Chapter 1: First Day
The face in the mirror was a stranger's.
George O'Malley stared at the reflection—sharp jawline, high cheekbones, eyes that were the wrong shade of blue-grey—and felt his stomach drop the way it had every morning for two years. He'd looked at this face a thousand times. Studied it. Memorized it. It still didn't feel like his.
This is what half a billion dollars in reconstructive surgery looks like.
He forced himself to look away, focusing instead on the simple act of knotting his tie. Navy blue. Professional. The kind of thing an attending trauma surgeon would wear on his first day at a new hospital. His fingers remembered the movements even if they looked wrong—longer now, the scars from the accident faded to thin white lines across his knuckles.
The apartment Vanessa had arranged was nice. Too nice. Floor-to-ceiling windows overlooking Elliott Bay, hardwood floors, a kitchen he'd never use. It looked like the kind of place Dr. Derek Shepherd would live, not George O'Malley.
Except George O'Malley was dead.
He'd seen his own memorial. Vanessa had shown him the photos during his recovery, thinking it would help with "closure." There'd been a bench dedicated to him in the hospital courtyard. A plaque with his name misspelled—O'Mally instead of O'Malley, because of course they'd gotten it wrong even in death. Meredith had cried. Cristina had looked angry. Bailey had stood apart from everyone else, her face composed in that way that meant she was breaking inside.
George picked up his hospital ID badge from the dresser. The photo was recent, taken last week at the Chen Foundation's request. Dr. Gideon Matthews stared back at him with a confident smile George had practiced in the mirror.
Liar.
His phone buzzed. Vanessa.
Good luck today. You're going to be amazing. Call me after your shift?
He typed back quickly: Will do. Thanks for everything.
Three dots appeared, disappeared, appeared again. Finally: Stop thanking me. You saved my life. I'm just returning the favor.
George pocketed the phone and grabbed his keys. If he thought about Vanessa too long, about everything she'd done—the surgeries, the rehabilitation, the falsified credentials that would get him fired if anyone ever looked too closely—he'd lose his nerve entirely.
The drive to Seattle Grace was muscle memory. He'd made this trip hundreds of times as a resident, usually exhausted, often terrified, occasionally triumphant. The building looked the same from the outside. They'd merged with Mercy West two years ago, but the original structure remained, all glass and steel and the weight of every mistake he'd ever made within those walls.
He parked in the attending lot. That was new. George O'Malley had never parked here, had barely been allowed to dream about it.
Stop thinking of yourself in third person. You're not dead. You're just... different.
The automatic doors slid open and the smell hit him immediately—antiseptic, floor cleaner, that indefinable hospital scent that was part cafeteria food and part human suffering. George inhaled deeply and felt something in his chest unclench. This, at least, was familiar. This was home.
"Dr. Matthews?"
He turned to find Miranda Bailey standing five feet away, clipboard in hand, eyes sharp as scalpels. George's heart stopped.
She was looking right at him and she didn't know. Didn't recognize the resident she'd trained, terrorized, and transformed into a surgeon. The woman who'd called him "O'Malley" with such exasperation and affection was staring at a stranger.
"Dr. Bailey." He extended his hand, grateful his voice came out steady. "It's good to meet you."
Her handshake was firm. "Chief Shepherd speaks highly of you. Trauma surgery, correct?"
"Yes, ma'am."
Something flickered across her face—surprise? Recognition? But it was gone before George could identify it. "Don't 'ma'am' me. I'm not that old." She consulted her clipboard. "You're observing in the ER today, getting familiar with our protocols. Tomorrow you'll take your first solo trauma. Chief wants you eased in gently."
"I appreciate that."
Bailey's eyes narrowed slightly, studying his face with an intensity that made George want to run. "You seem nervous, Dr. Matthews."
"First day jitters," he lied.
"Hm." She didn't sound convinced. "Well, come on. I'll introduce you to the other attendings before morning rounds."
