Chapter Four — Nail in The Head

The light filtered in through the slats of the blinds, painting faint stripes across the rumpled bedspread. Nate groaned softly as he stirred, the sound of birds chirping outside already grating against his nerves. He blinked at the ceiling for a moment, trying to remember what day it was, why his sheets smelled faintly of Derek Shepherd's stupidly expensive cologne, and why—

A deep voice broke through his thoughts. "Good morning."

Nate didn't have to look to know Derek was awake, propped up on one elbow, a lazy smile stretching across his infuriatingly perfect face.

"Don't," Nate muttered, turning his head to glare at him.

"Don't what?" Derek asked innocently, though the mischievous glint in his eyes said he already knew exactly what Nate meant.

"Don't look at me like that," Nate said, gesturing vaguely between them. "Like you're proud of yourself."

"Well, I am," Derek said, his voice dropping just enough to send a shiver down Nate's spine. "We had a good night."

Nate rolled his eyes and pushed himself up to sit against the headboard, the sheet pooling around his waist. "We shouldn't have done this."

"Oh, come on." Derek's voice was warm, teasing, as he reached out to trail his fingers down Nate's arm. "You're not seriously regretting it, are you?"

Nate swatted his hand away, though his resolve was already beginning to waver. "I'm saying it was a mistake."

Derek hummed thoughtfully, leaning back against the pillows with the kind of confidence that only Derek Shepherd could pull off. "Funny. Didn't feel like a mistake last night."

"Derek,"

"Or when you kissed me first," Derek interrupted, his grin widening as Nate's cheeks flushed.

"That was your fault," Nate said quickly, crossing his arms over his chest.

"My fault?" Derek raised an eyebrow, feigning innocence. "How exactly was that my fault?"

"You baited me!" Nate shot back, his voice rising slightly. "You were standing there, all smug and infuriating, and—"

"And irresistible?" Derek offered, his smile downright wicked now.

Nate groaned and covered his face with his hands. "God, you're insufferable."

Derek laughed, the sound low and warm, and Nate hated the way it made his chest feel tight.

"I'm just saying," Derek continued, his voice softening, "I don't think last night was a mistake."

Nate lowered his hands, his expression guarded. "You left me once, Derek."

The smile faded from Derek's face, and for a moment, he looked almost guilty. "I know," he said quietly.

"Do you?" Nate pressed, his voice sharper than he intended. "Because you can't just walk back into my life and expect me to forget about that."

Derek sat up then, his gaze steady and serious in a way that made Nate's stomach twist. "I didn't come back here to hurt you, Nate."

"Then why did you?" Nate asked, his voice softer now.

Derek hesitated, his eyes searching Nate's face as if the answer was written there. "Because I couldn't stay away," he said finally.

The words hung between them, heavy and full of something Nate wasn't ready to name. He looked away, his fingers picking at the edge of the sheet.

"You make everything so complicated," he muttered.

Derek chuckled, the sound quieter this time. "And yet, here we are."

"Don't," Nate warned, but the corner of his mouth twitched despite himself.

Derek shifted closer, his hand brushing against Nate's where it rested on the bed. "I missed you," he said, his voice barely above a whisper.

Nate's breath hitched, and for a moment, he let himself believe it. Let himself want it.

But then reality came crashing back in.

"I can't do this," he said, pulling away.

Derek frowned, his brows knitting together. "Nate—"

"I mean it," Nate cut him off, swinging his legs over the side of the bed. "This isn't...we can't just pick up where we left off like nothing happened."

Derek stayed silent, watching as Nate stood and grabbed a t-shirt from the back of a chair.

"Last night was...whatever it was," Nate continued, pulling the shirt over his head. "But that's all it was. It doesn't mean anything."

Derek's jaw tightened, but he nodded slowly. "If that's what you want."

Nate hated the way his chest ached at the quiet resignation in Derek's voice. Hated the way he wanted to turn around, to tell Derek to stay, to take the risk.

But instead, he grabbed his phone from the nightstand and headed for the door. "Lock up when you leave, I have work" he sighed, his voice steady despite the storm brewing inside him.

