Chapter 14 - Surgical Floor
The hospital felt different this morning. Meredith couldn't pinpoint what it was exactly. Her best guess was that it was a combination of different factors. One aspect was the general atmosphere, it was much calmer than usual. Due to the approaching holiday, there was less staff on the schedule and all patients that could safely go home had been discharged. It was still busy and there was a lot of work to be done but the sheer decreased number of people in the building made it seem quiet and almost eerie.
Meredith couldn't help thinking about the changes that were about to happen to Seattle Grace. That this was the calm before the storm. A merger was a big affair that always had significant consequences for an organization – to the general climate and work environment. She was aware that with the merger announcement the hospital would be thrown in some form of chaos. The question was what kind. It all depended on how the administration planned to communicate the decision to the staff. Derek's recollections so far didn't justify a big vote of confidence in their abilities to do so.
It was no secret that Meredith wasn't the biggest fan of Seattle Grace. There were a lot of weaknesses in their system and a lot of room for improvement. Restructuring the residency program was long overdue and if done correctly would benefit the institution immensely. However, mergers hadn't the best reputation for improving residencies. In the past whenever two hospitals became one, the residents and the 'lower staff' were the ones who had always suffered the most.
Mercy West was a teaching hospital as well. Both hospitals were almost interchangeable in the services they offered. Where Mercy West had a bigger and more reputable oncology department, Seattle Graces offered better maternal and neonatal care. Either hospital had a big surgical unit with an equal amount of surgical residents. The cruel reality was that the merger would cost people their jobs. Meredith was clueless about how they were going to go about the staffing problem. A hospital was a job machine and an essential service serving the entire community.
Over the past months as an intern, Meredith had been able to interact with employees she wouldn't have had the time to build relationships with otherwise. She had made friends with lab technicians, radiology techs, respiratory and physical therapists, orderlies, and some of the nurses. She was well connected within the walls of the hospital. With one phone call, she was able to rush lab results or get a STAT CT scheduled or have PT assess one of her patients.
Medicine was a team sport, succeeding was only possible as a team. Every job was important to reach the best outcome for the patient – a lot of physicians needed to be reminded about that. Posing as an intern for the last five months had once again shown her how important this aspect of the job was. Meredith very much appreciated whoever had helped her through the mountain of work, who had reminded her to write an order or check up on a patient or who loudly advocated for their patient's best interest. The nurses had saved her ass a couple of times, Meredith wasn't used to taking care of so many patients' bedside needs at once anymore.
As a surgeon, a lot of the workday was spent in an operating room isolated from the happenings on the floor. They relied on the nurses to be their eyes and ears, while they were operating. A lot of surgeons were brilliant in their field but disconnected, very self-centered, arrogant, and lacked the ability to connect with people. She knew a lot of surgeons that were proud of their reputation, which nursed the stereotype of being rude and unapproachable. The refusal of some to self-critic and -reflect, and to adapt their behavior to the time and place was despicable.
Meredith didn't know why but the nursing internship she had been required to complete before starting med school had had a lasting effect on her. It had been brutal and humbling. Not only had she struggled with the language barrier and the demanding tasks of the job, but she had also been the perfect target for some of the older nurses. She had been very young, foreign, and a bit of a smartass. It wasn't a secret amongst German med students that the nursing internship was a ruthless experience.
In the German system, there wasn't a lot of appreciation for nurses – from society, politics, or physicians. There was a lot of pent up frustration in the nursing staff, they were chronically overworked, understaffed, underpaid, and mistreated. A lot of that frustration was directed towards the people who were privileged to study medicine and were at the beginning of their path to becoming doctors. It wasn't uncommon that at the end of the internship one of the older bitter nurses would give a discouraging unjustified parting-message to the young student. It was all about scaring them into submission. Consequentially young doctors were hesitant and wary towards the nursing staff when they started working on the ward. They reacted with entitlement and the vicious circle continued.
Meredith had been guilty of this reaction as well. The nursing internship had still been a very important experience on her path to becoming a doctor. It had taught her a lot and after some perspective, she had been glad that it had been a requirement. It had taken some time before she had been able to see it like that and had been able to detect the underlying problem and then adjust her survival strategy accordingly – but she had figured it out.
Matze had been essential in opening her eyes. He had been a young driven neurosurgeon attending who had come to Munich straight after his fellowship. He had studied medicine in Germany, had done his residency in the states, had completed his fellowship in Switzerland. At the time he had been hired as the only pediatric neurosurgeon on the staff. Other than being a mountain bike lover he was very open-minded and liked to push the status quo on everything. He was never shy about calling someone out on their bullshit or when something didn't sit right with him. Meredith had met him at the very beginning of his career in Munich. He had been the new hire and she had been the second year resident assigned to his service. At first, Meredith had found it incredibly exhausting working with him. He was very demanding and particular how he wanted things done inside and outside of the OR. She had only been used to being taught inside of the walls of the operating room and being left to her own devices outside. Matze had been different, he had taught her beyond technique and surgical skills. He had broken her established ways to approach problems, had changed her way to think, and had encouraged her to find her own doctor-voice.
Ever since she had started working as a doctor, Meredith had been plagued by the fear of becoming her mother. She had been so invested in becoming a great surgeon that she had feared that she would end up surgery-obsessed, alone, and unable to keep any relationship. Her whole life it had been implanted in her that this was the only path to success. Ellis had taught her that in order to succeed she had to do things a certain way, especially as a woman. Matze had recognized her fears, her hesitations, and had detected her forward-thinking that she had hidden under an old-school way to approach medicine. He had broken that shell and had shown her that she was able to write her own story. His premise was that one didn't wait for the change to happen instead was the change they wanted to see.
They had formed a deeply rooted friendship and partnership over the years. They had become official work partners when he had been appointed to lead the endeavor to build the pediatric neurosurgery department. Together they had imagined how a department should look like and how it should be operated, what they wanted to see in modern medicine. They had been two people in charge of building a cutting edge department – one very idealistic, the other very realistic. Somehow it had worked.
Some of their ideas had been so outlandish that they had to let them go. In the end, they incorporated valued interdisciplinary team-work, honest and practical teaching, cutting edge technology and research, a big focus on patient- and family-care and no rooms for egos. Meredith had enjoyed the experience and until today this was one of her biggest accomplishments.
