Author's Note: I'm extremely sorry for the prolonged absence. I'm back, though, and you should begin to see updates on the multi-chapter pieces with some sort of regularity. :) Thanks for your patience!

SELFISH

and my heart gets no rest over you

He still wants her.

It's been a year since he walked these halls with Meredith, catching whiffs of Izzie and trying to guide the jaded roommate back to a life of oddly solid friendships and everlasting, angst-ridden love. A year since he closed his eyes and smiled into the ceiling and praised the notion of moments with the ones you love.

Now, as his nonexistent shoes make nonexistent squeaks on the tiled floor, he shoves his hands in his pockets and scowls, because it was all bullshit. Every last bit of it. Whiffs of Izzie are not enough.

Moments with Izzie are not enough.

He wanted the lifetime. The wedding, with the white dress and the fifty-thousand dollar flowers and the cake that Izzie would have baked, layer by layer, over the course of a particularly grueling week at work. The marriage, with the honeymoon and the slow move from Meredith's Intern Inn to a house outside of the city where he could enjoy being a man again and Izzie could enjoy being a woman. A wife.

He knows that she would never have been satisfied to sit back and let him support her--financially or otherwise. Even in her anguish, her stubborn streaks are present, and her fierce independence still surfaces in ways that make him smile.

Sometimes, he wishes he could've seen her face when she first found the eight-point-seven million dollar check. Wishes he could've been present for the fight that would've surely transpired had his death not loomed over them like a fog.

Even in the wee hours of the morning, when his heart was weak and his lungs were sore and he was sick and tired of being sick and tired, he loved fighting with Izzie. He thinks that their life together would've been full of the jovial bickering he so enjoyed.

He wonders if their death together will be.

He imagines touching her. Imagines provoking her with the charming, witty repartee that was immediately his trademark. Imagines sharing yet another moment in which he's intoxicated by her presence and she's irritated by his need to turn everything into a joke.

He lifts his chin and smiles at the thought of an eternity with Izzie.

He knows he'll get his wish.

He wonders if she knows. He wonders if she understands why he's suddenly everywhere, why she can't burn or drink him away.

He wonders if she'll put up a fight when she realizes what's really going on. A part of him hopes so--she is, after all, at her prettiest when angry. But the bigger part of him--the part of him that remembers the gentle clicks of her knitting needles in the wee hours of the morning--hopes that she'll be glad. That she'll see the same potential for fullfillment that he sees.

He sees the way she looks at Alex Karev, and his heart seizes in fear, because even as the sadness lingers in her soft brown eyes, she still looks...happy, almost. Like she's finally found the strength to move on and the man who can help her accomplish the task.

He wonders if she'll spend death shedding tears for Karev like she's spent her life shedding tears for him.

He hopes not.

xxxxxxxxxxxxxxx

They spend hours bickering about the reality of his existence. She considers every option--hallucinations, projections, psychosis. Residual grief. A haunting.

Karma.

He cannot tell her the truth. Instead, he asks her to touch him. Begs.

She obliges. Her fingers brush the cold, taut skin of his pectorals. She smoothes the hair on his chest until she palms his shoulder blades, gasping in confusion and surprise and what he hopes--believes--is relief.

Then she kisses him, and his world is on fire.

Trees that once stood bare and dormant are suddenly ablaze. His blackened sky is suddenly alight with purple and blue and gold. He can feel his nonexistent heart beating solidly against his nonexistent ribcage as his blood runs warmly through.

She breaks the kiss only to remove her shirt, and heat pulses along his lower half as his hands find her breasts.

They stumble backwards until they are both naked and he is filling her, thrusting deep into her core as her soft, pink lips whisper his name. He buries his face in the blonde locks at the base of her neck, and stars explode behind his eyelids as she trembles violently beneath him.

He collapses beside her and pulls her close. She rests her head on his chest, and as her cheek and chin fill his empty spaces, he thinks, finally. Everything is how it should be.

He has no idea how long they lie, side-by-side and spent, before her voice breaks the silence.

"I can hear your heart beating."

The ghost of a smile lingers on his lips, because he can hear it, too.

It only beats for you.

