alaska | grey's anatomy

⇢ CHAPTER 17

season 5 episode 17

"Dr. Grey." Izzie nodded her head at the girl for her to start presenting the information to the other interns. Lexie took a deep inhale before starting.

"Patient 'X.'" Lexie started, "A previously healthy 29-year-old female presented with stable vital signs, a normal physical exam, uh, with symptoms of occasional right upper quadrant pain, nausea and hallucinations."

"Good." Izzie nodded before looking at Holly, "Dr. Kepner."

Holly looked over the chart that Lexie handed over, "Head C.T., chest x-ray, C.B.C were normal, but chemistries revealed an elevated L.D.H."

Izzie nodded again as she looked at the rest of the interns, "So you are this girl's doctor. She comes to you, she's scared, she doesn't know what's wrong. You have to diagnose her. What do you do next? What test do you run?"

"How about a metic count or peripheral smear?" Ryan asked, looking up for confirmation.

"You'd be wasting your time." Izzie explained, "The C.B.C. was normal, remember?"

"You said there was abdominal pain." Pierce began, "What about an upper G.I.?"

"Good." Izzie smiled, reaching behind her to grab new scans, "That is exactly what patient X's doctor did next." The interns whispered to each other as they saw the scan Izzie placed against the light, "What does this tell us?"

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"Whoa, whoa. Wait, wait." Ryan announced as the interns shushed themselves from their loud disagreements, "I think I got it." He looked at Izzie, who was bored-ly sitting as she waited for the interns to come up with a diagnosis, "Liver enzymes are normal, cardiac workup is negative--"

Steve interrupted, getting on Ryan's thought process, "If L.D.H. is a false positive--"

"It's a trick question." Ryan answered, looking at Izzie with a smile.

Izzie tilted her head, "What?"

Holly frowned her eyebrows as she whispered at Lexie while the other interns celebrated, "That doesn't explain her hallucinations..."

"She's fine." Steve assured, looking at Izzie, "Patient 'X' is fine."

Izzie sighed, looking down, "She's not fine."

"Okay, well," Lexie looked at the chart, "her sed rate is slightly elevated."

Holly chimed in, looking at the rest of the interns, "Did we check for autoimmune disease?"

"Yeah," Ryan responded as the others nodded, "A.N.A. and C.R.P. were negative, too. At worst, she's got an anxiety disorder. The girl is totally fine. She is..."

"She is not fine!" Izzie outburst, causing the interns who celebrated to quickly grow silent, "She had hallucinations. She had visual, auditory and tactile hallucinations about her dead fiancé. She thought she could talk to him and touch him. She's not fine. She's not fine." She sighed, "You're missing something. You're not looking in the right place." Izzie got up and began to walk away, "Go back and figure out what you are missing."

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"So, what's this patient 'X' thing Izzie's making you guys do?" George asked as he sat next to Holly in the cafeteria with Lexie concentrating as she wrote down possible diagnosis'.

"We have to come up with a diagnosis and prognosis." Holly groaned, flipping through the pages of the chart, "We're not sure what it could be."

"But we'll get there." Lexie added, stressfully munching on a carrot, "We have to get there."

"Mm." George hummed as he nodded, "Do you guys want--"

"No." They chorused.

"Asking you for help would practically be cheating."  Holly spoke as she held her head, "We just need to think--" Holly glanced up at Lexie, "Brain."

"Brain?" George frowned his eyebrows.

"Brain." Lexie's eyes doubled, "We could've missed a--"

"Malignancy in her brain." Holly finished with a chuckle, grabbing the charts and papers along with Lexie, "We need to order an M.R.I. with contrast."

"A-And biopsy a lymph node." Lexie added as she grabbed a few more carrots.

"Thanks, George." Holly smiled, giving George a kiss before she ran off to find Izzie with Lexie.

"...You're welcome...?" George frowned his eyebrows again as he saw the two running off.

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Holly smiled, nodding at the other interns as she turned to face Izzie, "We have a diagnosis."

"A-And a prognosis... if we're right." Holly chimed, holding the notes in her hand up.

Izzie nodded, "Dr. Grey."

"Patient 'X'-- an elevated L.D.H. was our only clue." Lexie started, walking forward to gesture to the scans, "Uh, and then we found out that she had enlarged lymph notes and a suspicious mole, which was biopsied. Meanwhile, this M.R.I. with contrast showed a met on her right temporal lobe, and the biopsy revealed dividing cells. That coupled with further staging tests led to our final diagnosis of metastatic melanoma with mets to the liver, skin and brain." Lexie and the other interns stared at Izzie as they waited for her approval.

Izzie nodded, which caused a wave of relief to flood the interns, "Your prognosis?"

Lexie joined the group and Holly commented, "With chemo and radiation, uh, a few months." 

"At best." Ryan added, "Girl's pretty much toast."

Steve continued, "Survival rate's five percent. If I were her, I'd go on a really good vacation."

"Or go to church," Graciella noted and Holly nodded, "ask for forgiveness, prayers."

The interns all spoke at once as they discussed what they would do and Izzie turned off the lights to see the scans, "Good job, everybody."

An intern 'whoo-ed' from the back as Pierce frowned his eyebrows, "That's it?"

"After the last contest," Graciella reminded, "we got a prize."

"Yeah," Steve nodded, "what's our prize?"

There was a brief pause before Izzie glared at the interns, "You think every time you diagnose a patient, hand someone a death sentence, there's a prize? The prize is..." Izzie mockingly thought, "you didn't screw it up this time. The prize is you people actually did something right. The prize is you were doctors today. You were doctors. That is the prize."

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"Hey," George greeted Izzie as he was about to leave the resident's lounge, "uh, I just wanted to let you know, I'm still here, I still care."

Izzie smiled and nodded, "Thanks, George."

George looked at Izzie, remembering her suspicious behavior these past few days, "And you don't want to talk about it?"

Izzie shook her head, "Not yet."

"Okay," George nodded, "good night."

Izzie smiled back, "Night."

"Hey." Holly walked up to George, not noticing Izzie by the door as she smiled at him, "We diagnosed patient 'X' correctly after getting the scans." 

"That's great." George smiled back.

Holly looked to the left slightly and saw Izzie and walked up to the blonde, "Dr. Stevens."

Izzie turned around and hummed, "Yeah?"

"Thank you," Holly nodded, "for teaching us with patient 'X'. Thank you."

Izzie smiled, "No problem."

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we're getting close 😔