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CHAPTER TWENTY-THREE
deterioration of the fight or flight response.
season two, episode twenty-six.

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Billie heard something. Not much. She was unable to hear much. But she heard something.

Distant, vague, sinking into the dark abyss of her clouded mind. Like someone calling her name. Like someone not calling her name. Like someone calling her a Jane Doe and then talking about a car crash.

Billie tried to look up.

The first thing she saw once her eyes were wide enough for her to discern something through two narrow slits, were strangers. Strangers, touching her all over, dragging her from side to side. She felt something on her face, pumping fresh oxygen into her system which she neither enjoyed nor believed she needed.

She took her hands to her face, but the movement was only in her head. When she thought her hand was close enough to her mouth, she realized her body had only answered in the shape of a slight shift of her finger. As usual, everything around her spun, but she was stuck in one place. Unable to get out.

"Jane Doe, twenty-four years old."

"Deep laceration to the scalp and blunt trauma to the head, likely closed brain injury."

"Fractures on T7 through F12 and symptoms of widened mediastinum."

"BP, ninety over sixty, and GCS of eleven. Intubated on the field."

Billie understood those words. Really, she did. But when she tried to open her mouth, speak, scream or do anything that would get her out of that situation, the only thing that she managed to do was cause herself an even more excruciating amount of pain than the one she already felt.

She prayed to God she'd soon stop feeling this way.

Next to her, Miranda Bailey looked down at her intern, who laid semi-conscious on the gurney. The resident was in shock at first, seeing someone that she held so dearly tossed over and destroyed on the stretcher, but when she finally regained her senses, the whole anvil hit her at once.

"This is not Jane Doe, this is- this is Billie Black," she said as she followed the gurney into the ER. "Somebody page Derek Shepherd, and get me Meredith Grey too!"

☆

Derek walked into the trauma room and snapped on his gloves almost immediately, routinely, not paying a glance in the table's direction, thereby missing an important factor of the problem.

"Who is this?" he asked, walking up to the head of the patient distractedly.

However, there was no need for any of the nurses or even Bailey to reply. Once he saw his best friend, bruised and beaten up, he froze. Eyes widened tenfold, he looked up at the resident.

"What the hell happened?" he asked.

"Car crash, she's been in and out for the past fifteen minutes. Work-ups all indicate trauma to the head and possible underlying cardiac conditions," Bailey said softly, shakily, wrapping her stethoscope around her neck. "Burke's been shot and we- we need Cardio here, but there's no one... no one is..."

Derek hesitated. The sight alone, seeing her laying on the table with so much machines and wires hooked around her, made him want to run out of the room and forget he'd ever seen it, but he couldn't do that. Not to his best friend.

So, he grabbed his flashlight from his pocket and began doing the work-ups needed. But the more he checked her, the more he realized she was in a really bad shape, and the more worried he got.

"She's blown her- her left pupil," he cleared his throat, holding back the need to scream.

"Abdomen's rigid and I feel a build-up of fluids, likely pneumopericardium, but we need to get an x-ray and a CT as soon as possible to-"

Bailey's voice was cut off by the heart monitor, which began beating rapidly. Both her and Derek's head shot up and their faces dropped drastically once they noticed Billie's heart was beating fast, way too fast.

"She's tachycardic. Push in one of adenosine, STAT!" Derek yelled desperately, feeling his insides constricting at all the what-ifs and worst-case scenarios rallying through his head. He glanced over at Bailey. "Let's go get that CT, now."

☆

Izzie was pumping the LVAD desperately and George stood over in a corner, concerned, when Meredith walked into the room. All eyes turned towards her and there was a silence, a moment of shock to assimilate the situation.

"George's page said it was an emergency," she said, closing the door behind her.

"You paged Meredith?" Izzie scolded.

"We need help!" George yelled.

"What the hell is going on?" Meredith asked, eyes landed on the blonde's aggressive pump on the LVAD.

