Chapter Text
Alex Karev groaned as he woke up, he hadn’t meant to fall asleep in this stranger’s room, he very deliberately never did, but the bed had been so comfortable…. Fuck .
He glanced across, luckily the guy was still asleep, his morning wood standing to attention, like hell Alex was staying here any longer. He slipped off of the bed, wincing as it creaked, the guy, Barry maybe? Turned but didn’t stir.
Alex slipped his clothes back on, at least he had left them all in one place the night before, he slipped his shoes on, grabbed the money from the side table, checking to make sure it was still there.
“It’s all there.”
Alex jumped at the guy’s voice, he looked over to see the guy smirking. “Yeah, I know, habit. I’ve gotta get goin’.”
“Oh, here, tip for ya.”
Alex watched as he grabbed his wallet, slipping out a $10 bill, not a massive tip, but still more money he could use. He took it from him, sending him his most charming smile as he did, “Thanks,” his eyes flickered to the towel on the bed, it was black but Alex could see the dried liquids from the night before dried on it… and the fact it was a little damp. He picked that up too, “I’ll dump this in the laundry for you.”
“Damn, get the whole service from you, huh, pretty boy.”
Alex didn’t say anything, the asshole’s smile made his skin crawl. He didn’t want the guy to see that he’d pissed himself in his sleep, even just a little, it’d either piss him out, or even worse, he’d be into it, what he might be able to infer from it. Like hell he was putting himself in that situation.
He grabbed his cellphone, said a quick goodbye, and ‘thank you’, then fled the room, dumping the towel in some laundry chute as he left the fancy hotel, keeping his head down, knowing that he didn’t fit in here, even in his best clothes.
His cell buzzed as soon as he was in his car. Jimmy Evans. Fucker.
Demanding more money again. He was always demanding money. Jimmy, his deadbeat asshole father, had found out about his classification through Alex’s old wrestling coach, that was what he had told Alex when he got in touch when Alex moved to Seattle last year.
Littles who were surgeons weren't common, especially openly, some might have special dispensation to be them, like Jackson Avery. But Alex wasn’t some legacy, he didn’t have his own money, he didn’t have the power of a family name, and he didn’t have some rich renowned-surgeon as a caregiver and soon to be adoptive father. He was a nobody, having to fight for his chance to be a full surgeon one day, having to fuck people for money to survive, and having to pay off his biological father so he could even stand a chance to survive.
He ignored the text, the threats to out Alex at work, which would force him to be put into the system yet again, only this time he wouldn’t get to age out. He set off driving, faster than he should, he’d reply to the text later on, he’ll send the money, and hope that Jimmy would OD on it, or something.
Alex pounded on the door of the motel, three rooms down from his own. He hadn’t had time to even change from what he was wearing the night before, he’d have to have a shower at work, scrub his skin with the antiseptic smelling soap, it’d have to be quick: he was just glad he’d made the asshole wear protection, some of them were worse, and Alex would have had to spend a lot more time on clean up.
He pounded on the door again. “ C’mon ,” he growled under his breath. He raised his fist again but the door opened, revealing another smirking naked asshole. Alex was so sick of assholes, but this was yet another one he had to play nice with.
“Ali!”
“ Alex .”
“That’s what I said. What’s up man? You’re waking us up,” he pushed the door open so Alex could see the three other people in the bed, he didn’t react, he was mostly just impressed that they’d managed to fit so many people in the shitty motel beds.
“I need more shit,” he shot him a look, he wasn’t going to say the word, not here with strangers.
“Ah, the suppressants? You’re out already, man?”
“It’s been a month, I’m completely out.”
The guy nodded, he was still so clearly high himself, but he stumbled back into his room, rooting around on a coke covered dresser for the right bottle among all the others.
Alex tapped his fingers against the doorway, he was going to be late, and he needed the meds.
“Here.” He held up the bottle as he got back to the door. He didn’t hand it over. “$80.”
Alex took in the bright green bottle, frowning as he caught sight of the name on it, written on in sharpie. “What? No, Dylan ! That’s the worst shit , I got stuck on them last month too, you said you’d get the better ones, the white bottle ones.”
“Well, these are the only ones I got, so $90, take it or leave it.”
“You just said 80!”
“It’s the economy man, I don’t control it. You want it or not? Cause I’m gonna go and get my dick wet… unless you wanna join in, I’ll give you a discount?”
