In the bustling heart of Seattle, within the warm walls of the Shepherd household, the essence of family and laughter blended into a harmonious melody. It was family game night, a rare occasion of unwinding and togetherness for the renowned neurosurgeon Derek Shepherd, his brother in all but blood, the charming plastic surgeon Mark Sloan, Derek's wife Meredith Grey, Mark's wife Lexie Grey, the prodigious second-year resident Mary Shepherd, and her boyfriend, Jackson Avery.
The night commenced with Twister, a game that brought forth bouts of laughter and playful competitiveness. The living room was a canvas of colorful spots and tangled limbs. Mary, agile and quick-witted, navigated the mat with the grace of a dancer (albeit a very clumsy one), while Derek and Meredith displayed teamwork honed by years of marriage. Mark, ever the charmer, turned each move into a spectacle, eliciting laughter with his exaggerated groans.
Jackson, attempting a particularly challenging pose, slipped and landed atop Mark. The room erupted in laughter as Mark groaned jokingly, "Hey, Mary, I think your boyfriend's cheating on you with me!"
Mary rolled her eyes playfully, retorting, "Well, he has excellent taste, then!"
The game continued amidst chuckles and light-hearted teasing, with each member of the pseudo-family showcasing their flexibility and sense of humor. As they moved to the couches for a well-deserved break, the atmosphere was light, filled with the warmth of familial love.
Derek handed Mary a glass of apple juice, winking. "Here's your hardcore drink, kiddo."
Mary accepted it with a mock salute. "Watch out, I might just out-party all of you with this wild choice."
As they settled in, Mark proposed a quiz game. "Let's test the residents' knowledge, shall we? The one with the lowest points at the end has to make breakfast tomorrow."
Mary, laughing, knowing exactly why Mark was proposing the idea, "And this would not, by chance, have anything to do with the fact that it is your turn to make breakfast tomorrow?"
The only response she got was a subtle middle finger from the plastic surgeon.
The first round of questions began, with Derek posing intricate neurosurgical queries, while Mark focused on plastic surgery. Mary, her mind a repository of medical knowledge, answered each question with confidence - she also had the added advantage of sobriety.
Derek started with a more complex neurosurgical question, "Describe the functional connectivity between Broca's area and Wernicke's area in the context of language processing."
"Broca's area is involved in language production and is connected to Wernicke's area, which is involved in language comprehension, via the arcuate fasciculus. This neural pathway facilitates coordinated language processing," Mary replied with precision.
Derek nodded, smiling, "Point for the kid!"
Mark rolled his eyes but asked his question, "Discuss the indications for blepharoplasty beyond cosmetic enhancement, including its role in improving visual field deficits."
This time, it was Meredith who answered. "Blepharoplasty can be performed for functional reasons, such as removing excess skin that obstructs the peripheral vision, commonly seen in conditions like dermatochalasis. This surgical intervention not only improves aesthetic appearance but also enhances the patient's visual field."
Mark nodded, tallying up his sister-in-law's point. Meredith high-fived Mary, while Jackson and Lexie threw a pillow at the other two. By the end of the third round, Mary was tied with Meredith for first, with Lexie and Jackson, more than a little tipsy, tied for last.
"Final round - this one is worth double points. Shout out the answers, and reminder - the loser cooks tomorrow," Mark smiled, enjoying the competition.
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."
Mark nodded, then his tone sharpened. "And what's crucial in the postoperative care?"
"Monitoring for flap ischemia," Mary responded promptly.
"Yes, but don't forget the importance of managing donor site complications," Mark corrected sternly.
"Yes, sir," Mary acknowledged, her voice a blend of respect and determination, as she wrote down Mark's addition.
Jackson, leaning against the doorway, observed the intense tutorial. It was a window into the making of a surgical prodigy, a testament to the rigorous standards that Mary had been raised with.
Mark then posed a more challenging question, delving deeper into the nuances of reconstructive surgery. "Explain the anatomical considerations and potential complications when performing a deep inferior epigastric perforator flap for breast reconstruction."
Mary took a moment to gather her thoughts before answering, "The DIEP flap involves harvesting skin and fat from the lower abdomen, similar to a tummy tuck, but preserving muscle. Key considerations include ensuring the perforator vessels are intact for adequate blood supply. Complications can include flap failure, fat necrosis, and abdominal wall weakness."
