The fluorescent lights of Seattle Grace buzzed overhead, casting a cold, clinical glow along the busy corridor.
Lexie Grey moved quietly, sneakers soundless against the polished floors, her heart hammering against her ribs.
Ahead, the conference room: closed doors, glass walls, and inside—Chief Richard Webber, sitting rigid at the head of the long table, surrounded by attendings.
They were mid-discussion, voices low but urgent, and Lexie edged closer, her breath catching in her throat.
She crept to the glass, pressing in just enough to see Webber lean forward, hands steepled together, his face carved from stone.
Lexie squinted, trying to read his lips. "Karev."The name was unmistakable on the Chief's mouth. Karev? Karev was getting the first solo surgery?
She straightened instinctively, ready to bolt back to work before anyone noticed, when A warm breath brushed the nape of her neck.
She stiffened, freezing in place.
A voice, low and amused, murmured right behind her ear,
"What exactly do you think you're doing, Grey?"
Lexie yelped, spinning to find James Blackwood standing inches away, his navy scrubs hugging his lean frame, his dark hair swept back, his hazel eyes dancing with. His chart was tucked under one arm, his grin a spark that lit her up inside. Without thinking, she threw her arms around his neck, her cheek pressed to his chest. His scent felt like home.
"James," she breathed, her voice muffled, her heart soaring. But the hospital's chaos crashed in, then froze, remembering where they were. She jumped back like she'd been burned.
James's grin softened as his eyes followed the contours of her freckled face, taking in every nervous twitch she made.
"God, Lex, I missed you," he said, his voice low, rough with longing, a crack in the polished surgeon's armour. He stepped closer, his hand yearning to touch her, but he restrained himself.
Lexie's smile shattered completely. Her arms snapped across her chest, her posture rigid.
"Four days! You were gone for four days!" she exclaimed, her voice sharp and angry.
"You said twenty-four hours, James. One surgery in Boston, in and out. No calls, no texts. Where were you?"
James dragged a hand through his hair, shame creeping up his face, his stance shrinking like a scolded boy.
"I'm sorry, Lex. The aortic dissection went south—the aneurysm blew mid-op and took hours to stabilise.
Then my chief cornered me. Said if I was leaving Boston for Seattle, I owed him. A valve job, a bypass, emergencies...
I was in the OR nonstop, Lex. Barely had time to breathe, let alone call."
His voice dropped, thick with guilt.
"But... you didn't call me either."
Lexie opened her mouth, ready to snap back—but the words caught in her throat.
Her anger flickered, replaced by sudden nerves, fear twisting in her gut.
She hadn't called—not because she couldn't, but because she was hiding.
James couldn't know what she did.
"I... I was busy," she said quickly, her voice suddenly small and defensive, her eyes dropping to the floor. "ER chaos, charts piling up. I didn't have time."
James's brow creased, his gaze sharpening, sensing the dodge.
"You were worried about me, and you didn't call? Lex, that's not you." His tone was gentle but piercing, his hand brushing her arm, a familiar pat that sparked warmth despite her shame.
"What's going on?"
Before she could scramble for another lie, the conference room door swung open, and Richard Webber strode out, his presence like a gavel striking silence. His eyes landed on them, his brow lifting at their closeness.
"Dr. Blackwood," he said, his voice warm yet commanding as he extended his hand. "Welcome to Seattle Grace. A surgeon like you is a massive asset for our cardio department."
James shook his hand, his smile smooth and professional, the rawness of moments ago tucked away. "Thank you, Chief. I'm ready to dive in."
Webber's gaze flicked to Lexie, then back to James, curiosity glinting. "You two know each other?"
Lexie's heart stuttered, her cheeks burning, but James answered without missing a beat, his voice steady.
"We met at Harvard, where I gave a lecture on minimally invasive techniques while Dr. Grey was a senior. She asked some fantastic questions that left a lasting impression on me." He gave Lexie a brief, private grin, a partial truth that protected their secret like a fortress.