Without Matze, she would neither be the physician nor the person she was today. He had given her the tools and guidance she had needed to develop into the Meredith she was today. He had held her accountable for her actions, had helped her through difficult professional times, and had encouraged her to push the norm.
He had introduced her to pediatric neurosurgery. Before working with him Meredith had sworn off working with kids. She was convinced that she was unable to find a connection with children – she had been unable to connect with them when she had been one herself why should it be different as an adult? It had been surprisingly easy for her. Being overheard, ignored, and misunderstood for most of her childhood she was able to sympathize with her patients' fears. Something about seeing worried parents fighting for their sick kids gave Meredith hope. Hope that family – in whatever form – was a possibility and that most kids didn't have to go through what she went through. Neither her mother nor her father had ever bothered to fight for her – she had relied on other people to be that person for her and at some point, she had begun to self-advocate.
Operating on kids was hard, but it wasn't that much harder than working on any neurosurgery patient. The stakes in neurosurgery were high, the risk was high, the margin for error was slim. She enjoyed working with adults and could have easily picked a fellowship in any other field of neurosurgery. Not every surgeon had the ability to step into an OR with a child on the table and put away the fact that they were operating on a minor. Meredith had met surgeons who had never operated on a child in their career, she had met surgeons who had only operated on children and she had met those who did both and didn't differentiate between them. She was one who could put away the demographic and personal details of her patient and concentrate on getting them through surgery with the best possible outcome. In the OR Meredith was cool as a cucumber, she was very task-oriented, focused, precise, and demanding. From day one she had been able to leave whatever else was going on outside of the OR and solely concentrate on the surgery. Meredith suspected that she had inherited this 'talent' from her mother.
Emotionally pediatric neurosurgery could take a lot out of a person. In no other field of medicine had she experienced higher highs or lower lows. Nothing beat the feeling of seeing a patient walk out of the hospital being cured of their tumor, knowing that you saved their lives. On the other hand, losing a patient was so much harder. Sitting down with the parents telling them that they had exhausted all their medical options and that there was nothing else to do for their child. Watching their heartbreaking grieve while accepting defeat was the hardest part of the job that no one ever talked about. It was emotionally draining and Meredith was glad that she was able to escape into her other specialties from time to time. Spending a day as an anesthesiologist in OB was cleansing.
It had started pouring outside like it did most of the time these days. The wind was howling against the windows. The fluorescent light was a harsh contrast to the gloomy lighting outside. They had just finished morning rounds. Meredith switched on the overhead light in the workroom behind the nurses' station and sat her tea mug down next to one of the computers. She pressed the on-button of one of the computers. While waiting for it to start up she peeled herself out of her white coat and hung it up on one of the coat hooks. She entered her id number and password into the system and started putting in orders for the patients they had just seen. Meredith was one of two interns working on the surgical floor today. Alex was the other one. She had never worked with just Alex – to be honest, she didn't know him. She had heard a lot of stories from Cristina and Izzy. However, in all her time at Seattle Grace, they had only shared a couple of conversations neither being particularly friendly. She was curious how it would be, only working with him for the entire shift.
She was allowed to see patients by herself today which was a major difference to all the other days she had been working on the surgical service. There were around 20 patients on the floor. They were either waiting for surgery or were recovering from a previous procedure. The spectrum of patients was wide, the cases varied from easy to complicated. Meredith was mentally prepared for the worse but hoped for the best. For now, she was running things on her own because Dr. Bailey had been called into surgery and had taken Alex with her for an emergency appy.
Meredith finished up putting the last orders in the system. The charting system was a pain in the ass, nothing could be done without a formal written order. Nurses couldn't hang fluids without a written order, care could only be provided with written documentation. Which meant a lot of paper- and deskwork for her. It was the part of the job she despised the most. For now, everything was documented in the system and her patients were cared for, giving her some time to finally concentrate on the case that had been at the forefront of her mind since yesterday evening.
She had expected to find a tumor on Emma's scans, the evidence had been too indicative not to. Years of experience of seeing and treating brain tumor patients had made her sensitive to the signs. Emma had shown many major red flags in her history and her presentation.
As a surgeon, certain tumors held a certain beauty and fascination. The way they developed, invaded healthy tissue, and tried to survive could be intriguing. Hours were spent studying their genetic markups and characteristics to develop treatments and surgical approaches. It was important to know the enemy, its strengths, and its weaknesses before going into the battle.
This morning she had found a tumor – not the beautiful kind that could be admired, studied, and then beat. She had found the nasty kind that caused more despair than inspiration. The type of tumor was rather rare and only known to affect a specific age group. She doubted that anyone at Seattle Grace had any experience with this kind of tumor and if anyone was willing to issue an official diagnosis.
The whole situation didn't sit right with the young surgeon. She was missing her network. Back in Munich, she had had an entire team to her disposal – oncologists, neurologists, therapists, psychologists, social workers, and child life specialists. She would have known who to call and how to proceed. She would have known the protocols and procedures. Back in Munich, she would have had leverage, in Seattle she had none.
Meredith was aware that to get answers, to give answers, and to organize a treatment plan she would have to step on a lot of toes today. She felt obligated, Emma was her patient. She had bonded with the little girl, who despite her situation had been happy and willing to participate in Meredith's game. There had been an undeniable connection, that Meredith just couldn't ignore. The circumstances were unique in many ways. The family was in Seattle on vacation – they had flown halfway across the globe for a week to spent Thanksgiving with their family. Neither of them had expected that they would end up in the hospital getting life-altering news. They would return to Munich with heavy emotional baggage.
Meredith felt the need to make the situation as smooth as possible – as horrible as it was. She would use her network in Munich, her name and her knowledge to make sure the family had all the support they needed to get through this and if it was the last thing she would do at Seattle Grace.
Meredith opened the stairway door to the pediatric ward. Seattle Grace had one of the smaller pediatric units in the city. The Children's hospital was the main location for any serious pediatric issues in the city and region. They were chronically overrun by patients so the other hospitals had added their own smaller departments for less complicated cases. Pediatrics wasn't a prominent specialty at Seattle Grace – it existed. Every specialty that wasn't part of the teaching program was very underfunded and neglected. Seattle Grace had concentrated their financial resources on the maternal health center and the NICU.
