Chapter 3: The Woman He Saved
George's first solo trauma came at 9:47 AM.
The call crackled through the ER speakers: "Incoming trauma, ETA four minutes. Twenty-six-year-old female, motor vehicle versus pedestrian, GCS 9, hypotensive, suspected internal bleeding."
George was moving before his brain fully processed the words. Muscle memory from countless traumas, from the hours spent in this exact ER as a resident, took over. He grabbed a trauma gown from the supply cart and shoved his arms through the sleeves.
"Dr. Matthews!" A nurse—Sandra, her name tag read—appeared at his elbow. "You're primary on this?"
"Yes. Get me two units of O-negative on standby, notify the OR we might need a surgical suite, and page someone from ortho if you can find them."
"On it."
The ambulance bay doors burst open and controlled chaos flooded in. Two paramedics wheeling a gurney, a young woman strapped down, her leg twisted at an angle that made George's stomach turn even after everything he'd seen.
"Twenty-six-year-old female, hit by a car going approximately thirty-five miles an hour," the lead paramedic rattled off. "Open tib-fib fracture on the right, possible pelvic fracture, abdominal rigidity suggesting internal bleeding. BP's 80 over 50 and dropping. We've got two large-bore IVs running wide open."
They transferred her to the trauma bay bed in one smooth motion. George moved to the head of the bed, his hands already reaching for the penlight to check her pupils.
"Pupils equal and reactive," he called out. "Airway's patent but she's altered. Let's get her intubated. Sandra, where's anesthesia?"
"Two minutes out."
"We don't have two minutes. I'll do it." George grabbed the intubation kit, his hands steady despite the adrenaline flooding his system. This was what he was good at. This was where George O'Malley—Gideon Matthews—whoever the hell he was today—made sense.
The tube slid home on the first attempt. The oxygen saturation began to climb.
"Good," George muttered. "Okay. Okay. Let's get a FAST exam—Sandra, can you—"
"Already on it." She had the ultrasound wand in hand.
George ran the probe across the patient's abdomen, and his heart sank. Free fluid in all four quadrants. Massive internal bleeding.
"She needs surgery now," he said. "Page Dr. Torres for the leg, but we're going straight to the OR. This can't wait."
"Dr. Matthews—" Sandra hesitated. "Dr. Torres is in surgery. Won't be available for another hour at least."
"Then page whoever's available. This woman's bleeding out." George looked up and found Cristina Yang standing in the doorway, arms crossed, watching with clinical interest. "Dr. Yang—you available?"
Cristina raised an eyebrow. "For what?"
"Exploratory lap, probable splenic rupture. I could use an extra set of hands."
She glanced at the monitors, the ultrasound screen, and made her decision in approximately three seconds. "OR 3's open. Let's move."
They rushed the patient upstairs, George calling out orders as they went. Book the OR, prep for major abdominal surgery, get those blood products ready. The team moved like a well-oiled machine around him, and for a moment George forgot to be Gideon Matthews. He was just a surgeon, doing what surgeons did.
Saving lives.
The OR was cold and bright and exactly where George needed to be. He scrubbed in beside Cristina, who was watching him with that assessing look she got when she was cataloguing information for later use.
"You move fast," she observed.
"Trauma doesn't wait."
"No, I mean you move like you've worked here before. You knew exactly where the OR was, which supply carts to grab from, how the ER team flows." Cristina's hands moved through the scrubbing motions automatically. "Most new attendings take a week to figure out the layout. You knew it on day two."
George's stomach dropped. "I studied the hospital schematics before I arrived. Wanted to be prepared."
"Hm." Cristina didn't sound convinced, but she let it go. "What are we looking at in there?"
"Best case, isolated splenic injury. Worst case, multiple organ damage and she doesn't make it off the table."
"Optimistic."
"Realistic."
They entered the OR and took their positions on opposite sides of the table. The patient—still Jane Doe, no ID found at the scene—lay draped and prepped, the anesthesiologist monitoring her vitals with increasing concern.
"BP's 70 over 40," the anesthesiologist called out. "She's circling."
"Then let's not waste time." George held out his hand. "Scalpel."
The blade touched skin and George was home.
He worked quickly, efficiently, opening the abdomen and exposing the source of the bleeding. The spleen was ruptured, hemorrhaging into the peritoneal cavity. But there was more—a liver laceration, and something wrong with the kidney.
