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CHAPTER TWENTY-SEVEN
oh, the guilt.
season three, episode five.

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"Am I keeping you, O'Malley?" Bailey asked, glancing over everybody's shoulders at George, who wasn't joining the rest of the intern class because of a phone call. He immediately shut his phone closed and walked up to them.

Billie would've normally made a comment, a teasing remark in regards to George's slip-up, but she didn't. She was so focused elsewhere, with her head wrapped up in its own little bubble and her thoughts all pointing out to the undeposited check under her pillow that she wasn't even able to hear the conversation. Instead, she looked down at the floor, feeling Alex's intense stare on the side of her skull but not doing anything about it.

"M&M in fifteen minutes, people," Bailey declared.

"Wait, wait, wait. We get to go to M&M?" Alex stopped her.

"Even if we haven't finished our rounds?" George added.

"Even if. I want all of you at the M&M today." She nodded her head, then began walking away, but as Alex cheered silently, she heard him and turned back around. Her expression was stern. "People die in this hospital on our watch. Once a month, we meet to discuss how our actions as physicians contributed to the deaths. This is a serious exercise."

Bailey stared them all down briefly before a couple with a baby was approaching them. Still, Billie's focus wasn't there.

"Dr. Bailey?" the man asked, carrying the child. They approached the couple.

"Mr. and Mrs. Niles?" Bailey greeted.

"We kinda got turned around on our way to Admitting." Mr. Niles stated, maneuvering a map of the hospital with one hand as he cradled the baby with the other.

"Oh, not a problem. Dr. Karev?" Bailey called out over her shoulder, making the intern on question walk up to her. She then explained. "Mrs. Niles is scheduled for a mastectomy tomorrow. Why don't you show her and her husband up to the fifth floor?"

That's what called Billie's attention. Mastectomy.

She knew a mastectomy was typically performed on breast cancer patients under medical advice in order for the cancerous tumor to be completely removed off the breast tissue. She also knew that her mother had refused a mastectomy during the early stages of her cancer and that had been what ultimately and indirectly killed her.

Billie's head shot up when she heard the words. Her eyebrows furrowed together at the sudden torrent of memories and she couldn't help but ran up closer to Bailey and Alex in order to hear what was to be said about the topic.

"Is this the little man?" The resident smiled, looking down at the baby. "He is adorable."

"He's not so adorable at four in the morning when he's screaming and won't take a bottle," Mrs. Niles said, deadpan. "Can we just get to the room?"

She walked away further back, so Mr. Niles turned to Bailey, "It's been kind of a rough week. She had to stop nursing, Gus here just won't eat."

"Here, why don't I take you up?" Bailey said in regards to the baby, handing Alex the chart. Mr. Niles handed her the baby and she cradled it in her arms happily. "You know, you can try a little sugar water on the bottle, just until he gets used to it."

Alex was then told to drive the couple upstairs, so Billie caught up to her resident before she could walk away, "Dr. Bailey, can I-"

"Oh, Black, I actually wanted to speak with you," she cut her off, maneuvering the baby on her arms. "You can, uh, you're allowed to skip the M&M today. It's not... there's gonna be a lot of talk about your... uncle, and I don't want you to feel invaded or uncomfortable in any way."

Billie stood silent for a second, unsure of what to say, "Dr. Bailey, I was- I was gonna ask if I could be put on Mrs. Niles' case."

The resident looked down at her weirdly, unsure where the out-of-context statement was coming from. She glanced over her shoulder at the couple walking up the stairs and then back at her intern.

"I got Karev, don't you-?"

"Please?" Billie cut her off, not expressing any sort of emotion on her face other than pure anxiety.

Bailey hesitated before she huffed out, "Of course, Black. Yes."

☆

That morning, Billie chose not to skip the M&M. She knew there was more than likely going to be talk about Denny, but she didn't care. She knew she could handle it. Even with the twelve million uncashed dollars hidden under her pillow, even with the unresolved trauma of having lost her last remaining family, and even with the fresh memory of her uncle's lifeless body laying stiff six feet underground, Billie knew she could handle it.

She didn't sit by her friends. She didn't sit at all. She stood by the very back, leant against the door with her arms crossed over her chest. Something about the many people gathering in this hall to listen about her uncle's death really freaked her out.

