No Rest for the Weary

The door creaked open, and Meredith stepped inside first, shrugging off her coat and tossing her keys onto the counter. Jamie followed, scanning the warm, lived-in space.

The scent of garlic, roasted chicken, and something faintly sweet baking in the oven filled the air.

At the dining table, Derek was flipping through an old edition of a neurosurgery journal, one hand idly wrapped around a beer.

He glanced up, then leaned back slightly. "That's a surprise. Didn't know you were coming."

Jamie slipped his hands into his pockets, his expression unreadable. "Wasn't planning to."

Meredith arched a brow, smirking slightly. "Welcome to my humble home. It's not a penthouse, but…"

Jamie's lips twitched slightly, amusement flickering across his face. "It's cozy."

Meredith rolled her eyes but smiled anyway as she walked toward the kitchen.

Jamie turned his attention back to Derek. "I actually wanted to talk to George about his father."

From across the kitchen, Izzie—who was stirring a pot of sauce—spoke up without turning around.

"George is still at the hospital."

Meredith gave a small shrug. "Then you might as well stay for dinner and wait for him."

Jamie hesitated for a second.

Derek didn't, kicking out a chair lazily. "Come on, Knight. Sit down. We've got beer."

Jamie sighed through his nose, but relented, pulling out the chair next to Derek.

Jamie barely had time to get comfortable before his eyes fell on the medical journal Derek had been reading. He frowned, tilting his head slightly.

"Why are you reading an old edition?"

Derek looked up. "What?"

Jamie tapped the cover with two fingers. "That's the 1999 edition of the Journal of Neurosurgical Advances. They reissued a corrected version in 2000 after a publisher misprint. Page 214 had an error in the procedural diagrams for microvascular decompression. They used the wrong labeling for the trigeminal nerve compression site."

Derek blinked.

Jamie continued, "You read this one before. I remember because it was a Tuesday, and it was raining. We were at that diner across from the hospital. You were sitting at the counter, wearing that ridiculous Columbia hoodie—dark blue, slightly frayed at the cuffs. It was 10:42 p.m. You had just come off a seven-hour craniotomy, and you were reading this exact page while complaining about how embarrassing it was for a peer-reviewed neurosurgical journal to mess up something so basic."

Derek just stared at him.

Jamie tilted his head slightly. "You also spilled coffee on the corner of the page."

Derek lowered the journal slowly. A beat of silence stretched between them.

Then he muttered, "And that's why everyone thought you were a pain in the ass."

Jamie rolled his eyes, shrugging.

Meredith had been listening absently, but now she froze completely.

For a second, she just stared at Jamie, like she wasn't sure she had heard him right.

Her mouth opened slightly, then closed again.

She blinked.

"I knew you had a photographic memory, but this is insane."

From the kitchen, Izzie—still stirring the sauce—chimed in without turning around.

"Yeah, Baby Jamie is very smart."

Jamie let out a quiet exhale, already resigned. "Nancy. That menace."

Derek, grinning, was clearly enjoying himself.

Jamie reached for a beer, twisting off the cap with one hand. "I should have gone home."

Derek smirked. "To your peace and quiet?"

Jamie took a sip, mumbling into the bottle. "Exactly."

As if on cue, Izzie turned from the stove, wiping her hands on a dish towel.

"Dinner's ready."

She moved quickly, setting dishes on the table while Meredith grabbed plates. Jamie hesitated for a second but then followed Derek and took a seat.

The four of them settled in, the sound of silverware clinking against plates filling the space as they ate in comfortable silence.

Jamie reached for his beer, taking a sip before speaking.

"You ever feel like the world moved on without you?"

Derek glanced up, fork halfway to his mouth. "You weren't gone that long."

Jamie scoffed lightly. "It felt like forever. New York, I mean." He set his beer down. "Today I had a valve repair. One of Burke's patients."

Derek nodded, chewing.

Jamie continued, "It made me think back to New York. To my cardio fellowship."

Derek snorted. "Not that much time at all. I still remember what a pain you were during your residency."

Jamie arched a brow, amused. "Oh yeah?"

Derek nodded, grinning. "The kid who ran the OR like an attending in his first year."

Meredith, now intrigued, tilted her head. "Wait—first year?"

Derek smirked. "Yeah. First time I met him, I walked into an ER and found this kid—what, twenty-three at the time?"

"Twenty-one," Jamie corrected absently.

Derek pointed at him. "Exactly. Twenty-one, covered in blood, elbow-deep in some poor guy's abdomen, literally holding the guy's aorta together with his bare hands."

Meredith blinked. "What?"

Derek leaned forward. "It was a car crash. Guy was impaled. The idiot passenger pulled the object out before the EMTs got him to the hospital, so by the time he came in, he was hemorrhaging fast."

Jamie didn't add anything, just picked up his beer, listening.

Derek continued, "I show up for a neuro consult, expecting to deal with spinal trauma, and instead, I find him—this tiny, arrogant first-year—already working the case like he's in charge."

Meredith frowned. "And you let him?"

Derek laughed. "Oh, I tried to question him. Asked him what the hell he thought he was doing."

Meredith turned to Jamie. "And what did you say?"

Jamie finally looked up, meeting her eyes. His voice was flat, matter-of-fact.

"Right now, I'm your only chance of keeping this guy alive."

A beat of silence.

Meredith let out a breath, looking between them. "You said that to Derek?"

Derek chuckled, shaking his head. "Jamie wasn't wrong. The guy was hemorrhaging, and he was the only thing keeping him from bleeding out."

Jamie shrugged slightly, but there was a flicker of amusement in his expression. "I had it under control."

Derek huffed. "You were barely out of med school. It was your first day."

Jamie took a sip of beer. "I knew what I was doing."

Meredith leaned against the counter, intrigued. "So he was that good?"

Derek scoffed. "He was three steps ahead of everyone. And he knew it."

Jamie poked at his food, unfazed.

Derek went on, "Attendings would throw insane medical questions at him just to stump him. You know those trick questions you get pimped on in rounds?"

Meredith nodded.

