chapter thirty-eight ━ conjoined twins
( season eight, episode eleven )

❝So, uh—is anything going on
between you and Ellie?❞

ELLIE SAT IN the resident's lounge, pulling her blonde locks into two French braids while Jackson paced nervously behind her. "You're on the case, too, right?" he asked despite knowing her answer.

"Yes," she replied with a sigh, turning around to look at her. "Why are you so freaked out? You're just doing the exact same thing as Mark."

"But if I mess up, then I'm basically ruining two babies' lives!"

She nodded, humming to herself. "Well, that's one way of seeing it..." She shook her head and walked over to him, laying her hands on his shoulders. "You just need to take some deep breaths and we can go."

"Deep breaths," he repeated, nodding to himself. "Right." He looked down at the blonde in front of him. "Why aren't you also freaking out? You're the ortho surgeon for the red team."

"Because I know the procedure, just like you do," she replied, opening the door of the lounge and walking down the OR floor, Jackson trailing behind her. "You have to stop freaking out so much. Start trusting your abilities and show them off. Especially because Arizona is—"

"—losing it," Alex interjected, walking in step with them, looking slightly disgruntled. "She's freaking losing it, is what's happening."

Ellie shrugged, the three of them scrubbing in thoroughly. "She's just stressed," she said, defending her brother's best friend's girlfriend. "She just wants everything to go smoothly."

"Yeah, well, she could do that without acting like everything we do is wrong," Alex countered in annoyance.

Once the three residents had finished scrubbing in, they joined the large group of surgeons that were already gathered in the OR. Ellie moved to stand beside her brother and Derek just as Owen addressed his staff.

"Practice, practice, practice until it is perfect, people," he said, and Ellie glanced at Arizona out of the corner of her eye, who seemed to be impatiently tapping her foot. "This is a long, complex procedure with many parts. Therefore, many opportunities for error. So, we're gonna go over this again. Team leaders, get in place."

Derek nodded. "Alright, green team over here, please."

"Let's go, red!" Arizona chorused and Ellie walked over to her, Jackson and Alex following her. Meanwhile, Mark and Callie joined Derek on his team.

"We've offered this family every pro bono dollar, every surgical hand, every resource this hospital has," Owen continued. "So, I'm asking you for every resource that you have. Be sharp, be present, be focused. Dr. Robbins has been caring for these children since the day they were born. They will each get a new life today. Our actions will decide what kind of lives they will be."

"No pressure..." Ellie muttered under her breath, tilting her head.

Owen lifted off the sheet from the surgical table, revealing two baby dolls conjoined at the back. "Let's begin."

☀️

MARK AND JACKSON stepped up to the babies to practice their portion of the surgery. "Flaps are inset and viable."

"We're looking at at least eighteen hours," Owen told the group. "So come and go if you need to—hydrate, eat—but be here at least thirty minutes before your procedures."

Arizona stepped forward. "Alright. Next up: general surgery. First, we need to establish each baby's blood supply to the shared colon."

The general surgeon nodded. "Then we separate the colon, making the first incision—"

"I will make the first incision," Arizona interrupted and Ellie pressed her lips together. "So, we'll separate the colon..."

"Okay, and now I'm checking the displaced kidneys—"

"To make sure they're intact and functioning," the peds surgeon finished and Ellie and Jackson looked at each other.

The general surgeon blinked at her. "Uh, that's implied."

"I don't care," she said in annoyance. "Say it."

"Checking the kidneys to make sure they're intact and functioning..."

"Damn," Jackson said and Ellie glanced up at him. "She seems stressed."

She shrugged, shifting her gaze back to the two surgeons at work. "Well, she's been caring for them since they were born," she replied. "And now we change their lives. It could be stressful for anyone."

"You forgot to cauterize!" Arizona's voice pulled their attention back to the surgery. "You want this baby to bleed out?"

"Do I—? No, I—"

Arizona nodded. "Yeah, I should think not."

Ellie turned back to Jackson. "Yeah, no, she's brutal. I don't think I've ever seen her so brutal before."

"Okay!" Owen interjected before Arizona could further insult the general surgeon. "It's time to flip them."

Derek nodded in agreement. "Karev, you're up."

Ellie and Jackson stayed in their spots while Alex moved to the table. "Ready?" Arizona asked him.