Lexie nodded, her smile forced, her hands twisting behind her back. "Yeah, Dr. Blackwood's talk was… motivating." Her voice was too bright, but Webber bought it.
"Good," Webber said briskly. "Dr. Grey, gather the residents. Get them to me. I'll announce the solo surgery selection soon. Move it."
"Yes, sir," Lexie said, steady despite the storm in her chest. Webber nodded, clapping James's shoulder before striding off, his white coat billowing like a flag.
Lexie exhaled, her eyes meeting James's, relief and tension swirling.
"I gotta go," she said, her voice soft, her fingers grazing his hand, a fleeting, desperate touch. "But… we're talking later, right?"
James's grin bloomed, boyish and warm, his eyes promising everything. "Count on it, Grey. Find me when you're done playing spy." He winked, stepping back, his chart in hand as he headed toward the cardio wing.
Lexie turned, her sneakers squeaking as she raced to gather the residents.
===============================================
"I am happy to announce that the first solo surgery will take place tonight," Richard began, his voice steady. "A below-the-knee amputation, bone cancer. Mr. Collinsworth in 2212."
Alex muttered under his breath, "Poor bastard."
Izzie frowned. "No appendectomy?"
Alex smirked. "Saw action. Sweet."
Richard ignored their chatter, scanning the room. "Choosing who gets the first solo surgery is not solely based on surgical skills or the number of hours logged in the operating room. It reflects the highest form of trust—the trust to place a patient's life in the hands of one of our residents. For the first time, I can remember, every single attending chose the same person." He paused, allowing the significance of his words to sink in.
"Dr. Yang."
The room froze. Cristina's eyes widened, a rare crack in her composed facade. The others exchanged glances, a mix of envy and resignation. But Richard wasn't finished.
"However, Dr. Yang is out of the running. She is going to pick the winner instead. Dr. Yang will post her decision on the O.R. board at 4:00 P.M. Also, since your interns are still banned from the O.R., the winner will be allowed to pick a fellow resident to scrub in with them. Good luck."
The residents filed out, the weight of the announcement pressing down on them. Cristina lingered, her expression unreadable.
"This is torture for me," she muttered as Richard approached her.
"I'm not done with you, Yang," Richard said, his tone firm, a general issuing orders.
"Dr Blackwood's here today, and he's agreed to join our cardio department as head. But the contract's not signed yet. He's set to put pen to paper this evening, and I need that signature. You're spending the day with him. Make sure he's comfortable, and show him what Seattle Grace can do. By the end of the day, I want him locked in, with no second thoughts. If he walks, I'll know who to blame."
Cristina's jaw tightened, her mind already spinning with the challenge. Another test, another chance to prove herself, but the stakes felt higher, personal. She nodded sharply, her voice clipped.
"Understood, Chief. I'll make sure he stays."
Richard's eyes held hers for a moment, measuring, and then he nodded and turned away, his footsteps echoing in the emptying atrium. Cristina exhaled, her fingers drumming against her arm, headed for the cardio wing.
===============================================
The Seattle Grace cafeteria buzzed with the clatter of trays and soft conversations, offering a temporary refuge from the relentless pace of the hospital. James Blackwood sat alone at a corner table, holding a steaming cup of coffee in one hand and a glowing tablet displaying a patient chart in the other. The air was filled with the smell of overcooked eggs and bleach, but his focus remained sharp as his hazel eyes scanned the details of a 19-year-old patient named Ethan Carter, who had hypertrophic cardiomyopathy and was scheduled for a septal myectomy that afternoon. It was a tricky case with high stakes, the kind that made his heart race—not from fear, but from purpose. His navy scrubs were crisp, and his white coat hung over the chair. As he sipped his coffee, the bitter taste grounded him.
Focused on Ethan's chart: low ejection fraction and frequent arrhythmias. Just then, a snippet of conversation from the table next to him interrupted his thoughts like a scalpel cutting through silence.
