It's time for a disclaimer: I own nothing, I'm just letting my creative juices flow. Enjoy!

Turned Upside Down - Emergency Department

Away surgeries were more stressful and exhausting than Meredith had anticipated. It had been rewarding to be back in the OR, to have professional conversations on the same level, and to actually teach again. Richmond had done an amazing job to accommodate her needs to make the experience a complete success. The team couldn't have been more amazing and motivated to learn from her.

After some initial reservations to contact Richmond she had emailed the team her surgical approach suggestion. Complicated pediatric brain tumors were one of her specialties. In the last year of her training, she had concentrated on mapping those tumors and had worked on new minimally invasive techniques to resect them and reduce the overall surgery time. She had stumbled upon the case in the community and after some contemplations, she had decided that there was nothing to lose. So she had contacted the Richmond team. Meredith had actively picked the case and had offered her help.

It had been the first time that she had actively offered her services and expertise to another hospital. In Munich, they were the pediatric neurosurgery center for pediatric brain tumors in Southern Germany and West Austria. Patients were referred to them from all around. The department had been overworked and near capacity. Every few weeks during their tumor board meetings they would have to make the hard decision which patients they were able to take on and which ones needed to find a different hospital. There had been no capacity to look for cases or to fly across the country to operate.

During this surgery, she had experienced many firsts. It had been her first surgery as the lead surgeon on American soil. It had been her first surgery operating under her American medical license as a fully accredited German surgeon. It had been her first away surgery. It had been her first surgery after which she had left the patient in the capable hands of the local staff. It had been the first time that she had taught a group of American med students, residents, and attendings.

Meredith had demonstrated a great deal of professionalism and flexibility during this experiment. The environment had been completely different, she had to adjust to a surgical team she had never worked with before. The bureaucracy that had followed the surgery had tripled compared to the usual amount of paperwork. It had taken three professionals to figure out which forms to fill out and submit. It had been exhausting but incredibly rewarding to have a positive result. The six-hour surgery had been a complete success, she had been able to resect more of the tumor than she had thought was possible. The patient was doing incredibly well considering the circumstances.

Distracted by her phone Meredith pushed the button to call the elevator. She had finally found parking on the first level of Seattle Grace's underground staff car park.

She was back in Seattle. Earlier this morning she had come home, had slept for three hours before she had pulled herself out of bed to go to work. She had no idea where she would be working today. Yesterday she had gotten an email telling her that she wouldn't be allowed to hide in the ER for longer. She was sick and tired of this game and not willing to participate any longer.

When she heard the familiar elevator ding she stepped into the waiting car – still distracted by the second set of post-op scans from yesterday's surgery. It was too small to see any details but the initial scan looked very promising.

"Good morning Dr. Grey. Which button should I press for you or are you just along for the ride?" a familiar voice asked her.

"Hey," she smiled brightly when she noticed him leaning against the elevator railing. It was pathetic but she had missed him. They were alone. "It depends on where you're going Dr. Shepherd."

"Oh, I'm going to the fifth floor."

"I guess, I'm along for the ride then," she smirked, moving to lean next to him. Their arms touching through their warm coats. "You look nice today." He looked smart, dressed in a suit with matching shoes and a matching belt. The last time she had seen him like this was in Munich. Seattle Derek was more of a casual guy. She had a thing for dressed-up, all business Derek.

"Perfect," Derek smiled, his smile reached his eyes. She had noticed that his smile reached his eyes only on occasion, with her it always did. "Thank you, we have a department head meeting today. How was your Monday?" he asked.

"Quite successful," Meredith gave him a brief rundown. She handed him her phone so he could see for himself. She only ever showed him the scans. He only ever let her see his pre- or post-op scans. He took her smartphone and handed her a rolled-up magazine in exchange, "It's a little small, the tablet is still in the locker. What's this? Airstream monthly? Fishing weekly?" she teased while unrolling the magazine.

"It's the newest issue of NEJM. Bottom right corner," He told her while he studied her scans. Meredith checked the bottom right corner of the title page, to be surprised to read her name there.

"Wow, I thought they had decided against running it. This came out yesterday?"

"Yep," Derek confirmed grinning at her brightly. "It's four pages, plus a short introduction into the writer. Don't worry they didn't print a picture and they only used your first name initial."

Meredith grinned proudly: "This is cool."

"This is not just cool, it's huge. A neurosurgery feature in the NEJM is a big deal."

"I know but this is a real groundbreaking development in the personal department," she took her phone back, opened another email, and handed it back to him.

Derek scanned the email and broke out in a bright grin. "This is amazing, Mer. When did you get it? Why haven't you told me right when you saw me or called me? All this nonsense chit chat."

"First of all, this was not nonsense chit chat. I must have gotten the mail yesterday at some point and I just saw it this morning. You're the very first to know. Munich doesn't even know yet," The elevator came to a stop. It was the slowest elevator on the planet.

"Finally, things are beginning to look …" Their private bubble burst when the elevator doors opened on the first floor. Derek had stopped himself just in time and Meredith had reacted quickly and had moved away from him. He was still holding her phone while she held his copy of the NEJM. It was alarming how quickly they forgot that they were in a public space when they were together. Addison stepped on, she eyed them weirdly but said nothing.

The awkwardness was almost unbearable, the tension was cuttable with a knife. Derek slipped Meredith's phone into his pocket. Meredith started reading the medical journal not to distract herself from the situation.

The elevator stopped on the next floor and Richard joined the awkward party.

"Good morning Richard," Addison greeted him with a gorgeous smile, while Meredith and Derek both mumbled a "Morning".

"Good morning Addison … Derek … Meredith," the Chief greeted them individually, oblivious to the awkward situation he had stepped into.

Meredith was a fast reader who easily could tune out her surroundings when she emerged herself into a piece of interesting research. She turned page after page of the journal not noticing that she was being curiously eyed by the other elevator occupants. Richard shook his head and started a conversation with Addison and Derek.