"Suction," George ordered. "I need to see—damn. Cristina, look at this kidney."
Cristina leaned in. "That's shattered. You'll have to take it."
"I know. Can you handle the spleen while I deal with this?"
"Can I handle a splenectomy? Seriously, Matthews?" But she was already moving, her hands confident and precise.
They worked in tandem, moving around each other with a synchronization that usually took months to develop. George forgot to second-guess himself, forgot to worry about maintaining his cover. There was just the surgery, the patient, the desperate race to stop the bleeding before it stopped her heart.
"She's stabilizing," the anesthesiologist announced after what felt like hours but was probably only forty minutes. "BP's coming up. 90 over 55."
"Good." George tied off the final vessel on the kidney remnants. "Cristina, how's the spleen?"
"Done. Clean removal, no complications."
"Check for other injuries while we're in here. I want to make sure we didn't miss anything."
They ran through the checklist—liver laceration repaired, bowel intact, no other bleeds identified. George began the closing, his sutures neat and precise, the way Bailey had taught him.
Every stitch matters, O'Malley. You close sloppy, you might as well have done the whole surgery sloppy.
"You suture like Bailey," Cristina said suddenly.
George's hands froze for a fraction of a second. "What?"
"Your technique. It's exactly how Bailey teaches her residents." Cristina was watching him over her mask, eyes narrowed. "Even the way you hold the needle driver. That's a Bailey thing."
"I... I've studied her techniques. She's published extensively on surgical education."
"You studied surgical techniques from medical journals?"
"I'm thorough."
Cristina made a noncommittal sound and returned to her side of the table. They finished the closing in silence, but George could feel her watching him, cataloging every movement, every word, building a case he couldn't quite see.
The patient was wheeled to recovery, stable for the first time since she'd arrived. George stripped off his gloves and gown in the scrub room, exhaustion hitting him like a physical weight.
"That was good work," Cristina said, appearing beside him at the sink. "Clean, fast, no hesitation. You know your stuff."
"Thank you."
"Where did you really train, Matthews?"
George looked up sharply. "I told you. Johns Hopkins."
"And I'm saying that's bullshit." Cristina leaned against the sink, arms crossed. "Hopkins has a style. You don't have it. You have Bailey's style, Seattle Grace's rhythm, our protocols. So either you spent a year secretly observing here before taking the job, or you're lying about your training."
"I'm not lying about my training." Just about everything else.
"Then explain it."
"I can't."
Cristina's eyes flashed. "Can't or won't?"
"Does it matter?"
"Yes. Because I don't work with liars, Matthews. And right now, you're setting off every alarm bell I have."
George dried his hands carefully, buying time. "I trained at Hopkins. That's the truth. How I suture, how I move in an OR—that's just how I learned. Maybe I had a teacher who trained under Bailey. Maybe it's coincidence. But I'm not lying about my credentials."
Technically true. The credentials say Hopkins. They're just fraudulent.
Cristina studied him for a long moment. "You're hiding something."
"Everyone's hiding something."
"Not from me. I always find out."
"Then I guess I'll see you when you do." George pushed past her toward the door.
"Matthews."
He stopped but didn't turn around.
"That patient lived because you moved fast and didn't second-guess yourself. Whatever you're hiding, you're a good surgeon. Don't make me regret saying that."
George left without responding.
He found Meredith in the cafeteria at noon, eating a sad-looking sandwich and reviewing charts. She looked up when George approached, and her face brightened.
"Dr. Matthews! I heard about your trauma this morning. The nurses are impressed."
"I got lucky." George set down his tray—coffee and a muffin he had no intention of eating. "The patient's young, healthy. She had a fighting chance."
"Still. Dr. Yang doesn't compliment people. The fact that she called your work 'competent' is basically her version of a standing ovation."
George smiled despite himself. "She said competent?"
"She said 'he didn't fuck it up.' In Cristina-speak, that's high praise." Meredith pushed her charts aside. "Sit. Tell me about it."
He shouldn't. Should make an excuse and leave, put distance between himself and Meredith Grey before he did something stupid like confess everything. But George sat down anyway, because he'd never been good at self-preservation when it came to her.
"Ruptured spleen, shattered kidney, liver lac," he said. "Twenty-six-year-old woman hit by a car. Still Jane Doe—no ID."