George followed her through corridors he could navigate blindfolded. They'd repainted—a warmer cream instead of institutional white—but the layout was identical. Elevator bank on the left. Nurses' station around the corner. The supply closet where he'd hidden after his first failed intubation was still there, probably still smelling like bleach and shame.
"You trained at Johns Hopkins?" Bailey asked as they walked.
"Yes." The lie tasted like copper. "Finished my residency there, did a fellowship in advanced trauma."
"Why Seattle?"
Because I died here. Because everyone I love is here. Because I'm an idiot who can't let go.
"The program's reputation," George said. "And I wanted to work with Dr. Shepherd. His neuro-trauma collaboration is groundbreaking."
Bailey made a noncommittal sound. They rounded the corner and George saw them.
Meredith Grey stood at the nurses' station, blonde hair pulled back, reading a chart with the intense focus she brought to everything. She'd lost weight. There were shadows under her eyes that hadn't been there before. Next to her, Cristina Yang was arguing with an intern about something, her voice carrying that edge of controlled impatience that meant she'd already explained this twice and wasn't planning on a third time.
George's feet stopped moving.
"Dr. Matthews?" Bailey turned back.
He forced himself forward. One step. Another. Meredith looked up from her chart and her eyes—those eyes that had seen him at his worst, his best, his most pathetic—met his.
Nothing. No recognition. Just polite professional interest.
"Dr. Grey, Dr. Yang," Bailey said briskly. "This is Dr. Gideon Matthews, our new trauma attending. He'll be observing today."
Meredith smiled. It was her public smile, the one she used for strangers. "Welcome to Seattle Grace."
"Thank you." George managed to keep his voice level. "I've heard great things about the general surgery program here."
"Don't let Cristina hear you compliment her," Meredith said. "Her ego's barely contained as it is."
Cristina didn't look up from berating the intern. "I heard that, Grey."
"You were supposed to."
It was so painfully familiar—their dynamic, the easy banter, the friendship that had survived everything including his death—that George felt something crack in his chest.
"Dr. Matthews looks confused," Cristina said, finally turning to face him. She studied him with dark, assessing eyes. "We're not always this unprofessional. Sometimes we wait until the attendings are out of earshot."
Bailey snorted. "I'm standing right here, Yang."
"I know."
George found himself smiling despite everything. This was Cristina—brilliant, blunt, completely unbothered by authority. She'd mourned him too, in her way. He'd seen the photos, Cristina standing alone in the gallery during his memorial service, watching the proceedings like an observer at someone else's grief.
"I'll leave you to it," Bailey said. "Dr. Matthews, report to the ER in twenty minutes. Dr. Yang, your appendectomy patient in 2408 needs post-op checks. Dr. Grey, try not to let your interns kill anyone today."
She walked away, and George was left standing with two of his closest friends who had no idea who he was.
"So," Meredith said, and there was curiosity in her eyes now. "Johns Hopkins? That's impressive."
"It was... educational." Stop talking like this is a job interview.
"What made you specialize in trauma?" Cristina asked. She'd moved closer, and George resisted the urge to step back. Cristina had always been observant, had always seen things other people missed.
"I wanted to help people at their worst moment," George said, which was true. "Make a difference when it matters most."
Something in Meredith's expression softened. "That's... that's a good reason."
An intern rushed past, nearly colliding with George. "Sorry! Sorry, Dr.— Oh, you're new."
"Dr. Matthews," George supplied.
The intern—young, female, terrified—nodded rapidly. "Right. Sorry. There's a trauma coming in, ETA two minutes. Multi-vehicle collision on I-5."
Cristina's eyes lit up. "How many?"
"Four. Two critical."
She was already moving toward the elevator. "You coming, new guy? Or are you just here to look pretty?"
George followed, Meredith falling into step beside him. "Don't mind her. She gets excited about trauma."
"I gathered."
They rode the elevator down in silence. George could feel Meredith watching him, and he kept his eyes fixed on the floor numbers ticking down. Three. Two. One.
