Title: and we see the exit sign (and we see it all)

Author: darknessinastateofmind

Summary: "He always knew, one day, that he would get what he deserved. He knew, and he knows." In which Alex Karev is diagnosed with cancer. In which everyone and everything falls apart before it all falls together.

Warnings: Cancer, depression, references to (past) self harm, language

Pairings: Eventual Alex/Izzie

Disclaimer: I do not own Grey's Anatomy nor any of the characters mentioned. All rights belong to the owner.

Author's Note: Hey, I'm back! I've brushed up a little (okay, a lot) on the emotional trauma Alex is dealing with. And not just because of cancer, but because of everything, really. So, I'm excited for you to read this chapter, as it really goes into depth when it comes to his mental state! I didn't realize how dark it was getting until I'd finished writing it, but, oh well. Again, I'm not a medical professional and all the information here is found from the internet and used with a tiny bit of a creative license. I hope you enjoy this, and/or please review and comment! It might motivate me to update faster… :) Also, sorry about the difference in page breaks. FF.N was being weird again.

/

Long way down

Feels like a long way down

Feels like a long way down

Like a long way down

So honey don't leave, don't leave,

Please don't leave me now

- Long Way Down, by Tom Odell

/

CHAPTER m.

He wakes up to a dry mouth and an aching head. Awareness creeps in like fog, so slowly he doesn't even know he's awake until it happens. The incessant beeping of the machines around him only confirm where he is; the hospital.

Fuck.

Alex searches his mind for what could have landed him here. He vaguely remembers a plethora of colors and hitting the ground. What was he doing before he fainted?

Suddenly, he remembers. He remembers his sister, he remembers her words, he remembers his own. His stomach lurches, and he has to swallow back the urge to vomit everywhere.

"Oh! Dr. Karev! You're awake! That's incredible!" an extremely annoying, high-pitched voice chirps. It's one of Izzie's interns, whose name has completely escaped him. Or, it was never in his possession in the first place. "I'll go page Dr. Shepherd!"

"Wait," he whispers, hating the gross weakness in his voice. "What happened?"

"Uh, I don't know, like, every single detail, seeing as I was put on your case just an hour or so ago by Dr. Yang, a great honor, you know, because, like, you guys are good friends, right, and obviously, like, she would only put her best interns on your case and I, like, I guess I was so excited I didn't even, like, really read your chart very closely. Please don't tell me you'll, like, tell anyone, especially not, like, Dr. Yang, she's such a good surgeon but she's like really, really cranky, especially lately, and she'd probably kill me and, like, dissect all my insides if she found out I don't know every single tiny detail about your case, I'm so sorry I should probably just-"

Great. A talkative, arrogant intern with Yangphobia and an obsession with the word 'like'. "Just page Shepherd and Yang, okay?" he says, still too softly to have much effect, but gruffly enough to reinforce that wonderful 'I'm Dr. Karev and I will hit you if you annoy me' aura he had established before cancer, and smirks a little when the intern jumps and scurries out the room with a squeaked, "okay!".

"You damn near scared my intern to hell, Karev. Glad to know you still have it in you." Cristina walks in the room with a bemused expression.

"You stuck her with me on purpose," he mutters, but can't find it in him to smile back. Maybe it's because his head is killing him, or maybe because he basically told his little sister he didn't want her (when he wants her in his life so fucking bad, he can't even breathe sometimes, you know, because he misses her like an addict longs for drugs and he just wants to make sure she's okay and he wants her to smile and he wants to be the reason for her smile and he's just so tired of being alone, so fucking tired of it). Or maybe because everything is falling apart. Himself included.

"Maybe I did. Can't let you get too cocky, being away from those brats for so long." But she seems to see that his heart isn't into their banter, because she sighs and looks down at the chart.

"What happened?"

She sighs again, and sits down on the side of the bed. It squeaks slightly under the added weight "There was a complication. Intracranial hemorrhaging occurred. Luckily, we were able to catch it in time before any lasting damage occurred. You'll just have a killer headache for some time. It's just… another side effect, Alex."

There's something she isn't saying. Alex's known Cristina for years now, and they may not be Liz and Jack from 30 Rock (he's had a lot of downtime since cancer, alright?), but he's recognized the signs. It also helps that she's a terrible liar. "There's something else. My cancer's spread. Hasn't it."

"Alex…"

She's interrupted by Derek. He walks in with a chipper smile and those stupid, optimistic blue eyes. "Alex! You're awake! That's great. I'll just perform a few tests, and I'll have Dr. Swender come in and explain your situation to you."

