152. Boards Part 2

Disclaimer: I don't own TV shows. But I am a nursing student whose medical knowledge really came in handy in this chapter. ;)

You can do this.

Don't let your proctors intimidate you. Remember, they were in your shoes once, too.

Just pretend it's me sitting across from you asking you the questions.

Wife or not, you're the best neuro resident I've ever worked with in the span of my career, and I mean that.

Relax, be confident, and show them just how great you are.

Derek's words echoed over and over in Meredith's mind like a mantra. She tapped her foot against the carpeted hotel hallway, waiting for her board protcors to call her name. She was half convinced they'd forgotten about her when a middle aged woman with curly, brown hair stepped out of one of the rooms at the end of the hall.

"Dr. Grey," she announced.

Meredith stood up from her chair and let out a deep breath before walking toward the room, praying that she didn't wobble on the stupid heels she was wearing and fall over. She extended her hand when she reached her proctor. "Hi, nice to meet you," she greeted.

"Likewise. I'm Dr. Sandroff, the chief of neurology at Mayo. And that's Dr. Bromley," she introduced, gesturing to the older man next to her. "Dr. Bromley is the chief of neuro at UCLA."

"It's good to meet you, Dr. Grey," Dr. Bromley said, shaking Meredith's hand.

"Thank you, sir," Meredith returned. She took a seat in the chair across from the two in front of her and folded her hands in her lap. Maybe it was the adrenaline pumping through her, but now that she was in the room, ready to go, a calmness settled over her that she hoped would last.

"Welcome to your AMA Board Certification exam, Dr. Grey. As you may know, the exam entails four separate scenarios, divided into three thirty minute sessions, with a ten minute break in between. You need to pass two of the three sessions for certification, although we cannot disclose whether each session was passed or not. During the exam, you're rated based on your ability to diagnose and treat a patient from admission to discharge, and your strength in handling unexpected situations," Dr. Sandroff explained.

"Do you have any questions before we begin?" asked Dr. Bromley.

"No, I understand," Meredith said.

"Okay, then. Let's begin," Dr. Sandroff said with a smile, opening her examination packet. "A fifty-five year old female is admitted to the ER following an MVC. Paramedics started her on NS en route to the hospital. BP was 80 systolic, pulse was 125, blown pupil, and her GCS was 6. What would your initial course of action be?"

"I would switch her IV from NS to a bolus of LR, which would provide for faster fluid resuscitation to increase her BP and bring her pulse down. I would get a CBC, CMP, and do a type and cross of her blood. Given the force of impact, I would need to rule out DIC, which could put her at risk for hemorrhaging during potential invasive procedures. Then I would order head, cervical, and spinal CTs. The GCS and blown pupil are likely indicative of a brain bleed," Meredith answered.

"Okay. Head CT reveals a bleed in the left temporal lobe which is the result of a burst subarachnoid aneurysm that occurred on impact of the crash, and spinal stenosis in the lumbar spine," Dr. Bromley added to the case. "Immediately after the CT, your patient has a gran mal seizure, with no underlying seizure disorder."

"It was likely caused by the aneurysm. I would give one milligram of lorazepam through IM injection, then get her straight to the OR to reverse the brain bleed, pending the results of her CBC, PT, and INR. If her coagulation time was slower than normal, surgery would need to be delayed until it normalized," Meredith said with ease, several details of the case reminding her of Katie Bryce's.

Alright, everybody. It's a beautiful night to save lives. Let's have some fun.

Derek's trademark line echoed in her mind, and she remembered the first time she'd heard him say it as she walked into her first surgery five years ago. She touched the locket around her neck and smiled to herself.

Dr. Sandroff and Dr. Bromley looked at her, clearly impressed with the level of detail, and Dr. Sandroff made note of it in her packet. "Excellent. Some might have overlooked the blood results in favor of surgery, but you remembered to take that into account."

"Oh. Well, thank you," Meredith accepted.

