121. Ending on a Good Note

Disclaimer: The show belongs to Shonda; although, I wish I could adopt Meredith and Derek for myself so she wouldn't be able to mess with them anymore.

So, so sorry for the long wait. My laptop battery died, and this chapter was trapped in a Word document that I couldn't access until today. But now, everything is fixed, and I'm able to post. Enjoy!

Cristina was officially gone, out of the house, and back to living with Owen, thanks to Meredith's gentle nudging. She had only been staying with them for two days, but it was enough to almost drive Derek crazy. So now, as he sat on the couch with Lilly, sipping his cup of coffee, he reveled in the peacefulness. No barging into rooms without knocking, no grubbing cereal, and no sarcastic, unprompted commentary.

Derek glanced at his watch and sighed. Meredith had worked an overnight shift, and was scheduled to come home an hour before Derek had to go in. Professionally, the whole opposite shift thing worked; but personally, it wasn't exactly ideal, and they didn't get to see each other nearly as much as they'd like.

He kissed Lilly's forehead. "Mommy's gonna be home soon, Lillybug. You two get to spend the whole day together. But she's gonna be tired, so maybe you guys could take a nice, long nap together," he said, chuckling when she smiled up at him. "How's that sound?"

His pager buzzed on the end table and he picked it up to read it. "911," he read out loud. "Damn it." Derek reached for his phone and quickly dialed the ER nurses' station at the hospital, waiting three rings before someone answered.

"Nurses' station. This is Olivia," came the hurried voice at the other end.

"Hi, Olivia. This is Dr. Shepherd. I was just paged 911, but Dr. Grey isn't home yet, and I have my daughter. Do you know why I was paged?" he asked.

"Five car pileup on the highway. Nelson and Weller are already swamped with the incoming, and the ER is still overrun with lots of close head injuries. I think Dr. Grey is down here now, actually," Olivia said, barely audible over the hustle and bustle in the background.

Derek sighed, pinching the bridge of his nose. "Alright, uh, is there any way you could put her on the phone for one quick minute if she's close by?"

"Yeah, give me a second to go find her," Olivia said.

"Okay, thank you," Derek replied. He peeked into the back of Lilly's diaper and smiled amusedly. "You have impeccable timing, Princess," he said, walking over to the bin of baby supplies next to the bookshelf. He grabbed a fresh diaper, wipes, and powder, then retook his seat on the couch, his phone tucked between his shoulder and ear.

"Hey, hang on a second," Meredith said into the phone. "Don't leave him in the hallway! Take him to trauma three!" she yelled out to someone. "Sorry, I'm here. What's up?"

"I was paged 911, but it sounds like you're not making it out of there any time soon," Derek said, peeling back the adhesive tabs on Lilly's diaper.

"Yeah, it's pretty messy," Meredith sighed, her voice tired and frazzled after having already been on call the night before.

Derek chuckled. "Yeah, same here," he said, holding up Lilly's legs so he could clean her.

"What?"

"Dirty diaper," Derek explained.

Meredith smiled on the other end. "I'm jealous," she said. "Okay, well, we're already on the OR board for surgery in an hour."

"Together?" Derek asked as he slid the fresh diaper under Lilly's bottom and sprinkled her with powder.

"Yeah. The patient is almost eight months pregnant with twins, and she has a depressed skull fracture. She was admitted under my name, so I got put on the case. The other neuro attendings are scrubbed in somewhere else, so they paged you in," Meredith said, holding her hand over the receiver. "Meghan, check the supply closet for extra intubation trays! If there aren't any, run over to the clinic!"

Derek checked his watch again. "Is there anyone there who could watch her while we're in surgery?"

"I don't know. Everyone is down here now. Just bring her with you. We'll figure it out," Meredith said.

"Okay," Derek said, pulling Lilly's onesie over her head. He took the dirty diaper and picked her up off the couch. "I'll be there soon. I just need to get Lilly dressed, and get some of her stuff packed."

"Okay. Bring extra bottles just in case. And call me when you're parking. I'll see if I can sneak away for five minutes," Meredith said. "Love you both."

"Love you, too. See you soon," Derek said, ending the call. He shoved the phone in his pocket, then practically jogged upstairs. "Looks like you get to come to the hospital, and see what Mommy and Daddy do for a living," he told Lilly, tossing the old diaper into the disposal after he walked into her nursery. "We'll see if we can get Uncle Mark or someone to hang out with you for a few hours. If not, you might be donning a surgical mask in your Babybjorn."