Derek gestured at Jamie. "Didn't even faze him. Knew the answers without trying. He had this photographic memory—could recall an entire case he read once three years ago, down to the suture material used."

Jamie sighed. "It wasn't that dramatic."

Derek grinned. "Oh, it was. The Chief Resident hated him for it."

Jamie glanced up briefly, waiting.

Derek smirked. "Because of Jamie, he always looked bad in front of the attendings. Started calling him 'Fetus' out of jealousy because Jamie looked so young back then."

Jamie rolled his eyes.

Derek continued, "He was a rising star, and he knew it. The problem was, most could not catch his tail no matter how hard they tried."

Meredith chuckled. "Let me guess. Jamie had all that talent, but still came in before everyone else and stayed in the skills lab after the other residents had long left?"

Derek pointed his fork at her. "Exactly. The guy was pushing 90-hour weeks and still showed up looking impeccable in his tailored suits."

Jamie shot him a look. "I wasn't that bad."

Derek snorted. "Oh, you were. And then there were the nurses."

Izzie grinned knowingly. "Oh, this sounds good."

Derek smirked. "He was worse than Mark without even trying."

Jamie groaned. "Okay, that's enough storytelling for one night."

Derek leaned back, still grinning. "The point is, if he had stayed in cardio in New York, he'd have a Harper Avery by now."

Jamie's grip on his beer tightened slightly.

For a moment, he didn't respond.

The air shifted just enough for Meredith to notice.

Then Jamie cleared his throat, changing the subject. "Oh, speaking of embarrassing things…" He turned to Derek, his expression suddenly thoughtful. "Did I ever tell you guys about Derek's high school years?"

Derek's grin faltered slightly. "…What?"

Jamie leaned forward, resting his elbow on the table. "Yeah, see, the last time I was at the Shepherd house for Christmas, your sisters—your very loving sisters—were kind enough to show me some pictures."

Derek's face dropped instantly. "Oh, hell no."

Jamie's grin widened. "So here's the thing. Derek likes to act like he was always the golden boy, right? The charming, successful, great-haired neurosurgeon." He glanced at Meredith and Izzie. "You're buying that image, right?"

Meredith, very intrigued now, nodded slowly. "It's… what I've been led to believe."

Izzie grinned. "Absolutely."

Jamie took a slow sip of his beer before setting it down, enjoying himself. "Well. I regret to inform you that back in high school, Derek Shepherd was a 110-pound guy with an afro."

Izzie burst out laughing.

Meredith blinked, then turned to Derek. "Afro?"

Derek rubbed his temples. "It wasn't that bad."

Jamie continued, "Oh, it was. As if hair products didn't exist. And acne. Oh, so much acne."

Meredith, barely holding back laughter, covered her mouth. "You had acne?"

Derek groaned. "It was one year!"

Jamie wasn't done yet. "And let's not forget the saxophone."

Meredith lowered her hand slowly. "…Excuse me?"

Jamie nodded. "Derek played saxophone in the school band. And not like, a cool jazz band. Nope. Marching band."

Izzie had to put down her fork from laughing too hard.

Meredith stared at Derek, absolutely delighted. "Derek. You played saxophone. In marching band."

Derek, completely defeated now, exhaled. "…I hate you so much."

Jamie grinned, raising his beer. "Cheers."

-----------------------------

The last of the dishes were cleared, and the table had been wiped down. Meredith stretched, then turned toward Derek, grabbing his wrist.

"Come on," she said, her voice half-playful, half-demanding.

Derek blinked. "Where are we—"

"Upstairs."

She was already dragging him toward the stairs, clearly not done getting more details about his embarrassing high school years.

"Meredith—" Derek tried, but she just shot him a look.

"Saxophone, Derek. You played saxophone in a marching band. I have questions."

Derek groaned dramatically but let himself be pulled along. "This is betrayal."

Jamie smirked slightly, shaking his head as Derek disappeared up the stairs.

And just like that, it was just him and Izzie.

------------------------------

The kitchen was quiet now, save for the sound of water running as Jamie grabbed a dish towel and started drying. Izzie scrubbed a plate in the sink, her movements methodical.

They worked in silence, but not an uncomfortable one.

Then Jamie's eyes drifted toward the fridge, where the check was still taped up, edges curling slightly, speckled with faint food stains from weeks of being ignored.

He frowned slightly, then nodded toward it. "Why is that still hanging there?"

Izzie froze for just a fraction of a second, then snapped back almost too quickly. "It's none of your business."

Jamie nodded once. "You're right."

That caught her off guard. She expected him to push.

Instead, he just kept drying the plate in his hands, tone casual but firm.

"But letting it hang there isn't going to change what happened."

Izzie gritted her teeth. "And?"

Jamie glanced at her briefly, then set the dried plate down on the counter.

"It'll only serve as a constant reminder of him."

Izzie's grip on the sponge tightened.

Jamie continued, voice calm but unwavering. "Ignoring it may feel easier than dealing with it. Because if you deposit it, you're admitting that it's real. That he's gone."**

Izzie's jaw clenched.

Jamie finally looked her in the eye. "But letting it hang there, covered in food stains, isn't going to change anything either."

Izzie slammed a plate down in the sink, turning to face him. "Yeah? And what do you know about it?"

Jamie didn't react.

He didn't push back, didn't argue.

He just stood there, quiet. Watching her.

The seconds stretched between them.

Then, Jamie exhaled, setting the dish towel down.

"…You know." His voice was lower now, quieter. "It's never going away. That pain. That feeling of not knowing how you're supposed to survive in a world without them."

Izzie's eyes flickered, her breath catching slightly.

Jamie leaned against the counter, not looking at her now, just staring at the water in the sink.

"Because when the people we love die, a part of us dies with them."

Izzie's hands curled into fists.

Jamie's voice was steady, not forceful. "But trust me. Ignoring it won't take that pain away." He swallowed. "I tried."

Silence.

For the first time, Izzie didn't snap back.

Jamie turned his head toward her again, watching her reaction carefully.

