1. Mortality

“Dr. Cullen, you have to call it.”

I looked up from the patient under my hands into my colleague’s eyes. Dr. Rosales was staring back at me, her expression sad but firm. I drew a deep breath which brought with it a number of scents: the saltiness of the patient’s blood; the cloying nitrous oxide flowing through the oxygen mask; the pungent iodine; the dead tissue of the suture thread. This was the part of my job I loathed, the part I would childishly avoid whenever possible, leaving a patient on a ventilator for four extra hours until the next physician’s shift. Let him do it. Every doctor said they hated it, every doctor said they got into medicine to avoid it, but they all dealt with it. Of course, no one knew the real reason why I had this particular aversion; why I hated this moment more than any doctor who’d ever walked the earth before me. It was the very antithesis of my entire purpose. No one could possibly hate it as much as I.

Exhaling, I yanked my mask down and checked the clock overhead.

“Time of death, one twenty-seven A.M.,” I announced quietly, and beckoned to the two interns who were assisting. “Dr. Taylor, Dr. Merrick, close him up, please.”

“Yes, Dr. Cullen.” The two moved in on the body like a pair of carrion birds, eager for a chance to make the unnecessary sutures that would seal the incisions for the undertaker’s convenience. Cayuga Medical Center wasn’t the flagship teaching hospital in the area—those were down in Manhattan—but we had our share of new doctors to educate. Most of the time I found it useful, as you could leave interns to do things like sutures while you spent your time caring for patients in more serious condition. But days like today I wished they weren’t around. What I really needed was a little privacy, the ability to clear my head for a moment before running back into the crush of the hospital. Closing this patient myself would have afforded me that.

Instead I found myself before the scrub sink, stripping out of my gloves and gown and washing my hands. Dr. Rosales was beside me at the sink, the olive color of her arms obscured by the white lather.

“You okay, Carlisle?” she asked as I bent to take off my shoe covers.

“Yes,” I answered. “I’m fine. Just” —how did I put this?— “having a bad day is all. You just don’t need a surgery like that when everything else is going wrong. I had to call a code this evening on a patient I’ve been treating for a week, and—” I stopped. And these days was always one thing: Edward. I couldn’t stop myself from thinking about him, worrying about him. I wished that I had a human brain capacity so that it would be possible to use work to actually distract myself from the despair that shrouded my home. As it was, I simply added my concern for my patients to the deep anxiety already gnawing at my core. I ripped off my surgical cap and ran a hand through my hair. “I could use a cup of coffee,” I added lightly.

Dr. Rosales nodded, my answer satisfying her concern—I was merely tired, like every other doctor in the universe. I had not yet mentioned Edward’s condition to her or anyone else at the hospital; I knew what would come of it. Back when I’d begun practicing medicine, there was no thought that there might be a biological basis to anything emotional. Now selective serotonin reuptake inhibitors were prescribed like candy—for sleeplessness, for anxiety, even for shyness, in addition to the debilitating depression for which they were originally intended. Given the slightest indication of Edward’s melancholic state, an SSRI would be what they all would suggest. And then how was I to explain that my son had no serotonin?

We both donned our white coats and exited the operating theater together. “You doing the family, or am I?” she asked quietly.

“I’ll get it,” I answered. As much as I despised allowing a patient to expire on my watch, talking to the family was always something I could handle. I envied them, humans, with their full range of emotional expression. If only Edward were able to cry, perhaps he would be able to cope with Bella’s absence. Although of course if Edward were human, none of this would have existed in the first place—we’d never have left Forks, he’d have taken Bella to senior prom, they would graduate and go to college just like every other high school couple we knew.

For the four-hundred sixty-seventh time since we’d arrived in Ithaca (I’d been keeping track) I considered again that I had perhaps made a mistake in allowing Edward to demand that we relocate. I had promised him that we would, six months ago, when he’d been in danger of possibly biting her. We’ll come with you, of course. You only have to ask. They won’t begrudge you this, I’d told him then. But then it had all changed or rather, Edward had been changed. And after we’d dealt with the threat of James, the ensuing months had been glorious. Edward, my normally brooding son, had exuded so much joy that Jasper hung at Edward’s side any minute he wasn’t with Alice, basking in his brother’s emotions. It had been good for us all.

Edward had forgiven Jasper for the incident at the party—offered him sincere forgiveness, beyond a shadow of a doubt. But of course, Edward was completely incapable of extending that same forgiveness to himself. No matter what any of us said, including Bella, he couldn’t let go of the notion that he was personally and solely responsible for her danger. No amount of pleading from me could convince him to stay in Forks, and so I’d acceded to his will. The very moment that my mind had first formed the words my son to describe Edward, I’d promised myself that I would never force him to do anything. I had taken away any choice he might have about whether to live or die—I would never take another choice from him for the rest of time. He’d probed my thoughts, and I’d fervently imagined how utterly torn to pieces I would be if I ever left Esme. But the image of my brokenness hadn’t stopped him—if anything, it had only strengthened his resolve. He was more than willing to suffer so that she wouldn’t be subject to the dangers he perceived. And she was human, she would forget him.

