154. Unexpected Surprise

Disclaimer: I'm not Shonda Rhimes. (Remember that while reading this chapter, too.)

Thank you for all the love and excitement over the last chapter! It means so much to me!

Meredith opened the PDF attached in the email, and began scrolling through the results of her physical. As she suspected, her immunization records were up to date, her vision and hearing were near pristine, and no disease processes were found. She was about to close out of the email when a result from the blood work criteria caught her eye.

hCG level: 52Indicative of: Positive Pregnancy

All Meredith could do was stare at the screen. "Derek."

"Yeah?" He turned around, walking over to her when he saw the look on her face. "Mer, what is it?"

She handed him the phone, and his eyes scanned over the screen. When he saw what she had seen, he nearly dropped her phone to the ground. "Meredith."

"I didn't... we weren't even..." Meredith stammered, running a hand through her hair.

"Who cares? Meredith, we made a baby," Derek said, the same happiness radiating on his face the day Lilly was born. He leaned in and kissed her, unable to help himself. "I love you so much."

"I love you, too," Meredith said against his lips. "But Derek, I never got my IUD taken out."

Derek pulled away, his joy halted at least for the moment. "Okay, let's just take a minute and breathe."

"Okay," Meredith nodded, grabbing for his hand. She inhaled and exhaled as deeply as she could, and he did the same.

"Maybe it fell out. It's not often that IUDs fall out on their own, but it happens," Derek said.

"I don't know. I think I'd remember something falling out of my uterus," she said. She opened the calendar app on her phone, and scrolled back to June. "Okay, last month, I got my period on the 16th, so I wouldn't be due for it again until next week. That means I have to be less than a month along."

"It probably wouldn't even show up on a pregnancy test yet. Your blood test can pick up hCG at this stage, but a urine test wouldn't," Derek replied.

Meredith felt the burn of tears in her eyes, but she tried to keep calm for Lilly, whom Charlie delivered back to them after her ride around the yard. "We need to go to the hospital. If my IUD did fall out, I need to know. And if it didn't, I need to get it taken out."

"Okay, let's go." Derek turned off the oven, then opened the sliding glass door, letting Charlie and Lilly in before him. He saw Meredith brush a tear off her cheek as she walked toward the door, and he wrapped his arms around her. "Don't cry."

"It's been two minutes, and I'm already completely in love, Derek. The same kind I felt with Lilly when we found out she existed. If something happens, I—"

"Let's not worry until we have to. We'll go, get you checked out, come home, and celebrate the baby we made without even trying," Derek said.

Meredith smiled as best she could, wanting more than anything to believe him. "Okay."

...

Within the hour, Meredith was sitting in a paper gown on an exam table, wiggling her feet nervously as she waited for Dr. Halloran to arrive. "How crazy is this?" she asked Derek, who stood by her side, Lilly in his arm.

"Crazy in the best possible way," Derek said. He kissed the top of her head and she leaned into him. "It's gonna be okay, I promise."

"Kay, Ma," Lilly assured her, smiling at Meredith.

Meredith squeezed Lilly's tiny hand. "I love you so much."

"Lub," Lilly echoed.

Dr. Halloran knocked briefly before entering the exam room, Meredith's file in her hand. "Hi there. It's so nice to see you all again," she greeted. "Oh my goodness, look how big you got," she told Lilly.

Lilly buried her head in Derek's shoulder, and he patted her bottom. "She's a little shy around new faces, even though you're the one that delivered her," he chuckled, attempting to breaking up the nerves he knew Meredith was feeling.

"That's okay. You're beautiful, Miss Lilly," Dr. Halloran complimented.

"Thank you," Meredith said.

"So, you got a blood test for your physical today, and I see that your hCG levels are elevated," Dr. Halloran said. She set Meredith's chart on the counter and stepped on the sink pedal to wash her hands. "I'll just do an exam, and see if your IUD fell out on its own. And if not, then we'll discuss where to go from there," she said calmly.

Derek rubbed his hand along Meredith's arm, mirroring the doctor's calm demeanor. "Okay," he agreed.

