The OR at Seattle Grace—Room 4—hummed with quiet intensity, a place where time stretched and every breath felt borrowed. Overhead, the harsh fluorescent lights cast a pale wash over the scene, glinting off metal instruments and bouncing off the heart monitor's steady green line. In the middle of it all, Alison Hart, 45, lay still and open, her failing heart—worn down by years of cardiomyopathy—already removed.
Next to the patient stood Dr. James Blackwood, calm and sharp-eyed. His hazel eyes flicked across the monitors, the tubing, and the surgical field—absorbing everything. He adjusted the suction and then spoke—his voice steady, low, and authoritative.
,,Anastomosis prep. Let's move. Donor heart's ready. Alison's waiting."
On the opposite side, George O'Malley stood wide-eyed but determined. He was still adjusting to the surrealness of it all—the open chest, the missing heart, the weight of what they were doing. His cap sat slightly crooked, his hands hovered just over the sterile field, and excitement practically radiated off him.
"Ready, Dr. Blackwood," he said, almost reverent. "I mean—wow. This is… incredible."
James shot him a quick smile, a flicker of amusement breaking through his surgical focus. "Easy, O'Malley. Focus on the now, not the wow."
He nodded towards the donor heart, which the scrub nurse was carefully preparing. "Start with the left atrial anastomosis. Running suture, 4-0 Prolene. Clean and steady."
George blinked. "Me?" His voice cracked slightly before he caught himself. "You want me to start the anastomosis?"
"You've got this," James said, not missing a beat. "Get in there."
George took a deep breath and moved closer, gripping the needle holder like it was his lifeline. "Okay. Yeah. I can do this."
James watched closely, his eyes flicking between George's hands and the monitor's steady beep.
James kept an eye on him, watching the careful placement of the first stitch. "Even tension. No puckering. You're sewing a heart, not fixing a tear in your jeans."
George nodded, furrowing his brow in concentration as he began to suture. His hands moved slowly but deliberately. The needle pierced the tissue, and the Prolene thread glided through with practised care.
"Running suture, 4-0 Prolene," he murmured under his breath, using it as a mantra to keep himself grounded.
The room settled into a rhythm—the beep of monitors, the hiss of the ventilator, the soft murmurs of the surgical team. George stitched carefully.
James leaned in slightly, his voice dropping to a conversational tone, though his eyes never left George's work.
"So, O'Malley, you've been here a while, right? Settled into Seattle Grace, made some friends?" His question was casual, almost too casual, a surgeon's precision masking a personal motive.
George glanced up briefly, his focus still on the suture. "Uh, yeah, a couple of years now. Friends? Sure, I mean, Meredith, Izzie, Lexie, Cristina… they're great. Well, Cristina's intense, but you know that." He chuckled nervously, his hands steadying as he tied off a stitch. "Why do you ask?"
James shrugged, his gloved fingers adjusting the retractor with effortless grace. "Just curious. Lexie Grey? Isn't she an intern? It's rare to intern be friends with a resident must be a special intern." His tone was light, but there was a subtle edge, a probe aimed at the past Lexie had glossed over.
George's hands paused for a split second, his brow creasing. "Lexie Grey is best—always on top of her work. She was new back then, and needed a place. Super smart. We shared a crappy apartment for a while." He resumed suturing, oblivious to the flicker of tension in James's jaw. "It was no big deal. She moved out after… well, after some intern drama."
James's smile tightened, his voice still smooth but laced with a quiet intensity.
"Lexie Grey, huh? You two got along okay?" He kept his eyes on the surgical field, but his mind was elsewhere, picturing Lexie in that apartment, wondering what George wasn't saying.
George nodded, tying off another stitch with growing confidence.
"Oh, yeah. Lexie's awesome. She's like… a sister, you know? Always memorising protocols, keeping the place tidy. I was kind of a mess back then, she helped me." He laughed softly, missing the way James's fingers gripped the retractor a little tighter.
"Sister, huh?" James repeated, his tone neutral although his hazel eyes narrowed slightly.
"Good to know." He decided to drop the subject, realising he had pushed far enough without arousing suspicion. His chest tightened with a mix of relief and lingering unease—George seemed harmless.