However, just then, Cristina, who had been requested by Burke to go check on Denny due to the fact that he couldn't because of his gunshot wound, entered the room. Her face immediately fell and she looked between the three people alternately.

"What the hell is going on?" she repeated.

"Exactly what I said."

"She cut his LVAD wire!" George yelled accusingly.

"What do you mean you cut his LVAD wire? Does Billie know about this?"

"Are you trying to kill him?"

"I'm trying to save him. All I have to do is confirm that his condition is worse, and then Burke can call UNOS and he'll move up on the list and he will get his heart," Izzie explained nervously, but Cristina took her hands to her head.

"About Burke-"

"She's gone insane, right? It's not just me?" George shook his head.

"About Burke-!"

"Everything will be fine!" Izzie yelled. "When Burke gets here, everything will be fine. He will know what to do."

"About Burke!" Cristina finally yelled.

"What!" Everybody turned.

"He's been shot!"

The room fell into dead silence.

☆

Derek's hand was over his mouth as he analyzed the CT scan up in Radiology. Bailey was next to him and, behind her, the Chief stayed silent, watching the wreck showed by the x-ray in front of them.

"She's bleeding into her brain. Subdural hematoma." Derek shook his head. "I have to get in there as soon as possible, or else her brain's gonna swell."

Webber sighed, arms crossed over his chest in evident concern that he was trying not to manifest, "Do we know if she has any family we can contact?"

"We're her family. We're all she's got left." Derek blew out some air, looking up briefly and closing his eyes, but then opening them again at a new occurrence. "Alex Karev, I need him paged. She's gonna want him there when she wakes up."

"Karev's not available." Bailey frowned.

"Unless he's dying, then I want him here."

"He's at an organ recovery in Mercy West, Derek-"

"Then he gets the organs, and he comes back!" the man in question raised his voice. "His girlfriend, my best friend... she's dying. Really dying. She's got no one but me, him and herself to rely on. Don't you think Karev's gonna wanna know if something happens to her? Because I would go crazy if I came back and found out the love of my life was dead and nobody cared to tell me!"

Bailey and Webber stared at the neurosurgeon, but he just gave them a harsh look. They glanced at each other and, in the end, the Chief nodded.

"We'll get Karev as soon as we can."

Derek nodded, "I'm gonna go get Billie now."

☆

"He's been shot? Dude," Alex whispered through the phone as he stood in Erica Hahn's OR. The cardiac surgeon was ready to take the heart but, under Burke's orders, the intern wasn't letting her.

"We're gonna have to run these tests ourselves," Meredith explained.

"UNOS gave us an hour. In a couple of minutes, our time is up. I'm telling you, this chick is hardcore, she's not gonna wait."

"Okay, well, you just have to stall her!"

Alex sighed, "I'm not getting involved with this. Look, I don't care if that drawling, bedridden whiner ever gets a heart."

"Alex, do this," Meredith warned. "If not for yourself, then do it for Billie. You know how broken she'll be if Denny dies."

The mention of that certain cherry-scented girl made Alex's heart skip a beat. He looked over his shoulder at Dr. Hahn and shook his head, hating how much of a weakness he had for Billie when he caved.

"I'm not guaranteeing anything."

Alex hung up the phone and, just then, Meredith's pager went off.

☆

Derek had offered to prep Billie for surgery himself, even if that would usually be an intern's job to do. He had refused to leave her side other than for occasional check-ups on Dr. Burke's gunshot wound, but always paging Meredith every other minute and cursing whatever god was up there every time she failed to answer.

The cuts littered across Billie's face had been cleaned and sutured already, but the forming bruises gave her face an ugly shade of black and blue, which juxtaposed with the visible decolorization of her skin. Breathing raggedly, unconscious in bed, Billie finally woke up.

When Derek saw her eyes open, he froze.

"Billie," he called out.

The only part of the woman's body that moved were her eyes, which began shifting uncontrollably over her surroundings in order to somehow try and discern where she was. She tried to speak, but Derek soothed her.