He didn't wait for Derek to respond, closing the door behind him and leaning against it for a moment.

This wasn't supposed to happen. Not again.

The hospital as always was manic when Nate had made it into work. He had a look at the board for his planned patients during his shift, and it was unusually very quiet. Normally Nate would savour the quiet shift days, but today Nate wanted to be busy, he wanted to distract himself from Derek Shepherd.

His peace was short lived when the incoming trauma came in.

A man had fallen down a flight of stairs whilst holding a nail gun, and he had multiple nails embedded into his skull. The paramedics rattled off his details when they brought him in, and Nate wondered how this man was still conscious and alive. The main concern was the nails being on and close to vital structures, as the patient had already said he couldn't see.

Nate looked carefully at the man, considering what the best course of action would be, he swore under his breath. He needed another set of eyes on this, he didn't want to handle this case alone.

The only downside would mean that he would have to contact Derek.

Nate sighed, grabbing his phone, he scrolled through his contacts, hesitating for a moment before pressing Derek's name.

The phone rang twice before Derek picked up, his voice coming through smooth and annoyingly cheerful.

"Mercer," Derek greeted, and Nate could hear the faint sounds of traffic in the background. "To what do I owe the pleasure?"

Nate let out a sharp breath, already regretting this. "Don't get cute, Shepherd. I need your help."

There was a brief pause, then Derek's tone shifted—lighter, but with an undercurrent of something more serious. "Help? You calling me for a second opinion, or is this just an excuse to hear my voice?"

"Derek," Nate said, the warning clear in his voice.

"Alright, alright," Derek relented, though Nate could practically hear the smirk. "What's the case?"

Nate stepped into the hall, his voice lowering as he started walking toward the ER. "I have a man that fell down a flight of stairs while holding a nail gun. Multiple nails embedded in his skull. They're bringing him in now, but it's bad. I need another set of hands on the case, someone who actually knows what they're doing with cranial injuries."

Derek whistled low, the sound almost playful. "Multiple nails in the head? That's a party."

Nate's grip on the phone tightened. "It's a disaster waiting to happen, Derek. Can you just get here?"

"On my way," Derek said easily, though there was a new edge of professionalism to his voice. "Text me the details, and I'll head straight to the hospital."

Nate hesitated, his fingers tightening around the phone. He didn't want to acknowledge how much relief he felt knowing Derek was coming.

"You sure you can handle this?" Derek teased, the playful lilt creeping back into his tone.

"Don't push it," Nate said, his tone sharp, though the corners of his mouth twitched despite himself.

There was a soft chuckle on the other end. "I'll be there in twenty."

Nate ended the call without another word, slipping his phone back into his pocket as he went back into the patients room.

Derek showed up twenty minutes later, his presence as commanding as ever in the chaos of the situation . He was still wearing the same clothes from the night before, and Nate hated the way his pulse quickened at the sight.

"I'll get into my scrubs." He started, "Page Bailey and tell her we need interns." He finished, as he left to make his way to the locker rooms.

The room buzzed with barely contained chaos, voices overlapping as doctors and nurses scrambled to assess the man lying on the gurney. Jorge Cruz, mid-thirties, looked remarkably calm for someone with seven nails embedded in his skull. On the monitor, his vitals were erratic but not disastrous, a temporary reprieve.

Meredith's voice cut through the din. "Those look like..." She gestured toward the screen, her expression a mixture of horror and fascination.

"Nails," Derek confirmed.

The X-rays were grotesquely fascinating, a scatter of thin metallic spikes lodged in a perfect constellation throughout Jorge's skull. Somehow, miraculously, none seemed to have hit a major blood vessel. Yet.

"I can't see my hands," Jorge muttered, his voice shaky. His eyes darted wildly, unfocused and full of panic.

"Oh my God," George said, his face going pale as he stood frozen near the foot of the bed. "He's conscious."

"Breathe, O'Malley," Alex chimed in, smirking as he watched George sway on his feet. "You won't pass out. Probably."

