Gail

Ivy joins Meredith in the OR, "What do we got?"

Meredith dries her hands, "MVC with abdominal trauma, severely hypotwnsive since he arrived."

Edwards continues, "FAST exam show a fluid in the upper right quadrant, lots of it. It's gonna be a long night."

"Don't say that. I haven't slept in 48 hours," Meredith shakes her head.

"Neither have I. I thought I saw you go home earlier," Ivy looks to her sister in law.

She nods, "You did. I got odd an 18 hour shift to go home to find Zola, who is boycotting sleep, and Ellis, who had an earache. By the time I got the last one down, I got the call. Where were you?"

"Four hour lysis of adhesions. Then a triple-A ruptured in the ICU. Maggie and I had to do a balloon catheter bedside before we rushed him to the ER. Then a GSW to the abdomen that Edwards caught- a duodenal repair. And before all of this, Chris, who also has an earache, wouldn't go to bed neither would Allie cause she only goes to bed when Jackson tells her a story, but he was in surgery when I needed to get her down. Then Aurora is still a newborn so she never sleeps," Ivy lists.

"How long have you been here?"

"What day is it?" Ivy only slightly jokes.

She gets a small laugh before Meredith calls, "Scalpel."

Edwards asks her attendings, "How do you know when you're too tired to operate?"

"Right about when you make your first mistake."

"I hate that answer," Edwards sighs.

Meredith shakes her head, "You don't. You just keep going."

Edwards looks at the patient, "Don't love that one, either."

Making the first cut, Meredith leaves Ivy to instruct, "Okay, Edwards, grab a hemostat to lift."

"Dividing the fascia," Meredith cuts.

As monitors start beeping, Ivy calls out, "Okay, Edwards, get lap pads in here. Get in here. We've got massive bleeding. We need a bookwalter now."

Ivy places it on the patient. As they are trying to stop the bleeding, Meredith says, "Edwards, I can't see a thing."

"I'm trying. Ho!" She jumps back as blood squirts out, "Got it. Got it."

"Thank you. Okay, let's get more lap pads in there. Let's bring in another suction and we're gonna need the cell saver," Ivy looks over her shoulder.

Webber joins them, "Good evening, surgeons. I heard we've got a good one. I'm here to give you another set of hands."

Meredith nods, "Yeah, we could use it if you're available."

He chuckles, "Available? I'm primed. I napped all afternoon, ate a balanced supper, and just had a cup of coffee."

Ivy and Meredith share a look, "Did you?"

"All right, someone tell me what we've got on our table tonight," he moves to stand next to Ivy.

"A mess, sir," Meredith sums up, causing Ivy to chuckle.

"Uh, grade four liver lac, portal triad looks intact. We've just packed all four quadrants," Edwards gives a little more detail.

Webber gets a look, "Wow! That livers-"

Ivy cuts him off, "Destroyed. Like Grey said, a mess."

"Okay, hematomas tracking into zone two. Edwards, let's do a right medial visceral rotation," Webber instructs.

"Got it. Medium clip, please."

Meredith looks to Knox, "How many units has he had?"

Edwards answers, "We've gone through at least a dozen."

Ivy shakes her head, "He's bleeding out everything we pour into him. Keep suctioning. Other lap."

"Clamp. Retractor."

"Suction right there."

"I need two more clamps."

Webber starts telling them, "You know, back in the day, I would always come into the hospital overnight, even if I wasn't on call. That's when the most interesting surgeries came in. Best learning opportunities, am I right?"

Edwards nods, "Yeah. Yes, sir. Bovie up."

"I'll never forget this case back when I was a second year resident. It was about three in the morning, and I'd been on my feet for about 42 hours-"

"-Wonder what that's like. Right angle-"

"-This fella came into the ET with terrible abdominal pains. Claimed that an alien baby was inside, eating its way out," for a moment, no one laughs.

Edwards, sensing the awkward, fakes a laugh, "Thats funny. Uh, Dr. Grey, do you see this?"

Meredith looks to Ivy and Webber, "This kidneys cracked in half."

Webber continues his story, "Exactly. It was his kidney. Well, a kidney stone. It was the size of a coconut. It was six hours in the OR. Uh, this seems like a grade four injury to me."

"Any way we can salvage it?" Edwards asks.

"No," Meredith says as Ivy says, "Yes."

"If someone could clarify."

"Okay, it was the size of a dinosaur egg. It almost glowed."

Edwards points at the patient, "Actually, sit, I was talking about this."

Meredith looks up, "This liver is shredded. We don't have the time or the blood volume to spend an hour fixing a kidney."

Ivy shakes her head, "We could better control the extra blood loss we fix the kidney."

"Well, there will be no blood loss if we just take the kidney out."

Edwards interrupts them, "I'm very happy to keep discussing it, but I really think a final decision would be good."

"Take the kidney out," Meredith directs.

"You know what, Grey? Le-lets hold on for a minute, okay?" Webber stops her.

She shakes her head, "The patient doesn't have a minute."

"Should I clamp the hilum?"

Ivy answers, "No, we're gonna do a partial nephrectomy."

Meredith argues, "That would be useless."

"And why is that?"

"What?"

Webber clarifies, "Well, I wasn't asking for myself. I was asking for Edwards. Why is that?"

Meredith looks confused, "What does Edwards have to do with this?"

Ivy explains, "Shes our resident. This is for her to learn and it's an excellent teaching case. So elaborate."

"Ivy, please-"

"No. We're chiefs of general and trauma surgery. If we can't teach her then we don't deserve those spots. But if we don't make a decision, we'll be here all night and I have kids to get home to. So, I'm going to repair the kidney. Suture," Ivy smiles.