Alex shoved his hand into his pocket, pulling out his wallet, and counting out the $90, he shoved it into Dylan’s hand. “Like fuck.”
This didn’t seem to worry the guy who probably hadn’t been clean in years. He was surprisingly easy going for a coke filled dealer, better than other people Alex had met when he was getting his Little suppressants during college and med school. Alex held his hand out to Dylan for the bottle. They weren’t anywhere near as good as the ones he used to get from his wrestling coach, or from the dick he’d hookupped with in college for a place to stay, a meal card, and some meds.
He held his hand out to him, the bottle was dropped into his hand, Alex shoved it into his work bag, he’d take it when he got to work.
Dylan sent him a smile, “Well, offer’s always open if you change your mind, darlin’.”
Alex nodded his head, feeling sick, he wasn’t that desperate yet. “Yeah, maybe.”
He had to keep him on his side, he didn’t know anyone else he could get the suppressants from in Seattle, and there was no way Alex was going to stop taking them, he’d worked way too hard for his shitty life to just throw it away.
Derek stirred his muesli in his bowl, looking up to see his wife staring into space, her own spoon dripping milk back into her bowl of cheerios, he reached across, taking her other hand in his, gaining her attention.
“It’ll happen.”
“I wasn’t thinking about that.”
Derek sent her a look.
“Okay, I was thinking about it a little… It’s just… maybe it’s not meant to happen?”
“Meredith, you don’t believe in fate,” he knew that because she had told him in their early months of dating, she was pessimistic, and didn’t believe in fate or luck, he loved that about her. “And it will. Sure, none of the Littles we saw yesterday were right for us, but that’s okay, we will find one who we can give the perfect home to. It’ll just take time.”
“I know Derek, it’s just…”
“Your mom?” he guessed, he could track a lot of Meredith’s self esteem issues down to Eliis Grey, he was glad he’d managed to yell at her before she died.
“When I was classified as a caregiver she had told me it was wrong, that there was no way I’m one.”
“Meredith, I’ve seen you with Jackson, you’re a natural with him, more natural than Mark was when he first started fostering him. You’re going to make a great mom, I know you, I know that you will. But we always knew we wanted to wait for the perfect kid, one who feels right, who fits in here. It’ll take time.”
Meredith sighed, and nodded her head, “I know, I just… none of them have been right, for either of us, it just feels like a sign.” She sighed again, but before Derek could say anything she spoke again, “We should hurry up, we’ll be late for work, and there’s no way I’m letting someone else be chief resident.”
Derek chuckled, and let go of Meredith’s hand, letting her change the subject, because there wasn’t much else he could say, not to change her mind, or convince her.
He wasn’t as hopeful internally as he was externally. None of the Littles their case worker had introduced them to or told them about had fit, none had felt right, not to him. As Caregivers they were biologically different from Neutrals, they were meant to look after Littles, they felt an ingrained need to, it felt wrong, almost uncomfortable, not having a little to look after. Most Caregivers would just take the first Little who came into their sight, and sometimes it worked, probably most of the time, but Meredith and Derek weren’t like most Caregivers, they were them, and couldn’t chance it, or be so careless.
“Why are you wearing a shirt? You look weird.”
Alex scowled at Cristina, but didn’t respond as he walked into the residents locker room, pushing his way past Avery to get to his own locker, turning the dial, then hitting it when it wouldn’t open. He was so goddamn tired. He was going to be working a double shift today too, which would mean he’d have more money, but not until he was paid at the end of the month, what he needed was some cash in hand.
“Wait, did you have an interview? Are they interviewing for chief resident? Are you in the running for it?”
Alex hated the new people that came along with the Mercy West merger, he hated their dumbass orange scrubs, he hated how they made him fear losing the job he’d worked so fucking hard to get and to keep; he hated the nepo-babies Jackson Avery and Charles Percy, he hated Reed Adamson and the way she’d once proposed sex with him to get her a surgery, and he hated Lexie Grey who had transferred to their hospital with the transfer, and had fucked Meredith up for weeks revealing that she was her sister and wanted to be family with Meredith, even now Mer was only just talking to her about more than hospital stuff.
But currently he really hated meek April Kepner, and her current obsession with becoming the chief resident, and insistence that Alex was also fighting for that.
