The Knight’s Oath: Grey’s Anatomy

The lock clicked as Jamie stepped inside, the familiar silence settling around him. Some nights, it was a relief. Other nights, it felt like the walls were closing in. Tonight, he wasn't sure which.

He tossed his keys onto the console table, shrugging off his jacket and rolling his shoulders. The exhaustion sitting in his bones was the kind he liked—the weight of a long day, of hands steady in the OR, of doing what he was built for. Surgery was easy. It was everything outside of it that had a habit of creeping up on him when things got too quiet.

Exhaling, he turned toward the bathroom. Shower. Food. Sleep. That was the plan.

-----------------------------

Steam curled against the glass as Jamie braced his hands against the shower wall, the heat working through the tension locked in his shoulders. He let his mind go blank, let himself focus on the steady rhythm of water hitting tile. His thoughts should've stayed on the OR, on the clean precision of sutures and steady hands. But then—

Completely uninvited, her voice crept into his thoughts.

"You'd starve to death without me."

His lips twitched, a small smirk breaking through before he could stop it. He could hear the teasing lilt in her voice, the way she had looked at him that morning, standing in his kitchen like she belonged there.

And then, just as quickly, his brow furrowed.

Because it wasn't just this morning.

She was there all the time.

His fingers ran through his wet hair as he shut off the water, gripping the towel a little tighter than necessary. Why her? He didn't dwell on people. He didn't let them linger in his head. And yet, Lexie had carved out a space there so effortlessly, like she had always been meant to exist in the background of his thoughts.

Shaking off the feeling, he dried off, tugged on a plain black T-shirt and loose sweatpants, and headed to the kitchen.

The second he stepped into the kitchen, his shoulders eased.

The fridge was stocked. James had handled it. He barely glanced at the neatly arranged groceries before pulling open the door, reaching for eggs, pancetta, and parmesan.

Carbonara.

The decision wasn't intentional, but it felt right. His hands moved on instinct—slicing through pancetta in clean, even strokes, tossing it into the pan just as the oil began to heat. The sharp, smoky scent filled the space as he worked, the kitchen coming alive with the sounds of sizzling fat and bubbling pasta water.

There was a kind of calm in cooking, the same way there was in surgery—steps, precision, control. No space for second-guessing. No room for unnecessary distractions.

And yet—

"You'd starve to death without me."

The words slipped into his mind again, curling around the edges of his thoughts like they belonged there.

Jamie exhaled through his nose, shaking his head. Apparently, even his own damn kitchen wasn't safe from her.

He wasn't annoyed. Not really.

But she was everywhere.

And for some reason, he wasn't in a rush to push her out.

The pasta was ready. He drained it, moving on instinct, tossing the noodles into the heat, letting the residual warmth pull the sauce together. No shortcuts. No cream. Just the way it was supposed to be. By the time he plated it and leaned against the counter, his stomach was more interested in eating than his thoughts were in lingering.

The first bite was perfect.

But something was different.

His eyes flicked toward his phone on the counter. He could check. See if she texted first.

Could.

Shouldn't.

Instead, he smiled to himself, muttering, "Starve to death without me. Right."

Jamie set his fork down, the last traces of Carbonara lingering on his tongue. Good. Perfect, even. But somehow, it still didn't quite hit the same as it had this morning.

He exhaled, pushing the thought aside as he stood, grabbing his plate and walking over to the sink.

The sound of running water filled the quiet apartment as he rinsed his dish, letting the heat from the stream soak into his skin. A simple task. Something to do with his hands. He scrubbed the plate, set it on the drying rack, and moved onto the pan. It was automatic, like closing a patient after a long surgery, a habit, not something that required thought.

He liked when things were like that.

When things made sense.

By the time the kitchen was back in order, he dried his hands on a towel, stretching his arms above his head before turning toward the bedroom. Sleep. That was the last thing on the list.

But as he moved through the living room, his gaze caught on something.

The piano.

It sat in its usual place by the window, bathed in soft city light. Untouched, silent. Waiting.

Jamie paused.

A little music wouldn't hurt before sleep.

His feet moved before he could talk himself out of it. He stepped closer, the air shifting around him, something heavier settling in his chest.

His fingers brushed against the cool ivory keys, light and familiar. Muscle memory. Just like surgery. Just like cooking. Just like breathing.

And just as the first note pressed into the silence, he heard her laughter.

It wasn't real, wasn't in the room, but it was there, somehow still echoing in the space between his thoughts.

Jamie swallowed.

Then, without another second of hesitation, he sat down.

The first note was soft, a gentle hum that barely stirred the air. His fingers found their place without effort, instinct guiding them through the familiar patterns of Chopin's Nocturne in E-flat Major.

Slow. Melancholic. Beautiful in a way that felt like remembering something and forgetting it at the same time.

The notes drifted through the apartment, curling around the stillness like smoke.

Jamie let his eyes close for a moment, exhaling through his nose as the melody settled into him. The repetition, the swells, the quiet ache beneath the surface—it all fit.

His hands moved effortlessly, the music filling spaces he didn't know needed filling.

And still, her laughter lingered.

Lexie Grey.

Her voice had been stuck in his head all day. Her smile, too, the way she had looked at him before she left. He hadn't even known her that long, and yet, she was everywhere.

Jamie's fingers slowed, hovering over the keys.

Maybe if he played long enough, he'd drown her out.

Or maybe… he didn't really want to.

"I really need to get some sleep" Jamie mumbled 

---------------------------

Jamie stepped into the hospital, the automatic doors sliding open with a quiet hiss. The early morning light filtered through the glass, casting long streaks across the polished floors. The air was thick with the familiar mix of antiseptic, coffee, and the muted urgency of a new day starting.

He liked coming in early. It gave him space before the chaos hit full force.

His steps were unhurried as he made his way toward the changing room. Inside, the hum of fluorescent lights buzzed softly overhead, the scent of clean linen and faint traces of surgical soap clinging to the air.

He shrugged off his jacket, hung it in his locker, and pulled on a pair of dark navy scrubs. The fabric was familiar, comforting in its own way, like slipping into an old habit. His white attending's coat followed, the weight of it settling over his shoulders as he rolled his sleeves up to his elbows.

