chapter fifty-four ━ ellie and alex: peds duo
( season nine, episode eight )

❝You sounded like you could
use some cheering up. So, enter
the bag of fun.❞

ELLIE BIT THE inside of her cheeks before nodding and kneeling beside her brother. She let her hand glide across his face.

"Okay," she whispered. "Okay. Knife." She took the knife from Derek and Cristina sprayed it to sanitize it. As she began to cut, Mark groaned and tears filled her eyes at the sound though she quickly blinked them away. "Okay. Needle."

FLASH.

As minutes bled into hours, the number of surgeons gathering outside of Mark's room grew. Ellie looked up when she heard a beep from the monitor and she felt his heart very slowly stop. Suddenly, the machine began to flatline and she shook her head in denial.

"No," she whispered, looking back down at her brother. "No, don't go. Not yet. Come back." The continuous tone hit her like a ton of bricks as sobs filled her chest. "Mark..."

Ellie awoke with a start, beads of sweat covering her face. She ran a hand through her tangled blonde hair, trying to catch her breath, when she looked over to the left side of the bed. It was empty. Her eyes traveled to the note that sat on the pillow and saw it was from Jackson.

I had an emergency surgery. I'll be staying at the hospital for the night.

Sleep well, sweetheart.

Letting out a breath, she dropped the paper and glanced at her alarm clock; 3:18. She slipped out of the bed and wrapped a blanket around her thin frame as she walked out to the living room. She passed the photograph of her and Mark that she kept on the side table next to the couch and sighed.

"I miss you..."

She slumped down on the couch and pulled out her phone. She fiddled with the device in her hands and looked down at the contact she had clicked on. She brought the phone up to her ear and listened to the ringing that filled her eardrums.

She shook her head. "This is stupid."

She quickly hung up the phone before the person on the other end could answer. She threw the device down on the couch in defeat and held her head in her hands, her thoughts the only thing filling the silence of the still apartment. Just as she was about to try and fall back asleep, her phone rang.

ALEX :)

She picked up the phone once more and brought it to her ear. "Hello?"

"Ellie?" Alex's groggy voice came from the other end and she pressed her lips together. "Is something wrong? You don't call this early unless we have a patient together, which I... don't think we have. Do we?"

"No, I—" Ellie sighed. "I'm sorry. You're right, it is early. Just forget that I called and go back to sleep. We have work in about..." She looked at the clock on the oven and grimaced. "...four hours."

"Wait." She paused, her finger hovering above the 'end call' button. "Something happened. Go ahead, I'm listening." She heard him grunt as he sat upright in his bed and she tilted her head. "You're not hanging up until you tell me."

She shook her head. "It's nothing, really," she insisted and he frowned, hearing the tiredness in her voice. "Just go back to sleep, Alex. I'm sorry I woke you."

"If it was really nothing, you wouldn't have called me," he countered making her sigh. "I wasn't even asleep. Well—okay—I was, but now I'm not. Just tell me."

"Do you ever have a recurring dream?" she asked him, finally giving in to his insistence. "Like... a dream that—that no matter how much time passes, still comes back?"

"What was the dream?"

She paused for a moment. "The woods," she said quietly. "Mark dying... You know, the usual."

Alex let out a heavy sigh. "Where's Avery?" he asked.

"At work."

He nodded. "Alright. Give me twenty minutes."

Ellie furrowed her brows. "Twenty minutes?" she repeated. "For what? Alex? Hello?"

The dial tone filled her ears and she looked down at her phone, seeing he had hung up. She looked around in confusion before shrugging. She pulled herself up from the couch and walked into the kitchen, filling the tea kettle with water before setting it on the stove.

She settled herself back down on the couch with a book and a steaming mug of tea. She had just entered the world of Jane Austen when she heard a knock on the front door. With a huff, she opened the door to reveal Alex Karev with several bags in his arms.

"Um..." She looked at him; he was slightly out of breath and looked to be struggling with the weight of the bags. "Hello?"

"I come bearing things," he said and she chuckled, taking some of the bags from him.

