Alex Karev hated to be known.

Maybe that wasn't entirely accurate. He hated what people had to know, to know him. He hated the things he couldn't control that were as much a part of him as the things he could. Maybe more a part of him.

What he really hated was what they couldn't know. That his dad used to hit his mom. That he beat up his dad to make it stop. That he never had friends because no one could know that his dad used to hit his mom and that he beat up his dad to make it stop.

So maybe he hated not being known. He hated that he couldn't be known.

He thought of how everyone thought he was an ass. He thought about how much he hated that they thought that it was his fault. But he was a little happy too, just a little bit, because he knew it meant they didn't know him. He hated that that made him happy.

Whatever it was, he couldn't let people be close to him. As soon as Izzie learned about him, he couldn't take it. He had to put that wall back up, before she found out anything more.

Even so, she probably knew him better than anyone else. Well, probably Ava knew him better in regards to personality. But he was sure Izzie knew more about his experiences than Ava did.

Addison didn't know all that much about him. Some stuff that Ava knew, nothing that Izzie knew.

He definitely wasn't well known. If the three of them all got together and discussed, maybe they could figure him out. He hoped to God that wouldn't happen.

No, it was better to keep them at arm's length. Though maybe he couldn't do that with Ava anymore. Not with the baby and everything.

He told her he wasn't good at this stuff. He told her that she didn't want him for this. Her husband was surely a better father than Alex could ever be. And yet.

Maybe he could just focus on his current life, and nothing else. Not letting Ava know his past, or anything else except what he was with her.

Izzie couldn't leave well enough alone though. She couldn't let him be with Ava and just be. No, she had to butt in. God, his life was screwed up.

It bothered him that she wouldn't leave him alone. It didn't make sense, her concern for him. Telling him to drink fluids to help with his fever. It bothered him that she obviously didn't believe him when he said he was fine. Mostly because his head was killing him, he felt feverish, and he was anything but fine. She shouldn't have known that.

It bothered him that she couldn't be happy for him and leave well enough alone. She had to screw with him and mess things up because she knew him.

But he could put that aside. There were more pressing things to worry about, like what would happen when the baby was born.

Today, today he was the hero of two little kids because he saved their mother when her lung collapsed. Today he had felt almost proud of himself when he had them close their eyes for the scary part, telling them to look again when their mother was fine. Today he was glad he knew what to do.

But tomorrow he couldn't be proud of himself anymore. Tomorrow he would feel nothing but guilt because whereas today he was the hero for saving their mom, tomorrow he would be the monster who let her die. Tomorrow she would probably have whatever virus he had, and she would die from it. Tomorrow they would all know that because he saved her life today, she had to die tomorrow.

Tomorrow and yesterday are the forces that screw up today, even when today is fine, he decided, as he walked across the parking lot. Regretting yesterday and dreading tomorrow made today a living hell.

He sat in his car for a moment, just sat and let it wash over him. His mind was hazy, the sort of haze that sets in when you're sick and makes you forget what happens, which is probably better because when you're sick enough to be in a haze, you don't want to remember it. He felt both hot and cold, the way you can only when sick. He almost wished he had taken Izzie's offer to drive him home.

But it bothered him that she had realized he was sick enough to need a ride. And so he had said no. He almost wished he hadn't.

But then Alex reminded himself that what he felt now, the patient would feel tenfold tomorrow. He didn't dwell on his own illness, not when someone else was worse.

He managed not to wreck his car, making it all the way to Meredith's house without hitting anything, though he might have run a few stoplights. Stoplights are hard to see when your mind is hazy.

He stumbled up the stairs and crawled into bed without changing his clothes, pulling the blanket around him as tight as he could. He felt awful.

But, he reminded himself, it was worse for the patient. So he would suck it up and move on. At least, that's what he told himself.

He kept telling himself that, going through the night in a state of half sleep. He wondered if anyone knew this about him. That he was sick, but too stubborn to ask for anything. Izzie probably knew. She usually did.

Alex wondered about the patient he had both saved and killed. He wondered if it was right, what he did. Was it better to give her life today and death tomorrow? Or let her die today without forcing false hope on her and her family?

