Chapter 21: Probation
Days 51-54 - Week 2 Back
George was reviewing lab results in the attendings' lounge Monday morning when his pager went off.
SHEPHERD NEEDS TO SEE YOU. HIS OFFICE. NOW.
George's stomach dropped. He checked the time—8:47 AM. He'd been at the hospital for two hours, done morning rounds with his residents, checked on his post-op patients. Everything had gone smoothly.
So why was Derek paging him?
George headed to the administrative wing, climbed the stairs to Derek's office, and knocked on the open door.
Derek looked up from his computer. "George. Come in. Close the door."
George closed the door and sat down across from Derek's desk, his mind running through everything he might have done wrong. Had he missed something on rounds? Made an error in judgment? Overstepped with his residents?
Derek folded his hands on his desk. "Relax. You're not in trouble."
George's shoulders dropped slightly. "Then what's this about?"
"Your probation." Derek pulled up something on his tablet. "The board's decision included six months of probationary oversight. That means I'm reviewing your cases, observing your surgeries when possible, and providing regular assessments to the board."
"I know. That was part of the agreement."
"Right. But I wanted to make sure we're clear on what that actually means day-to-day." Derek turned the tablet so George could see it. "I've created a system. Every major surgery you perform, I want a brief written summary afterward—patient presentation, surgical approach, outcome, any complications. Every week, we'll have a fifteen-minute check-in meeting to discuss your caseload. And periodically, I'll observe you in surgery."
George nodded slowly. "Understood."
"I'm not doing this to punish you, George. I'm doing this to protect you." Derek's expression was serious but not unkind. "You're under a microscope right now. Every decision you make, every surgery you perform, every interaction with staff—people are watching. If something goes wrong, there will be those who want to use it as evidence that the board made the wrong call in keeping you."
"I know."
"So I'm making sure nothing goes wrong. Or if it does, that there's a clear record of your decision-making process, your adherence to protocols, and your competence." Derek leaned back in his chair. "This isn't about micromanaging you. It's about documentation. Protection. Making sure that six months from now, when your probation ends, no one can question whether you've met every requirement."
George felt something loosen in his chest. "Thank you. For explaining it that way."
"You've had a good first week back. Your surgical outcomes are excellent. Your teaching is solid. Your residents respect you. I want that to continue." Derek tapped his tablet. "So. Written summaries after major surgeries. Weekly check-ins—let's say Monday mornings at 8 AM before rounds. And I'll let you know when I'm planning to observe."
"That's fair."
"Good. Now get back to work." Derek paused. "And George? Keep doing what you're doing. You're proving people right for giving you a second chance."
George left Derek's office feeling lighter than when he'd entered.
Oversight. Documentation. Protection.
It made sense. And Derek was right—George was under a microscope. Every move scrutinized, every decision analyzed. Having Derek's official backing, his documented observations, would shield George from anyone looking for ammunition to claim he shouldn't be there.
His pager went off again.
TRAUMA INCOMING. CONSTRUCTION ACCIDENT. PATIENT CRITICAL. ETA 3 MINUTES.
George headed to the trauma bay at a run.
The patient arrived on a backboard, conscious but in obvious agony, a piece of rebar protruding from his abdomen.
"What do we have?" George asked, snapping on gloves while the paramedics transferred the patient to the gurney.
"Marcus Webb, forty-two, construction worker. Fell from scaffolding approximately twelve feet onto rebar sticking up from debris pile. Rebar entered right lower quadrant, appears to have penetrated through-and-through. Patient is conscious and alert, in significant pain. Vitals stable for now but we've got him on fluids."
George assessed quickly. The rebar was roughly three-quarters of an inch in diameter, entered the abdomen about two inches lateral to the right iliac crest, and exited through the patient's back at a slightly upward angle.
"Mr. Webb, I'm Dr. O'Malley. I'm going to take care of you. Can you tell me where you're feeling pain?"