The moment he stepped out, Tyler—the overworked, perpetually unimpressed male nurse—was already waiting for him, flipping through a patient chart with his usual deadpan expression.

"Knight," Tyler greeted, handing over the folder without looking up.

Jamie took it, arching a brow. "That bad?"

Tyler exhaled through his nose. "Depends. How do you feel about people swallowing things they shouldn't?"

Jamie flipped open the chart, scanning the details. "Depends. Is it a kid?"

Tyler scratched his jaw. "Nope. Full-grown adult. Walked in earlier this morning complaining of stomach pain. Turns out he—" he made an exaggerated motion toward his throat, "—swallowed a fork. Also, a few coins. And something else we can't identify."

Jamie let out a slow breath, flipping to the X-ray image tucked into the chart. Sure enough, a metal fork, several round objects, and an oddly shaped shadow sat lodged in the guy's stomach.

Tyler pointed at the unknown object. "So far, we've narrowed it down to either a bullet, a key, or some kind of cursed artifact. I'm betting on cursed artifact."

Jamie pressed his lips together, staring at the X-ray. "…How?"

"No idea. Didn't ask. Felt like one of those 'don't question it' situations."

Jamie rubbed a hand over his face. "Of course it is."

Tyler nodded solemnly. "Bailey ordered the X-ray and told me to find you. She's got rounds and said, and I quote, 'Knight can deal with it.'"

Jamie sighed, snapping the chart shut. "Of course she did."

Tyler clapped him on the shoulder. "Good luck. And if the object turns out to be haunted, I'm out."

Jamie rolled his eyes and turned toward the surgical board, already knowing this was going to be one of those days.

Jamie made his way toward the ER, weaving through the early morning chaos of the hospital. He had barely crossed the hallway when he spotted George O'Malley coming from the opposite direction, a clipboard tucked under his arm, his expression slightly dazed—typical George.

Jamie lifted a hand, stopping him in his tracks. "O'Malley."

George blinked up at him, clearly caught off guard. "Uh—Dr. Knight. Morning."

Jamie tilted his head slightly. "How's your dad doing?"

At the mention of his father, George straightened a little. "Still recovering from the valve replacement. They said he's stable, but, uh, tired."

Jamie nodded. "That's expected. The surgery went well, but his heart's been through a lot." He paused, eyes scanning George's face before continuing. "And the tumor removal? When's that scheduled?"

George shifted on his feet. "Four days."

Jamie considered that, his mind already calculating possible complications. He met George's eyes again. "Bring me his file later. I want to have a look at it."

George's eyes widened slightly. "Really?"

Jamie arched a brow. "Wouldn't have said it if I didn't mean it."

George quickly nodded. "Yeah—of course. Thank you. I really appreciate it."

Jamie gave him a small pat on the back, the kind of brief but reassuring gesture that didn't need words, and moved past him toward the ER.

Jamie stood at the nurse's station, rubbing a hand over his face as he stared at the empty bed that should have held his patient. "Of course," he muttered under his breath. "Of course, he's gone."

The nurse next to him, wide-eyed and visibly panicked, looked around the room as if Fork Guy would magically reappear. "I—I don't know where he went. I was just here."

Jamie sighed, pulling out his pager. His thumb moved quickly over the buttons. Page Bailey. Page the interns. Find him before this turns into an even bigger disaster.

Within minutes, the familiar trio appeared—Cristina Yang, Alex Karev, and Izzie Stevens. All three looked varying degrees of confused, unimpressed, and mildly amused.

Cristina was the first to speak. "You lost a patient?"

Jamie raised a brow. "You want to take over?"

"Nope. Just enjoying the chaos." Christina said with a deadpan face.

"Good. Enjoy it while you search." He crossed his arms, scanning the group. "I want him found. He swallowed a fork, a handful of coins, and something we haven't identified yet. If he eats anything else, we're going to be fishing a chandelier out of his stomach by lunchtime."

Alex snorted. "What, did he swallow the hospital vending machine?"

"Probably." Jamie didn't miss a beat. "Split up. Check the cafeteria, bathrooms, supply closets—anywhere a guy with zero impulse control would go."

Cristina arched a brow. "Supply closets. Seriously?"

"Trust me," Jamie said, already walking away. "You'd be surprised."

------------------------------

Izzie sighed as she pushed open the door to the supply room, her heels clicking softly against the tile. The room was dim, shelves lined with bandages, syringes, and a dozen other medical supplies. She was just about to give up when she heard a noise.

A quiet rustling.

She stepped further in, rounding the corner—and there he was.

Mr. Callahan, the man who had swallowed a fork, coins, and God-knows-what-else, was crouched on the floor, holding what appeared to be a plastic syringe cap in his hand. His eyes were wide, almost dazed, like he wasn't fully aware of what he was doing.

"Hey!" Izzie snapped, her voice sharp. "Don't—don't you dare."

He froze, the cap halfway to his mouth.

"Drop it," she said, taking another step closer.

For a second, she thought he might actually swallow it out of sheer defiance. But then, slowly, he set it down.

"Good choice," she muttered, pulling out her pager.

---------------------------

Jamie was at the nurse's station when Izzie appeared, dragging Callahan behind her.

"Found him," she said, slightly breathless. "Supply room. He was about to eat a syringe cap."

Jamie closed his eyes for a second, then looked at Callahan. "Seriously?"

Callahan shrugged, like this was just another Tuesday. "The fork hurts. This doesn't."

Jamie took a slow breath, reminding himself that yelling at the guy wouldn't help. "Alright," he said, voice steady. "No more eating. No coins, no forks, no syringe caps, no vending machine parts. You're done."

Callahan didn't respond.

Jamie glanced at the interns. "Yang, with me. We're scheduling the surgery."

Cristina perked up, already excited at the prospect of a surgical case. "What are we removing today? Fork, coins, and whatever else we find in there?"

"Everything," Jamie said, flipping through the chart. "No souvenirs."

------------------------------

The OR was already prepped by the time Jamie and Cristina stepped in. The monitors hummed softly in the background, the surgical tray laid out with instruments glinting under the bright overhead lights. Sterile. Precise. Predictable. Just the way Jamie liked it.

"Alright," Jamie said, scrubbing in alongside Cristina. "Let's go over what we're dealing with."