Dr. Halloran reclined the exam table, then pulled on a pair of gloves. "Okay, scoot down a little," she said.

Meredith inched herself lower on the table and guided her feet into the stirrups on either side as Dr. Halloran placed a blue drape over her knees.

"Okay, let's take a look. Just relax your legs for me," Dr. Halloran said, taking a seat on the stool at the foot of the table.

Meredith reached for Derek's hand and squeezed tight, grateful that Lilly was in the room, so she could focus on her, too. "Please tell me it fell out," she said.

"Unfortunately, it's still in place. But I don't want you to panic. It's rare, but this does happen," Dr. Halloran said.

"Damn it," Meredith whispered, turning her head away from Lilly, so she wouldn't see the fear on her face. "Okay, well, what do we do now?"

"I'm going to do an internal ultrasound. Your hCG is 52, which is still very low. You said your last period was June 16th, correct?" Dr. Halloran asked, remembering what she'd read in Meredith's chart.

"Yeah. I can't be more than a month," Meredith said.

"We'll just check to make sure there's actually an embryo, and if there is, we'll determine its position from the IUD," Dr. Halloran explained, wheeling over the ultrasound machine. She carefully inserted the transducer, and Meredith flinched slightly, keeping her vice grip on Derek's hand.

A blur of black flashed onto the monitor, contrasting with white and gray as it came into focus. "Okay, here's your cervix. And this is the IUD in the center. Above that is your uterus. And would you look at that. Right over here," she said, clicking on the grainy, barely visible circle of white, "is the embryo."

Meredith sucked in a breath, instant, maternal love taking over as soon as she saw it. "Oh my God," she whispered.

Derek leaned over the table and kissed her hard, unconcerned by Dr. Halloran's presence. "Look what we made. God, I love you," he said, wiping his eyes with the sleeve of his shirt.

"I'd say you're between two and three weeks. Obviously, it's very rare to detect pregnancy at this stage. That blood test you got today was a blessing," Dr. Halloran said. "The earlier IUDs are removed, the less chance of complications."

"So, you're going to take it out right?" Derek asked.

Dr. Halloran tapped on the keyboard with one hand, dragging the mouse with the other as she took measurements between where the embryo was implanted and her IUD. When she finally spoke a few minutes later, she, too, seemed relieved.

"You've got a smart, little embryo in there. It planted itself above the IUD, and in doing so, also seems to have pushed it downward. The IUD is not embedded in the placenta," Dr. Halloran said, showing them with her finger on the screen.

"So that means?" Meredith asked.

"That means if you're going to be part of .6 percent of women who conceive with an IUD, yours is the ideal situation," Dr. Halloran assured her.

Meredith put her free hand over her belly, letting out both sighs and tears of relief. "So, it'll be okay? We won't lose it?"

"There's always a risk of miscarriage with an IUD removal during pregnancy. But I've done the procedure before on women who were farther along, and whose embryos were in dangerous positions, and all of them went on to have viable pregnancies. And like I said, in your case, you got very, very lucky," Dr. Halloran said.

"I want it out now. Please, if you can, I need it out," Meredith said, already a mama lion for the baby she'd known about for under an hour.

Dr. Halloran nodded, removing the transducer, so Meredith could sit up on the table. "Absolutely. We'll get you into a procedure room, and we'll do it right away," she said.

"Thank you so much," Derek said.

Dr. Halloran handed them the small stack of sonogram pictures that she'd printed, their smaller-than-a-raisin baby right in the center. "Here you go. First pictures of this little one," she smiled.

Meredith and Derek each took a copy, and even though it felt like tempting fate, they smiled, too. Lilly looked at the black and white picture with piqued interest, cocking her head. "Dat?" she asked.

Rather than risk getting her hopes up for a baby, or having the news spread all over the hospital by morning, Meredith gave the simplest answer she could. "That's Mama's belly," she said.

"Ma bel," Lilly parroted, content with the answer.

