"Patients who undergo an amputation often feel a sensation where the missing limb was as if it's still there. The syndrome is called phantom limb. It's as if the body can't accept that a terrible trauma has occurred. The mind is trying to make the body complete again. Patients who experience phantom limb report many different sensations but by far the most common is pain. The body can be stubborn when it comes to accepting change. The mind holds out hope that the body can be whole again and the mind will always fight for hope, tooth and nail, until it finds a way of understanding its new reality and accepts that what is gone is gone forever"

"don't stop, just keep going on"

Derek, Lucy and Callie were walking down the hall in the hospital. "An acoustic neuroma?" Callie questioned him. "Oh, boy", he muttered. "A long, difficult surgery with a stupid-high post-excision mortality/morbidity? That's what you want to start my hand with?" "It's my hand", Derek corrected. "And thanks for making it sound so fun"

"You can't try something with a little margin for error?"

"I was supposed to operate on Jimmy months ago, but then the plane crashed. It has to be today"

"Well, if you can do this, I guess my hand can do anything"

"Still my hand"

They made their way to the nurses station where all the attendings were gathered and Owen came out. "Okay, folks. Let's just start", he said, going up the stairs and standing a few steps up. "As many of you know, Seattle Grace Mercy West has suffered a financial setback. The administration is working hard to keep the impact of that setback as small as possible. To that end, we're gonna have to initiate some cost-cutting measures. The board has hired a physician advisor to help". "What's a physician advisor?" Lucy asked.

"Well, she consults on maximising efficiency, streamlining processes, assessing where we can trim our budgets"

"Who to fire and when to fire them?" Bailey said.

"She's here to advise and to help. I was hoping to introduce her in person, but she seems to be late"

"On her first day?" Cristina said. "Not very efficient"

"You can expect to see her in the halls, in your labs, in the OR"

"So we're gonna have an accountant following us around in the ORs?" Derek said.

"She's not an accountant. She is a trained surgeon. Frankly, she is here to try to help us. Thank you for cooperation"

Arizona, Aurora, Alex and Cristina were in Nyah's room. "Everyone at Namboze was so worried when we heard the program might move to UCLA, myself included", Makena said. "You make the kids feel so at home here". "Well, we were never gonna let that happen", Alex replied. "No, I was away, but now I'm back", Arizona added. "And as long as Dr Karev and I are here, then the program stays here". "Okay, Nyah's pericarditis is quite severe", Cristina explained. "The pericardial sac around her heart is inflamed and starting to adhere to the heart itself. So I'll perform what's called pericardial stripping. So I'll remove the sac, and her heart will start beating on its own again". "What shall I tell her?" Makena asked. "Tell her we're gonna fix her heart, and she'll breathe much better", Alex said. Makena started translating for her as Alex, Aurora and Cristina left the room. "Nice program. Shame to see it go", Cristina commented. "Thanks. Wait. What?" Alex said. "What are you talking about?" Aurora asked. "We're getting a visit from the efficiency fairy", Cristina answered. "You think she's not gonna make this disappear?" "Look, shut up. We just got it back", Alex said.

"She's trimming fat. You're flying kids across the world for a pro bono surgery. That's pretty fatty"

"Yeah, they're orphans", Aurora pointed out.

"Well, now you're just making my point"

Cristina, Alex, Aurora and Arizona were operating. "The pericardium is free", Cristina said. "You should see an increase in cardiac function". "It's weird. Heart's floppy", Alex commented. "Still not the way a kid's heart should look".

"Could be endocarditis. I'll do a biopsy. Biopsy needle, please. Unless it's... Oh, my God. It couldn't, could it? Could this be endomyocardial fibrosis? I've only read about it. It's rare, subtropical. Could this be that?"

"Maybe. Remember we had that kid with Pentalogy of Cantrell?"

"This program...is a medical freak show goldmine. They can't cut it"

"Nobody's cutting it. Would you stop that?" Aurora said. "Robbins, tell her to stop saying that", Alex added. "I'm sorry. What?" Arizona said.

"You alright?"

"Yeah"

"Okay, take that to Path. Stat, please", Cristina instructed.