The room slowly filled up with people taking the seats until there was no more space left, and that's when the M&M began. Chief Webber stood in the stage, in front of the microphone, and started speaking.

"Okay, people. Let's begin." He cleared his throat, turning on the player to display the first set of information. Billie took a deep breath. "Patient 34986 died last month from complications following a heart transplant. Dr. Burke will present."

The girl felt her heart lodging on her throat as Webber and Burke switched places so now the latter was the one in front of the microphone. She gulped audibly.

Burke skimmed through the wrapped-up chart and looked up, locking eyes briefly with Billie. She felt herself growing even more nervous.

"Cause of death at autopsy was an embolus that dislodged from the suture line of the transplant and caused a CVA with brainstem herniation," he said.

Hands in the audience rose up to the ceiling in the wait to be called, followed along by multiple requests for his name. He pointed over at a female doctor on the front.

"So the company line is that he died of a CVA?" she asked with uncertainty.

"There's no company line. That's what he died of," Burke answered, then pointed at another doctor in the audience.

"Yes, let's get back to this patient's need for an emergent transplant. You're saying that his left ventricle had been weakened by the LVAD malfunction?"

LVAD malfunction. LVAD. Malfunction. It wasn't a malfunction. It wasn't a freaking malfunction.

Billie's heart was beating way too fast, but regardless of the symptoms, she knew she could handle this.

"His left ventricle was weakened by the fact that he suffered from congestive heart failure," Burke deadpanned.

A doctor in the audience scoffed, "C'mon, Doctor Burke. We all know the LVAD was cut by an intern."

No. No, of course not. Billie could not handle this.

Before she knew it, she was fumbling blindly for the door handle, hoping her lungs were strong enough to endure so little oxygen. She found the knob and turned it, then rushed out of the hall with a heaving chest.

☆

Edward found Billie sat up against a wall on the locker room, knees brought up close to her body and arms wrapped around them in self-protective embrace. Her chin was propped on her knee and her gaze was fixed on nothing in particular, so the man leant against the doorsill and looked down at her with his hands tucked inside the pockets of his lab coat.

"Not a fan of M&M's?" he asked, catching Billie's attention. The girl scoffed sorely.

"Not a fan of reliving my uncle's death, no."

Edward pinched his eyes shut, "Right. Sorry. Bad, bad statement."

Billie laughed very briefly, but as soon as her smile faded, it just gave space for the numbness to take over her body. From her toes, to her knees, to her stomach, to her head, Billie fell into an emotional trance; one she had been in living in ever since Denny had died and one that she was constantly reminded of, no matter how hard she tried to regain her sensibility. Even if she was hoping she'd start feeling better already, she wasn't sure she ever would. She wasn't sure this particular wound would ever stop hurting.

All those words, Edward noticed by the look on her eye.

"Are you okay?" he asked, walking up to her and plopping by her side against the wall, legs spread in front of him.

He'd asked it before, but this time, he meant it more deeply. More seriously.

"I'm always okay," the girl dragged.

Edward paused, "Are you sure?"

Billie turned her head and looked deeply into his sky blue eyes. She sighed in utter grievance.

"I thought I could do this, but I- I don't know, I'm not so sure anymore," she said. "It's so hard, and- and I've experienced loss before, but I just- I can't remember what it felt like, so I don't know how to handle it. I don't think they ever teach you that: how to handle death. And I thought I was starting to feel better, it really did feel that way, but then he sends me a twelve-million-dollar check as if having to carry his death on my back wasn't enough already."

Edward listened carefully, attentively.

"He wants me to move on. He does, I know that, but I-" she cut herself off and looked back into his eyes. "I can't move on. I can't forget him."

She took her hands to her hair and tugged a little at her roots, then allowed her head to fall limp, chin against her chest. She huffed.

"I feel like I'm going crazy."

☆

After the M&M was over, Billie was paged to Mrs. Niles room. She arrived at the same time that she made it her job to put on her lab coat, but as she walked in, she was greeted by the unamusing image of Mark holding breast implants. That was a sight she'd never get tired of.