"…I heard the interns went rogue," one doctor said quietly as he stirred his tea. "They performed surgery on one of their own—can you believe it? They nearly killed someone."
The other doctor scoffed, her tone dry. "Idiots. No wonder Webber banned them from the operating room."
James's pen came to a halt, his heart racing, a cold dread tightening in his stomach. Interns were turning against one of their own, putting a life at risk in a reckless pursuit of glory. Lexie—his Lexie—could she have been involved? Her band-aids, her evasiveness in the hallway, the promise she made to avoid such dangerous actions—it all swirled in his mind, like a puzzle with missing pieces. He didn't know if she was involved, but the mere thought felt like a knife: her scalpel trembling, her blood pooling, her smile fading. His jaw clenched, and he gripped the chart tighter, fear and suspicion battling within him. He needed answers, but Ethan's case required his attention, forcing his focus back to the chart when a shadow fell across the table.
"Dr. Blackwood," Cristina Yang's voice cut through, respectful but firm. "The Chief assigned me to you today. I will be your resident today."
James forced a smile, his anger at Lexie simmering beneath the surface. "Dr. Yang, good to see you." His voice was smooth. He pushed the chart toward her.
"Ethan Carter, 19, hypertrophic cardiomyopathy. We're doing a septal myectomy this afternoon. High-risk, but he's young and strong. I want you in the OR with me—let's see if you live up to the hype." He leaned back, his grin returning, though his mind was still half on Lexie. "How about we check on him now? Get a feel for the kid before we cut."
Cristina nodded, her eyes gleaming with hunger, already skimming the chart.
"One more thing. Those interns—what happened? The surgery they performed. I heard whispers, but what's the full story?"
===============================================
In Room 2212, the air was filled with the scent of antiseptic, accompanied by the soft beeping of a heart monitor. Ethan Carter lay propped up in bed, his lanky frame dwarfed by the hospital gown. His brown eyes were wary but bright. His parents, a weary-looking couple in their forties, sat beside him with their hands clasped, their faces etched with concern. Dr James stood at the foot of the bed, dressed in a white coat and exuding a steady presence, while Cristina took the lead. Her voice was clear and practised, presenting the resident's ritual as if it were a scene from a medical drama.
"Ethan Carter, 19 years old, was diagnosed with hypertrophic cardiomyopathy at age 16," Cristina began, glancing between the chart and the patient. "He presents with shortness of breath, chest pain, and recurrent syncope. An echocardiogram shows left ventricular outflow tract obstruction with a gradient of 60 mmHg. Today's procedure is a septal myectomy, which will resect the thickened septal muscle. This will relieve the obstruction and reduce the risk of sudden cardiac death."
Ethan nodded, his fingers twisting the bedsheet, while his mother, Mrs Carter, leaned forward, her voice trembling.
"Dr. Blackwood, you've done this before, right? It's… Is it safe for him? He's our only son.
James's expression softened, his hazel eyes meeting hers with a calm that anchored the room.
"Mrs. Carter, I've performed this procedure successfully many times before. While there are risks involved, Ethan is young, and his heart is resilient. We'll be removing the blockage to give him a chance at a full life—sports, college, all of it. I'll be with him every step of the way, and Dr. Yang here is one of the best residents I've worked with." He glanced at Cristina, offering a subtle nod of trust.
Mr. Carter cleared his throat, his voice gruff. "How long will he be in recovery? Will he need more surgeries later?"
"Recovery will take about a week in the hospital, followed by six to eight weeks at home," James replied, maintaining a measured tone.
"We'll monitor him closely with medication and follow-up appointments. If everything goes well today, as I expect it will, he shouldn't need another procedure for years, if ever. We're prepared for the long haul here." His smile was reassuring, a flicker of the charm that had won Lexie's heart.
The door swung open, and Alex Karev walked in, his scrubs stained and his expression focused.
