Chapter Twenty-Two: Moment Of Truth
*~*~*~*
"Karev? Watley?" Arizona made her way over to where Bailey and I were talking, Alex nowhere in sight. All of the fifth year residents were gathered outside the ER, preparing to leave for the airport. We were all flying out to San Francisco today to take our oral boards. A lot of attendings were out here with us, giving last minute advice.
"I need to talk to Mark." I excused myself, unable to handle another pep talk. I headed over to where Mark and Jackson were talking, the later seeming to be focusing on his phone rather than what he was being told.
"Now have salmon for dinner. And tell room service to make sure it's not frozen. You lose omega-threes if it's frozen." Mark advised him. "Avery, are you listening to me?"
"I'm trying not to." Jackson was honest as he grabbed his bag, ready to head over to the shuttle.
"All right, how are you on cash?" Mark asked, holding a bundle of bills out to him. "I figured you needed some."
"I'll take that." I took the cash from Mark while Jackson headed over to the shuttle, leaving us alone. "Really?"
"What? I'm looking out for my protege, my brother." He shrugged.
"He's not your brother yet." I reminded him, tucking the money back into the pocket of his lab coat. "So please stop trying to shove salmon and money down his throat."
"Fine." He agreed. "Now you should have chicken thighs and spinach for dinner to get plenty of omega-threes, I also packed you some walnuts and sunflower seeds to snack on during the flight. Are you sure you don't need money?"
"Please just shut up and kiss me." I shook my head.
"If you insist." He grinned before leaning down, pressing his lips to mine. I smiled into the soft kiss before we parted. He wrapped his arm around my shoulders, guiding me towards the shuttle.
"I love you." I gave him one more kiss before I climbed into the shuttle.
"I love you, too." He called after me. "Kick some ass!"
*~*~*~*
"Ow!" I looked over my shoulder, finding April running into some guy as we made our way through the hotel lobby, trying to check ourselves in.
"I'm sorry." The guy apologized.
"That's- Oh, Case Western Reserve." April noticed the hat he was wearing. "Uh, do you know Ted Stevenson, head of trauma?"
"I do, yeah." He nodded.
"He just offered me a job. I might be an attending there." April informed the guy, and I could see his smile falter. "April Kepner, Seattle."
"Kevin Banks." He ignored her outstretched hand. "I'm the guy whose job you took. I was waiting to hear, but I guess I just heard. Thanks a lot."
"Well, he hates me." April muttered.
"Come on," I grabbed her suitcase, leading her over to where the others were sitting.
"How do you do that?" Alex laughed, having seen the encounter, too. "You've been here, like, two minutes."
"My examiner is gonna hate me, too, instantly." April shook her head.
"Don't psych yourself out." Cristina told her.
"One in five people fail the boards." She reminded us of the statistic.
"Fine psych yourself out." Cristina shrugged.
"It's just a test. We've all dealt with worse." Jackson spoke up from his seat next to me. "No one's bleeding out on your table. We will be fine."
"Cristina." Meredith got up, dragging Cristina away with her.
"So, how about we register and then grab some lunch?" April suggested, earning nods from Jackson, Alex, and I. "Awesome, I'll ask Meredith and Cristina."
"Okay, if one of us had to fail, who do you think it would be?" I asked the two guys once April was heading over to Meredith and Cristina.
"Beth," Jackson frowned at me.
"It's hypothetical." I held my hands up in defense.
"Kepner." Alex answered easily.
"Come on," Jackson sighed, clearly not liking this conversation. I saw his gaze flicker towards the three girls. "Meredith."
"Really?" I frowned, surprised by his choice.
"No, Meredith, look." He nodded towards the trio of women. I felt my eyes widen at the sight of Meredith holding her stomach, vomiting onto the floor.
*~*~*~*
"Zola has the stomach flu and you didn't say anything?" Jackson questioned Meredith once she was cleaned up. She was now seated in a lobby chair again, the rest of us standing a few feet away from her.
