Chapter 32

"Fifth year is the hardest year of residency. Every surgery you do will go on your record, the wins and the losses. In just a few months you will.." Owen says. He was giving all of the 5th year residents a speech about the importance of this year.

"What did I miss?" Mer asks walking in wearing a pair of pink scrubs and taking a seat as Owen continues his speech.

"You're in OB? Oh, how the mighty have fallen." Jackson says making me slap him on the arm.

"Don't be rude." I scold him.

"She misses Zola, her uterus hurts." Alex says.

"Oh, leave her alone dirtbag." Cristina says to Alex. "You are embarrassing me." She whispers to Meredith.

"I'm getting to deliver babies. I'm making life, you know." Meredith says.

"Yeah, you know what, you're making me gag. Okay, slumming it in OB for a few weeks is okay, whatever, but wearing the vagina squad scrubs in public it's uh, we have standards Meredith." Cristina says before we turn our attention back to Owen.

"It is extremely important that you rack up as many good outcomes as possible for your boards. I am implementing a system. I will receive an email if any of you exceed more than ten bad outcomes in your OR. Ten, any more is unacceptable. Welcome Dr. Kepner." He says as April walks in late.

"Sorry, I got stuck in the lab with Bailey." April says.

"I don't care where you were. I care that you already have, let's see uh, two bad outcomes in your OR." Owen says.

"Loser." Alex smirks.

"Of course that's nothing compared to Karev's impressive five bad outcomes." Owen side eyes Alex.

"I keep getting dud patients." Alex says defending himself.

"Tell that to your board examiner. The point people is to keep your bad outcomes to a minimum or you will be hard-pressed to find a fellowship next year."

"Who are you texting?" I ask Cristina seeing her typing on her phone.

"Who do you think?" She smirks, before Owen's phone dings and he checks it.

"Dr. Yang are you sure you're getting all of this down?" He asks.

"Bad outcomes are bad, which is why I have zero so far, a perfect record I plan to continue during my Ortho rotation this week. No one dies during a hip replacement." Cristina says.

"Let's hope." Owen says before dismissing us. I go find Derek since today is my first day back on his service.

"Liliana, thank god you're back on my service." He says as I walk up to him.

"Aw, you missed me." I laugh.

"Of course I did. I always forget how clueless the other residents are until they end up on my service. I would specifically tell them I need 17 towels in the OR at all times and to separate the macrodissectors from the micros, which they always failed to do. And none of them knew how to go in and make the incisions like I like it, I don't know where they learned there technique from." He grumbles.

"What can I say, not everyone works the way we do." I shrug.

"You got that right." He nods.

"So what do we have scheduled for today?" I ask him.

"A bunch of boring cases."

"Boring is good, boring has less bad outcomes which is the last thing I need right now." I say before Derek gives me the chart, so I can go check the patients vitals. After I finish checking everyone's vitals I start walking back to the front desk until Meredith pages me 911, so I go to the labor and delivery floor to see what she needs.

"Meredith, what's wrong? Why did you page me 911?" I ask.

"You see that lady in there?" She asks pointing in a labor and delivery room where a women is sitting beside her husband holding her baby.

"Yeah, what about her?"

"She's got a butterfly tumor meaning..." Meredith says.

"That it extends into both sides of the brain. Do you know how many months she has?" I ask.

"6." Meredith sighs.

"She's dying so they decide to have a baby?" I ask.

"Well that's not the point. So I had St. Catherine's send over all her scans, and I want you to take them to Derek and get him to do a consult."

"Meredith butterfly tumors are inoperable."

"Come on, please just get him to take a look."

"No, no way." I shake my head.

"Liliana be inspired, you and Derek are just alike. You both love a good tumor and here's a beautiful tumor just waiting for someone to take that chance and operate on it." Meredith says.

"Fine, I'll show him the scans but that doesn't mean he'll say yes." I say taking the scans and walking away to find Derek. I find him sitting in the conference room with Mark and Owen.

"Derek I have some scans I'd like you to look over?" I say.

"Before you two consult on that scan, try a home made maple-ginger scone." Mark says to me pulling a scone out of his tupperware container.

"I would love to, but this is kind of the first priority right now and when did you learn to cook?" I ask.

"Its a passion of mine that I recently discovered since I'm letting your boyfriend lead on all of my cases and I have time on my hand, now try a scone you know you want to." He smirks.