Please don't recognize me. Please don't recognize me. Please—
The doors opened and they were hit with controlled chaos. The ER was exactly as George remembered—organized pandemonium, nurses moving with purpose, residents shouting updates, the distant sound of someone crying in one of the exam rooms.
"Dr. Matthews!" A nurse—new, George didn't recognize her—waved him over. "You're observing, right? Dr. Hunt wants you in Trauma One."
Owen Hunt. George's chest tightened. Owen had been there, at the end. Had tried to save the unsaveable, had identified George's body through military-grade dogtags and sheer determination when the face was too destroyed to recognize.
He made his way to Trauma One and found Owen already gowned up, barking orders at a resident George didn't know. Owen looked older, harder. The war had always been written on his face, but now there was something else—a weariness that went bone-deep.
"Dr. Matthews." Owen's handshake was crushing. "Glad to have you. You're just observing today, but I want your input. Hopkins has a solid trauma program."
"Happy to help however I can."
The ambulance sirens were getting louder. Owen moved to the bay doors. "Thirty-two-year-old male, driver of the first vehicle. Blunt force trauma to the chest and abdomen, GCS of 11, BP 90 over 60 and dropping. Second patient is a teenage girl, passenger, lower extremity trauma."
The doors burst open and the chaos became focused. George stepped back, letting the team work, but his eyes tracked every movement. The resident intubating wasn't being aggressive enough with the blade. The nurse on compressions was in the wrong position. Owen was trying to control the abdominal bleed while simultaneously managing the airway.
"He's crashing," the resident announced, voice climbing toward panic.
"I can see that, Brooks," Owen snapped. "Get me two units of O-neg and prep the OR. We need to open him up now."
George watched the resident fumble with the intubation, saw the oxygen stats dropping, and his hands twitched. He knew exactly what needed to happen, could see the three steps that would save this patient's life, but he was supposed to be observing.
You're an attending now. Act like it.
"Dr. Hunt," George said quietly. "The airway's compromised. Brooks needs to adjust the angle."
Owen's eyes met his for a split second, assessing. Then he nodded. "Brooks, adjust your angle. Tilt the head back more."
The resident complied and the tube slid home. The oxygen stats began to climb.
"Good catch," Owen said.
The patient stabilized enough for transport and they rushed him to the OR. George stayed behind, stripping off the gloves he'd donned by habit. The second patient was being handled by Callie Torres—he could hear her voice from the next bay, steady and competent as she assessed the leg injuries.
Callie. His ex-wife. The woman he'd married in Vegas, divorced amicably, and left behind when he died.
He couldn't face her. Not yet.
George found himself walking toward the surgical wing, muscle memory guiding him to the gallery. He needed to see this through, needed to know if the patient lived. It was what George O'Malley would have done.
The gallery was empty. He took a seat in the back row and watched Owen work through the glass. It was textbook trauma surgery—fast, efficient, no wasted movement. Owen controlled the bleeding, repaired the liver laceration, checked for additional injuries. A senior resident assisted, clearly competent but not at Owen's level.
The door to the gallery opened. Meredith slipped in, still in her scrubs, and took a seat a few rows ahead of George. She didn't notice him at first, too focused on the surgery below.
George should have left. Should have made an excuse and gotten out before—
"It's beautiful, isn't it?" Meredith said softly, not turning around.
He froze. "What?"
"The surgery. The way he just... knows what to do. It's like watching an artist." She finally glanced back and seemed surprised to see him. "Oh. Dr. Matthews. I didn't realize you were here."
"I wanted to follow up on the case."
Meredith nodded and turned back to the glass. "Owen's one of the best. Trauma's not my specialty, but I can appreciate the skill."
They sat in silence for a moment. Down below, Owen was closing.
"He's going to make it," George said.
"You sound certain."
"The injuries were survivable if treated quickly. Dr. Hunt didn't waste any time."
Meredith smiled, and this time it was real. "You really do love trauma."
"It's where I feel most useful."