"Enough," Nate interjected, his voice sharp. He stepped closer to Jorge's side, his tone softening as he addressed the patient. "Mr. Cruz, I need you to stay as still as you can, okay? Moving right now could make things worse."

"I can't see," Jorge said again, panic rising in his voice. "I can't see!"

"It's okay," Meredith said quickly, her hand hovering near Jorge's arm but not quite touching. "We need you to be very still, Mr..."

"Cruz," Nate supplied. "Jorge Cruz. He tripped and fell down a flight of stairs while holding a nail gun."

"Sick," Alex said, grinning despite the tension in the room.

Derek's eyes stayed glued to the monitor as he spoke. "Somehow, he managed to miss a blood vessel. That's a minor miracle." He moved closer to Jorge, his hands hovering near the man's head as he conducted a quick visual assessment. "Optic nerve's been affected. Can you feel this?" He touched Jorge's arm lightly, noting the lack of response.

"Numbness on the right side," Nate observed, standing opposite Derek now, his expression all business.

"What's our immediate concern?" Derek asked, looking up and addressing the room.

"Infection," Meredith answered without hesitation.

"Right," Derek confirmed. "I want these nails out in the next half-hour. We need a CT."

"CT's are down," one of the nurses interjected from the doorway. "They swapped them out last night, computers crashed. They're saying they'll be back up by 1:00."

Derek's jaw tightened, his eyes narrowing as he turned toward the nurse. "Of course they are. Typical."

"What are the options?" Nate asked, his tone clipped but steady.

George piped up, his voice uncertain. "An MRI?"

"No!" Derek and Nate said in unison, their voices sharp.

Alex rolled his eyes, leaning back against the counter. "Brilliant idea, Bambi. The guy's got nails in his head, and you want to put him in a giant magnet?"

"We'll need films from three axis points and a C-arm in surgery," Derek said, his tone decisive. He glanced at Nate, who nodded in agreement.

"Perfect," Nate said, his voice carrying a hint of sarcasm. "Because this case wasn't complicated enough."

"Excellent!" Derek said, ignoring the jab as he turned to the rest of the room. "You guys dig up research, see if this has ever happened before and if there's anything we need to know."

The group scattered, leaving Derek and Nate standing near the gurney as Jorge muttered, "My wife, my wife..."

"She's on the way," the nurse said quickly, glancing at the monitor.

"Your wife is on the way, Mr. Cruz," Meredith repeated, her tone soothing.

Derek stepped closer, his voice calm but firm. "Stay with him. Keep him calm and look for changes. No sudden movements."

Jorge groaned, his hands twitching at his sides. "I can't see," he said again, his voice breaking.

"It's okay," Nate said, leaning over slightly to meet Jorge's eyes. "We're going to take care of you. But we need you to trust us, alright?"

Jorge nodded faintly, his breathing slowing just enough to signal that he was starting to calm down.

Meredith leaned against the counter, jotting down notes in her usual thoughtful silence. Beside her, Nate Mercer was flipping through Jorge's chart, his sharp, meticulous gaze scanning every detail.

"You'd say your health's been good recently?" Meredith asked, glancing up from her notepad.

Jorge gave a small shrug, wincing slightly at the movement. "Maybe some headaches," he admitted, his tone casual, like he wasn't currently sitting in a hospital bed with a gun wound. "Nothing compared to now. Zona, that's my wife, she'll say, 'Why you think they call it a gun, moron?' She hates the damn things."

Meredith's lips quirked up at the edges, but Nate let out a low, dry chuckle, shaking his head. "With good reason," he muttered, his tone laced with quiet disapproval as he snapped the chart shut.

Jorge pointed at Nate with a knowing grin. "You sound just like her. You married?"

Nate's eyebrows lifted slightly, his mouth pulling into a faint smirk. "Not quite."

"Then maybe take notes," Jorge shot back, his grin widening despite the obvious strain on his face.

Before anyone could respond, the door swung open, and Derek Shepherd stepped inside, followed closely by Sona, who practically burst into the room.

