chapter two ━ burke's operation
( season two, episodes twenty-six & twenty-seven )

❝I'd be glad to come to
Seattle Grace.❞

𝐀𝐁𝐁𝐘 𝐅𝐎𝐋𝐋𝐎𝐖𝐄𝐃 𝐃𝐄𝐑𝐄𝐊 𝐈𝐍𝐓𝐎 𝐓𝐇𝐄 patient room and saw Dr. Preston Burke laying in the bed, his hand into a fist.

"How you doin'?" Derek asked him, walking over to the bed. Abby, meanwhile, pulled her long brown locks into a messy bun before taking the chart from the end of the bed and began reading it over.

Burke sighed at Derek's question. "I'm developing numbness in my... fourth and fifth fingers."

"And there's a pseudo aneurysm in the subclavian artery," Abby added, looking up from the chart and at the cardio surgeon.

Burke raised an eyebrow at her and Derek cleared his throat. "Oh, right. Dr. Preston Burke, this is Dr. Abigail Thompson. She's agreed to help me with your surgery."

Abby smiled at him. "Just Abby is fine. It's nice to meet you, Dr. Burke."

"You, too."

"Alright." Derek nodded, returning to the subject of the surgery. "You know the drill. We'll wait a few days, maybe the aneurysm won't grow."

"Even if it stays this size," Burke said with a huff. "There's too much damage."

"We'll just go in there and we'll fix it," Derek told him. "We'll relieve the compression on the nerves."

"But the operation could cause damage to the nerves," Burke pressed, looking between the two neurosurgeons.

Abby nodded with a sigh. "Yes."

"And I could..." He trailed off and let out a breath. "Lose function of the entire arm."

Derek pressed his lips together. "Y—Yes."

Burke looked at the two surgeons in the room. "Can you do this?" he asked them. "Are you good enough to do this?"

"I think so." Derek nodded. "But that's why I asked Dr. Thompson to join me. I need another set of eyes for this."

"Well, then what about you?" Burke asked, shifting his gaze to the female surgeon. "Are you good enough to do this?"

Derek also turned to Abby who let out a breath under their gazes. "I won't lie..." she said, clearing her throat. "It'll be hard. Anything to do with nerves is always a risk and it's always complicated."

"So you can't do it," Burke sighed, leaning further into the pillow.

"That's not what I said." Derek and Burke both looked back at her, the latter with a hopeful expression on his face. "That's not what I said. But... if we do this, then Dr. Shepherd needs to be on board. So it's up to him whether we do this or not."

Burke turned to his left and faced the man. "Derek?"

He let out a breath. "We'll wait until the morning," he replied. "And we'll evaluate after that."

Abby turned and watched him leave the room in a hurry with a stressed look on his face. "Excuse me," she said to Burke, walking after the man. "Shepherd. Derek, stop walking so fast!"

He walked into a room and closed the door behind him. She let out a breath and stopped in front of the room before knocking on the door and walking inside. She crossed her arms and leaned against the doorframe.

"What's going on?" she asked. "I've read some of your cases. A lot of people know about your career. They know who you are. You're a great surgeon."

"Not as great as you," he said, shaking his head. "You're the reason so many people want to go into neurosurgery. I mean, you—you've won awards. You were flown in to help me, for crying out loud! Because you're that good."

Abby sighed and took out the hair tie from her hair, massaging her sore scalp. "Don't let awards deceive you," she told him, sitting down on the chair across from him. "They don't accurately describe the things surgeons go through. There was a lot of trial and error to get there... mostly error. We're in a tough profession. One wrong move and we may have just ruined someone's life. One small fault and it's game over. But we chose to do this job because we wanted to help people. We wanted to give them a chance to go back to their regular lives. That's why we do this. Not for the glitz and glimmer of awards or recognition. We do it to give them a chance."

"He's a surgeon," he said, holding his head in his hands. "And surgeons need their hands and at 100% function. He's a good man, an honorable man, and a damn good surgeon. I can't be the one responsible for destroying his career."

Abby shrugged. "Then be the one to save it."

"I can't do it." He shook his head. "I can't."