Derek had experienced Meredith's reading speed but it still impressed him how her brain worked. While reading Meredith was very expressive, her facial impressions conveyed her thoughts. Whenever she wouldn't agree with a statement she would raise an eyebrow, or crinkle her nose. Whenever she read something intriguing she would furrow her brows and chew on her bottom lip.

On the fifth floor, the doors opened again. The three doctors exited the elevator in direction of their respected offices. Meredith followed, emerged into another article. She stopped by the scrub machine to pick up a fresh pair of light blue scrubs and made her way to the intern's locker room.

The intern locker room was the place for interns to decompress, get a quiet cup of coffee, or mourn. Every other staff member group had multiple designated places in the hospital to take a breather and sit down for a short break. The interns had a locker room. It was their designated sanctuary where they could voice their thoughts and feelings or rant to their friends. Meredith had never felt comfortable in this space. She felt like an intruder who was forced to witness private moments and hear things she was not supposed to hear.

Over the past months, friendships and alliances had been built among the interns. They were soldiers in the same battle. The battle to survive the intern year. They got each other's backs and stood up for each other. At the same time, the locker room was the breeding ground for rumors and the place with the most backstabbing and drama.

Meredith was an outsider. In the beginning, she had tried to fit in and play along, but she had soon realized that she was on a whole different path than them. She didn't experience the same firsts. She had coping mechanisms to deal with losing a patient or bad outcomes. She didn't worry about asking for the wrong instrument or not knowing the correct answer to a question. She didn't crack under the pressure or the responsibility. She had had much greater responsibility and had made much harder decisions before.

Meredith had only bonded with Cristina. They had connected over their shared interest in innovative medicine, over their jaded world view and their love for tequila. They had bonded as people and not as colleagues. George had always been nice to her and since she had helped him in the skills lab he had been extra nice. Alex tolerated her, he annoyed her and made stupid comments. As a teacher and a leader, she had developed a third sense for when people were compensating for something. Alex was for sure hiding something behind his tough exterior. Izzie was visibly annoyed with Meredith but couldn't decide if she should be her friend anyways. Her hot and cold attitude was giving Meredith whiplash.

Meredith was aware of the rumors that were floating around about her person. She was aware that people thought she was not the brightest, that they thought that she had failed the progress exam and that her mother had forced her into medicine. She was aware that her absence had been the topic of their internship so far and that there had been a giant betting pool.

The locker room was as busy as it was every morning. Meredith stopped in front of her locker to finish the last words of the NEJM article. With a sigh, she dropped her purse, the packet of fresh scrubs, and the journal on the bench to open her locker. She went through the motions to get ready for an unpredictable workday. Next to her, Cristina was recapping yesterday for her. Meredith was only listening halfheartedly – she loved Cristina but sometimes she talked too much about the medicine. Meredith clipped her pager to her waistband and stocked her white coat and scrubs pockets with the workday essentials. She was rummaging through her purse desperately trying to find her phone.

"What are you looking for?" Cristina asked, watching her friend now searching through her fall coat pockets.

"My phone. I know I had it earlier. But now I can't find it … There is no way it just disappeared," Meredith was frustrated. She needed her phone – especially today. She had promised the Richmond team that she would be reachable throughout the day. In her head, she retraced her steps. "Shit! Derek has it," she cursed.

"Derek?" Cristina asked looking at her skeptically. "Derek who?"

Meredith cringed that she had just let Derek's name slip and that Cristina had picked it up. She desperately tried to come up with a logical answer but came up blanc.

"Rounds! People we have rounds!" Dr. Bailey shouted into the locker room, motioning them to move faster, "I expect you to be on time. How many times do I need to repeat myself?"

Meredith checked her watch it was one minute before six, the time they were supposed to meet. She shrugged and let it pass. Meredith had been around her pregnant friends and had learned to just go with it.

As they followed their resident out on the surgical floor, Cristina whispered to Meredith: "Don't think I forgot about what you just said."

For the last hours, Meredith had been shadowing Dr. Bailey. Apparently, this was her new form of punishment. Bailey wasn't on the OR schedule today and had been assigned to the general surgery clinic. All morning Meredith had quietly sat on a chair in a clinic office, while Dr. Bailey saw her patients. Her task was to chart the visits while they happened. Instead of getting upset about being downgraded to a secretary, Meredith had taken the time to study her resident. She had never spent this much time with the woman that had so many doctors wrapped around her finger. Meredith had never understood the phenomenon Bailey. Why she - as a fourth-year resident – was able to walk around the hospital like she was the Chief of Surgery herself. Objectively Bailey was a smart, talented surgeon who had an exceptional connection with her patients. Her unquestioned confidence, her no-bullshit attitude, and her compassion for her patients were her most prominent character traits. For a fourth year, she was advanced, her technique was sophisticated and she was for sure an asset to the hospital. However, Bailey didn't earn her laurels while teaching.

Meredith had noticed that the doctors at Seattle Grace still used a very old school method of teaching in general. Her mother had once told her that residents needed to be shown their place, they needed to be scolded and yelled at. This statement had stayed with Meredith for many years of her education. She had never understood 'the eat your young' mentality. Meredith had encountered teachers that had practiced this method but had also been taught by many professors and mentors that had been very encouraging and had taken the time to answer questions and explain complex situations. Meredith herself had adopted the latter style of teaching. She personally had always profited more from this method and saw a lot of benefits in treating the younger generation with respect rather than scaring them to death.