She was a little consternated to find Alex was in the room too, but she simply chose to stand the furthest away from him that it was humanly possible and not spare a glance in his direction, even if his eyes caught on her the minute she was in the room. Billie would always take Alex's breath away.

"Sorry I'm late, Dr. Bailey," she whispered to her resident, standing behind her and Mark. The woman nodded.

"If you go ahead with the mastectomy, there are several reconstructive options." Mark walked up to Mr. and Mrs. Niles with the implants on hand. "Saline implants are used most often, but silicone has a more natural look and feel."

Mrs. Niles seemed insecure just as her baby began crying. She scoffed and shook her head.

"I can't deal with this right now," she said.

"Diana, c'mon. It'll take two seconds, huh?" Mr. Niles tried to convince her, cradling the crying baby on arms and hoping to find a way that would calm him down.

"You're the one who has to feel them, so you decide."

The husband shook his head, "I don't care."

"Dude, believe me. You care," Alex interfered, but Bailey cut him off, deadpan.

"Dr. Karev."

"Dude, he's right. You care," Mark added, making all heads turn to him.

Billie nudged him softly with her elbow, frowning at him, but Mr. Niles looked away and his wife simply pretended to be trying to sleep.

☆

Once the doctors left the room and dispersed each in their own direction, Billie noticed how Alex followed her out, but before he could say anything, she grabbed Mark's elbow and pulled him apart, ready to avoid having any sort of interaction with her ex-boyfriend. Alex stood close by, however, in the hope they'd finally get a chance to speak.

"Hey," Mark greeted, hooking his pager to the hem of his scrub pants. "What's up?"

Billie looked over his shoulder at Alex, who was still glancing over in their direction, "Just pretend I said something really funny."

"What?"

"Laugh!" Billie demanded, causing Mark to immediately let out a fit of nervous fake laughter, looking at her wide-eyed.

She drew her best smile and pretended there was something funny about the situation, then peeked over Mark's shoulder at Alex only to realize her plan was a success. Behind them, the man rolled his eyes and let out a huff, then proceeded to leave. Once he did, Billie's smile faded. She sighed in relief.

She knew Alex enough to know that his jealousy would always hold him back.

"Okay, you can stop laughing now," she said.

Mark did as told and looked her up and down in concern, glancing over his shoulder at an attempt to find the source of her disturbance, "What was that?"

"I can't meet Alex today. I just- I can't." She took her hand to cover her eyes briefly.

"You still not gonna tell me why you guys broke up? And were you ever planning on telling me you two were dating in the first place?" Mark arched an accusing eyebrow.

"Oh, hey, you don't get to do that. You're the one who left Seattle without even letting me know, then came back without even letting me know," Billie defended. "But he and I, we just... we have- had a rocky relationship. It was never really clear where we were at. Thinking back to it, we might have had, like, two good moments. It was all just drama, I- I think it's for the best that we broke up."

"Well, I know one thing or two about rocky relationships, and let me just tell you-" Mark leant down a little to look into her eyes. "-you just gotta talk it out. It's all it takes."

Billie sighed, "Yeah, maybe you're right."

☆

Billie walked into Diana Niles' room, where she laid pensively on her bed. She closed the door behind her and smiled at the patient, who simply rolled her eyes and turned her head to face elsewhere.

"I don't feel like talking."

Billie ignored her words and walked up to the rocking chair next to the bed. She picked up the teddy bear from it, sat on the chair and started toying with the stuffed animal, rocking herself slightly on the chair without a single word. Diana looked at her, confused.

"So, picture this," the intern began. "You're driving home at night after a long day at work, and all you can think about is getting to your baby."

Diana rolled her eyes, "If this is where you tell me to fight the cancer so I don't miss out on the joys of motherhood-"

"Then you get home. The baby's crying." Billie clicked her tongue, ignoring the woman's words. "The exhaustion hits and you resent that tiny baby's presence in your house. Your previously very quiet house."

"Why are you telling me this?"

"What do you do? First, you pick a fight with your husband, blame him for not settling the baby down. Then, you bitch about the neighbor's loud music. Then, if you're really tired and pissed off, you blame the baby. I mean, if you hadn't been breastfeeding, you never would've thought the lump was a clogged milk duct. You would've gone to the doctor as soon as you felt it. The cancer wouldn't have gotten this far and you wouldn't be here making this decision." The girl shrugged. "Am I close?"