The words are on the tip of his tongue, but she speaks again before he can give them breath.

"Which is odd, because they took it out for the autopsy."

His world begins to shake in time with the gentle tremor in her voice. Her doubt skates along the spaces in his chest; a cold wind that threatens his post-coital cocoon of warmth.

Her lower lip trembles, and an icy tear lands on his shoulder blade as she looks anywhere but him. "This isn't real, is it?"

He seizes her hand as fear seizes his newly beating heart. "This is real," he counters, his voice an urgent murmur. "Feeling this is real."

She begins to mutter hysterically, something about dreams and the morning after and the haze that is always broken so cruelly by the entrance of reality.

He knows he should listen, knows he should be taking notes so he can ease her fears, but he can only hear the steady thump of his heart against his ribcage.

She takes a slow, shuddering breath, and he pulls her closer to shield her from the cold. Her skin is slick against his, but he cannot remember the last time he has felt this warm.

"I'm just going to keep my eyes closed," she whispers into his neck.

Her eyelashes tickle the soft spot behind his ear, and he smiles, because he knows that nothing has ever been as real to him as this moment. "Okay."

xxxxxxxxxxxxxxx

They spend the whole day in bed together. He leaves his fingerprints everywhere--along her collar bone, across her breasts, down her sides. At long last, his palms find purchase on either side of her hips, and she screams his name again and again and again. The word echoes along the walls of the empty house.

They are perfect, sated, full, and together until the vibrations of her pager begin to mingle with her moans.

The pager buzzes from the table to the floor, and she leaves his side briefly to retrieve it.

She doesn't return. Instead, she runs a frantic hand through her newly shorn locks and begins stumbling around the room in search of her clothing.

"Shit," she mutters from the closet. "Shit, shit, shit..."

His stomach churns violently. "What?"

"9-1-1," she answers tersely, this time from the window. "I have to go."

He inhales sharply. "You don't have to go," he volleys, trying to keep his voice light. "You could always toss the pager out the window and come back to bed with me."

He expects her to be angry. Expects her to whirl around and shoot daggers with her eyes as she explains the importance of her job. Expects her to reprimand him, to admonish him for acting like a boy when she's trying to be a surgeon.

He does not expect the tears that are streaming down her face when she finally meets his gaze.

"Why?" she yells. Despite the increase in volume, it still sounds more like a plea than a tantrum. "Why did you come back? I had moved on! I got over you." She begins shaking her head incredulously as her eyes stray guiltily from the soiled bedclothes to the locked bedroom door. "I have a life and a job and a boyfriend, and now you're back and I'm in this room, all day, probably talking to myself. I'm probably going crazy and there is a real world out there and I'm stuck in here with you!"

He wants to tell her everything. That the real world isn't forever, and all of these things that she has are temporary. Lives and jobs and boyfriends--they all have a shelf life. He knows that now.

He knows that she will be stuck with him forever.

He wonders if they will spend their eternity having mind-blowing sex. He hopes so.

She is still staring at him expectantly, so he makes his face a mask and sits up cautiously. "Sorry I died."

He means it as a joke. Because right here, right now, he is not sorry at all.

Her eyes narrow to mere slits, and he thinks she has never looked more beautiful.

"No," she shouts, "screw you. You don't get to apologize for dying. Not when..."

Her voice falls to a whisper, and her eyes flutter shut. "Not when I killed you," she manages to gasp, her voice soft and strained.

He wants to reach out to her, wants to give her a hand to hold and a shoulder to sob into, but instead he reaches up and places two fingers against his chest. Immediately, the tips of his fingers begin to pulse.

"Izzie," he murmurs, a soft smile on his rugged face. "You didn't kill me. You brought me back to life."

xxxxxxxxxxxxxxx

They make love everywhere. On-call rooms, supply closets, shower stalls. Her bed.

It gets better every time.

She opens her eyes after a particularly earth-shattering orgasm, her lips parted in surprise and her eyes glittering with unshed tears. When she speaks, her voice is soft and breathless.

"You're really not going anywhere, are you?"

He smiles broadly and runs rough fingers through her hair.

"I'm really not going anywhere."

