The Evolution of Grey-Sloan Medical Hospital

Disclaimer: I do not own Grey's Anatomy, Private Practice or Station 19 or any of the characters bar my own that I create. The characters belong to the wonderful Shonda Rhimes of Shondaland and the ABC.

Pairing Mark/Lexie, Andrew/Justin (OC – named after me), Jo/Alex, Meredith/Derek, Addison/Jake

Chapter 4: Changes Are Afoot

"Change is necessary in the circle of life; some are good, and some are bad. How we handle the change, well that's up to us. We can accept the change for the better, or we can fight the change but be unprepared for the consequences that could be thrown our way. It happened to me." – Maggie.

Maggie Pierce was on the warpath to the Head of Cardio's office. She had just returned from having an extended leave of absence after her mother, Diane Pierce passed away from breast cancer. Everyone could see that she was fuming with anger as if the devil had made the wrong deal with God. She had heard throughout the hospital that two residents that she thought were just dating, had somehow gotten engaged and married, but the worst news of all was that one of the residents had the audacity to operate on an attending WITHOUT calling her for assistance.

Without so much as knocking on the door to her boss's office, she barged in and without taking a breath and let loose, not realising that there were other occupants in the room.

"YANG! JUST WHO DO YOU THINK YOU ARE HAVING A SENOR RESIDENT PERFORM A COMPLEX PROCEEDURE ON AN ATTENDING?!"

"Ah hem," Addison cleared her throat, clearly unimpressed as she was in the middle of writing Andrew's fellowship contract with Cristina, Bailey and Webber. "Doctor Pierce, you might want to watch your volume," she addressed the female cardio attending in an icily tone.

Suddenly, Pierce took in the sights of who was in the room and recoiled in shock. "Chief Montgomery, I apologise but that still doesn't give the resident the right to operate without consulting me," she replied in a somewhat snarky tone.

Cristina, who initially hired Pierce to oversee the cardio department while she did further study with Burke at the Klausman Institute for Medical Research in Zurich before returning to Seattle, hid her displeasure at how Pierce came barging into the room, and had Meredith's back every time there was an argument amongst her and Pierce. As far as she was concerned, Amelia, Lexie and herself were her sisters not Pierce, soon she stood up.

"Enough, Doctor Pierce, sit down NOW!" she slammed her hands on the desk, to her eternal gratitude, neither Bailey, Montgomery nor Webber flinched, obviously used to how Cristina used her temper and annoyance to get someone to listen.

"Now you are going to sit there, listen and not say a single word, or you will regret, got it?" Webber was slightly embarrassed that his daughter was acting out this way, he was pretty sure Bill and Diane would be shocked at the way she was behaving in front her peers. Ellis never did this to any attending while the two of them worked together in their residencies. Looking at the adults, there was a silent conversation, of who was going to give the explanation to the adult who was acting like a petulant child. Bailey won that conversation and pinned Pierce with a harsh stare.

"THAT senior resident happened to be Andrew Deluca-Jackson," Miranda started, giving Maggie the patent Nazi stare that made her shrink even further into her chair. Oh, Miranda was aware of how Maggie tried to woo Andrew into sleeping with her, there was actually a bet among the attendings of how long it would take for Justin and Andrew to start dating, however much amusement of everyone, it was Derek and Arizona who won the pool.

Maggie's eyes went wide in shock, "Under the supervision of myself and Doctors Webber, and Montgomery, both Dr. Deluca-Jacksons ran the necessary code when treating Doctor Shepherd and Doctor Hunt, it was a unanimous decision by the department heads to allow them to follow the case from start to finish without having to report to an attending. We were only there to assist and take directions, nothing more," Miranda continued, getting extreme pleasure of watching the cardio attending go into shock.

"B-But they're just residents….," Maggie started to stammer out, suddenly realising the corner that she was backed into by the authorities in the room.

"Not anymore," this time it was Cristina who spoke up, "Andrew saved my ex-husband, while Justin saved his mentor for my sisters." That subtle barb made Maggie cringe, she was well aware that Cristina did not approve of Magge causing fights between the sisters, one look at Webber made her realise that she had some serious sucking up to do to regain trust and respect from the hospital.