Diana's eyes were filled with tears, "You're a child. You're not a mother, you don't have an aggressive breast cancer that's eating you from the inside out. You don't get to explain this to me."

"No, you're right. I'm not a mother, I don't have breast cancer. Touché." Billie quirked the corners of her lips downwards and shrugged her shoulders. "But I was a mother and breast cancer took away from me my most important person, so I think that counts as something, right?"

Mrs. Niles looked at her, confused.

"I was six when my mother got breast cancer, ten when she died," she explained. "I was seventeen when I got pregnant with my abusive boyfriend's child. What would you have done then? Because I got an abortion and stayed with him anyway for the following five years."

Diana stayed quiet for a second, looking at her in shock. Her eyes were filled with the tears that had come along with the explanation of a past story and she stared at the intern in disbelief, as if such horrors were never supposed to be combined into one same life.

"I'm sorry," she whispered, then took a deep breath. "What kind of mother blames her own baby for her cancer?"

"A mother who's human. A mother who's overwhelmed." Billie stood up and grabbed her hand, squeezing it reassuringly.

"If this is gonna kill me eventually, wouldn't it be easier if it happened when Gus was little? Wouldn't it be easier for him if I just never existed?" Diana sobbed, making Billie look away briefly to hold back her own tears.

"Okay, now, this is the part where I tell you to fight the cancer so that you don't miss out on the joys of motherhood."

Diana smiled very briefly just as Billie's pager went off. She checked it, huffed, gave Mrs. Niles' hand one last reassuring squeeze, and then bolted out of the room.

☆

"I was kind of in the middle of something," Billie complained as she tied up her trauma gown, walking out into the ambulance station where Bailey was already waiting for her.

"Yeah, well, all of the other suck-ups are off doing God knows what. Hopefully, not cutting any more LVAD wires," Bailey deadpanned, but soon turned. "I'm sorry."

Billie shook her head. "That's fine."

A second went by before an ambulance was pulling up at the station, flashing every-colored strobe lights. The backdoors were opened and the paramedics rolled out a gurney in which an unconscious man laid.

"Alan Snyder, thirty-five. Had a syncopal episode and took a fall when he passed out. There's a large hematoma on the side of his abdomen associated with potential bleeding on the inside. Suffers from CHF which caused congestion of the kidneys. He's in kidney failure," the paramedic introduced, making Billie freeze in her tracks.

Thirty-five-year-old male. Shortness of breath, had a syncopal episode, pulse is rapid and irregular.

Denny.

It took her a second to react, but she helped the paramedics and Bailey roll the gurney into the ER regardless. Her eyes were on the unconscious patient, whose features slowly seemed to be resembling her uncle's. Her lips parted in shock.

Denny, Denny, Denny.

They rushed him into one of the trauma bays, but Billie stopped under the sill, unable to walk in. Immediately, Bailey began demanding all sorts of drugs to the trauma nurses, but the intern could not move.

"Black, c'mon, I need your help here!" Bailey yelled, glancing over at Billie.

However, when she saw her face, it hit her. She closed her eyes in regret.

"I'm sorry, uh, you can go. Please have one of my interns paged, repeatedly. You- You're free to go," Bailey said.

"No, I have to stay. This man is my responsibility." Billie shook her head, walking into the trauma bay and glancing at one of the nurses. "Let's start him on hemodialysis, please."

Denny, Denny, Denny.

☆

Bailey and Billie stood in Alan Snyder's room, updating him on what had happened. Passing out, the man had taken a fall that had caused his abdomen to bruise and a few emergent scans had confirmed internal bleeding, aside from the fact that he was in congestive kidney failure which had to be fixed as soon as possible.

"We're gonna have to rush you up to surgery immediately, Mr. Snyder," Billie explained with her heart on her throat, hoping the information they were dumping on him wasn't too much.

"You do?" He frowned, then looked down. "Well, crap."