"Baby?" Zona voice was sharp, breathless, her eyes wide as they landed on Jorge.

Jorge straightened slightly, the light teasing in his eyes softening. "Zona," he said warmly, though his voice carried a teasing edge. "You are in so much trouble."

Nate stepped back slightly, shifting his weight as he watched the scene unfold. His eyes flickered toward Derek, who was standing off to the side, his usual air of quiet command intact.

"Get a history from her before you scrub in," Derek said, his words directed at Meredith, though his gaze lingered briefly on Nate, unreadable.

"Okay," Meredith replied, her voice steady as she turned toward Zona, reaching for her notepad.

"Thank you," Derek added, his tone brisk as he turned to leave, his attention already elsewhere.

Nate remained where he was, his arms crossing over his chest as he watched Zona practically hover over Jorge, her hands fluttering anxiously near his shoulder. It was the kind of love that made itself loud and clear without needing words.

"You always get into trouble when I'm not looking," Zona muttered, her voice breaking slightly, though she tried to mask it with a playful smile.

"Wouldn't be me if I didn't," Jorge teased back, though the weight of the situation hung heavy in the air between them.

Meredith, ever the professional, stepped closer to Sona, her pen poised. "Zona, I'm going to ask you a few questions, okay? Just to get a clearer picture of what's going on."

Zona nodded quickly, her hands clutching each other tightly as if holding herself together.

Nate stayed near the back, his gaze alternating between Meredith and the couple. It wasn't that he needed to be there, Meredith was perfectly capable, but there was something grounding about staying in the room.

"You're good at this," Nate said quietly, just loud enough for Meredith to hear as she guided Zona through the questions.

Meredith glanced at him briefly, her expression softening. "So are you," she said, before turning her attention back to Zona.

For a moment, the room fell into a comfortable rhythm. Meredith's calm, even voice guiding Zona through her worry, Jorge's lighthearted quips breaking the tension every now and then, and Nate's steady presence in the background, his eyes quietly cataloging every detail like he was preparing for whatever came next.

Nate Mercer stood on one side of the table, his gloved hands poised but steady. His usually sharp gaze was narrowed, the faintest sheen of sweat gathering at his temple despite the cool air. The surgery was going to be tough, in particular, it was risky and Nate thanked this lucky stars that he'd asked Derek for help on this.  Derek's face was all business now, his typical charm replaced with unyielding concentration.

"Scalpel," Derek said, his voice cutting through the quiet like a thread of steel. The scrub nurse handed him the instrument with practiced efficiency. He glanced up at Nate, his eyes meeting his for a brief moment. "You ready for this?"

Nate arched a brow beneath his surgical cap. "You asking me if I'm ready, or just trying to psych yourself up?"

A faint smile ghosted Derek's lips, though it didn't quite reach his eyes. "Just making sure you can keep up."

Nate's smirk was subtle but visible behind his mask. "Don't worry, Shepherd. I've got it covered."

Their banter was an undercurrent, light enough to keep the tension from boiling over but never enough to distract from the gravity of the situation. Jorge's head was a battlefield, nails embedded in delicate structures that left little room for error.

"Let's start with the lateral fragment near the parietal bone," Derek said, pointing to one of the nails visible on the imaging monitor. "It's not as deep as the others, but it's close enough to the middle meningeal artery to make me nervous."

"Good choice," Nate said, already positioning his tools. "One wrong move, and it's game over."

The room seemed to hold its breath as Derek made the first incision, peeling back the scalp with a precision that bordered on artistry. Blood pooled briefly before the suction cleared it away, revealing the nail embedded in the bone beneath.

"Forceps," Derek requested, and the nurse quickly placed them in his hand. He worked methodically, loosening the nail with small, controlled movements.

Nate watched closely, his hands steady on the retractors. "Angle looks tight. You might want to rotate counterclockwise instead of pulling straight out."

Derek paused for a fraction of a second, glancing at Nate before nodding. "Good catch."

