This Is What Dreams Are Made Of: Merder

Boards, Boards, Boards

The day after Meredith decided to specialize in neuro, all of the fifth year residents were at Meredith's old house, finishing preparing for their board exams. 

"Let's take a break," Alex said. 

"Agreed, if we don't know this stuff now, we won't know it ever," Meredith said. 

"So, Mer is specializing in neuro, Alex in peds, Cristina in cardio, and I'm specializing in plastics, but April, you haven't chosen one yet.. I mean all we have left is trauma and general here.. unless you're planning on going to another hospital," Jackson said. 

"I'm still talking to North Western and trying to negotiate a contract, but I haven't completely written off here," April said. 

"So, Derek and I had an ultrasound the other day, and the baby looks amazing," Meredith said. 

"Grey-Shepherd babies are definitely going to be running the hospital someday, huh?" Jackson asked. 

"Of course. would you expect anything else from us?" Meredith asked. 

The rest of the night the five of them studied, Callie and Derek came over at points in the night to offer any help and last minute advice. 

The day before the exam finally came. All of the fifth years headed to Seattle Tacoma International Airport to head to Chicago O'Hare to take their board exams. 

"We got this," Meredith said as the five of them were standing outside of the airport. 

"I hope we all do," April said. 

Once they landed in Chicago and checked in with the board exam company, they were all in Cristina's hotel room. 

"A 65 year old woman is being seen by her primary care physician for a work up of osteoporosis, when she is found to have elevated calcium. Her P.T.H level was well above normal. Her doctor sends her to you." Alex says. 

"Elevated calcium and P.T.H would indicate hyperparathyroidism." Jackson says. 

"I would recommend the patient and parathyrodectomy." Cristina says. 

"First I would explore the right side, if that gland is large..." April says. 

"I would biopsy it. What does the path come back with?" Meredith asks. 

"Path comes back with parathyroid hyperplasia." Alex says. 

"I would resect it, and explore the other glands." Meredith says. 

"We're going to kick boards ass tomorrow." Alex replies. 

"We better get some sleep.. we have busy days ahead of us." Meredith said. 

With that, they all went to their hotel rooms and slept for the night. The 6am wakeup call comes a lot earlier than you would think. 

The morning of the board exams finally arrives. Meredith woke up extra early to make sure that she could eat a decent breakfast, so she wouldn't have any morning sickness during her exam. She headed down to meet her proctors around 6:30. 

"Dr. Grey-Shepherd. Nice to meet you, my name is Dr. Anderson, and this is Dr. Matthews. We will be proctoring your exam today." 

"Nice to meet you." Meredith said as she took a seat in front of the two doctors. 

"So we will state the scenario or question one time, and only one time. Once you give us an answer, you cannot go back and change that answer. If we need any clarification we will ask for it." Dr. Matthews states. 

"Sounds good." Meredith responds. 

"Let's get started." Dr. Anderson says. "You have a 40 year old male, who complains of rectal pain and burning with defamation, and occasionally some blood in the bowel movement." 

"I would do a rigid sigmoidoscopy, to make sure there were no lesions in the rectum. If there were lesions in the rectum, I would do an incisional biopsy and begin to fulgurate. I would cover the bowel with Omentum and close the fascia primarily." 

"The sutures tear right through the fascia." Dr. Matthews says. 

"In that case, I would use 1-0 nylon retention sutures through the full thickness of the abdominal wall." 

"Moving on." Dr. Anderson says. 

A question is asked, and Meredith thinks about her answer.

"I would be concerned about Crohn's Disease but differential diagnosis could be P.U.D, Ulcerative Colitis, or Appendicitis. I would repair it with an abdominal approach. Reduce the size of the hernia contents, excise the sac, close the hiatus and perform a floppy nissen for antireflux and gastroplexy."

"Okay." Another question is asked. 

"I would locate the fistula endoscopically. Then I would inject fibrin glue." 

"What about an abscess?" Dr. Anderson asks. 

"I ruled it out. I wouldn't open a patient up if I could easily treat them endoscopically. It's less invasive. I could open the patient up and do a tube duodenostomy, that would be the more invasive option. But I would recommend treating it endoscopically to my patient." 

The rest of the questions were questions Meredith had prepared for time and time again. They were almost too easy for her. Before she knew it, her exam was over, and she headed out of the room. 

"How was you exam?" She asked Alex when she ran into him going back to her room. 

"I mean it was a lot more simple than I expected. I think we over prepared, which is better than being underprepared I guess." He responded. 

"I hope we all pass. I'm not worried for any of us.. but I mean you never know." Meredith said as she unlocked her hotel room door and walked in, with Alex following her. 

"Yeah. Honestly, I'm kinda worried about Kepner.. she seemed like she was the one that was the least prepared out of all of us." Alex said as he laid down on one of the queen sized beds in the room. 

"I know." Meredith said as she laid down on the bed next to him. "You know, I felt the baby move a little bit during my exam."

"Rachel's pregnant." Alex said.

"Rachel's what?" Meredith said. "She didn't tell me that." 

"What did she tell you?" Alex asked. 

"Nothing.. nothing. She just told me that she was going to tell you something and would tell me eventually." Meredith said as she turned on her side and looked at Alex. "I'm proud of you, Karev." 

"You're proud of me?" He asked as he sat up. 

"Yes, I am. The Alex Karev I knew three years ago would have ran away from something like this. You're going to be a great dad, you know." She said. 

He smiled, and they waited for the rest of the group to come back from their exam so they could head to the airport and go back to Seattle. 

Once their flight landed, they all went to Meredith and Derek's house and sat and waited for the results of their exam to come through. 

"It's midnight." Cristina said. "Refresh your pages, refresh your pages!" 

"I passed!" Meredith said with excitement. 

"I passed!" Cristina and Alex said at the same time. 

"We all passed!" April said.

"Thank God." Meredith said, as she heard her phone ringing. "Hello?" She answered. 

"Hi, it this Meredith?" The voice on the phone said.

"Yes, this is she." She responded. 

"There's been an accident."