Once on the floor, she felt the familiar energy. The energy on the pediatric floor was always different from the rest of the hospital. Everyone worked extra hard to make the hospital stay as pleasant as possible. The walls were painted more friendly, the necessary scary hospital equipment was disguised, there were designated rooms for play and caretakers. Meredith noticed the difference to the surgical floor right away. There were fewer financial resources available, the equipment was run down and outdated but somehow they made it work. A nurse willingly gave her Emma's room number when she asked.
Meredith knocked on the door and entered after she heard conformation. The floral-patterned curtain around the door was drawn to give the mother and daughter some privacy.
"Good morning, Miss Emma," Meredith peaked around the privacy curtain. Emma sat on the bed, watching a show on the small TV. She seemed unbothered by her hospital stay, it seemed like that it was just another part of the vacation advantage. Leonie on the other hand looked even more anxious than she had yesterday. Meredith could tell that the unexpected admission was worrying the young mother – she tried her best to conceal her worries for her daughter's sake but she wasn't fooling Meredith.
"Hello Dr. Meredith," Emma smiled. Her smile was crooked. The drooping was even more prominent then yesterday, "Are you here to play a game?"
"No, not right now. I'm just here to say hello," Meredith smiled at the six-year-old. She was glad that Emma wasn't stressing out about any of this.
"Oh, okay," Emma replied disappointingly. "I liked the game and I need more stickers. Eloise put them all over the coloring book and now I don't have any more stickers and can't color the pictures."
"Emma!" Leonie scolded. She sat on the couch that doubled as a parent bed, always a watchful eye on her daughter.
"Aber es stimmt, Mama," Emma switched into German. „Eloise macht immer alles kaputt."
"Emma, Eloise ist drei Jahre alt. Sie weiß es einfach noch nicht besser," Leonie tried to reason with her.
"I'll see if I can find some more stickers and a new coloring book. I'm glad to see that you seem to be having fun," Meredith told the little girl. She never had a sister, but she had witnessed enough sisterly fights between Anna's girls that she understood the sentiment.
"Yeah, I get to watch TV and use the tablet. I'm usually not allowed to do that," Emma grinned, her attention already back on the show that was just coming out of the commercial break.
"The power of screen time," Leonie whispered.
"It's a magical tool. How are you doing? Do you need anything?" Meredith asked the mother, sitting down next to her.
"I'm exhausted. I couldn't sleep… Some answers would be nice," Leonie replied, deep worry lines on her face.
"No one has talked to you yet?" Meredith questioned.
"Nope. They were here for … what is it … zur Visite a couple of hours ago, nothing since. They weren't able to give us any information then. Something about still waiting for some test results but they think we'll be able to go home today. Do you have any information for me, Dr. Grey? Why they insisted on doing a lumbar puncture first? And then did an MRI even though they thought it was unnecessary? The waiting without answers is killing me, my brain just goes to these horrible scary places." Leonie's eyes were desperate.
"I'm sorry. I'm not on Emma's case. I'm not even supposed to be here. However, I'll make sure that someone talks to you before you go home. And whatever is going on with Miss Emma we'll make sure that we do everything we can," Meredith said diplomatically.
"You say that as if you already know something," Leonie accused. "Do you know something … anything? It is pretty hard to get answers here or to be noticed. We're not loud people, I don't want to bother anyone. I have the feeling they forgot about us. Do we need to worry? I'm freaking out," she asked.
Meredith knew that the unknown and the waiting was one of the hardest parts of having a sick child. She also understood why some diagnosis took time. In order to make sure that they weren't misdiagnosing their patient, they needed time. It was a complicated dance between, preparing the family of what was to come and not worrying them too much until they were sure.
Ever since Meredith had seen Emma's scan this morning she was feeling helpless. The times she had given a diagnosis of this magnitude were scarce. Those conversations were well prepared, were held in the privacy of a secluded room, and needed time.
The only thing she could do right now was listening to Leonie's worries to then allow her to focus back on her daughter. Pediatrics wasn't only taking care of children and their problems it was also taking care of the parents so they were able to do their jobs.
Meredith made eye contact with the young mother. "It's not yet the time to freak out. They are still running tests, I don't know the specifics. Just focus on Emma, there is nothing else you can do right now and you're doing an amazing job," Meredith watched Emma who was lounging on the bed, legs spread out in front of her, "You do your job. We're doing ours. And I can promise you that I'm doing everything in my power that whoever is in charge here doesn't forget about you. You'll get your answers and you will not be alone in any of this, I'll make sure of that. Okay?"
"Okay, if you say so," Leonie sniffed.
"I say so. You're not alone. You have people in your corner and I can be very annoying," Meredith reassured her when her pager went off, she checked it. "I'm so sorry, I would love to talk to you longer but I have to …" she said checking the message.
"No problem. You still use pagers?"
"Yep. I never thought that I would say this but I really miss having my own work phone. I'll see you later. Bye, Miss Emma."
It was annoying that she wasn't able to just pick up calls and talk to whoever needed her right then and there. Instead, she got a page with an extension number to call. Before she was able to make the call she had to find a phone. Meredith hated this system with a passion. She preferred having a cordless phone with her at all times.
"Yeah hello, this is Dr. Grey from surgery, I need a bed for a 66-year-old male nephrology patient, three days post-op after a colectomy. He's tachycardic at 120, hypertensive at 170 over 110 and he's sating at 91% on two and a half liters of oxygen. He has a fever, trouble breathing, and is complaining about chest pain. Cardiac enzymes are okay, white count and creatinine are elevated," Meredith rattled down the information as soon as the person on the other end greeted her. The floor was crazy today. She could barely keep up with the pages and consults. Meredith was the kind of person who thrived in stressful situations, she was great under pressure, she kept calm and became more organized the crazier the situation got. In these situations, she had no time keeping up any carefully drafted intern façade. The entire floor staff was stretched thin, there was no time for pleasantries or polite requests. Priority was to get things done and Meredith had no problem with letting some of her frustration out. "Well, then I suggest that you clear a bed."