Dr. Bailey was the former style of teaching coming alive. She rarely took the time to explain what was going on, she expected her interns come in over-prepared, to know every eventuality that could occur during a case. She would get annoyed if they would ask questions about procedures or needed help with anything. Whenever one of her interns made a mistake she automatically assumed it would reflect badly on her personally. Then there was the way she had handled Meredith's situation. Not once had she taken the time to talk to Meredith – not about her absence, nor had she inquired how Meredith was dealing with trying to keep up with the program. She had mentally put more pressure on the young woman, had openly voiced her disapproval, and made clear that she saw her as a waste of time. How Bailey treated Meredith was bordering on workplace harassment. Unfortunately, this treatment wasn't uncommon in the medical profession.

Meredith was having lunch in the cafeteria with Cristina and George. Clinic hours were finished for the day and she still had no idea where she would be working after lunch. Her phone was still in Derek's possession. She hadn't found the time to find him and have a non-suspicions hand-over. All-day she had received calls, emails, and texts on her smartwatch. She had recognized some phone numbers while others had been unknown to her. She hadn't been able to pick up any.

The cafeteria was busy. It was a big boring uninviting room with a window front and lots of tables. Patients and staff shared the dining hall. The food was mediocre at best and insanely expensive. Meredith tried to stay away from consuming this joke of sustenance but today she had joined her colleagues. It was nice eating lunch with friends again.

Both had covered the cardio clinic today. Cristina the cardio enthusiast was arguing with George over his lacking enthusiasm. Contrary to Cristina who was set on one specialty, George was still undecided where he would be heading after this internship. Not everyone was a Cristina who knew with certainty that cardiothoracic was it for her.

Meredith herself had started with a post-grad education in general surgery. Within the first months, she had developed a burning interest in neurosurgery. Two months into her general surgery program she had added her neurosurgery residency to her schedule and a year after that anesthesiology. She had continued with general surgery but had never quite enjoyed it as much as the other two. For her, it had always been her mother's specialty which provided a useful surgical basis knowledge but nothing beyond that.

"I'm just not sure if I like cardio," George sighed loudly, before biting into his sandwich.

"How can you not be sure if you like something nor not, Georgie?" Cristina asked.

"For the millionth time, my name is not Georgie, Tina, it's George," George pointedly looked at her, "I just don't know, okay? It's fine I guess but it's not that exciting."

"If you call me Tina one more time, you'll be very sorry." Cristina protested, throwing a french fry at him. Meredith watched the interaction between the two, shaking her head. She felt a vibration on her wrist notifying her of an incoming phone call. She checked her watch.

"Sorry guys I have to take this," she lifted her arm, "I'll be back."

"We will be here," George told Meredith. She exited the cafeteria to find a quiet semi-private place to take the call from Richmond. With no headphones on hand, she had to have the conversation out in the open.

Just outside the cafeteria, there was an atrium with a comfortable launch seating area, a big flat-screen TV, some greenery, and a fish tank. She had never understood why they had put it right in front of the cafeteria rather than incorporating it into the dining hall.

She stood to the side against a wall, taking the call. They had called her as the lead surgeon to take part in the update meeting. They discussed the patient's progress, the final pathology report, and the further plan of action. From time to time she would pitch in but she mostly listened with her watch by her ear.

Derek came up the stairs and walked towards the cafeteria. This could be her moment to get her phone back. But then she spotted Addison exiting the elevator.

"Derek!" she called, hurrying after him her heels clicking on the smooth floor. She was the only surgeon Meredith had met at Seattle Grey who only wore scrubs into the OR. Addison had a strong sense of fashion. She wore designer clothes and heels daily and seemed to have an abundance of clothes at her disposal.

"What, Addison?" Derek stopped and turned around. Meredith could tell that he was annoyed.

"An intern? Really, Derek? Really?" She asked him one hand on her hip the other wildly gesturing.

"What are you talking about?"

"I'm talking about your intern. You know the tiny, blonde one," she accused him. Meredith cringed inwardly. Her call had ended and the conversation in front of her had her full attention.

"Who?" Derek looked at her confusedly. Sometimes Meredith admired his obliviousness. Ever since Munich, he had only seen her as the kickass physician who had intubated a patient in a moving vehicle while having blood dripping down her face. He would share pre-op scans with her and ask for advice on cases. She regularly had to remind him that she was hired as an intern.

"The intern you've been sleeping with. The one in the elevator today," Addison spat through her teeth.

"I don't think it's any of your business. I stopped being of your concern when you decided to sleep with Mark in our bed, lived with him for months, and are currently carrying his child," Derek bit back. Meredith flinched. Once again they were fighting out in the open, throwing private information at each other's heads. When Addison had confronted him they had been alone but now people were walking past them, curiously glancing at the duo.

"And you have made that more than clear the moment you served me with papers," Addison snapped. "But for the love of god Derek you're not seriously this stupid. I really hope I don't have to explain the optics to you. You're the chair of neurosurgery – she's an intern. If this goes south, you're the one endangering your career. Especially in this day and age. And for what? A little fun in your 'let's move across the country and start over midlife crisis'. You're a highly educated 35-year-old man with an incredible gift but right now you're being reckless. Think of the potential consequences. She's an intern and not the brightest of the bunch … What do you think will happen when Richard finds out, or HR or the board?"

Meredith wasn't surprised that at that moment she agreed with Addison. She had repeatedly told him the same thing from the moment she had found out that he was one of her bosses. She reminded him daily why they couldn't eat lunch together or take just one car.

The blonde surgeon felt obligated to put a stop to this conversation for all their privacy sakes. People had started to gather - the fighting couple oblivious. She wouldn't be surprised if Derek would expose her secret to the entire hospital in the next second just to defend her honor. Meredith watched Derek preparing for his rebuttal, while she called him through her watch. Annoyedly he fished his phone out of his pocket and picked up after he checked who called him.

"Can I call you back? I'm in the middle of something."

"I know. I'm here and so are other people. I'm all for you two figuring stuff out but I would prefer if you could not do it in front of the entire hospital. I think you two would agree with me here," she told him.