Derek bounced her in his arm. "Uncle Mark is on call tonight. How about we go find him, so you can play with him for a while?" he said, knowing that Lilly wouldn't be allowed in the procedure room.

"She'll be in Procedure Room C right down the hall when you get back," Dr. Halloran told him.

"Okay, thank you," Derek nodded as he handed Lilly to Meredith for a quick kiss. If anyone could calm her down better than he could, it was their daughter.

Meredith hugged Lilly close to her chest and breathed in her dark ringlets of hair. "I love you, Lillybug. I'll see you in a little bit, okay?"

"Lub," Lilly said, pecking a kiss on Meredith's cheek.

"Are you okay with me telling Mark, or do you want me to make something up?" Derek asked.

"You can tell him. I know he won't say anything to anyone," Meredith said. "Just be quick, okay? I need you with me when they do this."

"I will, I promise," he said, giving her hand another supportive squeeze. He picked Lilly up, then slung her diaper bag over his shoulder. "Be back as soon as I can."

"Bye, Ma," Lilly waved.

Meredith smiled and waved back at her daughter. "Bye, baby girl. Have fun," she said.

Derek called Mark as soon as he left the room with Lilly, and they met up at the fourth floor elevator, walking into a quiet hall, so Derek could explain without gossipy ears listening in.

"If this is about the frame you and Grey owe me after your porn session this afternoon, I prefer cash. Whatever you two did in there today, I'm shocked that only one was smashed on the floor," Mark said.

Derek shook his head, and the look on his face told Mark it was serious. "Mark, Meredith is pregnant," he said.

"What? I didn't even know you guys were trying yet. Congrats, man," Mark grinned, patting Derek's back.

"Thanks. We weren't trying; just a completely unplanned surprise. She's between two and three weeks along. The blood test she got today picked up on her hCG levels. We would be celebrating right now, except she still has her IUD, and needs to get it taken out. Dr. Halloran said it should go smoothly because the embryo isn't near the IUD, but Meredith is scared to death. She's keeping a brave face on, but I know better than to believe it. Anyway, I know you're on call, so I was hoping you could watch Lilly, just until it's finished, and we're in the clear," Derek said.

"Yeah, it's no problem. I'll watch her as long as you need me to," Mark agreed instantly, taking the diaper bag from Derek's shoulder.

"I really appreciate it."

"Of course. Come here, beautiful," Mark said as he swapped Lilly from Derek's arm to his own. "I'll take her up to the attending lounge. The big screen TV is up there, so we'll just watch the second half of the Mariners-Yankees game while we wait. Don't rush, though. Just do what you have to do. We'll be fine."

Derek smiled at his friend. For all of their ribbing on one another, Mark was always there in a pinch, and at a time like this one, Derek was especially grateful. "Thank you, Mark. I owe you one."

"Replace my shattered frame, and I'll call it even," Mark joked.

"Alright, will do. I'll call you when we're through upstairs. Bye, Lilly. Daddy loves you," he said, kissing the top of her head.

"Good luck. Tell Grey I said congrats on making another perfect genius. And don't worry, my lips are sealed," he said before Derek could even ask.

Derek returned the pat on Mark's back. "Appreciate it; thanks."

He raced back upstairs as quickly as his legs would take him, and by the time he got to the procedure room, Meredith was just getting situated on the exam table. "Hey. Mark was more than happy to take her."

"Good. That's good," Meredith said, spinning her wedding ring around her finger in nervous anticipation.

Derek wrapped an arm around her shoulder and hugged her as best he could. "Meredith, it's gonna be okay. I know it's easier said than done, but you need to stay as calm as you can. Dr. Halloran is one of the best OB/GYNs in the country. She knows what she's doing," he tried to comfort her.

"I know. I just... this is a lot. I mean, when they say 99.4 percent effective against pregnancy, you think you'll be part of that number. You don't think you're going to be in that .6 that gets pregnant," Meredith said.

"If my sperm can battle birth control, and win the fight, I'd say that's a damn good sign that this baby is supposed to be here. Two or three weeks in existence, and he or she is already a warrior. Tough and stubborn, just like you," Derek said genuinely.