"I may not have known Denny," he said finally, "but I'm sure he would want you to hold onto the good memories you had together. And to live your life."

Izzie's eyes burned, but she kept her jaw locked.

Jamie nodded toward the check. "Deposit it. You don't have to do anything with it. Just deposit it. Until you figure out what comes next."

Izzie stared at him.

Jamie gave her a small, quiet nod. "And, Izzie… as long as you remember him, he'll always be with you."

A tear slipped down her cheek, but she didn't wipe it away.

They stood there, side by side.

Neither speaking.

Jamie exhaled, reaching for his jacket. He patted her shoulder once—just briefly—before turning away.

Jamie slipped on his jacket, adjusting the collar.

He paused at the doorway, turning back for a second. "Good night, Izzie."

Izzie, still standing in the kitchen, nodded slowly. "Good night."

Jamie opened the door, stepping outside into the cold night air.

The moment he did, the wind hit him, sharp and biting, and he realized it had started raining.

He exhaled slowly, raking a hand through his hair as the water dripped onto his jacket.

His mood was lower now, the weight of his own words lingering in his chest.

Because he hadn't just been talking about Izzie's loss.

He had been talking about his own.

Jamie pulled out his phone, staring at the screen for a second before pressing a contact.

The line rang twice before a warm, familiar voice picked up.

"Jamie?"

Jamie closed his eyes briefly, then opened them, looking out into the rain.

"Hey, Grandma." His voice was quieter now. "I think I'll stay at the manor tonight."

------------------------------

The rhythmic sound of shoes hitting wet pavement echoed as Jamie ran through the private estate driveway, his breaths measured despite the intensity of his pace. The morning air was crisp, the lingering rain from last night leaving the world cool and damp.

As he reached the front steps of the manor, he slowed to a halt, exhaling sharply as he ran a hand through his damp hair.

Standing near the grand oak doors, impeccably dressed in his usual butler attire, was James.

James tilted his head slightly, his expression as composed as ever. "What would you like for breakfast, sir?"

Jamie exhaled, rolling his shoulders back. "I'll have eggs Benedict, smoked salmon on rye, and a café au lait."

James nodded approvingly. "Very good, sir."

Jamie walked past him, stepping into the warmth of the manor.

amie ascended the grand staircase, moving through the hallway lined with polished mahogany and oil paintings. He pushed open the door to his bedroom, stepping inside the pristine yet lived-in space.

As he moved toward the bathroom, he stopped—his gaze catching on something.

Sitting on the antique dresser, where he had left it, was a delicate silver locket.

Jamie's footsteps slowed as he approached.

His mother's locket.

His fingers brushed over the cool metal as he picked it up, carefully opening it.

Inside, the tiny photograph remained untouched by time—his mother's smiling face on one side, a much younger version of himself on the middle and his father on the other side.

Jamie's expression softened, a small, rare smile gracing his lips.

For a moment, he just stood there, holding onto something that felt distant yet close all at once.

Then, gently, he placed it back down.

A moment was enough.

------------------------------

By the time Jamie came downstairs, he was impeccably dressed—a dark grey suit, crisp white shirt, subtly expensive yet effortless.

His grandmother sat at the breakfast table, already dining, sipping her tea with practiced elegance.

She glanced up as Jamie took his seat.

"Don't forget the gala tomorrow," she reminded, her tone casual but knowing.

Jamie sighed, picking up his coffee. "I haven't forgotten."

James arrived with Jamie's breakfast, placing the plate in front of him—scrambled eggs, toasted baguette, and smoked salmon.

As Jamie picked up his fork, his gaze lingered on the eggs for half a second.

A memory surfaced—Lexie, teasing him about "starving without her" and making breakfast in his clothes that were too big for her.

A small smile tugged at his lips before he even realized it.

His grandmother, who missed nothing, set her cup down slowly and narrowed her gaze at him.

Jamie noticed instantly. "…What?"

She tilted her head slightly. "When are you going to introduce me to her?"

Jamie blinked, confused. "Who?"

She gave him an unimpressed look. "Your girlfriend."

Jamie almost choked on his coffee. "I don't have a girlfriend."

She shook her head, exasperated. "A woman who can make you smile like that should have a ring on her finger before someone else gives her one."

Jamie sighed, rubbing his temple. "We had dinner twice. And she lives in Boston. No girlfriend."

His grandmother said nothing, but her expression made it clear that she didn't believe a word.

Jamie quickly changed the subject. "So. The gala. Who's attending?"

She gave him a long, knowing look but let it slide.

Jamie leaned back in his chair. "I talked to Webber about establishing a trauma center at Seattle Grace."

His grandmother raised an eyebrow. "And?"

"I need to start looking for staff. Funding." He sighed. "Tomorrow's gala might help with that."

Before she could respond, James entered the room, clearing his throat.

"Sir, your pager has gone off." handing Jamie his pager.

Jamie glanced down at it, eyes narrowing at the urgent message.

"Damn it." He stood up, grabbing his coat. "We'll talk later. I have to go."

He strode toward the front door, shrugging his coat on in one swift movement.

"Drive safe, Jamie," his grandmother called after him.

Jamie gave her a quick nod before pushing the door open and stepping out into the chilly morning air.

------------------------------

As the front door closed behind him, his grandmother set her cup down, watching him through the window.

A rare, knowing smile played at her lips.

She turned to James. "Did you see his smile?"

James, ever composed, nodded. "I did, ma'am."

She sighed, shaking her head with amusement. "Jamie better hurry up and give me some great-grandchildren."

James folded his hands behind his back. "He probably needs a push."

His grandmother hummed thoughtfully, a quiet, mischievous gleam in her eyes.

"Then perhaps it's time we give him one."

----------------------------------------

The cold morning air hit Jamie as he stepped outside, the drizzle from earlier now a fine mist, clinging to his coat. The crisp scent of wet earth and pine filled his lungs as he strode toward his car.

He slid into the driver's seat, already pulling his phone from his pocket. The pager alert had been marked urgent, and he didn't waste time dialing back.

The call barely rang twice before it was answered.