He tells himself that the look on her face is not one of disappointment.

xxxxxxxxxxxxxxx

She begins to ignore him.

She no longer slips into on-call rooms to slide her fingers under his shirt. Instead, she slips into the library and slides her fingers between the pages of a textbook. She reads charts in the hallways and begs Bailey for extra time in the OR and refuses to sleep until she cannot stand without swaying.

At first, he taunts her. Teases her. It worked at the beginning of their courtship; he is more than positive that it will work now.

Days pass. Weeks go by.

His gentle ribbing grows solemn. He tries begging. Pleading.

She slams her textbook shut and retreats to the gallery where distraction is imminent.

Later that night, while she is brushing her teeth, he slides two strong arms around her waist and buries his nose in her hair.

His lips find her crown, and the brushing ceases.

"Stop," she whispers.

"I can't," he tells her honestly.

Her jaw tightens noticeably. "Yeah? Well, I can."

She slips into the hallway and slides her hands along the closest doorframe.

He flinches noticeably as the fingers of her right hand curl into a fist. "You wouldn't," he mutters darkly.

She raises her chin defiantly and knocks. Once. Twice. Three times.

"Alex?" she murmurs softly into the crack, "it's Izzie."

"Iz?" comes the muffled response. "It's two in the morning."

"I know," she replies, sounding almost ashamed. "I just...I can't sleep. I..." She trails off and sucks in a deep, shaking breath, and when she speaks again, the sincerity in her voice makes his blood run cold. "Alex, I think there's something wrong with me."

In a moment, the door is open, and Alex Karev is rubbing sleep from his eyes.

"What?"

His heart beats wildly against his chest as Alex reaches out to touch Izzie's cheek. No, he wants to say. She's mine.

And maybe she isn't yet, but she will be soon enough.

"You don't have a fever," Alex mutters, but there's a tenderness in Alex's voice that he has never heard before.

He hates it.

"Not something medical," Izzie sighs. "Something...something mental." She closes her eyes, and her features contort in pain. "Look, I know I promised you that you were done with crazy, but..."

Alex silences her with a rough kiss that makes his blood boil. Mine.

"And I told you I wasn't going anywhere," Alex interrupts pointedly. "What's wrong?"

Izzie glances fearfully in his direction and, for the first time since the L-VAD wires and the transplant and the mess of beeping machinery, his heart physically aches.

"I'm having hallucinations."

"Okay..." Alex nods thoughtfully. "Any headaches? Loss of vision? Loss of consciousness?"

"I..." There's real fear in her voice now, and he almost hates himself for putting it there. "I don't know."

Alex inhales sharply. "Okay, let's try a different route. What are you seeing?"

She glances at him again and, this time, there are tears in her eyes.

He wants to tell her everything. He wants their death together to start now. He wants to see her happy and carefree again. He wants her to moan his name and curl into his chest and talk about the miraculous strength of his brand new heart.

"Denny," she whispers brokenly. "I'm seeing Denny."

Alex's curious countenance crumbles as his features twist sympathetically. "Oh, Iz..."

"No," she interrupts firmly. "Don't...don't patronize me. I don't need you to be sympathetic. I just...I just need it to stop."

He tells himself she doesn't mean it. That she'll be happier when she finds out that this--them, here, together--is inevitable.

He follows them to the hospital in silence.

xxxxxxxxxxxxxxx

She endures five days of tests.

It is a long, arduous process. As the specialists begin to accumulate as quickly as Mark's conquests, he can feel his patience waning.

He knows they have forever. He just wants forever to start now.

He tries to pass the time by cracking jokes, firing insults--anything to get a rise out of her--but she refuses to look at him. When she speaks to him, it is only one word, and her voice is always an urgent whisper.

"Stop."

He tells himself it's just the fear talking as he lays a gentle hand on her shoulder.

xxxxxxxxxxxxxxx

"I'll go to therapy, Alex," she says quietly. "I swear. If this is psychological, I'll call Meredith's shrink and I'll go until it stops. I won't be Rebecca, okay? You won't find me face-down on the kitchen floor, swimming in my own blood. I will fix this."

She only talks to Alex now.