Derek looked around, spotted her, and noticed the people around them. "Thank you," he hung up, turned to Addison "I don't think this is neither the time nor place to discuss this," He then turned around walking back to the stairs leaving a perplex Addison standing there. The redhead raised her eyebrows, shook her head, and then continued walking to where she was heading initially.

Meredith exhaled loudly – she was shaken. Meredith had insisted that they be incredibly careful to keep their relationship private and hidden. They had carefully picked places around the city to eat and had always stayed an acceptable distance from the hospital. They rarely talked while at work, and if only when they were one hundred percent certain that they were alone. Meredith hadn't even seen his office, didn't even know where it was. They would always take two cars to and from work. None of his sisters knew that he was dating someone, only his mother knew that he had met someone. She had no clue how Addison could have found out about them. It kind of stressed her out more than she liked to admit.

Everything that Addison had told him were valid concerns that Meredith shared and then some. Just because Derek didn't, didn't make them any less real.

Izzie, Alex, and two other female interns that Meredith only knew through passing had joined their table when Meredith returned to the cafeteria. The discussion was in full swing and it didn't take long for Meredith to figure out what the topic was.

"Who do you think it is?" one of the interns asked.

"I have no idea but I bet she gets special treatment. Do you think she's the reason why his marriage is in scrambles?" Izzie thought out loud.

After that comment Meredith tuned out the conversation, concentrating back on her half-eaten sandwich. Cristina leaned over and whispered in Meredith's ear: "I thought you hated him. I thought he hated you. What happened? I'm confused."

"Munich happened," she replied quietly, staring at her plate.

"Oh … Oh. So he knows?" Realization set in for Cristina.

"He knows," Meredith confirmed. "It's a long story."

"That you're going to tell me."

"Sure," Meredith rolled her eyes, checking her pager that had just vibrated. "Duty calls."

Dr. Bailey had been impatiently waiting for her. She had been paged to the ER for an incoming trauma case. Meredith had been kicked out of the trauma room before the paramedics had started their handover. Bailey had argued that there were too many people in the room already and that she should be watching through the glass window instead. Her resident was really testing her patience today. Meredith stood outside the trauma room watching through the glass doors what was happening on the inside. She soon lost interest – it wasn't like she learned anything from watching what she already done on multiple occasions nor could she help. She made her way over to the nurses' station to see if anyone she knew needed help.

"Meredith, are you working?" Nuri one of the triage nurses asked her.

"I'm working but I'm not supposed to be working in the ED today," Meredith told her with an eye roll.

"Too bad," Nuri sighed, scratching her head. "I guess I need to find someone else. We're swamped again."

Meredith held out her hand, "Come on, I'll take it."

"They're in room three," Nuri handed Meredith the paper chart with a big smile. "You're the best."

"No problem," Meredith replied, "If Dr. Bailey should be looking for me …"

"Then I'll think of something," Nuri winked.

"Thanks," Meredith sent her a knowing look before walking towards the room. She skimmed through the intake paperwork educating herself on the case before she knocked on the doorpost. "Hello, I'm Meredith and I'm looking for Miss Emma," Meredith entered the room with a smile, rubbing the hand sanitizer into her hands. "Who of you ladies is Miss Emma?"

"I'm Emma," the older of the two girls sitting on the exam table giggled.

"Hello Miss Emma," Meredith shook the hand of the six-year-old funnily which lead to more giggles. Over the years she had learned that even the youngest patients liked to be acknowledged as real people. Establishing a relationship with the patient from the beginning reduced their stress and allowed her to get more accurate answers. It had taken her many years to figure out how to efficiently navigate parents and patients, how to talk to kids of all ages, and to still get her job done.

"I'm Eloise," the younger sister introduced herself.

"Hello, Miss Eloise. Nice to meet you," Meredith shook her tiny hand in the same way she had her sister's previously. Meredith grabbed the spinny chair from under the exam table and sat down. "And who is this?" she asked the girls.

"This is my Mama," Emma giggled. She had big brown eyes and light brown curly hair.

"Hello Mom," Meredith smiled at the anxious-looking woman who occupied the chair, across from the bed. "I'm Dr. Grey," She rolled over with her chair, shaking her hand as well.

"Hello. Please call me Leonie. I only listen to Mom when it comes to those two little munchkins," she gestured at her two girls.

"Sure," Meredith laughed, "So, Miss Emma I'm going to talk to your Mom real quick, and then we are going to play a game," she told the six-year-old who was coloring in the hospital issued coloring book with her sister. The girl nodded. Meredith entered her login into the desktop computer, pulled up the new patient chart, and turned to the mother: "Why don't you tell me what made you come in today. I know it feels repetitive and that you already told the nurse. It just gives me a better picture if I get the information from the source."

"Sure, I usually wouldn't just come into the ER for this. I would make an appointment with our pediatrician, however, I have a feeling that it can't wait until we are back home and we have nowhere else to go."

"Don't worry that's why we're here. Besides, nothing beats a mother's intuition," Meredith told her reassuringly.

"This morning Emma woke up and I noticed the left side of her face drooping. It's only minor but it's there," Leonie explained, looking at her daughter with worry.

"Yeah, I noticed that. Have you noticed anything else that has been different over the last couple of days?"

"She has been complaining about a headache for about three days and she is unusually sleepy to an almost lethargic degree. Normally she is a very active kid. I honestly thought it was just the jet lag."

"You recently traveled? Did she have any fevers?"

"She had a fever about two or three weeks ago but I don't think it's related. We are here for Thanksgiving break. My husband is from Seattle and he had a meeting that coincided with the holiday. So we decided that it would be a good idea to spend Thanksgiving with my in-laws. I don't think we're going to be doing this anytime soon again. Flying halfway across the globe with two small children is no joke."

"I can imagine. Is the area where you live known for any infectious diseases?"

"Of course, that's what you were asking. No, we live in Europe. She's up to date on all her shots. Typically she's very healthy unless you want to count all the minor school bugs. Maybe I'm just hyper-aware."