Addison pondered what to do with the cardio attending, she couldn't terminate the contract as there was a new policy at Grey-Sloan that all departments had co-heads to manage the workload and ensure that all patients got the best possible care while in the hospital. Finally, she came to a decision.

"Doctor Pierce, in the past few years, your behaviour has been unacceptable amongst your peers. While you are no doubt a talent cardiothoracic surgeon, your constant need to be better than every other surgeon while refusing to contribute to the hospital, has seriously made me question, whether or not you are suitable for Grey-Sloan Medical Hospital," there was a sharp intake of breath from Richard, as he was wondering if his daughter was about to be fired from the most top hospital in Washington. "…. however, in light of recent circumstances, I am reassigning you to the clinic for a period of six months followed by regular sessions with Doctor Wyatt, to assess you mental, physical and emotional capacity for the job. If you adhere to these conditions and respond to the staff well, you will be reinstated as the cardio attending. Do you understand?"

Maggie slumped in her chair; she had no choice but to comply with the conditions set out by the Chief of Surgery. "Chief Montgomery, I apologise for my behaviour and will accept the consequences and conditions of my reassignment. I will use the time to teach the interns and residents the proper protocol of patient care while working on my own issues," the now demoted attending replied in a respectful manner.

Standing up, "I will take the rest of the day at home and reflect on what I have done. I am sorry that it has come to this, it was wrong of me to try and pursue Andrew when it was obvious to everyone but me that he had only eyes for Justin. I wish them nothing but happiness in their marriage," she continued, as a few tears made their way down her face, "Cristina, I never meant to interfere with your relationship with Amelia, Lexie and Meredith, they are your family, I was an only child so hopefully I can be your sister in the future. Doctors," she turned on her heel and walked out of the room, without another word, heading home to ponder the consequences to her actions that led to the demotion of working in the clinic for the near future.

Maya Deluca-Bishop was getting ready to head to the base of Station 19, when she received a message from Arizona Robbins.

Hi Maya,

It's Doctor Arizona Robbins at Grey-Sloan, nothing is wrong but could you please come to the hospital as there is a group of us that wish to talk to you. Bring Carina with you, as this is major.

Arizona Robbins

Wondering what could be so important that she had to go to the hospital, she went in search of her wife, "Carina, where are you?" she asked as, she left the kitchen.

"I'm in the bathroom, just doing my hair before leaving for my shift," she yelled out as Maya followed the voice. Minutes later, she was in the bathroom, "What's wrong?" Carina asked, noticing the concern look that was on Maya's face.

I just got a text from Arizona Robbins, asking me to meet a few of them at the hospital, something major is happening and told me to bring you with me." Maaya replied, still confused on what the text message could have for the two of them.

"Ah," Carina replied with a smile on her face, she had a feeling it might have to do with the project that Addison and Jake had been working on for years since they moved to Seattle from Los Angeles when the Oceanside Wellness Centre closed after Naomi and Sam got remarried.

"What is Carina?" Maya wasn't a gossip person but, Carina was her person, her wife.

"You know how Andrew and Justin flew to Brisbane and he was going to propose in front of Justin's loved ones?" Maya nodded, still have no ide where this conversation was heading. "Well, it turns out, that Justin's parents on both sides actually got together and organised a surprised wedding and honeymoon." Maya just stood there, with her mouth open and Carina just let out a sweet laugh.

"Wow, that's just amazing!" Maya laughed, "there's more?" she asked bewilderedly, as Carina's grin just got wider, "well tell me!"

"Jake and Addison have been working on a project with mine and Arizona's input and they managed to take two male sperm and create an embryo!" Carina was so happy that she didn't have to keep this a secret from her wife anymore, but she wasn't done with the news. "The next step is to take that same concept and create an embryo using two eggs!"

"Wow, that's incredible!" Maya marvelled in the advancement of science. "Wonder how Travis will feel if we tell him and Emmett could have a kid together." Their two gay friends who fight along Station 19 had recently got engaged, like every relationship, they had their ups and down.

"They would be ecstatic for sure," Carina agreed with the sentiment. "You need to send a message to Sullivan and tell him we've been called into the hospital." Maya puled a face, she still didn't get how Sullivan was made Captain, she hoped it wasn't because he was sleeping with Andy. Nevertheless, she messaged Sullivant to say that something came up at the hospital and will do desk duty when she got back.