He hopes the situation is temporary. Eternity is a long time to spend in silence.

He lets out a sigh of relief when a familiar brown mane sails through the door.

"It's not psychological," Dr. Shepherd intones, his voice deep and solemn. "Dr. Stevens, the MRI indicates that you have a tumor pressing on your temporal lobe."

"A stage three glioma," Meredith adds quietly. There are tears in her eyes, but the corners of her mouth are curling ever so slightly.

"Normally," Derek continues, "the prognosis is fatal. But--as you know--Dr. Grey and I have recently completed a clinical trial wherein we determined what we believe to be a suitable treatment for this condition."

He leans back against the wall and folds his arms smugly. He knows nothing about tumors or trials, but he knows why he is here.

He knows they will fail.

"It's not a guarantee," Derek warns softly, "but it's a chance."

"It's a risky treatment," Meredith adds, "but after Beth...we have reason to believe that it could work. Essentially, we'd be injuecting a virus into..."

He watches with bated breath as Izzie seizes Alex's hand and laces their fingers together. Be patient, he coaches himself silently. In a few days, Karev won't matter anymore. None of this will.

Izzie shares a vulnerable sigh with Alex before lifting her eyes to meet her roommate's.

"How soon can I have the surgery?"

xxxxxxxxxxxxxxx

Eventually, Alex has to work, and the two of them are left alone.

He drops himself to the bed and leans casually against the headboard.

"So," he begins lightly, "do you get why I'm here now?"

"Sure," Izzie scowls. "You're a product of stray neurons and an imbalanced hormone secretion."

He inhales sharply and reaches for her hand. She jerks back immediately, and his voice hardens.

"You heard Derek, Izzie. It's a fatal tumor." He raises his eyebrows pointedly. "Fatal."

She closes her eyes and flinches. "Meredith said I had a chance."

He snorts. "Didn't Meredith once tell George that he had a chance?"

"That was different," she spits through gritted teeth.

"Not that different," he retorts. "Izzie...look, you're going to die."

And there it is.

The truth.

A lone tear struggles down her cheek as she opens her eyes to glare at him. When she speaks, her voice is a trembling, broken thing that causes all of the air to leave him.

"Why do you hate me so much?"

His eyebrows meet just above the bridge of his nose as a frown creases his brow. "I don't hate you. I just want us to be together. Don't you?"

She closes her eyes again and leans back against the pillows. Around her, machines are beeping and hissing. Outside the door, shoes are squeaking against the tile as the surgeons swap charts and patient details.

Somehow, her silence is still the loudest sound of all.

xxxxxxxxxxxxxxx

He follows the gurney to the OR and watches from the sidelines, waiting patiently for her to crash.

She doesn't.

He stares impatiently as Derek's fingers pry the skin from her skull before removing the skull flap. He takes deep, steady breaths as the pink flesh of her brain is exposed. He can feel his heartrate increase dramatically as Meredith approaches with two needles in hand. As she inserts the tubing, he looks away, shivering violently.

He wants her to die, yes, but he does not wish her pain.

It is an odd dichotomy.

His eyes return to the table just in time to see Meredith and Derek lock gazes over Izzie's exposed lobes. Their eyes sparkle warmly in the bright light of the operating room, and he cannot help but think that Izzie used to look at him with the same reverence.

He does not know if she will ever regard him with the same adoration again, but he hopes so. Forever is a long time to spend in anger.

Meredith and Derek work quickly, exchanging few words as their hands move in tandem, and he cannot help but notice that there is a rhythm, a consonance that was not there before. The medicine has evolved, and the relationship has developed, but their chemistry is ever-present. Promises have been broken and chasms have been created, but they are reaching across the distance, finding each other's fingers, and gripping tightly. They are holding on.

He moves forward and wraps his cold fingers around Izzie's limp left hand.

Much to his chagrin, the heart monitor continues to beep steadily against the silence.

xxxxxxxxxxxxxxx

She falls into a coma immediately after surgery.