"And how do you mitigate these risks?" Mark pressed on
"By careful patient selection and meticulous dissection to preserve the perforators," Mary detailed.
Mark's gaze was uncompromising. "Exactly. And remember, postoperative monitoring for vascular compromise is crucial."
"Is vascular compromise always a risk?" Mary asked, her tone curious.
Mark nodded, a shadow of a smile playing on his lips. "Most of the time. You should write that down."
Mary did not respond, instead busying herself with noting down the information.
Jackson watched, a newfound understanding dawning on him. This was the foundation of Mary's exceptional knowledge, a relentless pursuit of excellence instilled by her brothers. Mark noticed Jackson's presence and offered a slight nod, acknowledging him without breaking the flow of the session.
Mary, however, was too absorbed in the session to notice. Her dedication was palpable, her responses sharp and informed. It was clear that these meetings were more than mere academic exercises; they were a rite of passage, a shaping of her surgical journey.
With a quiet respect for the moment, Jackson withdrew, leaving the siblings to their rigorous study. He returned to the kitchen, the sounds of breakfast preparation now intertwined with a deeper appreciation for the extraordinary relationship between the Shepherd siblings.
Jackson was placing the last of the pancakes on a large platter when Meredith, Derek, and Lexie entered the kitchen, the aroma of breakfast welcoming them. Derek, glancing around, asked, "Where are Mark and Mary?"
Jackson, stirring the pot of scrambled eggs, replied, "They're in the study. Going over some plastic surgery procedures, I think."
Everyone but Jackson nodded in understanding. His curiosity piqued, Jackson turned to Derek, "What's all that about? Yesterday, Mary was swearing at Mark jokingly, and today she's calling him 'sir' in a study session?"
Derek leaned against the counter, his expression softening. "Mary requested that Mark and I alternate study sessions with her. It's a mix of neuro and plastic surgery, depending on who's leading. We've been doing this since she started her residency."
"But why the formality? The 'sir' and all?" Jackson asked, puzzled.
"It's about maintaining professional boundaries," Derek explained. "In those sessions, she's not just my sister or Mark's; she's a resident under our tutelage. Calling us 'sir' helps keep the relationship strictly professional, especially when we need to be stern or correct her."
Jackson chuckled, "Stern? Mark looked like a drill sergeant in there."
Derek smiled wryly. "We can be strict, yes. But it's for her own good. Being tough on her in these sessions prepares her for the real pressures of surgery. And the 'sir' thing, it makes it less personal if we have to ream her out for a mistake."
Meredith, pouring coffee, added, "Mary is brilliant, but she's in a tough spot. Being so young and already a resident, plus being their sister, it's not easy for her."
Derek nodded, "Exactly. She faces a lot of criticism. Accusations of nepotism, questions about her age. She has to prove herself every day, more so than others."
Jackson served the breakfast onto the table. "But she's already ahead of everyone. I mean, she won practically every round last night. And she scrubs in on surgeries other junior residents aren't allowed on."
Derek began to dish out the pancakes. "That's true, but practical skills in surgery are different. Moreover, she's a Shepherd. She needs to be exceptional, not just good. And she knows it. That's why she asked for these sessions."
Lexie, taking a seat, said, "It's tough on her, but she's determined. I've never seen someone so dedicated at her age."
Derek passed the syrup to Jackson. "She's got talent and the drive. These sessions, they're not just about imparting knowledge; they're about shaping her mindset, her approach to surgery, to life. And I am sure I don't have to explain to you the pressure of living up to the family name."
Meredith interjected, "She's learning to handle pressure, to think on her feet. In an OR, that can make the difference between life and death."
Jackson, now understanding the gravity of the situation, said, "I guess I didn't realize how much pressure she's under. To be so young and already carrying so much."
Derek, taking a bite of his pancake, replied, "That's why we're there for her. To guide, to push her when necessary. She's got the potential to be one of the best surgeons of her generation. We just need to help her get there."
Meredith added, "And she will. She's got the best teachers, after all."
As they continued their breakfast, the conversation drifted to lighter topics, but the underlying current of their dedication to Mary's success remained a strong and unifying force in the Shepherd household.
Derek, sipping his coffee leisurely, glanced at his watch and turned to Lexie with a question. "How long have Mark and Mary been at it this morning?"
