A/N: Hey Guys, sorry this update took so long. I really struggled with this chapter. There is a reason I try not to write OR scenes lol. Having said that, I'm not knowledgeable in the medical field especially surgery, so please look over any mistakes.

"Suction! Suction! I need suction!" Alex felt himself get more and more frantic as he searched for the source of the bleeding, "Come on, damn it!"

"Blood pressure dropping."

"Get the paddles ready," the other surgeon instructed calmly. "Did you page Pierce?"

"Yes, doctor."

One of the surgical nurses reached up with a towel to wipe the perspiration from Alex's forehead, but he jerked away, "Where the hell is that blood?"

"Taylor went to try to get some faster."

"Why didn't we have more on hand like we had requested?" Alex heard his voice getting higher as the anxiety almost overwhelmed him. He could not be responsible for killing Jo's child. He just couldn't be.

"Karev, we've already used the additional units during the aortic grafting."

Alex glanced up at Lowther, the surgical oncologist who had partnered with him for the procedure, "Why didn't we have more on hand? I meant more after accounting for the aorta."

He could hear the frustration in the man's voice, "And it bled more than we had expected! This whole tumor is much more advanced than we realized which is why we should have closed an hour ago."

Additional alarms started going off as Alex finally clamped the vessel and breathed a sigh of relief, "There it is, just let me graft this and we'll close." He could feel the other doctor staring at him as he looked up and stretched his back, "Good job everyone." He chose to ignore the oncologist as Taylor made it back with the blood. Alex could barely contain his smile as he realized they were going to be successful.

Maggie bounced into the room as staff began garbing her, "What's up?"

"You're just in time to help me graft the celiac trunk," Alex stated more cheerfully than he felt.

"You…you hit that artery? I thought the chemo had shrunk it away from the major vessels?"

"We did too," Lowther explained, "We were prepared for complications with the aorta but the tumor was far more advanced than we realized from looking at the scans."

Maggie looked between the two as she stepped up and looked at the field, "Do you think she will be able to recover from this?"

She looked up desperately at Alex, tears shining in her eyes as Lowther glared pointedly at him, "I don't think so, no."

"She's got a better chance than she did several hours ago," Alex pointed out harshly. "Now can we work faster, the kid's already been under too long."

Lowther shook his head, "Karev…" He waited until Alex looked up to meet the oncologist's sad eyes, "Everyone knows she's not going to make it. I know it, the nurses on peds know it, Brad knows it," nodding toward the anesthesiologist. "Hell, even the girl's own father knows it. This surgery was about giving her more time and maybe helping with the pain but….we can't cure this child."

Alex stared at him sadly, "You all can think that. This gives us more time to come up with a better plan."

"Alex…" Maggie began as she motioned helplessly at the open cavity in front of them, "This is…I'm not sure she can bounce back from this. I don't think she's that strong."

He bowed his head to study the task in front of him, his voice so quiet he could barely hear his own words, "Of course she is. Have you met her mother?"

They worked quietly to complete the procedure and excise the remaining tumor. When everyone was sure Mattie was stable, the oncology resident was left to close while the attendings backed away. One of the nurses walked up to Alex, "Doctor, your mother has text three more times."

She followed him into the scrub room as he started the sink and sighed, "Anything seemingly important?"

The nurse lay the phone in the window, "No, just more encouraging quotes and Bible verses."

He nodded in acknowledgement as Maggie looked over worriedly, "Everything okay?"

"I don't know," Alex answered sighing deeply, "She's been texting all morning about how I'm a great surgeon and memes about strength and endurance and telling me how proud she is of me no matter what." He shook the excess water from his hands and grabbed a towel, "Guess I need to be looking at flights to Iowa to see what that's about."

Maggie smiled to herself, "She's probably just anxious about this procedure too. And I'm sure she learned that you're the surgeon and that gave her some anxiety. I'm certain she's fine, Alex."

"What are you talking about?"

Maggie started to laugh before seeing his completely perplexed face, "Your mom. She probably just knew the surgery was today from Facebook."

Lowther finished his scrub, "Well hopefully when Jo updates about today, she'll leave my name out of it." He turned to Alex, who was still staring at Maggie questioningly, "You ready to talk to them?"

"Yeah," Alex said as he tossed his towel into the bin and looked up at the clock, "They probably expected an update ten minutes ago."