Twenty minutes later, the two of them were sitting in the attending's lounge with the majority of the attendings that worked on Owen and Derek. They wondered what was going on, constantly playing scenarios in their heads. Finally, it was Addison that started the conversation.

"Maya, Carina, thanks for coming in at such short notice," Addison began, "I am pretty sure that you are aware, we have managed to create an embryo comprising of just sperm of Andrew and Justin. Seven to be exact. What we need is a surrogate, and all of us attendings plan on pitching in and the couple don't even know yet."

There was an eye conversation between the two women, tilted heads here and there, along with hand gestures and some conversations being held in Italian. Meredith having some idea of what was being said in Italian, wisely kept her mouth shut and waited for it to finish.

"I will do it," Maya replied, I need a break from fighting fires anyways, maybe join Warren in Crisis One. Carina exhaled the breath that she had been holding, while she was glad that she wouldn't be in the line of danger, she was happy that Maya could still utilise her skills while she carried the couple's baby.

"To keep this a surprise from the couple until the first trimester, we've enlisted a few of our old colleagues who have also followed us to Seattle," Jake now jumped into the conversation.

"Cooper and Charlotte?" Richard asked, this was a smart move on their behalf, less nosey people in the hospital. Jake nodded, "But where are they?" he asked, he would've heard if they had moved to Seattle.

"They have only just moved in the last few weeks, and setting up a private clinic in a nearby suburb." Jake replied, "they actually have started taking in patients from us if we get too busy along with any walk ins. Charlotte and Cooper are no way poor, they're quite well off but wanted to help the community more than go private. They actually managed to source funding from the Department of Health while having a large business trust fund that offsets any major expenses, so they are actually thriving."

"Oh good," Alex piped up, "not that I am complaining but we," "this time he pointed to Jo, Arizona and himself, "are getting slammed with non-emergent paediatric cases when it's not necessary, sprain wrists, fevers that can't be broken and so on, not that we don't want to help but we have to start looking at how we treat patients."

"I'll start put out notices that we are only to take emergent cases and all non-emergent issues are to go to the paediatric clinic to receive care," Arizona replied, looking at Addison, looking at the issue from a different point of view, wondering if other services could be diverted non-critically.

"Ok, we've gone off-track for a minute, sorry ladies," she sent a smile to Maya and Carina before she continued her train of thought. "Pierce can stay here," now Meredith was confused but Cristina whispered that she would explain later. "Jake is right, Coop and Charlotte are well equipped to do this, they can also take scans and send them to us for further evaluation and if they need to use the OR, they have privileges, any overflow of interns that aren't needed here can go learn the basics from either clinic, some residents may be required to supervise." Addison continued.

Now it was Meredith that jumped into the conversation, "All the attendings here will pay for the surrogacy, with medication, and checkups included so there is no financial burden on you. If you are agreeable ladies, we can do the procedure right now as Carina has been slipping you medication on the sly to get you ready as she had a feeling that this would happen. So, what do you say?"

"We're in," they chimed as one. Everyone cheered and it was then time for Addison to direct the two of them to a procedure room, but before that could happen, Maya suddenly turned around and said, "Wait, what about the station, I was meant to go into the field?"

"We know you sent Sullivan a message to say that you would be late, that was just a ruse. He was aware of the plan to begin with and had plans on you managing the station and would work with Warren about co-managing Crisis One anyways," Meredith replied sniggering at just how dumbfounded the two of them looked with their mouths open in shock. This set off a round of laughter, as Addison, Arizona and Alex directed the two of them to the procedure room to begin the process of surrogacy.

Soon everyone had left the room and it was just her and Cristina.

Closing the door and leaning against it, Meredith just simply arched a perfectly good eyebrow at her sister and out with it. Cristina sighed, as she knew that as soon as she received that look from her twisted sister, there was no way leaving the room until she got the answers she wanted.

"Pierce came barging into my office, while Bailey, Webber, Montgomery and I were trying to work out the details of Andrew's fellowship and demanded to know why she wasn't paged when Owen was operated…," that was as far as she got before she was interrupted by her sister.

