Chapter 86

"You asked for a consult. This is my advice." Derek says.

"That's not the point. I have to control the infection." Maggie says. Derek paged me for a consult on a patient that him and Maggie are working on, but ever since I've been in CT to analyze the scans, they have been bickering back and forth on the appropriate steps to take to treat this patient, so we haven't gotten far at all.

"Surgery first. She has an abscess of her brain ventricle." Derek argues.

"If I don't operate, she will die of sepsis. If it ruptures, she won't sur.." Maggie argues as they yell over one another.

"Hey, both of you calm down! Ever since I've been in here you two have done nothing but argue, which isn't going to help anyone come to a decision. Why was I even paged anyways? You two need a general consult for this patient." I say.

"That is exactly what I said and why I wanted to page Meredith." Maggie says.

"So why didn't you?" I ask.

"Because I wanted an objective point of view and I don't know if Meredith can provide that." Derek says.

"Just because Maggie and Meredith are sisters doesn't mean that Meredith can't provide an objective point of view. I mean we're talking about Meredith, she definitely won't let personal feelings effect her medical decisions." I say. Not to long ago we found out that Maggie and Meredith are sisters, which was shocking to everyone. Meredith didn't even know.

"Look, I'm just saying I think you can give us a more objective point of view." Derek says.

"I'm a neuro surgeon. Of course I'm always going to be in favor of doing brain surgery before any other surgery, which is why you need another more objective consult. If you don't want to page Meredith, page Webber, but you need a general consult for this case." I say before leaving for my surgery. Derek and I have been managing to get along pretty well at work lately, even though we still have the occasional disagreement, which is normal because we both have different professional opinions at times, but we haven't had any big arguments recently, which I'm extremely glad of because I hated arguing with him all of the time. I go get my patient prepped for surgery before taking him to the O.R.

"How's he look?" Owen asks walking into the room as I scrub in for surgery.

"C. T. showed a multifocal hemorrhage with some edema. I'll know more once I'm in there, but he's gonna need a full craniotomy" I say

"Alright." He nods.

"Was there something you needed?" I ask.

"Um no. Well, actually I just wanted to apologize for the other day. When I was asking all of those questions about Amelia. I know Derek's your best friend and she's his sister, so I shouldn't have put you in the position to answer questions regarding her career." He apologizes.

"No, it's fine. I'm the head of neuro now, so of course you would come to me with questions regarding any surgeons working in my department. I didn't mean to be so defensive, it's just I didn't feel like Amelia had anyone to take up for her, so I felt like I needed to defend her. You're the chief of surgery so you have every right to want know if Amelia is a capable surgeon or not. I just think its best that if you have questions regarding mistakes she's made in the past, you go to her. I know Amelia and she'll have no problem giving you an explanation." I say.

"Yeah, I'll keep that in mind." He agrees before leaving. I finish getting scrubbed in before going into the OR to operate. Since the hemorrhage is pretty bad and requires a full craniotomy, the surgery takes 8 hours. I manage to successfully stop the bleeding before closing the patient up and taking him to recovery.

"Hey you." Jackson says walking over to the front desk where I was reviewing my charts.

"Hey." I yawn,

"You tired?" He asks.

"Yes, I did two surgeries early this morning and I just got done with a 8 hour surgery, which is normally a walk in the park, but since our child is already taking most of my energy, I'm exhausted." I sigh.

"Sweetheart, maybe you should take it a little bit easier around here right now." He says.

"I'm the Chief of Neuro now. I can't take it easy. I have a department to run Avery."

"I know, but you're pregnant and you don't need to overwork yourself." He reminds me.

"I won't. If I feel like I need a break I'll get Derek to take some of my surgeries."

"You promise?"

"Yes, Avery. I'm actually about to go take a nap right now." I say.

"Okay." He says giving me a kiss before I walk away.

"Liliana, do you have a minute?" Amelia calls from CT when she sees me in the hallway.

"Well, I was about to go take a nap, but sure. What do you need?" I ask walking into CT.

"I wanted you to take a look at the scans of this tumor." She says pulling up the scans on the computer.

"Wow, this tumor is spectacular. This is a huge astrocytoma. See how it ignores anatomical borders. It's like a perfect butterfly. It starts in the subfrontal and extends practically into the hypothalamus. That is a thing of a beauty." I smile.

"Do you think it would be possible to remove it?" She asks.

"Well this tumor is smart, really smart and complex. Operating on a tumor like this could likely lead to a stroke, loss of vision, paralysis, and much more but in my honest professional opinion I feel that it's possible to remove this tumor. It'll be tricky and it would include a lot of risks and the patient would need a kick ass surgeon, but it's possible. Why do you ask?"

"Because this is Nicole Herman's tumor and she was told that it's terminal, but I believe I can remove it. But you're the head of neuro and for a tumor like this, I need your permission to even go near it, so I'm asking if you will trust me to remove this thing?" Amelia asks.

"Amelia, this is a giant tumor and it's not just anyone's tumor, it's one of our owns. That's a lot of pressure." I say.

"You said you believe that it's possible to remove this thing if the patient had a kick ass surgeon, right? Well that's me, I can do this. I need you to believe in me. I know that I haven't been working here long, but you know I'm talented or you wouldn't have defended me to Owen that day. Liliana, please let me remove this tumor. Let me show everyone that I'm not just Derek Shepherd's druggie sister." She pleads.

"You know that if you choose to take this on, this has to be your main focus. This a monster of a tumor." I say.

"I know and I'm willing to eat, sleep, and breathe this tumor." She assures me.

"Okay then. I am giving you permission to operate on this thing." I agree.

"Thank you for giving me this chance." She smiles.

"You don't have to thank me, just don't make me regret this." I say as I stand up.

"I won't." She smiles, before I leave to go to an on-call room. I manage to get a little bit of rest until my pager goes off and I see that Derek's paging me, so I go to the gallery where he's watching Meredith and Maggie's surgery.