The monitors beeped steadily, Alison's vitals holding strong. George finished the left atrial anastomosis, stepping back with a proud grin. "Done. How's it look, Dr. Blackwood?"
James inspected the suture line, his expression softening into approval. "Clean work, O'Malley. No leaks, good tension. You're learning fast. Alright, let's move to the aorta. I'll take the lead here, but watch closely—this next part's a masterclass."
James took the needle driver, his hands moving with preternatural precision as he began the aortic anastomosis. But instead of the standard running suture, he switched to a complex interrupted mattress suture, each stitch a delicate dance of thread and tissue. The technique was intricate, requiring perfect alignment to prevent turbulence in the blood flow. The scrub nurses exchanged glances, impressed, while George leaned in, his eyes wide with awe.
"Wow," George breathed, his voice barely audible. "That's… the interrupted mattress suture? For the aorta? I've read about it, but seeing it… It's like art."
James chuckled, his focus unbroken. "Art's one way to put it. It's a pain in the ass, but it's stronger, reduces stress on the vessel. You don't see it often because it takes time and patience." He tied off a stitch, his hands fluid, almost hypnotic. "Think you could handle it?"
George swallowed, his excitement tinged with nerves. "Me? Uh, maybe with a lot of practice. It looks… intense."
"Intense is right," James said, finishing the suture line and stepping back to check his work.
"Here's the deal, O'Malley. We've got a break before the next transplant this afternoon. Grab some suture kits, find a practice pad—or hell, use a banana" His lips quirked, a private memory flashing through his mind. "Work on this mattress suture. Show me you've got it down by the next surgery, and I'll let you throw a couple of these in the real thing. Deal?"
George's jaw dropped, his grin returning full force. "Seriously? You'd let me do that? Deal, Dr. Blackwood! I'm on it!" His voice was practically vibrating with enthusiasm, his hands already itching to practice.
James nodded, his smile warm but his eyes sharp.
"Don't get cocky. I want perfection, not effort. Nail it, and you're in. Screw it up, and you're back to holding retractors." He turned to the scrub nurse. "Prep for pulmonary artery anastomosis. We're almost done."
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The Seattle Grace cafeteria buzzed with the clatter of trays and the hum of gossip, offering a brief escape from the hospital's relentless pace. The air was filled with the scent of sandwiches and coffee, while harsh fluorescent lights illuminated the crowded tables. George O'Malley, Cristina Yang, and Alex Karev sat at a white table, their trays scattered with half-eaten sandwiches and coffee cups. George was focused on a practice pad and a banana, struggling with the interrupted mattress suture that James Blackwood had assigned. The banana's flesh was torn, and the thread was a tangled mess.
George leaned toward Cristina, his voice low, glancing up from his practice pad.
"Hey, Cristina. Can you mention that it's Izzie's birthday today? Because someone should do something about it. I am planning a party with balloons, streamers, and a bouncy house."
Cristina raised an eyebrow, her fork hovering over her salad, her smirk sharp.
"A bouncy house? What are you planning for a kid's party?" She eyed the mangled banana, her voice dripping with sarcasm. "And what's this, O'Malley? You're not suturing that banana—you're performing an autopsy. Did Blackwood teach you that disaster?"
George flushed, the needle slipping again. "It's the interrupted mattress suture. Dr. Blackwood's got me practising for the next transplant. It's… not easy."
Cristina snorted, stabbing a tomato. "Not easy? You're making it look like you're sewing a sock. Blackwood's gonna laugh you out of the OR."
George sighed, wiping sweat from his brow. "I'm trying, okay? He said if I get this, I can do it in the next surgery."
Alex, slouched with a burger, chuckled darkly. "Dude, that banana's a crime scene. Stick to balloons, man. Less pathetic." He took a bite, his eyes scanning the room.
George nudged Alex, undeterred. "But you know what? Alex should do something for Izzie's birthday."
Alex rolled his eyes, chewing. "I know, hosebag. I got it under control."
Izzie Stevens slid into a seat beside them, her expression a mix of exhaustion and distraction, her mind tangled with Denny's unseen presence.