She glanced at him, seeing his blue eyes full of doubt. She walked over to the table nearby and poured two cups of coffee. She gave him one of the cups and sat back down, stirring the cream and sugar into her coffee.

"When I was a first-year attending, I had a coworker come to me with a tumor in her spine," she began and Derek looked at her. "She wanted me to take it out. And said I was the only one who could do it. She was a nurse at UCSF and one of the best people I had ever met. So for weeks, I poured over her scans, her labs, her bloodwork, models, I looked at everything. I did everything to try and find a way to take out the tumor without paralyzing her. And... it was a twelve-hour surgery."

"So you got it out?"

"No," she replied softly, shaking her head. "The surgery was supposed to last longer. But the tumor had spread beyond her spine. So I closed. And when I told her, she told me to try again. All she wanted was to be tumor-free."

"You went back in?" he asked, shifting in his seat. "Even with that big of a tumor?"

She nodded. "I did. I did what my patient wanted. The next surgery was twenty-nine hours long. I had a rotation of other surgeons to step in for me so I could have a break. And I got it."

"You got it?"

"I got it," she replied, taking a sip of her coffee. "But she was paralyzed. This... nurse who I had worked with for only a few years was paralyzed. Because of me. But she wasn't mad. She wasn't mad and I couldn't understand why. And when I asked her, she told me that she knew she would never walk again. She knew enough about neurosurgery to know that. She just wanted to be alive. She wanted to be able to see her children graduate high school. To see them get married and become a grandmother. She said she didn't need the ability to walk to be able to see that."

She let out a breath. "All I'm saying is that some people would rather be alive. And your case is nothing like mine, but I think you owe it to your friend to try. And whatever happens... happens. But you'll cross that bridge when you come to it. There's no reason to freak out over something that might happen. For now, though, you should go tell your friend that we'll do the surgery. Both of us. Are you in, Shepherd?"

Derek found her hazel eyes before nodding. "Okay," he said and she smiled lightly. "Okay, let's do it."

"Good." She stood up. "I'll see you in surgery, Dr. Shepherd."

"Dr. Thompson?" She turned back from the doorway. "Thank you. For the pep talk."

Abby smiled with a nod. "Don't mention it. Oh." She looked at him. "And Dr. Thompson is too formal. Call me Abby."

___________________________

𝐀𝐁𝐁𝐘 𝐒𝐓𝐎𝐎𝐃 𝐍𝐄𝐗𝐓 𝐓𝐎 𝐑𝐈𝐂𝐇𝐀𝐑𝐃 𝐈𝐍 the OR, about to put Burke under when he turned to Derek. "Shepherd."

"You don't have to thank me," he said, shaking his head. "I'm sure you'll return the favor one day."

"I was going to say please try not to kill me," he countered making Abby chuckle lightly. "Same goes for you, Thompson. I may not know you, but I'd like to live."

Abby nodded with a smile. "We'll do our very best, Dr. Burke. Now, just breathe in the happy gas."

Richard looked between the two neurosurgeons as they scrubbed into the surgery. Richard was assisting them and they took their places.

"Okay," Derek said to the chief. "Retract that little bit right there. Okay, I am now removing the aneurysm from the nerve cluster."

Abby looked up when she heard a beeping from the monitor. "N.A.P.'s are dropping."

"Arterial pressure's down to 50%," a nurse added.

Abby looked down at the hand and back at Derek. "You didn't the nerve root, did you?" she asked him.

He shook his head. "I don't see any discontinuity of the nerves."

"Okay." Abby nodded and looked around the OR. "Let's do a reflex test on his hand. Dr. Webber?"

Richard nodded. "Okay." He tested the nerve and she looked at the hand. "Nothing."

"Try again," Abby said. Richard shook his head again after the test failed to get movement causing her and Derek to look at each other. "I don't get it. You've done everything right. This doesn't make sense. You would know if you severed a nerve."

"Derek, Abigail." They both looked at Richard. "Is the arm paralyzed?"

Abby pressed her lips together and Derek let out a breath. "Okay..." he said. "I'm gonna have to do a wake-up test."