The first nail came free with a soft metallic clink as Derek dropped it into the metal tray. It was a small victory, but no one in the room celebrated. There were still six more to go, each presenting its own unique challenge.

Nate stepped in as Derek moved to the other side of the table. "I'll take the frontal lobe fragment," Nate said, his voice calm but decisive. "It's pressing against the superior sagittal sinus. If we're not careful, we'll tear it."

"Be careful," Derek warned, though there was no condescension in his tone. Just trust layered beneath the words, an unspoken acknowledgment that Nate was more than capable.

"I always am," Nate shot back, his eyes never leaving the patient.

The room seemed to narrow as Nate worked, his hands moving with a surgeon's grace. He made the incision, exposing the second nail lodged precariously close to one of the brain's most critical veins. His movements were slow, deliberate, every millimeter feeling like an eternity.

"Clamps," Nate said, his voice steady despite the tension coiling in his shoulders. The scrub nurse handed him the tool, and he carefully secured the nail. He adjusted his grip, his gloved fingers tightening just slightly before he rotated the nail with painstaking precision.

Time stretched, the seconds ticking by like hours, but finally, the nail slid free. Nate exhaled quietly through his nose, dropping the second fragment into the tray beside the first.

"Two down," he murmured, stepping back as Derek moved in to take the next position.

The procedure continued in a rhythm of controlled chaos. Each nail posed its own challenge—one dangerously close to the motor cortex, another nestled against the optic nerve. Nate and Derek traded positions seamlessly, their movements a study in contrasts. Derek's style was smooth, confident, like he'd been born with a scalpel in his hand. Nate's approach was sharper, more analytical, his every action calculated down to the smallest detail.

"Dura's intact," Nate said as he finished removing the fourth nail. "No major damage."

"Good," Derek replied, his voice tight with concentration as he focused on the nail near Jorge's occipital lobe. "This one's going to be tricky. It's lodged at an angle, and if we pull too hard—"

"We risk rupturing the vertebral artery," Nate finished for him. "I'll stabilize while you work."

The two of them moved in tandem, their communication wordless now. Nate held the retractor steady, keeping the surrounding tissue out of Derek's way as he carefully maneuvered the nail. Sweat dripped from Derek's brow, but he didn't flinch, his focus unyielding.

Finally, the nail came free, the soft metallic sound of it hitting the tray like a weight lifted from everyone's shoulders.

"That's five," Derek said, stepping back to let Nate take the next one. "Almost there."

The sixth nail was embedded in a particularly precarious spot near Jorge's temporal lobe. Nate approached it with the same precision as before, his hands steady despite the ache beginning to build in his muscles.

"Careful," Derek said, his voice quieter now, almost as if he was talking to himself. "That angle—"

"I've got it," Nate interrupted, his tone sharper than he intended. He adjusted his grip, rotating the nail with excruciating slowness until it finally came free.

The seventh and final nail was the most dangerous of all, lodged deep near the brainstem. Derek and Nate exchanged a glance, the gravity of the situation settling heavily between them.

"Your call," Derek said, deferring to Nate.

Nate hesitated for only a moment before nodding. "Let's do it together."

They worked side by side, their movements synchronized as they tackled the final fragment. Every second felt like a lifetime, the tension in the room palpable as the nail finally slid free.

The silence that followed was deafening. Nate dropped the last nail into the tray, his shoulders sagging with relief.

"All nails removed," he announced, his voice steady despite the exhaustion creeping in.

"Vitals are stable," the anesthesiologist added, breaking the tension with the reassurance they all needed.

Derek leaned back, pulling off his gloves with a sigh of relief. He glanced at Nate, a faint smile breaking through his usual composure. "Not bad, Mercer."

Nate snorted softly, pulling off his own gloves. "Not bad yourself, Shepherd."

The faint tension between them lingered, unspoken but ever-present. But for now, it didn't matter. They'd saved a life, and that was enough.

The day had already been long, and Nate Mercer was moving through the corridor, coffee in hand, half-focused on the charts tucked under his arm. The hospital was a cacophony of noises, voices calling out, beeping monitors, the occasional sound of a gurney squeaking by, but nothing unusual. Until a voice rang out, sharp and furious, cutting through the everyday hum of the hospital like a blade.

