A/N: Hello guys! Sorry to leave you hanging for so long. I haven't forgotten this story. Hopefully the length of this chapter will make up for the delay in updates. Thank you so much for those of you who are still hanging in there for this story. I hope you all enjoy this chapter. Thank you so much for reading and please let me know what you think.

April swallowed hard and watched as her husband and Dr. Porter, another American physician who worked on the program, share a joke with Lucy Fields. Like the other woman was so funny. April rolled her eyes. Five days in and she was are ready pretty much over the OB/GYN.

Way over her, in fact.

Personally, April found Lucy Fields to be cold and back handed. Though, she could admit, some of that might stem from a residual jealousy of Lucy's history with her husband. Probably a lot of the dislike stemmed from that past.

It wasn't like she didn't know that Alex had led a full and robust romantic and sexual life before getting together with her.

April knew that. Heck, she dealt with the evidence of that on an almost weekly basis, when she co-parented her stepson Kyle with Alex's ex-wife Izzie. That had been hard at first, but in the end April thought that she'd done a good job of handling all her feelings about her husband's ex-wife. She'd built up a tolerance, if not a friendship with the other woman, and had no problem spending the occasional holiday or birthday with Izzie.

For the kids at least. Kyle, Adam, and Audrey loved each other and acted like it most of the time. So April figured they had to be doing something right.

Lucy Fields had no secret child with Alex, nor did she play nearly as big of a role in April's life as Izzie Stevens. Alex barely saw the woman, only when he made his short trips to Africa, and really even at Nambosi clinic as far as April had seen, the interaction was minimal. He ran classes that had to deal specifically with pediatric cases, while Lucy did a few on obstetrics and gynecology. She'd been in Malawi running the program long enough that she wasn't even the primary teaching OB anymore. Dr. Valero, a kind soft spoken man who April actually liked very much, did the bulk of the actual instructing on the subject done in the program. Fields did a lot of administrative and fundraising work.

So it wasn't like Fields was in April or Alex's face all the time. She was just around.

But somehow, for some reason, whenever April found herself in the vicinity of the blonde surgeon, she had to resist the urge to punch the smug look of Field's face. Not giving into the impulse was doubly hard whenever Alex was also nearby.

And she knew it was mean and that she wasn't really a violent person and that the jealousy over Alex was really unfounded, yet April couldn't shake the feelings that rose in her chest when ever she had to interact with Dr. Fields. And it didn't even all relate to her husband, when she really thought about it.

Maybe she was being paranoid, but sometimes it just felt like Lucy didn't treat her with much respect. Something in the way she spoke to April just felt...

She couldn't actually articulate it exactly. But something in the way Lucy treated her didn't make April feel good. It had started right away on that first day in Lilongwe.

The walk from the airport to the car hadn't taken very long, but Lucy acted like it was something that April couldn't handle. How many times had the woman turned back on the way to the car to ask the same damned question?

"Are you sure you don't need me to get you a wheelchair?"

Sure, April was stiff. Yes, she was using her cane. Her limp was much more pronounced than normal due to the length of her flight. But it wasn't like they were trekking across the Himalayas! April had been walking on her bad leg for years at this point, and she knew her limits. Right now she had to walk a little slower, and deal with a little pain, but that was it. April didn't need or want any more attention drawn to the fact that much of her right leg was synthetic.

She knew that already. She was painfully aware. But April didn't need a wheelchair any more than she needed Lucy Fields' constant badgering.

Alex had calmly whispered in April's ear, "Whatever. Just ignore it..."

But even that was hard, because in Malawi it seemed everyone seemed to comment on April's leg and cane. At Nambosi clinic, Fields led them towards their rooms, telling the students who'd assembled out front to help carry bags, "Dr. Kepner will need some help."

Marking April as different.

Within moments she'd heard the whisper go through the small crowd as they tried not to stare.

"She is lame?" One student asked another.

April had scowled. Maybe she was, but not that kind of lame.

"A cripple."

"Traumatic crusting injury. Near full lower leg replacement, instead of amputation. I read online. Very good work."

"America." They all nodded in awe and murmured in agreement. "Only in America."