She stood at the nurses' station, the receiver pinned between her shoulder and ear. The tablet with the patient information lay in front of her. Liz the nurse that had been caring for the patient since this morning sat across from Meredith following the conversation expectantly. Together they had determined that the patient needed a higher level of care than they could provide at the moment. Meredith listened to what the person on the other end of the phone line had to say. "Let me interrupt you right there. Don't come preaching about protocols. I've consulted cardiology, we've done a portable chest x-ray and a CT has been ordered. The latest labs are twenty minutes old. Everything that shouldn't be trending up is trending up and everything that shouldn't be trending down is trending down. We've exhausted our measures, despite everything we still have a severely sick patient who needs a higher level of care. The protocol is to request an ICU bed, which I'm doing right now."
Alex had been AWOL since the appy, which had finished hours ago. He must have disappeared somewhere between the operating room and the floor. He didn't answer his pages and everyone was too busy to actually go search for him. Since Bailey hadn't assigned them individual patients but instead had taken Alex to the OR, Meredith was stuck with the chaos that was the surgical floor. Under normal circumstances, there would be multiple interns covering the floor under the close supervision of a senior resident who would be in close contact with the attendings. Due to the approaching holiday, however, Bailey was the only senior general surgery resident that was working today. After the appy, Dr. Bailey had scrubbed in with the Chief of an emergency surgery that would take hours.
"I don't think that it's a PE but I can't rule it out without the CT. I suspect it's a pulmonary infection coupled with an aggravation of his co-morbidities," Meredith explained, listening again, "Listen, I don't really care. I care that we find a solution to the problem. The patient needs an ICU bed that's non-negotiable. How you find one is your job, not mine. I'm sure you have some patients who can be transferred to a step-down unit. Talk to whoever, so that we can get him up asap? … Thanks," with a loud exhale she slammed the receiver down.
"And?" Liz asked.
"They'll see what they can do, no promises though."
"Of course. It's always the same," Liz rolled her eyes.
"I would go up myself and clear a bed but I just can't leave. Not as it is right now."
"What do you want to do, Dr. Grey?"
"Have respiratory on stand-by and let's just have everything set up for intubation just in case. Keep a very close eye on him and let's nag the ICU team every five minutes or so. I'm going to update the wife real quick," Meredith picked up the phone again and dialed the emergency contact number on the patient's chart, "Have you seen Dr. Karev?" she asked before Liz walked away.
"I'm sorry I haven't seen him since rounds," Liz told her.
"Great. Me neither. Can you page him again, please? " Meredith asked, running her hand through her hair, "Hello, this is Dr. Grey calling from Seattle Grace Hospital, am I speaking to Mrs. Wood?" The conversation was brief but informative, just long enough to convey the important information.
In the office, Meredith sat down and took a big sip of her now cold tea. It was one of those days. It was noon and she hadn't been able to drink, eat, or sit down since she had come back from peds. If things continued as they did half the floor would be a critical care unit by the end of the day. One patient was down in CT with a suspected surgical complication, another had spiked a post-op fever and needed intervenes antibiotics, another was experiencing urinary retention and everyone had something to complain about. Working on the surgical floor was exhausting, too many different complaints from too many specialties. A notification on her tablet alerted her that her patient's CT scans were added to her medical file.
Seeing the scans Meredith cursed herself for sitting down in the first place. Mrs. Rodriguez needed surgery and that sooner than later. She had an uncommon complication after her surgery that only happened rarely and needed a special surgical team to take care of the complication. Meredith stuffed her cell phone in her coat pocket and grabbed the tablet before leaving the office again.
"Hey Olivia, is Mrs. Rodriguez back from radiology yet?"
"No, not yet."
"Can you please ask transport to bring her to pre-op?" Meredith asked, picking up the phone to call the interventional radiology team.
"Pre-op?" Olivia asked, "Shouldn't Dr. Bailey or a senior resident decide whether she needs to go back to surgery."
"Dr. Bailey is still scrubbed in with the Chief, isn't she?"
"Yes, she is."
"Would you be so nice then?"
"Sure thing, Dr. Grey. Anything I should tell pre-op?" Olivia asked.
"Just tell them to run pre-op labs and prep her. I'll be up as soon as I talked to IR. Thank you," Meredith told her. Olivia looked skeptical, she was one of the nurses that was chronically skeptical towards interns and Meredith in particular.
She organized an IR team, an OR, and a surgical team for Mrs. Rodriguez.
"Dr. Grey, Mr. Wood's pulse ox is down to 87 and his breathing is very labored," Liz stopped Meredith before going up to pre-op to talk to her patient and her family about what was going on. She followed the tall curly-haired nurse into the room.
"Hello again, Mr. Wood," Meredith checked his breath sounds and frowned. "Okay, here is what we're going to do. I'm going to intubate him and get him on a ventilator. You're going to call the ICU and tell them that he's now intubated and that they should get a move on, with a very nice greeting from me. We get respiratory in here to check the vent settings. Then you're going to page Bailey again, just like the last times. She's still in surgery, but I'm heading there any way to talk to them about Mrs. Rodriguez. I'll be back as soon as I can," Meredith whispered to Liz, who started to prepare for intubation. Meredith stepped closer to the bed. Mr. Wood's lips were blue and he looked very pale, "Mr. Wood, I don't like this development. I think it's the time that we do what we have talked about earlier. The support is going to help you until we can get your lungs healthy again."
"My wife," he rasped barely audible.
"Your wife is on her way. I talked to her, you don't need to worry. She's fine and you're in very good hands," Meredith smiled at him compassionately. "Are you ready?" He nodded weakly and Liz handed her the induction meds for the intubation. "I'll see you later, Mr. Wood."
As soon as the meds took their effect, Meredith intubated him. Anatomically he had a tricky airway and with the added inflammation of the infection, it wasn't the easiest intubation she had ever done. For the countless time today, she was thankful that she was not in fact an intern – she would be drowning and her patients with her. Liz connected him to the ventilator and Meredith adjusted the settings.
"I rarely see such effortless intubation by an intern," Liz told her after.
"Thanks," Meredith nodded, throwing her gloves into the bin by the door. "Sorry, I have to go talk to Bailey and the Chief. I would stay but..."