Everyone stops by to see her. Alex pulls a chair next to the bed and studies with one hand in hers. George does charts at her feet. Cristina eats lunch at the window. Meredith and Derek arrive with pilfered folding chairs and check her vital signs in between games of Go Fish in hopes that some sort of progress will occur. Even Bailey makes a brief appearance, clasping Izzie's warm hand long enough to offer a few words of advice.

The tension is thick, and the spaces between their awkward conversations are deafening, but they love her, so they stay.

He knows they will lose her, but he isn't sorry. Because they may love her enough to close their eyes and pray to a God that they might not actually believe in, but he loves her more. Needs her more.

It will work out, he thinks. They will still have each other, and he will finally have Izzie.

xxxxxxxxxxxxxxx

On the third day, she opens her eyes. He leans over and places a delicate kiss on her lips, but she stares right through him.

Alex moves forward and grasps her hand. "Iz," Alex demands. "Iz, can you hear me?"

Her eyes follow the sound of Alex's voice.

He reaches for her other hand and kisses her again, harder this time. "Izzie," he whispers fervently. "Look at me. Look at me."

She coughs against the ventilation tube, and Alex slams his palm against the call button.

"Izzie." He is pleading now. "Izzie, please. Look at me."

He grasps her hand and presses it to his heart. His pulse is weak and rapid, but the throb of her veins against the pad of his thumb is strong and steady.

"She's breathing over the ventilator," Alex says behind him. "She's coughing, too. I think she's trying to extubate."

He steps backwards in anticipation as Alex and Nurse Olivia reach to remove the breathing tube.

This is it, he thinks.

The tube comes out, and she coughs. Once. Twice. Three times. For a moment, the entire room is still, and the silence is heavy with the weight of fearful anticipation.

Her chest rises, and his face falls.

Somewhere behind him, Alex lets out a whoop of joy.

"Meredith!" Alex yells into the hallway. "She's breathing on her own!"

His breath hitches in his throat as he watches her chest rise and fall in a slow, steady rhythm.

He exhales slowly.

He does not inhale again. He doesn't need to.

xxxxxxxxxxxxxxx

Her pupils are responding to light now. She can regulate her own blood pressure. She reacts violently to pain.

She opens her eyes and tracks Dr. Shepherd as he moves around the room, flashing penlights in her eyes and asking her to squeeze. Release.

He remembers releasing inside of her as her walls contracted around him. He wonders if she will ever touch him again.

"Dr Stevens," Derek calls loudly. "Izzie. Do you know where you are?"

Her voice is raw, hoarse and broken as she answers groggily. "Seattle Grace Hospital," she murmurs.

"Very good. Do you remember my name?"

"Dr. Derek Shepherd."

"Excellent. Do you remember what year it is?"

"2008."

"Yes. And who is the President?"

"George W. Bush."

"And the President Elect?"

"Barack Obama."

Every answer is like a stake through his chest.

"Can you touch my finger? Very good. Now, can you touch your nose? And back to my finger? Excellent..."

Meredith's pen moves rapidly across the chart, recording Izzie's "miraculous" progress.

He cannot help but think, as he watches her identify the characters on Derek's many flashcards, that this is not the miracle for which he'd been hoping.

"Do you know who this is?"

"Dr. Alex Karev," she answers coyly. "My boyfriend."

Derek exchanges a broad smile with the resident in question. "You're making excellent progress, Dr. Stevens," Derek concludes brightly. "The road will be long, and we will have to go in again and remove the tumor, but I expect a full recovery."

She beams, and he feels like he is dying all over again. But he is still here, and so he continues to hope that, this time, she will die with him.

xxxxxxxxxxxxxxx

She cries out in her sleep. Most nights, there are no words, just sounds. Sometimes, she speaks to figures in her dreams. Sometimes, she sits upright in bed, eyes wide and unblinking, and one of the residents has to coax her back to sleep.

Every time, he thinks she has seen him. Every time, he hopes that she is moving towards his light, that she is sitting up to enjoy one last breath and a terrified smile with her earthly companions before joining him. Forever.

Every time--no matter how much he yells, or cries, or hopes--her eyes flutter shut without meeting his gaze.

On the night before the tumor removal, she says his name.

"Denny."

He watches, fearful and motionless, as her eyes remain closed. Is she dreaming?