Derek gently laid her down on the changing table to get her dressed, and Lilly smiled up at him. He laughed. "Good, I'm glad you're on board."

...

Meredith stood at the OR board with Derek, rocking back and forth on her heels, Lilly hugged to her chest. She hadn't seen her daughter since last night, and the thought of leaving her again to go scrub into surgery was close to unbearable. She scanned her eyes up and down the schedule. "Everyone is scrubbed in somewhere."

"There has to be someone," Derek said, running a hand through his hair.

"We're not leaving her with a random nurse or an intern," Meredith said. "I want her with someone we know."

"So do I," Derek agreed. "If worst comes to worst, just one of us can scrub in."

Meredith shook her head. "You're the only available neurosurgeon, and the patient is already high risk because of her pregnancy. And I really can't afford to pass up a neuro surgery if I want to finish residency on time," she said, sighing. "Damn it."

"Mer, relax. We'll figure something out," Derek promised.

"I know. I'm trying really hard to stay calm. I'm just exhausted, and I was really looking forward to going home after thirty-six hours on my feet," Meredith said, checking her watch for an ETA on when they were scheduled to scrub in.

She felt her phone vibrate in her pocket, and she quickly pulled it out, seeing Bridget's name on the display. "Hello?" she answered.

"Hey. I would've walked right up to you, but there's some fancy red tape on the floor that makes me persona-non-surgeon-non-grata," Bridget said.

Meredith turned around, and saw Bridget leaning against the wall in the perpendicular hallway, near the waiting area. She hung up the phone, smiling as she and Derek walked toward her. "What're you doing here?" Meredith asked.

Bridget dropped her phone into her purse. "I was here to have lunch with Mark, but he got pulled into surgery because of the freeway wreck. I was just about to walk to the elevators to go back to my car when I saw you guys standing there with Lilly," she explained.

"Yeah, we're scheduled to go into surgery in twenty minutes," Derek said.

"And I'm guessing you haven't lined up a sitter yet?" Bridget assumed, peeking over Meredith's shoulder to smile at Lilly.

Meredith laughed. "No, still working on that."

"Let me take her," Bridget offered.

"Oh, no, that's..." Meredith started, shaking her head guiltily.

"I'm happy to help you out. Lilly's my niece. That's what I'm here for," Bridget said. "And I'm not a doctor or anything, but I'm pretty sure hospital policy frowns on babies in the OR."

"Are you sure? We don't want you to feel obligated just because you're already here," Derek said.

"Yes, I'm sure. My sister has three girls, and I watch them all the time. Plus, I'm a kindergarten teacher. I'm around kids all day. One, well-behaved baby is like a dream," Bridget said.

Derek looked at Meredith, and she smiled at him, then at Bridget. "Okay. But only if you're absolutely sure."

"I am. She'll be perfectly fine. We'll have fun," Bridger assured them.

"Thank you. We owe you one," Derek said. "There's extra bottles and diapers in her bag. I fed her and changed her before I got here, so she should be okay until three o'clock or so. FYI, she loves Elmo's World, and she's recently become a fan of peek-a-boo." He reached into his pocket and handed Bridget his spare car key from his key ring. "Her car seat's in my car. If it's easier, you can just drive it if you want."

"Oh, it's fine. I'll move it," Bridget said, taking the key, and then Lilly's bag from his shoulder.

"She's kind of the perfect baby, but if you have any problems, just call. I don't care if one of us has to leave," Meredith said, giving Lilly one last hug and kiss before she handed her to Bridget. "We love you, peanut."

"Have fun, okay?" Derek said, kissing the back of Lilly's dark head. "You're a lifesaver. Thank you," he told Bridget.

"No problem. Now go fix brains, and don't worry about anything. We'll have a blast," Bridget promised, letting Lilly look curiously over her shoulder.

"Bye, Lillybug. We'll see you in a little while. Love you," Meredith said, smiling sadly as Bridget walked with Lilly toward the elevators. She sighed as her daughter went further and further down the hall, and she leaned into Derek. "I feel like a terrible parent."

"We didn't plan this. We don't even have a babysitter. This has only happened once since she was born. I say once in three months is a pretty damn good record," Derek pointed out.