Meredith winced. "That's rough."
"She'll make it, though. Kidney loss isn't ideal, but she's young enough to adapt."
"You sound relieved."
"I am. I don't like losing patients."
"No one does." Meredith took a bite of her sandwich, made a face, and pushed it away. "Okay, that's disgusting. Want to sneak up to the attendings' lounge? They have actual food up there."
"Won't we get in trouble?"
"You're an attending, remember? You're allowed." She stood, gathering her things. "Come on. I'll show you the secret route that avoids the nurses' station. Bailey's less likely to catch us that way."
George followed her through the hospital, and it was painfully familiar—the back hallways, the service elevator, the way Meredith moved through the building like she owned it. She'd always had that confidence, even as an intern, like the hospital was her territory and everyone else was just visiting.
They took the stairs up two flights—"Faster than waiting for the elevator," Meredith explained—and emerged in a quiet hallway George remembered from his resident days. The attendings' lounge was at the end, marked with a sign that still read "AUTHORIZED PERSONNEL ONLY."
"Won't they care that you're not an attending?" George asked.
"I'm friends with the attendings. They pretend not to notice." Meredith pushed open the door and gestured him inside. "Welcome to luxury."
The lounge was nicer than George remembered—they'd renovated since his death. Leather couches, a kitchenette with an espresso machine, floor-to-ceiling windows overlooking the city. Mark Sloan was stretched out on one couch, asleep with a surgery cap over his eyes. No one else was around.
"Jackpot," Meredith whispered. "Sloan's dead to the world. We can raid the fridge."
She opened the refrigerator and pulled out containers of actual food—pasta salad, fruit, sandwiches that looked like they'd come from somewhere other than the cafeteria. George took a plate mechanically, barely tasting anything as Meredith chatted about hospital gossip.
"—and then Karev tried to convince the patient that his kid's rash was totally normal, meanwhile the kid's turning purple, and Bailey walks in and just destroys him. It was beautiful."
George found himself smiling. "Sounds like Alex."
"You know him?"
"No, I just—I mean, I've heard about him. Dr. Bailey mentioned him." Smooth, O'Malley. Real smooth.
Meredith settled onto the couch opposite Mark's, curling her legs under her. "You're different from most attendings."
"How so?"
"You listen. Most of them talk at you, not with you. Like they're imparting wisdom from on high and we should be grateful." She gestured with her fork. "You're asking questions. Learning the dynamics. It's... refreshing."
"I don't like pretending I know everything. That's how mistakes happen."
"See, that right there. That's what I mean." Meredith studied him with those too-perceptive eyes. "You remind me of someone. I can't figure out who."
George's heart stuttered. "Oh?"
"Yeah. It's been bothering me since yesterday. The way you move, the way you talk about patients like they're people instead of cases." She tilted her head. "Do you have siblings? Maybe I knew them or something."
"No siblings. Only child."
"Hm." Meredith took another bite, thinking. "Well, whoever it is, it'll come to me eventually. I'm like a dog with a bone when something bugs me."
"I've noticed that about you."
"Have you? We've only known each other two days."
I've known you for years. I've seen you at your worst and your best. I know how you take your coffee and which surgeries make you cry and the fact that you pretend to be dark and twisty but you're actually terrified of being abandoned.
"You're not subtle," George said instead. "You have that intensity that some people have. The ones who feel everything deeply and try to pretend they don't."
Meredith's eyes widened slightly. "That's... surprisingly accurate for someone who just met me."
"I'm observant."
"Apparently." She set down her plate and leaned back. "Okay, Dr. Matthews. My turn. Tell me about you."
"What do you want to know?"
"Why trauma? And don't give me the 'I want to help people' line. Everyone says that. What's the real reason?"
George considered lying. Deflecting. But Meredith was looking at him with genuine curiosity, and he found himself wanting to give her something true, even if he couldn't give her the whole truth.
"I died once," he said quietly.
Meredith sat up straighter. "What?"
"Not literally. But close enough. I was in an accident, years ago. Catastrophic injuries. I should have died." George looked down at his hands. "But someone saved me. A team of surgeons who refused to give up, who fought for me even when I was just another John Doe on a table. And I realized—that's what I wanted to do. Be the person who fights for the ones everyone else writes off."