"You want to see it? You really want to see it? Fine!"

Nate paused mid-step, his brow furrowing. That was Izzie Stevens. He glanced toward the locker room door, now slightly ajar, where her voice was coming from, loud and indignant.

"Let's look at that tattoo up close and personal, shall we?"

Curiosity got the better of him, and Nate moved closer, hesitating at the threshold. He didn't want to invade her privacy, but it was clear something was happening inside, a confrontation of some sort.

When he peeked in, his eyes widened. Izzie was in the middle of the room, shrugging off her lab coat. A group of interns, including Alex Karev, stood frozen, their faces a mix of guilt and fascination. The walls were plastered with photos of Izzie in glossy, professional poses. It didn't take a detective to figure out what had happened.

"Damn it, Karev," Nate muttered under his breath.

Izzie was on a roll, her words biting and her movements sharp as she yanked her shirt off, revealing a tattoo on her side. "And what are these? Oh, my God! Breasts! How does anybody practice medicine hauling these things around?"

Her hair came down next, and then she was shimmying out of her pants. "And what do we got back here? Let's see if I remember my anatomy. Glutes, right? Let's study them, shall we? Gather around and check out the booty that put Izzie Stevens through med school."

Nate blinked, momentarily stunned by the sheer force of her anger and by her absolute lack of hesitation in turning their mockery against them. There was something fierce and admirable about her, even as she stood there, practically undressed, in front of her colleagues.

Alex was staring at the floor now, looking more ashamed by the second.

"Have you had enough, or should I continue?" Izzie demanded, her voice shaking with rage. "Because I have a few more very interesting tattoos."

The room was silent except for the hum of the fluorescent lights overhead.

"You want to call me Dr. Model? That's fine. Just remember that while you're sitting on 200 grand of student loans..." Her voice cracked slightly as she yanked her pants back on, her movements hurried and jerky. "I'm out of debt."

With that, she stormed out of the room, her lab coat trailing behind her like a cape.

Nate stepped aside just in time, barely avoiding her path. "Izzie—"

"Not now, Dr Mercer!" she snapped, brushing past him and heading down the hallway.

Nate hesitated for a beat, glancing back at the interns, who were still frozen in place. His gaze landed on Alex, and his expression darkened. "Seriously, Karev? What the hell is wrong with you?"

Alex opened his mouth to respond, but Nate was already turning on his heel, following after Izzie.

He found her in one of the quieter stairwells, leaning against the cold cement wall. She was still trembling, her arms wrapped tightly around herself. The fire in her eyes had dimmed, replaced by something softer, more vulnerable.

"Izzie," Nate said gently, his voice low as he approached her. "You okay?"

She didn't look at him. "Do I look okay?"

"No," he admitted, stopping a few feet away. He didn't want to crowd her. "But I figured it was worth asking anyway."

Izzie let out a bitter laugh, her head tilting back to rest against the wall. "They've been calling me Dr. Model since day one. Like that's all I am. Like I didn't work my ass off to get here."

Her gaze softened, just a little. "That's not how they see it. To them, I'm just a joke. Something to laugh at."

"Then screw them," Nate said firmly. He stepped closer now, leaning against the wall beside her. "You're a damn good doctor, and anyone with half a brain can see that. If they can't, that's their problem, not yours."

Izzie glanced up at him, her eyes shiny but no longer on the verge of spilling over. "You mean that?"

"Of course I do." Nate's tone was steady, sincere. "You're here because you deserve to be. Not because of what you look like, or because of some photos from your past. You worked for this, Izzie. Don't let anyone take that away from you."

For a moment, she was silent, her gaze dropping to the floor. Then, she straightened up slightly, brushing her hair back from her face. "Thanks, Dr Mercer."

"Anytime." He pushed off the wall, offering her a small smile. "Now, come on. Let's get back out there and remind everyone why they should be taking you seriously."