"You know what? I'll take it. Alex, you take my place"

"The nurse can take it", Alex pointed out.

"No, I'd rather take it myself"

Arizona, Alex, Aurora and Cristina were operating while Alana and Owen watched from the gallery. Suddenly, Arizona knocked something over. "What happened?" Cristina asked. "You need me to step in?" Alex asked. "No. No", Arizona said. "Robbins?" Owen said from the intercom. "Try to picture the waves".

"I'm trying"

"Okay, really, what is happening?" Cristina said. "Just calm the waves", Owen encouraged. "These are tsunami-force waves, Owen", Arizona replied. "Look, you should go. I'll take over", Alex offered. "Alright. No one is moving", Cristina ordered. "I'm stripping the endocardium from the papillary muscle. I screw this up, I'll have to replace the mitral valve, so don't move". "I can switch out...", Alex began. "Just shut up", Arizona interjected. "I'm at the beach".

"I have to switch, Alex", Arizona said weakly. "No one is switching", Cristina stated. "You're holding the mitral valve, so don't move". "What's wrong? Are you sick?" Aurora asked. "Alex, take that scalpel...", Arizona instructed. "What? What are you doing?" Cristina interjected.

"...and stab me in the foot"

"What?" Alex said. "What?" Cristina added. "What?" Aurora said. "My prosthetic. Stab me", Arizona ordered. "What is wrong with you?" Alex said. "Dr Karev, I am the chief of surgery", Owen said from the intercom. "This is an order. Stab Dr Robbins in the foot right now". "What?" Aurora exclaimed. "Alex", Arizona said as he picked up a scalpel.

"Arizona? Alex!"

He crouched down and stabbed her prosthetic. "That's better", she sighed.

Cristina, Alex and Aurora were in Nyah's room. "Her heart is pumping like a champ", Alex said. "Thank you, all of you", Makena said. "What else do you have over there?" Cristina asked her.

"I'm sorry?"

"Sick... Orphan... Children? Kids with heart problems?"

"She means, she's glad the program is up and running again", Aurora said. "We all are".

"Yes"

Alana was in a meeting with the attendings. "Alright, welcome. Welcome, everyone", she greeted. "Thank you so much for coming. It has been a privilege to watch you work, and I am so impressed with what I've seen. Dr Karev's paediatric African exchange program...". "You cannot cut that program", Cristina interjected. "I'm sorry, but these children, these... Little orphans... We are the only hope they have. Many of them have rare disorders that most western doctors rarely have the opportunity to treat. And if you stop the program, I will never get that chance again. They. They will never get that chance, the precious children".

"I have no intention of cutting it"

"Super"

"It's a no-brainer from a PR standpoint. That kind of positive visibility is gold. However, there will have to be some cuts. And I'm going to suggest one that is going to seem surprising at first, but that addresses fiduciary concerns with nominal impact on the core facility and the human and physical resources"

"I'm sorry. What?" Lucy questioned. "Yeah. I'm out", Bailey agreed. "I am proposing that we close your ER", Alana stated. They all made statements of shock and disbelief. "We're a level one trauma centre", Owen reasoned. "We're a hospital", Richard added. "In the last three days, your ER went from being in shambles to peak efficiency", she explained. "Well, then why would you propose cutting it?" April asked.

"This allowed me to see that in either case, it's not bringing in the money"

"It's bringing in the patients", Owen said.

"Over half of whom are non-emergent, underinsured, and belong in a primary care physician's office. You have surgical interns in there doing chest exams. It's haemorrhaging resources. Look, I know these cuts are going to be painful. But understand that I am trying to keep your hospital doors open"

"This is ridiculous. You can't close the ER", Derek argued. "You went to med school. You have to ask yourself...". "Do you have a better idea?" Bailey interjected. "Because the way I see it, this woman is trying to keep the hospital from closing, in which case there'd be no patients, we'd have no jobs, and some of us don't have a few million to fall back on. So unless you have a better idea, why don't you just sit there and listen to what she has to say?". "Alright", Alana said, clearing her throat. "So... The other proposals include a review of ICU, step-down closures with a reorganisation of post-op care...". 

hope you enjoyed! comment your opinions! song is walking on a dream by empire sun