"Hey, hey, hey. It's okay. Don't try to talk," he said, cupping her cheek softly and caressing her face with his thumb. "You've been in an accident, but you're okay now. We're gonna save you, yeah?"

Despite his pleads for her not to say anything, she opened her mouth, "A... Alex."

Derek nodded quickly, "He'll be here. He will."

Just then, Meredith, answering to her page, broke into the room. Her eyes landed on Derek, but soon fell to her person, who laid weakly on bed with almost unrecognizable features due to the force of the accident.

"Where the hell have you been?" Derek spat out through gritted teeth, taking advantage of the moment of silence that followed Meredith's shock. "I've been paging you repeatedly for the past hour."

"What happened?" Meredith asked with concern, walking up to the bed and standing on the opposite side of Derek, looking down at her person. She gasped a little. "Oh, Bil..."

"She was in a car accident. I was prepping her for surgery, but she woke up and I just- I just wanted to make sure she was okay."

After hearing his words, Billie smiled ever the slightest and whispered, "I love y..."

However, her voice trailed off. The silence that filled the room quickly dissipated by the sound of the heart monitor, which went off just as fast as Billie fell unconscious. Derek's and Meredith's heads shot up.

"She's tachycardic and hypotensive," Derek informed. "Pulsus paradoxus."

"BP's dropping," Meredith added amidst the chaos of shrill beeps.

She took off her stethoscope and listened to her heart as the neurosurgeon palpated her abdomen, completely out of his field but ready to go even further for his best friend. He then palpated her throat very softly and widened his eyes.

"It's Beck's Triad," he said. "She's got cardiac tamponade."

Meredith frowned, but her eyes were wide, "She's gonna die."

☆

"What do we do? What do we do!" Izzie yelled as the sound of Denny's heart monitor beeped erratically.

"I'm starting dopamine and dobutamine drips. We can use those together, right?" George asked as he handed Izzie the LVAD pump. "What about milrinone?"

"I don't know!"

"You know, none of us know. Just start dobutamine and dopamine," Cristina said, placing her stethoscope against Denny's abdomen.

"I feel like my chest is running away..." the man said softly, trying to push away the oxygen mask George was pressing against his face, but failing miserably.

"His heart rate's two hundred and seventeen."

"He's in SVT!"

"No, no. Izzie, stop pumping. Stop," Cristina demanded. She stayed silent for a second, listening to Denny's heart, but George shook his head, leaning down against the cupboards and starting to search them desperately.

"There's no change, we need that medicine!"

"What medicine?"

"I'll know it when I see it! I- I think, the one that stops the heart."

"No, the whole point is to keep my heart beating!" Denny said deliriously through the oxygen mask.

"No, no, no. It only stops it for six seconds," Izzie informed.

"George, it's adenosine!" Cristina said, but grimaced. "His heart is speeding up, guys."

"You guys, we have to do something! He cannot take this for much longer," the blonde yelled.

"God, Billie would know what to do. What would she do?" Cristina closed her eyes. "What if we shock him?"

"Found it!" George stood up with the adenosine on his hand. "Cristina, come over here. Lift up his arm. The nurses always lift the arm when they push adenosine. It gets to the heart faster."

Denny began sobbing at the pain, "Izzie!"

"No, it's okay! It's okay. It just feels like-"

"I'm gonna die!"

"You're not gonna die, I promise. It's just the meds."

"Okay, we're heading back at flatline," Cristina informed, watching the heart monitor intently after they managed to push in the drug. She turned towards George and whispered. "Are you sure we used the right drugs?"

"The book said it was right, I used the one I know!"

Izzie paused, holding the oxygen mask against Denny's face, "He's not gonna die, right?"

Nobody answered.

"Right?"

The machine flatlined.

One...

Two...

Three...

Four...

Five...

Six.

