shoulders. "Last year, though I suppose," she frowns in consideration "it depends on your definition of beauty queen."
"Was she part of the circus?" she asks, completely monotone. "Or I suppose," she mocks Mari's accent "you were actually at a drag show."
"Katie," her mother sighs, rubbing at her eyes.
"Perhaps you wouldn't have labeled her such, but she commanded a room with thousands of people in it by whipping her wig off."
Katie looks at her dully. "Wow."
Mari nods, widening her eyes. She's better, at mimicking Katie's irreverence to pull her in, contrasting sharply with her sincere parents, and Derek's easy charm. " I know. Have you ever been in a big room with a lot of people? Look around, see the way people's eyes glaze over, listen to them mutter about little things that have no relevance and little importance, and feel mind-numbingly bored with it all?"
Katie doesn't blink.
"Breast Cancer Benefits are like that too," she says conversationally, "though people like to pretend they're not. They bring out the statistics, reuse the same platitudes. Clap when prompted, eat a mediocre dinner. Pretend it's not boring and corporately sanitized and always leading to hey, cancer sucks, but have you tried giving us more money?"
Katie's father snorts. Derek smiles curiously.
Mari lowers her voice. "That's why what Samantha Jones did shocked them. It's one thing to say a woman is still a woman when chemo strips her of her hair, and takes away the glow of good health, and another to show the reality. That it isn't ugly."
Katie swallows.
"So…maybe she wasn't a queen, but beauty and power?" she raises her brows, pausing on it. "I think the hundreds of women who stood up in solidarity would say she had that in spades."
Katie splits her attention during the cognitive exam, to Derek, and to Mari.
"How do you not notice?" she frowns. "Wigs look totally fake."
"Because you only notice the bad ones."
She rolls her eyes. "Yeah, sureee."
"I bet I could fool you," Mari challenges, smiling secretly as she crosses her arms as leans back in the chair next to Katie's bed.
"I bet you couldn't."
She has to think over her schedule first, before figuring out when she could work it in.
"I can visit you Friday after my shift, and you won't be able to if I dyed my hair or I was wearing a wig."
"Alright Katie, what were the three words I gave you?" Derek interrupts, shaking his head.
"Gold, waterfall, zebra," she answers before turning back to Mari. "Why would you have a wig?"
"To look different," she answers literally.
"I'll be outside, by the way, talking to your parents. In case either of you suddenly realize I'm not in the room," Derek quips, doing just that.
Katie leans back into the bed with an exhausted sigh. She tilts her head back, before slowly lolling it to look at Mari.
"Did you have cancer?" she asks frankly.
Mari snorts at her utter lack of social grace. "No."
"What color is it then?"
"That would spoil the surprise."
"I think you were the first person she's listened to, since she's been here." Derek remarks, opening Katie's chart at the nurse's desk.
Mari leans over to glance at his notes, seeing what medication Katie is on, how he wants her to be monitored. His handwriting is a quick, pointed cursive that she finds thankfully legible.
She's impressed actually, by his thoroughness. Vision, grip, reflexes, and sensitivities with the usual cognitive tests but sprinkled in without Katie realizing they were prompts for her memory, things she corrected him on, remembered steps to different tasks.
She almost asks if he's warned Katie's parents that she might be epileptic now, isn't out of the woods of some cognitive disfunction, and depression, but stops because that might be an overreach. She isn't one of Katie's doctors, she's just…a consultant?
Sherlock Holmes, she thinks, wishing that were true.
"Were you in any beauty pageants?"
Mari blinks, peeking up at him in confusion. "No."
He hums, pen tapping. "I suppose that isn't the sort of thing Ellis Grey would encourage?"
Mari pulls back. She looks out over the post-op, in varying degrees of post-surgery, wondering why he's asking. "No," she agrees.
She's not sure what her mother would have said, because the opportunity never came up, and it's past the point where she can ask her now. Beauty pageants, she parrots her mother's voice when she's particularly scornful, as if beauty is all that women should strive for?
Or she's just as likely to say something else, about the practicality of beauty, and women being smart as long as they used it as a tool to reach higher.
"You like The Clash," Mari muses, glancing over at Derek with a turn on her head. "So, you like 80's punk rock?" she infers.
He nods agreeably enough. "Sure."
Mari was a child of that decade, but he was a teenager. It might be sentimentality more than the style, but he should be familiar with this one.
"Do you know Surrender by Cheap Trick?"
"Mommy's alright, daddy's alright, they just seem a little weirdddd," he sings quietly.
Mari bites the corner of her lip. It's worrying that she finds his off-key singing charming.