"Situation," he says with a snort. "That's original."

He's released two days later, filled to the brim with chemo and shitty feelings.

Alex isn't speaking to Izzie. It's childish, the rational part of him knows, but… Well, it's not like he's known for his overwhelming wisdom and maturity. Plus, he's actually, legitimately mad at her. Calling his sister was really not cool. If it were anyone else who had done it, he would've done much more than ignore said person. But, well. It's Izzie.

He spends the majority of his time alternating between staring at the wall, being too sick to stare at the wall, sleeping, and throwing up. Not very different than his usual routines, but for some reason, everyone thinks he's depressed.

Which is completely insane. He's not depressed. Depressed is… Well, his mom, right? Depressed is constant crying and screaming and that terrifying imbalance between catatonia and raging hysteria. Depressed is everything he's not.

Depressed just isn't him. That's opening a whole can of worms he's avoided his whole life, and he can't start now.

But Cristina comes in and lists hundreds of facts and statistics that make a bit of sense. And Meredith comes in and bombards him with all that 'you've got to be strong, Alex, because you have us' shit that's pretty much all she's been talking about this past century. And Izzie's just an emotional mess, and George is awkward and weirdly nice, and Bailey is gruff and worried at the same time, and everyone is just good to him. Why is everyone so good to him?

And he's just so tired. Physically, yes, but emotionally as well. He's so fucking tired of this support he's been getting. He's tired of being sick. He's tired of his life and his guilt and his past he's tired of ignoring Izzie.

That's it. He's not depressed. He's just sick and drained and tired.

/

Obviously, no one believes him when he says he's fine.

(Because, he isn't fine, he's never been fine, but right now, he's the most not-fine he's ever been in his life, worse than that time his dad beat him five seconds away from death, worse than that time it was reversed, worse than any other time in his life.

Because, sometimes there are fires erupting from his wrists, and he's reminded of the sweet coolness of a razor blade against soft skin, he's reminded of the delicious way it feels to butcher himself, he's reminded of terrible things he's done, to others and to himself.)

He's got a reputation to uphold, though. A reputation he must keep up.

"Alex, you okay?" Meredith has awoken, and she stretches from her curled up position on the couch to the left of the bed. She yawns hugely while saying, "what time is it?"

He shrugs. "I dunno. Late, I guess. Or early. Whatever."

She nods, her hair a crazy mess, looking absolutely exhausted despite the how many hours of sleep she'd just had. He supposes he looks pretty similar, if not worse, but he's been rocking the 'emaciated skeleton-man who's just spent the last fifty-eight years in hell' look for enough time, it's become the default.

"You should go to your room, Mere. Get some actual sleep." Alex shifts positions, an ache building in the small of his back.

She nods and yawns again. "Yeah, I think I will. But… Not right now. Let's talk." Meredith leans forward, elbows propped on her knees, chin in her hands. She looks like a little kid, her blue eyes so big and earnest and just dripping with compassion. How can he not say anything?

"What do you want me to say?"

"You've been so distant lately. Which, you know, I totally understand why you would be. Having cancer and needing help on some occasions tends to violate the Alex Karev code, right? Need to keep up that" - and here she does lazy air quotes with her fingers - "tough guy persona. But, you'd be surprised how helpful it is to talk about it. I should know."

He rolls his eyes. "Wow. Never expected I'd get this conversation from dark and twisty girl, over here. Do you want to compare bra sizes while we're at it?"

"Bra sizes?" Meredith wrinkles her nose. "Where'd you get that?"

He shrugs. "I dunno, don't girls do that at sleepovers?"

She let out a hearty laugh, and after some consideration, he joined in with an echoing chuckle. "I can assure you, that does not happen. You've been watching too much… Gossip Girl, or something."

Alex chews on the inside of his lip. "There's nothing to talk about. I'm fine, okay? I know all of you guys think that I'm depressed, or whatever, but give me a break! I have cancer. I'm pretty grumpy in general. I'm fine."

Meredith purses her lips, but nods after a few seconds. "Okay. If that's what you think. I'm going to bed now, okay? Sleep well." She stands up, yawns, and trudges outside.

There's an emptiness in his chest when she leaves.

Alex struggles to get out of bed the next day. Of course, he pretty much struggles to get out of bed everyday, but there's a heaviness in his entire body that he's sure wasn't there the day before. Physically, and mentally. Maybe he's going crazy. Or maybe he's just dying.