"Sir, you don't have to worry in the least. Once we take you to surgery, we're gonna fix the bleeder and the dialysis will soon start working on your kidneys, and after that, you should be just fine," Bailey added. Billie tucked her hands on the pockets of her lab coat awkwardly. "Is there anyone you'd like us to call?"

"Uh, no, not really." Alan shrugged, then glanced at the intern, "Are you gonna be there? In the surgery?"

"Me?"

"Yeah."

"If you want me to, then of course." Billie nodded. "You want me to be there?"

"Yeah." He smiled kindly. "You just seem warm. Like you've seen the bigger shit."

The girl smiled briefly.

Denny, Denny, Denny.

☆

Up in surgery, Bailey was letting Billie assist more than usual, probably because of the intern's determination to make this man her whole responsibility, or maybe even because she knew it was not the right time to deny her something of the sort.

Billie's clamp was on the vessel as Bailey cauterized it, but as the quiet OR gurgled in the process of work, the heart monitor went off. Both surgeons' heads shot up and Billie's own heart fell to her feet.

"Sinus tachycardia. Push in five bisoprolol, STAT," Bailey demanded. "Black, check the chest cavity. Let me know what's happening up there."

Billie did as said, but the more she searched, the more her field was clouded by an oncoming spurt of blood. It took her a second, but finally, she got a clear view of Alan's heart. Her lips parted in shock.

"Aortic dissection." She looked up at Bailey.

The resident turned to one of the scrub nurses, "Who's the cardiothoracic surgeon on call?"

"Dr. Burke, but he's in surgery."

"Then page Dr. Allen."

Elbow deep in a blood-filled body cavity, Bailey looked at Billie. The intern, with a heaving chest and her finger over a major bleed in Alan's heart, sought the comfort needed in her resident's eyes, but at the lack of it, she ultimately freaked out.

"Dr. Bailey, what the hell do we do? The blood already burst through the outer wall of the aorta, we're losing him." She raised her voice. The resident didn't answer. "Dr. Bailey."

"I don't- I-"

"Miranda, what do we do!"

"I don't know!"

"Well, somebody has to do the repair!" Billie yelled, scooping out the excessive blood with her one hand at the same time that she kept her finger over the aorta. "Page Dr. Burke and Dr. Allen again, please! Get someone in here, anybody who can do an aortic repair!"

"They're not answering."

"PAGE THEM AGAIN!" Billie yelled in distress, feeling her eyes brimming with overwhelmed tears. She glanced at Bailey, who hadn't moved yet. "He's going to die, Dr. Bailey. This man is going to die."

Denny, Denny, Denny.

☆

It wasn't long until Edward arrived at the OR, freshly out of another surgery. He scrubbed in speedily and rushed into the room, getting gloved and gowned immediately. Bailey had finally managed to regain her senses, working to cauterize the smaller bleedings of the vessels as if it would somehow help, and Billie's finger was still on the aorta.

"Aortic dissection?" Edward walked up to them.

"Yes. Black has her finger on the bleeder, but the blood is still gushing out. His BP bottomed out multiple times and his rate is low, in the nineties," Bailey explained and Edward started working right away.

He had Billie take her finger off Alan's heart and soon began operating on it in order to seal the dissection, but the minutes he had taken to arrive at the OR had given the heart walls time to weaken. In the end, the job was up to him only.

"Billie, start the cardiac massage. Fast and steady, give it a good squeeze," he demanded.

Billie did as said, holding Alan's heart in her hand. She began squeezing it softly in short intervals, but she shook her head.

"His aorta's disintegrating," she said. "That can't be any good."

"I know, but you have to keep going." Edward's eyes were fixed on the heart monitor. "Okay, pass me the paddles. Charge to five. Clear!"

One shock. Nothing.

"Ten. Clear!"

Two shocks. Nothing.

"C'mon, charge to twenty. Clear!"

Three shocks. Nothing.

"Push in lidocaine and amiodarone," Edward demanded. "Keep in twenty, charge again. Clear!"

Four shocks. Still nothing.

"Remove the paddles and start heart massage."

Doctors did as told. Billie held the heart once again, oblivious to Mark's presence on the gallery, staring down at her in pure concern. Her gown and gloves were covered in blood. The metallic smell of it was conspicuous all around the room, even through their masks.