"She what?" Meredith snarled, while she had a on and off relationship with Maggie, she did not appreciate that she interrupted her brother while he was in the middle of saving her sister's ex-husband. She was solely tempted to go give Maggie a piece of her mind, but it was what Cristina had said next that stopped her.

"When Addison gave her a dressing down, she tried to pull the shit again but it wasn't until I slammed my hands on the table and Webber rebuked her, that she finally paid attention. Bailey was not happy either and gave her the patent Nazi stare that was usually reserved for the interns…,' by now both women were chuckling at the irony of the youngest Grey being pinned down by the Nazi.

"Seriously," Cristina resumed telling her the drama that unfold before Maya and Carina turned up in the attending's lounge, "she could have been fired but you know that all departments are being run by two people, well Addison decided that the fitting punishment would be to spend six months in the clinic and get this…attend therapy sessions with Wyatt!"

By now, both women were holding to each other to stay standing up as they were laughing so hard at the irony that Maggie had to see Meredith's old shrink. Finally, they composed themselves as Cristina wanted to wrap up the story before she had to go into surgery and preform a CABG on a fifteen year old and Jo was the senior resident to assist. "She then apologised for the way she had been acting and how she wished Andrew and Justin well in their marriage and hope that she could be sisters properly along with Lexie and Amelia, before leaving to evaluate her own behaviour."

Meredith let out a groan of annoyance, "If she wants to TRULY be my sister along with you, Lexie and Amelia, then she has some serious sucking up to do, not to us girls but Justin, Andrew, Derek and Mark." Cristina gave a shrug as if to say, "you'll get no argument out of me," before the two of them hugged it out and promised to check in with each other throughout the day, before they went their own way to prepare for the mountain of surgeries that awaited their expertise.

Derek was sitting up in bed, cuddling Zola, Bailey and Ellis, who had come down from the daycare centre to visit, when Addison popped in to visit.

"Hey Derek, how are you?" Addison asked as she kissed the top of his head in endearment.

"Aunt Addie!" the three of them yelled, glad to see their favourite aunt, she smiled at her nephew and nieces. While she was sad that her marriage to her best friend was over years ago, she was glad for the nieces and nephews from Meredith and Derek as well as Mark and Lexie.

"Hey kiddos, how are you all?" Addison smiled as she embraced her family, something that she would never get tired of seeing in the expanded Grey family.

"We're good, glad to see that Dad is ok," Zola replied for the three of them as Bailey and Ellis nodded their head up and down.

"That's good to hear kids. Hey, Uncle Jake, is in the cafeteria with Henry if you want to go say hello and get a snack, while I talk to your Dad alone, I'll send a page to let him know you're coming," the adults laughed at the trio excited to see their Uncle and cousin. Addison quickly put her head out the door and asked a nurse to take the trio to her husband and to allow them to have what they wanted and put it on her account.

"They adore you Addie," Derek smiled, "I am doing well, still sore. Justin actually broke down crying yesterday."

"Is he ok? He was hesitant to operate on you, Miranda and I had to reassure him that this was your wish if something happened," Addison replied, questioning whether they moved too soon with having the student run the service and operate on his mentor.

"I told him that the dark blue scrubs look well on him and that he did the right thing and he just snorted and started laughing," Derek laughed, before turning serious. "I heard that Maggie got reassigned to the clinic, what happened?"

The redhead had a sombre look on her face and was about to explain how it went down, when an intern came into the room.

"Doctor Shepherd, sorry to interrupt your discussion with Chief Montgomery, but you're needed up in radiology for an x-ray, CT scan and ultrasound and I have to take you," Fred Vincent replied, standing there looking slightly awkward at interrupting a private conversation.

"Was it Doctor Deluca-Jackson that ordered the scans?" Addison asked, pretty sure that the follow-up was imminent, but it was only day three post-surgery.

"Who?" Vincent replied having no idea who requested the scans.

"Oh, for fucks sake, you go stand in the hall and don't say a word until I say so, "Addison snapped at the intern, "and if you repeat that I swore at you, I'll make sure that every rectal exam page that comes in for the next two months has your name on it!" before she whipped out her phone and sent a quick message to Justin.