Cristina adjusted her mask. "Thirty-eight-year-old male, history of swallowing foreign objects. This time, we've got a metal fork, a few coins, and one unknown object lodged in the stomach. No perforation on imaging, but possible mucosal irritation."

Jamie nodded. "We're going in laparoscopically unless we hit a complication."

Cristina grinned behind her mask. "Minimally invasive. Nice."

Jamie rolled his eyes. "Let's see if you still think that when you're fishing around for a mystery object."

The anesthesiologist gave the go-ahead, and Callahan's vitals remained stable as Jamie positioned himself at the operating table. Cristina took her spot beside him, ready with the laparoscopic camera.

"Scalpel."

The scrub nurse handed it to Jamie, and he made a small, precise incision just above the umbilicus, carefully inserting the Veress needle to establish pneumoperitoneum—a controlled inflation of the abdomen using CO₂ to create space for visualization.

Once the pressure stabilized, Jamie switched to the trocar, guiding the laparoscopic camera into the peritoneal cavity. The screen flickered on, giving them a clear magnified view of Callahan's stomach.

Jamie narrowed his eyes. "There's the fork."

The prongs of the metal fork were angled awkwardly against the stomach lining, causing irritation but no full-thickness perforation. The surrounding mucosa was inflamed, but intact.

"Good news," Jamie said, shifting slightly. "No perforation. Bad news—this thing is wedged in at an angle. We're going to need a grasper."

Cristina was already on it. "Grasper coming in."

She guided the laparoscopic forceps into position, but the fork barely budged when she tried to manipulate it.

Jamie tapped a finger against the table, thinking. "Suction. Let's clear out any residual gastric contents before we reposition."

Once the area was cleared, Jamie adjusted his approach.

"We're going to rotate the handle end first," he instructed. "Cristina, stabilize the stomach wall. I don't want this thing scraping along the lining."

Cristina nodded, pressing gently with an external hand on Callahan's abdomen while keeping steady with the laparoscopic instrument.

Jamie maneuvered the forceps, rotating the fork handle-first toward the gastroesophageal junction, where he could extract it more safely. The screen showed a slow, careful movement, the metal glinting as it dislodged from its original position.

The moment the fork slid free, Cristina let out a quiet, "Nice."

Jamie chuckled. "Yeah, yeah, don't get too impressed yet. We still have a mystery prize to find."

He shifted the camera lower. The coins were floating in the gastric contents, easy enough to retrieve, but the unidentified object was still partially obscured.

Jamie angled the camera for a better view—and froze.

"What the hell is that?" Cristina murmured.

The screen showed a small, round, irregularly shaped metallic object lodged deeper against the stomach lining.

Jamie frowned, adjusting the focus. "It's not a bullet. Not a key either. Suction again—I need a clearer look."

As soon as the excess fluid was cleared, the true shape of the object revealed itself.

Cristina squinted. "Is that… a freaking thimble?"

Jamie exhaled sharply through his nose, shaking his head. "Of course it is."

Because why not?

"Alright," he said, adjusting his grip. "Let's retrieve it before I lose what little faith I have left in humanity."

Using the laparoscopic retrieval bag, Jamie carefully enclosed the thimble and the coins, ensuring nothing slipped further into the digestive tract. Once secured, he extracted the bag through the port, completing the removal process.

"Check for residual bleeding," Jamie instructed, shifting his focus back to the stomach lining.

Cristina moved the camera along the gastric wall. "No significant bleeding. Minor irritation near where the fork was wedged, but it should heal with conservative management."

"Good," Jamie said, satisfied. "Let's close up."

He methodically removed the laparoscopic instruments, deflating the abdomen before closing the incisions with 3-0 absorbable sutures. Finally, he applied sterile dressings and stepped back, removing his gloves with a snap.

"Surgery went well," he said, glancing at the anesthesiologist. "Wake him up. We'll keep him on observation for a day or two."

Cristina looked over at him, still processing. "I'm sorry, but a thimble?"

Jamie gave her a look. "After today, nothing surprises me anymore."

Cristina smirked. "Maybe next time, we'll pull a Monopoly piece out of someone."

Jamie sighed dramatically as they stepped away from the table. "If that happens, I'm officially quitting medicine."

He peeled off his mask and headed toward the scrub room, already thinking about how he was going to explain to Bailey that, yes, the fork guy was fine, and no, he had no logical explanation for how the hell he had managed to swallow a thimble.

------------------------------

Jamie walked toward the attending's lounge, Harold O'Malley's file still in his hands. The weight of it wasn't physical—it was the uncertainty inside those pages, inside the scans that didn't sit right with him.

He'd seen cases like this before. Esophageal cancer spreading into the stomach. It was always bad, but sometimes it was worse than it looked on imaging. And if Harold's tumor had already invaded further than they thought—if it was wrapped around major vessels, infiltrating the peritoneum—then the surgery they had planned wouldn't be a resection.

It would be opening him up and closing him back down.

Jamie wasn't willing to go in blind.

But it wasn't his call—not yet.

Bailey and Webber were Harold's primary surgeons. If he wanted more tests, he needed to convince them first.

-------------------------------

The attending's lounge was relatively empty, save for Miranda Bailey standing near the coffee machine, pouring herself a fresh cup.

Jamie knocked twice on the doorframe before stepping in. "Dr. Bailey."

She glanced up, raising an unimpressed eyebrow before looking back at her coffee. "You lose another patient, Knight?"

Jamie huffed a quiet breath. "No, but give me an hour."

Bailey let out a dry chuckle before taking a sip. "What do you need?"

Jamie set Harold's chart on the counter. "I want to order another PET scan and a repeat endoscopic ultrasound."

Bailey's brows furrowed. "Why?"

Jamie opened the file, flipping to the imaging. "The PET-CT was done two weeks ago. The tumor's already invasive, and we're assuming the margins are clear enough for resection, but…" He exhaled sharply. "I don't like the positioning of these extensions into the stomach."

Bailey took the file, scanning it herself. She saw what he saw—but she also saw the problem.

"Webber already signed off on this plan. The board approved the surgery," she said. "If we delay for more scans, we push everything back, including his post-op chemo and radiation."