"About two and a half hours," Lexie responded, buttering her toast.
Derek set down his cup. "I'll go get them. It's time for breakfast."
As he walked toward the study, Derek's mind reflected on his role within the family. Since their father's death, he had taken on the mantle of a parent, particularly for Mary, but also as an elder brother for Mark. This duality of roles was never easy, but it was a responsibility he bore with love and dedication.
Entering the study, Derek arrived just as Mark was reprimanding Mary. "You need to differentiate between an intracerebral hemorrhage and a subarachnoid hemorrhage more clearly," Mark's voice was strict, his expectation for precision clear.
"Yes, sir," Mary replied crisply, her tone respectful yet determined. "An intracerebral hemorrhage is bleeding within the brain tissue itself, while a subarachnoid hemorrhage occurs in the space between the brain and the surrounding membrane."
Derek smiled at the scene, a testament to their family's commitment to excellence. "Time for breakfast," he announced, his voice kind yet carrying an authoritative undertone that neither Mary nor Mark could ignore.
Mark shut down the laptop and wrapped an arm around Mary in a side hug, his stern demeanor melting into brotherly affection. "You did well," he praised. "I know I was a bit of a jackass, but you did good, kid."
Mary beamed at her brothers as they walked to the breakfast table. Derek, walking alongside her, mentioned, "I'm taking today's session, Mary. Mark has a meeting at the hospital."
"Can we go over your surgery from last week? The neuroblastoma?" Mary asked eagerly.
"Sure," Derek replied, his smile broadening at her enthusiasm.
As they settled down for breakfast, Jackson, intrigued by the morning's events, asked, "So why the stern approach in the study sessions? You're stricter than Owen Hunt on his worst day. I'd know."
Derek chuckled, knowing the history between Owen and Jackson was not particularly smooth. "It's about preparing her for the real world of surgery and setting a high standard. The OR doesn't give second chances, and neither do we in those sessions."
Mark added, "It's tough love. We want to ensure she's beyond reproach, skill-wise and knowledge-wise. We are overly strict so that no one at the hospital can possibly find a reason to reprimand Mary."
Curious, Lexie asked, "When's the next session?"
"In about two hours," Derek answered, cutting into his pancake. "We'll go over the neuroblastoma from last week."
Jackson, intrigued, expressed a desire to join. "Can I sit in? It'd be nice to have a neuro refresher."
Mark raised an eyebrow at his resident, but addressed his brother, half-joking. "Trying to steal my resident, Derek?"
Derek, with a hint of seriousness, addressed Jackson. "You're welcome to join, but be prepared. I'll be just as harsh on you."
Jackson nodded, accepting the challenge. "I could use the rigor. It's been a while since I've logged any neuro hours."
The conversation continued, light and engaging, as they discussed everything from hospital cases to plans for the day. The familial bond was palpable, a blend of professional respect and deep affection.
After breakfast, the family worked together to clean up. Derek and Mark took care of the dishes, while Meredith, Lexie, and Jackson wiped down the counters and table. Mary, humming a tune, gathered the napkins and placemats.
With the kitchen restored to its usual pristine state, they moved to the living room. The morning sun streamed through the windows, casting a warm glow over the room. Derek pulled out the Monopoly board, a favorite for family game time.
As the Monopoly board sprawled out on the living room table, the Shepherd household was alive with the competitive spirit and laughter that only a family game could evoke. Derek, Meredith, Mark, Lexie, Mary, and Jackson each picked their tokens, ready for a bout of property acquisition and friendly rivalry.
Mark was particularly invested, his eyes gleaming with the thrill of competition. "Watch out, folks, I'm on a mission to monopolize Park Place and Boardwalk before anyone realizes what's happening," he declared, throwing the dice with a flourish.
Derek, always the strategist, just smirked in response. "Dream on, Mark. It's all about the railroads for me today."
As the game progressed, Mark's ambitions seemed increasingly attainable. He had already secured two properties on the coveted green color group and was eagerly awaiting his next turn to complete his set. "If I get Pennsylvania Avenue, it's game over for all of you," he teased, his anticipation palpable.
However, fate—and Derek—had other plans. With a roll of the dice that seemed too perfect to be true, Derek landed on Pennsylvania Avenue first, his expression triumphant as he handed over the cash to the bank. "Looks like the game's not over after all," Derek quipped, much to Mark's chagrin.
