Code Blue | Grey's Anatomy // Book 2 // COMPLETED

41 | Efficiency

We've all heard the buzz words "Streamline, optimize, integrate, adapt." Every day someone comes up with a new strategy or tool or technology to increase our efficiency. The idea is to make our lives easier. But the question is, does it?

"They've installed cameras," Meredith said as her, Cristina, and I stepped into a patient room and stared up at the device that stared right back down at us.

"They're all over the C.C.U." Cristina said, "Next they'll be in the O.R.s, the hallways, the on-call rooms. We're being spied on. Who knows what evil lurks behind that electronic eye?"

"Morning, Dr. Yang." a robotic voice spoke from the camera.

Cristina turned to us and whispered, "Big brother knows my name."

"Big brother can see your name tag." I grabbed her tag from her shirt.

Cristina looked at it, "Excuse me."

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"The cameras are not here to spy on you. They are here to supplement you." Alana explained as we gathered in an O.R., "On the other side of the camera is a remote physician. An extra set of eyes to help reduce mistakes, improve patient care, and maximize physician hours...now the initial program..."

Alana went on, but I'm pretty sure I wasn't the only one who tuned out. "And of course, ultimately reduce costly litigation." Lana finished up, "So does that answer your questions?"

"With disturbing clarity," Cristina replied.

Alana nodded, "All right. Let's move on then. As you can see, this O.R. has been arranged with maximum efficiency, specifically for O.R. turnover. Now, what are the main causes for bottleneck? The layout of O.R. supplies, equipment, and instruments. So what we have done here..."

"What did we miss?" Callie and Arizona came in late.

"O.R.s are sloppy," Webber told them.

"There are doctors in the ceilings," Bailey added.

Arizona looked up, "What? What do-what does that even mean?"

"We'd know if you'd just put her stupid tights on her," Callie told Arizona, talking about Sofia I assumed.

"I was talking her into it, okay?" Arizona countered, "She was getting on board."

Callie scoffed, "Um, she's two. At a certain point, she doesn't have to get on board. She has to be in day care. So you pick her up and you yank her tights on her."

"That's what you do. And then she cries." Arizona argued.

Callie rolled her eyes, "Yeah, because you wasted all the time cajoling her, so now I have to be the bad cop. If you just made it clear in the first place that she has no choice-"

Bailey hushed her. "Because when every second counts, you need the most efficient approach." we turned our attention back to Alana.

Callie agreed, "Mm. What she said."

"Your average time between surgeries is thirty-seven minutes." Alan informed us, "With these new O.R. procedures, I'd like to see that cut that in half. Thank you, everyone."

As we turned to the exit, I sighed, "We could play a drinking game with her. Every time she says the word 'efficient.' you drink."

Alex nodded, "I'd play."

"Of course you would." I walked over to Meredith and Cristina.

"Closing the E.R. should cut down on time." Cristina said, "We won't have any patients."

"How's Hunt feel about that?" Jackson asked.

Cristina shrugged, "Oh, he says he's not gonna do anything about it until it actually happens."

"Oh, it's happening." Jackson scoffed.

"And he can't be a Trauma surgeon without an E.R." Alex added.

I huffed, "Forget him! He's already had time to be an actual Trauma surgeon. What about me?! I'll have to switch specialties...and that's not exactly going to be easy."

"Is he gonna leave town?" Alex asked Cristina, "'Cause if you go with him, I'm screwed. I'm kind of depending on your rent check."

"Way to make this all about you," Cristina told him.

Meredith shook her head, "The E.R. is not going to close. Derek has a plan."

"Where is Derek?" Cristina asked.

"He spent the night with Kepner," Meredith answered.

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As I made my way down to the E.R. for its final day, Owen paged me to an O.R. where he needed an extra Trauma surgeon in surgery for a chain saw accident. Smiling, I rushed up to the O.R. to preform my possible last Trauma surgery at Seattle Grace Mercy West.

"This is a mess." Owen huffed as Alana held her hand over the patient's neck which had burst or something, "I don't think we can fix this primarily. Can you check for back bleeding?"

"Yeah." I nodded and took a look, "He doesn't have any."

Owen sighed, "Okay. Which means he has poor collateral flow. We're gonna need a shunt."

"I can put it in if someone will get me a rummel tourniquet," Alana said.

Owen nodded as Boki, the scrub nurse, handed Alana what she needed. "Thank you." Alana took the stuff. She began to hum as she worked and Owen chuckled. "Sorry." she apologized, "I-I used to do that."

"It's like riding a bike, huh?" Owen asked.

"Yeah, if the bike's going two hundred miles per hour," Alana said.

"That's what makes it fun," Owen mumbled.

Alana nodded, "Yeah, damn right, it does."

"So why did you stop in the first place?" Owen questioned.

"Yeah, Hunt, I got your page." Derek walked in, "You're worried about a brain bleed?"

Owen nodded, "Yeah, we didn't get a chance to do the scan. His carotid blew."

"Is that Kepner?" Derek asked.

"Cahill." Alana used her last name, "Dr. Shepherd, hi."

I looked to him, "Forrest, too."

"So instead of telling us how to do our jobs, now you're just doing them?" Derek got ready to look at the brain.

"That would be more efficient," she noted.

Owen shook his head, "No, she was in the right place at the right time. She probably saved his life."

"I got lucky," Alana admitted.