"Unless we open him up and realize he's already unresectable," Jamie countered. "At that point, we're wasting time anyway."

Bailey sighed, pinching the bridge of her nose. "You really think it's worse than this?"

Jamie hesitated for only a second before answering. "Yeah. I do."

Before Bailey could respond, the lounge door swung open, and Webber walked in.

He stopped, noticing the file in Bailey's hands and Jamie's expression.

"Let me guess," Webber said, giving Jamie a pointed look. "You want more tests."

Jamie nodded. "I want better visualization before we go in."

Webber folded his arms. "What are you suspecting?"

Jamie kept his tone even, factual. "More peritoneal spread than we initially thought. If it's reached the omentum, or if there's vascular invasion, then this stops being a resection and turns into a palliative surgery. If that's the case, we should know now, not when he's already on the table."

Webber studied him for a moment. "And if we order these scans and it turns out you're wrong?"

Jamie held his gaze. "Then I'll be the first one to admit it."

Bailey sighed, exchanging a glance with Webber. Finally, she muttered, "Damn it. Fine."

She turned to Jamie. "You get one more scan. PET-CT. I want to know if this is worth pushing everything back for. But if it comes back clean?" She pointed at him. "You don't get to second-guess this surgery again."

Jamie nodded once. "Fair enough."

Webber exhaled. "Alright. Order the scan."

Jamie turned to leave, already pulling out his pager to send the request.

"Knight," Webber called after him.

Jamie paused.

"You better be right about this."

Jamie didn't answer. He didn't need to. Because in his gut, he already knew.

And Jamie always trusted his gut. It saved his live more times than he could count.

Jamie walked out of the attending's lounge, the weight of Harold O'Malley's case pressing heavily against his thoughts. His pace was steady, but his mind was somewhere else—inside the OR, mapping out tumor resections, anticipating complications, running through every possible outcome.

The decision to order another scan had been a small victory, but it didn't erase the uneasy feeling in his gut. If the cancer was worse than imaging showed, what then?

He was so caught up in his head that he almost didn't notice Derek Shepherd stepping into the hallway at the same time.

The collision was minor—just a brush of shoulders—but enough to snap Jamie back to the present.

"Jamie," Derek greeted, looking momentarily surprised before his usual easy confidence slid into place. "You alright?."

Jamie blinked, taking a second to reorient himself. "Derek." He exhaled, shaking his head. "Yeah. Just thinking about a patient."

Derek gave him a once-over, his gaze sharp despite the visible exhaustion clinging to his features.

"You look like hell," Jamie remarked.

Derek huffed out a tired laugh, running a hand through his hair. "That obvious?"

Jamie crossed his arms, smirking. "I know the look of a surgeon who's been pulling long hours. But this?" He tilted his head. "This looks like personal exhaustion."

Derek sighed dramatically. "Meredith snores."

Jamie arched a brow. "So?"

"So," Derek continued, "she forces me to sleep in the same bed because, and I quote, 'she is a girl with abandonment issues.'"

Jamie let out a short laugh, shaking his head. "And how exactly did you survive this before?"

Derek gave him a knowing look. "I used to wait until she was asleep, then sneak onto the couch and set my alarm before hers. It was a flawless system."

Jamie chuckled. "You've got it bad."

Derek smirked, about to fire back a response—

But then he froze.

Jamie wasn't just laughing.

He was smiling.

Not his usual dry amusement, not the polite smirk he threw at people when they bored him.

This was something else.

Something lighter.

Something real.

Derek narrowed his eyes. "Okay… what was that?"

Jamie frowned slightly. "What?"

"That." Derek pointed at his face. "That look. I don't think I've ever seen that look on you before."

Jamie rolled his eyes. "You're overthinking it."

Derek wasn't buying it. His eyes studied Jamie like a puzzle that suddenly didn't fit together.

"Who is she?" Derek asked, his voice curious but measured.

Jamie shook his head immediately. "It's not important."

Which, Derek noted, was not a denial.

Jamie glanced down the hallway as if searching for an exit. "She lives in Boston. We just had dinner twice. That's it."

Derek folded his arms. "Twice?"

Jamie sighed. "Don't start."

Derek's smirk deepened, but there was something thoughtful behind it.

He knew Jamie better than most people. Knew that Jamie didn't get attached easily, that women were never a priority in his life. If Jamie wanted company, he found it. And when he was done? He moved on.

But this?

Derek had never seen Jamie look like this over nothing.

And for the first time, Jamie didn't look like he was actively trying to move on.

Derek could've pushed. He could've prodded, teased, gotten the truth out of him.

But if there was one thing he knew about Jamie, it was that pushing would only make him shut down completely.

So instead, Derek just nodded, letting it go—for now.

"Right," he said, his smirk lingering as he turned to walk away. "You just had dinner. Twice."

Jamie sighed again, watching him disappear down the hallway.

And even though he should've been thinking about Harold, about the surgery, about the impossible decisions ahead…

His mind kept circling back to Lexie.

And the fact that, for some reason, the thought of her made him smile.

------------------------------

Jamie walked through the hospital corridors, his pace steady but his mind already focused on the next task. Burke's cases.

Taking over another surgeon's patient load wasn't unusual, but the weight of inheriting the cases of a world-class CT surgeon like Preston Burke wasn't lost on him.

He reached the nurses' station, his fingers tapping lightly against the counter as he addressed the nearest nurse.

"I need the chart for Mr. Latham," Jamie said, his voice even.

The nurse—a redhead in her mid-thirties, sharp-eyed and efficient—nodded, flipping through the stack of files before pulling out the one with Latham's name.

Jamie took it, flipping it open as he walked toward the patient's room.

The soft, rhythmic beeping of the heart monitor filled the air as Jamie stepped inside. The man lying in the bed—Mr. Richard Latham, 62 years old, severe mitral regurgitation—looked up as the door swung open.

Latham's sharp, blue eyes studied him immediately. "You're not Dr. Burke."

Jamie nodded once, stepping forward and setting the chart down. "No, I'm Dr. Knight. Dr. Burke is dealing with a health issue, so I'll be taking over your case."

Latham exhaled through his nose. "Didn't expect a last-minute switch."