He really wasn’t part of that fight: he was just fighting to stay awake, to be able to buy his meds, to send his mom money, to pay Jimmy Evans off, and to buy the cheapest food he could find, but he played the part, smirking whenever he’d claim that he was a shoo-in to get head resident.
“No,” he told April, completely deadpanned, finally pulling the locker open. He grabbed his scrubs from inside, his shower was going to have to be really fast. “I’m interviewing to be chief of surgery of John Hopkins, they gave me the job but I turned it down, I wanted to stay slumming it here with you orange freaks.”
“Real nice, Karev,” Jackson stepped forward, slamming Alex’s door shut, “she was just asking you a question, you don’t have to be a complete dick all of the time, you realise that, right?”
“Oh boohoo, go cry to your daddy, Avery-”
He was pushed back into his locked, there was suddenly a lot of movement in the room, Cristina pulled him backwards, holding tight to him, even as he tried to struggle out of her hold. Jackson was held back by Percy and Lexie, and Meredith stood between the two of them, glaring at both Jackson and Alex.
“Both of you cut it out!”
“He started it!” Alex finally pushed himself from Cristina’s hold, onto the floor of the locker room, breathing heavily as he looked up at Meredith, his hand pointing out at Jackson.
“You’re the one who-”
“-I don’t care!” she shouted above their raising voices, “Jackson go walk it off.” she stared at him until he stormed out of the locker room, Percy and April following behind him. She sent everyone else in the room a look, until they turned their attention back to what they were doing, and quietly started to talk amongst each other again. She looked down at Alex. “Are you okay?”
Alex pushed himself to his feet, “Fine,” he grumbled, “dude’s weak.”
“He managed to push you down.” Cristina pointed out. “Look, I’m on your side Evil Spawn, most of them annoy the shit out of me, and most of them wouldn’t know what a surgeon is even if they were awake on the table themselves. But you did get pushed down.”
That made Alex feel a little better, even if she was still reiterating that he got pushed down.
“I’m serious, Alex, are you okay?”
Alex hated how Meredith was frowning at him. She’d always been the one out of their intern group to take him in, to see him when everyone else overlooked him, to call him out on his shit but to give him second chances. It was harder to lie to her, but he had to when it came to this.
“Fine, I’m just a bit hungover,” he grabbed a few pills from the bottle he’d forked over for that morning, and dry swallowed them. “I’m gonna have a shower.”
“You better be fast,” Cristina pointed out to him, “aren’t you with Shepherd today?”
Alex nodded his head, he still had no idea what his specialty was, unlike both Cristina and fucking Avery, even that prick Percy seemed to know he wanted to do which was general surgery. Alex had thought about going into cosmetics, until Avery did so, and Alex realised that Mark Sloan was Jackson’s Caregiver. He wasn’t going anywhere near that whole situation.
“Yeah,” he grabbed a towel, then locked his locker, fleeing the room.
“What’s going on with him today?” Meredith frowned after him as he left the room, to the adjoining communal bathroom.
Derek was about to start his rounds when he was almost ran into by Alex Karev, who was on his roster currently. He was a good surgeon, but he was cocky, arrogant, and guarded; he hadn’t yet realised that he needed to learn to at least bond with other people on a surface level, that no surgeon was in the OR alone, they were part of a team.
“Sorry,” Alex panted, “sorry, sorry I rushed here I didn’t-”
Derek sighed heavily. If he hadn’t seen Alex sitting by the bedside of a dying man for hours after his shift when Alex was an intern, he wasn’t sure he’d let him work with him today. “-Don’t be late when you’re with me again, got it?”
Alex nodded his head, straightening up, and slowing his breath, “Yes, sir.”
“Good. Now, let’s get going, these people shouldn’t have to wait around for hours for us to bother to show up.”
“I really didn’t mean to.”
Derek hadn’t expected Alex’s voice to go so soft, Derek could have sworn that he was actually hurt by Derek’s words. Derek had been told about a hundred times by Amelia, since the two had reunited and she joined his department as an attending, that he could be cold when pissed off. He cursed himself internally, he knew he was on a shorter tether, not having any luck with the fostering and adoption agency was starting to get to him.
“I’m sorry, I didn’t mean to hit out at you like that. Let’s just get started, okay, fresh start; you weren’t late, and I wasn’t an asshole, deal?” He smiled when Alex looked surprised but quickly nodded his head.