"Everywhere," the man gasped. "But mostly—mostly my stomach. And my back. Is it bad?"
"You've got a piece of metal through your abdomen, so yes, it's serious. But you're conscious, you're talking to me, and your vitals are stable. That's all good. We're going to get you to surgery and remove this carefully." George turned to the nurses. "Get me a portable X-ray and CT. I need to see exactly what this rebar is touching before we move it. Page the OR and tell them we're coming as soon as imaging is done. And someone find Dr. Shepherd—tell him I need him in the gallery for this one."
The nurses moved. George examined the patient more thoroughly—abdomen rigid, likely peritonitis from bowel perforation. Blood pressure holding but heart rate elevated. Breathing shallow from pain.
April Kepner appeared in the doorway, already gowned. "Dr. O'Malley, I heard the page. Do you need assistance?"
"Yes. Get me a detailed history—medications, allergies, previous surgeries. And start a second IV line, wide bore. We're going to need access."
"On it."
The portable X-ray machine was wheeled in. Everyone stepped back while images were taken.
George studied the films on the monitor. The rebar had entered the right lower abdomen, passed through what looked like loops of bowel, possibly nicked the iliac artery or vein, and exited posteriorly near the lumbar spine.
"CT now," George ordered. "I need to see the vessels."
The patient was carefully transported to CT—with the rebar still in place, moving him was precarious—and scanned.
George reviewed the images with the radiologist. "There. The rebar is pressing against the right common iliac artery but I don't think it's fully penetrated. And here—it's definitely through multiple loops of small bowel. Possible involvement of the cecum."
"You're going to have to remove that very carefully," the radiologist said. "If it's tamponading any vessels and you pull it out wrong, he could exsanguinate."
"I know. That's why I'm doing this in the OR with full vascular control ready."
They transported the patient to OR 2. George scrubbed while April and the surgical team prepped the patient. Dr. Murphy and Dr. Avery joined as additional assists.
In the scrub room, George washed methodically, mentally running through the surgical approach. This was going to be delicate. Extremely delicate.
The door to the scrub room opened. Derek walked in, already in surgical scrubs but not scrubbing.
"Gallery?" George asked.
"Gallery," Derek confirmed. "I want to see how you handle this one."
"It's going to be complicated."
"I know. That's why I want to watch."
They walked into the OR together. Derek headed up to the observation gallery while George positioned himself at the surgical field.
The patient was draped around the rebar, which stuck up obscenely from his abdomen like some grotesque industrial art piece.
"Okay, everyone," George said. "This is Marcus Webb, forty-two, impaled with rebar through the right lower abdomen. Imaging shows the foreign body is adjacent to the right common iliac artery, through multiple loops of small bowel, and near the cecum. We're going to do an exploratory laparotomy, carefully extract the rebar under direct visualization, assess and repair all damage, and pray we don't have a vascular catastrophe. Questions?"
"No, sir," Murphy said.
"Then let's go. Scalpel."
The scrub nurse handed him the scalpel.
George made his incision—a midline laparotomy, carefully avoiding the rebar. He extended the incision long enough to get good exposure, then used retractors to open the abdomen.
Blood and stool immediately welled up.
"As expected," George said calmly. "We've got bowel perforation and contamination. Suction. Lap pads. Let's pack the quadrants and get control of this bleeding."
He worked systematically. Placed packs around the rebar to stabilize it. Explored the abdomen to identify all the injuries.
"Okay. The rebar has gone through the terminal ileum here—" He pointed. "—and the cecum here. Both are perforated. There's also a tear in the mesentery. I need to assess the vascular damage before we remove this thing."
George carefully dissected around the rebar, exposing the right common iliac artery.
"There," he said. "The rebar is pressing against the artery but it hasn't penetrated. That's good luck. If I remove this carefully, we might not have a vascular injury to repair."
"How are you going to remove it?" Murphy asked.