"Blood work comes back normal. How would you begin the surgery to fix the brain bleed?" Dr. Bromley asked.

"I would do a craniotomy over the left temporal, and after I located the bleeding, I would suction and track it back to the source to find the burst aneurysm. At that point, I would choose the clip that best fit the aneurysm neck and secure it to stop the hemorrhaging. To ensure the clip was secured properly, I would do a matador move by inserting a pin into the sealed off portion, and if there was no blood flow, the clipping was a success," Meredith replied.

"What would you do if the aneurysm ruptured further before securing the clip?" Dr. Sandroff asked.

"I would put a temporary clip on the feeding artery to stop the blood loss," Meredith said.

Dr. Bromley nodded at her prompt answer. "And if the aneurysm still continued to bleed?"

"Then I would gain control of the common carotid in the neck," Meredith answered.

"During the surgery, your patient's ICP rises from 15 to 22," Dr. Sandroff added.

"I would dose with mannitol to reduce the swelling. If she was no longer hypotensive and her BP was above 100 systolic, I would also push Lasix to further diurese," Meredith said.

"Okay, then. After you close, and the patient is monitored for several days in the ICU, what would your next step in her care be?" Dr. Bromley asked.

Meredith's mind flashed back to the CT viewing room, where she stood next to Derek as he showed her the scans of the patient who had driven into the fish market. Spinal stenosis. Narrowing of the spine, most often a result of aging. Causes numbness in the leg and feet.

And then, unrelated to the case, You know what says thank you like nothing else? Derek's voice asked: Sex.

Before an array of porny images from that night had the chance to float into her mind, Meredith jumped back into the present.

"I would treat the spinal stenosis by doing a laminectomy in the lumbar region of the spine. An incision would be made in the midline of the back, and the erector spinae muscles would need to be dissected to allow for a more complete visual field. After I gained visualization of the nerve roots, I would remove the lamina. Depending on the degree of compression, I might undercut the facet joints to further decompress the nerves," Meredith answered.

"And what if after the surgery, the patient regains consciousness, but develops paralysis in his lower extremities?" Dr. Sandroff asked.

"I would order an MRI to check for a possible clot in the upper spine," Meredith replied.

"MRI comes back clean. What do you do now?"

Meredith knew it was a risk, but she gave the answer she knew Derek would give. "I would operate anyway. If the hematoma were to expand, it could travel to the brain stem, in which case, the patient wouldn't be able to breathe."

Sometimes you gotta take a chance to save a life, said Derek's voice in her mind.

"I would make the incision from the base of the neck to the ribcage. Then I would search along each lamina for the clot until I found it. Once I did, I would suction, pack, and use three to four milliamps of stimulation on each extremity to determine function and ensure reversed paralysis," Meredith said, and by the look on her proctors' faces, she knew with certainty that she'd passed her first session.

Show me something. Give me a reason to believe.

One session down, two to go.

...

Eight hundred miles north in Seattle, Lilly sat on the kitchen table with Derek's arms flanked on either side of her. She watched as he poured cake batter into the pan, trying to get a taste of the chocolate.

"You can't eat cake batter, Lillybug. It has raw gigis in it. How about a chocolate Cheerio instead?" Derek asked, offering one to her from her snack bowl.

Lilly reluctantly accepted it, but rather than try for the batter again, she changed her train of thought. "Mama?" she asked.

"Mama will be home in a few hours, I promise. Right now, she's down in San Francisco showing her proctors what a great surgeon she is. That's why we're making a cake for her, so when she gets home, we can celebrate. Although, if Mommy knew we were baking a cake already, she'd yell at me for jinxing her," Derek chuckled.

His phone signaled a text, and he picked it up off the table. "We got a message from Mommy. Let's see," he said as he opened it. "First session was so easy! About to go in for my second. Love you both," he read, a proud grin spreading over his face. He texted back a quick "See, I told you! Keep on kicking ass!" and put it in his pocket.