Alex had cleared his throat and stared down the whisperers, students he was familiar with apparently, "Simmer down guys. This isn't some freak show. It's no big deal and I don't want to hear you acting like it is."

Chastised, the students nodded and ducked their heads. They respected Alex. Nothing more on the topic of April's leg was mentioned and the group busied themselves gathering luggage.

"I'm sorry, I just gave them all a heads up that she'd need a little accommodation," Lucy explained, feigning apology.

It wasn't like April didn't need help sometimes. But the operative word was sometimes. And more often than not April liked to try to do most things herself before she turned to others for assistance. Because it turned out that more often than not she could do far more than people expected her too. Heck, even being a successful trauma surgeon wasn't something outsiders might think she was capable of.

"When I need it, I'll ask for it," April muttered, watching awkwardly as the students carried her suitcases away.

Field's smile didn't ever seem to reach her eyes. "Just trying to help."

And maybe that was the whole thing really.

April was jealous in one sense of the woman's previous relationship with her husband. But the thing that probably bothered her more was the fact that Lucy treated her like a cripple. It felt like she went out of her way to point it out. And the vast majority of people at the clinic followed her lead.

Not that they weren't nice. In her trauma classes virtually all the students seemed to hang on April's every word, eager to learn strategies that would help them handle trauma cases in the field. Unlike many of the other courses and training offered, which was often geared toward treating and stabilizing critical patients in Africa, before sending them on to partner institutions in the United States, most of what April focused on in her trauma lessons didn't require fancy technology, sophisticated systems or state of the art hospitals in order to be successful.

In theory, a checklist, mental or written, could be used in any circumstance.

And the students seemed to appreciate that. They asked good questions, respected when she didn't want them to talk, and vigorously participated in her prepared skills labs. But sometimes April found that her students could be too nice. They tried to stop her from running out into the courtyard with them to practice trauma drills. They tried to prevent her from climbing stiffly onto a gurney to demonstrate a technique on a dummy. They were always following her around with chairs.

It was infuriating.

"Everything alright, Dr. Kepner?"

April blinked, suddenly snapping out of her zone out and turning to face Dr. Fields, Porter and Alex. On her reading the other woman looked smug, which put April even more on edge.

"I'm fine," she replied tersely. Under her breath she muttered, "I don't need a freaking wheelchair."

Alex cleared his throat and walked over to April's side grabbing her elbow and guiding her away from the other doctors, "Okay...we've gotta go guys. Homework to grade. See you later."

When they'd reached the relative safety of their room, April scowled and pulled her arm away from her husband, as he looked on with a smirk.

"What?"

He crossed his arms, "Nothing."

"I'm fine!" April repeated firmly.

"Oh yeah? Because if looks could kill, I think Fields woulda been six feet under," Alex quipped. "It's actually pretty hot."

"I can't help it," April pouted. "Something about her just sets me off."

"Hey, I get it," her husband chuckled and flopped onto the bed pulling out his cell phone and poking at the screen. "She stole my freaking job, remember? But you know, I don't think we'd get away with it if we took her out. You'd totally blab."

April glared, "It's not funny, Alex. She treats me like an invalid. And then so does everyone else..."

Sighing heavily, April settled down on their bed too. Alex loved Nambosi clinic. He loved the work, he loved the students, the charity. Alex loved Malawi. And April had longed for so long to share this aspect of his life with him. Because she wanted to love what he loved and support him in his work. But it was barely 5 days in to their 14 day trip, April was starting to realize that she didn't love it there. Not at all.

It disappointed her.

April thought she would like Nambosi Clinic and and she wanted to very much. Especially given the recent distance that had cropped up between herself and Alex. She'd thought joining him in something he liked would reconnect them. But the harder April tried, the more obvious it was that this program, whether because of the location and distance from her home, her unease with her disability at the clinic, or the proximity to her husband's annoying ex, was not working for her.

She missed her children desperately. She missed her ER. She missed her car. She missed her friends. April missed it all.

When she was a girl she yearned to get as far away from home as possible. And for medical school and residency she really had. April had built her life in Seattle, miles away from her childhood home Cook, Ohio.

However, the older April got, the more she started to realize that maybe she was a homebody at heart.