"Yeah."

Ellie leaned her head on Jackson's shoulder. "See?" she said and he looked down at her. "You don't seem as tense anymore."

"Yeah, well, that's 'cause I had help from a very wise woman," he replied.

"Oh?" she asked with a smile, lifting her head and tilting it. "And who might this 'wise woman' be?"

He shook his head. "Oh, you wouldn't know her," he said and she chuckled softly. "But she's going to be one hell of a surgeon."

She nodded. "I like her already..."

Mark, meanwhile, was standing next to Derek, watching his sister's facial expressions intently. "Is he flirting with her?"

Derek, who had been watching the surgery, looked up at him. "Who?" he asked before following his gaze. "Avery? They're just talking."

"I don't know..." Mark muttered with a frown, crossing his arms. "I don't like it."

"Calm down, you overprotective big brother," Derek replied, clapping him on the back. "They're just friends. Like they have been for years."

Mark nodded slowly. "Right... just friends..."

Arizona huffed. "Karev, you rushed it!" she exclaimed and everybody looked back at the surgery. "You're—like—two steps ahead of me."

"No, you over me," Alex countered, shaking his head. "Yours over mine, everything's fine. Mine over yours, babies in the morgue. That's how it works."

Ellie blinked at him. "That's a horrible pneumonic device."

Arizona seemed to be thinking the same as her. "That's your pneumonic device?"

"Great," Owen interrupted, once again preventing more arguing from occurring. "Now Brandi's wounds are exposed, and little Andi's gone without oxygen for a whole minute."

Arizona raised her hand, getting tangled with the oxygen tubes. "Okay, I—Can we start over?"

"No, there's no time," Owen replied, shaking his head. "Let's just finish this practice and try the flip again. Next!"

"Neuro."

"Ortho."

"Ooh." Ellie nudged Jackson on his shoulder. "That's me."

"Okay," Derek said, clearing his throat. "So, we will access and separate the conjoined spinal canal."

"And separate the bony elements of the spine," Callie added, beginning the procedure. Just then, while they were continuing their work, Bailey walked into the OR and took Meredith with her.

Ellie looked at Derek. "Spinal separation complete."

He nodded. "Okay. I am now prepared to separate them quickly."

"Wait. Hold on." Ellie hung her head and glanced at Arizona. "What about complications? I mean—what if there's a double hemivertebra or a tethered cord?"

"We will cross that bridge when we come to it," Derek told her while Callie sighed lightly.

"We're done here," Owen informed them.

"I—I'm sorry," Arizona said, shaking her head. "What if we're standing on that bridge right now?"

"Dr. Robbins, I said—"

"No, no, no, no," she argued and Ellie rolled her neck, letting out a breath. "We haven't even separated them yet. We haven't gone through the post-separation surgeries. There's so much m—"

"Dr. Robbins, stop." Arizona fell silent and looked at Owen. "We're done practicing," he said. "We have practiced our parts—not only here in this OR—but in the shower and on your drive to work. We're ready. We know what to do. Now we just have to do it." The surgeons stepped away from the table and Ellie moved back to her spot beside Jackson when two nurses rolled in a gurney. "Ladies and gentlemen, I present to you Andi and Brandi Edwards. Let's give them new lives, shall we?" Ellie gave a panic-stricken Arizona a reassuring smile. "It's showtime."

☀️

ELLIE STOOD BESIDE Derek, the two of them watching Mark and Jackson's portion of the surgery. "Raising the skin flap," Mark said. "Avery, you there?"

He nodded. "One step ahead of you."

"You want to race?"

"No, no, no," Arizona said, immediately shaking her head and her eyes shifting to the attending. "No racing."

He let out a breath. "That was fun last night," he said, changing the subject. "Did you and Meredith have a good time? I know Julia did."

Derek nodded. "Yeah, we did. You got enough length there for coverage?"

"Yeah, I'm dissecting from the base to the midline," he replied. "Did Meredith say anything about Julia?"

"She liked her."

"Jackson, slow down!" Arizona exclaimed, watching him work from over his shoulder and Ellie's eyes flickered to him.

"And Zola liked her, too?"

"Yes," Ellie answered with a sigh, looking at her brother. "Everybody likes Julia. Let's see..." She glanced around the room. "Has anyone else here met Julia? Do you all like her, too?"