"Dr. Blackwood," Alex said, his voice breaking the silence of the room. "Dr. Shepherd needs a cardio consult. Are you free?"
James nodded calmly. "Tell Derek I'm on my way." He turned back to Ethan and his parents, a reassuring smile returning to his face. "We'll check in before the surgery, Ethan. Rest up, alright? You're in good hands."
Ethan nodded, and his parents murmured their thanks as James stepped out, Cristina by his side, while Alex was already on his way.
===============================================
"Cristina still hasn't talked to me," Lexie said, her voice tinged with hurt. "Which is normal, except it's worse. Two weeks suspension, and she hasn't even bothered to say one mean thing."
Ryan, sprawled in a chair, smirked. "Karev called me a moron, which is good."
Sadie, picking at her nails, sighed. "Well, none of the residents even look at me. The least they could do is hate us."
Ryan stretched, his grin widening. "Well, I'm gonna get some sex. Sex always makes me feel better."
Lexie's eyes widened. "Don't look at me."
Sadie shook her head. "Me either."
Graciella raised a hand. "That makes three of us."
Lexie, found Mark Sloan in the hallway, his confident stride unmistakable. "Hi," she said, her voice bright but nervous. "I get it. I'm the one who organized a crazy cabal of secret cutter interns. The thing is, I've been advised to seek out s*x as a way out of my sad predicament, but I think I would rather just learn today, so... what do you say? You, me..."
Mark's eyebrows shot up. "Why are you talking about sex to me? It's inappropriate. I'm your teacher. I have things to teach... double board certified things."
Lexie's face flushed. "No, that was always… that's what I was talking about, for… for you to teach me medicine. The… the sex was that… that was a joke." She laughed, the sound high and nervous, her eyes darting away. "Besides, I have a boyfriend, so, you know, I'm not… I'm not looking for… that."
Mark's jaw tightened almost imperceptibly, a flicker of jealousy he quickly buried beneath his trademark charm.
"A boyfriend, huh?" he said, crossing his arms with a studied nonchalance. "Didn't peg you for the settling-down type, Little Grey. Who's the lucky guy?" His voice was light, but there was an edge to it, a curiosity laced with something sharper, something he was trying hard not to show.
Lexie shifted, her fingers twisting the hem of her scrub top, her mind racing to construct a believable lie. "Oh, um, it's… It's just someone. You wouldn't know him. He's not… he's not from the hospital." The words felt awkward, stumbling over themselves, but she continued, eager to shift the conversation away from the unsettling warmth in his gaze. "He's wonderful, really… supportive. We've been together for a while."
Mark narrowed his eyes slightly, his grin returning, though it carried a forced ease that didn't quite reach his eyes.
"Supportive, huh? That's nice," he said. He tilted his head, studying her with an intensity that made her skin prickle. "What's his name? What does he do? Come on, Grey, give me the details. I'm curious." His tone was playful, but there was a subtle challenge to it, a need to know that went beyond casual interest. The way his fingers tapped lightly against his arm revealed a restlessness and a hint of envy he was trying to conceal.
Lexie's heart raced, her mind scrambling for a response. She hadn't expected him to press, hadn't anticipated the way his attention made her stomach flutter, a dangerous pull she wasn't ready to acknowledge. "His name's… Tom," she blurted, the first name that came to mind. "He's a… a graphic designer. Lives in Seattle. We met at a coffee shop, and it's… It's good. Good." She forced a smile, hoping it looked convincing, though her voice wavered under the weight of his scrutiny.
Mark's smile tightened, a muscle in his cheek twitching as he repeated, "Tom the graphic designer." His tone was mockingly thoughtful, but there was a bite to it, a flicker of something raw he quickly masked with a chuckle.
"Sounds like a real catch. You two are serious, then? already picking out curtains and wedding venues??" He shifted his weight, his posture still relaxed, but his eyes betrayed him, searching her face for a crack in her story, a hint that this "Tom" wasn't as real as she claimed.