"I know," Alex sighed, flopping down on his back. "Fields can be a bitch."

Closing her eyes April laid back to join her husband, curling close to his side, "I'm sorry. I just don't like the way she makes me feel is all..."

"Well, whatever. What Fields thinks doesn't even freaking matter anyway," he replied irritably. "It doesn't matter what any of them think. What matters is what you think!"

"But-"

"Only you can hold you down," Alex advised sagely. Almost wise. And very familiar.

April's eyes, widened in instant recognition and she propped herself up on one elbow to watch her husband in amusement, "When did you read my old notebooks?"

He shrugged playfully, "Found 'em in a box in the study when you went to that conference a few months back. You know you really worry too much about pointless crap. I mean, you are better now than you were back when you wrote all that stuff, but-"

"So you read them?"

"Once or twice. Whatever. I missed you."

April laughed and turned to face the ceiling, "Those were never meant to be read. Certainly no by you."

"It's not all crap," Alex added. "Some of the quotes and stuff were pretty good. Like that one. And all that other Oprah philosophical crap. Or the ones about me." He made a face am mimicked her voice, "'Alex Karev is a great pediatric surgeon'. "

She rolled her eyes. Once, years ago she would have been mortified for anyone, especially Alex, to read her small notebooks. But in this moment, April actually thought the idea that her husband read her old residency notebooks because he missed her was really sweet. At the time of writing them of course, April would have thought it was the end of the world.

Back then April had kept all her private thoughts in the pages of the small red objects. She actually still wrote sometimes, but now, with motherhood and a bustling career, she wrote far less. There were still things she had a hard time sharing with her husband however. These days those private thoughts and fears all related to her daughter.

Deep down, April knew that it was something she should talk to Alex about. For Audrey's sake. For Alex's sake. For the sake of their marriage. But...it was hard to face the possibilities. She couldn't actually be sure there was anything so wrong with her daughter, and she didn't know how her husband would respond if there was. She wasn't sure she wanted to Alex's family history, thinking that something might be wrong with Audrey was pretty unbearable.

And yet? Not knowing was somehow easier to face. Ignoring the question, in fact, not even asking the question in the first place, was far easier than facing the possible answer.

"'Alex Karev is so sexy'."

"I did not write that," April poked her husbands belly.

It was Alex's turn to prop up in his elbow. He watched her seductively, "Not yet!"

Biting her lip, April couldn't fight the grin that spread across her lips. He might do it unconventionally, but Alex always seemed to know just what she needed to calm down. He could divert her attention away from whatever was bothering her. He could always make her feel good about herself. And he was helping now.

But one thing was certain. April knew Alex couldn't make her love Malawi. He was good, but he wasn't a miracle worker.

April grabbed Alex's hand and laced their fingers together, speaking dejectedly, "I don't really think I like it here..."

He squeezed her hand and pursed his lips, "I know, April. We'll be home before you know it. But you are doing really great. Word on the street is that the trauma seminar is the student favorite this session."

"Oh yeah?"

"Yeah, pisses me right off, since peds is usually the popular one."

"Oh boo hoo," April teased before sighing once more. Even Alex's valiant attempts at distracting didn't make her feel much better. She did appreciate his efforts.

"I miss Adam and Audrey."

A lot.

Which was probably another huge contributing factor to April's heightened irritability in Malawi. Their old therapist, Dr. Wyatt would probably say that all the frustration with Fields and the dislike of Malawi was all really a means of deflecting from her real feelings. It was always easier to be angry than sad.

A rather ineffective coping strategy that both Alex and April had in common.

She knew it was cliche, but April's heart ached for her two babies. She dreamed about them and worried about them. Would Adam ever forgive her for letting go of his hand and leaving him behind? Would Audrey have another freak out under her parents watch? Were they really as okay as their parents brief emails said they were?

"Me too." Alex tapped his fingers on the side of his phone glumly. He glanced at his watch and grinned, "But I know just the way to cheer us up."

April found herself smiling to because she knew exactly what her husband was thinking. He wanted to call her parents and check in with their children.

"It's early for them..."

Alex rolled his eyes and started to dial, "It's a farm April. And I have slept at your parents enough times to know that you are all early morning freaks...it'll be fine."

