Chapter One: Fusion
Disclaimer: Grey's Anatomy and its characters obviously do not belong to me.
March 27th, 2005
Her bottom lip was dry as she gnawed on it. The early Seattle spring was utterly devoid of moisture, and her skin was always a desert by the time April arrived. But she could never stop herself from chewing on her lip as she wrote post-op notes in her neat cursive. She didn't realize her teeth were worrying over the pink skin until she began to taste copper pennies. Only then did she stop. But still, her body was tense as she wrote, her letters nearly breaking through the flimsy page on her clipboard as she stood at the nurse's station. Mid-morning sunshine spilled through the hospital windows, bathing the entire floor in golden. She knew that the rain would inevitably start back up again at some point today, the last remnants of cold winter storms.
Around her, the entire surgical wing of the hospital was buzzing. She knew from the last board meeting that there would be plenty of new blood on this Monday, not only in the ORs. A new batch of interns and a new head of neuro. Eve, however, was paying the gossip no mind. She had spent the entire night in the OR, doing the first round of repair on a motorcyclist's horrendously damaged spine. This afternoon, she would go in a second time, and her stomach was a nest of oily eels. The procedure would be delicate, very delicate. Her head was pounding from lack of sleep and overabundance of caffeine. For a moment, she put down her pen, sighed, smoothed her already immaculate French braid, and applied some chapstick retrieved from the pocket of her lab coat.
The chapstick stung her lip, and a flash of North Carolina briefly lit up in the back of her brain. She'd never had this problem of broken lips in childhood, when even in winter the air had been humid somehow. And the summer air had been, of course, a swamp one had to swim through. Even after years on the West coast, these sensory flashes happened often, annoyingly so. Achingly so. She shook her head, banishing thoughts of cancer wards, bloody urine, vomit in pots. She looked down at herself, smoothed her ironed scrubs, thought to herself: Dr. Sullivan. She was Dr. Sullivan, standing over the hospital beds now instead of sleeping in uncomfortable chairs next to them.
She went back to her notes, locking away the humid summers and the jaundiced hands, her mind's eye back to staring at blood vessels and nerve roots.
. . .
Derek's shoes were squeaking on the tile floor as he walked at Richard's side. They were new; he was sure by the second week the soles would already have started to wear down from hours standing in the OR, running around the ER, becoming silent on the shiny floor. For now, though, everything was new. New job, new trailer in the woods, new city, new separation from his wife. Save for his four years of undergrad in Maine, he had never lived anywhere besides New York. The Seattle air was certainly new to him, but he had been trying to breathe it slow and easy in the two weeks since he had moved. He was certain his nerves would calm the first time he got to step inside a Seattle Grace OR—the OR, where he could save something. He thought in passing of Addison and Mark sweaty and satisfied in his marital bed and sighed, shoving his hands in the pockets of his lab coat.
Richard led him across the bridge above the first floor of the surgical wing, walking slowly as he spoke, trying to orient Derek. Derek was glad that it had been Richard who hired him; as much as he needed the new, a familiar face wasn't exactly a detriment either. As they neared the stairs down to the first floor, Richard stopped for a moment and leaned against the railing. He pointed subtly to a head of dark hair turned away from them, standing straight and rigid at the nurse's station.
"I'll introduce the two of you next," Richard said. "Dr. Eve Sullivan, head of ortho. She did her residency here. Half the board thought I was out of my mind when I promoted her to attending. Said she was too young, too shy. She barely says a word outside of surgery. But now, the residents fight tooth and nail to scrub in on her cases. She has a spinal fusion this afternoon; you might want to stop by the gallery and watch her work. You might learn a thing or two about the spine, Dr. Shepherd. She's been published a few times for her fusions."
Derek raised his eyebrows at Richard. "Well, it sounds like I shouldn't pass up an opportunity like that."
They descended the stairs, wading through the sparse groups of hospital staff, many of whom let their eyes linger on Derek for a moment, sizing up the new attending. He paid them no mind; Derek had never been squeamish about attention.
"Dr. Sullivan," Richard said, going over to her.
Her head perked up. She turned around and faced them as they approached. She had the kind of face that required more than a quick look, Derek noticed immediately. With her thick, dark hair pulled away from her face, he saw that her pale skin was covered in a healthy spray of freckles. Her eyes were a disarming shade of blue, bright and stormy and intense, stark against the dark of her hair. The striking intensity of her eyes stood out amidst the softness of her features. She certainly was the youngest-looking attending he had ever seen.
"I wanted to introduce you to Dr. Derek Shepherd, the new neuro attending," Richard said, clapping Derek jovially on the shoulder. "He was a student of mine, so you can bet he's a fine surgeon. You two will be working together quite a bit on your spinal cases, I'm sure."
Eve smiled a small, reserved smile, sticking out her hand with its long fingers. "Pleased to meet you, Dr. Shepherd."
Derek returned her smile broadly, noticing the strength of her handshake as he returned it. "Derek. And likewise."
She nodded a bit, breaking their handshake. She was almost as tall as him, her posture straight and confident, despite the clear shyness coming through in her soft, husky voice and the way she remained a careful distance away from both of them. "Derek."