"Dr. Knight, this is Commander Elliott from the U.S. Coast Guard. We have an active situation—urgent medical assistance needed on-site."

Jamie tightened his grip on the steering wheel.

"What kind of situation?"

"A commercial salvage diver is trapped under a collapsed shipwreck, approximately 120 feet below sea level. We can't move him without significant risk, and he's been down there for over seven hours. His oxygen is running low, and we suspect potential crush syndrome."

Jamie's jaw clenched. Crush syndrome. A delayed release of a trapped limb could send a lethal flood of potassium and metabolic toxins into circulation, causing sudden cardiac arrest the moment they freed him.

"Who's treating him now?"

"He's receiving surface-supplied air, but he's trapped in an unstable air pocket. We have a dive medic on-site, but this is beyond their expertise."

Jamie exhaled sharply. "And you're calling me because?"

"We need a surgeon with experience in deep-sea trauma and advanced critical care. You were our first recommendation."

Jamie should have known. His combat experience, specialized dive training, and trauma expertise made him one of the only surgeons in the region who could handle something like this.

His mind was already running through the logistics. 120 feet. Not a safe depth for an unplanned extraction. CO₂ toxicity. Oxygen depletion. Potential nitrogen narcosis.

It was bad.

Jamie put the car into drive. "Where's the extraction point?"

"We have a chopper waiting at the Seattle Harbor Helipad. You'll be taken directly to the Coast Guard Cutter."

Jamie glanced at the time—6:42 AM.

"I'll be there in ten."

------------------------------

By the time Jamie arrived, the rotors of the Coast Guard helicopter were already spinning, kicking up mist from the water. A crew member in full tactical gear motioned him forward.

A diver—Lt. Adam Walker—was fastening his own harness as Jamie climbed in.

"You must be Knight." Walker's grin was sharp, assessing. "Hope you don't get seasick."

Jamie barely spared him a glance as he secured his gear. "Tell me about the patient."

Walker leaned back, speaking over the hum of the rotors. "Name's Matthew Hayes, 32, professional salvage diver. He was inspecting a sunken vessel when part of the wreck collapsed. His right leg is pinned under a steel beam."

Jamie's eyes narrowed. "How's his circulation?"

Walker's expression darkened. "That's the issue. We're looking at possible compartment syndrome. If we pull him out too fast, it could send a massive clot or toxic buildup straight to his heart."

Jamie ran a hand over his hair, thinking. "Has he shown signs of hypoxia?"

"Hard to say. His comms were spotty in the last check-in. Last we heard, he was getting dizzy. CO₂ retention is a real concern."

Jamie exhaled slowly. Seven hours trapped, limited airflow, CO₂ narcosis setting in—this wasn't just a case of getting him out. It was about keeping him alive once they did.

"We'll need to control the release of his limb before extraction."

Walker raised a brow. "What are you thinking?"

Jamie's mind was already racing through the options.

"Pre-hydration therapy before extraction. IV sodium bicarbonate to counteract acidosis, calcium gluconate to stabilize his heart, and a controlled decompression ascent. If his leg is too far gone, I'll have to perform a fasciotomy on-site."

Walker stared at him. "You're serious?"

Jamie secured his medical pack. "Would you rather he dies before we reach the surface?"

The diver gritted his teeth. "Alright, Doc. Your call."

The helicopter tilted forward, accelerating toward open water.

------------------------------

The rotors thundered overhead as the Coast Guard helicopter descended onto the deck of the Cutter Sentinel, its bright orange hull cutting through the swells of the North Pacific. The moment the skids touched down, Jamie and Walker were already moving.

A crewman in a half-unzipped wetsuit jogged toward them, beads of saltwater clinging to his jawline. His radio crackled over the noise.

"Dr. Knight?" His voice was sharp, no-nonsense. "Commander Elliott's waiting below. Follow me."

Jamie nodded, stepping onto the deck with practiced ease, his boots hitting metal with a solid thud. The cold ocean air bit through his gear, sharp and briny. His gaze swept across the scene automatically—a habit from combat deployments. The deck was alive with movement.

The dive team prepped near the stern.

A makeshift medical station was already set up.

This was a battlefield.

Walker fell into step beside him as they descended into the ship's operations center, where Commander Elliott—broad-shouldered, mid-forties, exuding quiet authority—stood over a waterproof display of the wreck site.

Elliott didn't waste time. "Dr. Knight." His gaze flicked up. "Glad to have you aboard. We've got a situation, and I need solutions."

Jamie stepped forward, scanning the twisted remains of the shipwreck on the monitor. It was a graveyard of rusted steel, barely holding together.

"Seven hours trapped," Jamie said, eyes locked on the wreck. "Oxygen's running low. How stable is the structure?"

Elliott exhaled. "Not stable. The collapse is worsening, and the air pocket won't hold."

Jamie's jaw tightened. They had minutes, not hours.

And if they pulled him up too fast, they'd kill him anyway.

"He's already hypoxic," Jamie said. "If CO₂ builds up further, he'll lose consciousness, then respiratory arrest."

Elliott folded his arms. "And your plan?"

Jamie turned to Walker. "Underwater IV. Sodium bicarbonate for acidosis, calcium gluconate to stabilize cardiac function, warmed saline to counter hypothermia."

Walker's brow lifted. "You think you can start an IV at 120 feet?"

Jamie's reply was immediate. "I don't think. I do."

Elliott nodded once. "You get one shot at this, Doctor. If that wreck shifts, it could bury all of you."

Jamie didn't hesitate. "Then let's move."

The dive deck was a controlled storm of movement. Jamie moved with sharp efficiency, double-checking his gear. A crew member handed him the vacuum-sealed IV kit. Everything was prepped for deep-sea use, but the real test was executing it.

Walker was securing his harness when another diver—a younger, cocky Petty Officer Taylor—snorted.

"You sure you wanna be carrying all that, Doc?" He smirked, gesturing at Jamie's medical pack. "I can take it for you—y'know, so you don't drown us."

The room stilled slightly.