"Nothing wrong with hyper-awareness," Meredith smiled, "You said Emma had a fever two to three weeks ago, did you see her care provider for that?"

"Yes, she had an ear infection in her right ear. We got some antibiotics and she was fine within two days. No further complaints," Leonie recollected.

Meredith added the information to the electronic chart, before asking: "Any seizures, vomiting, nausea, or any known conditions or diseases? Any head trauma, falls, tumbles?"

"No. She has hay fever but other than that nothing," Leonie shook her head.

"Okay then," Meredith saved the notes. "Here are the options. We could run a bunch of tests to try to get to the bottom of this. However, I don't think that those will give us any clarifying answers. I would suggest that I do a neurological exam first before we unnecessarily draw a bunch of blood. Are you okay with this?" Meredith asked.

"Yeah sure."

"Okay, Miss Emma are you ready to play a game?" Meredith asked the little girl.

"What kind of game?" she asked not sure if she was up for it.

"A game that I made up. I bet you made up games before?"

Emma nodded, "At school, my friends and I always play made up games."

"Do you like school? Are you in kindergarten?"

"No, Eloise is in Kindergarten. I'm in first grade," Emma told Meredith. The way she pronounced kindergarten sounded very familiar.

"Eloise is in pre-school," Leonie clarified for Meredith. "There are some disadvantages to raising them bilingual."

"I get it," Meredith smiled.

"We live in Germany. Daddy's German is very bad, it's funny when he tries to talk. I speak English with him. With Mama, I speak both. She's a doctor. Daddy works with a computer, sometimes he works from home then he talks on the phone a lot and very loud," Emma told Meredith with big eyes. The information just poured out of her. "We live in a house and we have a garden with a swing set and a sandpit. My Oma and Opa have a dog, his name is Wastl, he is tiny and cute but also very mean. What kind of doctor are you?"

"I'm a surgeon. I operate on people to make them better," Meredith explained.

"My Mama is becoming an anest… anesthi … she puts people to sleep," Emma looked at Meredith intently, "How do you play your game?"

Meredith couldn't take full credit for her 'game'. It had been a joined effort by many departments to come up with a fun way to conceal a long neuro exam into a game. A multi-disciplinary team had worked for many months before they had started trails. It had been part of an effort to make the whole hospital experience a little more kid-friendly. Most kids were more or less aware that something scary was happening to them. They could feel their parents' anxiety, they spent hours in doctors' offices without getting much information themselves. For most of them going to the hospital would become a constant part of their lives. Adults would poke them and make them feel horrible. They would have to have uncomfortable tests and surgeries without understanding the reason. The protocol was an effort to make the experience a little more bearable and give the patient back some control. It was working and had been implemented by multiple other institutions around the world.

Meredith had been part of the initial team who had come up with the original idea and had watched the child specialists come up with the amazing protocol. Back in Munich, she had had a team of nurses, psychologists, therapists, and technicians that all had helped. It was a collaboratory process.

During the exam, there were many giggles by Emma and Eloise – who had joined in. Meredith had noticed more and more deficits that concerned her. She exhaled dramatically: "Miss Emma, you beat me. I guess the winner needs a price, right? What about a sticker?"

"Yes, I love stickers," her eyes lit up and a giant smile spread across her face. Little kids were so easy to please. "Mama, I won a sticker," she declared proudly.

Leonie smiled at her daughter.

"I guess I need to on a sticker hunt," Meredith told Emma before she turned back to the dark-haired anxious woman on the chair. Meredith sighed quietly before she began: "I don't think that Emma has any acute infections or inflammation, of course, I can't rule it out just yet. But her neck isn't stiff, she doesn't show the typical symptoms for meningitis and she has no fever. However, three different cranial nerves show some form of deficit in various degrees. Her eyes are twitchy and her muscle tone is weaker on the left side. Her balance is off. I would like to run an MRI and I don't say this lightly." Leonie swallowed hard. "I know this is a lot to take in. With your training your brain tends to go jump to the worst imageable outcomes, just don't go there yet. We don't know anything."

"Mhm," Leonie nodded, trying to keep her composure.

"I hate to ask this, but this is unfortunately how the American health care system works. I assume you have travel health insurance," Leonie nodded, "Good. I don't want to run an MRI and find out after, that your insurance doesn't cover it and leave you with the insane cost. I have to speak with my colleague whether he thinks that an MRI is appropriate but when I do I want to be sure that it's fully covered. They're a little stingy when they don't know if the costs are covered," Meredith smiled a little.

With shaking hands, Leonie pulled out her wallet looking for the card to call the insurance emergency hotline. It was evident to Meredith that the news had shaken the young woman. She was alone with two small children in a foreign hospital and she had just learned that her daughter had a probable brain condition. The kids were getting restless, who knew how long they had been waiting before Meredith had come in to see them. Leonie looked stressed and overwhelmed. Meredith noticed the yellow card, she knew the provider, she had worked with them before as a transport physician.

"I can call for you if you want," Meredith offered. Normally this would be the job of someone else – a volunteer, a nurse's assistant, or the front desk staff. Physicians never called around for patients unless they needed a consult on a case. Meredith's situation was different, her schedule wasn't busy, she had no patients of her own and she was sick and tired of being put on the sidelines.

"Are you sure? They probably only speak German."

"I'm sure. No need to worry," Meredith ensured.

"Thank you," Leonie handed her the card.

"Mama," a little hand pulled on her mother's sleeve.

"Was, Eloise?"

"Ich hab soo Durst," she reported her thirst by spreading her little arms and looking at her mother with big eyes.

"Ich auch und Hunger," Emma agreed.

"Ich weiß, meine Schätze. Wir haben leider nichts mehr. Ihr müsst euch leider noch ein bisschen gedulden bis wir was neues besorgen können," Leonie explained to her daughters patiently.