Jamie didn't react to the tension in his voice. It was expected. It was normal. Patients built trust with their surgeons. Trust that could be hard to transfer.

"I understand," Jamie said simply, pulling up a chair beside the bed. "Surgical changes can be unsettling, especially before a major procedure. But I've reviewed your case, and the plan remains the same. We'll go in minimally invasive, repair the mitral valve, and improve your heart function."

Latham let out a slow breath. "Burke said repair was better than replacement."

Jamie gave a small nod. "It is—if the valve structure is salvageable. Your last echocardiogram suggests that it is, but if we get in there and find extensive damage, we may need to switch to a mechanical valve. Either way, the goal is to get your heart functioning efficiently again."

Latham frowned slightly. "Mechanical valve. That's the one where I'd have to take blood thinners for the rest of my life, right?"

"Yes," Jamie confirmed, watching Latham's expression. "But let's not get ahead of ourselves. A repair is still the plan."

Latham absorbed that before asking, "And you? You're a cardiothoracic surgeon?"

Jamie met his gaze. "Cardiothoracic and trauma. I completed my fellowship at New York Presbyterian before serving as a trauma surgeon overseas. I've handled more valve repairs than I can count—including ones done in less-than-ideal conditions."

Latham's brows lifted slightly. "Combat surgeon?"

Jamie inclined his head slightly. "For several years."

Latham's lips pressed together in thought. Finally, he let out a slow breath. "Well… I guess that means if something goes wrong, you won't panic."

Jamie's expression didn't shift. "I don't panic."

Something about the way he said it wasn't arrogance—it was just fact.

Latham studied him for another few seconds, then nodded. "Alright, Dr. Knight. Let's do this."

Jamie gave a curt nod. "Good."

Just as he stood, the door swung open, and Cristina Yang stepped inside.

"You paged me?" Cristina asked, already scanning the monitors as she stepped inside.

Jamie handed her the chart. "Latham's mitral valve repair. I want you to prep him and scrub in."

Cristina's gaze snapped to his, her expression flickering with mild surprise.

"You want me assisting?"

Jamie tilted his head slightly. "No, I want you in the gallery eating popcorn."

Cristina rolled her eyes.

"Of course you're assisting," Jamie said simply. "You trained under Burke. You know how he operates. I expect you to anticipate his techniques, but adapt to mine."

Cristina shot back. "So I should be prepared for faster sutures and less hesitation?"

Jamie arched a brow. "Should I be prepared for backseat commentary while I work?"

Cristina grinned. "Wouldn't dream of it."

Jamie gave Latham one last look. "We'll see you in the OR."

With that, he walked out, already visualizing every step of the surgery in his mind.

------------------------------

The OR lights were blindingly bright, casting sharp reflections against the sterilized instruments. The room hummed with quiet precision—monitors beeping in steady intervals, the distant murmur of anesthesia being managed, the rustling of gloved hands preparing for one of the most delicate surgeries in cardiac medicine.

Jamie stood at the scrub sink, methodically washing his hands in controlled, practiced motions. His focus was already locked in, every step of the procedure playing in his mind like a pre-visualized sequence.

Behind him, Cristina scrubbed in, her usual sharp energy contained beneath a layer of controlled anticipation.

"You've done mitral valve repairs before, right?" she asked, not looking up from the water running over her hands.

Jamie glanced at her. "Plenty."

Cristina said lightly. "Yeah, in trauma. Where you're usually patching something up just enough to keep the patient alive."

Jamie arched a brow. "And yet they still lived."

Cristina huffed a small laugh. "I'm just saying, cardiac surgery in a controlled setting is different. Longer procedures. More finesse. You have to be patient."

Jamie dried his hands, turning to face her as he pulled on his gloves. "And you have to be adaptable. If this were trauma, we'd have minutes. Here? I have time. Doesn't mean I'll waste it."

Cristina met his gaze, intrigued. She had expected confidence. But this wasn't arrogance. It was quiet, steady certainty.

She was starting to see why Webber had trusted Jamie to take over Burke's cases.

"Let's get to work," Jamie said simply, stepping into the OR.

The patient was prepped and draped, anesthesia stable, the bypass team standing by. Jamie took his place at the operating table, surgical instruments neatly arranged in front of him.

Nurse: "Patient is prepped and ready, Dr. Knight."

Jamie nodded, glancing at Cristina, who stood opposite him.

"Alright, Yang. Walk me through the approach."

Cristina's eyes flickered with a spark of competitiveness—he was testing her.

"We start with a median sternotomy, exposing the heart and pericardium. Once we visualize the mitral valve, we establish cardiopulmonary bypass, arrest the heart with cold cardioplegia, and make a left atriotomy to access the valve."

Jamie nodded approvingly. "Good. But we're not doing a sternotomy."

Cristina blinked. "We're not?"

Jamie gestured to the instruments. "Minimally invasive. We're going in through a right thoracotomy, between the ribs. Less trauma, faster recovery."

Cristina's lips parted slightly in realization and intrigue. "Right. That's Burke's method."

Jamie picked up the scalpel. "It's mine now. Let's get started."

Jamie made a precise right thoracotomy incision, carefully separating the intercostal muscles and inserting a rib retractor to create space. Unlike trauma surgeries—where he would have had to rush to control bleeding and stabilize—this was meticulous, controlled work.

His hands moved with mechanical precision, muscle memory kicking in as he reached the pericardium.

Nurse: "Pericardium exposed."

Jamie gestured. "Yang, open the pericardium."

Cristina took the forceps, making a small incision in the thin sac surrounding the heart, carefully retracting it to expose the left atrium.

Jamie scanned the field quickly. "No adhesions. We're clear to proceed."

He turned to the perfusionist. "Start cardiopulmonary bypass."

Within seconds, the bypass machine took over the heart's function, circulating oxygenated blood through the patient's body.

Jamie waited for the indicators to stabilize, then gave a short nod. "Administer cold cardioplegia."

A chilled potassium solution was introduced, arresting the heart in diastole.

The room fell eerily quiet—no heartbeat, just the steady hum of the bypass machine.

Cristina's eyes flickered over the monitors, her focus sharpening. "Heart is arrested. Ready for atriotomy."

Jamie made a clean incision in the left atrium, retracting it to expose the mitral valve.

