The Shepherd Legacy

Game Night

Derek raised the level, "Discuss the complex interplay between dopamine depletion and the manifestation of motor symptoms in Parkinson's disease."

The youngest resident was the first to answer. "Dopamine depletion in the substantia nigra pars compacta leads to imbalanced neurotransmitter activity in the basal ganglia, contributing to the motor symptoms of Parkinson's disease, such as bradykinesia, rigidity, and tremors. This imbalance affects the direct and indirect pathways of movement control," Mary elaborated.

Mark rolled his eyes jokingly, thinking of the next question. "Okay, smartass. How about this - discuss the pathophysiological mechanisms leading to rosacea and the role of environmental factors in its exacerbation."

The room fell into silence for a moment, before Meredith spoke up. "Rosacea's pathophysiology is not fully understood but involves vascular hyper-reactivity, inflammation, and possibly mite Demodex folliculorum. Triggers like sun exposure, heat, spicy foods, and stress can exacerbate the condition, leading to flare-ups of redness, papules, and pustules," she explained, her voice confident.

Mark's eyes widened in surprise as he pulled out his phone to search for the answer. He rubbed the back of his neck, quickly reading through the links. "Holy shit, that's right. 2 points for Mer!"

Meredith laughed, Mary joining in. It was now time for the final question.

"Okay, final question," Derek started. Mary and Meredith kept talking - they were, once again, tied for first, and did not have to worry about cooking. "Discuss the mechanism of action and time window for administration of alteplase in acute ischemic stroke management."

This time, it was Lexie's turn to shine. "Alteplase... a tissue plasminogen activator, works by dissolving blood clots that cause ischemic strokes, restoring blood flow to the brain. It must be administered within a 3... no, a 4.5-hour window from symptom onset to be effective and reduce the risk of permanent neurological damage," she answered, giggling. She had already gone through most of the wine.

Derek shook his head at Lexie's state, but confirmed her answer, chuckling. "Yeah, that's two points for Lexie. And with that... it seems like we will all be having Chef Avery's breakfast meals tomorrow."

Mary, a little skeptical of her boyfriend's cooking, replied, "Yeah, I think I will stick with Uber Eats and order some waffles from the cafe nearby."

Jackson, good-naturedly grumbling about his loss, accepted his task of making breakfast for everyone the next morning. The night wound down with shared laughter and light-hearted jests, each member of the Shepherd household retiring to their rooms.

--

As the first light of Sunday filtered through the windows of the Shepherd residence, Jackson Avery found himself alone in the kitchen, the task of preparing breakfast a reminder of his playful defeat from the night before. The absence of Mary from their shared bed was noticeable, her side cool and untouched since an early departure.

As he busied himself with the sizzle of eggs and the aroma of brewing coffee, the distant murmur of voices drew his curiosity. Following the sound, Jackson found himself outside the Shepherd brothers' study. The door was slightly ajar, allowing him a glimpse into a world of intense learning and discipline.

Inside, Mark Sloan was in his element, a stern mentor to his young but passionate sister. Mary sat attentively, her focus unwavering as she absorbed the intricate details of complex plastic surgery procedures. Mark's voice was firm, his demeanor demanding perfection, as he quizzed Mary.

"Describe the steps of a microvascular free flap procedure," Mark instructed, his eyes scanning a medical journal.

Mary replied with precision, "Harvest the flap, prepare the recipient site, anastomose the vessels, and ensure flap viability."