He became aware of full consciousness at 2:12. He knew it was 2:12 because he was staring at the clock. For how long, no one knew. Hazy…

As suddenly as he became aware of being awake, he became aware of a sharp pain in his stomach. Another thing to contend with, another thing the patient would feel tenfold tomorrow. Another thing he didn't want anyone to know.

The next thing he was aware of was being on his knees in the bathroom, throwing up. God, he was miserable, and sick, and so very alone.

For all the things about his patient's death, at least it wouldn't be alone. She had a family, and they would stay with her.

He didn't have a family. He had himself who no one could know. His father who wasn't around after that incident, his mother who was equally absent. He supposed he had Ava. Ava, whose name he made up, who he had to call Ava because Rebecca was someone else's wife. Ava would maybe be his family, but she wouldn't really know him. His kid was his family, but what if he was a bad parent? Today he was a hero, but tomorrow he would be a monster. What would he be to his own kid?

A hand was rubbing slow circles on his back. Alex wondered why people did that. It didn't make the puking stop, and it didn't make it hurt any less.

Maybe it was just for contact, to make him feel like he wasn't so alone. She knew him too well.

When he finally stopped throwing up, after he had wiped his mouth with a bit of toilet paper and leaned back against the wall, the hand moved to his face.

"Alex, you're burning up," she said softly.

"I'm fine," he said hoarsely, too stubborn to admit otherwise, even though they both knew the truth.

Izzie dampened a cloth, put it against his forehead. "I told you that you were taking on too much. You should have listened to me…" she trailed off.

"You don't have to…" he mumbled, closing his eyes.

"Shut up," she said quietly, refusing to leave. Alex fell silent.

"It isn't that I'm not happy for you," Izzie said after a moment, as she handed him a paper cup full of water to rinse his mouth. "It's just that…"

Alex opened his eyes and looked at her. She was a little bit blurry, but he could still see that she was struggling with what to say.

"I don't want you to do anything you'll regret. You know as well as I do how much it sucks to regret something you can't undo. I'm afraid you'll get yourself into this relationship with Rebecca or Ava or whatever, and then you're going to wish you hadn't. You don't deserve that, Alex."

She did know him too well. He knew how much he feared regrets.

She got the thermometer from the medicine cabinet and put it in his ear.

"It's 103," she said, clearly worried.

"I'm fine," he mumbled. She sighed.

"C'mon. Let's get you back to bed." Alex let himself be led back to his room. He lay down, and was surprised when Izzie sat down on the edge of the bed, smoothing a hand over his forehead.

"I killed a woman," Alex said, his voice rough.

"You saved her life," Izzie said, her eyes sad, sad for him because she knew what he was thinking.

"Tomorrow she'll die, and it'll be my fault. I saved her today to kill her tomorrow."

"Alex…"

"What if I'm with Ava to give the baby a father, but I'm a horrible dad? What if it's better for it to not have a dad at all?"

Izzie gave him that look, the one that infuriated him because he knew she understood.

"I was fine! I was fine, and then you had to keep talking about it!" he exclaimed. "You had to keep going on about it, and now I'm not sure anymore! You should have just left it alone."

"I'm sorry," she whispered. She started to stand up, but then she didn't. "I'm sorry," she said again. "But I couldn't. I can't let you do this, when I know…"

"Know what?" he whispered, his heart sinking. He watched her as she struggled with herself over something.

"I can't let you because I know you couldn't be happy like that." She took his hand. "She isn't the right one for you, Alex. She's married, and she already has a kid."

Alex opened his mouth to speak, but Izzie cut him off.

"You saved her life. You pulled her out from under a pylon. And then you kept saving her. You gave her your life, Alex. Everything you had to give. She took it all, and she's still asking for more. It's not right for her to do that. It's not good for you."

"I…" Alex said, but he had no words.

"She isn't right for you," Izzie said again. She stood up, taking a few steps backwards towards the door, never looking away from him. "Just…think about what I said, okay? And get some sleep." She pulled the door closed behind her.

Alex's mind still felt hazy, a thick smoke swirling with Izzie's words, the words that made perfect sense, that he didn't have to tools to argue with right now. That he didn't have the desire to argue with.

She had watched him with Ava, and she knew what was happening. She knew what would happen next. And she was right about all of it.

She really did know him too well. And the thing about it was, he didn't hate that at all.