"Well, you can take the lead on that after this fiasco," the older oncologist said gruffly as they made their way down the hall. Maggie's pager went off and she dashed back the other way apologetically, asking Alex to keep her informed. For some reason, this made Alex more anxious, not realizing how having a familiar face nearby had helped to calm him. The full weight of what he was about to do hit him suddenly, causing him to feel nauseous. How could he look Jo in the face and tell her that he almost killed her daughter?

As they rounded the corner, he immediately spotted her in the waiting room. Austin was leaning against her shoulder as she ran her fingers through his hair. Bailey was sitting next to her, her hand on Jo's thigh comfortingly while the two were engaged in a conversation as Bailey seemed to be encouraging her. Hayes was standing just in front of her and to the side engaged in a deep conversation with one of the doctors he had seen on the peds ward. Alex's gait slowed as he took in everyone present: Meredith, Link, Amelia, Jackson, even Tom Koracick along with several people he did not recognize. Link was the first to spot him and gently put a hand on Jo's unoccupied shoulder from behind, causing her to jump up and reach for Hayes' hand anxiously. They took a step towards him together with the two boys on each side. Alex cleared his throat, "Maxwell is closing now. You should be able to see her as soon as she gets settled in the ICU. The tumor was more complex than we had anticipated, but we were able to get more of it out than we had expected when we first opened. She did really well considering."

Alex could feel Lowther staring at him from the side, but was completely focused on Jo as she squeezed Hayes' hand harder, her voice barely a whisper, "She's okay?"

"She's okay," he reassured as Jo let out a wail of relief, Hayes immediately taking her into his arms and hugging her tightly as the two boys joined in to hug them as well.

The rest of the crowd gave the family a moment to themselves before slowly stepping forward to comfort and give well wishes to the parents and siblings. Alex stood back taking in the scene, satisfied with his explanation for the time being. He watched as Link whirled Jo around like he had the first time they saw each other at Grey-Sloan, her smile even more brilliant this time. Jo glanced at Alex, happier than he ever remembered her being, but did a double take, her smile immediately disappearing as she turned more fully towards him, "What aren't you telling us?"

The joy and laughter seemed to immediately halt as everyone stared at her. Alex looked around anxiously, "What?"

Her eyes blazed, "You're hiding something. Tell us. Now."

Hayes took a step forward and put a hand on Jo's back, looking between them uncertainly, "Jo, she's fine. There's no reason for them to lie about that when we're going to see her soon."

Jo looked at him angrily before looking back at Alex, "I can tell you're lying. Or just omitting something. This is the 'oh Jo, I just need to go to Iowa to check on Mom, I'll be back as soon as I can' look."

Hayes stared at her for a moment before looking back at Alex in disbelief, "Anything else we should know?"

Alex looked around the room before his eyes landed on Meredith, hoping for an anchor, but her eyes were blazing with anger and disbelief as well. "There were some…unforeseen complications. The tumor was encroaching the aorta, which we had planned for, but the tumor was more advanced than we had anticipated. Mattie lost a good bit of blood during that phase of the surgery. We had not prepared for the tumor to be as close to the celiac trunk and did not foresee that as an issue, but it was clipped and she lost a good bit of blood then too."

He paused, looking around the group insecurely as no one moved or made a sound. Suddenly Jo lunged for him looking as if she wanted to rip his face off, "You son of a…"

"Woah, woah, woah," Link interjected as he grabbed her around the waist and pulled her back, "I'm sure they would have explained that later. The important thing is that she's stable now and the surgery was a success, right? Right?" He looked towards Hayes as Jo was still seething in his arms. Hayes gave a barely noticeable nod as Jo pushed herself away from Link, "Right?"

Jo took a couple of deep breaths then reached up to push the hair out of her face before pointing at Alex, her eyes holding more anger than he had ever seen, "You….you stay away from me." Hayes took a step towards her but she crossed her arms over her chest and walked past him, "I'll be in daycare with Ian. I just…I need a minute before we see Mattie."

Alex watched as an older brunette he had not seen before rubbed Hayes' bicep as she rushed after Jo, leaving the rest of the room in a dumbfounded silence. Lowther thankfully spoke up, "We'll send someone out to let you know when she's settled and you can see her. If you have any questions, just page me."