She stepped to the side, letting him into the apartment, and peeked inside one of the bags she held, seeing a box of tissues and a tub of ice cream. In another, were dozens of movies and a bag of trail mix. Alex set a tray of coffee on the counter—one hot and one iced.

"Alex..." she said and he looked back at her. "Are you trying to impress me? You do know that I'm a committed, loving relationship, right?"

"Oh, haha," he replied, rolling his eyes. "You sounded like you could use some cheering up. So, enter the bag of fun."

"Bag of fun?" she repeated in amusement. "Alex, you brought, like, seven bags. Would it be bags of fun?"

He shook his head. "Don't ruin this." She held up her hands in surrender and he continued. "I don't know, I—I thought you might want to watch a movie and eat trail mix. And... This is stupid."

"No, no," she said, hugging him tightly. "It's really sweet. Thank you. You really didn't have to do all of this. Especially at 3:30 in the morning."

"I wanted to," he replied, pulling away from her hug. "Try and help me relieve some of this guilt that I have."

Ellie sighed and tilted his head. "It's not your fault that you weren't on the plane, Alex," she told him and he glanced at her. "What happened to Arizona was traumatizing, but you deserved that job at Hopkins. She was having a bad day that day—and she may regret that decision—but you do not get to blame yourself, okay?"

He smiled lightly. "I thought I was supposed to be cheering you up."

She shrugged. "Well, that's what friends do. Now... let's see what else you have in your bags of fun."

"Bag of fun!"

☀️

"WHAT DO YOU mean you had a pregnancy scare last week?" Alex asked as he and Ellie walked into the hospital later that morning.

She shrugged. "I mean we had a pregnancy scare last week," she said, glancing at him. "I was late and I'm never late, so we took my blood. Wasn't pregnant but I was... I don't know, a little disappointed."

"And what did Avery think?"

"He was actually very supportive," she replied, a small smile tugging at the corners of her lips. "When the time comes... I don't think we'd be against it happening."

She patted him on the shoulder and they went their separate ways. She found Jackson at the nurse's station and she walked over to him, hugging him from behind.

"Well, good morning," he said with a chuckle, twisting around to face her. She tightened her grip on him, resting her head against his chest. "You seem clingy this morning."

"I'm tired," she replied, stifling a yawn. "But at least I got the good intern today."

He kissed the top of her head. "Well, how about I buy you a coffee and a muffin?" he asked and she shook her head.

"Thanks, but Alex already bought me two," she said before pecking his lips. "I gotta go. The peds duo is back, baby!"

She and Alex both arrived in the hallway at the same time. The former pulled her light locks into a messy bun as the latter took out his stethoscope.

"Alright, Wilson, fill us in."

"Baby born with a C.D.H.," the intern told the two fellows. "I intubated him, but the SATs are still low."

Ellie tilted her head. "Could be pulmonary hypertension," she said, looking at Alex who nodded in agreement.

"You ever hooked a baby up to ECMO before?" he asked Jo and she sighed.

"I never intubated a baby before five minutes ago!"

Ellie let out a breath. "Okay, everybody, let's take a breath. There's no need to freak out," she said to them before looking at the intern. "We hook up catheters into his neck, pump his blood into the ECMO machine—which puts in oxygen—and takes out the carbon dioxide. Then it cycles it all back in."

Jo nodded. "Okay."

She looked down when her phone went off and sighed. "I'll catch up with you guys. Go ahead." Alex nodded and continued down the hallway with Jo while Ellie looked at the phone contact, frowning at the sight. "Liz?"

"Beth!" She grimaced at the nickname and let out a breath. "Why am I getting a call from an intern asking me to donate a nerve for Derek's arm? Why isn't he calling me himself?"

"Whoa, whoa, slow down, Liz," Ellie said. "What are you talking about? Who's calling you?"

"I don't know, an intern named Heather Brooks, I think?" Liz replied and Ellie rolled her eyes; oh, brother. "Oh, do you know what size Zola is wearing now?"