Sitting in her study, Meredith squinted at the dim glow of the tablet screen in front of her. Changing the contrast seem to have no impact on the way that the words grew fuzzy right before her eyes. Neither did the angle she held her head or whether or not she wore her glasses. Then again Meredith had been researching and reading reports from some of the Canadian mammal trials on the pacemaker project for most of the day. Still the difficulty in reading after long periods of time unnerved her.

Ellis Grey had needed glasses to read before the end.

Derek teased Meredith about it, recalling the time she'd experienced vision loss as a result of their fertility treatments years ago. It was nice that now they could actually look back those times and feel more than just complete anguish, but needing glasses again was an unwelcome reminder to Meredith that she was getting older. Older, just like her mother had.

One step closer to Alzheimer's? It was definitely a worry.

Not that Meredith allowed herself to stop and think about her motivations very much, she suspected that deep down a huge part of her driving motivation for diving into the brain pace maker research was the fear she had of ending up like her mother. She'd taken the test once. To see if she had it. But the result was still carefully tucked away in her medical file. Neither Meredith nor Derek could bring themselves to read the results however. Not knowing was somehow easier to face.

Suddenly, a tiny pair of hands appeared before Meredith's eyes from behind the couch.

"Guess who?" Zola giggled covering up her mother's field of vision.

It was a game the Grey-Shepherd family had played on a regular basis ever since their daughter was very small. Zola was cheeky and outgoing and always loved to play a guessing game with her parents. Usually they tried to come up with outrageous, funny or unexpected answers that would make Zola laugh.

Today Meredith decided to rhyme, "Maya Angelou?"

"No!"

"Are you a chef from Le Cordon Bleu?" she continued to tease, lifting her hands to her daughter and patting them playfully. "I'm hungry."

Meredith realized that had no idea how long she'd been holed up in the study reading about the results of brain pace maker model studies on mice. She knew that she'd started her reading around lunchtime, having had the house to herself while Derek took their daughter to her soccer practice. But now it seemed dark outside.

"Daddy made spagetti!" the little girl laughed.

"It's Zola!" Meredith announced triumphantly, reaching up and pulling her daughter over her shoulders and into her lap with a heave.

The girl was not so small anymore, and the movement took more effort than it once had, and with a jolt, she realized that it wouldn't be too long before her little girl was too big for this kind of lifting. Zola snuggled close and peered inquisitively at the research on her mother's desk.

"How was your practice, Zo?"

The little girl shrugged, "It was okay, I guess. We're getting better, but I don't think we'll win our next game...it's hard. I don't wanna be a loser again."

"That's okay baby girl. You're trying. It's not all about winning," Mer comforted, knowing that this was actually one of the harder lessons she and Derek tried to teach their daughter.

"That's not what Aunt Cristina says..."

"Well, Aunt Cristina says a lot of things."

But Meredith new her twisted sister had a point. They were all surgeons. By nature and by their successes, both Derek and Meredith were intensely competitive people. And so was most everyone in Zola's life. They enjoyed 'winning' in the sense that they liked getting cases they wanted, the liked getting awards they felt they deserved, and best of all they liked beating the brain problems they treated. But Meredith had grown up as Ellis Grey's daughter, and she'd known Jackson Avery long enough to understand that growing up in that kind of environment, with incredibly successful and competitive parents, could be very demanding if not handled properly.

In some ways, Meredith was fortunate Ellis Grey was dead. Jackson's mother Catherine still continued to hover over her son about everything from his career's lack of 'flash', to his role in the Harper Avery foundation, to her lack of grandchildren. Being the child of a surgeon wasn't easy.

So she tried her best not to emphasize winning as the end all be all of life for Zola.

"Daddy made dinner?" Meredith asked. "Already?"

Zola nodded and pointed to an image of a mouse on the tablet screen, "Why do they have wires in his head?"

The girl didn't often show much interest in what exactly it was her parents did. She new that they were doctors and that they worked on people's brains, but usually zoned out when Derek and Meredith talked too much shop. It was kind of humbling actually. Their daughter never bowed at the altar of medical admiration the way a lot of other people did. Then again, given that most of the parents Zola's closest friends and a good number of her family members were all surgeons, the feat probably didn't seem all that unusual or impressive to her.