It wasn't a lie. It was the most honest thing he'd said since returning to Seattle.
Meredith was quiet for a long moment. "What kind of accident?"
"Motor vehicle. I don't really remember most of it. Just waking up in a hospital months later, looking like..." He gestured at his face. "This."
"This?" Meredith looked confused. "What's wrong with this?"
"It's not my original face. Reconstructive surgery. Extensive reconstruction."
Her eyes widened. "I... I had no idea. You can't tell."
"That's the point. The surgeons were that good."
Meredith reached out and took his hand, and George nearly flinched from the contact. "I'm sorry you went through that."
"Don't be. It made me who I am."
"Still." She squeezed his hand. "That must have been terrifying. Waking up different."
You have no idea.
"It was," George admitted. "I didn't recognize myself for a long time. Still don't, some days."
"Is that why you came to Seattle? New start, new face, new life?"
"Something like that."
Meredith smiled sadly. "I get that. After everything that's happened here—the shooting, the deaths, the constant trauma—sometimes I want to run away and start over somewhere no one knows me. Just be a different Meredith Grey."
"Why don't you?"
"Because this is home. These are my people. And even when it's horrible, even when I lose someone I love, I can't imagine being anywhere else." She released his hand and stood. "Come on. I promised I'd show you the hiding spots, remember?"
"Now?"
"You have somewhere else to be?"
"I should check on my patient."
"She's in recovery, stable, and being monitored. You have fifteen minutes. Come on."
George followed her out of the lounge and down another back hallway. They climbed stairs, went through doors marked "STAFF ONLY," and eventually emerged on the roof.
"This is it," Meredith said, spreading her arms. "The best hiding spot in the hospital. No one comes up here except the people who know about it."
The view was stunning—the city spread out below them, the sound in the distance, the sky grey and heavy with the promise of rain. George walked to the edge and looked down at the street below, and for a moment he was back there, his body breaking, his life ending, everything he'd ever been scattering across the asphalt.
"You okay?" Meredith appeared beside him, concern in her voice.
"Yeah. Just... heights."
"We can go back inside."
"No. No, this is good. I need to get used to them again." George took a deep breath. "Thank you. For showing me this."
"George used to come up here," Meredith said softly. "The guy I told you about yesterday. When things got overwhelming, when he needed to think—this was his spot."
George's throat tightened. "Was it?"
"Yeah. We'd find him up here sometimes, just standing at the edge, looking out at the city. I asked him once what he was thinking about and he said—" She paused, remembering. "He said he was reminding himself why it mattered. All the pain, all the stress, all the death. He said looking at the city, seeing all those lives down there, it made the hard days worth it."
George closed his eyes. He'd forgotten saying that. Forgotten the way Meredith had stood next to him, not pushing for more, just being there.
"He sounds like he was a good person," George managed.
"He was. One of the best." Meredith turned to face the city. "I think you'd have liked each other. You have the same... I don't know. The same way of seeing people. Like everyone matters, even when they're difficult or broken or dying."
"Maybe I would have."
They stood in silence for a moment, looking out at Seattle. George felt the rain starting, light drops that would turn into a downpour soon enough.
"We should get back," Meredith said. "Before we get soaked."
But she didn't move, and neither did George. They stood there in the rain, two people who knew each other better than they had any right to, and George thought about telling her. Just opening his mouth and letting the truth spill out.
I'm George. I'm alive. I'm right here and I've missed you so much it hurts to breathe.
"Meredith—"
His pager went off. Then hers. Then both of them simultaneously.
Trauma. Mass casualty. All available surgeons to the ER immediately.
The moment shattered. Meredith was already running for the door, George right behind her. They flew down the stairs, through the hallways, and burst into the ER to find controlled chaos.
Bailey was directing traffic. "Building collapse on Fourth Avenue. We've got twelve incoming, more possibly trapped. Dr. Grey, Trauma Two. Dr. Matthews, Trauma One. Move!"
George ran for Trauma One and found Owen already there, gowned and barking orders. The doors burst open and the first patient arrived—a construction worker, crushed beneath debris, barely conscious.
And George forgot about Meredith, about confessions, about everything except the work.
He was a surgeon.
The rest could wait.
Six hours later, George emerged from his fourth surgery of the day to find Vanessa sitting in the surgical waiting room.
She stood when she saw him, and the relief on her face was palpable. "There you are. I've been calling."