"Very, very carefully." George looked up at the gallery where Derek was watching. "Dr. Avery, I need you to be ready with vascular clamps in case this goes sideways. Murphy, you're on suction. Kepner, you're going to help me stabilize this as I extract it. Everyone stays calm, moves slowly, and nobody panics if we get bleeding. Clear?"
"Clear," they said in unison.
George gripped the rebar with both hands. "Okay. I'm going to pull this out in one smooth motion, following the same trajectory it entered. Ready?"
Everyone tensed.
George pulled.
The rebar slid out smoothly, leaving a trail of blood and bowel contents.
No arterial bleeding. No catastrophic hemorrhage.
"Good," George said, setting the rebar aside on the instrument tray. "We got lucky. The artery is intact. Now let's deal with the bowel damage."
For the next three hours, George worked meticulously.
Resected the damaged portions of terminal ileum and cecum. Created an ileocecal anastomosis to restore bowel continuity. Repaired the mesenteric tear. Irrigated the abdomen with liters of saline to wash out the contamination. Checked every inch of bowel for additional injuries. Assessed the retroperitoneum for bleeding. Examined the exit wound for any muscle or nerve damage.
His hands were steady. His mind was clear. His residents assisted perfectly—Murphy anticipated his needs, Avery managed the retraction, Kepner suctioned and held tissue.
In the gallery, Derek watched silently.
Finally, George was satisfied. "Okay. All repairs are holding. No active bleeding. Abdomen is clean. We're going to close, leave a drain in place, and start him on broad-spectrum antibiotics for the contamination. Let's go layer by layer."
They closed. Fascia, subcutaneous tissue, skin. George did the final sutures himself.
"Time?" he asked.
"Three hours, forty-two minutes," the circulating nurse reported.
"Good work, everyone. Let's get him to ICU. Close monitoring for infection, watch his bowel function, serial labs. I want to know immediately if his white count starts climbing or if he shows any signs of sepsis."
The patient was transferred to ICU. George wrote detailed orders, checked the surgical site one more time, then headed to the surgeons' lounge to write up his notes.
Derek was already there, working on his tablet.
"That was excellent work," Derek said without preamble.
George sat down heavily, exhaustion hitting him. "Thank you."
"I'm serious. That extraction was textbook perfect. One smooth motion, no vascular injury, minimal additional trauma. And your bowel resection and anastomosis were clean, efficient, and well-executed." Derek set down his tablet. "You handled a very complicated case with confidence and skill."
"I had good help. My residents were solid."
"They were. But you were leading. You made the right calls, you kept everyone calm, and you saved that man's life." Derek paused. "You're better than you were before, you know."
George looked up. "What?"
"Before your... before the accident. You were a good resident. Competent, compassionate, hardworking. But you second-guessed yourself constantly. You were anxious, uncertain, always looking for approval." Derek's expression was thoughtful. "This George? The one who just performed that surgery? He's confident. Decisive. Still compassionate, still careful, but there's no hesitation. You know what you're doing and you trust yourself to do it."
"Near-death does that to you, I guess."
"Maybe. Or maybe you just needed time to become who you were always capable of being." Derek stood up. "I'm going to write up my observation notes for the board. But George? That surgery is going to be exhibit A for why they made the right decision keeping you."
After Derek left, George sat alone for a few minutes, processing.
Better than before.
He'd never thought of it that way. In his mind, he was still the same anxious, insecure George he'd always been, just wearing a different face.
But maybe Derek was right. Maybe something had changed. Not just his appearance, but something fundamental.
Confidence. Competence. Trust in himself.
George pulled out his phone, started writing the post-surgical summary Derek had requested. Patient presentation, surgical approach, decision-making rationale, outcome.
His pager went off. ICU, checking on an order.
Back to work.
That evening, George found Bailey in the attendings' lounge, reviewing surgical schedules.
"Dr. Bailey, do you have a minute?"
"Always. Sit."
George sat down. "I wanted to thank you. For assigning me residents. For trusting me with a team."
