The decision to leave Seattle had been an easy one to make. Alex had friends, sure, but he really only felt close to Meredith, and that was mostly because of how screwed up they both were. And Lord knew he'd accumulated a ton of baggage in his short tenure in the Pacific Northwest--Olivia, Izzie, Lexie... and Rebecca. The implosion of his ill-advised relationship with "Jane Doe" was certainly the most compelling personal reason he had to find a new zip code. She still thought he'd change his mind, that he'd decide to give them another shot, and even though she was back home with her husband and her baby, Rebecca's number appeared regularly on his cell phone's caller I.D. screen. He just never answered the calls.

But he had a pretty damn good professional reason for wanting to move on, too, and that was the loss of his mentor. When he'd finally been forced to fill Addison Montgomery's position after keeping it open for more than a year, the chief had been surly as hell, his mood growing worse with each passing candidate interview. It seemed to everyone that he'd really only hired Steven Alberts because he was the person the board disliked the least. And the former Boston resident hadn't needed much time to realize that following in the brilliant redhead's shoes was no easy task. And no one had proven harder to win over than Alex Karev.

Alberts was a good doctor and his surgical skills were certainly top notch, but he didn't have that... whatever it was that Addison had, and everyone in the NICU felt it. He wasn't the guy who'd take a leap of faith and try something that seemed impossible to save a life when it didn't make sound medical sense. And while no one would have ever called Dr. Montgomery a daredevil in the O.R., she had pushed boundaries and pulled off too many amazing saves for just anyone to impress the nurses and residents who had worked beside her.

Alex found the guy wholly uninspiring; so much so that he'd briefly considered going back to plastics. But there was no rush from plastics anymore. It was a rotation just like anything else, and he only felt a tug in his gut that said "this" when he worked a neonatal case. So he'd endured Alberts, but it had become clear through his third year that if he was going to be the surgeon he wanted to be, he needed to consider changing programs.

When he'd finally approached Bailey about it, she'd told him he was a damn fool for waiting so long and gave him a list of programs he should check into. Alex knew he couldn't afford to discount any of them, their questionable geography notwithstanding, because if he wanted to be in a top neonatal surgical unit at this stage of the game, he was going to have to sell them on taking a transfer, and it might take all five applications to get even one to accept him.

But he'd been luckier than that. His diligence in his past surgeries with Addison had allowed him to discuss the procedures in detail on each of his interviews, and he found he was making not just a good impression, but a great one, not only because of his experience, but because Alex Karev was showing passion and dedication and even... shockingly enough... a hopeful nature... about a specialty he'd laughed at in his past life as a kiss-ass plastics chaser.

He'd ended up with two offers--one from one of the best children's hospitals in the country, Children's Healthcare of Atlanta, and one from Children's Hospital Los Angeles, which had recently begun an effort to try and up its national ranking by getting its associated school, the University of Southern California, to recruit two top surgeons from Philadelphia and Morgan Stanley to join their mutual staffs.

Atlanta had been fine as a city, and after living in Seattle, Alex figured he could handle anything, really. But he just liked Los Angeles better. And while he knew that there would be no lack of cases at the Georgia hospital, both Torres and Chief Webber had commented on how well his Montgomery-honed skills would play in L.A., where he would be the best of a program on the rise, not another great surgeon at an already great program.

So Los Angeles it was. But while he had found his true calling thanks to his mentor, he'd never really thought about ringing her up and saying, "hey, moved to L.A., want to get together?" It really wasn't his style, and after all the drama he'd been through in Seattle, he was enjoying just being a guy on his own, his life all about moving from surgery to surgery and grabbing a few hours of sleep where he could get it.

The hospital wasn't fancy, and Alex felt like he got a memo every other day about one fund-raiser or another that they had to do something to support, but he was in surgery every day, and his prior experience from Seattle Grace had him very far ahead of the game. And those fund-raisers, annoying as they might be, were going to help build the new hospital, one with a NICU he'd heard would make Seattle Grace's look like a starter model.

So he was doing well, really. He'd settled into a pretty easy life, commuting from his studio apartment in Los Feliz to the hospital by riding his bike up and down Hillhurst--a risky proposition sometimes thanks to the traffic, but one that kept him fit even when he was short on time for the gym. He had made a few casual friends at work that he could grab a beer with when the urge hit, and he'd established a new, very firm rule--no sex with anyone in the hospital--no fellow doctors, no nurses, and definitely no patients. It meant hookups took a little more effort, but it also meant a lot more peace in his work life.

This morning he'd gotten up early and ridden in before sunrise so he could get a jump on charts. He was working with his favorite attending today, and Mitchell Ross was an even bigger stickler when it came to charts than Addison Montgomery, which was saying something. But Alex had them in tip-top shape by the time Ross rounded the corner of the nurses' station.