"They rewrote a line, during recording. Too scandalous."
He tilts his head, intrigued.
"Mommy served in the WACS in the Philippines," she sings. "Now I had heard the WACS recruited old maids for the war was recruited old maids, dykes, and whores."
"You're kidding."
"Nope," she pops the 'p'. "Like I said, too scandalous." She pauses, "but poignant. Can you get a new nurse assigned to her?"
Derek frowns at the transition. "Why?"
Meredith was her intern. She has to word it, so it doesn't reflect on anyone individually.
"She had stiffness in her neck and shoulders when she came in, but she didn't mention it because she thought it was from working out."
Derek's jaw clenches. "Which is a symptom of a subarachnoid hemorrhage."
Mari makes a face in agreement. Katie almost died, for a symptom unspoken.
"People are never their best selves when they're being mocked," she muses, something of an observation, and an excuse. "Unless they have an unusual amount of grace. I think Katie fell into the trap of matching it by exaggerating her worst characteristics and hiding her discomfort." It was apparently epidemic. Feminine pursuits apparently weren't in vogue. She's not sure Ellis Grey wouldn't have been on the side of the beauty queen. A girl who followed her passions keenly and didn't apologize.
"I told her about the chance for rebleed," she confesses.
She isn't sure what warnings Derek gave going into and coming out of the surgery. He doesn't look angry, just thoughtful, but she gives him a moment in case he wants to address her for the overstep.
"I didn't give her a list of symptoms," she reassures, lest he worry Katie's pain will be psychosomatic "just told her to bring up any concerns or discomforts, and not to worry about being too forthright."
Derek sighs, running his hand through his hair. "I didn't think she would be the type to hide discomfort."
She doesn't have an answer to that. It was baffling sometimes, that people still lied and kept silent, choosing secrets and pride and embarrassment over their own care. But the truth was, they didn't know it was that serious, what they were risking, what they didn't know was relevant.
He presses his lips, folding up the chart. "Do you think I was being mocking?"
Mari gives him a look, asking if he really wants her to answer that.
Four sisters, he said. There was some mockery, for the teenage girl who acted like a teenage girl, who was seemingly shallow in the face of her dreams being put on indefinite, or permanent, hold.
"Only a little," she holds up her fingers a centimeter apart.
Derek exhales, turning so his back rests against the admin desk. He slouches, so their heads are almost aligned, his hands stuffed into his white coat.
"How did you know?" he wonders, inclining his head towards Katie's side of the room.
Mari pauses. "Her guard was up." She says simply. "How long do you think it will be until she can return to gymnastics?"
"Months. If she can."
"You should tell her parents the gymnastics saved her life."
He raises his brows.
"It did," she insists. "There were no indicators that this was a burst aneurysm. That we knew of. If she didn't take this pageant so seriously, or her rhythmic gymnastics with such fervor, I would not have considered that diagnosis."
Assuming she lived, the brain bleed would have needed to get much worse. She likely would not have woken up so cognizant, Derek's skill notwithstanding.
"Maybe she can't have gymnastics again, but at least she won't have her parents telling her that's a good thing."
It's the first time today, that she sees Meredith.
She smooths down her skirt, wondering if Meredith will ask why she isn't in a white coat.
"How's hour 51 out of 72 treating you?" she opens with, dropping her hand with her wristwatch.
Meredith doesn't look up, scribbling notes in one of her charts. She's uncomfortably huddled in a blocky chair pushed into a corner of the post-op room, a pile of metal charts under her current one.
Mari scrutinizes the little she can see of Meredith's face. "Are you hydrating? Too much coffee always gives me such a headache. I actually used to set an alarm, to remind myself to drink water, so I could get ahead of it."
"Oh?" Meredith murmurs, low and expressionless, still not looking up. "You had 72 hour shifts in your intern year? I didn't know internal medicine was so hardcore."
Mari brows furrow. "It had its moments." She says slowly. "Have you slept at all?"
Meredith looks up, jaw tense, and eyes unreadable. "Mari, I don't need your advice. I may be behind you, but I'm in surgery. So, if you're done talking to me, I really need to finish these S.O.A.P. notes."
Mari just stares, eyes narrowed to match hers. "Of course," she says, saccharine in a way she knows Meredith hates, pressing her nails into her palms behind her back. "Dr. Grey."
"Just so you know," she calls out when Mari turns away. "I already signed Katie Bryce's chart M. Grey, so you need to come up with your own signature if you're going to steal my cases."
Notes: A little Scrubs cameo, a bigger ER one, and a Sex and the City reference.
Next: ER orientation. Invasion of MAGIC interns.