"I guess," Meredith said halfheartedly.

"Alright, let's go to pre-op. I want to see the patient before we go into surgery," Derek said, putting his hand on the small of her back. He knew leaving Lilly was hard for both of them, but he hoped that being in the OR would distract her. "How did she present when she came in?" he asked her.

"Her GCS was only three," Meredith said as they walked down the hallway.

Derek looked over at her. "Three?" he echoed. "So she was unconscious."

"Yeah. Her car flipped over, so there was blunt force trauma, which caused the depressed skull fracture. She's slightly hypotensive, but her heartbeat is strong enough for surgery," Meredith said. "Same goes for the babies."

"How far along is she?" Derek asked.

"We estimated between thirty-one and thirty-three weeks. According to the paramedics, she was wearing a seat belt, which kept her abdomen from being too jostled around," Meredith said as she pulled back the curtain when they reached the pre-op area.

Derek flipped open the chart, and began reading all of the notes that both Meredith and the paramedics had written down. "She's a Jane Doe?" he asked.

Meredith nodded. "For now. There was no ID on her. The police said if they recovered any info. at the scene, they'd bring it here. She probably had a purse or something, but so far, no news," she said.

Derek clicked on his penlight and examined the woman's pupils, checking to see if there was any movement in her eyes. "There's a little dilation, but not much."

"Does she have a chance?" Meredith asked.

"GCS of three, little pupillary response... I don't know. I've seen people come back from worse. She's pregnant. I'm gonna do everything I can," Derek said, frowning at the woman's rounded belly under the blanket.

Meredith took his hand and squeezed it gently. "Yeah."

...

Staring into an open brain was always a rush, wrought with thrills and challenges, a meticulously interwoven puzzle that could be destroyed with a single knick or slice or hiccup. But now, as Derek stared into his pregnant patient's open brain, the puzzle's pieces were already in dismay, crushed by the shard of skull pressing against it. He'd been standing there for ten minutes in silence, trying to find a way to navigate the mess.

Meredith stood on the ready with suction, waiting for him to make a move, any move. She glanced over at him. "Are you going to start?" she asked him.

"I'm thinking," Derek said. "I just... how do I?"

"Alright, well, think out loud. Let me help," Meredith said.

"Her brain is a lot more damaged than the scans made it seem. Her frontal lobe is practically crushed by the skull fragment. I have to lift it out from underneath. But even if I can do that, there's a risk of hemorrhage or brain swelling; not to mention, a damaged frontal lobe is a recipe for her living as a vegetable," Derek said.

"You have to try," Meredith said.

"I know," Derek said, taking a breath under his mask. "Okay, be ready to suction."

Meredith moved closer to him and nodded. "I'm ready."

Derek carefully began removing the embedded skull piece from the patient's brain, making sure not to push it deeper or accidentally jut into the surrounding tissue. Meredith suctioned the blood around the area so Derek could have a clear view of the surgical field.

"No jagged edges," Derek said, finally freeing the rounded piece of skull from her brain.

"Good," Meredith said in relief. She glanced at the monitor. "BP is 90 over 60."

"How are the babies doing?" Derek asked.

"Systolics aren't as high as they should be, but so far, both babies are holding steady," the OB resident said, sitting by the fetal monitor.

"She's bleeding more than normal. I can't place the titanium mesh until it slows down," Derek said.

"BP is dipping down. She's at 80 over 40," the scrub nurse said.

Derek shook his head in frustration. "Damn it. She's getting bradycardic. Push one of atropine. Let's see if we can get her BP back up," he called out.

Another scrub nurse administered the medicine, and they all glanced at the monitor, hoping to see a steady climb to a normal heart rhythm. But as soon as it went up, it came back down again, eventually plummeting so much that the patient flatlined.

"Start compressions. And page any available OB attending to do a crash-C," Derek said.

"You want to take the babies out?" Meredith asked.

"I don't want to. We have to. There's over a ninety percent chance of survival, as long as we get them out in time," Derek said.

"Damn it," Meredith whispered.

"Dr. Halloran is next door in OR 4. She's scrubbing out now," the scrub nurse announced after she hung up the phone.