"Morning, Karev. You ready to get started?"

"All set," Alex replied, "but I noticed our morning surgery was pushed back?"

Ross nodded and took a sip from the horrible wheatgrass thing that he drank every morning. Alex had tasted it once and could barely eat the rest of the day.

"Emergency consult for a former colleague--former for both of us, actually. Addison Montgomery."

The name caused Alex to physically stop, and it wasn't until Ross also paused and looked back at him that the resident realized he wasn't moving. Shaking off his temporary paralysis, Alex quickly caught up to the attending.

"We're seeing a patient of Dr. Montgomery's?"

"No. Her son. Well, foster son for now, but she's adopting him. And the little guy has one very sick heart--coarctation of the aorta. Which is?"

Alex answered without a beat. "A narrowing of the aorta that causes limited blood flow to the heart. The left ventricle ends up working harder, which adds to the stress on the heart. Usual symptoms are difficulty breathing, heavy sweating, pale skin, irritability."

"All of which he has, along with a side order of ventral-septal defect, though it doesn't look like the hole is that big from his first set of tests, but we're going to run our own today." Ross added.

"Is he on prostaglandin E?"

That made his attending smile. "Good call. Yes, Addison had him started on it, and they're watching his blood pressure very closely. He's tending to the high range, and surgery sooner rather than later is probably going to be his best bet, but she's a mother on this case, not a surgeon. She wants to make sure cutting this soon is really the best option. He was transferred in this morning."

Alex nodded, but he bit back the half dozen questions that came to mind because as they rounded the hallway corner, their interns were waiting for them. So he went into stern resident mode, prodding the students with questions when he needed to, explaining procedures when Ross deferred to him. Rounds flew by, and after assigning his interns their duties for the day, Alex dashed to the lounge for some coffee, which he poured and downed in record time before heading off toward the place he spent more time in than his apartment.

More than a few of his mornings in Seattle had begun with him walking into the NICU to find Addison Montgomery stationed by an isolette, her red hair dangling over her shoulder as she held a tiny hand and whispered comforting words. But it felt different to see her standing there with a small form curled over shoulder as she soothed away tears while trying to hide her own.

"Now, Ryan, I know you're tired of being poked, but there's mostly just pictures today, okay? We need some new pictures of your heart so we can get it fixed up."

She had already removed the baby's clothes, and he seemed to be taking exception to the loss of the warm cloth. When her hand sought a navy and white blanket that was on the table near the isolette, Alex picked it up and moved it closer to her. She took it and said thanks without really looking at him, and only after she'd draped the soft fleece around the baby did she look for the person that went with the helping hand. Her eyes went wide as recognition dawned.

"Alex? What are you... Hi."

She chuckled and he smiled in response.

"Hey."

"I'm sorry. I... I mean, of course I knew you were here at Childrens because Miranda told me, but I... I guess it never occurred to me I'd see you 'here' here."

"Yeah, I was pretty surprised to hear your name this morning, too."

As they spoke, Addison had continued to bounce gently, her hand rubbing circles through the blanket against the baby's back. The little boy had calmed significantly thanks to her efforts, and Alex watched as the infant opened his eyes to stare at the person holding him.

"So this must be the guy, huh?"

"This is Ryan," she said. "And, Ryan, this is Dr. Karev, and you know that look I get every time a new doctor or a nurse tries to pick you up? Well, Dr. Karev already knows that look very well, so [i]I[/i] already know he'll take extra special care of you."

She sounded deadly serious, but the grin that crept onto her face told Alex that his former mentor was most definitely pulling his leg. He leaned closer and took hold of the little boy's right hand. The infant's fingers quickly curled around his.

"Hello there, Ryan. It's nice to meet you. And you can call me Alex when your mom's not around to insist on the Dr. Karev thing."

When he glanced back at her, Addison looked a little thrown. When she noticed his noticing, she shook her head.

"Sorry, it's just... still getting used to the 'mom' thing. This all happened so fast."

Alex nodded and gestured to indicate he wanted to take Ryan. He waited for her to drop a kiss on top of the baby's head before she was willing to pass him into the resident's waiting arms.

"I've heard that can happen," he said as he made sure the blanket was still covering Ryan well enough to shield is exposed skin. "Waiting forever to adopt and then it happens overnight."

"Well, I wasn't exactly looking for it. I mean, considering it for the future, but... Ryan kind of just... I guess he just needed me."

"That sounds like a story."

Alex turned toward the scale and began to unwrap the baby as Addison followed, but at a comfortable distance, not glued to him like she thought he might drop the little boy.

"Well, long story short, my practice participates in this safe harbor program for teen mothers. I wasn't even on duty the night Ryan was born, but Cooper--he's our pediatrician--he called me in because he knew there was a problem with little guy's ticker right off. And while I was busy looking after this one, the hospital and child services were jumping through hoops looking for someone willing to take on his health problems, and when there weren't any takers..."