"I can't see you, but I think...I know you're still there."

Her words are slow and deliberate, but apprehensive, and he thinks, this. This is how a heart breaks.

"After you died, I was on the bathroom floor for...a long time. A day, almost."

His eyes flutter shut, and he can feel the cold tile against his cheek.

"It felt like years."

He feels the coarse pink taffeta against his shins, feels her hand on his chest and her soft blonde hair between his fingers.

"I thought the world was ending. I loved you so much, and I thought we were going to be happy, and..."

We are! We are going to be happy!

He screams without sound. He knows she cannot hear him. But he wants her to.

God, he wants her to.

"I know it's not your fault. I know you didn't die on purpose. I know you fought, long and hard, and...you had a life, Denny. You had a reason to fight. You had lots of reasons to fight."

He can feel her breasts against his chest, her cool hands on his shoulder and the warmth of her smile as she presented him with his first homemade sweater.

"I love you. I'll probably love you forever, but...I can't spend another night on the bathroom floor. They picked me up, and they dusted me off, and...I don't want to die young. I don't...I love you, but I...I can't. I'm sorry, but I just...can't."

She inhales shakily, and he squeezes his eyes shut against the tears in her voice.

"I guess I just want you to know that I have reasons, too. And tomorrow, if I see a light--any light--I'm running in the opposite direction."

He crawls into bed beside her and wraps his nonexistent arms around her shoulders as he buries his nonexistent nose in her neck. Because she is warm--so very warm--and, for the first time in a long time, he is cold.

xxxxxxxxxxxxxxx

She survives the second surgery.

They wheel her into a private room in the ICU, a room designated for recovery, and she sleeps.

In the morning, Dr. Shepherd returns with flashcards and a penlight. Derek asks her a series of questions, and she answers all of them tiredly, but correctly.

"Do you know why you're here?"

Her eyes meet Alex's across the room, and she sighs shakily. "I have a brain tumor. A...a stage-three glioma."

"Had."

Izzie squints at Meredith in confusion. "What?"

"Had," Meredith repeats with a grin. She shares a smile with Derek that makes him sick to his stomach. "The tumor is gone, Iz. We got it all."

Izzie's eyes are wide with fearful anticipation and, if only for a moment, he thinks, yes. She really does want me.

"You got it all?" she whimpers.

Derek winds his fingers through Meredith's before shooting a radiant smile in Izzie's direction. "We got it all," he affirms softly.

Their euphoria is loud and immediate. It permeates every inch of the silence until his head aches, but the broad, megawatt grin on Izzie's soft, feminine features is what ultimately breaks his heart.

Alex kisses her hard on the mouth, and she kisses back.

He closes his eyes against the cacophony and lowers himself onto the cold, unforgiving tile.

xxxxxxxxxxxxxxx

He spends a week on the bathroom floor.

It feels like years.

xxxxxxxxxxxxxxx

She recovers slowly. Specialists parade in and out of her room, reading charts and scanning lab reports and marveling at her miraculous recovery.

Alex is by her side the whole time. The day she is discharged, he helps her into a wheelchair and rolls her through the double glass doors. She tilts her head up and smiles into the sunshine, and when she opens her eyes, Alex's lips are on hers.

He stand in the shadows and watches with two nonexistent fingers pressed to his nonexistent left pectoral.

His chest is still.

xxxxxxxxxxxxxxx

Izzie and Alex work quickly, exchanging few words as their hands move in tandem. Occasionally, they lock gazes over the table. Their eyes sparkle warmly in the bright light of the operating room.

He does not know where things went wrong. He has no idea when the Fates changed their plans, when Cupid's arrow changed destinations.

He has lost all hope that her death is imminent, that eternity is theirs.

He still wants her, but he knows better than to belive that he will ever get his wish.

As he watches her work side-by-side with Alex, he cannot help but notice that there is a rhythm, a consonance that was not there before. The medicine has evolved, and the relationship has developed, but their chemistry is ever-present. Promises have been broken and chasms have been created, but they are reaching across the distance, finding each other's fingers, and gripping tightly. They are holding on.

He knows he will have to let her go.

He does not know how.