"How could you? Are- Are you trying to sabotage us all?" April asked.
"It's not like it's the black plague." Meredith rolled her eyes.
"You are supposed to be our friend." April shook her head.
"Oh, April, calm down." Meredith said as she started to get up.
"Y- You stay right where you are, typhoid Mary." Alex warned her before looking at the rest of us. "Come on. Let's go register."
We all followed his lead, getting into the right lines based on our last names. I got into line with Cristina, the others in the lines to our left. I glanced around, bored as I waited in line, but I stopped when I spotted a familiar face.
"Holy shit." I swore.
"Dude, is that your mom?" Alex asked Jackson, recognizing Catherine Avery, too.
"Baby." Catherine smiled as she made her way towards Jackson. "I know. I know you don't want to see your mother before the boards. But they are wearing this old girl out. Got me examining three sessions tomorrow, and I might not see you, so I had to say good luck."
"Can you promise to kill me if she's one of my examiners?" I asked Cristina, keeping my voice low so Catherine wouldn't overhear. "Just perform a C-section first."
"Deal." Cristina nodded.
"Oh, and I've got it." Catherine said, making me glance her way once more, spotting her digging through her purse.
"No, no, that's fine. You don't-" Jackson shook his head.
"It's in here somewhere." Catherine assured him.
"That's fine. That's okay." Jackson tried to tell her, making me curious.
"That's what you always say, but you always want it in the end." Catherine pointed out.
"Okay, all right." He sighed. "Mom, I'm good. I am."
"I'm in room eight oh nine when you change your mind." She told him before walking away, heading past Cristina and I again. She stopped when she spotted me. "Bethany."
"Dr. Avery." I nodded respectfully.
"Good luck on your boards." She told me before continuing on her way.
"Mommy bring you your pinky?" Alex asked once Catherine was gone.
"It's my lucky pencil. She brought my lucky pencil." Jackson corrected him.
"You know this is an oral test, right?" Alex reminded him.
"Yeah, I know. I just used it for my SATs and my MCATs, and my intern exam." Jackson shrugged.
"So, it's your binky?" Alex asked.
"It's..." Jackson sighed. "Sort of like my binky, yeah."
*~*~*~*
"Okay, fifty-six year old presents with pancreatic ductal obstruction and dilated main pancreatic duct." Jackson read off the card as we all sat around Cristina and I's room, studying. "Post-op procedure... yes."
"Dude, give it a rest." Alex told him. "If we don't know it by now, we're screwed. Besides, you've got your magical pencil to see you through."
"He's got a magic pencil?" Cristina raised a brow, not seeming to have heard that part of the conversation down in the lobby. "Oh, say more."
"His mommy brought it." Alex added as he brought his phone up to his ear, trying to call Arizona about Morgan's baby, again.
"Wait. How magical is this pencil? And can it stop that?" She pointed at where April was crying for what seemed to be the hundredth time today.
"I'm sorry." April apologized through her tears. "I'm sorry. This all just got really, really real."
"And man down." Cristina sighed.
"Two men down." I corrected her.
"She's right." Jackson nodded in agreement. "First Grey, now-"
"Meredith's not down." Cristina argued. "She's fine."
"Whoa. Shut up." Alex told all of us. "Dr. Robbins... Well, you don't answer my texts. I just want to know if you got Tommy's x-rays back yet... Is Morgan, uh, are- are you gonna operate? I gotta go."
"Go where, to eat?" Jackson asked as Alex headed towards the hotel room door.
"No, I gotta go back to Seattle." Alex shook his head.
"What?" April's voice broke as Alex left.
*~*~*~*
A groan escaped me when I woke up the next morning to the sound of my alarm. I ignored the desire to just curl up and go back to sleep, forcing myself up and out of the bed. I headed towards the bathroom, only to find Cristina curled up on the floor, next to the door that connected our room to Meredith's. I could hear her own alarm going off on the other side of the door.
"Are you up?" Meredith asked.
"Uh-huh," Cristina nodded despite the fact that Meredith couldn't see her.