Bailey set down her tablet. "You earned it. Your first week back was solid. Your surgical outcomes are excellent. Your teaching is clear. You're exactly the kind of attending residents need."
"Derek watched my surgery today. The rebar impalement."
"I heard. How'd it go?"
"He said I was better than before. More confident, less anxious." George paused. "Do you think that's true?"
Bailey studied him for a long moment. "Yes. I do."
"Why?"
"Because the George O'Malley I trained was brilliant but terrified of his own brilliance. He'd second-guess himself, apologize for taking up space, defer to others even when he was right." Bailey's expression softened. "You don't do that anymore. You walk into a trauma bay and you lead. You make decisions without constantly looking for validation. You teach residents without apologizing for correcting them. You've grown up, George. Whether that's because of the accident, the recovery, the two years away, or just time—I don't know. But it's real."
George felt emotion rise in his throat. "I still feel like that anxious resident sometimes. Like I'm faking the confidence."
"Fake it till you make it is a legitimate strategy. And honestly? I don't think you're faking anymore." Bailey picked up her tablet again. "Now go home. You did a three-hour surgery after a full day of rounds and consults. Rest. Come back tomorrow ready to teach those residents something new."
"Yes, Dr. Bailey."
As George stood to leave, Bailey added, "And George? I'm getting there. With forgiving you. It's slow, but I'm getting there."
"Thank you. That means everything."
DEREK'S PERSPECTIVE (Days 52-54)
Derek Shepherd had watched a lot of surgeons over the years. Good ones, bad ones, brilliant ones, mediocre ones. He'd trained residents, mentored attendings, and observed countless procedures from the gallery.
But watching George O'Malley perform that rebar extraction on Monday had been something special.
Not because of technical brilliance alone—though George's technique was flawless. But because of the complete transformation from the resident Derek remembered.
That George had been talented but timid. Skilled but uncertain. Capable but constantly seeking approval.
This George was none of those things.
Derek sat in his office Wednesday afternoon, reviewing the surgical observation notes he'd compiled over the past two days.
Monday: Rebar impalement. Complex abdominal trauma. George performed a delicate extraction with no vascular complications, repaired multiple bowel perforations, created a clean anastomosis. Estimated blood loss: 400cc. Surgical time: 3 hours 42 minutes. Outcome: Excellent. Patient stable in ICU. Teaching moments with residents were clear and educational. Recommendation: Exemplary performance.
Tuesday: George wasn't in surgery—he had consults and teaching rounds. Derek had observed him teaching his residents about trauma assessment protocols. Patient, clear, encouraging without being condescending. The residents were engaged, asking good questions, taking notes.
Wednesday morning: Appendectomy with complications (perforated appendix, peritonitis). George managed it smoothly, taught Murphy how to handle the contamination, explained his decision-making process throughout. Surgery time: 1 hour 28 minutes. Outcome: Good.
Every observation showed the same thing: competence, confidence, teaching ability.
Derek closed his notes and headed to the surgical floor to find Bailey.
He found her at the nurses' station, reviewing charts.
"Miranda. Got a minute?"
"For you? Always. What's up?"
They walked to a quiet conference room. Derek closed the door.
"I've been observing George for his probation oversight," Derek said. "And I wanted to get your take on something."
"Shoot."
"He's better than he was before. Significantly better. More confident, more decisive, better teacher. Do you see it too, or am I imagining things?"
Bailey nodded slowly. "I see it. He's grown up. Matured. Found his footing."
"What do you think caused it?"
"Near-death tends to clarify priorities. Two years of recovery gave him time to process who he was and who he wanted to be. The physical transformation removed some of his insecurities about his appearance." Bailey paused. "And maybe... maybe George always had this in him. He just needed to stop being so afraid of it."
"That's what I think too." Derek leaned against the table. "How are you with all this? Personally, I mean."