Their last patient during their morning rounds was also who they’d be operating on that day.
Alex sucked in a breath as he saw a Little in the bed. He glanced quickly at the file, he hadn’t read it at all, not with them already running late, and a previous patient asking them both a million questions.
Sure enough the guy in the bed was a Little, with a dropped age of around 8, clearly nervous, but not scared. His parents, or Caregivers were clearly scared though… He read a little further down as Derek greeted them all fondly.
This was a care Derek had apparently been working on before he’d been assigned Alex as his resident:
Abdul Naqvi was 37, with a dropped age of 8. He’s a freelance accountant, or was before the epileptic seizures he suffered from got so severe and frequent that it was doing serious damage to his entire life. They’d tried every type of medicine, medical marijuana, changes to his lifestyle to minimise his stress and possible triggering stimuli, and deep brain stimulation. Nothing had helped.
This was really the last option.
Abdul was clearly dropped at the moment, when regressed Littles would shrink physically depending on their dropped age, he was about 5ft at the moment, and was hugging a teddy. One of his dads was holding a book, but put it down when Alex and Derek had entered the room.
Derek grinned down at the Little, ruffling his hair, and pulling a lollipop out of his pocket. Alex tried not to frown: did Derek always have those? Were they just for patients or could Alex get one? Like if he did good at brain surgery could he have one? That last thought was at least a little sarcastic… maybe he should just pickpocket it from him, that was like riding a bike, and he still had some metaphorical sticky hands…
“It’s so nice to finally meet you all, as you’re aware I’ve been consulting constantly with your neurologist in Delaware, and that the agreed next step is a big one, but I think we all know that it’s the only one we’ve got if we want to help your son.”
The two men winced but nodded their heads.
“Oh, this is Doctor Karev, he’s my resident, he’s going to be assisting me with Abdul’s tests, and if all goes to plan with his surgery.”
Alex saw Derek look at him from the side of his eye, Alex quickly looked away from the older man, and held his hand out to both of the men, “Hi, it’s nice to meet you both.”
“I’m Kevin,” the tall korean man said, his handshake was firm, and his shirt was rumbled.
“I’m also Kevin,” the shorter bald black man blushed, “I know, it was funny at first, believe it or not.”
Alex laughed politely, then held his hand out to the Little in the bed, “Hey there, I’m Doctor Alex, I’m going to be helping Doctor Shepherd look after you while you’re here, if that’s okay? That’s a cool book.” He pointed at the book at the end of the boy’s bed. It was one preparing kids for surgery, probably younger than Abdul’s headspace but with all the seizures and medication he was probably sleepy a lot and needed things a little more understandable.
Abdul’s eyes lit up, “You know it?”
Alex hesitated, then nodded his head. He sent him a small smile before he admitted, “My mom was a librarian, so I read lots of books when I was a little, a, er, a kid. I loved the ones about gross things in the human body, and learning about everything to do with doctors, it’s why I became a doctor.”
It felt like a massive reveal, with his best friend’s (god, was Meredith his best friend? He couldn’t think about how sad that was right now, because he knew the feeling wasn’t mutual) husband in the room.
“You can read them, if you want?”
“I might take you up on that a little later,” he found himself wondering what would happen if he did, if he sat there and read a book, would everyone know? Would everyone figure it out? “I’m going to talk with Doctor Shepherd and your dads right now, how about you find the grossest thing you can in the book to show me?”
That seemed to interest him enough that Alex could take a step back from the bed, back with the adults, he stood beside a bemused Derek Shepherd. He held tighter to the file still in his hand.
“Doctor Karev,” Derek said, his voice back to the professional tone, “what do you know about functional Hemispherectomy?”
Alex searched his brain for a half a second. “It’s a surgery where you remove the damaged part of the brain, usually the temporal lobe, then you cut the corpus callosum in hopes of stopping the hemispheres from communicating with each other.”
“Good job.” Derek smiled, “I know we’ve talked about this on the phone, but do either of you have any questions for me?”
“Do you really think thi-this cutting his brain in half will work?” One of the Kevins asked.