At least, we both hoped to God she would. This was the last thing gnawing at me—Bella Swan was no vampire, despite her continued demands to join us. Yet her bond to Edward seemed every bit as irrevocable as his to her. I hoped it was not. I hoped that Bella would vent loudly to one of the girls from school, that they would draw Edward’s face and throw darts at it (he unfortunately hadn’t left her any photos to destroy for catharsis), that she’d listen to terrible melancholy pop music and cry for hours and then finally, angrily, decide her life was better off without Edward Cullen.

But I couldn’t ignore my suspicion that across the country I had my mirror in Charlie Swan: that he, too, was watching his child live each day in agony, powerless to do anything to help.

I was still considering all of this when I rounded the corner into the surgical waiting area. I had nearly forgotten how young my patient was, but as I saw his family, I felt a stabbing pain in my gut. His parents were young—maybe in their late forties. I pulled up the memory of his chart in my mind, visualizing myself flipping the page, getting the boy’s statistics. Justin Moeller, 22 years old. He’d laid down a motorcycle at seventy miles per hour, shredding his body and sustaining third-degree burns from the bike’s exhaust system. We couldn’t stop the hemorrhaging; he’d bled out under my hands.

The woman looked up as I approached. Her eyes were already bloodshot from crying. I could almost see her appraising my clean appearance, my white coat over my scrubs. I watched her register the fact that I was clearly not returning to the operating room. Her lower lip quivered, and then her mouth yawed wide as she began to wail. Her husband took her in his arms and looked up to me to confirm his wife’s reaction.

I nodded. “I am so sorry,” I said quietly. “We did everything for Justin that we could. I am so very sorry.”

It would be a lie to say that saying these words didn’t affect me; how could they not, when what I strove for more than anything was to atone for the sins of my kind through this work that I was called to do? But I was always careful to insulate myself from the pain of my patients’ families. I didn’t have to worry about Edward falling off a motorcycle. My children were all but indestructible. And yet somehow, in the wet eyes of Justin Moeller’s father, I saw the reflection of my own grief, and the thing pulling inside me finally snapped. It frightened me. My son could not die. What on earth was I channeling that made me feel that I had something in common with this man?

The boy’s mother looked at me. “Can we see him?”

I nodded. “One of the assisting doctors will be out in just a moment and they will take you to him. In the meantime, may I send a counselor to you?” Like most of the hospitals now, CMC had a full cohort of grief specialists, who were supposed to be called upon by the doctors.

This remark just made the woman cry harder, but her husband nodded, mouthing Thank you. I nodded.

“Is there anything else I can do for you?”

The woman shook her head, but the man caught me with a hard gaze.

“Do you have children, Dr.—”

“Cullen,” I supplied. “Carlisle Cullen. And yes, I do.” How did he know what I was thinking?

He shook his head, his eyes flooding over. “Take care of them,” he said, his voice shaking. “Just—take care of them.” His composure broke, and it took everything I had not to break down there with him. Instead, I merely nodded, swallowing deeply.

“I am sorry,” I whispered again. He nodded.

My feet felt strangely unsteady as I moved toward the nurses’ station and away from my patient’s family. I requested the grief counselor, and the nurse, one whose name I did not know, called the psychiatric floor after trying to give me the most seductive look she could manage. Disgusted at being hit on when I was so worried about my family, I made a deliberate show of the splayed fingers on my left hand as I thanked her. I could depend on my wedding ring to stop those few that didn’t pay attention to their gut reaction to the unnaturalness of my being. Sure enough, the nurse looked the other way.

Stealing one last glance at the family in the waiting room, I crossed the hallway to the back stairwell. My office was upstairs. As I crossed the hall I listened for anyone who might be coming my way—the din of a modern hospital was incredible. I heard the squeaks of dozens of non-slip nurses’ shoes across the linoleum tiles. The creak of the doors separating wards from each others. Conversations overlapping each other, whispered, spoken, shouted. A doctor in one of the operating theaters, asking for a scalpel. I could zero in on any of these to distract myself, but I found I couldn’t get my mind to focus. Seeing the utter torture in the eyes of my patient’s parents had unhinged something within me, and I could only think on one thing: I had to know how Edward was. Now.

Ascending the stairs at a human’s pace was agonizing, but I never knew when someone might burst into the stairwell. My office was, as usual, dark—the hospital had chosen red and grey for its colors, and so my office was decorated in a dark charcoal and burgundy that made it foreboding. Esme had softened the décor a little by adding several lamps (this was also to offset the shades which were drawn on every sunny day), and I complemented her work by hanging two large black-and-white sketches from my collection. They thankfully were never recognized for what they were, as Aro had acquired them directly from da Vinci well before the man’s work was recognized for the genius it was. Aro was quite fond of me even though he found my lifestyle perplexing, and he had sent the art to my home in Massachusetts about forty years after I had come to the New World. It was a much appreciated gift, and I’d always kept them nearby—they had hung in my bedroom in Forks.

I closed the door and in the same instant was across the room at my desk, listening to the sound of the telephone as I waited for my wife to pick up. She reached the phone in our house halfway through its first ring.

“Alice said you’d be calling.” No hello. I didn’t care.

“And?” I didn’t need to say anything else. Alice would have seen everything—my patient’s death, my conversation with his father, my reason for calling Esme. But Alice or no, nothing could have prepared me for the heartrending plea of her response:

“Carlisle, he needs you. Please come home.”

Chapter Notes


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