George pulled out his phone—dead battery. "Sorry. Mass casualty. I was in surgery."
"I heard. It's all over the news." Vanessa crossed to him, reaching up to brush something—probably blood—from his temple. "Are you okay?"
"Exhausted. But everyone I operated on survived, so that's a win."
"That's more than a win, that's a miracle." She smiled. "Come on. You need food and sleep, in that order."
"I should stay. Make sure my patients—"
"Are being monitored by a team of competent residents and nurses who will call you if anything changes." Vanessa took his arm. "You've been on your feet for eight hours. You need to rest."
George was too tired to argue. He let Vanessa lead him to her car, let her drive him to her apartment, let her push him onto the couch while she ordered food. He must have dozed off because the next thing he knew, she was shaking him awake.
"Food's here. Thai. Your favorite."
They ate in comfortable silence. George was too exhausted to make conversation, and Vanessa seemed to understand. She just sat close, her presence grounding him, reminding him that someone in the world knew who he really was.
"Meredith showed me the roof today," George said eventually.
Vanessa looked up from her pad thai. "Oh?"
"She said it was George's hiding spot. Where he went when things got overwhelming."
"Was it?"
"Yeah." George set down his fork. "She stood next to me and told me about this resident she lost. About how he used to look at the city and remind himself why it all mattered. And I realized—she remembers me better than I remember myself sometimes."
"What do you mean?"
"I mean I've been so focused on being Gideon Matthews that I've forgotten what it felt like to be George O'Malley. The real George, not the dead martyr everyone mourns. The messy, complicated, flawed person I actually was."
Vanessa moved closer, taking his hand. "You're still that person."
"Am I? Because I lied to her face today. Multiple times. I told her I was in an accident and got reconstructive surgery, which is true, but I made it sound like it happened to someone else. Someone who isn't standing in her hospital, using a fake name, pretending to be a stranger."
"You're protecting her."
"I'm lying to her. There's a difference."
Vanessa was quiet for a moment. "Do you want to tell her?"
"More than anything. And also not at all. Because if I tell her, I have to tell everyone, and then..." George trailed off. "Then it becomes real. What I did. Letting them mourn me. Letting my mother bury an empty casket. Staying hidden while they suffered. There's no coming back from that."
"George—"
"Cristina cornered me after surgery today. She knows something's off. She can tell I trained here, that I move like Bailey's residents. She's going to keep digging until she figures it out."
"Then maybe it's time to tell the truth."
George pulled away. "I can't. Not yet. I need... I need more time."
"Time for what?"
"To figure out who I am. Whether I'm George or Gideon or some screwed-up combination of both." He stood, pacing. "To prove I deserve to be here, that I'm not just some fraud wearing a dead man's skills and a stranger's face."
Vanessa stood and caught his hands, stopping his pacing. "Listen to me. You are not a fraud. You're a brilliant surgeon who saved four lives today. Four people are alive because of you. That's real, George. That matters."
"Does it? When it's all built on lies?"
"Yes." She pulled him close, wrapping her arms around him. "Yes, it still matters. The lives you save don't care what name you use. They just care that you were there when they needed you."
George buried his face in her hair and tried to believe her.
They stayed like that for a long time—her holding him together, him trying not to fall apart. Eventually Vanessa pulled back and guided him to the bedroom.
"Sleep," she ordered. "Real sleep, in an actual bed. I'll wake you if the hospital calls."
"I should go home—"
"Stay. Please. I don't want you driving when you're this exhausted."
George was too tired to argue. He collapsed onto her bed still in his scrubs, and Vanessa curled up beside him, her presence a comfort he hadn't realized he desperately needed.
"Vanessa?"
"Mm?"
"Thank you. For everything."
She pressed a kiss to his shoulder. "Stop thanking me. Just let me care about you."
George fell asleep thinking about Meredith on the roof, about the way she'd looked at him like he mattered, like he was someone worth knowing.
Even though she had no idea who he really was.
Even though he was lying to her with every breath.
Even though eventually, inevitably, the truth would come out and she would hate him for it.
In his dreams, he was back on the roof. But this time when he turned around, Meredith was looking at him with recognition in her eyes.
"George," she said. "I knew it was you."
And in his dreams, that was a good thing.
In reality, George knew, it would destroy everything.
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