Meredith couldn't help but smile at that, and she let herself relax the slightest bit. "Probably another girl, then," she mused.

"Fine with me," Derek grinned.

"Me, too."

Dr. Halloran and a nurse they'd recognized as Theresa entered the room with their tray of equipment and an ultrasound machine. "How are you doing in here?" the doctor asked as she washed her hands once again.

"Okay. Just nervous. How long does something like this take?" Meredith asked.

"No more than ten minutes. Theresa is going to keep the transducer on your belly the entire time, so we can keep an eye on the embryo during the IUD removal. Luckily, your strings are still visible, so I'm just going to pull them out with your IUD very slowly. If all goes well, the IUD comes out, there's no jostling of the embryo on the uterine wall, and then it's all finished. Most women don't feel any pain at all, but if you do, it's no worse than a PAP," Dr. Halloran explained calmly.

"Okay," Meredith said, taking a few deep breaths as Theresa reclined the exam table.

"Legs up. There you go," Dr. Halloran said. She draped Meredith's knees like she did before, and Theresa exposed her lower abdomen.

"I'm going to squirt some gel on your belly. It might be a little cold," Theresa warned her. She rolled the bottle between her palms for a few seconds before squirting a small dollop just below Meredith's belly button.

Meredith didn't flinch at the cool, blue gel on her skin, her mind too preoccupied by the sonogram she was holding, her other hand glued to Derek's. Her uterus appeared on the screen, and there it was again, their tiny, grain of rice baby that they both already loved so completely.

"There it is. Good visualization of the embryo. I'm going to go ahead and get started, if that's okay with you, Meredith," Dr. Halloran said.

"I'm ready," Meredith consented.

Derek brushed his thumb over her knuckles and smiled at her. "Warrior, remember," he said softly.

"Yeah," she whispered, scrunching her face in discomfort as Dr. Halloran began the procedure.

"Okay, speculum is in place. Just try to stay as relaxed as possible," Dr. Halloran coached her. "I'm going to use the forceps to grasp the strings, and gently pull on them. Like I said, little to no pain."

"It's okay if it hurts. As long as it hurts me, and not the baby, I don't care," Meredith said.

Both she and Derek held their breaths as Dr. Halloran started to remove the IUD, keeping their eyes trained on the blobby sac of white. Meredith gasped as she felt it slip out, but when it was finished, she let out a long, slow breath. "Is that it?"

"That's it. Embryo didn't move an inch. Safe and sound, just how it implanted," Dr. Halloran said. "How do you feel, Meredith? Pain or cramping?"

"No, I'm fine. Just... are you sure the baby's going to be okay?" Meredith asked.

"I want you to take it easy. No sex, no exercise, and if it's possible, limit your work hours. In a week, week and a half, I'd like you to come in for a repeat ultrasound. If there's been no spotting, cramping, or other signs of miscarriage, then I think it's safe to say you'll be out of the woods. It'll be no more high risk than any other pregnancy," Dr. Halloran said.

Meredith dropped her head into her hands, finally letting herself feel the joy she'd been holding back. "Thank you. I, um... thank you," was all she could say.

"You're very welcome. You have my pager number. Call me if you think anything is wrong, day or night. You've got a tough, little embryo in there. Quite the miracle if I've ever seen one," the doctor said.

"I'll keep it safe," Meredith promised.

Dr. Halloran gave Meredith's arm a light squeeze of encouragement. "Of course you will. You're a mommy."

Derek pressed a kiss to her temple, feeling her body relax into him. "Mommy of two," he grinned.

Meredith smiled, using her gown to blot the tears on her cheeks, so they wouldn't drip onto the first baby picture of their second child. "Mommy of two."

...

Their surprise-ridden anniversary was winding down, and given how the day could have ended up, they were nothing but grateful for the day they'd been given. Lilly lay sleeping between her parents in their bed in her Monsters, Inc. pajamas, thoroughly worn out after the long, adventurous day.