She stopped as Alex lowered Ryan into the scale. The baby began to fuss, clearly bemoaning the loss of his comfy fleece wrap, so Alex jotted the weight down as quickly as he could and then scooped his patient back up and into his warm blanket.

"There you go, little dude. All better now, right?"

The baby responded well to his voice, cooing and snuggling against him, and Alex felt a little more tension leave his body. That was always a crapshoot--he'd learned early on that not all babies would like you. And the idea of her kid not liking him... but he and Ryan seemed off to a good start.

"His color looks pretty good," he observed before glancing back down at the chart. "His weight's at 7.8 pounds."

That brought a smile to her face, and she reclaimed Ryan for the brief trip to the exam table.

"Hey, you gained four ounces. Good job."

"So he's feeding better?" Alex asked.

"He's definitely been better since we got him on the right meds. He's still having a lot of trouble breathing when he eats, but he seems less fussy... to me at least. "

Addison settled the baby onto the table, and Alex moved to listen to his heart. The murmur caused by the ventral-septal defect was obvious the moment he put the stethoscope to work, and he could only imagine that the enlargement of the small organ's left ventricle was going to be horrifying to see on the MRI screen.

"Isn't, uh, Mattel closer to where you work?"

She nodded. "It is, and it's a great hospital. But Mitchell is here."

Alex nodded, no further explanation needed. His boss was second to none when it came to infant heart surgeries, even if they didn't have the fanciest facilities in town to work with.

"So Mitchell wants you to get us through all the basics and get a new MRI before he chimes in?"

She wasn't upset, just being matter of fact. It was exactly what she would have done, really, given a resident with Alex's level of experience. Still, he had to remember she was there was a parent, not as his attending.

"I can page him if you--"

"No, no," she said, her hand motioning for emphasis. "But just so you know, we're trying it without sedation first."

Alex picked Ryan up and held the baby up close to his face.

"She's bossy, dude. I'm just warning you."

*****

For an intern without a strong grip on their emotions, a cardiac MRI on an infant was a trial by fire. One or both parents were generally involved in the process, especially if you were doing a non-sedation procedure, and that meant stress and tears were inevitable. The babies themselves were usually very tired and cranky and getting them to sleep was oftentimes an ordeal. And if you couldn't manage to get the images with the baby naturally at rest, then came the dreaded moment when you had to sedate the infant, usually with the parents stress and tears magnified by a thousand and your own heart pounding in your ears as you tried not to make the baby hysterical while you helped the anesthesiologist put them out.

The first grudging "attaboy" Alex Karev had ever gotten from Addison Montgomery had been earned on his first infant cardiac MRI. He'd had about every piece of bad luck imaginable--baby wouldn't go to sleep, hysterical mother, angry father, and a nervous Nellie anesthesiologist who was being upset by the parents. Alex had watched the unfolding chaos for all of two minutes before he took control of the situation, taking the parents outside the MRI room to explain why the sedation was necessary, keeping them out just long enough so that when they returned, the baby was already calmed and on his way to sleep.

Dr. Ross' warning that on this particular case, Addison Montgomery was a mother, not a surgeon, was much on Alex's mind as he watched her settle into a rocking chair that sat in the MRI room to help parents with the sleep ritual. Not that most people could tell anything was wrong by looking at her--she looked impeccable and that air of calm, in-control "super doc" was certainly the vibe she was giving off. But if you knew Addison at all, you knew that her hands didn't shake, ever. And yet as she reached for Ryan's bottle, he saw the slight tremble of her fingers.

It made him feel a little queasy to realize how nervous she was. Sure, he should have expected it, even been thrown by not seeing a bigger display, but this was Addison Montgomery, for crying out loud. And while he'd seen her worry over a patient and turn into a 13-year-old girl over the men in her life, he had never seen her scared until today. He hoped it was a view he rarely saw again.

"I can step out and just come back in when you think he's ready."

She shook her head, stopping his movement toward the door.

"He likes noise, actually. Too much quiet creeps him out. So if you don't need to be somewhere else..."

Alex chuckled and sat down in the chair opposite her.

"I'm pretty sure when Ross told me Ryan was my only patient this morning, he meant it."

A fleeting smile passed over Addison's face as she looked down at Ryan and adjusted his position when she saw him working overtime to get his formula down. The slight shift eased the baby's efforts and his eyes began to close as he continued to drink.

"So you said before that you weren't looking to adopt."

"I was not," she said, her eyes lifting to meet his. "I mean, I'd thought about it. Mostly when I was dating Kevin. He's this cop I saw for awhile."

"You and a cop?" he laughed. "I have a hard time picturing that."