"Don't worry about it, go."
It had been bold to walk into the Chief's OR to inform him that Mrs. Rodriguez was experiencing a serious complication and that she was in another OR being taken care of by a different team. She knew that and she had been scrutinized by Dr. Bailey the moment she had uttered the words. Meredith's effort to keep the Chief in the loop about his patient had been taken as an accusation for a surgical mistake. She was aware that complications happened even with the simplest of procedures and that sometimes those complications were out of any one's control. The important thing was that the patient was the priority, that the problem was addressed and taken care of, and most importantly that the care wasn't compromised by an over-inflated ego. She had made very clear that she wasn't accusing anyone of anything and that she was just informing them about the state of the surgical floor and their patients before she excused herself. The Chief seemed to understand that, she wasn't sure about Dr. Bailey.
She ripped off the surgical mask and threw it in the bin by the door. The OR had always been one of her happy places. The place where she spent most of her hours of being a doctor, nowadays she only saw the inside of an operating room when she flew halfway across the country or was the messenger of unfortunate news. It was a weird feeling to know more people on the other side of the line than from the surgical staff. She took off her shoe covers and threw them in the bin as well.
Meredith suppressed a yawn when she pushed the button of the elevator. It was that time of the day when she swapped the stairs for the elevator. She had come in at five and it was only one in the afternoon. She was tired and the hardest part of the day was still in front of her. She checked her phone if she had gotten any messages while she was in the OR. She was waiting for a call from the tumor specialist at Children's. It had taken several phone calls before she had been able to get the direct number. All-day she tried to catch up with Emma's case development, unfortunately, she was always a step behind. Secretly organizing treatment for a patient that was based abroad while working the craziness of the floor was more difficult than expected even for someone with Meredith's contacts. She had no idea how much longer they would be in the hospital before being discharged home without any answers. There was no way she would send them home without talking to them and time was running out.
No new messages. Lost in thought she starred at the elevator doors willing them to open.
"Hey," he whispered in her ear from behind.
Meredith turned around. He was wearing his navy scrubs like he did most of the time. The navy brought out the blue of his eyes – actually, anything blue accented his eyes. She could tell that he had just come out of surgery, his hair was all flat from wearing the scrub-cap for the hours. She knew that he would fix it as soon as he was in his office. She had never met a man that had such an extensive hair care routine. "Hey, I didn't hear you coming," she smiled.
"I noticed," Derek chuckled. "You were in surgery?"
"You wish," Meredith laughed, "No, I just delivered an update about the dumpster fire that is the surgical floor. Where are you going?"
"I'm going to grab a bite to eat." They stepped in together when the doors of the elevator opened with a ding.
"Lunch, lucky you," she commented. Derek turned around and leaned against the elevator railing to get some weight off his feet. Standing for hours was exhausting on the feet no matter how great the shoes or how fit the person. She walked closer to him resting her forehead on his chest, closing her eyes.
"How's it today?" he asked, wrapping his arms around her, relaxing his chin on her head.
"It's pouring," Meredith stated.
"I can see that. That's Seattle for you. You should have considered moving somewhere with a milder climate if you dislike the rain," he chuckled.
"I mean figuratively, Derek," she lifted her forehead of his chest to glare at him. The sound of her pager going off, underlined her statement. "Mhm, new record fifteen minutes without a page. I hate that thing. It's the stupidest invention of mankind. You should think that we have better communication methods by now."
"Like what?" Derek asked her to humor her.
"I don't know, maybe a device on which you could actually talk to people when they contact you. A device that is independent of your actual location. And rather than only getting a number paged so that you need to go looking for a phone to call them, you could just pick up and talk. We could call it a cordless phone or a cell phone."
"Someone should invent that," Derek laughed.
"I think they already did." Her pager went off again, she checked it.
"Seems urgent."
"It's a different number. As I said, it's pouring. No time for lunch, no time for charting, no time for anything, in part because Alex is AWOL," she sighed.
"Alex is AWOL, where is he?"
"If I knew he wouldn't be missing. It's not like he didn't come to work today. He just chooses to ignore our pages. I bet if Bailey pages him with a surgery he would come running. It doesn't really matter … no, actually it does but no time to think about it."
"Because it's pouring," Derek commented.
"You're catching on," Meredith teased. "How's your day?"
"It's only pouring in a literal sense. Nothing major to complain about as of yet. The surgery went great and after lunch, I have a mountain of paperwork to go through. Just another Wednesday in the office," he shrugged.
"What about the Mercy West thing?" Meredith wanted to know.
"Way to ruin my day," Derek groaned.
"Why should I be the only one having a bad day?" Meredith teased.
"It's not like I have stopped thinking about it since yesterday. There's a meeting later tonight, I should know more after."
"I know, you seem tense," Meredith spotted the tension that was there since last night. She was feeling it as well just not to this extend.
"I am. There are just so many unanswered questions."
"Mhm," she confirmed, "I'm curious when and how they will make the official announcement and what happens after."
"Those are just some of my questions," Derek sighed. "Somehow it'll be fine. We'll be fine."
"We'll be fine but what about everyone else? I'm not so sure about that."
"Unfortunately true. Have you put any more thought into your next steps?"
"One of the many things I haven't stopped thinking about since last night. I would like to have some sort of job perspective before I hand in my resignation. It's not the most rewarding job I'm doing here, but at least I have something to do," Meredith explained while her pager once again made itself noticed. "It's kind of hard to look for options when you haven't even time to drink, eat, or sit down."
"I understand."
The elevator slowed down and came to a halt. Derek gently lifted her chin, so that her lips touched his for a quick kiss. She wanted to protest his public display of affection. Their relationship was still a secret and since his and Addison's fight yesterday he shouldn't be doing any of this within the walls of the hospital. He felt her reservation and pulled away with a smile. She couldn't help to grin, he made her feel like a pathetic emotional teenage girl. The doors of the elevator slid open on the surgical floor.
"Go put out your dumpster fire. There may be a hot bath waiting for you tonight. Maybe a bottle of wine and some dinner and a handsome boyfriend," he told her suggestively with a cheeky smile, while she walked onto the floor shaking her head.