Derek smiled at her. "Show of hands if you liked her?" he asked, joining in. "Ah, you did? You did?"

Lexie sighed. "I think I'll update the parents."

Ellie looked over at her. "Lex—"

"It's fine."

She sighed and watched the brunette leave the OR while Arizona continued to look over Jackson's shoulder. "Hunt, they're clearly racing. No racing!"

"We're not racing."

"We have been rehearsing this for months," Arizona said and Ellie pinched the bridge of her nose. "And now they're gonna jeopardize the patient because—"

"Robbins," Owen interrupted once more. "You take care of your team. I'll look at the big picture."

"Done!"

"I win!" Ellie snorted at her brother, disguising it as a cough to not get an angry look from the peds surgeon. "And by that..." Mark said, amending his words at Arizona's harsh glare. "...we mean ready for the colon resection. Cafeteria?"

Jackson nodded. "Race you there."

Ellie laughed to herself while Owen cleared his throat. "General surgery teams... let's go!"

☀️

WITH THEIR PORTION of the surgery finished, Mark and Jackson sat in the cafeteria and the plastics attending looked at the resident. "So, what's going on between you and Lexie?" he asked him.

"Oh—uh—we broke up," Jackson replied, looking up at his mentor.

"Why?"

He shrugged in response. "It just wasn't working out," he said, clearing his throat. "Why do you care? Am I spying for you again?"

Mark shook his head. "No, I was just curious," he told him before taking a sip of his bone-dry cappuccino. "So, uh—is anything going on between you and Ellie?"

Jackson stared at him. "What?"

"You and my sister," Mark clarified as though there was another Ellie they could be talking about. "Is there anything going on between you two?"

"Uh—no."

"Really?" Mark asked, confusing Jackson even more. "Because the two of you were acting very... friendly in the OR earlier."

He furrowed his brows. "What are you talking about?"

"Always stealing glances at each other," Mark said, beginning to list off everything they've ever done. "Always laughing at something the other said. You really haven't noticed?"

"Well... no." Jackson shook his head. "I'm sorry... Do you want me to ask out your sister? Normally brothers don't want that."

"That makes it sound wrong," he said and shrugged. "But, if you really like her, you should go for it. Especially because everybody knows that she's out of your league." Jackson chuckled, smiling lightly. "Look, I love Ellie more than anybody in this world. Maybe even more than Sofia, I don't know. And I'm usually not one to encourage people to ask out my sister because, in my mind, she's still twelve and obsessed with the Harry Potter books—she still is a bit—but the way she looks at you is one I haven't seen from her before."

Jackson blinked. "What are you talking about?" he asked.

"I'm just saying..." Mark said, standing up. "If you ever figure out your feelings for her, you don't need to worry about me trying to kill you. I may threaten you, but that's just my job as her big brother. Okay, then. I'm gonna go watch the surgery."

Jackson looked behind him as Mark retreated, more confused than before. "Wait. You need to explain some more!"

Meanwhile, in the OR, Arizona and the general surgeon were doing their procedure on the twins. "Looks like Andi has the bulk of the blood supply to the colon," Arizona said.

The general surgeon nodded. "So we'll give her all the colon then?"

"And leave Brandi with an ileostomy?" Arizona retorted and Ellie sighed. "I don't think so. I'll do an ileoproctostomy."

"Maybe they should just share so we don't have to—"

"No!" Arizona interrupted harshly making Callie and Ellie share a glance. "Check the function of the blood supply to the kidney."

"Flip's coming up!" Owen reminded his surgeons though they certainly did not need that reminder—especially not Arizona Robbins. "And I don't want a repeat of this morning's rehearsal." Out of the corner of her eye, Ellie saw Alex walk over to the trauma surgeon who nodded after speaking briefly with the resident. "Who wants to replace Karev on the flip?"

Ellie raised her head and furrowed her brows in confusion. Richard looked around and raised his hand. "Uh, I'll do it," he volunteered and Owen nodded, allowing the former chief to go and scrub into the surgery.

Ellie walked over to Alex and crossed her arms. "I think Webber just stole a surgery from you," she said making him look at her. "Oh, you naive little man..."

She patted him on the shoulder and turned her attention back to the important step of the procedure about to happen. Richard stood across from Arizona at the surgical table and she looked up at him.