Denny dragged in a deep breath as the line on the heart monitor became ripply again, signaling a heartbeat that was steady, for now. The three interns breathed out in relief. Izzie began pumping the LVAD again.

"You fools better have a good explanation for this." Bailey glared at them from the door.

☆

Derek, Meredith and Dr. Allen, a fellow colleague of Dr. Burke's, went ahead and decided to urgently operate on Billie. While intern and neurosurgeon worked to repair the brain bleed, Dr. Allen performed a pericardiocentesis in order to drain the blood from the pericardium.

"You said she was in a car crash? Because this injuries aren't consistent. Her heart wall is practically disintegrating," he asked, eyes fixed on his work.

Derek looked up briefly, but then looked back down. Meredith next to him swallowed with difficulty and tried not to look at her person's unwinded features, caused by the effects of the happy gas.

"She crashed twice. Her brain and her heart have already been put through a lot of strain," Derek deadpanned.

They operated in silence for a few more seconds, each doctor in their own little world, but it wasn't until the heart monitor went off that they all looked up. The anesthesiologist was the one to speak.

"BP's bottomed out."

As in cue, a gush of blood coming from Billie's heart stained Dr. Allen's gown and mask, causing him to look away for a second before he started working non-stop in sync with the beeps of the heart monitor.

"What's going on? Allen, give me something." Derek breathed heavily.

"The IPP exceeded her atrial venous pressure. It's impending venous return to the heart. I have to switch to a thoracotomy."

Meredith and Derek glanced at each other. Allen ordered the scalpel and the scrub nurses worked fast, changing the setting into the one needed. The Cardio attending pressed the scalpel against Billie's chest and made the incision.

The machine flatlined.

One...

Two...

Three...

Four...

Five...

Six...

Seven...

☆

"How are you feeling, Denny?" Bailey asked the patient, who laid in bed with a smile as Izzie pumped his LVAD.

"Really, really good. Like an athlete or a superhero. Or some other kind of really healthy person." He smiled, then swallowed.

"You're funny. You're a funny guy," Izzie teased.

"Izzie, no speaking," Meredith, who was just recently out of surgery, whispered.

Denny shrugged at Izzie, then turned to Bailey, "Where is my kid, by the way? Billie. 'Cause she's been gone a long time."

Bailey's lips parted slightly and she glanced over at Meredith, who she knew was aware. However, the blonde simply looked down, so the resident made the call to stall that revelation.

"You don't have to worry about that right now, Denny," she said.

"Well, in that case." He smiled. "I cut my own LVAD wires, you know? I went rogue. All by myself."

"Shush. You're weak enough as it is. Please don't waste energy on lying."

Bailey kept her eyes on Denny's as Cristina walked into the room.

"Dr. Bailey?" Izzie called out.

"I did, indeed, said no speaking."

"I don't care." the blonde raised her voice, causing Bailey's head to shoot in her direction. "He's gonna get the heart, right? You're gonna sign the charts and talk to the transplant coordinator?"

George walked into the tension-filled room and handed Bailey a few papers, "Here are the labs."

"See? See, his BUN and creatinine are increasing. He clearly has pulmonary edema. He deserves to move up to 1A status on the transplant list. UNOS will give him the heart. You just need to call-"

"Isobel Stevens, I take my medical advice from doctors. You are a visitor," Bailey cut her off.

"What?"

"As of now, you are a visitor in this hospital. You will not be a doctor in this hospital again until I decide you are. And you better hope you don't run into either the Chief or Billie, because I'm sure they'll be more than delighted to kick your pathetic little ass out of the program with so much as a hundred and fifty grand charge for attempted murder., With her eyes fixed on Izzie, Bailey demanded. "Olivia, take over the heart pump."

Izzie pumped the LVAD furiously, looking down at Denny, who she claimed was the love of her life. Olivia came up beside her and took the heart pump, starting to work it herself. Izzie's glare didn't fade whatsoever.

"He gets the heart though, right?"