"Derek—"

"There's only one person who can help me figure out whether or not I've damaged the relay or not," Derek interrupted Richard. "That's Burke."

Richard shook his head. "He's been through a lot of trauma today."

"All due respect, Dr. Webber," Abby said, coming to Derek's defense. "We're trying to prevent the trauma he'll feel when we tell him he's paralyzed. Prevent everyone from feeling that trauma."

"We need Yang," Derek said.

Richard nodded and left the OR in search of the intern, leaving the two neurosurgeons to wait.

"I just don't get it." Derek looked at Abby. "I didn't sever a nerve. He should be able to move his arm."

"Don't worry," she reassured him. "We'll figure it out."

A short time later, Richard returned with Cristina and she scrubbed in, moving to stand across from the attendings.

"Dr. Thompson?" she asked, looking at her. "I didn't know you were still here. What are you doing here?"

"Working on your boyfriend, it would seem," Abby replied, still looking at the arm. "Shall we continue, Dr. Shepherd?"

"Yes." He nodded. "Okay. How are we doing?" he asked the anesthesiologist.

"He's just at the edge of consciousness," he answered. "Very light. He should be up soon."

Derek sighed. "Okay. Yang, you're up."

"Oh." Her eyes widened. "What? Sorry. What do you need me to do?"

"When he comes to, he's gonna be disoriented, and he's probably gonna fight the intubation," Abby said. "We can't numb the arm because we need him to move his fingers, so he's gonna be in a lot of pain. We need you to keep him focused, okay?"

Cristina nodded. "Okay. Yeah."

"Okay," Derek echoed, swallowing the growing lump in his throat. "Let's—Let's—Let's wake him up."

"Hey," Abby said, tearing his focus away from the surgery for a moment. "Just take a deep breath. We'll cross that bridge when we come to it, right?"

"Right." He nodded and took a breath.

"Burke, it's Cristina," the intern said. "I—I'm sorry, I..." She looked up at the attendings for a moment. "Wake up. Wake up. Wake up. Burke. Baby, wake up. Do it for me. Open your eyes." Burke's eyes fluttered open slightly. "Hi. Hi."

Derek and Richard both held him down as Burke tried to fight the intubation. "Get ready," Abby said, moving to the machine. "Get ready. Hold him down. Calm him down."

"Yang!"

"Calm him down," Abby said to the intern. "Get in front of him. Cristina, get in there. Get in his face and calm him down."

"Yang!"

Abby looked between Richard and Derek before letting out a breath. "Alright. Hold down his arm, Dr. Webber. Hold his arm. Derek—Derek, talk to him."

"Preston," Derek said, bending down. "Preston, look at me. Look at me. Right here. Listen, listen, calm down. Calm down. Calm down. Listen... There was a complication. We can fix it. We just need you to move your fingers on your right side. Can you do that? Preston, you can do it. Move your fingers."

Abby looked at his hand and it moved ever so slightly. She nodded. "Okay. Good. Now we need you to touch each finger of your right hand to your thumb, okay? One... two... you're doing great, Dr. Burke. Keep going. Three. Good. One more. That's good." She nodded and looked at Derek. "Good."

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"𝐖𝐄𝐋𝐋," 𝐀𝐁𝐁𝐘 𝐒𝐈𝐆𝐇𝐄𝐃, 𝐖𝐀𝐋𝐊𝐈𝐍𝐆 𝐎𝐔𝐓 of the OR. "I have officially been awake for almost three days and I'm not entirely sure if my feet are still where they should be."

Derek chuckled. "I can assure you, they are."

"Well, that's good," she said with a smile, taking off her scrub cap. "I think I'll find a hotel room before I fly home. You did good today, Dr. Shepherd."

"Yeah, you, too."

Abby patted him on the shoulder before walking onto the elevator. The doors started to close when Derek put his hand out, keeping them open and she furrowed her brows in confusion.

"Wait. There's a, um, there's this prom thing happening tonight for the chief's niece," he said. "Do you... would you want to go?"

She narrowed her eyes playfully. "Shouldn't you be going with your wife?" she asked.

He shrugged. "I could always go with a friend," he replied.