"Dr. Halloran delivered Lilly. The babies will be okay," Derek attempted to comfort her, trying to focus on the profuse brain bleed and not the inevitable death of a pregnant woman he couldn't save. "Make sure to page the NICU, and tell them two preemies are coming up within the next ten minutes."

"There's no chance she could live?" Meredith asked.

"Her brain is hemorrhaging too fast, and her frontal lobe was crushed on impact. Son of a bitch," Derek said, grabbing another suctioning tool to help Meredith drain it out. "I thought she might have a chance, but there's just too much damage."

"Both fetal heartbeats are starting to drop," the OB resident announced. "She's losing too much blood."

Dr. Halloran entered the OR, and was immediately given a fresh pair of gloves after re-scrubbing. "What've we got?" she asked beneath her mask.

"Jane Doe, pregnant with twins. She keeps flatlining, and has practically no heart rhythm. The babies need to come out," Derek said, packing the woman's mangled brain with gauze to keep the pooled blood from spilling onto the floor.

Dr. Halloran walked over to the OR table, catching a quick glance at the patient. "Damn it. She's not a Jane Doe. This is one of my patients," she said. "Okay, scalpel."

"You know her?" Meredith asked.

"Celeste Mackley. She was scheduled to come in for a routine sonogram this afternoon, but she never showed up. I figured she got busy with work or something. She was involved in the wreck?" Dr. Halloran assumed, making the incision across the woman's abdomen.

"She was hit on the driver's side, and the whole car flipped. They had to slice the car door off to get her out of it," Meredith said, echoing what she had been told when the patient had been brought into the ER. She exhaled, trying to keep her emotions at bay. "How far along is she?"

"Thirty-three weeks. Boy and a girl. Scissors," she requested of the scrub nurse. She gently popped the amniotic sac of the first baby, a girl, and took her out, immediately handing her off to the OB resident. "Dr. Grey, could you come take baby number two over to the warmer once I get him out?"

"Sure," Meredith said, handing the suction to Derek. She stood on the other side of the table and watched as Dr. Halloran broke the other sac, freeing the second baby. Meredith swallowed thickly when she saw how small the boy was, gently swaddling him in the blanket after Dr. Halloran cut the umbilical cord.

Seconds later, the woman's weak, thready pulse stopped registering on the monitor, and it became a resounding shrill beep of an irreversible flatline. Just as Derek was about to call time of death, there was one tiny cry, followed seconds later by the other. He nearly lost his breath at the sound, a sound that was both full of hope, and an enormous punch in the gut. Two babies taking their first breaths while their mother took her last.

He blinked back the tears in his eyes and cleared his throat. "Time of death: 13:42."

...

Meredith sat on a bench in the resident lounge, packing her bag to go home. She'd only gotten six hours of sleep in the last forty-eight, and all she wanted to do was go pick up Lilly, and get under the covers with her and Derek. But Derek's shift wasn't over until seven o'clock that night, if his brain shunt surgery scheduled in a half hour went well. She sent a quick text to Bridget, saying she'd be there to get Lilly soon, then put it in her pocket.

"Hey," Derek said as he entered the doorway.

Meredith smiled. "Hey."

"I just checked on the twins up in the NICU. No neurological issues. For being preemies, they're fighters. Both strong and stable so far. And they're co-bedded, so that'll help," Derek said, sitting down next to her on the bench.

She looked over at him. "Any word on whether or not there's family? Husband or boyfriend or something?"

Derek sighed and shook his head regretfully. "Her husband was killed overseas, back when she was three months pregnant. She moved out here and got a job. Fresh start, you know."

"Is there anyone? Any relatives at all?" Meredith asked, her eyes hopeful.

"They're still trying to get in contact with people. The police still haven't brought in any cell phone or wallet or anything. Other than what Dr. Halloran knows about her, there's not much to go on."

"Sucks," Meredith frowned.

"Yeah," Derek said. "I'll check in on them before I leave, make sure they're okay."

Meredith sighed. "They have no one."

"They have each other," Derek reminded her. He pressed a kiss to her temple. "And they have us, too."

"Us?"

"For now. Until we find them some people, we can be their people. Fake, surrogate, hospital parents," Derek said chuckling lightly. "So far, Lilly approves of us. I think they would, too."

"Okay," Meredith said. She saw a picture of Lilly and Derek in her cubby and smiled. "I'm gonna go get her. I know I saw her a few hours ago, but I miss her so much."