JJ

Did you order the scans for Derek post-op follow up for today? I have an incompetent intern that can't distinguish between you and Andrew.

A few seconds later there was a reply.

Addie,

Yes, it was me, I specifically told that intern that as the attending on the case, I need Derek up in radiology asap. Amelia is here as well and just rolled her eyes; I am considering talking to Andrew about just going by our own surnames at work. Ow! Amelia just smacked me across the head as if to say don't you dare.

Addison let out a snort.

"What is it?' Derek asked before she handed over the phone and soon the laughter between the two of them erupted again. "I needed that," he wiped his eyes as tears started leaking before another message just came through.

God we must have a bunch of idiots, Andrew requested similar scans for Owen. He was just telling me that the intern could not tell Owen who requested them. We must've had the similar thoughts of going solo when Cristina slapped him for being stupid.

By now the entire nurses wing could hear the howling of laughter coming from the room as the exes could only imagine the newlyweds being put into their place by the senior attendings. Soon, their laughter came under control and Addison said that she would walk with him and fill him in what happened with Maggie.

"I like Maggie but she really had no right to question Andrew, let alone you," Derek replied as they waited in the elevator to go down to radiology, "You did what any other attending would do when Owen and I were in an accident. Family don't operate on family. Sometimes I get the feeling that Maggie has severe abandonment issues but I am with Ellis on this, she did the right thing for her daughter at the time."

The Chief of Surgery could only hum in agreement after hearing stories of what Ellis had been before and after she got Alzheimer's from Meredith and Richard, along with reading the diaries that Meredith let her read when she asked about the insulin trials. Soon they arrived radiology and the nurses helped Derek onto the bed before Addison joined Justin in the booth and promptly smack him upside on the head.

"Ow! Addison was that really necessary?! I saved your best friend!" Justin complained good-naturedly as he rubbed the same spot that he got hit moments ago. The young attending received a glare in response and put his hands up in surrender, Amelia just chuckled at the by-play between the two of them.

"Ok CT is coming through, there's no change, no bleeding the shunt seems to be functioning well, the ventricles are a good size." Justin viewed the scans and made his assessment, "Amelia can you set up the MRI please?" Amelia nodded and allowed the brother and sister to have a few moments together before starting up the scan. It wasn't long before the scans came through. "This is what I thought would happen, it happens to me," Justin scrolled through the full scan of the brain and noticed that the dial had moved near to the one, "I'll have to readjust it after the ultrasound but the scans look pretty clean, Amelia what are your thoughts?"

Amelia had the CT scan and MRI both side by side, "Honestly Justin, you did everything right, the cranial pressure is right and the blood is filtering properly through the shunt," Amelia could not find any fault, honestly if both her and Derek took time off, she would be confident that he could run the entire department by himself. Addison nodded approvingly before asking, the nurse to set Derek up for an x-ray.

"No tenderness around the abdomen," Addison examined the scan with a critical eye, "there's still some tenderness around the kidney and liver but that's to be expected, the tube is well positioned in the abdomen, I'd say you, Mirand and Mark did a good job JJ," she concluded as she fired off a message to both Bailey and Sloan giving them a short update on Derek.

By now, Justin, had Derek set up and had applied gel on his left side of his neck, with a quick warning that the gel might be cold, it was time to do the final test. "There's a slight swelling to the neck," he observed as he moved the head around the neck to examine further. "Thankful no leakage," before he saved the scan and shut the machine off and wiped Derek's neck clean of the gel.

He was about to reset the setting on the shunt before his phone went off.

911

All available personnel to the ER immediately, burn victims on route

Kepner

"Shit!" Justin exclaimed, "This is not good," looking at Derek and then Amelia deciding what to do. "Amelia, I am being paged to the ER but I'm not done with Derek," he shouted. "Go, I can reset Derek's shunt and do a quick x-ray and put him back in his room and then join you." Amelia spoke in the microphone. "It's pretty much done anyways." Justin nodded and sprinted off to the ER, leaving Derek with Addison, Amelia and other technicians.

"This is going to be a long day, isn't it?" Addison asked no one in particular, hoping there weren't pregnant women among the burn victims.