He let out a small breath as he studied the structure. This part had always been his favorite—the moment of truth.

The valve was prolapsed, with thickened leaflets and chordae tendineae elongation, causing severe regurgitation.

"Yang, tell me what you see."

Cristina leaned in slightly. "Posterior leaflet prolapse. Thickened annulus, possibly some calcification. We can repair this."

Jamie smirked slightly behind his mask. "Agreed. Let's get to work."

Jamie worked quickly but precisely, using an annuloplasty ring to reinforce the valve structure.

"Yang, place the first suture."

Cristina took the needle driver, carefully stitching one end of the annuloplasty ring to the valve annulus.

Jamie watched her hands, then spoke lowly, instructively. "Tighter on the tension. You want it snug but not strangling the tissue."

Cristina adjusted slightly, then secured the stitch.

Jamie nodded. "Good. Keep going."

For the next forty-five minutes, they worked in synchrony, placing sutures, reinforcing the valve, ensuring the chordae were properly repositioned.

With the repair completed, Jamie turned to the perfusionist.

"Warm him up and start weaning from bypass."

Slowly, the bypass machine's function decreased as Jamie and Cristina waited.

Then—a single electrical blip.

Another.

Then, suddenly—the monitor picked up a steady rhythm.

Jamie watched the numbers stabilize, a sense of finality settling over him.

"The repair is holding," Cristina confirmed.

Jamie exhaled. "Let's close."

For the next thirty minutes, they meticulously closed the atrium, removed excess fluids, and secured the thoracotomy incision.

amie glanced at the anesthesiologist. "Let's bring him off sedation and prepare for transport."

The nurses moved efficiently, checking vitals and ensuring stability.

Jamie turned to Cristina. "Get him to the ICU. I want post-op labs and an echo within the hour."

Jamie pulled off his gloves, watching the patient's heart beat steadily on the monitor.

Jamie had been a bit rusty with civilian routine procedures. Years focusing on trauma had that effect, but it started to feel natural again.

Like it had never left him.

------------------------------

Jamie sat at one of the smaller tables in the attending's lounge, his sandwich untouched as he flipped through the pages of a research paper. His focus was locked in, barely registering the usual background noise of the hospital—monitors beeping faintly from down the hall, the murmur of distant conversations, the scrape of a chair across the floor.

"Advances in Minimally Invasive Mitral Valve Repair."

He had done the procedure earlier, but knowing his technique was solid wasn't enough. He wanted to know if there was a way to make it better.

A chair slid out across from him, and Bailey dropped into the seat with her coffee in hand.

She glanced at the paper, then at his still-wrapped sandwich. "That your idea of a lunch break?"

Jamie turned the page. "Eating and reading. Multitasking."

Bailey arched a brow. "You ever take an actual break?"

He finally looked up. "Not really my thing."

Bailey let out a short breath, something between amusement and mild exasperation. "You're sitting here reading research papers instead of eating. You got a problem, Knight?"

Jamie tapped the edge of the paper. "Just making sure I know what's changed while I was off fighting wars."

Bailey studied him for a second before shaking her head. "You? Behind? That'd be a first."

Jamie set the paper down, finally picking up his sandwich. "Not behind. Just catching up."

Bailey took a sip of her coffee, her eyes still on him. "Good surgery today."

Jamie nodded. "Yeah." He glanced at the paper again. "But I can do better."

Bailey tilted her head slightly. "You're already better than most people in this hospital."

Jamie chewed his food, considering that for a moment. Then, with a slight shrug, he said, "Not enough."

Bailey didn't argue. Instead, she stood, giving the table a quick pat before heading toward the door.

"Try not to read yourself into an ulcer, Knight."

Jamie let out a quiet breath, shaking his head as he turned another page.

Yeah. Like that was gonna happen.

------------------------------

Jamie sat at the small table, flipping through the New England Journal of Medicine article on Advancements in Aortic Valve Repair and Endovascular Aortic Surgery. His sandwich sat untouched as he absorbed the latest findings on surgical techniques for acute aortic dissections.

He had done these surgeries before. Repaired them in open battlefields, in operating rooms with limited resources. But the science kept evolving.

And Jamie never let himself fall behind.

Then his pager buzzed.

TRAUMA CODE BLUE – ER

Jamie's mind immediately switched gears as he grabbed his coat and moved toward the emergency department.

The ER was already in controlled chaos when Jamie arrived. He spotted Bailey at the trauma bay, surrounded by residents and nurses.

"What do we got?" Jamie asked, snapping on gloves as he approached the gurney.

Bailey barely glanced at him. "Twenty-five-year-old male, collapsed mid-game. Complained of chest pain before he lost consciousness. BP's crashing—60 over 40. Tachy at 140. EKG shows nonspecific ST changes."

Jamie's gaze moved over the patient—a tall, athletic young man, drenched in sweat, skin pallid. His chest rose and fell in uneven, shallow breaths.

One look, and Jamie's mind was already building the anatomy in his head, reconstructing the problem in layers.

Bailey continued, "No history of cardiac disease. No trauma. ER was thinking heatstroke or exertion-related syncope."

Jamie frowned. "Not with distended neck veins and muffled heart sounds."

He pressed two fingers against the patient's carotid artery—thready, barely palpable. The numbers didn't match heat exhaustion.

Then he glanced at the vitals again.

Blood pressure discrepancy.

Left arm: 92/54. Right arm: 64/40.

Jamie's head snapped up. "He's got aortic dissection."

The room paused for half a second.

Cristina, standing nearby, whipped her head toward him. "Wait, what?"

Jamie was already moving. "I need a STAT portable ultrasound. Now."

As the nurse brought over the ultrasound machine, Jamie took the probe himself and placed it over the patient's chest.

The screen lit up in black and white, showing the beating heart.

Jamie's eyes tracked the aortic root, following the ascending aorta upward. He barely heard Bailey speaking—his focus was on the image forming in front of him.

Then he saw it.

A flap. A thin, oscillating intimal tear inside the aortic lumen.

Cristina peered at the screen. "Oh, hell."

Bailey muttered, "That's a damn dissection."

But Jamie's focus narrowed in further. He wasn't just looking for confirmation—he was looking for the details that mattered.