Alex glanced at her, his tone teasing but cautious. "Is he here?"
"Who?" Izzie asked, frowning.
"Your friend," Alex said, referring to Denny.
"No, he's not here," Izzie said, her voice tight.
Alex smirked, leaning back. "Well, if he shows up, tell him I'll share my girl but not my sandwich. This thing cost four bucks."
Lexie Grey approached, balancing a tray with a turkey sandwich and a coffee, her ponytail loose, her scrub cap tucked under her arm.
"Hey, can I join?" she asked, her voice warm but cautious, sliding into a seat next to George.
"Sure, Little Grey," Alex muttered, barely glancing up.
Lexie's eyes landed on George's practice pad, the torn banana, and the tangled thread.
"George, are you… practising sutures?" Her tone was curious, a spark of recognition in her gaze—she knew that suture, thanks to James's lessons with fruit in the procedure room.
"Yeah," George said, frustration evident. "Interrupted mattress suture. Blackwood's challenge. But it's a total mess."
Lexie bit her lip, suppressing a smile, her hands hovering over George's setup.
"Mind if I try?" She set her tray down, taking the needle driver and a fresh banana from George's tray.
"I've… seen this before. It's tricky, but there's a way." Her hands moved with precision, the needle piercing the banana's flesh, the thread forming a neat, even mattress stitch.
"Keep your wrist loose, angle at 45 degrees, pull gently. It's like… weaving a tiny net."
The table fell silent. Cristina's fork froze mid-air, her eyes narrowing. Alex leaned forward, burger forgotten. Izzie blinked, pulled from her haze. George stared, jaw slack, as Lexie tied off the stitch, the banana a model of surgical finesse.
"Whoa," Alex said, breaking the silence. "Since when does an intern pull off cardio sutures like that? You moonlighting as a surgeon, Grey?"
Cristina's smirk faded, her voice sharp.
"Yeah, Little Grey, what's up? You're banned from the OR, and you're throwing mattress sutures like an attending? Spill."
Lexie's cheeks flushed, her heart racing. She couldn't mention James.
"Oh, um, I… learned it in the skills lab," she stammered, grasping for a lie. "Late nights, practising on… pigs' feet. And, you know, photographic memory. I just… picked it up." She forced a nervous laugh, eyes darting away, hoping it held.
Cristina's eyes narrowed, unconvinced.
"Pigs' feet? Right. And I'm the chief of surgery." She leaned back, letting it slide for now, but her gaze lingered, probing.
George, oblivious, grinned at Lexie. "That was awesome, Lexie! Can you show me again?"
Lexie exhaled, relief flooding her. "Sure, George. It's just practice. Here." She guided his hands, adjusting his grip, her voice patient. "Loose wrist, 45 degrees. You'll get it."
Meredith Grey approached, her face strained, the tension with Cristina palpable.
Alex leaned back, his voice shifting to gossip. "The dude from MRI was all freaked out about death row guy. Couldn't put his cuffs in the machine, so they had to Velcro him to the table. Tech thought he was gonna tear it all off and storm the booth like the Hulk or something."
Izzie's curiosity piqued. "What did he do?"
"I don't know," Alex said, shrugging. "I guess he lay there and had the MRI. What did he do to get on death row?"
"Did he mow down a bunch of people with a machine gun?" Alex mused. "Probably found his wife in bed with a hooker and a handyman."
Izzie shook her head. "They don't give you the death penalty for crimes of passion. People understand that."
Meredith, now seated, interjected, her voice weary. "All crimes are crimes of passion. There's always a reason. People don't do stuff like that because they forget it's illegal."
Cristina abruptly stood and left without a word, her tray abandoned. Sadie Harris slid into her spot, her presence shifting the dynamic. Alex turned to Meredith, half-joking. "When you kill her, is it gonna be a crime of passion?"
"No," Meredith said, her voice weary. "It's not a big deal. We had a fight. She took it too far. That's all."
Sadie leaned forward, smirking. "Wanna know what I think?"
"Not really," Meredith said, shutting her down.