"Alex, what the hell?!" Meredith called, startling him. Things on the floor had finally calmed down enough for her to go search for her co-intern. She was pissed that he had left her hanging all day without even pretending to care. The day would have been so much easier and less stressful if they had been able to divide and conquer. Meredith was ready to leave him hanging out to dry so that he exposed himself that he hadn't been involved in any of the actual patient care. However, she needed him to cover the floor so she could talk to Emma's parents. The floor couldn't be without a doctor and she needed some page-free time. So she had decided to be the bigger person and drag out whatever hole him to do his job. Which didn't mean she wasn't extremely pissed off. She had found him in the tunnels, sitting on a spare hospital bed, with books and papers scattered around him.
"What?" he asked, dropping a book on his lap.
"What, for real?!" Meredith was fuming. "You're on the clock, in case you've forgotten. There're patients you're responsible for, work to do, colleagues to support. Pages that need to be answered."
"I was in surgery," he shrugged, opening the book again.
"Bullshit! You've finished the appy, " she checked her watch, "Six hours ago And you've been AWOL since," Meredith called out, "Save yourself the energy and stop lying to me. While you're catching up on your reading, I've been on the floor picking up your slack. By the way, Ms. Ross is settled in a room for the last four hours, happily sucking on popsicles."
"Come on chill out, Meredith. It's not like there was anything surgical happening, it's not like I missed anything important."
"Being a surgeon is more than just swinging a scalpel. You better get that into that thick skull of yours real fast if you want to finish your residency. Patient care is just as important as knowing how to do the procedure. And you can not ignore pages. Under no circumstances. Never."
"Now you sound like Bailey. You seriously need to chill out," Alex rolled his eyes.
"Of course I sound like Bailey. This is the basis of working in a hospital – hell for keeping any job. You don't neglect your responsibility, even if you deem your responsibility as unworthy."
"I had other things to do, okay," Alex defended himself.
"What could possibly be more important than doing your job? Especially now," Meredith asked, still very much annoyed with him.
"Nothing of your concern."
"Really? Give me one solid reason why I shouldn't report you to Bailey or Rosenthal for today? I highly suspect that it's not the first time that you just disappeared. It's just the first time with limited staff so your absence was actually noticed. This could end fatally."
"You're not going to rat me out."
"Try me," Meredith challenged him, totally serious and it showed. " I have no problem going to either if I need to fear for the safety of the patients because you can't be bothered to show up. Do you even like being a doctor?" That question had done it, she witnessed his demeanor change. His tough-guy exterior crumbled and he became defeated.
"Of course I like being a doctor. But what's the point, if I have to stop being one soon anyway?"
"What are you talking about?"
"I tanked the progress exam and if I don't pass the re-do in two weeks I'm out," Alex admitted.
"So you skip work to study. Not the smartest strategy to keep your job here," Meredith snorted. "Why the hell didn't you say anything? We could have talked about it. I could have helped you. But instead, you decided the best course of action by yourself, exacerbating the situation."
"You could have helped me? How? You're the one who must have tanked it even more than me. Look at you, you haven't been in an OR for weeks. You're not even able to put on a band-aid without Bailey's permission or supervision. And you want to help me?" Alex snickered, his change of demeanor didn't last long.
"A little advice on the side, things are not always like they seem," Meredith stated and added: "Why are you so adamant to piss every one of who tries to offer you help? Why do you make your own life so hard? There are people who are more than willing to help and teach. But I've understood you don't need my help. Now get your lazy ass of this bed and get it up on the surgical floor or I swear to god. And if you think that I'm mad than just wait until you the wrath of the nurses."
After she had dragged Alex back to work, she had gone to the locker room to change. She couldn't change the fact that her lab coat was nameless and that it was way too big for her. But she could change the fact that she felt uncomfortable and less confident in her light-blue hospital-issued scrubs. She had an open love-hate relationship with those scrubs. Most of the time the machine gave her the wrong size. The pants were always several sizes big and with the tops she had a fifty-fifty chance of them either being too big or just right. They wrinkled easily and the material didn't hold its shape from being laundered so often. The only advantage was that she didn't have to wash them herself. It still felt wrong wearing them all day without being in surgery or working in the ER.
Meredith needed to be in the right headspace to have the incredibly difficult conversation with Emma's parents and if changing out of her scrubs did the trick she was more than happy to try. There was no such thing as being ready for this. She could prepare herself and be ready to give the parents all the support they needed to get through this. It was never easy and it never got easier. Avoiding the reality and shying away from the hurt she would cause didn't make it easier either. She couldn't back out, there was only one way and that was forward.
In the process of getting to this point, she had pissed off almost every department that had anything to do with Emma's care. She couldn't count how many 'no-s' she had heard today and how many times she had been transferred from one person to another – from department to department. She had been stunned by their unwillingness to think outside the protocol box. She had offered her help and her connections in coming up with a course of action. It had been indescribably frustrating that no one was willing to talk to the parents and that no one was feeling the same sense of responsibility that she felt.
Meredith didn't want to be the one to scatter their world, but if no one else was willing to do so she would have to step up. Because leaving them in the dark to have them run in an open knife back home was not an option for her. The family deserved answers, they deserved to know what they were up against. Knowing was better than not knowing.
She had worked with her Munich team. Together they had opened up options and had come up with a possible treatment plan that was ready to be implemented the moment they came back home, should they choose to do so. The final decision was with the parents, it wasn't her place to dictate what they should do or not do and where they should seek treatment. She only offered a lifeline, that they could hold onto should they decide they needed it.
Meredith stood in front of a conference room door. The very same one she had been in when she confronted Derek about Jamie back in September. Through the windows, she observed Leonie and her husband anxiously waiting for whoever was going to give them answers. Meredith could imagine what was going on in Leonie's head. As a physician, you know that being asked into a private room for a conversation never meant good news. Good news was shared openly, bad news, however, was given in private. There was no way of sugar-coating the fact.
Meredith's pager was turned to silent and safely stored in her coat pocket. The floor knew only to page her when things went very south. She needed all the support she could get. Liz had organized the room for her and getting them down here. She had asked if Meredith needed help after seeing her scramble to come up with a plan all day. Meredith suspected that Liz had her suspicions about her qualification, but had thankfully kept quiet.