Bailey exhaled sharply. "Alright. OR. Now."

---------------------------------------

The patient was prepped and draped, his chest sterilized, the OR filled with the rhythmic beeping of monitors and the soft hiss of ventilators. Cardiopulmonary bypass was primed and ready, the perfusionist already adjusting flow settings.

Jamie stood at the head of the table, scrubbed in, his mind building a 3D map of the patient's chest in his head. Every vessel. Every risk. Every move they would need to make.

Bailey stood beside him, Cristina across the table, retractors in hand.

"Alright," Jamie said, his voice calm and controlled. "Alright. Let's save a live."

Bailey nodded beside him, Cristina across the table, retractors in hand.

Jamie took the scalpel and made his incision, a precise midline cut along the sternum. With practiced ease, he switched to the sternal saw, the hum of the blade cutting through bone filling the air before Cristina moved in with the Finochietto retractor, spreading the ribs to expose the pericardium.

Then came the first problem.

As Jamie carefully incised the pericardium, a rush of dark, unclotted blood spilled into the cavity.

Cristina muttered a curse under her breath. "Tamponade."

Jamie reached for the Yankauer suction, clearing the pooling blood to get a better look. The ascending aorta was swollen, pulsating abnormally, its walls barely holding together. The dissection had spread, weakening the vessel until it had begun leaking into the pericardium.

"He wouldn't have made it another hour," Bailey murmured.

Jamie didn't hesitate. "Get him on bypass."

Cristina moved quickly, placing a venous cannula into the right atrium while Jamie secured the arterial cannula into the femoral artery, routing blood out of the heart and into the heart-lung machine. The perfusionist gave a sharp nod.

"Flow set. Cooling patient to 28°C."

Jamie reached for the aortic cross-clamp, securing it just above the dissection. "Let's stop the heart."

Bailey called for the cardioplegia solution, a cold potassium mix injected into the coronary arteries. Within seconds, the heart stilled.

Silence.

Now they had their window.

Jamie's hands moved with calm precision, his mind already a step ahead, reconstructing the dissection in his head, layer by layer. He could see the tear, extending beyond the aortic root, but it was what lay beneath that worried him.

"Give me the ultrasound probe."

Cristina frowned. "We already confirmed the dissection—"

Jamie's voice was firm. "I need to check the coronaries."

Bailey handed over the probe, and Jamie carefully scanned along the aortic root. A moment later, he saw it.

A thin, almost imperceptible extension of the dissection into the right coronary artery.

Cristina let out a breath. "That's why he collapsed."

"If we'd gone straight to a graft replacement, he would've arrested as soon as we re-perfused," Jamie murmured, already adjusting his plan. "We need a bypass before we replace the aorta."

Bailey nodded, reaching for the saphenous vein graft, which had already been harvested from the patient's leg.

"Time to move," Jamie said.

With 8-0 prolene, he began the delicate process of suturing the vein graft to the right coronary artery. Every stitch had to be perfect—one wrong move, one misplaced suture, and blood wouldn't reach the heart the way it needed to.

Cristina watched closely, retracting where needed, suctioning away excess blood. "You always this fast?"

Jamie didn't look up. "You always talk this much during surgery?"

Bailey chuckled softly. Cristina rolled her eyes but kept working.

Once the bypass was secure, Jamie turned his attention to the next step.

"Dacron graft," he called.

Cristina handed over the synthetic tube. With swift, controlled movements, Jamie carefully excised the torn portion of the aorta, leaving only the stable tissue behind. The damage was worse than expected—the walls were thin, stretched almost to rupture.

He set the graft into place, stitching its proximal end to the aortic root. Every move was calculated, precise. His fingers worked like a machine, suturing faster than most surgeons would dare—but not a single stitch was misplaced.

Bailey muttered, "Damn, Knight."

Jamie finished the final suture, reinforcing it with BioGlue to prevent micro-leaks. Then, with a final check, he nodded. "Alright. Let's rewarm and take him off bypass."

The perfusionist increased the temperature, and within minutes, the patient's core body temperature rose to 37°C. The heart-lung machine gradually slowed as normal circulation was restored.

Now came the moment of truth.

The team held their breath as Jamie released the aortic clamp. Blood surged into the graft, and a second later—

A single blip on the monitor.

Then another.

And then—the slow, steady rhythm of a heartbeat.

Cristina exhaled. "Damn."

Bailey checked the pressure. "BP's holding. No arrhythmias."

Jamie stepped back slightly, letting the relief settle in. "Alright. Let's close."

With careful precision, he secured the pericardium, reapproximated the sternum with heavy stainless steel wires, and sutured the skin closed in smooth, uninterrupted stitches.

As the team moved the patient off the table and onto the transport gurney, Jamie pulled off his gloves, tossing them into the bin.

"Get him to the ICU," he said. "He's got a shot."

Bailey gave a nod. "Nice work."

Cristina, watching the heart monitor stabilize, tilted her head. "You missed this, didn't you?"

Jamie didn't respond right away.

Because she was right.

------------------------------

The weight of the past few hours sat heavy on Jamie's shoulders as he stepped into the scrub room, peeling off his gloves and tossing them into the bin. The distant beeping of monitors faded behind him, the hum of the OR slowly retreating as the door swung shut.

His surgical gown was streaked with traces of blood, remnants of the fight they had just won. He reached for the ties at the back of his neck, tugging them loose before pulling the fabric over his head in one clean motion. His muscles ached—his hands should have been shaking from hours of micro-suturing, but they didn't.

They never did.

Not when it mattered.

Jamie grabbed a fresh towel, wiping his face before reaching for his white coat. As he slipped it on, he exhaled, letting the shift settle—the moment where he stopped being the surgeon in the OR and became the doctor standing in front of a family waiting for answers.

The hardest part of the job wasn't the surgery. It was this.

He pushed through the double doors and made his way toward the waiting room.

A man and woman sat in one of the small clusters of chairs, hands clasped tightly together. The father—**mid-50s, still in his work clothes, a loosened tie hanging from his collar—**looked up the second Jamie entered the room. The mother—**late 40s, blonde, still wearing her visitor badge from when she'd seen her son that morning—**stood instantly, eyes wide, searching Jamie's face for any hint of news.

