The Twilight Twenty-Five

Prompt: Heart

Pen name: rhpsfaerie

Pairing: Carlisle

Rating: M

Note: All medical mentions were researched, but I have no medical expertise, so if someone spots something that is not correct, please let me know.

May 13th

I arrived at work early, feeling as though I needed to get away from the emptiness of the house. After one hundred years, I was finally an empty nester. Alice and Jasper had decided to move to Russia for six months while Jasper "found" himself and what he really was interested in doing with the rest of his existence. Emmett and Rosalie were living with Tanya and the others in Alaska, trying to help them deal with the loss of Irina. It had been taking a huge toll on Tanya, especially, and Rosalie felt like she and Emmett were better off staying with them. Edward and Bella had stayed in Forks to raise their daughter close to her grandfather and other loved ones.

With the Cullen clan finally separating, Esme and I decided to go to Pittsburgh. It'd been a long time since we'd spent any significant time on the East Coast, and we both missed it. I wanted to get back into doing surgery, and Allegheny General had a position open for a cardiothoracic surgeon. I jumped on it immediately, and Esme, forever my rock and biggest support system, smiled and said, "Let's do this. It's time that just the two of us had an adventure. No more of these pesky kids." She winked, and we were on a plane the next day.

I sighed as I remembered the events that led me to this hospital four months ago. It'd been a lot harder than I thought leaving Forks, especially since Edward was still there. As much as I loved Esme, Edward held a special place in my heart. He was my first "child" in this life, the first person I'd brought over, and the first person I'd cursed because of my own flawed emotional responses. Even though he'd always reassured me that I'd done the right thing, I still couldn't help feeling guilty about condemning him to this life, condemning them all to this life. Even Bella, who would never have known our kind, existed had I not "created" Edward all those years ago.

Time to stop wallowing, Carlisle, I thought to myself. What's done is done, and you have to live with yourself for eternity. No use in letting the guilt and regrets take over. Let's save some lives.

I walked over to the first patient's room to the left of the nurses' station, looking at the medical chart while nodding at one of the interns to present the patient's history.

"The patient's name is Nathaniel Dennis, age sixteen, and suffering from dilated cardiomyopathy, diagnosed three years ago. He was admitted yesterday evening, complaining of shortness of breath. Tests revealed that his lungs were filling with fluid, which we took care of, and that he is in heart failure. At this point, I believe that the best course of action is to call UNOS and get him on the transplant list while we pump him full of ACE inhibitors to keep his heart working," the intern said. She nervously twirled a loose strand of her pale blonde hair around her finger, desperately seeking my approval in her presentation and course of action.

I smiled at her and said, "Sounds good to me, but get in contact with Nathaniel's cardiologist so that you can come up with a medicinal course of action as well. Can't put all of our eggs in one basket while we wait on a new heart."

"My name is Nate," the patient said from his bed. I looked over at him and was startled for a second. For second, I thought I was having a hallucination of the night I'd changed Edward all those years ago. I'd never seen a shade of hair that exact color of reddish-gold in all the years I'd been alive, except for that one exceptional young man.. I looked closer at the patient and saw that his eyes were an icy blue, almost too blue to be real. I wondered errantly whether this boy wore contacts.

"Nate, don't be insolent," a woman in the corner of the room chastised.

"And who are you?" I asked her.

"I'm Lina Dennis-Carlson, Nate's aunt. I'm his guardian," she stated from her chair. She didn't look like she'd be moving any time soon.

"Yeah, my parents are dead. They both had heart problems, too, and it got passed down to me. Thanks for the genetic gifts, Mom and Dad!" the boy said bitterly.

"Well, we're going to do everything we can to make sure you walk out of this place healthy and happy, alright, Nate?" I said to him as I walked over to his bed. I could hear his heart thrumming away, the beats a complicated, irregular rhythm. I could tell without even examining him that his left ventricle had almost completely stopped function, and that his heart valves were going to be the next casualty of his disease. He didn't have much time left, and I felt incredibly sad all of a sudden. I had no idea why, but this case was effecting me greatly, and I didn't even know this patient.

"We'll see," he muttered as he turned to look out the window.

"Alright, let's move on to the next patient," I announced to the room full of interns. We left Nate's room and continued with our rounds. The rest of the day, I couldn't help but think of that bitter young man and how much he reminded me of my first "son."

I called Edward that night and told him all about the young man. "And his hair is the exact same color as yours, Edward. It was so startling to me, and I have no idea how I didn't notice that the second I stepped into the room," I told him as I sat with Esme in front of our fireplace.

"You've been kind of distracted lately. Every time I call, your mind seems to be somewhere else. Is everything okay?" Edward asked. I heard Bella's laughter and Charlie's gruff voice in the background.

"I'm fine. I'm just feeling the effects of not having any children around for the first time in my life. It's really strange not having a house full of adolescent vampires."

"Bella, Nessie, and I will come visit you soon. I'll call Alice and Jasper and see if they can cut their Russian getaway short, and get Emmett and Rosalie to come along, too. As much as I hate to admit it, I miss you, too, old man," he joked.