"I hear you're something of a genius when it comes to spinal fusion," Derek said.
The faintest of blushes lit up Eve's pale skin, her eyes darting to Richard for a moment before returning to Derek's face. "Hardly. The Chief exaggerates."
"Maybe sometimes," Derek said, "but not in this area, I don't think."
Blushing harder, Eve opened her mouth to respond, but was interrupted by the pager at her hip. As she looked down, Derek watched her expression change instantly, a furrow forming between her neat brows and a solemn quality overtaking her rosebud lips.
"It's Mr. Jenkins. Excuse me," she said, grabbing her clipboard and rushing off up the stairs before either of them could say anything else.
"Her fusion for this afternoon," Richard explained. "Keep an eye on her in the OR. You won't believe it's the same person; she's a drill sergeant."
. . .
Richard was right. Derek had arrived in the gallery halfway through the procedure, after completing a mountain of paperwork with Richard's disinterested assistant. The surgery was decidedly more entertaining than the paperwork. He sat in the freezing gallery, surrounded almost entirely by what he could tell were brand new interns, a burnt and forgotten cup of black coffee going cold in his hand. Eve was, simply put, mesmerizing. Granted, he felt that way about most surgeries, but usually because of what was going on under the scalpel, not behind the attending's surgical mask.
Her voice was clear and level, authoritative. But she never rose above speaking volume, never shouted. She did not behave like the typical ortho surgeons he had seen, who were usually gifted but more rough and sporadic with their technique and teaching, enchanted by the chaos of splintered bone and extremities covered in gaping wounds. Eve, however, moved with smooth, rhythmic precision, in a way that reminded him of classical music. She never stopped, always in motion, always cutting or cauterizing or suturing. And the way she spoke to the first-year residents who were assisting? Derek was shocked that such a shy person could have such command of a space. He could feel the fear already building up in the interns sitting around him.
"Dr. Jordan, you are aware this patient coded twenty minutes before we had to rush him into this OR, yes?" she asked a very short young woman whose brown eyes Derek could see widen even from up in the gallery.
"Yes, Dr. Sullivan."
"Then would you please explain to me why you're holding the retractor in such a way that if it goes any looser we'll be dealing with a severed nerve root?" she asked, her hands never stopping as she worked. She did not look up from the spine while she spoke. "Don't you think this patient deserves your most precise work, given the day he's had?"
"I'm sorry, Dr. Sullivan, I-"
"I don't need you to apologize, I need you to adjust your grip," she interrupted. "We've talked about this before. Apologies in the OR are a waste of time. Three millimeters to the left."
The resident dared not speak again, only followed Eve's instructions.
"There. Perfect, Dr. Jordan. Hold it exactly there," she said, her voice holding the same neutrality while she praised as it did while she disciplined.
In the blink of an eye, the monitors started screaming with uneven beeps. Eve did not flinch like the residents.
"BP's dropping!" a gangly young man exclaimed.
"Control your tone and step away from the patient, Dr. Davis," Eve said, dead calm. "Dr. Jordan, what do you see on the monitor?"
"V-tach," Dr. Jordan answered, her tone carefully neutered now.
"Then do something about it," Eve said, her movements steady. "Push one of epi. Dr. Davis, count it out. And use your inside voice, please."
From his place in the corner of the room, Dr. Davis counted, his voice wavering slightly but remaining at the volume she had requested. Derek could see that his hands were balled into fists. Dr. Jordan came back to stand beside Eve, the monitors still blaring with chaos as Eve's hands remained methodical and practiced.
"Dr. Jordan, please watch closely. This is how we handle this type of bleeder," Eve said, working swiftly. "The angle changes everything. Those three millimeters are the difference between life and death."
As Eve spoke, the monitors' sounds grew stable and even. Derek could feel the tension in the shoulders of those in the gallery and in the OR ease. But Eve's posture remained unchanged, straight and sure.
"Pay attention to this next sequence, Dr. Jordan. Dr. Davis, you are also welcome to look, but not to touch. Timing is everything here." Still, her bright eyes were laser-focused on her work, her delicate fingers deft. Then, in her controlled voice, as she started a complex surgical sequence, she began to recite in a careful rhythm: "'Do not go gentle into that good night. Old age should burn and rave at close of day. Rage, rage against the dying of the light.'"
"What the hell is she doin'?" a smarmy-looking intern with a buzzcut and his arms crossed over his chest asked from beside Derek.
"You haven't heard about her, Alex?" a blonde woman asked. "That's the Ice Queen. She uses poetry to keep the pace during spinal fusions."
The intern, Alex, snorted. "What a whackjob. Next you'll tell me she uses tarot cards to predict the outcomes."
"You better not let her hear you talking like that," another intern, a young man with a nervous energy and an unfortunate bowl cut, said. "I saw her make a resident cry for calling a patient by her first name instead of 'Mrs. Johnson' during rounds."
At this point, Derek zoned out of the conversation, totally transfixed as Eve continued her command of the OR in between lines of poetry.
