Doctor Carlisle Cullen leaned exhaustedly against the white semi-circle desk of the nurses' station as the hour hand hit nine o'clock and the sky fell into a seemingly never ending darkness on that humid, August night. He gripped his throbbing temples for half-a-second, desperately needing the moment to compose himself. It had been a long twelve hours and that was before the stretchers of wounded had started arriving at Los Angeles Presbyterian Hospital by the truck load.

With an exasperated sigh and a disappointed groan Carlisle had called his beautiful wife, Esme, postponing their plans for date night once again. She had been supportive as always and that's what he loved about her: the endless understanding and acceptance she supplied him with. He would definitely have to make it up to her. After about eight hours of sleep and a shower, of course.

But that would have to wait because the bodies were piling up and there was a traffic jam of stretchers blocking the ambulance bay. With a deep breath he forced himself in the direction of the chaos and quickly began triaging the patients in order of seriousness, sending those who would make it a few more hours into the ER to be examined and having others rushed up to a waiting operating room.

Carlisle had always thought medical school and residency had been the most stressful time of his life. The long hours, endless shifts, and constant bantering he received, even from the nurses, had made him question his career plans several times over the course of those years. But each time Carlisle felt the rush of the diagnosis and the thrill of saving another patient he knew why he was here. He wanted to help. He wanted to make a difference. And he couldn't help admit that he was good at it. He had been offered a job right out of medical school and now as a licensed physician he spent most of his time attending to patients in the ER.

However, tonight Doctor Compassion, as Esme like to call him when they were alone together, was running out of forced smiles and the phrase, 'everything is going to be okay' was seriously starting to sound like it had a death wish. Carlisle couldn't even force himself to choke out the simple words anymore without feeling as if he wielded a loaded gun.

The ER was testing his patience in the worst way and the problems were only just beginning. He was now running on his sixth cup of coffee (Sheila, the ER nurse supervisor, had switched him to decaf half way through his shift) and the end of this horrible night seemed to be nowhere in sight. He would have to ask Sheila to put another pot on in the break room if he had any hope of surviving this mess.

Carlisle was now expecting some of his colleagues to show up early, scratch that, he was hoping to God they showed up early, since the hospital was experiencing a high-stress emergency situation.

Carlisle had seen the horrific plan crash on the news. A passenger flight had gone down just outside of LA carrying at full capacity. The speculation right now was faulty wiring but Carlisle knew the investigation into what really brought the plane down would take months to sort through and by then the general public wouldn't care about it anymore.

Right now though, all Carlisle cared about was the fact that there were mass casualties and injuries by the dozens arriving every few minutes. He hadn't expected the ambulances to show up this quickly. They hadn't even had time to prepare, stocking the ER with supplies and clearing out less critical cases. It all kind of happened at once and the normal chaos of the ER collided with the intense scene of blood and body parts being pushed around the halls as if this was a serial killers mad house opposed to a place where people were supposed to be healed.

The ER was no longer just the emergency room, but a trauma center, separating the critically wounded from those who were stable: the living from dying, the dying from the dead.

Carlisle had never pronounced so many people dead in his life. He was sure tonight would haunt him for many years to come as the image of chalk pale skin and cold, lifeless fingers gripped the forefront of his mind. It replayed over and over again like a bad song stuck in his head.

Some of the people he couldn't even make out faces on for the fire had obliterated all recognizable features. Those ones were taken directly to the morgue. The coroner would have to have them identified through dental records in order to inform their families. Carlisle had written Jane Doe and John Doe on so many death certificates and charts tonight as people without any idea who they were, were rushed through the doors with broken bones, missing limbs, contusions, concussions, critical internal bleeding…the list was endless, as was the screaming. The pain was tangible in the air. With each moan and shudder, each high pitched shriek, each sobbing, dying breath Carlisle could feel the pain eating away at his limbs, making his muscles heavy. The hurt he couldn't seem to stop was making him weary.

And the ambulances weren't stopping either. It had been flashing red outside the ER windows for the past three hours. Eventually Carlisle could no longer distinguish the wail of the sirens from the screams of the broken bodies that surrounded him at every turn of a corner.

"Doctor," one of the nurses who had been pulled off the maternity ward to provide an extra set of hands, called to him. His head snapped up immediately, jumping back to reality, alert and attentive as ever, despite the red lines that leeched into his eyes and the purple bags that were forming under them like heavy, weighted reminders he would have to bear for his shortcomings.

For his failures.

How many would die on his watch tonight?

How many would he be able to save?

How many had taken their last breaths in his care?

Carlisle couldn't think about it anymore. When he did his hands would tremble with uncertainty and that would help no one.

"The patient's coding again," the nurse spoke urgently, a manual ventilator clasped tightly in her gloved hand.

Carlisle rubbed the back of his neck with his right hand, kneading at the tension. He took his clip board off the desk and pulled a pen from his pocket. This was the third time the patient had, for all intents and purposes, died on the table. He wasn't coming back from this and Carlisle knew it. He followed the nurse into the room, a silent prayer on his lips.

Carlisle had always been a man of faith, but tonight he didn't feel as though he was on speaking terms with God, a least, out loud.

The patient's injuries were severe and his mind was too far gone as Carlisle watched the man's eyes roll back in his head. They tried for thirteen minutes to revive him, pumping electrical currents into his chest with a defibrillator, before Carlisle called it.

Time.

It had finally stopped for this man. And Carlisle resented that, even as he wrote the numbers and signed his name. He felt like the incarnation of death himself, approving the absence of this man's life on Earth with a flick of his wrist and a swish of the ball point pen. Carlisle felt hollow, the emptiness making his heart echo in his ears, only reminding him with a sick irony that he was alive and his patient was not.

Time of death.

9:27 PM

For the first time that night Carlisle's life had been altered, changed forever in a way he would never imagine; only he didn't know it yet.

Carlisle let the old man go peacefully, closing his eyelids when the last residual shudder from the shock escaped him.

"Do we know his name?" Carlisle choked out, tears brimming at the corners of his eyes. It was too much, the death and carnage were too much, even for a seasoned doctor to handle.

"Edward Masen Sr.," the nurse spoke confidently. "His son is asleep in the next room. They just gave him a shot of morphine. He has a concussion and a dislocated shoulder. Other than that he seems to have been pretty lucky."

"There was nothing lucky about being on that plane," Carlisle noted solemnly as he filled out the paperwork. It seemed that there was always more to do when he lost a patient than when he saved one, as if celebrating a life saved was not as worthy of documentation.

"I didn't mean that," the nurse began at once.

"I know," he said, forcing out one of the few smiles he had left. He pulled the white sheets over Mr. Masen's face so the porter would know the deceased was to be taken to the morgue. "Find me when the boy wakes," Carlisle asked politely. "I'll tell the boy about his father then. Let him enjoy the few happy hours of sleep the meds will give him before we destroy his world even more."

"I will, thank you doctor for your help," the nurse said with a sad smile of her own as Carlisle left, defeated once again in his fight for life by another patient who had been claimed by death.