Bailey was quiet for a moment. "I'm getting there. Slowly. I'm still angry about the lies. I'm still hurt that he let me grieve. But I'm also... relieved he's alive. Proud of the surgeon he's become. Hopeful that we can rebuild some kind of relationship, even if it's different than before."
"That's fair."
"How are you with it?"
Derek considered. "I didn't know George as well as you did. He wasn't my resident, wasn't my responsibility. So for me, it's easier to separate the professional from the personal. Professionally, he's an asset. An excellent trauma surgeon who's proving himself daily. Personally... I'm glad he's alive. I'm disappointed he lied. But I'm willing to move forward."
"You're lucky you have that distance."
"I know." Derek straightened up. "But I wanted to tell you—he's doing really well. His probation oversight is going to reflect that. The board is going to see documentation of excellent surgical outcomes, good teaching, professional conduct. When those six months are up, there's not going to be any question about whether he should stay."
Bailey smiled slightly. "Good. That's what I hoped for when I gave him those residents."
"You took a risk assigning him a team so early."
"Not really. I've seen George O'Malley work since his intern year. I knew he had this in him. He just needed the opportunity to show it." Bailey picked up her tablet. "Now, if you're done with your probation oversight debrief, I have seventeen post-op patients to check on."
"Go. I'll write up my weekly report."
After Bailey left, Derek sat alone in the conference room, thinking about George's journey.
Two years ago, George O'Malley had died—or so they'd all thought—trying to save a stranger. A heroic death. A tragic loss.
Now he was back, reconstructed, changed, but still fundamentally the same person where it mattered: in his compassion, his skill, his dedication to saving lives.
Derek had seen people crumble under less pressure than George was facing. The constant scrutiny, the cold shoulders from former friends, the loneliness of being back but not fully accepted.
But George showed up every day. Did excellent work. Taught his residents. Handled his probation oversight with professionalism.
That took strength.
Derek opened his laptop and started writing his weekly probation report for the board.
Subject: George O'Malley, Probationary Period - Week 2
Summary: Dr. O'Malley continues to demonstrate excellent surgical skills, appropriate decision-making, and effective teaching abilities. This week he managed several complex cases including a rebar impalement with multiple bowel perforations and a perforated appendix with peritonitis. All surgical outcomes were positive. His interactions with residents, nursing staff, and other attendings have been professional and collegial. No concerns to report.
Recommendation: Continue probationary status as scheduled. Dr. O'Malley is meeting and exceeding all expectations.
Detailed Observations: [Derek attached his surgical observation notes]
Next Steps: Continue weekly check-ins and periodic surgical observations. Next review scheduled for Week 4 of probation.
Derek sent the report to the board, copied Bailey and Richard, and filed it in George's personnel record.
Then he went back to his own work, confident that George was going to be fine.
Better than fine.
George was going to thrive.
GEORGE (Day 54 - Thursday Evening)
George was finishing his notes in the attendings' lounge when Derek walked in.
"Got a minute?" Derek asked.
"Of course."
Derek sat down across from him. "I just filed my first official probation report with the board. Week two assessment."
George's stomach clenched. "And?"
"And it was glowing. Excellent surgical outcomes, effective teaching, professional conduct. No concerns whatsoever."
The relief was physical. George felt his shoulders drop, his chest loosen.
"I wanted you to know because I know you're probably anxious about this," Derek continued. "The oversight, the scrutiny, the documentation. But George, you're doing everything right. Your surgeries are excellent. Your teaching is solid. Your residents respect you. The nursing staff works well with you. You're rebuilding trust one day at a time."
"Thank you. For the oversight, for the documentation, for protecting me."
"That's my job. And honestly? It's easy to document excellence when you're performing at this level." Derek stood up. "Keep doing what you're doing. In six months, when your probation ends, you're going to have a file full of reports just like this one. No one will be able to question whether you belong here."
After Derek left, George sat alone for a few minutes, processing.
Two weeks back. Fourteen days. And Derek was already filing positive reports.
His phone buzzed. Text from Vanessa: How was your day?