“Functional Hemispherectomy,” Derek told them softly. “Abdul is the perfect prospect for this surgery; his epilepsy is on one side of his brain, it affects an area too large for just a small part to be cut away, I do think this is the best thing: Littles brains aren’t like Neutrals, or Caregivers, which is why they shrink when they’re dropped, why their brain is aged differently than ours, even when they’re not dropped, their brains are constantly still developing. This is a positive, because it means that with this surgery the healthy side of the brain might be able to help with some of the function of the other side.”
Alex knew all of this, logically, he’d gone through college, med school, and his year of being an intern, he wasn’t dumb, he knew the physiological and psychological differences between Littles, Neutrals, and Caregivers… but it hit differently hearing it from a doctor he knew well, when it was just him in a room with three Caregivers and another Little.
He felt a stabbing pain inside of him, he shoved it down, he didn’t need to care about what Derek said, he could shove down being Little, he could be normal.
He answered questions Derek put to him, with robotic accuracy; going over the possible side effects of both this specific surgery, and surgeries in general.
Derek introduced them to Arizona and Meredith, the latter of whom was on the peds service this week, which meant they would be working with Abdul, with Littles falling under peds typically.
Alex smiled when Derek claimed the surgery for himself, saying that Arizona would be deeply involved knowing that he’d get to help on this surgery. He wanted to do the surgery, to prove that he could, to himself, and to everyone else, even if no one else knew about him… but he also wanted to be there to make sure that Abdul was okay, he liked the Little, as much as he would allow himself to like any little.
Once everything had been agreed to, Alex got to work with Derek. They did several scans, then set up a WADA test to both confirm the tests done by Abdul’s doctor back in Delaware, and to check to see if he had to be awake during the surgery or not.
Alex was a little relieved that Abdul wouldn’t have to be awake during it, both for Abdul, and because it meant that they wouldn’t have to worry about keeping him calm during surgery.
By the time all of this was done Alex was onto his night shift. He ate a cheap damp sandwich and a pot of mostly flavourless ramen, along with more suppressants, they were so shit, he knew he’d have to keep on top of taking them to make sure he didn’t slip.
He probably shouldn’t have eaten either of those, not when he felt stomach pain from it, that’s what he got for eating stupid fucking vending machine food, but he couldn’t splurge on cafeteria food, not when this was cheaper. He’d get over it, he swallowed some Advil and just pushed through.
He slept on and off in the breakroom, relieved no one was using it to fuck in, for once, every so often getting woke up by his pager calling him to different patients, with cups of coffee between all of it.
Abdul’s surgery went as well as Derek could logically tell without seeing him out of the OR, but deep down Derek could feel it had gone well, that the surgery was a success- not that he was about to say that outloud, he didn’t believe in luck or fate or jinxes…. Except when it came to the OR then it was all fair game, and no one should say the ‘Q word’ or count their chickens before they hatched.
Alex Karev had done good work, the surgery had taken around 12 hours, not the longest one either of them had done, Derek was guessing, but still, it wasn’t an easy thing, especially considering Alex was downing coffee like it was water before they had to come in. He must be feeling it now, as Derek sewed Abdul’s head up, because Derek realised, for the first time, how pale he was looking. Perhaps a little sweaty.
“Are you feeling okay?”
It took Alex too long to realise Derek was talking to him. He nodded his head, staying where he was in the OR. “Y-yeah.”
Derek frowned as he finished the very last stitch, before stepping aside for the nurses to bandage him up, before they took him to be monitored in the Pediatric Intensive Care Surgical ward.
“Karev?” Derek could see how out of it the younger man looked, he took hold of his arm and tugged him so that he was out of the way of the nurses, and turned him towards him, to look at him. “I’m serious, are you okay?”
“F-fine,” but the end of his word was cut off with a wince and a whimper.
“No.” Derek told him firmly, no way was he letting him ‘I’m fine’ his way out of this, he’d been with Meredith for too long to buy that crap, he wasn’t about to let it slide with Karev. “What’s wrong? Karev, you’re a doctor, tell me your symptoms. If you’re sick I need to know, we’re in an OR with a kid whose skull was just led open for hours, if you’re not feeling well we need to know.”
Alex shook his head, “N-no, I-? ...not ill.”
Derek frowned as Alex blinked heavily, his eyes darting around the room without seeing anything. This wasn’t good.
Alex let out a strangled groan as the pain in his stomach grew more painful than it ever had before.
Then the world went dark.