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The hallways of Seattle Grace Hospital thrummed with controlled chaos, a symphony of beeping pagers, hurried footsteps, and the low murmur of nurses charting at the station. Sunlight streamed through the tall windows, catching flecks of dust in the air, while the faint scent of antiseptic lingered. Dr. James Blackwood, his navy scrubs slightly wrinkled from a long shift, strolled through the corridor, a small bag of potato chips in hand. His hazel eyes scanned the hospital's layout, taking in the OR board, the trauma bay signs, and the steady flow of staff. He popped a chip into his mouth, the crunch satisfyingly loud, a small rebellion against the hospital's sterile rhythm.
As he rounded a corner near the pediatric wing, a flash of blonde hair and a distinctive roll of wheelie sneakers caught his eye. A woman in a white coat glided past a gurney, her ponytail bouncing, her voice bright as she called out to a nurse about a patient's chart. James froze mid-crunch, the chip bag crinkling in his grip. That laugh, that energy—it was Arizona Robbins. A grin spread across his face as he strode toward her.
"Hold up," James called, his voice warm with amusement. "Arizona Robbins, queen of the peds wing?"
Arizona spun around, her blue eyes lighting up, a radiant smile breaking across her face.
"James Blackwood!" She laughed, arms opening for a quick, enthusiastic hug.
He barely had time to put down the chips before she hugged him—tight, fast, warm.
"I heard you were here," she said, stepping back. "The cardio hotshot everyone's whispering about. But I've been slammed and couldn't find you."
"Well, lucky for you, I found you instead." He stepped back,his grin boyish but his eyes warm with praise. "What's it been, five years since Hopkins?"
Arizona planted her hands on her hips, her smile infectious.
"Too long, that's for sure. I'm thrilled we're working together again, just like the old days. Hopkins was a blast with you around." Her tone turned teasing, but sincere.
"But please tell me you're not gonna run off to Africa again. Speaking of—what was that like? Spill, Blackwood."
James laughed, leaning against the wall.
"Africa? Hell of an experience. Spent a year volunteering—clinics, field surgeries, you name it. I saw cases so wild, you wouldn't believe me if I told you. Fixed a guy's heart with half a suture kit and a flashlight once. Top that, Robbins."
Arizona's eyes widened, her laugh bright and incredulous.
"A flashlight? Okay, you win." She tilted her head, giving him a playful once-over. "Gotta say, Africa suited you. Back at Hopkins, you were, like, a little chubby. Now? You're all… fit and rugged?"
James grinned.
"Ouch, Robbins Chubby?." He straightened, his tone light but proud. "Africa was one year, yeah, but then I went full Field Surgeon for another. Six months in Iraq, six in Afghanistan. Running from bombs and stitching up soldiers'll whip you into shape real quick."
Arizona's jaw dropped, her wheelies squeaking as she leaned forward, genuinely stunned.
"Field Surgeon? Iraq and Afghanistan? James, I did not see that coming from you.. When did you turn into a war hero?"
James shrugged, his charm masking a flicker of modesty, the chip bag crinkling in his grip.
"War hero's a stretch. Just needed something real after Hopkins. Won the Harper Avery, got restless, you know? War zones teach you fast—every second's a lesson. But I'm back now, been in Boston two years. Seattle Grace is… a new chapter."
Arizona shook her head, half-laughing, half-awestruck.
"You're unbelievable, Blackwood. Harper Avery, Africa, combat zones? And now you're just… munching chips, strolling through my hospital like it's no big deal?" She nudged his arm, her smile warm.
"It's so good to see you, James. This place is nice, but having you here? Feels like I've got an old friend in the trenches."
Before James could respond, Alex Karev approached, his scrub cap askew, a thin stack of papers in hand. His expression was gruff but professional, his eyes flicking to James with a nod. "DR Blackwood." He turned to Arizona, holding out the papers. "Dr Robbins, Jackson Prescott's post-op LFTs. Results are ready—Bailey's waiting for you to check 'em."
Arizona took the papers, her smile tightening with concern as she glanced at the top sheet. "Thanks, Karev. I'll get on this and page Bailey." She looked up, her tone firm but appreciative.