George: Good. Really good. Derek filed his probation report. It was positive.
Vanessa: Of course it was. You're brilliant. Coming home soon?
George: 30 minutes. Want me to pick up dinner?
Vanessa: Already ordered Thai. Just come home.
George smiled. Home. Vanessa's apartment had become home. The place he returned to at the end of long days. The place where someone waited for him, cared about him, celebrated his victories.
He packed up his things, changed out of his scrubs, and headed to the parking lot.
In his car, George sat for a moment before starting the engine, just breathing.
Two weeks back. Positive probation report. Residents who respected him. Derek's acknowledgment that he'd grown and improved. Bailey's slow forgiveness. Alex's steady friendship.
It wasn't everything. Meredith still wouldn't talk to him. Cristina maintained her professional-only boundary. Callie had made eye contact once but nothing more.
But it was something. It was foundation. It was progress.
George started the car and drove home to Vanessa, Thai food, and the life he was building one day at a time.
At Vanessa's apartment, George found her already setting up dinner on the coffee table—pad thai, spring rolls, tom yum soup, all his favorites.
"You ordered a feast," George said, dropping his bag by the door and kissing her hello.
"You had a good day. We're celebrating."
They ate on the couch, George telling her about the rebar impalement surgery, Derek's observation, the positive probation report.
"See?" Vanessa said. "I told you. You're doing amazing."
"Derek said I'm better than I was before. More confident, less anxious."
"You are."
"But I don't feel different. I still feel like that anxious resident half the time. Like I'm faking the confidence."
"Maybe confidence is something you fake until it becomes real." Vanessa set down her plate. "Or maybe you're not faking at all. Maybe you're just finally letting yourself be as good as you've always been."
George thought about that. About the surgeries he'd performed in the last two weeks. The residents he'd taught. The patients he'd saved.
None of that felt like faking. It felt like... doing his job. Being himself.
"Bailey said she's getting there. With forgiving me."
"That's huge."
"It is. But it's also slow. I keep wanting everyone to just... be okay with me. To forgive me and move on. But that's not how it works."
"No, it's not. Forgiveness isn't a switch. It's a process." Vanessa took his hand. "But people are processing. Bailey's getting there. Derek trusts you professionally. Alex is your friend. Your residents respect you. That's progress, George."
"What about Meredith? Cristina? Callie?"
"They're processing too. At their own pace. You can't control that. All you can control is showing up, doing good work, and being the person you want to be." Vanessa squeezed his hand. "And you're doing that. Every single day."
George pulled her close, rested his forehead against hers. "I love you."
"I love you too."
They finished dinner, cleaned up, and settled on the couch to watch mindless TV. George's phone buzzed periodically—texts from his residents asking questions, updates from the ICU on his post-op patients, a message from Alex confirming next week's beer at Joe's.
Normal. This was becoming normal.
At 10 PM, George did his PT stretches while Vanessa got ready for bed. His right leg was sore from standing for hours in surgery, but the stretches helped. The routine helped.
In bed, Vanessa curled against him, her head on his chest.
"Two weeks down," she murmured sleepily. "Twenty-two more to go."
"Twenty-two weeks until probation ends. But the rebuilding? That's going to take longer."
"I know. But you're doing it. One day at a time."
George closed his eyes, feeling the weight of the day settle over him.
Positive probation report. Derek's trust. Bailey's slow forgiveness. His residents' respect. Patients saved.
Progress.
Slow, incremental, sometimes frustratingly slow progress.
But progress nonetheless.
George fell asleep with Vanessa in his arms, his mind quiet for once, his body exhausted but satisfied.
Tomorrow he'd wake up and do it all again.
Because that's what surgeons did.
They showed up. They did the work. They saved lives.
And slowly, gradually, they rebuilt what had been broken.
One surgery at a time.
One day at a time.
One small victory at a time.
[END CHAPTER 21]
patreon.com/Twilightsky588 - completed with 75 chapters/460 000 WORDS