"Fine." I say grabbing a scone and taking a bite "This is actually really good." I say surprised.

"Okay, that's enough of American bake off. Let's go look over the scans." Derek says, before we walk out of the conference room.

"What do you have for me?" He asks.

"The scans of a patient with a butterfly tumor."

"Butterfly tumors are inoperable." He frowns.

"No, I know, but this patient she's a new mom and it's a really sad story actually, but I was wondering if you'd do a quick consult."

"This is why you needed me so urgently? To tell a women her tumors inoperable, to remind her how sad her story is. You know what, just go find that article I need."

"No." I shake my head.

"What?"

"I said no. Derek, I really think we can remove this tumor, just at least look at the scans, please." I say.

"Fine." He sighs grabbing the scans. As soon as he lays his eyes on the tumor a smile spreads across his face and I know what that means. He's inspired and that no just turned into a yes. He follows me to the patients room, so we can consult with her about her tumor.

"Wait, I mean all the doctors we've seen said the tumors inoperable. Surgery could put her in a coma or kill her." The patients husband says.

"We just want to take another set of scans." I say.

"Exactly and it'll be good for you to have some alone time with Emma. You know that way I can die knowing that you're not going to drop her on her head." She jokes.

"Fine, run the scans." The husband agrees. We take the patient up to CT and run her scans before bringing her back to her room. After a little while passes my intern brings me the CT results and I page Derek to meet me in the patients room.

"Most astrocytomas spread out through the corpus callosum, it fans out like smoke, but if you look at your tumor, Mary I've never seen anything like it. Look at the edges, they're smooth, defined." Derek says.

"They're easier to cut around?" She asks.

"Yes, if we can keep the entire dissection inside and never let it drift outside." I explain.

"I'm sorry, are you saying what I think you're saying?"

"Mary, I think we can remove your tumor." I smile.

"Mary, this isn't a decision you make on a whim." Her husband says.

"He's right you need time to make this decision." Derek agrees.

"We don't need time, we've decided. Sign me up." She says.

"Emma, yeah, if you get to call brain tumor I get to call Emma. It's not just the two of us anymore, we have a daughter. She needs these six months with you. I mean you're her mom. Please Mary, don't do this." Her husband pleads. We walk out and give them a little time to discuss things and they decide she's going to get the surgery. We get an OR reserved and get her prepped before taking her to surgery and getting scrubbed in.

"You know this was really risky of you, taking part in this surgery with such a high chance of a bad outcome." Derek says as we operate.

"Believe me I know. My first thought was to say no, but she has a daughter and a husband, she deserves the chance to live her life with them." I say.

"Sentimental." Derek says making me laugh.

"Shut up, I need to focus." I chuckle, this was the first time I've ever led in surgery on a tumor like this and I was not trying to make any mistakes.

"Okay, I've cleared out the tumor on the right side of the brain, but there's all these vessels blocking the way now, like a line of defense. This tumor is smart, maybe we should stop I mean she has six months at least that's something." I sigh.

"No, you got this. This tumor is smart but you're smarter, now focus."

"Okay." I nod before beginning to operate again.

"Dammit, she's herniating." I sigh as the monitors go off.

"That means a vessel leaked and the tumors starting to swell, we're going to have to drain the ventricle." Derek says handing me the blunt tip needle.

"Derek, I think you should do it. I might mess up I've never dealt with a tumor like this before."

"Stop doubting yourself, you've got this Liliana." He assures me.

"Okay." I say taking a deep breath before going in. It's difficult, but we finish surgery successfully. Derek sends me to tell the husband the good news since I did a majority of the surgery.

"Just tell me." The husband says nervously standing up rocking the sleeping baby.

"We got it, we got the whole tumor." I smile.

"Thank you, thank you. You have a mommy Emma, you have a mommy." He cries looking down at his daughter, I sit down with him and explain the recovery process before I have a nurse take him to see to her then I go to the locker room to get out of my scrubs.

"Hey you." Jackson says kissing me as he walks into the locker room.

"Hey, do you know what I did today. I operated on an inoperable tumor successfully, because of me a little girl is going to get to grow up with a mother and a husband gets to grow old with his wife. I love being a surgeon." I smile. Even though this job is grueling and tiresome, days like today remind me why I am who I am today, a surgeon.