He has an appointment with Dr. Swender this morning. More of 'discussing his treatment options'. Everyone knows nothing is working. He's a dead man walking.

Or, as he struggles to make it down the stairs and has to sit on the step to catch his breath… A dead man barely walking. A dead man.

Derek, who seems to have moved into the house, sees him. "Whoa, Alex, are you alright?"

"Fine," he grumbles, shoving away the hand trying to help him. "Just taking a break."

He nods, and says, "Meredith is cooking breakfast." Alex makes a face, and Derek laughs. "Let me rephrase that. Meredith and Izzie are cooking."

A pause. "Here, let me help you up." He frowns, but takes the hand anyway.

Things have changed.

/

Izzie drives him to the hospital. Everyone else has already gone, but it seems that she's worked something out with the Chief. Because, he can't drive himself, now. There's a lot he can't do by himself.

And, they don't let dead men drive.

"Alex, I'm sorry," she whispers. Her voice is thick with regret and sorrow and apology. And pity.

His cheek is pressed against the cool glass window, and he turns towards her. He's still angry. But he's also still tired. So he says, "It's okay, Iz."

She smiles gratefully. "It's really not, though. I should've talked to you about it. I shouldn't have called her. I'm just really sorry."

"Why'd you do it?"

"I… it's because I love you, Alex. You're one of my best friends. And you're so unhappy. I just want you to be happy. I thought that your sister would give you that. I shouldn't have assumed anything." They've reached the hospital. He pushes open the door, pulls the beanie lower, over his eyebrows. (If he still had eyebrows.)

They're nearly at the entrance when he says, "I'm sorry, too."

Alex isn't looking at her, but she's smiling. He knows it.

/

It's so strange, being in the hospital again. And awkward. Izzie leads him to the oncology department, then leaves him with a gentle squeeze of his hand and a soft smile. He misses her.

Alex makes his way to Dr. Swender's office, his head down the entire time. He pushes open the door. Immediately, something is wrong. Something is terribly wrong.

It's Dr. Swender, yes, but it's also Chief Webber and Dr. Bailey. All standing there, staring at him like the fucking Inquisition.

"Hell, no," he says and turns to leave.

But Bailey can move like lightning if she wants to, and she grabs his arm and plops him down on the chair before he can find a way to escape. "Sit down, Karev. We have things to discuss."

"What the hell?" he explodes. "What is this?"

"Alex," Dr. Swender says calmly, "It has come to my attention that you've been exhibiting signs of depression."

"Jesus Christ. I'm done, alright? I'm freaking fine. I don't need this." He moves to get out of the chair, but Bailey shoots him an icy glare and a threatening Karev… It's enough to chill his blood. He sits back down.

"I know you might not think that your mental health has anything to do with your physical well being. But the unfortunate truth is that, at times, I've seen the strongest of patients lose their life because of their mental state."

Alex grinds his teeth. Takes a deep breath. Tries not to scream. "So - what. Are you saying I could be cancer-free now, if I'd just kept a positive attitude? Is that what you're saying?"

Bailey sighs, steps forward a little. "Depression is more than an 'attitude', Alex. That's not what we're saying. We're saying that this is a really terrible time for you. It's difficult. We understand. It's perfectly normal to be depressed under these circumstances. We want to help you. I want to help you."

He stares at her. A second. A minute. An hour. Forever? He's just so tired.

He's just so tired, now. He's always been tired. He was born tired.

She's staring at him now. Crying. A tear slips, unbidden from her eye, and Alex is shocked to find that his cheeks are wet. "What do you mean, Alex?" Bailey ask him, her voice torn and beaten. "What do you mean, you were 'born sad'?"

"I'm always tired, Dr. Bailey. I've never not been tired. I was born tired. I was born sad. It's not just this. No amount of treatment will cure me. You don't have to waste your time." There's an immediate sense of relief that washes over him the moment the words wash out of his mouth. And then, doom. What the hell has he done? Saying poetic shit like this? They're not idiots. They'll know. They'll see the scars.

He isn't aware of the thunderous pounding of his heart and the sweat pooling in his palms and the tightness in his throat as he struggles to fucking breathe and suddenly, there are a lot of loud noises and screaming and 'someone get him oxygen!' and he's sliding onto the floor, his heaving gasps stuffing the air with noise, he's done for he's over he's dying he's dying he's dying he's dying he's dying he's dead.

He's dead.

Good.