They got up off the bench, and Derek wrapped his arms around her. "Imagine what it'll be like when she goes off to college in eighteen years," he said.

Meredith rolled her eyes amusedly. "I don't even like thinking about what a wreck I'll be on her first day of preschool, let alone college," she said as she hugged him back. "You're still scheduled to go into surgery?"

"Yeah. I should be in an out in an hour, barring any complications."

"Okay." She put her hands on his cheeks and kissed him. "Love you."

"Hmm," he murmured against her lips. "You usually save those kinds of kisses for home. Or behind locked doors here."

"This is our first alone time in two days. I wanted to take in the moment," Meredith said, fixing the collar of his white coat. "Wanna walk me out?"

Derek reached for her hand after she slung her bag over her shoulder. "Sure; let's go."

...

Meredith walked up the steps to Mark and Bridget's house, waving at Lilly when she smiled at her through the glass door. Bridget used her free hand to open it, letting Meredith inside. "Hey. I didn't think you'd be done so soon," Bridget said.

"Yeah, our patient died on the table," Meredith said, trying to stifle a yawn. "How was Lilly?"

"She was perfect," Bridget said. She kissed the baby's cheek and handed her over to Meredith. "Seriously, I don't think I've ever heard her cry."

Meredith laughed. "Oh, believe me, she cries. She just likes to show off in front of company," she said, hugging Lilly to her. "God, I missed you."

"Not a good afternoon, huh?" Bridget assumed.

"I'm used to patients dying; but when it's a pregnant patient, it's enough to make me want to quit and never go back," Meredith sighed, following behind Bridget to sit on the couch.

Bridget patted Meredith's arm in sympathy. "I'm sorry. I know it's hard. Mark says the same thing sometimes. Did the baby make it?"

"Twins, actually. A boy and a girl. We got them out in time, thankfully. They're small, but we're hopeful they'll pull through. But the dad died a few months ago, so instead of just being down one parent, they have neither. Just a crappy way to start your life, you know?" Meredith said as Lilly grabbed a handful of hair in her tiny fist. "I know I shouldn't let stuff like this bother me. It's just part of the package."

"That would be hard on anyone. And you're a mom. Of course a case like this is gonna hurt," Bridget said. "Is there any family around?"

"We don't know yet. My OB is actually the one that delivered them, so she's probably gonna pull her file for emergency contacts or something. She's a good doctor, so at the very least, they'll be taken care of while they're in the hospital," Meredith said.

"That's good," Bridget nodded before pausing. "Not to change the subject, but this OB... you'd recommend her?"

"Oh, yeah. She's really sweet. And she doesn't make it awkward when I see her around the hospital. You know, considering she's seen the parts of my body that I'd prefer only Derek see," Meredith managed to laugh before she raised her eyebrows in suspicion. "Wait, are you..."

"No, no. I'm not, I promise," Bridget interrupted. "We're just... we started trying a few weeks ago. My OB/GYN is retiring, and I need to find someone new."

Meredith's mouth went agape in surprise. "You're trying?"

"Yeah. We haven't told anyone. Mark hasn't even told Derek. We know we just got married in May, and were planning to wait a while, but we're ready. Honestly, Lilly's the reason we decided to go for it," Bridget said, smiling at Lilly who was sucking on the ends of Meredith's hair.

"Really?" Meredith smiled.

"You guys are so happy. And we're so in love with Lilly. We really want that, too," Bridget said, folding up Lilly's duck blanket and putting it back in her bag.

"You're both gonna be great parents," Meredith said as she reached out and wrapped her arm around Bridget to hug her. "And until it happens, just enjoy the trying. It's mind-blowingly fun, and it pays off," she said, holding up Lilly as proof. "I have all the conception books, too, if you want them. And it's not just stuff about fallopian tubes and cycle tracking. There's some pretty hot sex tips."

"Oh, yeah?" Bridget asked interestedly.

"Yep. There's even a chapter on the best positions for conceiving a boy or girl. And, you know, Derek and Mark are pretty set on eventually becoming in-laws, so a nice boy for Lilly to marry would be great," Meredith joked, kissing the top of Lilly's head.

Bridget laughed. "Okay, got it."

...

For those that are interested, I'm writing a MerDerZola Christmas fic, and hope to have it posted sometime on Sunday. So, be on the lookout! :)