"So, it would seem as though you and I did more than have porny practice sessions for your boards," Derek said, admiring the sonogram picture they'd put in a frame the minute they got home.

Meredith laughed, one hand resting over her belly like a magnet. "Well, you said you would try to be just as efficient knocking me up as you were last time. You definitely succeeded."

"The Shepherds have always been a fertile bunch. If my sperm were determined to defeat your IUD, nothing was gonna stop them," he boasted playfully.

"Clearly," she agreed.

Derek reached over Lilly and rubbed a hand over Meredith's back. "How are you doing? Feeling okay?"

"Yeah. I'm still a little shaken up, but I feel good. I'm happy," she said, biting her lip as she felt the tears build again. "I'm really, really happy."

"Me, too."

"Derek, I was so scared. Anything could've gone wrong. What if the baby had implanted next to the IUD, and Halloran wasn't able to take it out? I'd never be able to forgive myself for putting the baby's life in danger like that," Meredith admitted.

"I know. But we can't think like that. The baby's fine, and you're fine," Derek assured her, handing her the framed sonogram. "Looks like a happy, healthy little blob to me."

"We didn't get Lilly's first sonogram until she was seven weeks, and I thought her blueberry-sized self was tiny. A blueberry is huge compared to our rice baby," Meredith said.

"Rice baby will keep on growing. In a few weeks, she'll be a blueberry, and then an eggplant, and before you know it, it'll be March 23rd," Derek said.

"March 23rd," Meredith echoed, the prospect of having two babies in the house making both of them happier than they could even fathom. "I wonder if this one will come on his due date, or follow in his big sister's shoes, and surprise us."

"Well, he already gave us the surprise of a lifetime today. I think he'll keep us on our toes," Derek chuckled.

"Yeah, probably. Lilly was seven days late. This one might come seven days early," Meredith pondered.

"Or maybe ten days late. Then we'd share a birthday," Derek said as excitedly as a child on Christmas morning.

Meredith rolled her eyes playfully. "I'll do my best to make that wish come true," she said.

He lifted Meredith's shirt just above her belly button and kissed her stomach for the first of many times to come, soaking in the warmth of her skin. "Mommy and I already love you so much. And you've got the best big sister who's gonna love you just as much we do."

Meredith smiled, watching as Lilly's chest rose and fell as she slept. "She's going to seem so much more grown up now."

"I know. It'll be an adjustment at first, because she's so used to having the spotlight all to herself. I think she'll handle it well, though. She'll want to be involved and do all of that big sister stuff. We'll make sure she knows she's just as loved as she always was," Derek said confidently.

"When should we tell her? She's still so little, so we'll have to keep it as simple as we can. But she's so chatty, too. Once we tell her, it's only a matter of time before she spills the beans," Meredith teased, though she knew it was the truth.

"When you were pregnant with her, you started showing early. Once there's a little bump, she'll probably understand it better," Derek suggested.

"I don't want to jinx it either, just in case... you know," Meredith shrugged, unable to bring herself to finish the sentence.

"Hey, hey. We can't think like that. Remember what you told me as you put Lilly's very first sonogram on the fridge? You said the baby was safe and sound, and there was no way you'd ever let anything happen to it. You were right then, and it'll be the same with this one," Derek said.

"Today was... I've never been that scared in my life, and you got me through it. And I just really, really love you," she said softly.

"I love you, too. And I'll always be there for you, Lilly, and this little jellybean that snuck up on us," Derek chuckled, putting his hand over her lower belly.

Meredith placed her hand next to his, smiling at the nickname. "Jellybean, huh?"

"Well, Lilly was 'Blueberry' before we named her Lilly. This one needs a nickname, too. Besides, he kind of looks like a jellybean," Derek pointed out on the sonogram photo.

"Okay, then. Jellybean it is," Meredith agreed. She shook her head in quiet awe, tracing her finger over the small, white circle in the picture. "There's four of us now. I can't even wrap my mind around that."

"Greatest anniversary present ever."

Meredith put her hand on Derek's cheek and kissed him, reveling in the joy of the baby they'd made without even trying. "Totally is."