She studied him with those too-perceptive eyes. "Can I ask you something?"
George's throat went dry. "Of course."
"Have we met before? You seem... familiar somehow."
No. No no no no—
"I don't think so," George said carefully. "I would have remembered."
Meredith laughed. "That's either very smooth or very creepy, Dr. Matthews."
"Gideon," he said, because George O'Malley would have been awkward and self-deprecating, and he needed to be different. "And I meant it as a compliment. You seem like someone worth remembering."
Her cheeks colored slightly. "Now I'm certain you're being smooth."
Down in the OR, Owen was finishing the last suture. The patient's vitals were stable. George felt the familiar satisfaction of a life saved, a death prevented.
"I should get back," Meredith said, standing. "But it was nice talking to you, Gideon. If you need someone to show you around the hospital, let me know. I've been here long enough to know where all the good hiding spots are."
"Hiding spots?"
"For when you need a moment to breathe. This place can be overwhelming, even for attendings." She paused at the door. "We lost someone a couple years ago. One of our own. He was... he was really good at finding quiet spaces when things got too intense. I think you'd have liked him."
George's heart was hammering so hard he was sure she could hear it. "What happened to him?"
Meredith's smile faded. "He saved someone's life. Pushed them out of the way of a bus. He died a hero, but..." She shook her head. "He should have just been alive. We'd have preferred that."
"I'm sorry."
"Yeah. Me too." She opened the door, then looked back. "George—he was our friend. His name was George O'Malley, and he deserved better than dying alone on a street."
The door closed behind her.
George sat in the empty gallery for a long time, watching the OR team clean up below, and tried to remember how to breathe.
She misses you. They all miss you. And you're going to lie to them anyway.
His phone buzzed. Bailey, summoning him for afternoon rounds. George stood, straightened his tie, and put the mask back on. Dr. Gideon Matthews. Confident. Competent. Completely fictional.
The afternoon passed in a blur of introductions and hospital protocols. He met Derek Shepherd—who was warm and welcoming and showed no sign of recognizing the resident he'd once called 007. He ran into Alex Karev in the hallway—Alex barely looked at him, just nodded and kept walking, absorbed in his peds case. He saw Callie from a distance in the cafeteria and immediately changed directions.
By the time his shift ended at six, George was exhausted in a way that had nothing to do with medicine. He made it to his car, collapsed in the driver's seat, and stared at the hospital through the windshield.
I'm home, he thought. And I've never been more alone.
His phone rang. Vanessa.
"Hey," he answered.
"How was it?" Her voice was gentle, like she already knew the answer.
"It was... hard."
"Did anyone recognize you?"
"No. I'm a complete stranger to them."
Silence on the other end. Then: "Do you regret coming back?"
Did he? George looked at the hospital, at the lit windows where somewhere inside, Meredith was probably finishing her charts. Cristina was likely terrorizing an intern. Bailey was making sure everyone knew she was watching. Owen was checking on his trauma patient. Derek was doing whatever god-like neurosurgeon things he did.
His people. His hospital. His life.
Even if they didn't know it.
"No," George said quietly. "I don't regret it."
"Good. Because you're a brilliant surgeon, Gideon, and they're lucky to have you. Even if they don't know who you really are."
Who I really am. If only I knew that myself.
"Thanks, Vanessa."
"Come over for dinner? I made too much pasta and I hate eating alone."
He should say no. Should go home, process the day, build better walls. But Vanessa was the only person in the world who knew the truth, and God, he needed someone to know.
"I'll be there in twenty minutes."
"Perfect. Drive safe."
George started the car and pulled out of the parking lot, watching Seattle Grace disappear in his rearview mirror. Tomorrow he'd do it again. Walk into that hospital, lie to the people he loved, and try to remember what it felt like to be someone real.
Tomorrow he'd be Dr. Gideon Matthews, confident trauma attending.
Tonight, just for a few hours, he could be George.
Even if only one person in the world would call him by that name.
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