"I love her so much, Lilly. She's a talented, beautiful genius, just like you," Derek said, kissing the back of Lilly's curly-haired head. He took her off the table and placed her on her feet, then walked the cake pan over to the oven.

When Lilly heard the screen door open, she quickly bolted into the living room. "Mama!" she yelled with excitement.

After putting the cake in the oven, Derek trailed after her. "It's just the mail, Princess. Mama will be home in a little while," he said.

Lilly's lower lip quivered when she realized Meredith actually wasn't there, and then the waterworks started. "Mama," she began to sob, fat tears rolling down her cheeks.

The sad look on her face made Derek want to cry, too, and he scooped her up into his arms. "I know you miss Mommy, Lillybug. I miss her, too. But she'll be back here before you know it."

Lilly tucked her face into the crook of Derek's neck as she continued to cry, Meredith's absence finally starting to affect her. Derek knew this had been Meredith's biggest fear, so he was determined to get Lilly settled down. If by chance Meredith called after her second session was over, and she heard Lilly in hysterics, he knew there was no way she would be able to concentrate through her third and final round.

"Shh, it's okay. You're okay," Derek soothed her, rubbing small circles over her back.

He remembered some old voicemails from Meredith on his phone, and he figured listening to them was worth a shot, so Lilly could hear her voice. He made a detour into the kitchen to warm a bottle, then went into the living room, dropping down onto the couch with Lilly.

"How about we try this?" Derek handed Lilly her bottle and let her stretch out on his lap. He went to his past messages, most of which were from Meredith and tapped one on the list, a voicemail from over a year ago.

"Hey, it's me. I hope you're having more fun today than I am. Maternity leave sucks. All I do is clean the house and eat cereal. Which reminds me, we're out of cereal. Can you pick me up some Lucky Charms on your way home? Ouch. Lilly, I think you've done enough yoga for the day. My ribs can't handle any more stretches. What was I saying? Oh right, Lucky Charms, the box that has the extra marshmallows. Okay, I have to pee again. Love you. Bye," said Meredith through the phone speaker.

Lilly's face lit up when she heard Meredith's voice, and she glanced up at Derek. "Mama," she said, reaching for the phone.

"Yeah, that's Mama back when you were in her tummy," Derek said, poking Lilly's belly softly with his finger. He played another message on the list, letting Lilly hold the phone in her hand.

"Hey, it's me. I guess you're still in surgery. I was just calling to ask you to stop by the hospital pharmacy on your way out and get me some Midol. I would run out to the store and get it, but Lilly's just getting over her sniffles, and I'd rather not drag her out into the cold. Plus, we're cuddled under a blanket watching Elmo, and my uterus rebels against me whenever I move. Sorry, I'm rambling. Love you. Talk to you later. Bye," said voicemail Meredith.

Lilly smiled through the remainder of tears streaked on her face. "Mama," she cooed, hugging the phone to her chest.

"Mama calls me more than anyone, so we're in luck," Derek said as he wiped her face with his hand. "Let's listen to another one. You pick."

Derek showed her the voicemail list, and he let her scroll through it with her finger. "Dis," Lilly decided, tapping on a message from this April.

"Hey. You won't believe what I just did. I was in surgery with Nelson for the medulloblastoma patient. And I'm standing there, ready to suction, when he hands me the scalpel. Derek, he let me resect it by myself! I wasn't sure if I'd be able to, because the edges were so fuzzy, but I did it just the way we practiced, and I got the whole thing! The guy won't even need chemo. Holy crap, I can't even think right now. I'm on such a high. Anyway, if you haven't made dinner yet, don't. I'll pick something up on the way home to celebrate. Give Lilly a kiss for me. Call me back!" Meredith said with such vibrancy in her voice, which made Derek remember why he'd saved that particular message.

"Lub Mama," Lilly said happily, snuggling herself into Derek's arm. "'Gain."