"Yup it is Chief," one of the technicians replied as they watched Amelia finish the job that was left by the junior attending. "Page me when he's back in his room Amelia," she replied as she heading off to the ER, Amelia just nodded saying she would do so and continued speaking to her brother.

There was only one word to describe the state of the ER.

Chaotic.

"Hey Avery, what we got?" Sloan asked as he walked into Trauma Room Two, looking at the other half of the "Plastic Posses," and then the patient on the table. Avery was assessing the damage.

"Hey Sloan, this patient managed to get most of the occupants out of the house but suffering small smoke inhalation has a small burn on his right arm," Avery replied, "can you give me a hand with the intubation, while there is small amount of soot in his airways, we have to give him medication to clear it out," he continued as he got an intubation tray ready.

"Not a problem, Mark replied, as he got gloved up and waited to see what size tube Avery needed to intubate the patient.

Meanwhile, Callie had just finished stitching up a minor cut when he heard her name being called out, "Callie, I need you in here in Trauma Room Three now!" The head of orthopaedic attending walked into the room and saw Andrew standing in the dark blue scrubs.

"Deluca, what's the situation?" Callie asked, as she rolled up her sleeves and put on gloves.

"First of all, its Deluca-Jackson," there was a gasp as Callie held in a squeal of excitement. "I need a hand to stabilise this patient's hip, he broke it when he fell out of the burning building. Warren anticipates there being more patients coming to the hospital," Andrew replied as he braced his foot against the frame of the bed while Callie did the same. Working in sync, they both pulled on the sheet that was being used to stabilise the hip, criss-crossed the sheets and tightened it again.

"This is turning into a shitshow…," Callie mumbled, as she examined the patient for further injuries, looking at the scans on the monitor, "Oh god," she exclaimed as she saw more patients coming through the door, "someone better page Karev right now, I just saw a kid come in with multiple factures possibly," she heard someone pick up the phone and started paging Alex. "You got this Andrew?" she knew she would have to get the full story out of him soon but right now was no the time.

"Si, andare," Andrew replied in Italian, sighing that this was going to be another long night in the OR, he saw Carina and Maya meet with some of the attendings this morning but they ignored him, he wondered why but right now, but there were patients to attend to in the ER. Well, he mused at least the sex with his husband over the past few days were magical.

Owen groaned as he tried to sit up, he was glad that he had a high threshold for pain and was doped up on painkillers. Andrew had popped by to do his post-op scans and chuckled as Cristina slapped him for suggested that he and Justin drop the hyphenated name just to stop confusing the interns. He laughed even harder when he heard that Justin copped the same treatment.

The recollection of the accident came back in bits of pieces as it was the norm when people suffered a concussion, however he was glad that Andrew had stepped up and did what any senior resident would do after he read the chart of both his and Derek's, he had heard from Andrew how Justin was worried about operating on his mentor, but he reassured him that it was the right choice.

He heard that there was an accident in the ER and had sent a page that he would micromanage the staff from his bed. Looking at the staff rosters he sent out a message that had been approved by Addison.

Hi there,

Sorry for calling you in on your day off, there has been a mass casualty that has unfolded in Seattle, many people are either burn victims or dead. It is an all hands on deck situation.

Chief Montgomery has approved overtime for this crisis and rest assured that once the hospital is back to manageable levels, you can have extra days off.

Please do not ignore this message, this came directly from Chief Montgomery.

Owen Hunt

After that message was sent, he then busied himself with Derek to co-ordinate extra supply that was needed to deal with the fallout of the tragedy that was unfolding.

This was obviously going to be a sprint to the finish not a marathon, by the end of it, he would be surprised if any of the staff remained standing on their feet.

"If we didn't have change, how would we learn to adapt? What happens to the body when it experiences trauma? Do we fix the trauma and deny the change, or do we embrace the change and realise that we can change for the better?" – Alex

I am on a roll with this and another story, sooo much has taken place and there's still more drama to come. Maggie in trouble, Justin and Andrew about to become parents, trauma everywhere! Owen and Derek are slowly recovering from theirs and now a fire has broken out in the city!

What did you think?

Catch you next time on the flipside! Don't forget to review!

Justin