Mark threw his hands up in mock frustration. "This is rigged! Derek's got some sort of neurosurgeon mind trick happening with the dice."
Meredith laughed, rolling her eyes. "Oh, please. The only trick Derek has is being insanely lucky at board games."
Lexie, who had been quietly amassing a collection of utility companies, chimed in, "Don't count out the little guys. These utilities might just power my way to victory."
Jackson, ever the observer, added, "Or drain everyone's finances slowly but surely. Lexie's playing the long game."
Mary, focusing on her own strategy, managed to hold her own, though her holdings were modest compared to the sprawling empires of Derek and Mark. "It's not about the size of the property; it's about how you use it," she said wisely, eliciting a round of nods and murmurs of agreement.
The game continued amidst laughter, playful taunts, and strategic negotiations. Mark, despite his initial setback, remained spirited, his every move accompanied by a running commentary that kept everyone entertained.
In the end, it was Meredith who emerged victorious, her collection of properties and wise investments proving too much for the others to overcome. "Looks like the Grey method wins again," she said with a wink, gathering the Monopoly money with a satisfied grin.
As they cleaned up, Derek glanced at his watch and nodded at Mary. Without a word, both understood it was time for their session. As they left for the study, Jackson lingered, watching them go. He turned to Mark, a reflective look on his face. "You know, it's not just Mary's dedication that's impressive. You and Derek are sacrificing hours of your time just to help her."
Mark paused, the humor fading from his eyes as he considered Jackson's words. After a moment, he nodded solemnly. "We're her brothers, but we're her guardians, too. This family is all she has. All any of us have, really. If spending a few extra hours every day ensures her success, then it's worth every second." Mark smiled, thinking back on some of the sessions. "It's good review for me and Derek, and we get to spend time together. Not every day is a quiz, sometimes we just read medical journals and watch some surgeries. It may not sound like fun, but for a bunch of surgeons, it is."
Jackson nodded, the admiration in his gaze unmistakable. "She's lucky to have you guys."
Mark shrugged, the playful glint returning to his eye. "Well, someone's got to keep her in line. Might as well be us."
Jackson followed Derek and Mary into the study, his curiosity piqued by the prospect of witnessing one of Derek's surgical reviews. The atmosphere was markedly different from the playful competitiveness of the Monopoly game, replaced now by a sense of focused academia.
Derek booted up his laptop and pulled up a video of the recent complex neurosurgical procedure he had performed. "This surgery involved the resection of a deeply seated neuroblastoma located near critical vascular structures," he began, his tone embodying the precision and confidence of an experienced neurosurgeon.
As the video played, Derek paused at key moments, pointing out the intricacies of his approach. "Here, you can see the angle of incision was designed to minimize damage to the surrounding brain tissue while providing optimal access to the tumor. Had I approached it laterally instead, I would have sacrificed my field of vision," he explained, highlighting the precision required in neurosurgery.
Mary, pen in hand, scribbled notes diligently, her focus unwavering. Jackson, on the other hand, watched intently, absorbed in the complexity and skill displayed but not taking notes.
Derek paused the video at a particularly critical juncture. "Notice how I ligated the draining vessels here," he pointed out, zooming in on the screen. "This step was crucial to controlling blood flow and reducing the risk of intraoperative bleeding. The choice of ligature and the technique used were dictated by the vessel's size and proximity to the tumor. I used split cranial sutures instead of interrupted sutures."
As the session progressed, Derek began to quiz them. "Based on the approach we discussed, why is it important to control bleeding from these vessels before tumor resection?" he asked.
Mary responded without hesitation, "Controlling bleeding is vital to maintain a clear surgical field and minimize the risk of postoperative complications. It also reduces the potential for damage to surrounding brain tissue."
Derek nodded in approval and then turned to Jackson with a question designed to test his understanding of the surgical nuances. "Can you explain the rationale behind the choice of incision angle in relation to the tumor's location?"
Jackson hesitated, his mind racing to piece together an answer. "Well, it... it provides better access to the tumor, right?" he ventured, the lack of detail in his response evident.