"You sure you can do this?" she asked him.

He nodded. "Disconnect and cap subclavian IVs," he recited making Ellie glance at Alex briefly. "Anesthesiologist holds the ET tube, and designated circulators, and the techs hold the monitors. Yours over mine, babies—"

Arizona shook her head. "Don't, don't," she said and Ellie chuckled lightly. "Okay. One... two... three."

Ellie bit the inside of her cheek, watching them lift the babies gently. "Easy, easy, easy."

"And we're done," Arizona announced with a chuckle of relief and Ellie let out a breath, beginning to clap.

Maybe now she won't snap at everyone.

☀️

ELLIE JOINED DEREK and Callie for their portion of the surgery, working on the spinal cord when the neurosurgeon groaned. "Damn it." She looked up at him briefly. "Spinal dermoid cyst. It's all tangled up in the spinal root."

"A lot of scarring in there," Ellie added.

Callie nodded. "I don't see a clean approach."

"Well—no—well—" Ellie and Callie both sighed when Arizona interjected and the resident hung her head. "You have to take it out because the cyst could become malignant."

"Yes, we're aware," Callie said, looking over at her wife in mild annoyance—correction, major annoyance. "Thank you."

"Maybe if I can come in from an angle... like this..." Derek muttered to himself before shaking his head. "But then we risk the contents spilling out—"

"Which could cause a chemical meningitis," Arizona interrupted.

Callie looked at her. "Dr. Robbins, we've got this," she said somewhat forcefully.

"What if stretch the nerve root here?" Ellie suggested.

"Well, that might paralyze Brandi."

Callie groaned. "Yes!" she exclaimed. "Brandi might end up paralyzed. Yeah, no one understands that better than the three of us do, which is why we will be making this decision, okay? Us. Not you. You alright with that?"

Arizona sighed. "Just make sure—" She fell silent when Callie cleared her throat and she nodded. "Yes, I'm okay with that."

"No more talking from anyone in this OR," Derek said and Ellie looked at him. "We need complete silence from now."

Ellie glanced up at the observation deck and she locked eyes with Jackson who chuckled lightly and took a bite of his apple. She rolled her eyes playfully and looked back down, neither of them noticing the knowing looks on April and Mark's faces who were sitting on the other end of the gallery.

"Okay, we're ready for the final cut," Derek said and a nurse handed him a scalpel. He made the cut and Callie smiled to herself.

"Alright, separation complete."

The doctors around them began clapping and Derek shook his head. "No, no, no, no. Not yet. We still need to check on the motor function. Let's do... two milliamps of stimulation on Andi first, please."

Ellie looked down at the baby's foot and it twitched making the blonde smile. "Good."

"Let's try Brandi now," Derek continued. "Two milliamps of stimulation." They all looked down at the second twin's foot, which didn't twitch. Ellie glanced at Derek and he let out a breath. "Let's go up to three milliamps, please."

"Come on, Brandi," Callie urged.

Derek tickled her foot, trying to get any kind of reaction but there was still nothing. Ellie looked up at the observation deck briefly. "Let's go up to four milliamps of stimulation."

"Come on, Brandi..."

Derek tickled her foot once more and Ellie held her breath. Suddenly it twitched and she let out a small laugh. "Hey, there you go. Alright. Good."

Owen nodded at his surgeons. "Great work, everyone," he said with a smile. "One step at a time, by the numbers, like we practiced. Let's move."

Another gurney was brought over to them to bring Brandi to a separate over to complete her surgery. They gently lifted her away from her sister and rolled her out of the OR. Ellie followed behind it with the rest of the red team.

☀️

ELLIE WAS STANDING beside Jackson in the OR, slightly zoned out when Owen walked in to check on their progress.

"What's going on, Avery?" he asked, shaking the blonde out of her thoughts. "You should've finished your flap by now."

"Yet I haven't even started," he replied, disgruntled. "Why don't you give me a call when you're ready?"

He walked out of the OR and Ellie sighed, looking back at the surgery. "Her kidney's completely necrotic," she informed the chief.

The monitors around them started going off and Richard looked up at them. "V-tach."

"Okay, push thirty milligrams of calcium," Arizona said. "She's already showing signs of renal failure."