One deep inhale before Meredith knocked on the door and opened it immediately after. The parents' heads turned to the door and Meredith gave them an encouraging smile, while she closed the door behind her.
"Dr. Grey, I wasn't expecting you," Leonie greeted her. She looked worse to wear than she had this morning. The waiting was getting to her, "Thank god for a familiar face. Are you joining us? We were told to come down here. I hope we'll finally get some answers."
"That's why I'm here," Meredith told her, "I'm going to talk to you about Emma. You must be Dad?" she greeted the man sat next to Emma's mother with a handshake. "I'm Dr. Grey."
"I've heard a lot about you, Dr. Grey. Emma couldn't stop talking about the stickers last night. I'm John."
"Emma's quite the chatterbox," Meredith placed her tablet and documents on the table and pulled out a chair opposite the couple.
"Oh yeah," Leonie agreed, "I thought you weren't on her case anymore."
"I'm not really – it's a long story but I believe that you deserve to get some answers before you'll be sent home. There has been a lot of chaos today and I apologize for that and that it has taken so long for someone to talk to you. To be honest I don't understand it myself. I can imagine how excruciating the last hours must have been, not knowing," Meredith told them honestly. "Is it okay if we continue the conversation in English? I'm more than happy to switch into German but I believe it is easier if we continue in the native language of the non-medical person."
"I appreciate that thank you," John looked at her gratefully.
"However, should any of you at any point need more information or an explanation just interrupt and ask. I know this can get quite overwhelming."
"Okay," they nodded. John took Leonie's hand into his.
"Good," Meredith prepared herself for the next part. "As you know I noticed some cranial nerve deficits in Emma's initial neuro exam yesterday. That's when I talked to you about the MRI. My attending didn't agree with my assessment and insisted on a lumbar puncture. The pathology report, unfortunately, showed abnormal cells in the CSF."
"Oh god!" Leonie gasped, close to tears.
"Abnormal means what?" John asked.
"Abnormal means they detected a change in the cells that would suggest a malignancy somewhere in the central nervous system."
"So cancer cells?" John questioned.
"Yes," Meredith confirmed, "After the report, they ordered the MRI last night. Finding cancer cells in the spinal fluid most often is an indicator of a tumor in the brain or the spinal cord. Unfortunately, my initial suspicions were confirmed by the MRI and we did find a tumor on Emma's brain scan. I'm very sorry," Meredith told them, the tight heavy feeling of sadness in her chest becoming unignorable. Leonie's tears spilled over and John held on to her hand for dear life.
"Emma has a brain tumor?" he whispered.
"Yes, I'm so sorry. I know this must be really hard."
"Where?" Leonie inquired quietly.
"Unfortunately, it's a brainstem tumor," Meredith's voice was barely above a whisper by this point.
"Oh god!" the young mother couldn't control her sobs any longer. Meredith pushed the Kleenex box over the table.
"That's not good, is it?" John asked.
"No, it's not. Emma has a tumor called diffuse intrinsic pontine glioma, also known as DIPG. It's the most common and most aggressive brainstem tumor in children. I am so, so very sorry." Meredith hated this part. She hated watching whoever she delivered bad news to break down in front of her.
"Where do we go from here? Chemo, surgery, radiation?" John asked trying to make sense of everything. He had been blindsided by the diagnosis.
"Surgery is not an option, honey," Leonie whispered, her tears falling freely. She had medical training and from the moment Emma's face had started drooping she had feared the worse. When Meredith had suggested the MRI she knew that her worse fears could be a possibility That it would be this devastating was even a shock to her.
"Why not?"
"Unfortunately surgery is really not an option. The location and the way the tumor grows makes it inoperable," Meredith pulled Emma's scans up on the tablet to give visualization to her explanation. "This is the brain stem and this is the tumor. It's called the pons, which controls breathing, balance, and other vital functions. One of the tumor's characteristics is that it grows diffuse. It basically means that the growth is not well contained and the tumor cells grow into other tissues," Meredith had turned her tablet towards them and was circling the tumor with a pen. "Chemo is also not really an option either. To be honest it just makes the kids more miserable and the effectiveness couldn't be proven. Treating brain cancer with chemotherapy is very tricky and almost always non-effective because of the blood-brain barrier," Meredith clarified, "Standard of care right now is radiation therapy to shrink the tumor and stall its growth. I'm going, to be honest with you. DIPG is known to be one of the most devastating pediatric brain tumors. Unfortunately, there is no cure and treatment only buys time. In the end, the tumor will be fatal. However, people are researching the tumor and are working on new treatments. In the last decade, treatment quality has significantly improved. Right now there are trials in the clinical phase, that Emma could be enrolled in if you chose so. There's not a lot of hope but it isn't entirely hopeless either," Meredith detected pure despair on their faces. This was the hardest part of the jobs. The lows were just so incredibly low.
"How long do we have?" Leonie cleared her throat.
"As you know, answering this question is not an exact science. We heavily rely on data and statistics. Every case is different, just like every child is different, please keep that in mind. Statistically, the median life expectancy after the initial diagnosis is eight to eleven months. The two-year survival rate is about ten percent," Meredith told them sadly. She had known that the life-expectancy was short and a survival rate was almost nonexistent. Researching the actual numbers for this conversation was outright depressing.
"Those are not good odds," John choked out.
"No, they're not. I'm so sorry," the young doctor confirmed compassionately.
Now was the part of the meeting where she let the information sink in. Their brains needed some time to process. Continuing giving them data and talking about the treatment would only overwhelm them more than they already were. So she kept quiet, gave them some time, and waited for the questions that were going to come.
"How did I miss this?" Leonie broke the silence.
"You didn't. You caught it, you went to the ER when you noticed the changes, you did everything right. DIPG presents suddenly without warning. One day everything is fine and the next there's a significant change. Like the facial weakness or a lazy eye or the kid loses their balance and the day before they were doing cartwheels. Almost every parent can name the specific day the symptoms started. You can't blame yourself," Meredith told her earnestly.
"Okay. What do we do now?" Leonie questioned desperately.