"I didn't know we were friends," she said before shrugging. "Sure, I'll go. But after a nap. Maybe I won't look so much like death warmed over."

She smiled at him before the elevator doors closed. When she arrived at her floor, she was walking toward the exit when Meredith Grey came up to her. "Dr. Thompson. Before you go, I just had a question."

Abby nodded. "Yeah, what's up?"

"I had a question about seizures... in dogs," she said and Abby raised her eyebrows. "See, Dr. Shepherd and I have a dog, Doc, who has cancer in his bones and it seems to have spread to his brain. Do you think there's a chance he could make it through this?"

"Um..." Abby blinked and ran a hand through her hair. "Shouldn't you ask Dr. Shepherd? He is a neurosurgeon, and the co-parent of your dog, apparently."

"Our relationship isn't the... greatest right now," she replied. "Please?"

She let out a breath. "Well, dogs are different than humans," she said. "But, from what I can tell, it seems unlikely. I'm sorry."

"Okay." Meredith nodded. "That's what I thought. Thank you, Dr. Thompson."

Abby watched her walk away. "I have so many questions..."

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𝐋𝐀𝐓𝐄𝐑 𝐓𝐇𝐀𝐓 𝐍𝐈𝐆𝐇𝐓, 𝐀𝐁𝐁𝐘 𝐖𝐀𝐋𝐊𝐄𝐃 into the hospital and saw it all decorated with a black and white theme. "Wow..." she muttered to herself, wincing slightly. "This brings back memories..."

"You look nice." She turned around at the sound of the voice and saw Derek walking toward her in a tux.

"So do you," she replied, taking in his appearance. "It's nice to see you in something other than scrubs."

He chuckled lightly. "Punch?"

"Sure. Thanks." She followed him over to the drinks table, still looking around at the decor. "So, where's Addison?"

"I think she's still getting ready," he replied. She frowned at the tone in his voice but didn't pursue the topic any further. A man joined them and Derek looked at him. "Oh, Abby, this is Finn. He was mine and Meredith's vet for our dog."

"So you did share custody of a dog?" she asked. "Hmm. I didn't fully believe it at first. Well, I'm sorry for your loss."

"I'm not interrupting, am I?" Addison asked, walking up to the three. "'Cause if not, then, Derek, you wanna dance?"

"I'd love to."

Abby smiled, walking over to the pretzels. "Just means more snacks for me."

During a short break from dancing, Abby was talking with Finn, Derek, and Addison when Richard and Bailey came up to them. "Shepherd."

"Yes?"

"Uh, have you seen Bailey's interns?" Richard asked. "Grey, Yang. I'm looking for Izzie Stevens in particular."

Derek shook his head. "No, I haven't. No."

"Chief."

Richard looked at Bailey who nodded ahead of her. They followed her gaze and saw four of the five interns all following Izzie. They walked past them without a glance but Izzie doubled back.

"It was me," she told Richard, her voice breaking and her eyes red. "I cut his LVAD wire. I did it. No one helped me. And now... I thought I was a surgeon, but... I can't. I thought I was a surgeon, but I am not. So I quit."

"Well," Addison sighed as the interns except Meredith left. "I guess that... puts an end to the evening."

Derek nodded. "Yeah."

"Yeah," Abby agreed. "And that brings me going back to San Francisco."

"Or not," Richard said and she looked at him. "Maybe you come and work here instead."

"Come to Seattle?" she asked. "But you have a neurosurgeon. A damn good one, too."

"But we could have two," Richard said, looking between them. "You two would be a good team. I saw you today. It's as though you can read each other's mind. Just think how good you'd do if we had you two together."

Abby glanced at Derek. "I don't want to step on his toes. He was here first."

"Don't look at me," Derek said, shaking his head. "This is up to you. Though, I wouldn't mind another neurosurgeon."

"Didn't seem like that when I first got here."

"Oh, come on, I apologized!"

Abby chuckled before turning back to Richard. "I'd need a few weeks to square everything away in California."

"So...?"

She nodded with a smile. "I'd be glad to come to Seattle Grace."

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━ author's note:

she's gonna regret coming to seattle...

should've just stayed in san francisco...