"How are you feeling?" I asked.
"Worse." Meredith said.
"Get up." Cristina sighed, pushing herself up to her feet.
"Seriously, Cristina, I don't think I can." Meredith insisted.
"Open the door." Cristina told her.
"Just go get ready. I'll be fine." Meredith tried to assure us.
"Open the door, Mer." Cristina refused to back down. I could hear her whimper on the other side of the door before it opened. Cristina and I went to step into the room, only to be greeted by Meredith turning away and throwing up in the small trash can by the door.
"Easy. Easy." Cristina rubbed her lower back. "Okay, now that's the last time you throw up. Mind over matter. You can do this. Okay?"
"Let's get you showered and dressed." I led Meredith towards the bathroom.
*~*~*~*
"Matthew Anderson." One of the examiners called the name of the guy sitting next to me, leaving me with Cristina and Meredith sitting across from me, waiting to be called for our exam.
"Cristina..." Meredith began.
"Mind over matter." Cristina reminded her as a door opened.
"Cristina Yang." A woman called.
"Pleasure to meet you." Cristina shook her hand before following her into the room.
"You can do this." I shot Meredith a reassuring smile as two other doors opened.
"Meredith Grey." A man called out while a woman called, "Bethany Watley."
"Nice to meet you," I shook the woman's hand before following her into the room, the door closing behind me. I walked over to an empty seat, sitting across from an older woman and man.
"Welcome to the American Medical Board of Surgery certifying examination." The woman welcomed me. "We'll give you four separate scenarios in three thirty-minute sessions, ten-minute breaks in between."
"To pass the test, you must pass two of the three sessions." The man spoke up. "Now you can fail a session and still pass. But examiners are not permitted to indicate whether you passed or failed each session. You'll be rated on your ability to diagnose, manage treatment, handle the unexpected- Basically, the strength of your constitution in crisis. And when we move on to the, uh, next scenario, there's no doubling back, meaning, once a question is asked- you may not go back. Understand, Dr. Watley?"
"Yes," I nodded.
"A sixty-five year old woman is being seen by her primary care physician for a workup of osteoporosis when she is found to have elevated calcium. Her PTH level was well above normal. Her doctor sends her to you." The woman delivered the first scenario.
"Elevated calcium and PTH would indicate primary hyperparathyroidism." I began. "I would offer the patient a parathyroidectomy. I would first go about exploring the right side, and if that gland is large I would biopsy it. Following the biopsy, I would- What does path say?"
"Path come back with parathyroid hyperplasia." The man confirmed for me.
"Next, I would run an IPM. If the IPM showed PTH levels in the normal range I would, um, feel comfortable concluding the procedure." I said, feeling my stomach knot under their intensive stares.
*~*~*~*
"You have a forty year old man who complains of rectal pain and burning with defecation and occasionally some blood in the bowel movement." The scenario for the second session was presented.
"I would do a rigid sigmoidoscopy, to make sure there were no lesions in the rectum. If there were lesions in the rectum, I would do an incisional biopsy and begin to fulgurate." I explained my process to them. "I would then cover the bowel with omentum and close the fascia primarily."
"The sutures tear right through the fascia." The woman told me.
"Then I would use 1-0 nylon retention sutures through the full thickness of the abdominal wall." I corrected.
"Moving on." The man said.
*~*~*~*
"Are all your questions gross?" Meredith asked Cristina and I when we joined her in the bathroom during our break after the second session.
"Gross? What do you mean, gross?" Cristina frowned.
"It's just the stomach flu." I shook my head, taking a seat in one of the chairs by the sink.
"Uh, they keep asking me about bowels and bloody stools?" Meredith shook her head.
"It's general surgery. What do you expect?" Cristina shrugged.
"You're not helping. At all." Meredith groaned.
"My guy is a freakin' fossil." Cristina complained. "The last time he was in the OR, it was lit by candles."
"Maybe I'll just live in here, in this stall, in my filth... till I die." Meredith suggested as someone knocked on the bathroom door.