The blonde sighed. "Liz, I'm gonna have to call you back." She quickly tied on her scrub cap and made her way down to the OR floor, finding Heather in an operating room with Meredith, Bailey, and Callie. "Well, that's convenient..." She opened the door. "Mer, why is Derek's sister calling me to complain about an intern calling her about nerves? And what problem with his nerves?"

"Uh—"

Just then, Derek walked in, holding a mask over his mouth. "Meredith, I just got a call from Lizzie—"

"So did I."

He looked down at Ellie who shrugged. "Why is she calling you?" he asked before shaking his head. "Never mind. She's under the impression that she's gonna donate a nerve to me."

"Yay!" Heather cheered in excitement and both Derek and Ellie looked at her making her shrink down under their gaze. "Not yay..."

"I thought I made it clear that I didn't want my family involved," Derek said to Meredith, looking back at her.

Callie shrugged. "Well, a live donor nerve is preferable," she replied. "And it's easier to find."

"My hand, my sisters, my decision," he insisted.

Meredith let out a calmer breath. "The longer we wait, the less chance we have that it will work," she told him. "And we need this work—sooner rather than later."

"Sounds like a no-brainer to me," Bailey said, putting in her input.

Ellie nodded. "You may hate that you owe your sister something, but just think about your hand," she said and he looked at her. "Your surgical career!"

"Who'd you get to make the calls?" Derek asked his wife and Ellie pointed at the intern beside her. "Call them back and undo what you did."

"And tell them to stop calling me," Ellie added. "And to stop calling me Beth. Now, as for you—" She grabbed Derek by the arm. "—you're coming with me."

"Ow. Ellie, you're hurting me. Ellie!"

The four surgeons watched the young fellow drag the neurosurgeon out of the OR and Meredith turned back to her intern. "Don't undo a thing."

Once outside, Ellie finally let go of his arm and faced him with her arms crossed. "Uh—" Derek scratched the back of his neck. "—something wrong, Ellie?"

"Oh, no," she said sarcastically, shaking her head. "It's definitely not that I'm finding out things from your sister. And one who doesn't work in the same hospital as you—the same state! Now... tell me about your nerves."

"It's nothing."

She frowned. "Do you want me to use my puppy dog eyes?" she challenged him. "Because I will use my puppy dog eyes."

"You're not ten," he said with a scoff. "That's not going to work on me."

"Do you want to test that theory?" she asked him and he swallowed, letting out a breath.

"Callie thinks that the best way for me to get full function in my hand back is to use a live nerve," he said. "Meredith suggested maybe one of my sisters donate a nerve to me. But I said no."

Ellie nodded. "Okay... Why?"

"Because they're going to hang it over my head!" he replied and she sighed. "And they'll resent me for them not being able to do anything for a month."

"Oh, for—" She was cut off by her phone ringing and she pulled it out, smirking at the contact. She turned the phone around to show Derek and he rolled his eyes.

"Please, don't an—"

"Hi, Katie," she said, putting the phone on speaker and he hung his head. "Long time no chat."

"Bethie!" She shivered at the nickname and Derek chuckled at her making her glare at him. "What's this message that I got about needing to donate a nerve for Derek's hand? What happened to his hand?"

Ellie looked up at Derek before covering the phone with her hand. "You didn't even tell them about your hand?" she hissed at him.

He shrugged. "I didn't see the need to."

She groaned and turned back to the phone call. "Uh—that's a question for your brother, not me. I'd suggest giving him a call. I'm sure he'd love to talk to you. Bye, Katie!"

Ellie smirked as she hung up and Derek looked back at her. "Do you hate me today?" he asked.

"You don't tell me—or your sisters—anything, so yes, I do hate you today." Derek's phone rang and she smiled innocently. "Enjoy your chat with Katie."

He let out a breath. "Hi, Kathleen..."

☀️

ALEX AND JO were working on the baby when Ellie joined them, putting on a mask while a nurse held out a gown and gloves to her. "You're doing great," Alex said while observing Jo's work and Ellie slipped into her place beside him. "You've isolated the jugular and the carotid, avoided the vagus nerve. Now you need to put in a venous drainage cannula."