"The scientists are using the wires to deliver a little jolt of electricity to the mouse when neural pathways collapse," Meredith explained eagerly. "That way the mouse doesn't loose his memory."

Her daughters face scrunched up, "How do they know if a mouse is forgetful?"

"They check if he remembers where he hides his food, where he sleeps, how to get out of mazes. Stuff like that."

"Why do they even care if a mouse forgets things?"

"Because these mice have a disease called Alzheimer's. It's a disease people get too, and since we're both mammals it causes similar damage to the brain. If they can figure out how to stop it in mice with electricity, they might be able to help people too."

"Alzheimer's," Zola's tongue formed the word very carefully. "That's very bad, huh?"

Meredith considered the question carefully. She supposed with neurosurgeon parents, Zola had definitely heard the word before. She'd certainly been present for many conversations about most of the kinds of conditions Meredith and Derek treated on a regular business. Like most children, she seemed to shut a lot of the talk out, but she supposed something was bound to have cut through. Even if Meredith hated to talk about it.

"Yes," she answered. "It makes you lose all your memories..."

Zola frowned and glanced up to Meredith, "Your mom had it, didn't she?"

Meredith had no idea how Zola knew that, because she honestly had never talked about Ellis Grey very much with her daughter. Ellis and Zola represented two completely different lives for Meredith and she really didn't want them to overlap. And Zola never really asked about her grandmother, because she was close with Derek's mother. Or so Meredith thought.

"She did."

The girl swallowed. "Daddy said it can be her-reditary...like passed down in families and stuff. Well...not adopted ones."

Involuntarily, Meredith felt her arms tighten around Zola as she nodded.

The girl must be getting her information from Derek. Though she couldn't understand why the hell such a weighty subject might come up between father and daughter. It's not the kind of thing you should talk about with a 9 year old. She made a mental note to chastise her husband.

Zola turned back to face her mother and asked seriously, "Will you get it?"

The question almost broke Meredith's heart. It was actually one of her greatest fears. Meredith hated the idea of losing her mind. Forgetting her husband. Forgetting Zola. Forgetting who she was. Meredith did not want to end up like Ellis Grey. She knew she had the genes at the very least.

Whether they would work together at some point and cause her to lose her mind was out of control. Whether there was a treatment that could prevent or cure the disease by the time Meredith did find out whether her DNA would betray her was something that she had control over. That's why she was determined to explore this pace maker idea.

Even if the whole thing went far past the line of emotion and separation that surgeons are supposed to maintain. She had to push and take part in Alzheimer's research.

"I don't know honey," Meredith finally responded. "I hope not..."

"Me too, Mom," Zola swallowed and leaned close. "But don't worry. If you get it, I'll help you remember your life. I'll take care of you. I promise."

As freely and sweetly as the offer was made, Meredith knew exactly what taking care of a parent with Alzheimer's entailed, and she knew that it was the last thing she wanted for her daughter. Her mother's illness and the words that it caused her to speak hurt Meredith more than she liked to admit.

Zola's words reinforced her conviction to pursue her research even more. She needed to get approval for clinical trial. She needed to figure this out. She needed to do everything she could to stop Alzheimer's disease from ruining families.

Meredith needed to protect Zola from herself.

"Alright," Alex clapped his hands together, as the last of his medical students filtered into the cramped classroom, quieting the last of the chatterers. "So, today we're gonna talk about making tough calls in medicine. The hard decisions, sometimes even life or death ones, that have to be made as a physician. We all know that is hard with any patient, and we also know that it's even harder to make the tough calls when the patient is a kid."

Ten days into his crash course in pediatric surgery basics, and Alex had reached his least favorite, but probably also one of the most important lessons. When to face reality. It was hard enough to do with any patient. It was hard to make that switch from life saving to end of life care. It was hard to know when to let go.

Especially with kids. Even when the stakes weren't that high, treating children you knew you couldn't cure was a challenge.

Looking around the room, Alex saw a cascade of somber expressions appear across the faces of his normally lively class. The kind of expression that revealed that several of his students at least, had dealt with this kind of situation with patients before. Which made sense. A huge part of the reason the Africa program existed in the first place was to help doctors in places like Malawi achieve the best possible kinds of outcomes for their patients.