I laughed, "Thanks. Go enjoy your family. I'll talk to you soon." I hung up the phone, and Esme moved over to me and curled up in my lap.

"Sweetie, everything will be okay. I have faith in you as a doctor and as a person. You'll make the right choices and give this kid a new chance at life," she said as her hand stroked my cheek. I kissed her lips softly, glad that I had at least one person who would never leave my side.

****

June 13th

"Well, hello there, Dr. C! How're things going?" Nate said as I walked into his room.

"Great, and you?" I asked as I sat down next to his bed and laid the chess set on his bed's tray.

"Still in heart failure. Dr. Cho told me I moved up a spot on the UNOS list, though!" he said with a fist pump in the air.

I laughed and asked, "How many more spots until you're at the top?"

"About fifty. I'm feeling optimistic, though."

"That's good."

As I set up the board game, I thought back to all that had happened in the past month. I'd come to visit Nate a lot during my shifts at the hospital, and even came to visit sometimes when I wasn't scheduled. I'd learned pretty quickly that his aunt resented his illness and that she was grateful whenever someone came in to the room, because that meant she could escape. Nate told me that she used to work for a major corporation, but had to quit her job so she could take care of him. Her husband was never around, and she hated that she was stuck at home all the time with, as Nate stated, "her diseased, sickly nephew that she wished would just die already." I'd tried to reassure him that his aunt loved him, but was immediately told that she plainly told him one night that she wished he'd just disappear.

Nate was bright, articulate, well-read, and interesting. He was interested in music, and wanted to learn how to play piano. He read philosophy for fun, and was fluent in four languages. I'd never met anyone else with this kind of wit, intellect, and sheer stubbornness, with the exception of Edward. Esme told me that she thought I was growing so attached to him because of his similarities to my first son, but I dismissed her. When I thought about it later on, though, I realized she was absolutely right.

"So, Doc, tell me about your family. We always talk about me, so tell me about you," Nate said as I made the first move of the game.

"Well, I've been married for some time to my wife, Esme. About seven years ago, we adopted her niece and nephew when their parents were killed in a car accident. After that, we adopted a pair of sisters who'd been in foster care for a while, and a pair of troubled brothers whose parents had died in a fire." I said the speech I'd rehearsed a thousand times, making sure my voice didn't give away a hint of the dishonesty that was spewing from my mouth.

"So, you and your wife kind of pick up a bunch of us urchin types, then. Think you'd be willing to adopt me?" Nate asked, his eyes opening wide. In the past month, he'd lost a substantial amount of weight, and his eyes seemed like burning globes in his sunken face.

"We'll see." I chuckled. "The first priority is getting you well, though." We continued with our game, but Nate's words haunted me the entire time as I thought about something that hadn't crossed my mind in nearly a century: should I save him by turning him? It's how I'd come to have most of my "children" in my life, and I couldn't imagine living without them now. Should I adopt this remarkable young man and give him a new chance?

That night, I brought the idea up to Esme.

"Really, he doesn't have anyone in this world to care for him, and we can. The rest of our clan is separated, doing their own things, and it's so lonely in this house. He can bring life to it," I said to her as I paced the floor of our living room.

"But you'd have to change him to keep him alive, Carlisle. I don't know if I want you to do that. You suffered from the guilt of changing Edward, Rosalie, Emmett, and me for decades. I still see the lingering effects of it, and I don't want to see you struggle with that again. It breaks my heart," she said as she stepped in front of me and wrapped her arms around my waist.

"I know. I'm struggling with the thought of it now. But Esme, you don't know him. You don't see the thirst for life and the desire for greatness in him. He's so much like our Edward, and a bit like Rosalie too, in his tenaciousness. He would flourish in our lifestyle. I just don't know if I can take someone's humanity away again." I kissed her forehead gently.

She brought her hands to my face and forced me to look her square in the eye. "I don't know about you, but I have plenty of humanity left. Edward is the sweetest, kindest person, and Alice is practically a saint. Just because we aren't human doesn't mean we are lacking in humanity."

I sighed. "As always, my darling, you are right."

She smiled. "Of course I am." She lifted her face to mine and kissed me gently. My hands moved to the hem of her shirt, and I lifted the fabric from her frame roughly.

"God, I love you," I whispered to my mate as she tore my clothing from my body, not caring that she was ruining it as the shreds scattered the floor. My hands and mouth roamed her body, desperate to feel her against me, underneath me. As she drew me inside her, letting me fill her as I had so very many times before, I felt truly alive for the first time that day. I let the pleasure, the ecstasy of being joined with my soul's other half fill me as the worries and the mental warring of Nate's situation floated away, if only for a brief moment.

****

June 25th

"Carlisle, thank God you're here," Dr. Cho said as I entered the surgical wing.

"What happened with Nate?" I asked frantically, unable to hide the emotion from my voice.

"He went into full arrest about four hours ago. We got him back, but he's fading fast. He's number two on the list for his blood type now, and we're just playing the waiting game." I nodded and went straight to Nate's room.