"Ich schau mal ob ich was organisieren kann," Meredith said, getting ready to hunt down whoever was willing to sign off on the MRI.

"Why do you speak German?" Emma asked, curiously eying her, "Grandma doesn't speak German."

"Well, I used to live in Germany for many years," Meredith told her. Emma's eyes went big as her worlds collided.

"Okay, super. Danke. Wenn Sie mir das jetzt noch per Mail schicken könnten wäre ich Ihnen sehr dankbar. … Klar," Meredith told the lady on the other end of the line her hospital email address. She had been on hold for twenty minutes before someone had picked up. It was almost 12:30 at night in Germany. The woman on the phone had been very helpful and had given Meredith the all clear for the MRI. "Vielen, vielen Dank. Sie haben mir wirklich sehr geholfen. Auf wiederhören," Meredith hang up the telephone, with a loud exhale. She sat at the ER nurses' station. Nuri had told her that Bailey was in surgery with the trauma case so she at least did not have to worry about her. The ER was buzzing, it looked like chaos with a system.

"Back at it again," Brandon commented, he sat next to her writing a discharge note. He was the ER Chief resident and not much older than thirty. In the ER they were all on a first-name basis.

"What?" Meredith asked.
"You're back at it again. Meredith and her many hidden talents. With whom were you speaking anyways?"

"Travel health insurance company of my patient."

"Which patient?"

"Six-year-old in room three," Meredith leaned back into her office chair, "She needs an MRI. Can you sign off on it?" she asked with a smile.

"She needs an MRI?" he questioned with a raised eyebrow. "Of what?"

"The brain," Meredith told him and proceeded to present the case to him. Simultaneously he pulled up the chart on his computer.

"Why an MRI, though? A blood test or a lumbar puncture would be reasonable. Or a CT."

"Sure I can draw blood to get a baseline. We won't figure out the origin of her neurological deficits with that, though. Do you think a lumbar puncture is reasonable? Based on what evidence?" she questioned.

"She had a fever from otitis media. The bacteria could have spread to the brain membranes which could explain the nerve deficits. What if this is atypically presenting meningitis? I think this is enough evidence to justify a lumbar puncture. Have you checked her ears?" Brandon asked.

"Of course I have. They're clear. She hears fine and she isn't complaining about an earache, doesn't have a fever or a stiff neck. The ear infection was on the right, she is presenting with weakness on the left. She was prescribed amoxicillin, finished the course, and checked back with their pediatrician after. They did everything as they were supposed to. Including coming in today. Her symptoms are sudden onset, her mother is worried," Meredith argued.

"I'm not saying that they did anything wrong. I'm just confused about why you would shoot for an MRI first before checking off all the other boxes."

"Good. Because I don't think she has an infection and all standard blood tests just rule out infections. If I as the physician don't think that a test is going to benefit the diagnostic process I'm not going to order it. Especially if that means sticking a giant needle in a six-year-old's back. In particular, if an MRI is noninvasive, less traumatic and will give us probably a good idea of what's going on."

"What do you think you'll see on the MRI?"

"A brain tumor."

"A brain tumor? Really? When you hear hoofprints think horses, not zebras, Meredith," Brandon sighed.

"Yes really, a brain tumor. This has nothing to do with zebras. Don't try me."

"Not about zebras? Based on one exam you assume that a little girl has a brain tumor? Most other doctors would check for multiple other things before even going there. You just jumped to that conclusion supported by your years of experience, I assume?"

"Come on, do you really think I would even assume a diagnosis like that without a reasonable concern? The combination of her history and her presentation concerns me," Meredith debated. "All I'm asking is that we do the MRI to check. I'm more than happy should my theory be wrong. This isn't about me. This is about Emma."

"I don't know, Meredith. It just doesn't sit right with me. What if you're so caught up with the thought that she has a brain tumor that you missed something?"

Meredith sighed frustratedly. She ran her hand through her mid-length hair. She knew that convincing one of the ER physicians about her suspected diagnosis would be a hard task. Everything about her physical appearance – her nameless lab coat, the light blue scrubs, her young age, and her hospital ID – identified her as an intern. Even if she decided to spill her secret right now, there was no way of knowing if he would believe her. She was getting desperate. She had seen enough patients with similar histories to know that her concern was valid. What frustrated her the most was that if they decided against the scan and her concerns were correct Emma's condition could rapidly deteriorate, potentially endangering her life. There was no way of knowing without the imaging. "Go see her yourself or have someone else look at her."

"Have you consulted Neuro?" Brandon asked in thought what the right next step would be.

"No, I have not."

"Do that," he nodded in agreement. "Let them decide what to do next."

"Fine," Meredith tried really hard not to be visibly bothered by the request.

"Now you're annoyed," Brandon stated.

"I'm not annoyed," Meredith spat through her teeth.

"Yes, you are. I can see it. Look, I get it. As an intern, you see things that are not there …"

"Don't," Meredith held up her hand to stop him.

"It happens to the best of us. My judgment is clouded by your assumption and I don't feel comfortable deciding what we should do or not do. Neuro is far better equipped for that. For what it's worth, Meredith, I've never seen an intern arguing this passionately on a patient's behalf with a superior. It takes balls. One would even doubt that you're indeed only an intern. You're relentless, a force to be reckoned with. Don't let this pull you down," he told her sincerely while taking the discharge letter for his patient out of the printer, "For all, we know you could be right," he winked before turning around and walking away. He and Meredith had hit off right from the beginning.

She missed the professional discourse among colleagues. Being an intern was so serious – she had not expected that. The competitiveness was at an all-time high and the stress and anxiety of being responsible for patients were weighing heavy on them. Meredith couldn't identify with this anymore. For her being a doctor was comparable to going to work at any other job. An attorney had to defend his clients at court. A pilot was responsible for passengers and crew. A teacher was responsible to teach the new generation. A firefighter fought fires and saved people. A ballerina danced on stage to portray a story and make the audience feel something. Saving lives was her responsibility.