Outside in the distance, Alex could vaguely hear the sound of his wife's voice on the wind as she ran another skills lab in the clinics central court yard. He knew she hadn't exactly fallen in love with the place, like he had after Robbins had gotten him involved in the project in the first place. April was trying hard to have a good time, but Alex could see the truth. She put on a good show.

And it was actually cool. Alex was glad she had the chance to see his work outside of Seattle, even if he was fairly certain that this would be April's only trip to Malawi. It was all that give and take crap in marriage. In the same way he didn't exactly love cooking or chick flicks or helping out his father in law on the farm yet he still did all that stuff with April, she was returning the favor in Malawi. And doing a decent job with trauma class to boot.

Which pissed Fields right off, much as the other woman tried to hide it. There was a reason she had transitioned over to the admin side of things at Nambosi clinic.

April was a better teacher than Lucy. She was more effective, more fair and more approachable for students than the stony faced OB/GYN. In her short time at the clinic, April was also more popular among the students too and Fields knew it. So, she pushed April's buttons. Alex tried to stop the catty back handed stuff he saw going down between his wife and his ex girlfriend whenever he saw it, because he was damned if anyone, especially Lucy of all people, would treat his wife without complete respect.

But frankly he felt a bit out of his depth.

Honestly, they way chicks fought didn't make any sense to him. At all. If they were dudes, April and Lucy would just go outside and beat the crap out of each other. And April would win (he knew she freaking would) and that would be the end of it. Full stop. Close the freaking book.

Chicks would smile at each other to their faces and then talk shit behind the other's back. They'd do little tiny things that they knew would bother the other person. They'd let the whole conflict gnaw away at them for days.

Alex just didn't get chicks sometimes.

He noted that many of his own students gazed longingly toward the windows. Today, the consensus seemed to bethat trauma class would definitely be more fun.

Swallowing hard, Alex pressed on, "The key thing to remember though, is that in any situation, no matter what, there is always something you can do for your patient. It might not be the something you want to do. You might not be able to fix their hurt, cure their disease or make them well again, but there is always something you can do to make them comfortable."

The solemn class in front of him nodded.

In the front row, one of Alex's more promising students, Mercy Unganwo, seemed to be thinking deeply. Her strong features were set in a frown, though her determined jaw was set, as always. She was one of the more interesting students too. Her ending up in medical school was nothing short of a miracle given her family background and origin in one of Malawi's isolated rural villages. A generous donation to the Africa Projet's endowment from the Harper Avery Foundation, courtesy of freaking Jackson, allowed for the program to host the kinds of scholarships that even allowed Mercy to study at Nambosi clinic.

She didn't talk much, but Alex was consistently impressed by her performance in skills labs and her articulate essays. She was smart. She was passionate.

It was like Robbins always said about Alex. You just know when someone is good for peds.

Mercy was one of those people. What he wouldn't give to trade her out with some of the idiot residents he had to deal with back in Seattle. Sometimes it seemed like those students just failed to appreciate their education at one of the country's best teaching hospitals. The stuff they freaked out over. They didn't know how lucky they were.

"So, alright," Alex continued slipping his hands deep into his lab coat pockets and fidgeting with the remote in his pocket. "You are probably wondering what I mean by 'something'. If you can't help really, then what can you do?"

The class whispered among themselves and continued watching intently, while Alex fidgeted with his pockets. He knew what he wanted to talk about. Which memory of which patient he was going to use to illustrate the major point of the lesson. It was the same example he always used. He wanted to tell them about a young cancer patient he'd cared for years ago who'd died of end stage cancer named Marcello Conti. In the end, there was a shift in his care from life saving to end of life treatment.

Marcello's loss was a big one for him. April had helped Alex learn the very lesson about tough medical decisions that he wanted to teach his students today, and in the end it had also turned out to be the reason he told her that he loved her for the first time.

But it was still hard to talk about. Crap like that was always hard for him to talk about. So Alex stalled.

"How many of you hear have dealt with patients were you had that moment? When you realized that nothing you could do would make them healthy again? Show of hands?"