"Sick woman in here. Go away." Cristina yelled.
"Uh, I- I really need to get in there." I recognized April's voice.
"Uh, sorry. Closed for maintenance." Cristina lied.
"Please let me in." April begged.
"Come back later!" Cristina ignored her pleas.
*~*~*~*
"I'd do a biopsy." I told my examiners halfway through the third session.
"Path shows LCIS." The man informed me. "What's your best mastectomy approach?"
"I'd make a periareolar incision to preserve the infirmary fold." I answer easily. "However, for LCIS, a mastectomy isn't the right approach. Instead, you should observe and repeat mammos."
"You already did a skin sparing mastectomy." The woman pointed out.
"That was a trick question." I shook my head.
"You had all the facts to answer." The woman told me.
"The questions are designed to get your response-" The man began.
"I understand." I sighed, already knowing that I would be failing this session because of one simple trick question.
*~*~*~*
"That was hell. Actual physical hell." Meredith swore as she, Cristina, April, Jackson, and I all sat on the curb outside the hotel.
"I think I went a tad overboard." Cristina admitted. "A lot overboard."
"They took something from me." Meredith rubbed her neck.
"I feel like I just sold my unborn child to Satan." I groaned.
"Yeah, that wasn't an exam. That was an interrogation." Jackson shook his head.
"Like, way... way overboard." Cristina frowned.
"The mind games." Meredith shook her head.
"Trick questions." April piped up.
"It felt like Al Qaeda in there." Jackson sighed in frustration.
"Next test is June." Meredith reminded all of us.
"June's not bad." Cristina commented.
"Two thousand thirteen." Meredith finished.
"What's done is done." I said. "Let's just not even talk about it anymore."
"Anyone know how Alex did?" Meredith asked.
"Anyone know if Alex made it?" April countered. None of us had seen him since he'd left yesterday, worried about Morgan's baby.
"Made it?" Cristina and Meredith both frowned, clearly not having known about Alex's decision to head back to Seattle. "What do you mean, made it?"
*~*~*~*
"Ugh. Gotta pee. Gotta pee. Gotta pee. Gotta pee. Gotta pee." April rushed past the rest of us and into the ER once we'd gotten back to the hospital late that night.
"What time do you got?" Jackson asked as he, Alex, Meredith, Cristina, and I paced around, our phones in our hands with our emails opened.
"Twelve oh four." Cristina told him.
"Oh!" Jackson groaned, agitated. "It's supposed to come online at midnight."
"I mean, it's four minutes late." Meredith rubbed the back of her neck. "Come on, people."
"Crazy doctors, they crashed the system." Alex guessed.
"I already know I failed, so I don't know why I keep hitting the refresh button." Meredith sighed.
"Stay positive." I told her.
"Okay, if anyone failed, it was me, because my guy had a vendetta." Cristina pointed out.
"Please." Alex scoffed. "I've got the odds on failure."
"Are any of you on call? I've got a trauma." A nurse hurried out of the ER, looking at all of us.
"No!" We all told her.
"Wait. Wait. Wait." Jackson said, making us all look at him. "I passed. I passed."
"I passed! I passed! I passed! Yes!" Cristina grinned at her phone as my results appeared on my own.
"I passed!" I let out a large sigh of relief, feeling as though a weight had been lifted off my shoulders.
"I passed! I passed!" Meredith squealed.
"Alex?" I looked over to our friend, him being the only one who hadn't said anything yet.
"It's not coming up." He groaned.
"Here. Here. Use mine." Jackson handed him his phone. We all anxiously watched as he pulled up his results, smiles filling our faces at the relieved look that filled his face. We all hugged each other, jumping with joy. I stepped back, laughing as Jackson and Cristina started to dance around, singing some indistinct song.
"Wait. Wait. Where's April?" I asked, noticing that the redhead hadn't rejoined us. We all looked towards the ER doors, finding her coming out, her phone in hand. All of our smiles melted away at the crushed look on our friends face.