"Again? Okay." Derek kissed the top of her head and smiled into her curls, thanking his lucky stars that he'd saved the messages. Perhaps his subconscious mind knew they might come in handy for such an occasion. Whatever the reason, he breathed a sigh of relief and played another one. If Meredith's physical presence wasn't available at the moment, he was glad her voice was. If that gave his daughter comfort, he'd let her listen to as many as she wanted. And they did.

Lilly fell asleep sprawled out on top of Derek with his phone clutched in her tiny hand. When it came time to take the cake out of the oven, Derek carefully wiggled himself out from underneath her, and laid her where he had been sitting on the couch.

"Come here, Charlie," he said, patting the recliner after raising it.

The dog jumped up and made himself comfortable, with his head next to Lilly's arm. Derek scratched behind his ears in praise. "Thanks, buddy. Keep an eye on your sister for me. I'll be right back," he whispered, pushing his phone out of Lilly's hand like a Jenga block in case Meredith called.

Sure enough, after taking the cake out of the oven, his phone rang. He picked it up off the counter and answered as soon as he saw Meredith's name on the screen.

"Hey. How's it going?" Derek asked.

"I just finished."

"Yeah? How was it?"

"It feels like I just ran a marathon. I went in there, and as soon as I sat down and got started, all of the nerves disappeared. I did exactly what you said. I just stayed calm, and acted like it was you asking me the questions," Meredith said.

Derek grinned with equal amounts of love and pride, wishing more than anything that she was here so he could show her just how much. "See, you had nothing to worry about! I'm sure you were the most impressive neuro resident they've ever proctored. God, I'm so proud of you."

"I don't want to jinx myself. The scores are being posted at midnight, so until then, I'm just going to be cautiously optimistic," she said, letting out a breath. "What are you guys up to?"

"We just... made a cake," Derek said quickly. "Now Lilly's sleeping on the couch."

"A jinxing victory cake?" Meredith asked.

Derek chuckled, peeking into the living room to check on Lilly. "Possibly. But come on, you know you passed with flying colors."

"Is it chocolate?"

"Of course," he said.

Meredith smiled in acceptance. "Fine, you're forgiven," she decided. "So I'm packing now, then I'm taking a cab to the airport."

"After she comes with us to hotel bar for a drink!" Cristina yelled into the phone.

"Go out for a drink. Your flight doesn't leave for a few hours anyway," Derek pointed out.

"I can't drink. I want to nurse Lilly tonight," Meredith argued.

"Then get something nonalcoholic. You deserve to celebrate with your friends. And when you get home, you can tell me all about the boards, and then we can celebrate," Derek said.

"You're sure Lilly's okay?" Meredith asked.

"She's great. Don't worry about anything here; just go out and have some fun," Derek encouraged, purposely choosing to omit Lilly's small crying fit earlier, knowing if she knew, she would be more upset than Lilly had been.

"Okay, fine. I'll go. I'll call you when I get to the airport," Meredith said. "But you better have lots of porny things planned for tonight, since I slept in the most comfortable hotel bed last night, and we didn't even get to... use it."

"I've got it covered," Derek chuckled.

"Okay, then."

...

Derek stood in the airport gift shop in front of the counter, letting Lilly look at the wide array of balloons displayed in front of them. "Okay, we've got pink, blue, green, purple, orange, red, and yellow. Which one should we get for Mommy?" he said, pointing to each one.

"Ma lell," Lilly decided after pondering for a few moments.

"Yellow? Good choice," Derek praised, Lilly sitting on his hip. "Just one yellow, please," he asked the cashier.

The cashier inflated the yellow balloon with helium from the tank, then attached the string to the knot. "Do you want me to tie it around her wrist?"

"Sure; thanks," Derek agreed. He held out Lilly's wrist, and the young girl fastened a string bow around it. "Look how pretty, Lillybug."

Lilly waved her arm back and forth, laughing in delight when the balloon above her head swayed with her. "Mamama!" she said in anticipation.

"Yeah, Mama should be getting off the plane any minute," Derek said as he paid for the balloon, smiling at the cashier. "Thank you."