Jamie didn't even blink. He slowly turned to Taylor, voice calm, flat.

"Name and rank."

Taylor faltered. "Uh—Petty Officer James Taylor, second-class diver."

Jamie took a step forward, his presence unshakable. "Well, Taylor, I may be just 'Doc' now, but six months ago, I was a U.S. Army Major." His voice was even, controlled—but razor-sharp.

Taylor's smirk faded.

Jamie didn't break eye contact. "Take your gear and leave. You're not diving today."

Walker let out a low whistle. "Damn."

Taylor hesitated. Jamie didn't. He turned to a nearby crewman. "Relay this to Commander Elliott. I pulled a diver. Can't trust someone who thinks this is a game."

The crewman hurried off. Taylor looked like he wanted to argue, but Jamie was already strapping on his gear.

The air shifted.

Not just respect.

Recognition.

Jamie wasn't just some civilian surgeon tagging along.

He was one of them.

Walker barely had time to turn before Jamie stepped past him and dove off the deck.

The ocean swallowed them whole.

The world above faded into silence, replaced by the rhythmic hiss of their regulators.

At fifty feet, sunlight still trickled through.

At eighty, the world darkened.

At a hundred, it was black and shifting, the wreck looming ahead—twisted beams of steel jutting at unnatural angles.

Walker signaled ahead, his dive light cutting through the gloom. He pointed toward a narrow collapse point where debris had caved in.

There.

Matthew Hayes.

Pinned beneath a fallen steel beam, his right leg crushed, blood leaking into the water. His regulator bubbles were weak, erratic.

Jamie pushed forward first, maneuvering into the wreckage with precise, measured movements.

He placed a gloved hand on Hayes' shoulder, applying slight pressure.

"Matt, it's Dr. Knight. Can you hear me?"

A long pause.

Then, a weak, garbled response crackled through comms.

"…Yeah… still here…"

His breathing was shallow, his response delayed. The CO₂ buildup was bad.

Jamie needed to act—now.

He reached for his IV kit, adjusting his buoyancy control to keep still. With methodical precision, he rolled back the sleeve of Hayes' suit, searching for a viable vein.

One breath. One chance.

The needle went in smoothly.

Blood clouded the water for a second before flushing away. Jamie secured the catheter, injecting bicarbonate and calcium gluconate to counteract the metabolic collapse.

Walker signaled the lift bags into place.

The wreck creaked ominously.

"Move," Jamie ordered.

The moment the beam lifted, Hayes' body jerked violently.

Jamie clamped down on Hayes' leg, preventing the sudden flood of circulation from triggering cardiac arrest. His fingertips pressed against the femoral artery, monitoring for vascular overload.

"Reperfusion shock's hitting," he said sharply. "He's going into metabolic distress."

Walker cursed. "You called it."

Jamie was already injecting calcium chloride. "Stay with me, Matt," he murmured. "We're getting you out."

The tremors gradually slowed. His breathing steadied.

Jamie signaled. "Ascend. Now."

They moved slowly, controlled.

The water pressed around them.

Fifty feet.

Eighty.

A hundred.

Then—they breached.

The moment they surfaced, hands hauled them onto the deck. The trauma team was already waiting.

Jamie ripped off his mask, shaking water from his face.

"Get him on a stretcher—now!" he barked. "Keep the IV running, start warmed fluid infusion, and prep the hyperbaric chamber!"

Hayes' eyes cracked open, his voice hoarse.

"Didn't… think I'd make it."

Jamie exhaled.

"Neither did I."

Walker clapped Jamie on the shoulder. "Hell of a job, Doc."

Jamie barely heard him. His focus was elsewhere. Hayes was alive—but not out of danger.

Without another word, Jamie stripped off the top half of his dive suit, grabbed a set of dry scrubs, and was already moving.

------------------------------

The rotors thundered overhead as the medevac chopper cut through the Seattle skyline, the glow of the city stretching out beneath them. Inside, the cabin smelled of antiseptic, aviation fuel, and tension.

Jamie sat beside the stretcher, his eyes locked onto Hayes' vitals. The hyperbaric treatment had bought them time, but his potassium was borderline critical, his circulation still unstable. The plasma exchange had worked—for now.

But now wasn't enough.

Jamie adjusted his headset, pressing the mic. "ETA?"

The pilot's voice crackled over comms. "Two minutes. Seattle Grace is standing by."

Jamie exhaled, already bracing for the landing.

When the wheels hit concrete, the hospital's team was already there.

----------------------------

The automatic doors slammed open as they wheeled Hayes through the corridor, the wheels of the stretcher clattering against the tile.

"Thirty-two-year-old male, crush injury, prolonged entrapment, severe metabolic acidosis," Jamie reported as they moved. His voice was sharp, controlled, cutting through the chaos like a scalpel.

Webber was waiting. "What are we dealing with?"

Jamie didn't slow. "Rhabdomyolysis, reperfusion injury. We pushed plasma exchange in the field, but his CK is through the roof. If his potassium spikes any higher, he's coding."

Derek, already flipping through the incoming neuro scans, arched a brow. "You pulled off plasma exchange on a medevac?"

Jamie barely glanced at him. "Would've been easier in a hospital, but here we are."

The monitors beeped sharply.

Jamie's focus snapped back. Hayes' heart rate dipped.

"BP's dropping," a nurse called.

"Damn it," Jamie muttered. He pressed two fingers against Hayes' femoral pulse—weak. Thready.

Webber stepped in. "His kidneys are shutting down, aren't they?"

Jamie nodded. "We need CRRT started immediately—slow, continuous dialysis, nothing too aggressive or we tank his pressure."

A nephrology fellow hesitated. "We were prepping for hemodialysis—"

Jamie's head snapped up. "Hemodialysis will bottom him out in minutes. He needs low-flow filtration, or his heart won't make it."

Silence. Then Webber gave a single nod. "Do what he says."

The team scrambled into motion.

---------------------------

The room smelled of antiseptic, oxygen, and uncertainty.

Jamie stood at the foot of the bed, arms crossed, watching. Waiting.