The saving of the man on the table became a routine. Heart massage, shocks in five, ten and twenty. Repeat. Billie's heart stopped with every shock, with every chance that Alan Snyder might be saved like she couldn't save her uncle, and with the disappointment whenever the line would simply remain flat.

"Dr. Allen, he's been down for twenty-eight minutes."

Edward sighed and stayed still, looking down at the mess of blood in front of them. He then glanced over at the patient's face. The OR was suddenly heavily quiet.

"What was his name?" he asked.

"Uh, Alan Snyder, sir," Bailey said.

Edward nodded, "I'm so sorry, Alan."

Billie looked between both doctors briefly, still massaging the heart with a frown on her face. They were giving up. They couldn't give up.

"He's not dead yet." She scoffed. "It hasn't been thirty minutes, he's not dead yet."

"Dr. Black, please remove your hand from the body cavity."

"He's not dead yet, he still has two more minutes! Give me the paddles," Billie said, turning to one of the nurses. The woman hesitated. "I said pass me the paddles!"

"Billie, he's gone! It's over!"

"PASS ME THE PADDLES!" Billie yelled, finally getting the nurse to place the paddles on her hands. "Push five lidocaine. Charge to twenty. Clear!"

"Billie!"

She shocked the heart and saw the sudden peak on the flatline showed by the heart monitor, but after that, nothing. On the gallery, Mark stood up and took a step forward, looking down at the scene with a frown of concern.

"Again. Clear!" Billie shocked him once more, feeling her eyes brimming with tears. She had to save him.

"Black, step away from the patient!" Bailey raised her voice a little, trying to get her distressed intern away from the patient.

"Charge again, clear!" Billie shocked him once more. "Again, clear!"

Edward removed his mask and looked at the girl across from the table, just as Mark made the choice to rush down into the OR. He surrounded the table and stood behind the intern, then wrapped his arms around her stomach and pulled her away from the table, causing her to scream out a string of profanities.

She let go of the paddles and began struggling for him to let go, tears slipping out relentlessly in grievance. Mark held her tightly away from the table, ignoring her pleads for him to let go.

☆

Billie's hand was tightly cradled amongst Mark's fingers. Her step was slow, shaky, almost as if she was in physical pain, but truth was... there was nothing happening within the cage of her body that she could feel. No grief, no pain. She could feel nothing.

Her emotions had drowned out in the OR as she screamed over Alan Snyder's dead body, so she had been left devoid of any feelings. Her heart beat normally, her tears didn't flow anymore, her mind was blank. Every part of herself had been left in the air, alone to wither, the night Denny had died, but it had taken her too long to notice to the point that she was faced with yet another death. That was her breaking point: reliving.

Mark held her tightly, but his touch was merely a tingle on her skin. His reassuring squeezes were just shocks to her heart that created a peak on the flatline, but didn't restart her heartbeat regardless. As if there was no more life left inside her.

It was surprising, really. She had been faced with the veil of death very early on her life, when a part of her heart had died along with her mother. The heartbreak, the grief, the pain, the abuse; she had lived it and relived it over and over again, like an endless loop with no loopholes. No escape, no way to get out. Moving to Seattle to run away had only been the first of a long list of mistakes, because it had only worsened her life to extreme extents.

Billie could take the hardest hits. She really did. She handled them and pushed them away, and was able to survive. But she had a limit. Billie could take the hardest hits, but there were some that were just too much. There were some hits she could not handle them, despite how much she insisted that she could.

Mark and Billie traveled down the fifth floor and arrived at the Psychiatry lounge. They stood in front of Admission, where the receptionist looked up at them with a soft smile. Billie said no word.

She didn't hear Mark's words as he checked her in. A distant sound, a vibration in a set of strings. It rattled her lungs and shook her chest, but despite it all, his voice was simply a cold current of air and an empty spot beside her.

NAME

Billie Jean Black

EMERGENCY CONTACT/S

Mark Sloan, Edward Allen

ADDITIONAL HEALTH CONCERN

Recent car accident, healing incision

LIST OF MEDICATIONS

Xanax, Prozac

ALLERGIES

Cephalosporins

REASON OF ADMISSION

Comprehensive medical care