He was asleep, but his aunt was there, sitting in her usual chair. She looked excited when I walked into the room.

"Great, now I can go get my coffee," she said as she stood up. I moved in front of her, my expression hard as stone.

"Why are you even here if you don't care about him?" I asked her, my voice low but even.

"Because I'm the only person he has left. My parents are both gone, and my sister died from the same disease that's about to claim her son. I hate that I was stuck with him, but it doesn't change the fact that he has no one but me. I wish I could have been better for him," she said as her eyes welled up with tears. I couldn't respond, and she left the room quickly.

"Go figure Aunt Lina would actually care," whispered Nate behind me.

I turned around and moved to sit next to his bed. "I kept telling you that, but you never listened," I responded gently.

"It kind of makes me wish I didn't sign that DNR an hour ago. It'd be nice to reconnect with her."

"You signed a DNR?" I asked, unable to mask my surprise.

"I know the odds, Dr. Cullen. I know what my chances of survival without the transplant are, and the odds that I'll get one in time. If that heart can go towards saving someone else, I'm happy with that outcome. I'm okay with dying, finally. I'm not bitter anymore. Aunt Lina gave me the legal permission for it, and it's all set."

"What if I told you there was something I could do for you to where you wouldn't need the transplant and you wouldn't die?" I said, unable to keep the words from flying out of my mouth.

"I'd say bring it on."

"I need to go make some arrangements and talk to my wife, but I'll be back soon, I promise."

I flew out of the room and out of the hospital, unable to keep my thoughts in one succinct pattern. All I knew is that I couldn't let Nate die, that I couldn't let his spark burn out. I didn't care about the guilt, the regrets I knew I'd feel for taking his human life. I just knew that I couldn't let him die, not without giving him this choice.

I was home in moments and was surprised to see Edward and Bella there.

"What are you doing here?" I asked. I didn't have time for my first son, as much as I loved him. I needed to talk to Esme about Nate.

"Esme called and told me she thought I needed to visit and talk some sense into you. She told me that you were considering turning one of your patients," he said, his golden eyes burning holes into me. Bella stood next to him, their hands clasped tightly, and I knew that she was the only thing reigning Edward in at that moment.

"Edward, he's a remarkable young man. He's so much like you. You won't understand until you meet him."

"So, what, now that we've all decided to live apart from you for a while, you have to create a replacement family? What about the idea that you were stealing our humanity? Remember how you told me it was the most reprehensible act you committed when you changed me? What is it about this boy that makes you want to put yourself through all of that again?" Edward's expression was one of pure confusion. To see him so conflicted because of me made my heart crack a little.

"I don't know what it is. I just know I have to do everything I can to help him. Where's Esme?"

"Right here," she answered behind me. "I've already prepared a room for him, Carlisle, once you've done whatever it is you want to. I'll stand by your decision, whatever it is." I turned around and looked at my wife. She was the picture of grace and poise, and she was waiting for a response.

"I'm going to do it," I said bluntly.

She nodded. "I figured as much. We'll be ready for him when you're ready to bring him here."

I left the house in a flash.

When I arrived at the hospital's surgical floor, I dashed into Nate's room, saying, "Come on, Nate, we're going on a trip." But the room was empty.

I searched frantically for Dr. Cho, and finally found him in the staff lounge. "Where is Nate?" I shouted at him. Then I saw the expression on his face. There were tears in his eyes.

"He signed the DNR, Carlisle. There was nothing we could do," he said, his voice breaking under the strain of the emotion he felt.

I flew out of the room and to the morgue down in the basement. There has to be a spark left, I thought. If there's the tiniest spark, I can change him and bring him back.

When I entered the cold room, I asked the attendant, "I need to find the body of Nathaniel Dennis. Can you help me?"

He searched for Nate's information while I listened and looked for any signs of life left in any of the body compartments. I couldn't find anything.

"Here we go," the attendant said, and pointed to a compartment right in front of me. I opened the drawer and was met with the sight of Nate, his face peaceful and serene in death. There wasn't even a hint of a spark at life left. He was gone.

I stroked his face tenderly as the sobs ripped from my chest. I ran my fingers through his hair, hair so much like my Edward's, and I cursed the fact that I couldn't cry for this wonderful, interesting, spirited young man. I said a silent prayer for him, hoping that he would at last be reunited in heaven with his parents, and that he would know no more suffering.

I left for home, and when I arrived, my entire clan was there; Alice, Jasper, Rosalie and Emmett had come back. Edward embraced me first, and he held me as my heart broke for the boy that was almost my son. Esme followed him, and then the rest of my family held me. We huddled on the floor for what seemed like hours, recounting stories of the past, plans for the future, and I remembered a special young man who wanted life and accepted death.

I knew that I would never forgive myself the rest of my entire existence for not giving him life fast enough. Edward squeezed my hand after that thought and said, "You wouldn't be you if you could forgive yourself, Carlisle. Out of all of us, you have the biggest heart."