Jamie approached, his expression calm but open. "Mr. and Mrs. Carter?"

The father stood. "That's us. Is he—?"

Jamie gave a small nod. "Your son is out of surgery. He's stable."

The mother let out a soft breath, one hand covering her mouth, eyes welling up instantly. The father, clearly trying to hold it together, exhaled sharply, nodding once.

Jamie motioned toward the nearby seating area. "Why don't we sit?"

They followed his lead, but their postures remained tense, like they were bracing for impact.

Jamie leaned forward slightly, resting his forearms on his knees—not relaxed, but not distant, either. This part was about connection. Clarity. Making sure they understood what came next.

"The surgery was successful," Jamie started, his tone even and measured. "Your son had what's called an aortic dissection—essentially, a tear in the inner lining of his aorta. It caused blood to leak between the layers of the artery wall, which is why his blood pressure dropped so dangerously low."

The mother swallowed hard. "But you—you fixed it?"

Jamie nodded. "We replaced the damaged section of his aorta with a synthetic graft to reinforce the artery. That repair will hold. We also had to perform a coronary bypass, because part of the tear extended into an artery that supplies blood to his heart."

The father's brow furrowed. "A bypass? Like… open-heart surgery?"

"Yes," Jamie confirmed. "But we caught it in time, and he tolerated the procedure well. We were able to restore blood flow before any major damage occurred."

The mother wiped at her eyes. "And he's okay now?"

"He's stable," Jamie emphasized, choosing his words carefully. "He's in the ICU right now, still on a ventilator while we monitor his heart function. That's normal for a surgery this extensive. Over the next 24 to 48 hours, we'll be watching his blood pressure, kidney function, and for any signs of complications."

The father's jaw tightened. "What kind of complications?"

Jamie kept his voice steady. "The main risk after aortic surgery is stroke or organ dysfunction, particularly the kidneys, because they rely on healthy circulation. We'll be watching closely for any changes in neurological function once he wakes up. The next few days are critical, but so far, he's doing well."

The mother nodded, absorbing the information, but her voice was small when she asked, "When will he wake up?"

Jamie softened his tone slightly. "In the next few hours, once the anesthesia wears off. The ventilator is just a precaution—it helps his body recover without added stress. Once he's breathing well on his own, we'll remove it."

The father let out a slow breath, rubbing his hands over his face. "And after that? What happens?"

Jamie sat back slightly, adjusting his approach. "Recovery for this kind of surgery takes weeks to months. He'll need to stay in the hospital for at least a week, possibly longer, depending on how his heart and lungs respond. After that, he'll go home with restrictions—no heavy lifting, no strenuous activity—because we need to protect the graft and make sure his heart heals properly."

The mother nodded, as if committing each instruction to memory. "And after that? He plays basketball. That's his whole life. Will he—will he ever play again?"

Jamie hesitated—but only for a second.

Honesty mattered more than false hope.

"We need to take this one step at a time," he said carefully. "Right now, the priority is getting him through recovery. Many athletes return to activity after heart surgery, but it depends on how well his heart heals and whether his doctors clear him for play."

The mother held her breath before nodding.

Jamie leaned forward again. "What matters right now is that he's here. He made it through the hardest part. And we're going to do everything we can to get him back to full strength."

The father exhaled, nodding firmly. "Thank you, Doctor. Thank you for saving him."

Jamie nodded once, because this was the part he never knew how to respond to.

It wasn't about saving people.

It was about fixing what was broken.

Jamie stood. "One of the ICU nurses will come get you when you can see him. If you have any questions, I'll be nearby."

The mother reached out suddenly, touching Jamie's forearm lightly—not gripping, just grounding herself. "Thank you," she whispered.

Jamie gave a brief nod before stepping away, already feeling the weight of the next case pressing in.

Because the job never stopped.

And that was exactly how he liked it.

-----------------------------

Jamie stepped into the locker room, the door swinging shut behind him, sealing off the hum of the hospital for the first time in hours. The cool metal of his locker pressed against his fingertips as he opened it, methodically changing out of his scrubs.

His muscles ached—a dull reminder of the hours spent standing, his hands inside a man's open chest, reconstructing vessels with microscopic precision. But it wasn't the exhaustion that weighed on him. It never was.

He shrugged into a plain t-shirt, pulled on his jacket, and ran a hand through his damp hair before shutting the locker door. The click echoed in the now-empty room.

Time to get out of here.

Jamie walked down the quiet hallway toward the exit, rolling his shoulders as he glanced at his watch. Almost midnight. The halls were mostly clear, only a few night-shift nurses moving between stations, their voices hushed.

He was already thinking about what came next—sleep, maybe, or more likely, another research paper—when a familiar voice cut through his thoughts.

"Knight!"

Jamie slowed his stride just as Meredith caught up to him, her expression somewhere between hesitant and determined.

"Grey." He stuffed his hands into his jacket pockets, waiting for whatever this was about.

Meredith fell into step beside him. "Look, I know you're probably done for the day, but…" She hesitated, then exhaled. "Would you come by my place? Talk to Izzie?"

Jamie frowned slightly, tilting his head. "What's going on?"

Meredith gave a tired half-smile. "She still has a check for eight-point-seven million dollars taped to my fridge."

Jamie raised a brow. "The Denny Duquette money?"

Meredith nodded. "It's been sitting there for weeks. She won't cash it, won't tear it up. Just stares at it like it's supposed to give her an answer." She sighed, rubbing her temple. "I don't know what to say to her anymore, and I thought… maybe you could. Because your the only one I know with that kind of money."

Jamie let out a slow breath, considering that for a second. Izzie Stevens wasn't his patient. This wasn't his responsibility.

But he'd seen how she'd been moving through the hospital lately—there, but not really there. A surgeon who wasn't sure if she still belonged.

Jamie understood that feeling.

So instead of brushing it off, he just nodded.

"Yeah. Let's go."

Meredith blinked, then gave a relieved nod as they stepped through the sliding doors, the cold night air wrapping around them.

Jamie adjusted his jacket, his exhaustion temporarily forgotten.

Because if there was one thing he knew how to do, it was look at something broken and figure out how to fix it.

Even when it wasn't a heart on an operating table.