"Her kidney was fine earlier."

Arizona shrugged. "Maybe something used arterial spasms while we were checking the function of the blood supply," she suggested, letting out a frustrated breath. "I don't know, but at this point, I don't think it's salvageable."

"She hasn't had any urine output since she's been in this OR," Alex told her and Richard looked at him.

"Did you clear out the clot?" he asked.

"Yeah."

"Were there any adhesions?"

Arizona shook her head. "No. The vessels are clear, and yet the kidney is—is dead."

Ellie and Alex looked at each other as though they were getting an idea. "What if we tried a bypass graft?" Richard suggested.

"A kidney transplant," the residents said in unison making the others look at them.

"We've got the perfectly matched donor right next door," Ellie added, gesturing to the OR that Andi was currently in.

Alex nodded in agreement. "They used to share all three of those kidneys," he continued. "There'd be no need for immunosuppressants because they're identical twins."

"They'd be saving each other," Owen said, tilting his head.

Arizona looked between her two residents and nodded. "Okay. Karev, Sloan, this was your idea. Make it happen."

They shared a high-five before hurrying out of their OR to the one next door which they found empty. "Where's Andi?" she asked the nurse who was cleaning.

"We finished," she replied.

Alex groaned and started out the door, Ellie following behind him. Once they were outside of the OR, they saw Andi with her parents. "We need Andi back in the OR," Alex told them.

"What's wrong?" her mom asked.

"Brandi's kidney failed," Ellie replied gently. "It's straining her other organs, including her heart. So we're going to do a kidney transplant."

Her mom shook her head. "No, you can't."

"It's okay," her husband said, taking her in his arms. "Let them take her."

"I can't lose them both," she told the residents desperately. "Please. No. You can't. Please."

Ellie paused and looked back at the new parents while Alex wheeled the gurney back to the OR. "I promise, they're both going to be okay," she said to them, taking the woman's hands in her own. "I promise. You will have both of your girls at the end of all this. Okay?"

The woman looked at her and nodded slowly. "Okay."

☀️

ELLIE AND RICHARD stood behind Arizona when Alex walked in, holding the kidney. "It looks healthy," he told the peds surgeon. "Are you ready?"

She nodded. "Yeah. Go and scrub in."

Ellie moved to stand beside Arizona while Alex made his way to the scrub room and Richard followed him. She tilted her head at the sight of them talking before Richard began to scrub in, joining Arizona for the surgery.

Once the kidney had been put inside Brandi, Arizona stared at the organ. "Why aren't we getting any urine?" she asked.

"There's a kink in the vessels," Richard answered. "Papaverine, please."

"Hey, why are you doing this and not Karev?" Arizona asked him, looking up at him briefly. "It was his and Sloan's idea."

"I picked Karev's pocket."

The two blondes looked up at him while Alex did a double-take. "You what?"

"Twice in one day, Karev?" Richard asked, looking at him. "Honest to God... It was like taking candy from a baby. No, that's not right. It's not fair to the baby." Arizona and Ellie looked at each other—the former mildly confused and the latter entirely amused. "IT was easier than taking candy from a baby. At least the baby puts up a bit of a fight. Removing clamp." A squirt of urine shot up and Ellie smiled. "We have urine."

"The kidney's working," Arizona said, a wide smile gracing her features. "We did it!"

☀️

"WELL, THAT WAS the longest day ever," Ellie said with a sigh, collapsing on the couch beside Alex once they had both returned to their apartment.

"You're telling me."

She looked at him. "How did Webber manage to steal two roles from you?" she asked him. "I thought you were tougher than that."

"He guilt-tripped me," he replied with a groan, taking a sip of his beer. "I don't really know either. But something good did come out of this."

"The twins were separated successfully?" she asked.

He shrugged with a nod. "Well, yes, but also—" He stood up and looked down at her. "—Avery couldn't keep his eyes off you."

Ellie furrowed her brows as he walked into his bedroom. "You can't just leave after saying that!" she called out, and he closed the door behind him. "Alex!"

☀️

━ author's note:

have I mentioned how much I love Ellie and Alex's friendship?

also... we're in the final countdown before ellie and jackson get together and this ridiculously long (and unplanned) slow burn can FINALLY end

and then all the sadness that is the end of season eight can occur... and then i'll run and hide again...