"Sorry I'm late," Ellie muttered. "Family drama."

Alex shrugged. "It's cool," he replied. "Wilson, here, has been doing a good job."

She smiled. "Glad to hear it."

All three of them looked up when they heard the monitor go off and Jo looked at her fellows. "I hadn't even—"

"He's coding," Ellie said, interrupting the intern. "Wilson, switch with Karev. You need to do CPR while he hooks the kid up to ECMO."

"At the same time?" Jo asked. "How will that work?"

"Start compressions now!"

Jo nodded and did what she was asked, using her index and middle finger to pump his chest. Ellie handed Alex the tools he needed, as though he was reading his mind before he could ask for them.

"Stop," Alex said and Ellie glanced at him before nodding. "Go. Keep going. Stop."

Ellie handed him the tube, attaching it to the other end while he did the same to the baby. They worked in silence—but seamlessly—as though they had been working together for years.

She nodded. "Okay. Keep going, Wilson."

"Stop," Alex said and Ellie handed him the clamp while also keeping an eye on the monitor. "Go."

She continued to watch the monitor as the beeping kept going. After what felt like an eternity, Jo looked up at her superiors. "How long have we been going?" she asked them.

"Twenty minutes," Ellie replied, her eyes still glued to the monitor.

"Stop," Alex told Jo and Ellie watered down to the tube to give better visualization just as Arizona came in using her cane; it was her second week back at work.

"Karev, Sloan, I heard you had a crush ECMO," she said. "Do you need any help? Need me to step in?"

Alex shook his head. "No, we just need to connect the circuits," he replied. "Okay, initiate bypass."

Jo turned the dial and they all watched the monitor as it slowly returned to normal. Ellie let out a breath of relief and slumped against Alex. "Oh, we did it," she sighed, looking at Alex.

He chuckled. "Son of a bitch."

Arizona smiled at them. "And it seems like only yesterday that I was showing you how to do your first pulmonary hypoplasia. You are a good team together—and I'm taking all the credit. I hope you're taking notes, Wilson, they're some of the good ones."

She walked away and Jo turned to the two surgeons. "So, what's next?"

"Well, now that he's hooked up to ECMO, the baby needs to be monitored twenty-four-seven," Ellie replied with a sigh. "It's gonna be a long day and an even longer night. Better get a nap in, we're gonna be here for a while."

☀️

LATER THAT NIGHT, Ellie stood beside Alex and Jo, talking to the baby's mother and grandmother.

"You're saying that the baby needs that machine to live?"

"Well, for now," Ellie replied with a nod. "ECMO, it works a little like bypass to give your grandson's heart a rest."

"For how long?" the baby's mother asked and they looked at her. "'Cause my friend Nikki's having a party for me on Friday and I'm supposed to bring the baby."

Ellie and Alex glanced at each other before hearing Jo's voice. "Kimmy, your baby will be here a lot longer than Friday."

"How much longer?" her mother asked. "Weeks? Months?"

"It's hard to know at this point," Alex answered.

"I'll have to call Nikki," Kimmy said to her mother. "She ordered cupcakes and stuff. Mom, where's your phone?"

Jo looked at Ellie and Alex before forcing a smile onto her face. "Kimmy, would you like to go in and see your baby now?"

"No, thanks."

"Are you sure?" she asked. "You won't hurt anything. I can wheel you right up next to the bed."

Kimmy looked up from digging through her mother's purse. "It's like he's gonna know who I am or anything," she said. "I'm tired. Can I just go back to my room?"

Her mother nodded. "Sure, baby."

Ellie's phone rang and she immediately groaned. "Oh, for crying—" She answered the call. "Nancy. Hi."

"Beth, why isn't Derek answering my calls?"

"Mm, probably because he's a jerk," she replied with a shrug before sighing and waking away. "Was there something you needed?"

"Yes," Nancy said, nodding. "Has Derek gotten somebody to donate a nerve yet?"