"Lucky for this guy his chain saw slipped today." Derek said, "Tomorrow he'd be dead already."

"We can't repair the carotid under tension." Alana told us, "It'll pull apart."

I nodded, "Or clot. It's tricky."

"We can't use one of these vessels to patch it." Owen sighed, "The chain saw chewed everything up pretty good."

"I could take a piece of saphenous vein from the leg-" Alana suggested.

Owen nodded, "Yes. Good. Good. Go ahead. Prep the leg."

"All right. Scissors and betadine, please." Alana ordered.

The nurses got everything ready, "Right away, doctor."

"So I hear somebody's nose came off?" Jackson walked in with his intern, Stephanie, by his side, "Can I have a headlamp, please?"

"Almost." I told him, "Take a look."

"Well, I would if we could find out where we're keeping the headlamps these days." Jackson sighed in frustration as the nurses looked for the headlamps, "And what should've shaved off half a second has now added five." the nurse placed the headlamp that she finally found on his head, "Thank you. Gauze, please. Oh, sorry. Meant to just say 'gauze.' That 'please' just cost me a tenth of a second."

"All right, Avery." Owen warned, "That's enough."

Jackson looked up to him, "Chief, you know this is all about turning over the tables for her. I mean, I feel like I'm working the dinner shift at a jumbo burger in here."

"Dr. Avery." Stephanie tried to stop him as he had not yet realized that Alana was in here with us.

"She should just replace us with surgical robots, really." Jackson continued, "I mean, that's essentially what she's asking us to be."

Stephanie turned to him, "Shh."

"Bless you." Jackson thought she sneezed, "You don't tell us how to run an O.R. if you don't actually work in one. That's all I'm saying. You can tell Dr. Pantsuit hasn't been in one in years."

"Until today." Alana finally spoke up.

"Well..." Jackson placed gauze on the man's nose, "I can repair this post-op. So just give me a shout when you're done. Thank you...doctors. Best of luck."

"I thought I was gonna be fired." Stephanie joked on the way out.

Owen turned to Alana, "Sorry about that."

"Oh, it's fine." Alana told him, "It's easier if there's a bad guy."

"My people just care about this place," Owen spoke.

Alana worked on the leg, "I know. I know you're all upset, especially you and Dr. Forrest, losing your E.R., but I also know that without me, you'd lose this entire hospital. So if you need to blame me instead of thanking me, I'm fine with that, because I will know who saved it. I've saved a dozen before just like this one, and no one thanked me for those either."

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"Okay. Ready?" Owen asked us, "Fingers crossed."

Alana nodded, "Yes. The sutures will hold. There will be no bloodbath."

"Okay, let's go, doctor." Owen said, "Remove your clamps. Dr. Cahill?"

Slowly Alana removed the clamps and laughed as the leg vein worked, "Okay. Okay, good. I-I-I totally wasn't sure that was gonna work."

Owen chuckled, "I get it. I get it. But you did great. I'd never have thought you'd spent a day outside of an O.R."

"Oh, thank you very much." Alana smiled under her mask and looked at the time, "Oh, good God. I have to go. I-I've-I've lost a whole day. You're all right if I-"

"No, no, we're not done." Owen stopped her.

"But it's pretty straightforward-" Alana said.

"No, we need to finish the debriding." Owen argued, "We need to put in drains, close, then you get to tell the family that you saved him, he's alive because of you. And then they get to thank you. And that's the best part."

Alana sighed, "10-blade please."

Once the surgery was over, we got our patient into the I.C.U. and his family came to visit. "Oh my...he's gonna live?" the wife asked Owen.

"Mm-hmm." Owen nodded.

"Thank you." she smiled.

Owen turned to Alana, "But this is who you really should be thanking. If it wasn't for her-"

"Thank you." the wife hugged Alana, "Thank you so much! God bless you. Thank you."

"I did forget what a rush it is," Alana said as we walked through the halls.

Owen nodded, "Uh, yeah. What, saving someone's life? Yeah, it's not bad. You know, we could do that again tomorrow if we had an E.R."

"We figured it out." April and Derek ran over, handing Alana a binder, "We can save the E.R."

"We got each department to make some cuts, and I'm gonna have to park it Tacoma, but it is going to work." Derek explained.

"I'm sorry." Alana looked to us and handed the binder back to April, "You misunderstood. No amount of budget cutting or shuffling is going to save you're E.R. or your hospital, for that matter."

"You're getting us ready to sell." Derek figured it out.

"What?" Owen asked.

Alana nodded, "A buyer is going to save your hospital. I just need to make it presentable."

"I'm sorry. Wh-what?" I asked.

Owen turned to her, "You're staging it, like a house."

"Exactly." Alana told us, "And the E.R. is like the shag carpet. It's gotta go. Sorry."

I turned to her, "I hope you realize that as you get rid of the E.R., you're also getting rid of mine, April, and Dr. Hunt's main job."

Alana ignored me as she took off, "I had a wonderful time today."

To really be efficient you have to eliminate what doesn't work. You have to figure out what's important and hold on tight to the things that matter most.

I heard the doorbell from outside as I waited for Alex to open the damn door. Once he did, he looked at me strangely, "Why are you here?"

"The hospital is getting ready to sell and I might lose my job." I held up a bottle of wine I bought, "I would like to drink. Will you drink with me?"

Alex opened the door wider and invited me inside, "You don't have to ask me twice."