Dr. Wyatt, his old therapist, said Alex did crap like that because he thought that putting stuff off would make it hurt less when he actually had to talk about it. Like people who thought that pulling a bandaid off slowly was better than ripping it off in one go. In that session, while April snickered, Alex had calmly informed the psychologist that saturating a bandaid in baby oil messed with the adhesive enough so that it could be pulled off at any speed without pain to the skin.

Alex was a pediatric surgeon after all and a father. He knew things.

Wyatt told him he was missing the point.

About half of the students raised their hands slowly. Alex nodded. Many of the kids int he program had some experience practicing medicine in the field, but the depth of that experience varied.

"Not with a patient but..." Mercy mumbled as her brow furrowed and she skeptically lifted her hand in the air. She was the last of the group to do so.

Leaning back against his desk Alex nodded, "Okay so, it looks like many of us have already experienced this kind of moment. For those of you that haven't, you can't be a doctor and not encounter this. Don't worry. It's coming."

The gravity of the topic didn't stop a small round of laughter at his attempt to lighten things. Taking a deep breath, Alex glanced around the room. It was now or never.

"Um, when I was a 5th year resident," he explained haltingly, pressing the button on the remote in his pocket and activating the first slide of his power point. "I was treating this kid, Marcello..."

An image of the sickly teen appeared, surrounded by Alex, April, Cristina, Mer and Jackson as they hung out in his room studying for boards. Along side the image bullet points detailed Marcello's condition, and Alex began to walk his class through the development in his case during the last weeks of the boy's life. He used this case as an example because it was one that really stuck with him, and because one of the teenagers dying wishes was for his life to mean something. And even though he didn't live very long, Alex at least figured his legacy would come from the students Alex shared his story with.

"In the end his tumor grew to the point where it eroded his lungs," Alex winced as he flipped to the slide that contained Marcello's final chest x-ray. It was pretty bad. "He experienced increasing breathing issues. Now, his family, like I said, lived far away. And they were on their way but...well, his condition wasn't great." He pointed to his chest, "So you wanna know what course of action this genius argued for?"

Hands shot up instantly. Alex pointed to the one he'd seen first, Robert Saka.

"To give him doses of medicine that would ease his pain and respiratory distress? Morphine or something such as that? To mak him comfortable in his final moments?"

"That's what we ended up doing. That was the right course of action in Marcello's case. But, I wasn't used to making tough calls yet. I argued that we try an experimental procedure that had only been tried a few times for cancer patients."

The students looked around in shock. They seemed to think it was crazy that Dr. Alex Karev could and did make mistakes. Which still caught Alex off guard. Having success was still a surprise to him.

"Everyone screws up," Alex shrugged. "Especially when you are close to the patient. In this case the best thing for Marcello was to make him comfortable and keep him company until he passed. That was all we could do. It was tough for me to face, but fortunately I had people around me that helped me see the truth. Once I did, I totally was on board with the course of treatment. Because of course another surgery was only going to make things worse and of course he'd rather die being hugged by people that cared about him than cut open on a surgical table. For his case, this was clearly the way to go."

The description seemed to hit some people. Even when you dealt with poverty, lack of resources and death every day, if was still difficult to hear about a loss. Some students dabbed at their eyes. Others sniffed. Mercy looked at her hands.

"Honestly sometimes the hardest thing to do, as a doctor and in life, is face a reality that you don't like. Sometimes the truth will freak you out. Sometimes it'll piss you off. Sometimes it'll make you feel powerless. It can cloud your judgement enough that your actions are more what is best for you and your feelings than they are for your patients. Fantasy land crap. But you know what? You can't be that effective until you face what is ahead of you..."

Alex swallowed hard and concluded, just as the clock signaled the end of his lesson, "Learning how to get better at accepting the truth is actually one of the hardest parts of your job. Especially when you know that medicine is capable of great things. It just doesn't work for everyone. Or every kid. Some food for though. Thanks and see you guys tomorrow."

As the class began filtering out, Alex turned to shut down his laptop. When he closed down the power point, his desktop background greeted him, and made him swallow hard, given the nature of his lesson. It was an image of his family. Amber, April and himself, plus the three kids grinning on the front steps of his house. Well Kyle and Adam were grinning anyway. Audrey was sitting on his lap, with a more blank expression, seemingly more focused on rubbing her fingers along the Velcro if her shoe than anything else.