Hayes nodded, but continued to glare at Alex as they turned to leave. Alex was grateful that his day was effectively over and hid out on peds catching up on charts until time to go home. He tried to call the twins on his ride back to Meredith's house, but there was no answer on Izzie's cell. He figured they were probably at a practice of some kind or having dinner or finishing up their homework. Disappointed, he made his way to the living room and crashed on the couch. He sighed when he heard the door opening, wishing he had a few extra minutes alone. Maggie cautiously peeked around the corner then approached him slowly, "You okay?"

"I guess. For someone who almost killed their soulmate's child and then isn't able to speak to their own," he moaned not having caught the word he had used to describe Jo although Maggie had, smiling at him sweetly. Alex looked at her with annoyance, "What?"

"Nothing," she assured, her eyebrows raised at the thought of Alex being truthful about his feelings. "Nothing at all."

She started to walk towards the kitchen, when Alex stopped her, "Maggie?" She turned to him in question, causing Alex to lean forward and rest his elbows on his knees, "When you said my mom knew about the surgery from Facebook….how did you know that?"

"Oh Jo has a page she updates. She said it's a lot easier than trying to keep up with texts and phone calls."

"But how do you know my Mom is following that?"

Maggie smiled slightly and gave a small shake of the head, "Why wouldn't she?"

Alex stared at her in confusion, unbeknownst to Maggie, who had started back into the kitchen to fix herself dinner. Alex took out his phone and tried to search for a Facebook group for Mattie, but quickly became agitated when so many came up with her name. He was concentrating so hard that he missed Meredith coming in, her voice startling him, "What are you doing?"

He jumped back against the cushions, his hand over his chest as he looked up with a slight grin, "Geez, you gotta sneak up on people like that?"

"What was that today? You think you can hide major complications like that from parents who happen to be genius surgeons? What the hell were you thinking?"

"I wanted to comfort them is what. I wanted to do what I thought was best for my patient and I wanted to give them time to celebrate her coming through it before I told them the details."

Meredith dropped her purse on the other chair, "So you were going to tell them?"

"Jesus Christ, Mer, of course I was. I'm not crazy. You give parents time to process and let out some anxiety first because otherwise they don't hear the details you give them."

Meredith nodded as she sat down beside him and looked at his phone, "You have a Facebook page now? You really have changed over the years."

He gave a hint of a grin, "No, I just heard Jo has a group for Mattie that my mother apparently is a member of. I was just trying to find it."

"Well you won't that way," Meredith explained as she pulled out her phone. "Jo has that thing locked down like Fort Knox."

She pulled up the page and handed the phone to Alex as he smirked "`Moving Mountains for Mattie'? Who came up with that?"

"I'm pretty sure Jo did. She didn't want to make it easy to find." Alex looked at the page with a profile picture of a neuroblastoma ribbon and a generic description, but the contents of the actual page were much more personal: pictures of Mattie in the hospital, older pictures of her before her illness, updates on her condition. "Wow, this is something." He scrolled through, stopping as a picture caught his attention. He lingered for a while on one of Hayes, Jo and all four kids in front of a castle. Jo was holding Ian close to her chest, seemingly trying to soothe him with a huge smile on her face. Mattie was on Hayes' shoulders her arms raised to the sky and a huge smile on her face as Hayes, Liam and Austin all seemed to be laughing. "They try to get back to Ireland every year at least once," Meredith explained, her voice quiet, "Of course they won't make it this year."

Alex looked at her sadly before scrolling again, this time a picture of Jo and Mattie almost taking his breath away. Jo was in a hospital bed with no makeup, her longer hair in a messy bun. She held a newborn Mattie on her bare chest, doing skin to skin contact, as she smiled brightly at the camera. She looked so relaxed and happy, the image a punch in the gut for him. "It feels like it should have been me holding the camera," he said softly, almost to himself.

"What?"

He looked up at Meredith with a sad expression, "All of these," he said as he motioned at the images on the phone, "It feels like it should have been me. Births, holidays, birthdays, vacations…I feel like I've missed out and this….this guy is just living my life."

Meredith looked at him sadly, "Even now?"

"Even more now." Alex rubbed his face in frustration, "More so every day."

Meredith looked at him sadly, "And where would Eli and Alexis and Izzie fit into that?" When he looked at her brokenly, Meredith patted his thigh before standing to leave him to his thoughts, "Be sure not to like any of the older posts, okay?"