"You're very welcome. Have a nice day," the girl returned, waving to Lilly.

"You, too."

Derek set Lilly on her feet once they left the store, and reached for her hand. "Okay, let's go see Mama."

"Mamamama," Lilly practically sang as they walked toward the escalator where Meredith was meeting them. "Mama, Da?"

"Any second," Derek promised, checking his watch.

Lilly noticed Meredith coming down the escalator before Derek did, and she let go of his hand, her little feet running as fast as they would take her. "Mama!" she squealed in delight, reaching out her arms.

"Lillybug!" Meredith said with an equal amount of excited joy. She wrapped her arms around Lilly and hugged her close. "Mommy missed you so, so much. Next time I need to go away, I'm bringing you with me."

"What about me?" Derek teased, kissing her after she stood up with Lilly.

Meredith smiled against his lips. "Hmm, I guess you could come along, too."

"Boon, Ma," Lilly said, bopping her wrist up and down so she would notice.

"You got Mommy a balloon, too? Thank you, baby girl," Meredith said.

"She chose the yellow one. Yellow for your bright, bright future," he grinned. "So how was it? Who were your proctors?"

"Sandroff from Mayo, and Bromley from UCLA," Meredith said.

Derek looked over at her in visible awe. "Damn, those two are neuro gods."

"You know them?" she asked.

"Yeah, I've met them both. Sandroff spoke at the conference in Portland that I went to with Mark, and I've consulted on cases with Bromley back at New York Pres. before he transferred to UCLA. If you survived your boards with them, you can walk on water," Derek complimented.

"Well, I had five years of top notch education thanks to the hot neurosurgeon I work with," Meredith smiled.

Derek pulled up the handle on her suitcase and slinked his arm around her waist, the three of them heading for the exit. "I may have helped along the way, but you became the incredible surgeon you are all on your own."

They spent the whole ride home talking about her board scenarios, and Derek grew more impressed with each one. It wasn't just Meredith's ability to perform under pressure, but the details of the answers she had given that made him certain that one day, she would be the head of neuro.

"And then when we got to my third scenario, it was a corpus callosotomy case. At first, all I could think about was the porny S-E-X we had while you quizzed me on that. But then once I focused on the patient's brain, and not your... you know what," Meredith amended for Lilly's sake, "I described the procedure, the possible complications, all of it. They tried to stump me, but they couldn't," she boasted playfully.

"Of course they couldn't. Right, Lilly? We knew Mommy could do it," Derek said.

Lilly sat snuggled in Meredith's lap, clinging to her ever since the airport. "Mmm, choc?" she reminded him.

"Mmm, choc," he echoed. "Oh, the chocolate cake we made for Mommy. You want some cake?"

"Mmm!" Lilly agreed, her tiny bottom wiggling in excitement.

"As long as Daddy cuts it. It seems a little jinxy to cut my own victory cake before I know if I was victorious," Meredith laughed, scooping Lilly into her arms and heading into the kitchen with Derek.

Derek couldn't help but laugh at the way she still doubted whether or not she passed, when she'd just spent the last hour conveying her ass kicking brilliance. "Fine, as long as you eat some."

"In all the years you've known me, when have I ever passed up cake?" she asked, taking a seat at the island with Lilly.

"True," he conceded. "So what about your friends? Do they all think they passed?"

"Yeah, we're all pretty confident. I made them promise to text me when the results were posted. I won't be able to sleep tonight unless I know we're all board certified," Meredith said.

"I'm sure you all passed," Derek said as he grabbed a knife from the utensil drawer.

"Well, if Izzie passed, that means she's getting the OB fellowship with Halloran, and she already said she would be happy to deliver her own godchild," Meredith relayed.

Derek looked up from the cake he was cutting, unable to hide his slight laugh. "Hey, that's your decision. You'll be the one in the stirrups, not me," he said.

"I want to wait and see what kinds of baked goods she bribes us with before I make my decision. I might say yes if there's banana bread involved," Meredith joked. "But before she can deliver any baby, we need to make one."