The CRRT machine hummed softly, filtering out the toxic byproducts still threatening to shut Hayes down.

Jamie could feel Derek watching him.

"You're waiting for something," Shepherd finally said.

Jamie exhaled, rubbing his temple. "I need to see if the limb is viable. We stabilized him, but if the circulation isn't improving, we're losing the leg anyway."

Derek leaned against the counter, arms crossed. "And if it's too far gone?"

Jamie didn't answer. He already knew the answer.

If they were too late, there would be no choice.

But he wasn't ready to call it yet.

------------------------------

Three Hours Later

The latest scans flickered across the screen, and for the first time in hours, Jamie felt the slightest shift in his chest.

Viability. Delayed, but present.

A chance. A small one—but a chance.

Jamie turned, snapping off his gloves. "Get OR Three prepped. We're salvaging the leg."

Callie Torres looked up from across the room, her interest piqued. "Thought you were prepping for amputation?"

Jamie grabbed his phone, already dialing. "I was wrong."

Torres smirked. "Big words for a control freak."

Jamie didn't rise to the bait. He was already moving.

-----------------------------

The overhead lights cast a bright, sterile glow over the operating table as Jamie Knight and Callie Torres stood scrubbed in, prepped for the extensive reconstruction ahead. The damage to Hayes' leg was severe—crushed muscle, compromised circulation, and significant tissue loss. Most surgeons would have called it a lost cause. But Jamie Knight wasn't most surgeons.

As Jamie examined the exposed tibia, he turned slightly toward Callie. "What year are you in now?"

Callie, focused on retracting the damaged tissue, glanced up briefly. "Fourth-year resident. Third in ortho."

Jamie nodded, as if filing the information away. "I didn't do an ortho residency," he admitted, shifting his grip on the surgical instruments. "But I've rebuilt more shattered limbs in the field than I can count. If you pay attention, you might learn something."

Callie arched an eyebrow at that, but didn't argue. She'd seen Jamie operate before—he wasn't just talking.

He motioned toward the exposed bone. "Alright, here's the plan. The tibia's intact, but the periosteum is shredded. We're going to reinforce it with a combination of external fixation and vascularized grafting. The goal isn't just saving the limb—it's preserving long-term function."

He picked up a surgical pen, marking the areas along the bone where he intended to secure the graft. "First, we'll debride the necrotic tissue. Any muscle beyond salvage comes out. No heroics."

Callie handed him the scalpel without hesitation. Jamie's hands moved with practiced precision, slicing away the darkened, non-viable muscle. Each cut was deliberate, controlled.

"Next step," Jamie continued, "we stabilize the tibia. External fixation first—adjust the frame to allow micro-movements. Too rigid, and he's at risk for nonunion."

Callie reached for the fixation kit as Jamie positioned the pins. The metal frame clicked into place, securing the leg in alignment.

Jamie nodded. "Good. Now for the vascularized graft."

Callie watched as Jamie made the incision at the donor site, carefully dissecting the segment of the latissimus dorsi muscle. His movements were seamless—efficient without being rushed.

"I've done free flaps before," she said, studying his work. "But not like this."

Jamie didn't look up. "In the field, you don't have the luxury of ideal conditions. You learn to adapt."

With the donor tissue prepped, Jamie carefully anastomosed the artery under the microscope, connecting the vascular bundle to maintain perfusion. The overhead monitor displayed the magnified view, each suture precise.

"Good flow," he muttered, watching the graft pinken. "Torres, check compartment pressures. If the anterior compartment's creeping up, we need to prep for a fasciotomy."

Callie checked the readings and exhaled. "We're on the edge."

Jamie nodded. "Let's relieve the pressure now before we lose perfusion."

With practiced efficiency, they made precise incisions along the fascial planes, watching as the muscle fibers relaxed. Jamie placed a temporary wound vac, ensuring that any residual edema wouldn't compress the newly restored circulation.

"Alright," he said, stepping back slightly. "Graft's holding, fixation's secure. Let's close in layers."

They worked together seamlessly, suturing the tissue with careful precision. Finally, Jamie secured the last stitch and straightened.

Callie exhaled. "I can't believe we just saved that leg."

Jamie peeled off his gloves, tossing them onto the tray. "We stabilized it. Whether we saved it? That'll take time."

She watched as he scrubbed out, his usual unreadable expression in place. She had worked with brilliant surgeons before—but Jamie had a way of making even the impossible seem controlled, methodical.

"Not bad," she admitted.

Jamie smirked faintly. "Not bad yourself."

-----------------------------

The ICU was dimly lit, the quiet hum of ventilators and heart monitors filling the space. Jamie and Callie stepped inside, moving toward Hayes' bed.

Jamie checked the chart first, scanning the post-op vitals. Blood pressure stable. Urine output improving. No signs of compartment syndrome.

"He's holding," Jamie muttered, more to himself than anyone else.

Callie nodded, arms crossed. "For now."

There was a brief pause before she spoke again. "You ordered a new imaging study on O'Malley's dad."

Jamie didn't look up. "The last scan was too old."

Callie narrowed her eyes. "Too old, or not telling you what you wanted to see?"

Jamie's grip on the chart tightened slightly, but his expression didn't change. "It was too old," he repeated, shutting down any further discussion.

Callie studied him, catching the subtle evasion. He wasn't lying exactly, but he wasn't telling her everything either.

"Right," she said slowly. "And that's all you're gonna say?"

Jamie finally met her gaze. "I don't know what's going on between you and O'Malley, but if you have questions, talk to him."

Callie hesitated. For a moment, she looked like she wanted to push the issue—but then she exhaled, rolling her shoulders. "It's complicated."

Jamie let out a dry chuckle. "It always is in this hospital."

Callie smirked slightly. "That's why you don't do relationships, right?"

Jamie shrugged. "It's one reason."

She studied him for a moment, then suddenly snorted, shaking her head.

Jamie frowned. "What?"

Callie smirked. "The nurses talk. A lot."

Jamie's expression darkened. "That's concerning."