Lexie laughed, the sound more genuine this time, though it was laced with nerves.
"No, no, nothing like that. Just… you know, taking it day by day. But he's great. I'm… I'm happy." She met his eyes, willing herself to hold his gaze, to ignore the way his proximity made her breath catch. The lie felt fragile, a thin shield against the spark she felt between them, a spark she couldn't afford to entertain.
Mark's smile softened, but there was a glint in his eyes, a mix of amusement and something deeper, something he wasn't ready to name. "Good for you, Grey. I'm glad you're happy." His voice was warm, but beneath it lay a hint of strain, a flicker of jealousy that he pushed down with layers of charm. He straightened up, his tone returning to a professional level, though his gaze lingered on her a moment longer than was necessary.
"But if you're serious about learning, I've got a hypopharynx reconstruction today. Cutting-edge stuff. You in?"
Lexie nodded eagerly, relief flooding her as the conversation veered back to safer ground. "Yes. I want to learn. Thank you, Dr. Sloan."
Before Mark could respond, Miranda Bailey approached her presence a grounding force in the chaotic hallway.
"Dr. Sloan," she said, her tone professional but eager, her eyes bright with anticipation. "I heard you're performing a hypopharynx reconstruction today."
Mark nodded, a spark of pride in his eyes, his focus shifting away from Lexie, though the ghost of their conversation lingered in his tightened jaw. "I'm gonna make a woman speak again. Well, let's hope."
Bailey's eyes lit up, her enthusiasm palpable. "I read up on the surgery and…"
"You read up on my surgery?" Mark asked, amused, his earlier tension easing as he slipped back into his confident persona.
"Since it's your first time performing what I understand to be a very cutting-edge surgery, I was hoping you might need an extra set of hands," Bailey said, her voice steady but hopeful.
Mark considered her for a moment, then nodded. "Fine. You can join Dr. Grey and me."
Bailey frowned, her brow furrowing. "Dr. Grey, who's been banned from the O.R.?"
Mark smirked, his eyes flicking to Lexie with a hint of mischief, though the shadow of his earlier jealousy still lingered in the set of his shoulders. "She's on cappuccino duty, which, Dr. Grey, I'm still waiting for."
Lexie nodded quickly. "Right away. Thank you." She hurried off, her cheeks still burning from her earlier blunder.
===============================================
The operating room was a sterile enclave, its white walls sharp under fluorescent lights, the air heavy with the faint hum of machines and the tang of antiseptic.
Holly Anderson, 16, lay on the table, her pale face shadowed beneath the surgical drape, her chest rising with the ventilator's steady rhythm. Monitors glowed softly, their beeps a fragile tether to life. Derek Shepherd stood at the head, his hands poised over Holly's exposed brain, a delicate field now strained by a carotid dissection. Alex Karev stood beside him, his scrub cap crooked, his jaw set with focus. Cristina Yang faced them, her sharp eyes tracking every move, her paper chart clutched tightly. James Blackwood, the new cardio surgeon, stood next to Cristina, his navy scrubs crisp, his hazel eyes scanning the data on monitors, ready to step in.
James leaned toward Derek, his voice low, a nostalgic grin breaking the tension. "Remember New York, Derek? I, the wide-eyed intern, fumbling sutures, you barking orders as the hotshot resident. ORs were brutal, but you taught me to keep my hands steady."
Derek's eyes crinkled, a rare smile softening his focus.
"You were a pain in the ass, Blackwood. But you learned fast. Got that Harper Avery for a reason." His voice held warmth, their shared history a brief anchor in the storm.
Derek's voice cut through the moment, calm but commanding. "Let's focus, people. Yang, watch Karev. He's sewing the graft, and I want to see if he's got what it takes."
Alex's breath caught, his eyes widening. "Really?"
"Absolutely," Derek said, his tone firm. "Show us you're prepared, Karev."