"Well, we'll be doing that before you know it."

Meredith fed Lilly a dime-sized piece of cake off her fork, then broke off a piece for herself. "And if I don't pass out from exhaustion tonight, then I promise we can practice. Plus, this cake is really good. There might be some sexual favors coming your way, too," she said, covering Lilly's ears for the last sentence.

But Lilly paid no attention to the conversation, her focus on the cake instead. "Mmm, mo?" she asked, licking the frosting off her sticky fingers.

"You got your love of chocolate from Mommy," Meredith said as she gave her another bite. "So did she notice Dr. Squirrel was AWOL last night?"

"Nah, I let her sleep in your spot next to me. I put up the rail on the side, and Charlie slept at the bottom, so she was safe. She hogs the bed more than you do," Derek chuckled. "When I woke up, she was sleeping horizontally with her feet on my chest."

Meredith kissed the top of Lilly's head. "That's my girl."

Lilly turned around on Meredith's lap, and returned the kiss, pressing her chocolate covered lips to Meredith's cheek. "Lub," she smiled.

"I love you, and your chocolately face, too," Meredith giggled. She reached for a napkin and began wiping it off. "I know it was only one night, but I missed your messy kisses, peanut."

"You wouldn't think it was cute if I kissed you with a face covered in chocolate frosting," Derek said with feigned hurt.

Meredith rolled her eyes, licking some chocolate off her own fingers. "No, I would not."

...

The countdown to midnight was on, and Meredith felt more nervous waiting for the board scores to be posted than she'd been taking the board exam itself. Lilly lay snoozing between her and Derek, fast asleep after she finished nursing, and to keep herself from refreshing her email every five seconds, Meredith combed her fingers through Lilly's curls.

"I might throw up. You've been warned," she told Derek.

Derek laughed, reaching across Lilly and rubbing his hand along her arm. "I think you're more nervous right now than you were giving birth," he said. "A few minutes from now, you'll wonder why you worried in the first place."

"You know, you have more faith in me than anyone else in my life ever had," Meredith said.

"You've never given me any reason not to," Derek said earnestly. "In all the ups and downs we've had since I met you, you were still the only constant in my life. And you still are. You and Lilly, and the rest of the perfect, beautiful babies I make with you."

Meredith squeezed his hand in hers. "I love you."

"I love you, too."

Meredith's phone chirped with a new email alert, and she let out a breath, reaching for it on the bed. Within seconds of checking it, the anxious look etched all over her face dissolved into something else entirely: joy. The tears welled in her eyes before she spoke, and she smiled at Derek.

"I passed."

"See? I never doubted you for a second, Dr. Grey," Derek grinned. He cupped his hands on her cheeks and kissed her, showing her just how much he meant it. "I'm so proud. Congratulations."

"Hmm, thank you," she murmured, trying to stifle a moan.

Almost instantly, four texts came through on her phone, which momentarily broke up their kiss. Meredith breathed a sigh of relief as she read each one. First Alex, then Izzie, followed by Cristina and George. "Holy crap, we all passed. Thank God," she said.

"Then you all just made Bailey a proud mama," Derek said, knowing their former resident would be filled with as much pride as he was.

"We need to celebrate."

"I bought sparkling cider," Derek replied.

Meredith laughed. "I had something else in mind."

"Oh, yeah?" When it came to his wife, her only other form of celebrating involved nudity, and on a night like this one, Derek was more than happy to oblige.

"Mhm. I'm going to tuck Lilly in, give her a hundred kisses, and when I get back..."

"I'll be naked and waiting. I know the drill," Derek chuckled. He kissed Lilly's soft cheek, careful not to wake her up. "I love you, Princess."

Meredith gently scooped Lilly off the bed, and cradled her close to her chest. Derek watched as she left the room with a slight spring in her step, holding the littlest love of their lives, and finally letting herself feel the happiness she deserved. Ellis Grey had nothing on her.