"I... have no idea," she answered. "I've been in surgery, doing my job. I'm not his babysitter. And why are you all calling me? It's getting really annoying."

"Derek's just as much your brother as he is ours," Nancy argued and Ellie rolled her neck. "Don't you want to help him?"

"Of course I do," she replied. "But I can't do anything. You and your sisters are the blood relatives. Nance, I gotta go. I'll be sure to have Derek call you."

☀️

"WHAT THE HELL is wrong with you?"

Derek looked up from where he was speaking to the interns about a potential surgery for his hand. Jackson and Callie raised their eyebrows when they heard her snap and glanced at each other.

"What?" he asked, furrowing his brows.

"I keep getting calls from your sisters, telling me that I need to do more," she said in frustration. "That I need to help you more. And that you need to call them more. Whatever. I'm not your freaking babysitter."

"Ellie—"

"Mark wouldn't want this for you," she continued, ignoring Jackson and Derek paused. "Yeah, I'm going to play the 'Mark' card. He wouldn't want you to give up on your surgical career. He would want you to find a way. And Callie and Jackson? They're trying to find you a way."

She let out a breath. "You have a chance, Derek. To go back to the life you had before... everything. You can get your hand back, and have a chance for normalcy again. And don't give me any of that doubt. Because you know as well as I do that Mark would do everything in his power to get you your hand back. But he can't. Because he's dead. You aren't."

"Ellie—"

She shook her head and steadied her breathing. "I won't let you give up on your career," she said quietly. "Because if you don't do surgery, then you're not the Derek Shepherd that I know and love. I've already lost one brother, I'm not losing another one.

"So whichever one of your overbearing sisters calls you, you will answer the damn phone, you will accept their help, and you will get back to being the great neurosurgeon that we know you are. Are we all understood?" There were a collective nods from the group and she let out a breath. "Good. If you'll all excuse me... I really need a nap."

☀️

"MER, I THOUGHT you were shutting this down," Ellie said the next day, walking over to Derek and Meredith in the lobby where she found Heather Brooks standing in front of the couple in frustration.

"You know that live nerves are better than dead ones!"

Ellie tilted her head. "I guess I missed something..."

"Even I know that and I'm an intern," Heather continued. "And you." She looked at Meredith. "You put me in a really awkward position today. You just threw me to the wolves—not that I'm comparing your sisters to wolves—but oh, my God, they're out for blood. They are furious with you that you didn't call them yourself."

"That's what I've been saying!" Ellie exclaimed, throwing her hands up.

"And they told me some things, okay?" Heather said and Ellie chuckled. "Unkind things. And now I know stories about you. And you, too. And Dr. Sloan."

Ellie frowned. "What did I do?"

"I know things about the three of you that I don't want to know," she told them. "I don't want to be in your secrets or your fights. It makes me really, really, really uncomfortable."

"Let me guess..." Ellie sighed when she heard the voice and immediately turned around, her gaze settling on one of the many brunettes she had grown up with. "Your parents had a messy divorce and always put you in the middle. Am I right?"

Heather looked at her. "How'd you know that?"

"Lucky guess," she replied before holding out her hand. "Lizzie, one of the wolves. And the better Elizabeth from New York." Ellie rolled her eyes, crossing her arms. "Good to see you, Mer. I hope you got some baby pictures handy because I did not take the Red Eye just so my brother could hack my nerves into hamburger meat." She looked at the blonde. "Hi, Beth."

"Beth?" Meredith asked, glancing between the Shepherd siblings and Ellie who was biting the inside of her cheek.

"It's their nickname for Ellie," Derek told her. "She doesn't like it."

Ellie smiled forcefully. "Nice to see you, Lizzie."

☀️

━ author's note:

I think lizzie was the only sister I could tolerate ( besides amelia, of course )

I had a chapter before this in the original version, but it was short and boring, and the only thing I liked was the pregnancy scare. so, I mentioned that, but that was it. basically, they are both on the same page for the future :)

y'all aren't ready for parent-jallie ( rereaders know, but still )