Alex stepped forward, his hands trembling slightly as he took the needle driver. The graft—a delicate lattice of tissue meant to stabilise Holly's haemorrhaging brain—was a test of skill and nerve. He exhaled, his world narrowing to the needle, the suture, the fragile tissue beneath his hands. His movements were deliberate, each stitch a small act of defiance against the chaos threatening to engulf them. Derek watched closely, his expression a mask of concentration, while Cristina's eyes tracked every motion, cataloguing Alex's precision, his hesitations, his resolve.
For a moment, hope flickered. Holly's vitals stabilised, the monitors settling into a steady rhythm. But then, a sharp beep shattered the fragile calm, the monitors flashing red as Holly's brain began to change color on the imaging screen, a vivid, unnatural hue that signalled disaster. Alex froze, his hands hovering above the graft.
"What just happened? Her brain is changing colour."
Derek's voice was a low growl. "She's haemorrhaging. Push 100 of mannitol." He moved to take over, but James's voice cut through, sharp and decisive.
"Hold on, Shepherd. It's not just the brain. Look at the cardiac output." James's eyes flicked to the monitors, his hands already reaching for a tray of instruments. "The hemopericardium's compressing the heart, and I'm seeing signs of a carotid dissection. We've got a narrowing window. I'm going in."
Derek's eyes widened, but he nodded, stepping back to give James space. "Go."
James moved with a surgeon's grace, his hands a blur of precision as he performed a pericardiocentesis, inserting a needle to drain the blood from the pericardial sac. The monitors responded almost instantly, Holly's heart rate stabilizing as the pressure eased. But James wasn't done.
"The carotid dissection's the real threat," he said, his voice steady.
"It's restricting blood flow to the brain, causing the haemorrhage. I can stent it, but we need to move fast."
Cristina's breath caught, her eyes locked on James's hands. She'd seen cardio surgeries before, but this was different—a masterclass in speed and skill. James worked with an almost preternatural calm, threading an endovascular stent through Holly's vascular system to repair the dissected carotid artery. His movements were fluid, each decision precise, as if he'd mapped the procedure in his mind before touching the patient. Derek adjusted his instruments, working in tandem to manage the brain haemorrhage, their efforts a synchronised dance of desperation and hope.
Alex stood frozen, his hands still clutching the needle driver, his eyes wide with awe.
"He's… he's fixing it," he muttered, barely audible. The weight of his limited role pressed down on him, but it was eclipsed by the spectacle of James's skill, a reminder of the surgeon he aspired to become.
The monitors steadied, the red alerts fading to green. Holly's brain, moments ago a kaleidoscope of danger, began to stabilise on the imaging screen, the haemorrhage slowing as blood flow returned. James stepped back, his hands steady, his expression one of quiet satisfaction.
"Stent's in place. Blood flow's restored. The hemopericardium has drained. She's stable."
Derek exhaled, his shoulders relaxing for the first time since the surgery began. He turned to James, his voice thick with admiration.
"That was unreal, James. New York didn't do you justice. I've never seen anyone pull off a stunt like that under this kind of pressure."
James's lips twitched into a modest smile. "Team effort, Shepherd. Your work on the brain bought us the time we needed. And you," he nodded at Alex, "those stitches held. Solid work."
Cristina's eyes lingered on James, her analytical mind cataloguing every move he'd made. She'd seen brilliance before—Burke, Hahn—but this was something else, a blend of instinct and precision that redefined readiness. "That was…" she started, then caught herself, her voice steadying. "Beyond impressive. You saved her life."
Alex, still reeling, found his voice. "You just… You turned it around. I thought she was gone." His tone was raw, a mix of awe and gratitude, his earlier fear replaced by a spark of inspiration.
The O.R. fell quiet, the monitors' steady beeps a triumphant chorus. Holly Anderson, against all odds, was alive, her heart beating strong, her brain spared from the brink of catastrophe. Derek clapped James on the shoulder, a rare gesture of camaraderie. "You've raised the bar, James. Seattle Grace is lucky to have you, even for a day."