She hesitated, then nodded, a determined look crossing her face. Together, they headed back down the hallway, the air between them lighter now, the weight of the moment beginning to lift.

Jorge Cruz's surgery had gone well. But, he wasn't out of the clear, which brought Nate into the imaging room. The room hummed with the soft buzz of the overhead lights. Nate Mercer stood at the lightboard, his arms crossed tightly over his chest as he studied the glowing MRI scans. His eyes darted between the dark, midline shadow nestled near the hypothalamus and the surrounding tissues.

The sharp, almost cocky voice broke the silence. "So, is this the part where you say 'Shepherd, I need you'?"

Nate didn't turn around. He didn't have to. That voice, that ridiculous lilt of flirtation, had been living in his head for years.

"I paged you because I need your hands," Nate replied evenly. "Not your commentary."

Derek Shepherd leaned casually against the doorframe, his ever-present smirk firmly in place. "Hands, commentary, you're getting the full package today. Lucky you."

Nate sighed, finally glancing over his shoulder. Derek was still in his scrubs, hair slightly mussed like he'd just stepped out of an OR. He looked infuriatingly relaxed, while Nate had been tense for hours, running diagnostics and mentally cataloging the next steps for Jorge Cruz, their trauma patient who'd somehow survived seven nails in his head.

"You're assisting," Nate reminded him, turning back to the scans. His tone was clipped, professional. "This is my case."

Derek pushed off the wall and moved to stand beside him, close enough that Nate could feel the faint warmth radiating from his body. "Oh, I know, Dr. Mercer. Lead away."

Nate ignored the edge of teasing in Derek's voice, focusing on the scans. "There," he said, pointing at the screen. "That's the tumor. Midline, near the hypothalamus. It's small, but it's already pressing against the optic chiasm."

Derek's smirk faded as he leaned in, his face inches from the glowing light. "That explains the vision loss. But how the hell did it go unnoticed until now?"

Nate shrugged, his tone sharp. "The nails distracted everyone, understandably. We caught this on a deeper series of scans while checking for secondary injuries."

Derek tilted his head, scrutinizing the image. "It's tricky. Vascular structures are a minefield here. How's his neurological response?"

"Minimal weakness on the right side, but he's stable for now," Nate replied. "The tumor's slow-growing, but if we leave it, it'll cause permanent damage, blindness, motor deficits, or worse. We have to go in."

Derek nodded, his eyes flicking between the screen and Nate. "It's delicate, but doable. You'll need steady hands."

"Which is why I paged you," Nate said, his voice firm. "This isn't a one man job, Shepherd. I'll take lead, but I need you to back me up in case things go south."

There was a flicker of something in Derek's expression, pride, maybe? But it was quickly replaced with his usual charm. "You know, you could've just said, 'Derek, I trust you completely, please assist me in this groundbreaking surgery.'"

Nate shot him a glare. "This isn't a joke."

Derek held up his hands in mock surrender. "I know. You're the lead, Nate. I'm just here to make sure you don't faint under pressure."

Nate ignored him, stepping back from the screen. "We have to prep the patient for the news."

Nate Mercer stood beside Derek, his posture slightly forward, as though bracing himself for the conversation. He wasn't the one leading this discussion, whilst this was Nate's case, he let Derek, lead the discussion, but he was there to offer his insight and to support his patient through what was about to be one of the hardest conversations of their lives.

Derek leaned forward, as he addressed Jorge. His tone was steady, empathetic but direct, "Best practice is probably to remove the tumor. 'Probably' because I can't get it all. Ninety nine percent, but not all of it."

Jorge nodded slowly, his lips pressing into a thin line as he processed the information. "Okay," he said, his voice gruff but resolved. "Let's do it."

"Wait," Derek interrupted gently, raising a hand. "You haven't heard the downside." He took a deep breath, glancing briefly at Nate, as though grounding himself before delivering the next blow. "The tumor is located in a part of your brain where your memory and your personality reside. Because of the fuzzy edges of this type of tumor, I'd have to cut out a lot."