Callie's smirk widened. "Apparently, that one nurse you had a one-night stand with before you officially started at Seattle Grace? She spread the word. Said you were great in bed. And rich."

Jamie exhaled sharply, pinching the bridge of his nose. "Fantastic."

Callie looked far too amused. "Since then, a few nurses have been trying to get your attention. You, of course, haven't given them the time of day."

Jamie crossed his arms. "And?"

Callie grinned. "Now there's a betting pool."

Jamie blinked. "A what?"

"A betting pool," Callie repeated, clearly enjoying this. "On whether you stay single or end up in a relationship."

Jamie stared at her, completely speechless.

Callie shrugged. "Odds are leaning toward you staying single. But, you know, if you suddenly start dating someone, there's money to be made."

Jamie let out an exasperated sigh. "You people need better hobbies."

Callie chuckled, stepping toward the door. "Well, I should get back to work."

Jamie waved her off. "Yeah, and stop listening to gossip."

Callie reached the doorway, then paused, glancing back at him. "By the way… thanks."

Jamie raised an eyebrow. "For what?"

"For taking a look at George's dad's case," she said simply. "It means a lot to him."

Jamie held her gaze for a beat before replying. "He can thank me when I save his dad's life. There's nothing to thank me for now."

Callie nodded slightly before slipping out of the room, leaving Jamie standing in the dim light of the ICU, watching over Hayes.

The work was never over.

But for now, Hayes was still breathing.

Jamie glanced at the clock on the wall. 6:00 PM.

He exhaled slowly, dragging a hand through his hair. The day had blurred together—one emergency after another. His original plan had been to assist in Burke's cardio surgeries, but that wasn't happening anymore.

"Looks like Burke's cases will have to wait until tomorrow," he muttered under his breath.

That's when he felt it.

His stomach growled—loudly.

Jamie blinked. He hadn't eaten since…?

A second passed before he sighed. Lunch didn't happen. Breakfast barely counted.

He shook his head and turned toward the hospital cafeteria.

------------------------------

The scent of hospital food filled the air, a mix of stale coffee, reheated pasta, and whatever mystery protein they were serving today.

Jamie grabbed a tray, barely registering the options before piling on something quick and high-protein.

Across the room, the interns were huddled together, deep in conversation.

Meredith Grey: "She keeps pretending we were some big, happy family. We aren't. She appears suddenly with her pregnant daughter and suddenly she wants to bond?"

Cristina Yang: "Can we focus on something important? Someone needs to ask Burke about his hand."

The table went silent.

Cristina Yang: "I mean, it's not like I can ask him. We don't talk."

Alex Karev snorted, looking bored out of his mind.

Alex Karev: "Man, I wish I had your problems. You at least get surgeries. You know what I get? Running errands for Mark Freaking Sloan. He doesn't teach. He just makes me do scut work."

George O'Malley, on the other hand, looked completely distracted. He hadn't touched his food.

Jamie shook his head, making his way over to George.

Jamie: "O'Malley. Your dad's results—are they in?"

George looked up, blinking as if pulled from a trance. Then he nodded.

George: "Yeah. I looked for you earlier, but then I heard you went all 'GI Joe' again."

Across the table, Karev barked out a laugh.

Jamie shot him a look.

Karev (grinning): "What? It's not my fault you go full action hero every time someone needs saving."

Jamie ignored him and turned back to George.

Jamie: "Get me the results. I'll look at them after I eat."

George nodded and got up, leaving to retrieve the file.

Jamie finally sat down, grabbing a fork and digging into his food.

He barely had two bites before

BEEP. BEEP. BEEP.

Jamie's pager went off.

He cursed, already standing. He shoved one last bite into his mouth, grabbed his coat, and walked out without a word.

Behind him, Karev chuckled.

Karev: "Knight really can't sit still for five minutes."

--------------------------------

Jamie pushed open the ICU doors, his jaw tight, shoulders squared. The pager still vibrated against his hip, but he already knew why he was here.

Hayes.

The moment he stepped inside, the ICU nurse on duty rushed toward him.

"Dr. Knight—his foot's turning blue."

Jamie didn't break stride. His gaze locked onto Matt Hayes, whose face was pale and twisted in pain. The blankets had been pushed back, exposing his right leg, which was swollen tight as a drum. His foot was dusky, almost cyanotic.

Jamie's stomach sank. Compartment syndrome.

Damn it.

The post-op swelling had cut off circulation, crushing the blood vessels and nerves. If Jamie didn't fix this now—Hayes would lose the leg.

Jamie was already at the bedside, pulling off the surgical dressing.

"Matt." His voice was sharp, direct. "Can you feel your foot?"

Matt let out a shaky breath. "Barely. It feels… fuzzy."

Jamie pressed two fingers against the dorsalis pedis artery, just above the ankle.

Nothing. No pulse.

His jaw clenched. No blood flow meant they had minutes before permanent damage.

"Nurse, get me a Stryker compartment monitor. Now."

The nurse nodded and ran to grab the device.

Jamie ran his hand along Matt's leg, pressing firmly against the muscle compartments. The tissue was rock hard, unyielding.

Yeah. This was bad.

Callie Torres entered just as the nurse returned with the monitor.

"What's going on?" she asked, stepping up beside him.

Jamie didn't look up. "Post-op compartment syndrome. His leg's dying."

Callie's brows furrowed as she took in Matt's leg. "Damn. That developed fast."

Jamie grabbed the pressure monitor, sterilized the skin, and inserted the needle into the muscle compartment. The screen beeped once before displaying the reading.

35 mmHg.

Jamie exhaled sharply. "We're out of time."

Jamie looked up at Callie. "OR's prepped?"

Callie grimaced. "No chance we get him in before it's too late."

Jamie nodded once. Then, without hesitation, he grabbed a sterile marker and started drawing incision lines along the leg.

Callie's eyes widened. "You're doing it here?"

Jamie's expression was unreadable. "I'm not losing this leg, Torres."

She held his gaze for a second—then nodded, stepping back. "Alright."

The ICU nurse was already setting up a sterile field. Jamie snapped on gloves while Callie reached for a syringe.