"Focus. See how my hands match the rhythm?" she asked the residents. "Precision is everything. Timing is everything. Dr. Jordan, you will adjust the retractor on the next line. Ready? 'Good men, the last wave by, crying how bright…'"
. . .
To Eve's surprise, the rain never did start up again. But the evening was cloudy and chilly, the setting sun turning the sky to cotton candy. The stone bench was cold beneath her as she sat under a bare maple tree, gentle breeze rustling through nothing but empty branches. She still had post-op notes to finish, but her brain had turned to mush by the end of the eight-hour spinal fusion. She needed a smoke to get some sort of buzz back in her mind and power through the last of the notes. She saved the pack of Marlboro Reds in her locker for the most special occasions, the toughest surgeries, having cut back to about one a month. Mr. Jenkins had survived, but barely. As soon as one bleeder was dealt with, another would spring open. He wasn't conscious yet. She'd had to tell his wife, a young woman with pink hair, a lip ring, and a baby on her hip, that her husband was hanging on by a thread. Well, she hadn't used those words. But those were the words that had been ringing inside Eve's head as the wife asked what would happen if her husband never woke up. But he would. Eve kept telling herself that as the smoke bloomed in her lungs and filled her with a familiar burn. Her hands were steady as she smoked, but the eels were still swimming in her stomach.
Behind her, she heard footsteps crunch on the long-dead leaves. She turned to find Dr. Shepherd, with his perfect hair and dancing eyes. She cringed a bit as he stepped out of the exit door and looked straight at her turning figure, smoke rolling in curly streams off her cigarette.
"Dr. Shepherd," she said, standing up and immediately putting out her cigarette on the stone bench. Her face was flaming, she knew.
"Dr. Sullivan," Derek echoed. "I'm sorry if I startled you. I was trying to find the parking lot, but I seem to be a bit turned around."
"Oh, well, then you're on the wrong side of the building," Eve said, the flush not leaving her freckles. She tossed the remnants of her cigarette in the trashcan to her left, then crossed her arms over her chest as she turned back to him. "Take a straight shot back through the first floor, and you'll be there. No one comes out here anymore; they built a new garden outside the East wing last year. More manicured. But that means out here there's not usually anyone breathing in the secondhand smoke. I'm sorry about it, by the way. I don't usually…it's only after the really tough ones."
Derek waved a hand to dismiss her worry and smiled his twinkle-eyed smile. "It's okay. After that spinal fusion, I'd say you've earned whatever you need to destress."
She scoffed, a bit sheepish. She knew she had been babbling; it was the most she had said to another attending outside the OR in quite a while, save for medical jargon. She fought the urge to bite her lip as her embarrassment ballooned. "I appreciate that. You were in the gallery?"
Derek came closer, but still left some space in between the two of them. She saw that he had changed out of his scrubs, now in a collared shirt, sweater, and jeans. He wore an expensive watch on his left wrist. Richard had told her before Derek arrived that he was coming to them from a private practice in Manhattan. It was no wonder.
"I was," Derek said. "I have to say, you certainly lived up to your reputation. And it's quite a reputation to live up to."
Eve laughed, a small and self-deprecating sound. "And what reputation is that? Church mouse who goes Full Metal Jacket in the OR?"
"Something along those lines, according to Richard," Derek said. "He never mentioned using Dylan Thomas during fusions, though."
Her smile shrunk a bit, and softened. She shrugged. "English major."
"Is that so?" Derek asked, his grin widening.
"Guilty." Then, after a moment: "They usually leave that part out in the medical journals."
"That's a pity," Derek said. "It's a fascinating approach."
"Thank you," she said, the blush creeping back onto her face rosier in the light of the sunset. "You've got quite a reputation yourself. Apparently, you're the man who solves impossible cases."
"When I'm lucky," Derek said.
"I doubt that luck has anything to do with it," she said. Then, with a dry humor he didn't expect: "And, I hate to tell you, but Manhattan modesty never rings true."
Derek laughed. "Another life. And I'm from Brooklyn originally."
"Ah, well then that explains it," she said, her dimples popping out as her smile turned wry. "I suppose you get a pass."
"Thank you very much."
"You're very welcome." Then, after a brief pause hanging in the air between them, her smile fading as she glanced down at her shoes: "I should go. Lots of notes to write."
"Of course," Derek said, his own smile growing smaller.
"Just remember," she said, passing the stone bench, the wilted butterfly bush, and, finally, Derek, on her way toward the door, "a straight shot to the parking lot. I promise it's not nearly as complex as Brooklyn."
"So far, I beg to differ," Derek said. "It was nice meeting you, Dr. Sullivan."
"Eve," she said. She pointed over her shoulder at the door with her thumb. "At least when we're not in there."
Derek nodded. "Have a good night, Eve."
"You too, Derek," she said, then disappeared inside.
Derek stood under the bare maple tree for a moment, watching the sunset light slowly die through the thick clouds. He took a deep breath, slow and easy.
. . .
Author's Note: A Derek Shepherd fan fiction? In 2025? It's more likely than you think.