"Today you will take Emma home and then you'll try to celebrate Thanksgiving with your family to the best of your abilities. I'm going to prescribe her steroids that will help until you can be seen by her team. You'll meet with the multidisciplinary team that will take care of Emma's needs through this all. They will be the ones who know all the specifics and play by play. Radiation will be the first treatment step. It will shrink the tumor significantly and some of the symptoms should subside at first. The tumor grows very rapidly and at some point, radiation can't keep up. At some point, the side effects will outweigh the benefits. Then you'll need to think about trail options. Some trails test different drug combinations or medical devices. I'm sure you know this," Meredith looked at Leonie, "but some of the big trails are only available at certain hospitals or in certain countries. For Emma, there could be a promising option. It could be that Emma might need a tumor biopsy. This is the purely medical and research side of the team, their main focus is the tumor. And then there is Emma's side. Their main focus is quality of life so that Emma can do what she wants to do for as long as possible. This might mean different kinds of therapies, like speech, physical or occupational, or making sure her eyesight is okay or organizing help for school. Whatever might come up. This is just a rough overview," Meredith explained.
"This seems great, but we don't live in Seattle. What do we do? How do we get an appointment with a specialist in Munich?" John wanted to know. The heartbreak was visible on his face.
"I'm sorry, I forgot to mention, this is not the Seattle plan, this is the Munich plan. This morning I sent over the scans to Dr. Beck, who is the DIPG specialist in Munich. I used to work with him and we talked about Emma's case. He's part of the childhood brain tumor team at the lmu. Whenever you come back home you'll have an appointment with the team to talk about the specifics. As soon as Emma is discharged I'll send over Emma's medical record – with your permission of course. That will just simplify some things and you'll be less likely to run some test twice."
"How?" John blurted out, "Sorry. This is all very overwhelming and the thought of having to get an appointment in Munich even with Leo's connections …"
"You don't need to apologize. I can imagine, that's why I'm here to talk to you. Until a couple of months ago I used to work in Munich. I have direct access to get you in there. I want you to know that the final decision is yours. You know what's best for Emma and your family. Go to the appointment listen to what they have to say and then talk about it."
Leonie nodded, she seemed grateful for the lifeline. Like most parents who were in this situation, she was still processing the news. "What are we going to tell Emma?"
"I always tell my patients' parents the same thing. You know your child best. You know them, you know how much information they can handle, you know how to talk to them and you know what you want to tell them. I also tell them that kids know that something going on and that protecting them from the truth is hurting them. Their body is affected by the tumor, they have trouble seeing or hearing or doing simple everyday tasks that were easy before. They need to know, why they need to go to the hospital or why they are in pain all the time. You'll figure out what to tell Emma and Eloise. It doesn't need to be today or tomorrow, you are allowed to grieve and feel," Meredith told them, "Any of this is easy."
Derek had just come out of the most frustrating meeting with the Chief. None of his questions were answered and instead, he had added about one hundred new ones to his list. He had packed up his belongings and was heading home for the night. The paperwork could be done at the kitchen table with a cold beer or a big glass of wine. He had rented an Airbnb over Thanksgiving and the weekend for Meredith and himself since her roommates would be off work and at home the entire time. Meredith knew that he was planning something but she didn't know the actual plan.
He stepped off the elevator on the surgical floor. He didn't know why he had no patients on the floor and he could have easily texted her the address of their home away from home. He liked seeing her work, it fascinated him. There was still so much that he didn't know about her, daily he was blindsided by her intelligence. Most of the time she was unaware of her brilliance. She was so used to people around her knowing her that she didn't even realize that her behavior was very unusual. Derek knew that by going to the surgical floor to sneak in a private conversation with her would get him in trouble later tonight. She took the 'keeping things separated' rule very seriously and he didn't, which annoyed her greatly. It was part of the fun.
Meredith usually sat in the office behind the nurses' station, doing her charting and reading highly complicated research papers about things he'd never heard about. But she wasn't there today. Alex sat there with an unimpressed expression, apparently, he had reappeared.
From across the nurses' station, he spotted her in the very same conference room she had confronted him about Jamie. Meredith sat there with two people. The couple looked very concerned as if someone had just told them very bad news.
Derek had an idea who they might be. The scans had passed through him earlier today. He didn't know any specifics other than the scans had been bad. He had seen her name on the chart. He had heard the complaints about her from one of his surgeons. He could have bet that she would be taking on the task that no one else was willing to do. It hadn't even surprised him that she hadn't told him about it earlier when they had talked. Meredith never asked for help.
"Where the hell is, Grey?" he heard Dr. Bailey approach the nurses' station. Derek knew all about Meredith's and Bailey's professional quarrel. He had to agree with Meredith, professionally it wasn't right for Bailey to punish her for something that had no evidence for. However, he still liked Dr. Bailey, she was a special one. "Oh, hell no! What does she think she's doing? She's not supposed to talk to patients without a resident present," the small Dr. pushed herself past Derek, her destination the conference room.
Derek put out his arm to stop her. "Don't," he said with conviction.
"What?" she turned around to stare at him.
"I said, don't. You can yell at her after, you can ban her from the OR for another year or you could cut her some slack and watch."
"What's that supposed to mean? She left and then she came back, and then she didn't give me a reason for her disappearance and then she cheated. She left you hanging Shepherd," Bailey protested.
"I know, and she had her reasons for leaving so suddenly. I'm not saying that the way she left was the right way. All I'm saying is, don't go in there. This is the worse day of their lives, we should allow them to have this moment in privacy with someone who knows how to be there for them."
Bailey opened her mouth to fire back a responds, but closed it back up when she watched Meredith embracing the woman tightly, who had tears running down her cheek. They couldn't hear what Meredith was saying they could just see her mouth moving while she hugged the devastated woman.
"You know she's not a doctor, despite what you may think
8/22/20
It's been a while. I'm sorry. This chapter was really hard to write and life took over. It's summer and I try to enjoy the most of it. Mostly socially distanced with mask but still - it's summer. I hope you liked it.
I'm truly speechless about the responses I got for the last chapter. I love reading all your reviews1 Thank you so much!
The next chapter might be a while just as a warning, it's coming but I don't know how much time I'll have. And I like my chapters long and detailed - I really like to continue down that path.
Please stay healthy and happy! Thank you for reading and drop me a review, bye!