Alex might have gotten a handle on making tough calls in medicine, but he was crap at facing reality in his own life. He knew better than probably anyone other than his sister Amber, just what kind of crazy that existed in the Karev family. It was DNA. Between his mom and Aaron, who both had incredibly complex mental health problems there was a distinct possibility that Audrey had inherited something, even though the thought left him sick to his stomach.

The older Audrey got the more clear it was that she wasn't exactly normal. The distance and time away from her in Malawi had given Alex time to think. April too, not that she'd said anything to him about it, a fact which made him feel grateful. He wasn't ready to talk about it, but he was ready he supposed to use the trip as a time to evaluate things. The trip was giving them both time to think.

To look at the situation more objectively without being around the toddler 24/7. It's amazing what you can normalize to when you are around it everyday.

In the emails and skype calls Alex and April had shared with her parents to check on the kids, it was clear that Joe and Karen were getting run down. And while they never came out and said it, Alex would bet money that the reason they were getting exhausted was because of his daughter. What was it Joe had said in the last call? Or Karen in the one before that? Sometimes in the video chats it looked like they'd only barely managed to get the little girl dressed. Sometimes it looked like they hadn't at all.

Audrey is a handful. That's what people said.

Alex had several probable ideas as to why people said that, but he honestly wasn't sure he could handle actually knowing why. He didn't think he could hold onto his own sanity if he found out his daughter really had inherited a condition. He didn't think he could live with the guilt. Because it would be his fault she had it. April's family was full of freaks in their own right, but none of them actually had a mental heath disorder. They fought but none of them ever tried to kill a sibling.

He didn't think he could live with the guilt.

After all the other students had left, Mercy lingered behind. Alex looked up thoughtfully when he realized she stayed behind.

"This was a good class today, Dr. Karev."

"Well, uh...whatever. It's something we all have to learn."

Mercy sighed heavily and nodded, "Yes. It is."

He didn't know the young woman well, and he wasn't exactly one of those touchy feely kind of teachers, but he could tell that she had been deeply impacted by the days lesson. And for whatever reason, Alex was drawn to this student. He liked her . She reminded him of himself in a lot of ways. Remembering her earlier comment he decided to prod.

"What did you mean, earlier in class? When we raised hands. You said you had experience making tough calls and facing reality, but not with a patient?"

Something flashed in Mercy's eyes and for a second, Alex thought he'd blown it completely. He half expected Mercy to turn on her heel and run out of the room.

Finally she shrugged, and stated, "Once in my village, when I was...perhaps 14? Many became sick. Many children. I had five brothers when the sickness came. Now, I have three."

Realization dawning, Alex's eyes widened. Damn.

"Ah..." He didn't really know how to respond. "That sucks."

Nodding, Mercy approached Alex's desk and pointed to his computer screen, "Is that your family? I recognize Dr. Kepner..."

Happy enough with the change of subject, Alex smiled proudly and pointed to the picture, "Yup. Those are my kids. Kyle, Adam, and Audrey."

A hint of a smile crossed Mercy's lips, "They look like you too. Well, except..."

"Yeah, Adam looks like April," Alex chuckled. "It's mostly the hair..."

"They are all very beautiful."

Alex beamed, "I like to think so."

The student's expression became thoughtful again, "This was a very good class today, Dr. Karev. Something we all can find useful."

"That's the idea."

"It is difficult to accept things."

"Yeah. Sometimes it really is," Alex agreed.

"Especially for your own family," Mercy continued. She paused and then added almost to herself. "It will be easier as a doctor."

"Maybe."

Shaking her shoulders slightly, Mercy slowly gathered her books and turned towards the door, "We must accept things, even when they are hard, right Dr. Karev? It must be done."

"Er, right," Alex replied awkwardly watching the girl leave his classroom. He let his mind and his thoughts wander back to the image on his desktop screen. He swallowed hard, looking for a long time at Audrey.

It must be done. Some thing must be done. He was her father. There had to be something he could do for her.

But what?