"I'll numb the area."

Jamie grabbed a scalpel. "Make it fast."

Matt gritted his teeth, his breaths uneven. "This—this is happening now?"

Jamie didn't look up. "This is happening now."

Jamie made the first incision.

The scalpel sliced cleanly through the fascia, the tight connective tissue trapping the swelling inside.

The second the compartment opened, a rush of dark, venous blood spilled out. The pressure release was immediate.

Matt let out a shaky gasp. "Oh my God—I can feel my toes."

Callie grabbed the Doppler probe, pressing it to Matt's foot.

She listened—then grinned. "Pulse is back."

Jamie nodded once. "Good."

He flushed the wound with sterile saline, making sure there were no clots obstructing circulation. The muscle inside wasn't necrotic—they'd caught it just in time.

"We're doing a staged closure," Jamie announced, his voice steady. "Leave the incisions open. We'll monitor for 24 hours before closing."

He reached for a wound vac system, carefully securing it over the open compartments.

Callie watched him work, then exhaled. "That was close."

Jamie didn't respond immediately. He knew how close it was.

With Matt finally stable, Jamie stepped back, peeling off his gloves and tossing them into the biohazard bin.

"Monitor for rebound swelling. If pressures rise again, call me immediately."

The ICU nurse nodded.

Callie was still watching him.

Jamie sighed. "You need something, Torres?"

She hesitated—then shook her head. "No. Just… that was impressive."

Jamie arched an eyebrow. "You sound surprised."

Callie smirked. "I figured you were good. Didn't realize you were 'field-surgery-in-the-ICU' good."

Jamie exhaled. "I don't let my patients die if I can help it."

Callie just shook her head, amused. "I gotta get back to my cases."

She turned to leave, but paused at the door.

"Hey, Knight."

Jamie looked up.

"Get some food before your next hero moment. You look like crap."

Jamie let out a low chuckle. "Yeah, yeah."

But as she walked away, Jamie glanced at the clock.

6:30 PM.

He was still running on one meal and a whole lot of adrenaline.

He muttered under his breath. "Still didn't finish my damn dinner."

With one last look at Matt—stable, breathing, alive—Jamie turned and left the ICU.

Time to find food before the next emergency.

---------------------------------------

Jamie pushed open the hospital doors, stepping into the cool night air. His muscles ached, his brain still running through a hundred different things at once. He reached into his pocket, grabbing his keys—only to stop mid-motion.

His car was still at the harbor.

Jamie exhaled through his nose, rubbing his temple. Right. He'd taken the medevac straight to Seattle Grace and never made it back to pick up his damn car.

James would send someone for it in the morning.

He was about to call for a ride when he caught movement out of the corner of his eye. Derek, walking out of the hospital, looking just as exhausted.

For a second, Jamie debated it. Then, with a sigh, he called out.

"Shepherd."

Derek glanced up, blinking at him. "Yeah?"

Jamie ran a hand through his hair. "You heading home?"

Derek nodded slowly. "Yeah. You?"

Jamie exhaled. "Car's still at the harbor. You mind giving me a ride?"

Derek tilted his head, surprised, but then just gestured toward the parking lot. "Yeah, come on."

The car smelled faintly of coffee and old cologne, the kind of scent that settled into leather seats over years. Derek started the engine, rolling out of the hospital lot as Jamie settled in, staring out the window.

After a few minutes of silence, Derek glanced over. "So… Meredith didn't leave me alone last night because of you."

Jamie scoffed lightly, shaking his head. "You should've kept your mouth shut about New York."

Derek sighed. "Yeah, well, I didn't expect you to drop a memory bomb in the middle of dinner."

Jamie shrugged, leaning against the window. "Wasn't planning to."

A beat of silence stretched between them.

Derek frowned slightly. "You alright?"

Jamie didn't answer immediately. His gaze stayed on the city lights flickering past, his fingers absently tapping against his knee.

Then, finally—"Yeah. Just tired."**** A pause. Then, quieter, almost to himself—"Probably not gonna get much sleep tonight."

Derek glanced at him. "Why?"

Jamie let out a slow breath. "O'Malley gave me his dad's scans earlier."

Derek didn't interrupt, sensing something heavier behind Jamie's words.

Jamie shifted slightly, rubbing his jaw before continuing. "He has mets."

Derek inhaled sharply but said nothing.

"It's worse than I thought," Jamie admitted. "I need to go through some papers. Journals. See what's changed while I was gone. Because right now…" He sighed. "He wouldn't survive an open surgery."

Derek's grip on the wheel tightened slightly.

Jamie leaned his head back against the seat, staring at the ceiling. "The chances of a cure are minimal. Without surgery, he probably has weeks to months. If we can get the surgery done without him suffering multiple organ failure…" He hesitated. "Well, that'd be up to his oncologist, but maybe a year. Maybe two. Hard to say."

The car was quiet except for the low hum of the engine.

Derek stared at the road ahead. Then, after a moment—"Don't run yourself into the ground, Jamie."

Jamie didn't react.

Didn't nod. Didn't argue.

He just kept staring at the skyline.

Minutes passed, the city lights flickering against the windshield, stretching into the distance.

Then, finally—"I just want to spare O'Malley the pain of losing his dad."

Jamie's voice was quieter now. More tired than he had let on all day.

He turned his head slightly. "You should understand that, Derek."

Derek's jaw tightened, his fingers flexing slightly against the wheel.

"Yeah," Derek muttered. "I get that."

But then he, too, went silent.

Neither of them spoke again for the rest of the drive.

The car rolled to a stop in front of Jamie's building. He exhaled, pushing the door open.

Jamie paused before getting out, glancing back at Derek. "See you tomorrow."

Derek just nodded. "Yeah."

Jamie stepped out, shutting the door behind him as Derek drove off, disappearing into the city.

He stood there for a moment, hands in his pockets, staring up at the sky.

No rain.

Jamie let out a breath. A quiet, bitter chuckle.

"Well, this is gonna be a long night."

With that, he turned and headed inside.

4o