Nate jumped in, his voice softer but equally steady. "Jorge, there's a significant chance that you could lose your memories, who you are, your sense of self."

The words hung in the air like an axe about to fall. Jorge's jaw tightened, and Zona's lips parted as if she wanted to speak but couldn't find the words. Derek pressed on, careful but unwavering. "The alternative is gamma or cyberknife treatment with focused radiation. It's less invasive. There's little chance of memory loss or losing who you are, but it would only give you three to five years."

"Three to five years?" Zona's voice cracked as she finally spoke, her disbelief clear. She turned to Jorge, her eyes glistening with unshed tears. "That's not enough time. Jorge..."

Nate's chest tightened as he watched the couple. These moments never got easier, no matter how many times he stood in this position. He could feel the weight of their love, their fear, their desperate desire for more time. It was the human side of medicine that textbooks couldn't teach you.

Jorge's gaze remained on the table for a long moment before he looked up, his expression resolute. "Zona, five years is still time. It's time I get to spend with you. Time I get to hold your hand, to watch our kids grow up. If the surgery takes away who I am..." He shook his head, his voice breaking. "What good is more time if I'm not me?"

Zona's tears spilled over, and she let out a shaky breath. "But if you don't do the surgery, we'll lose you anyway."

"That's the thing, isn't it?" Jorge said, his voice low. "We're already losing."

The room fell into a strained silence again, the weight of the decision crushing. Derek glanced at Nate, his brow furrowing slightly. It was subtle, but Nate caught the look, it was a silent plea for help, for another perspective. Derek might have been the one steering the ship, but even he had moments where he needed a copilot.

Nate leaned forward, his voice was calm, almost conversational, but there was a quiet intensity behind his words. "Jorge, this isn't a decision you have to make right now. You and Zona can take the night to think it over, talk it through. We'll answer any questions you have. Whatever choice you make, we'll support you."

Zona looked at Nate, her watery eyes grateful for the reprieve he'd offered. Jorge, however, was shaking his head. "I don't need the night," he said firmly. "I've lived a good life. I've made memories I'll cherish forever. But I'm not risking losing myself, not for a chance at a few extra years where I don't even recognize the woman I love."

Derek opened his mouth to respond, but Nate beat him to it. "It's your decision, Jorge. And whatever you decide, we're going to do everything we can to make those years as good as they can be."

Jorge nodded, a small, shaky smile breaking through the tension. "Thank you," he said, his voice quiet but genuine.

Zona squeezed his hand again, a silent conversation passing between them that neither Nate nor Derek could understand. She turned to Derek then, her voice barely above a whisper. "If we go with the radiation how long does he have before we need to start?"

"We'd want to start sooner rather than later," Derek said, his tone gentle. "But tonight, focus on each other. You don't have to carry this decision alone."

The room grew quiet again as Derek and Nate exchanged a glance. There was no triumphant victory here, no life-altering save. This was the harsh reality of medicine, where even the best options weren't always good enough. But they'd done their part, they'd armed Jorge and Sona with the knowledge they needed to make the hardest choice of their lives.

Derek rose first, stepping toward the door. Nate followed, pausing just before leaving to glance back at Jorge and Zona. They were huddled together, Jorge's hand cupping her cheek as she cried into his shoulder. It was raw and heartbreaking, but there was love in the way he held her, in the way he whispered something into her hair that Nate couldn't hear.

As Nate stepped into the hallway, Derek fell into stride beside him. They walked in silence for a moment, the weight of the conversation still lingering. Finally, Derek spoke, his voice low. "You handled that well."

Nate glanced at him, a hint of surprise flickering across his face. "I didn't do much."

"You reminded them that they weren't alone," Derek said simply. "That's not nothing."

Nate didn't respond, but the faintest hint of a smile tugged at his lips. Maybe it wasn't nothing.

AUTHORS NOTE
i'm probably going to change the title of this chapter later but i just didn't know what to call it, I've actually written the next two chapters which is so unlike me, so I'll probably try to upload them over the next few days! anyways I'm hope you liked this update :)