Derek's expression tightened. "Yes, but I was looking for more specificity. The proximal angle of incision, in this case, was chosen to minimize disruption to the brain's functional areas while allowing for an adequate surgical corridor to the tumor. It's critical to pay attention to these details."
Before Derek could continue his reprimand, Mary interjected softly, "Derek." Her single utterance was a gentle reminder of Jackson's unfamiliarity with their rigorous study sessions.
Derek paused, then nodded, acknowledging Mary's point. He resumed the session, directing the subsequent questions primarily towards Mary, who answered each with confidence and precision.
Despite the mild embarrassment, Jackson was mostly grateful for the redirection. The questions Derek posed were indeed challenging, diving deep into the specifics of neurosurgical techniques and decision-making processes.
At one point, Derek asked, "What are the implications of resecting a tumor located near the motor cortex, and how does it influence postoperative recovery?"
Mary's answer was thorough. "Resecting tumors near the motor cortex requires meticulous planning to avoid damage to areas controlling voluntary muscle movements. It influences postoperative recovery significantly, as damage to these areas can result in motor deficits. Intraoperative mapping and monitoring are key to preserving function."
Another question followed. "How do we manage the risk of cerebral edema during and after a procedure like this?"
Again, Mary was ready with her response. "Administering corticosteroids pre- and postoperatively can help manage cerebral edema. Intraoperatively, careful management of fluid intake and ensuring adequate venous drainage are essential to prevent swelling."
The session continued in this vein, with Mary demonstrating not just her memorization skills but a deep understanding of the surgical principles involved. Jackson, though he found himself on the back foot with Derek's questions, was engrossed in the learning opportunity, his initial blush of embarrassment fading into a keen interest in the complexities of neurosurgery.
As they concluded, Derek turned off the laptop, and the trio stood, stretching from the long session. Jackson, still processing the depth of knowledge he had been exposed to, thanked Derek for the insight. "I have a new appreciation for what you guys do," he admitted, a genuine note of regard in his voice.
Mary smiled at Jackson, her earlier intervention a subtle but powerful reminder of the supportive dynamics within their unique family.
As they exited the study, the timing couldn't have been more perfect. Mark, just returning home, raised an eyebrow at the trio, a mischievous glint in his eye. "So, Jackson, thinking of switching to neuro after today?" he teased, fully aware of the intensity of Derek's teaching sessions.
Jackson, still reeling from the depth of neurosurgery he'd just been exposed to, shook his head so vigorously it drew laughter from Derek and Mary. "No thanks, I'll stick with plastics and you, Mark. Neuro's a bit too intense for me," he declared, making a dramatic show of his preference.
Derek, joining in the banter, reminded Jackson, "Remember, you've still got to log some neuro hours for your boards."
Jackson, quick with a comeback, replied, "I can do that later. I'll try to avoid Derek if I can," which elicited more laughter from the Shepherds. This light-hearted exchange underscored the welcoming and inclusive atmosphere Jackson had found himself in—a stark contrast to the relationships he experienced with his own family.
Despite being an Avery, not a Shepherd, Jackson felt an increasing sense of belonging with this family. The interactions he shared with the Shepherds and the Greys were something he had seldom experienced with his own mother and grandfather. The familial warmth and support were refreshing, especially considering he had only been hanging around the Shepherds for a couple of months.
For Mary, the expectations set upon her were incredibly high, not unlike those Jackson had known in his own family. However, Derek and Mark's approach was fundamentally different from that of Harper Avery and Catherine Fox. To Derek and Mark, Mary was a sister first—a family member they supported unconditionally, regardless of the expectations and pressures of the medical world.
Noticing Jackson's growing comfort and enjoyment in their family dynamic, Mary left Derek's side to intertwine her fingers with Jackson's, offering him a supportive kiss on the cheek. This display of affection was met with exaggerated groans from Derek and, more vocally, from Mark, who playfully moved to separate the two, even going as far as to smack Jackson lightly on the head.
"Not in front of us, at least," Derek joked, his tone light but carrying the slight edge of an older brother's protective instinct.
Mary rolled her eyes at their reactions, the scene perfectly capturing the unique blend of professional excellence and familial warmth that characterized the Shepherd household. Despite the challenges and expectations, it was clear that love, support, and a healthy dose of sibling rivalry formed the foundation of their relationships—a dynamic that Jackson was increasingly grateful to be a part of.