Beyond that she enjoyed the personal relationships and interactions with colleagues, the banter, eating lunch together, and grabbing a drink after work. Meredith missed those things.

When she had started her shifts in the ER she had let her guard down. For the first time in Seattle, she had enjoyed going to work. She was less afraid that someone would find out that she was more than an intern. She still had erred on the side of caution.

Meredith picked up the phone and called neuro for a consult. This was the only thing that she was able to do for the family in room three right now. The neurology and neurosurgical departments were confusing. Even though both were run and managed independently, they shared a single ER consult hotline. Derek had tried to explain the reason behind this move on multiple occasion and she still had trouble seeing any logic in it. Both departments refused to share resources and patient information in Clinic or on the floor but were okay with this concept.

The hotline was manned with a PA who then would decide who needed to be paged – neurology or neurosurgery. After, a resident would call her, to see if the case fell into their jurisdiction. It was lengthy and unnecessary.

Meredith talked to the PA, she presented the case to her and the PA told her that someone would contact her shortly. She sat in front of the phone for fifteen minutes before she got to talk to a neuro resident who told her he would be down to see Emma as soon as he was done on the floor, but it could take some time.

Meredith returned to the room with stickers for the girls and an update for mom. A volunteer had brought in food and beverages for the family. They all looked exhausted. The jet lag was evident. Eloise had curled up on her mother's lap. Emma sat on the exam table unenthusiastic watching something on a tablet, her eyes visibly turning in.

Meredith stayed until she got paged to the surgical floor. She had talked to Leonie for half an hour, sensing that the young mother needed some company. Leonie was in her second to last year of training to become an anesthesiologist at a city hospital in Munich. She had studied medicine at the other university in Munich. It always amazed Meredith how small the world was. They chatted about their experience studying medicine in the Bavarian city. Leonie seemed a little more at ease when Meredith left her for the surgical floor. Her husband was on his way, Eloise had fallen asleep and Emma was fighting sleep as well. She promised that she would check on them before she left for the night but told them that she hoped that they were already done by then.

Meredith closed the door to the garage behind her and locked it. She took off her shoes and left them by the door. Following the delicious smell, she walked straight into the kitchen. Her stomach was growling – she was starving. With a loud thump, she set her heavy purse down on the kitchen table.

"I could get used to this," Meredith walked up behind him and wrapped her arms around his torso, resting her head on his back. Derek stood at the stove, stirring the contents of a pot.

"Used to what?" Derek asked smirking, turning around in her hug to face her.

"Coming home to home-cooked food," Meredith smiled mockingly at him, reaching up to give him a kiss. "And to you of course."

"Don't get used to it," he grinned, leaning down to kiss her.

"I won't, don't worry. What's for dinner?" she peeked into the pot.

"Chili. I waited for you so that we could decide together but then I was too hungry to wait any longer. I didn't know when you would be home," Derek explained. He had his dress shirt sleeves rolled up and his top button undone. Music was playing in the background while was making dinner.

"I should have been home an hour ago, but I got caught up with a patient and then I had trouble getting my car to start," Meredith opened a cabinet, took out a glass and filled it with water.

"That thing is going to die soon. You should think about investing in a more reliable model. One that doesn't fall apart," Derek shook his head.

"I know. It's just …"

"Mer," he interrupted her, "You don't have student loans, you don't have to pay rent, you're an accomplished woman. There's no need for you to drive a car that you would buy a sixteen-year-old in the assumption that they will crash it at the next best moment. You can afford a decent car."

"I know. It's just I never owned a car before and buying a new one is a big purchase," Meredith argued, refilling her glass at the faucet. She usually returned dehydrated from work.

"Please, you bought your condo when you were twenty-four," Derek snorted, "It's a just new car, Mer. No one is saying that you need to buy a Porsche. It should be safe and reliable."

"I know," she rolled her eyes, making a face, while she began setting the dinner table.

"How was your day?" he changed the subject.

"It started great. My article got published, my patient is going great, I got the anesthesia residency confirmation, I got to talk to you. Then I spent the morning in Clinic, being Bailey's secretary. I had a bland sandwich for lunch, found out that Addison knows about us, stopped my boyfriend from defending my honor – which is sweet but not necessary," she looked at him. "Well, the interns picked up on the fact that you are seeing one of them and Izzie News Network has a new breaking story. So that was fun. Then I got paged to the ER only to be kicked out of the trauma room and forgotten when they took the patient to the OR. I then found myself a patient, saw them independently, argued with the Brandon, called for a neuro consult – got forgotten by them, wrote some orders, checked on patients, yelled at the neuro resident for forgetting my patient. All while not having my phone because you took it this morning," Meredith recollected her day, sitting down at the island.

"Your phone is on the charger in the study. Are you always this busy?"

"God no, I think it's linked to the article. They somehow always get the contact information. It's the same after speaking at a conference. I haven't had time to check yet. It drained my watch."

"Oh, okay. I had to put it on silent. Why did you need a neuro consult?" Derek asked, pouring the chili seasoning over the ground beef. "They basically already had the neuro consult there."

"I know, but I disagreed with Brandon on the next diagnostic step and he wasn't willing to sign off on an MRI. Suspecting a brain tumor in a six-year-old is apparently a zebra," she opened a bottle of wine and poured two glasses. "He said I might have overlooked something and he didn't feel comfortable doing an MRI instead of a spinal tap. I mean, I get it. It seems like an outlandish assumption to make by an intern in the ER. So kudos to him for being thorough. It just sucks for the family that they had to wait so long and have to go through the entire exam again. Who knows what they have to go through to get answers. I just really hope I'm wrong." Meredith got up and handed him a glass of wine.

"Thank you."