Addison rolled her eyes. "Why does everyone say that? He was a perfectly wonderful guy, he just happened to be a cop. Besides, I was ready for a non-surgeon boyfriend."

Had he not been one of the men who had probably driven her to that conclusion, Alex might have teased her, but he thought better of it and settled for a quiet "mm-hmm."

"Anyway, we had talked about it because we both wanted kids. But then we kind of hit a... I don't know, we got stuck in a rut, and finally we both realized we weren't headed for that kind of future. So I was back to thinking about trying to have a baby on my own, going through all the treatments and seeing if it would happen. And then my phone rang, and Ryan was at the other end."

"Isn't it... I'm really not trying to be a jerk, but I mean, isn't it a lot to take on, when you know things could... I mean..."

Her pace in the rocking chair slowed as Ryan neared the end of his bottle, his sucking motions now coming after lulls where his lips sat still and pursed around the nipple.

"I know things might not turn out the way I want them to," she began, her voice tightly controlled and measured. "But he needed someone to fight for him. And I told myself all the horrible ways this could turn out... from his heart being too damaged to his mother deciding to come back. And I still couldn't make myself get up and walk away."

Alex watched as Addison eased the bottle away from the now sleeping infant's lips and set it to the side. When he saw her start to stand, he moved to the MRI machine to check the blankets and pillows to make sure they were positioned correctly. Once Ryan was settled into his safe cocoon, Alex slipped the custom-sized baby ear plugs into his ears and then used softly padded earphones to cover the plugs and keep them in place. The baby slept soundly through each movement.

Addison had already removed all of her jewelry and made sure she was metal-free so she could stay in the room during the scan. Alex handed her a set of headphones and then moved a chair closer to the MRI machine before he stopped near the controller.

"I'm gonna go ahead and slide him in, okay?"

She nodded, her position staying exactly the same until the slide began to move backwards, drawing Ryan away from her and into the circular chamber. Once the little boy was too far away for her to touch, Addison sank into the chair and drew the headphones over her ears.

"I'll keep a close eye on him from the other side. If you need anything, you know where to find me."

Another one of those quick flashes of the smile he remembered from late nights in the Seattle Grace NICU... another refusal on her part to give in to the worry he knew was threatening to suffocate her... then Alex moved out to the other side of the observation window.

The technician began the scan, and Alex held his breath until the loud noises that filled the MRI tube went unregistered by Ryan, who apparently was settled well into dreamland. Alex eased down into the seat next to the tech and waited for the images to come up on the real-time screen.

Once he saw the first one, he felt his face change. When his eyes lifted, she was staring straight at him. And he knew that even if she wasn't aware of the specifics, she could see what was facing them from his reaction.

Ryan was going to need surgery... immediate and extensive surgery. His left ventricle was grossly deformed from the strain it was under, and they were probably going to have to skip the bypass graft repair on his aorta and go for the full resection, rerouting the vessel completely around the narrowed area. They also needed to close the hole in the baby's heart to further ease the strain the overtaxed organ had been under since he'd been born.

Alex had seen Ross perform the resection on another patient--successfully so. But their other patient hadn't been suffering from such a severe compromise of the ventricle, and Ryan's blood pressure, controlled now thanks to the meds he was on, was going to be a real danger to them in surgery given how long the repairs were going to take.

Long minutes passed as the rest of the images that would confirm Ryan's treatment plan were taken and saved, and then finally, Alex stood to return to the room. Addison was already up and anxiously waiting for him to bring Ryan out of the tube, and as soon as the still sleeping infant was within her reach, she pulled him up and into her arms. She didn't tried to hide the shaking this time, nor did she try to control her voice as fear and a slight tremble crept in to her usual tone.

"It can't wait, can it?"

He was a resident who was supposed to take the information he'd gathered to his attending and let the senior surgeon handle the discussion of treatment with the parent. But he was also Alex Karev, and the woman who had opened the door to his career was standing in front of him with her heart about to break open. And the resident and the man were at war with one another over what to say.

"Ross may have another idea," he answered, wondering how his voice could sound so weak when all he wanted was to sound like he was sure they could make this go away.

She shook her head, her hand moving along Ryan's back.

"Alex... just tell me."

Sighing, he reached out and gently ran his hand over Ryan's silky black hair. The baby scrunched up, curling into his mother to find relief from whatever was trying to disturb his sleep.

"It can't wait. He needs to go into surgery as soon as possible."

Her eyes closed as she nuzzled the baby with her cheek. He watched as she made no move to wipe away the tears that slipped down her face despite her lowered lids.

"Okay," she whispered. Her body began to sway gently from side to side, but he wasn't sure if she was doing it to comfort Ryan or herself.

Another "okay" slipped past her lips, and not knowing what else to do, Alex quietly walked back out into the tech room to page Mitchell Ross and give him the bad news.

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