Last Trauma

Ivy walks into an empty patient room with Meredith and Cristina. They stare at a camera, "They've installed cameras."

"They're all over the C.C.U. Next they'll be in the O.R.s, the hallways, the on-call rooms," Cristina lists.

"Not in the E.R. because apparently the way I run it is sucking resources," Ivy says, bitterly.

Cristina whispers, "We're being spied on. Who knows what evil lurks behind that electric eye?"

A man's voice pops up, startling the trio, "Morning, Dr. Yang."

Cristina whispers to the sister in laws, "Big Brother knows my name."

"Big Brother can see your name tag," Ivy tells her, walking out of the room.

Crsitna covers it and walks out behind her.

○○○○

The attendings stand in an O.R. as Cahill explains, "The cameras aren't here to spy on you. They are here to supplement you. On the other side of the camera is a remote physician, an extra set of eyes to help reduce mistakes, improve patient care, and maximize physician hours. Now the initial program... so does that answer your questions?"

Ivy raises her hand, "How do we have the money to pay for these cameras and the remote physician but not enough to keep the E.R. open by exploring other possible money saving ways?"

"All right. Let's move on then," Ivy nods her head, having expected to be ignored, "As you can see, this O.R. has been arranged with maximum efficiency, specifically for O.R. turnover. Now what are the main causes for bottleneck? The layout of O.R. supplies, equipment, and instruments. So what we have done... because every second counts, you need the most efficient approach," Cahill continues.

Ivy sighs, rolling her neck back and forth, trying to relieve the stress.

Cahill then drops, "Your average time between surgeries is 37 minutes. With these new O.R. procedures, I'd like to see that cut in half. Thank you, everyone."

Everyone grumbles at the dismissal. Ivy follows Cristina and Meredith out as Jackson holds the door for them, "Closing the E.R. should cut down on time. We won't have any patients."

"Hows Hunt feel about that?" Jackson asks Cristina, knowing that Ivy is absolutely livid.

"Oh, he says he's not gonna do anything about it until it actually happens," Crisitna tells them, Ivy nods as she's had that same conversation with him almost daily since they found out.

"Oh, it's happening. And he can't be a trauma surgeon without an E.R. Is he gonna leave town? Cause if you go with him, I'm screwed. I'm kind of depending on your rent check," Alex questions, earning a slap on the back of the head from Ivy.

"Way to make this all about you. And what about McBaby? She's a trauma surgeon."

Ivy crosses her arms, "McBaby is holding back her thoughts at work because if she says what she wants, she will be fired."

Meredith argues, "The E.R. is not going to close. Derek has a plan."

"Where is Derek?"

"He spent the night with Kepner and Ivy," Meredith tells her.

"Where are they now? And why aren't you with them?" Cristina turns to Ivy.

Ivy sighs, "They are still in a conference room finalizing the plan and it was decided that I take a step back. Cahill and I don't get along at all. So me going to her with the cuts is just a terrible idea."

They all nod in agreement as Ivy gets paged to the pit, "Welp, maybe my last trauma page. God, I'm going to kill her."

○○○○

Owen and Ivy are getting suited up when Cahill comes up to them, "Dr. Hunt, I sent contractors to measure the E.R. space."

"Yeah, and I told them to get lost."

"I know. That's why we're talking," Cahill tells him.

Ivy starts leading the trio, "The E.R. is open for one more day. Which means we will see patients, we will do what a hospital and surgeons do. I know you may have forgotten that since you last did a surgery when the titanic sunk, but we have patients to see."

Owen smirks at Ivy as Cahill follows them, "Dr. Hunt, Dr. Shepherd, the E.R. is closing. I know you don't want it to, but you're gonna need to let that go."

Hunt backs Ivy up, "While we are treating patients, I don't want your workman in the way."

"We are on a tight schedule with the renovation. I was hoping that you would cooperate," Cahill speaks to him.

Ivy stops and turns to her, causing Cahill to freeze as well, "Listen, he's not the one who you need to get on your side. The E.R. is MY baby. I run it. I staff it. I choose who is allowed to work in it on any day. It is still an E.R. today, so it is under my jurisdiction for one more day. You get in my way, and you'll regret it."

They get on an elevator as Owen turns to Cahill, "I'd just like you to name one thing that you can put in there that's more useful than an E.R. Especially one that's ran by Dr. Shepherd."

"Its still under review, but-" Hunt cuts her off, but that gets Ivy thinking.

"In the army, the guys at the front get the most saves. Why?" Owen points to Ivy.

"Because the closer you are to the moment of injury, the better chance you have to help. That is what an E.R. is," she finishes.

Cahill looks between the two, "Where are we going?"

They refocus, "Roof. Medevac's coming."

She starts stuttering, "Uh, I-I-I-I shouldn't. I should hop off now-"

"Emergency medicine is the front line. We're the first responder. We're closest. It's the most important thing that a hospital does," Owen continues to argue.

"Its arguably-"

"So name me one thing that you would replace it with that matters more," Owen states.

Cahill sighs as the elevator dings, "You made your point. Now if you don't mind, I have a big day, and I-"

The paramedics come in with the patient, "40 year old male logger versus chain saw," Ivy immediately starts assessing, "Deep neck laceration affecting most of the major blood vessels and extending into the chest. He's hypotensive and tachycardic. Oh, and his nose is pretty much sliced off."