"You're welcome. You look like you need it. How was your day?"

"It was okay," he shrugged unenthused, "First surgery went fine, second got postponed because there were some staffing issues. It's always unfortunate to push back a surgery if the patient is about to get to the OR. They and their family were very understanding but it just doesn't sit right with me," Derek turned off the stove and filled two bowls with the chili. He carried them over to the table. Meredith followed him with their wine glasses.

"What kind of staffing issue? Isn't there supposed to be back-up?"

"Normally there is, but with Thanksgiving around the corner, we run on limited staff as it is. Only emergent cases are scheduled for surgery so more people can spend time with their families. If one of them gets sick or is unavailable the whole system needs to be reevaluated. There is no surgery without an anesthesiologist or a CRNA."

"That sucks. I'm so out of the loop what is happening on the surgical floor – it's alarming," Meredith commented. "It tastes great, Der."

"Thank you but it's actually a seasoning mix."

"You could have just taken the credit," Meredith teased.

"I could have. Well, I haven't told you the biggest shocker yet. During the department head meeting, admin informed us that coming January first, Seattle Grace and Mercy West will be merging or we will be absorbing them or we will be absorbed by them."

"Wait, what?! ... What? How? Why?" Meredith asked, clearly surprised by the information.

"That's all I know. They just dropped the bomb without answering questions."

"There must be a reason, right? Do you know about the numbers?"

"The numbers aren't the best, but I don't think 'going under' bad. But what do I know? I'm just now getting a feel for my department's numbers. A month, Mer. Within a month they expect us to combine two staffed hospitals into one functioning medical center. How?"

"They didn't give you any specifics?" Meredith asked.

"None," Derek shook his head, "We went through the typical agenda and then at the end they dropped the bomb. They said that Richard and Dr. Fisher will brief us soon."

"I think this merger probably has been in the works for months. There is no way of going through a deal like this within a month, they are just now letting you know about it. This is how Admin thinks. For most of them, health care is just another product that they sell. It's easier to merge two companies that sell FMCG, or any similar product. Production costs get reduced because of the economies of scale, the market share increases, et cetera. In health care you don't get those effects, health care is a service industry, there are people involved - sick, dying people. You can't just cut costs when it comes to people. Of course the bigger you are the better prices you get with suppliers but that about it," Meredith rambled. She looked up in Derek's face who starred at her. "I'm boring you, right?"

"No, not at all. I just never paid much attention to economics and business in school. My mom always told me, I should take an econ class because one day I will need it. I never took one. Look at me now," Derek laughed.

"You're doing a pretty fine job running a department for not having heard an econ class. Don't beat yourself up. Is this an acquisition or a merger?"

"I don't know. I don't know," Derek shook his head, "I'll let you know as soon as I know more, so you can bring some light into the dark. I'm just worried that people are going to lose their jobs. That some of my people are going to lose their jobs. Mercy west has a neurosurgery department as well. How is this going to play out?"

"I guess you have to wait and see."

"I guess so."

Both were lost in their thoughts for a while, finishing their dinner in silence.

Derek was loading the dishwasher while Meredith cleaned the kitchen.

"You know what this means?" Meredith asked out of the blue.

"What?"

"I was thinking about it anyway, it's time that I bow out. Now that I have confirmation from the anesthesiology board, I have no reason to stay at Seattle Grace and take up space. Should the other boards decide differently, I now have some leverage to fight them on their decision. There is no reason to hide anymore," Meredith told him with a grin.

Derek looked at her a smile playing about his lips: "I guess there is not. We should celebrate that."

"We should, shouldn't we?" Meredith smirked.

"For sure," Derek nodded. Meredith giggled loudly when she took his hand to follow him upstairs.

Meredith had come in early this morning. Her job was to have all patient information ready for rounds. It was always one intern's job to collect the data and concerns from the nurses that had accumulated overnight. She usually did it ten minutes before rounds started but Derek's postponed surgery had been pushed to early this morning. She had been awake and had decided to go leave with him.

She sat at a computer at the nurses' station, sipping her morning tea. She pulled up Emma's file - she was curious about what they had found and if they had done her suggested MRI.

Emma had been admitted to the pediatric unit last night, which confused Meredith. When she read on she understood why. Neurology had decided to do a spinal tab first. They had found cancer cells in her spinal fluid which had prompted them to finally order the MRI to get to the bottom of it. Meredith exhaled sadly as she read the odyssey in the chart. They must have waited for hours and it didn't read as if they had informed her parents about the finding of the spinal tab yet. They had done the scan late last night but it hadn't been read by radiology yet.

She opened the file. Meredith had read many brain MRIs in her career. Every single one was horrible in their own way. Behind every scan were a patient and a story. Some were happy stories, patients that were cured with one surgery. Some told the story of surgical excellence, teamwork, and a heroic fight to beat the tumors. Some told the story of freak accidents or horrible tragedies where they were able to save lives with their skills. Others told the story of recurrence, deficits, and lost fights. And then there were the ones that were so horrible that they were unable to even attempt to do anything, where the tumor was in an inoperable place.

"No, no, no, no, no," Meredith mumbled as she analyzed the scan. She switched to the other view, that only confirmed her fear. Her heart broke. "Fuck!" she exclaimed loudly, forgetting where she was.

7/4/20

Another long chapter. I wanted to get this out last week but I just finished it. It takes time to get the chapter up to my liking, to fit all my ideas in it, and to edit it. I hope you liked it. I'm still blown away by all of your support, it makes writing much more fun if you know someone is reading and looking forward to it. So thank you. I love reading your reviews and thoughts.

I hope you continue to stay happy and healthy and wear a mask. I always pretend to be a Grey's doctor when I wear mine, it makes it more fun. I have yet to break out in song or quote iconic lines. ;-) Have a great weekend!

Happy fourth to all my American readers. It's a different one this year, like almost everything.