A/N: I tried to do my research, but I'm not an expert, so I'm sorry if there are any mistakes!

My private life is an inside joke, no one will explain it to me

Shell Games, Bright Eyes

Elena knew something was wrong the moment Dr. Elverson entered the room. His head was down and he walked slowly to the chair. It was a short, round one that swiveled and rolled.

"Mrs. Gilbert," he started as he looked into her eyes. "Your test results have shown that there are…complications, with your pregnancy."

Elena swallowed. Damon hurried to her side and put an arm around her where she sat elevated on moveable hospital bed. "What complications?" He was angry, she could tell. She put her arm around him.

The doctor swallowed before continuing. "I'm sorry to tell you that the embryo was found attached to the wall of your left fallopian tube." He handed Elena an ultrasound photo and she looked at it with numbness. "Normally these cases are few and far between, and the egg will miscarry naturally by passing through the fallopian tube wall. However, the embryo in your case appears to be…developing."

Elena still didn't say anything. Damon didn't know if he could.

"This means that the embryo will develop there, instead of the uterus. If it is left unattended, it will continue to grow until your tube bursts and you will experience internal bleeding. Obviously, you have access to modern medical facilities, so it isn't likely to result in death. But to let it progress would very likely result in surgery, and obviously that's never where we want to go if we don't have to."

Elena just looked at him. As if she wasn't quite sure why he was telling her this.

He reluctantly continued. "The baby never survives in these cases, and it is very dangerous to the mother, so we have to act quickly. I'm very sorry." He put a hand on Elena's shoulder, but she couldn't meet his eyes. "The only feasible option now is to remove the threat to the mother's health." He was looking at Damon now.

Damon's throat constricted and his eyes filled with water. He nodded his understanding.

"The nurse will be in shortly. Methotrexate is the standard chemical used in this instance." He left without a word.

Elena still hadn't said anything. "We should talk about this." Damon prompted.

She turned to him with a small smile. "I know. We're not even married yet and we have a baby on the way. I realized when he called me Mrs. Gilbert." She shook her head and gave a harsh laugh. "Not that it really matters. I don't need to get married to know I love you more than life itself." She kissed him on the cheek.

Damon was dumbstruck. "Elena. The doctor said…"

"I'm not talking about that." She said quietly.

"Elena, this is your life." Damon took her shoulder in his hand.

She shrugged it off. "I'm not taking it!" She yelled. He'd never seen her eyes so angry or hurt. "How can you think of doing that to our child? You'd abandon him just like that?"

"Elena, I love you and I will not let this happen. I don't care if I have to shove it down your throat!" He was yelling back at her.

"I'm not going to take anything. I don't care if this baby kills me." She stood.

"Then you'll both die!" Damon tried to shake sense into her, but she ripped free.

"Get off me! I'm not just going to get rid of it like I matter more than the baby growing inside me."

"You do, Elena. You do matter more." He got on his knees before her. "Please don't do this. I love you. If you love me like you say, please don't do this."

She took his face in her hands. "I have to think like a mother, now." She said through her tears. "And I just can't do that. Not for myself. Not even for you."

"Is it—is it religious? Because, Elena, you can't seriously be saying that you'd die for a baby that's dead anyway." He pleaded desperately.

"Didn't you hear him? He said the baby is developing." She kneeled beside him and clutched his face and tried to will her hope to transfer to him. "Damon," she kissed his cheek. "This baby is clinging to life. How is that any different from us, when we were too young to help ourselves?"

"Elena," he tried to keep his voice steady. "I'm not risking you for what's essentially an undeveloped corpse infecting you, hurting you."

It's not dead, yet." She said coldly. She moved to walk out and Damon scrambled after her.

"Elena! The nurse has to come. They'll talk sense into you! Please, wait!" She was walking fast and Damon scrambled to keep up. He saw the doctor walking the opposite direction through the hospital and swerved. "You have to help me! She's refusing to take it! She's leaving, please help me convince her!" He grabbed the man by his white coat.

He looked around. "Of course I'll talk to her. Where is she?"

Damon looked for her in a panic, but she was out of eyesight.

The doctor understood. "Bring her in. Anytime. I'll talk to her, because this is serious. But we can't force her to do anything. If worse comes to worse," he sighed. "She will have a miscarriage or internal hemorrhaging. You have to watch her carefully if she can't be convinced. You take her to emergency care if you even suspect."

Damon nodded and wiped at his eyes.

He searched everywhere for her. She wasn't answering her cell. She wasn't anywhere near the hospital or hospital grounds. Finally, he just hoped she took the bus and got home safely, so he took his car to their apartment.

Caroline was leaning on the frame of their bedroom. He rushed forward to find Elena, but Caroline stopped him. "She called me for a ride home." She swallowed and her eyes were sad.

"She told you." Damon said.

It broke Caroline's heart to hear him so broken. "She's been crying ever since we got here. She's really hurting." Caroline wiped her own tears from her cheeks. Elena had called her for a ride home. Whatever place she was in, their history hadn't even seemed to register.

"Why would she—" Damon choked off. "Why would she do this to me?"

"Damon, right now she's only thinking of the baby." Caroline gave a bitter laugh. "She's selfless like that. We should give her some time."

They moved to the couch. Damon sat and hated himself for it. "She doesn't have time."

"We just have to watch her, make sure—"

"I am not going to just sit around and watch her go through that."

"She's not going to change her mind." Caroline said. "She's gone her whole life loving people who've let her down. She's not going to do that to someone else."

"It's not even a 'someone!' It's a thing, like a parasite."

"Damon," Caroline admonished.

"You have to convince her!" Damon grabbed Caroline's arms. He had a crazed look in his eyes. "You could convince her! If anyone can, you can." His voice lowered as he pled with her. "Please, help her."

"I've hurt her too much, already. I can't do that. This is her decision." Caroline said softly.

Damon pushed her away and into the couch. "Are you really so selfish? You just think if you do whatever she wants, even if it kills her, she'll forgive you? Fuck, what kind of sister are you?" Damon stood and paced. He looked at the closed door to Elena.

Caroline stopped him from moving towards it. "I-I researched it. She'll be okay."

"No, Caroline." Damon said with hate in his eyes. "You've never understood her, never cared to. But I do. And I know that this will kill her. Maybe not her body, but her spirit? Everything she is? I don't think she can take much more."

Caroline looked at him with hate of her own. "I spent my childhood, and Elena's, protecting her. Don't you fucking tell me I don't understand her. That I wouldn't give anything to-" she broke off, her throat catching, before she regained her composure. "If I were being selfish, I would trick her into taking that drug, just like I did before." Caroline's angry, tear-filled words rang through in Damon's ears. "Because you know what? I am selfish. And I can't imagine a world without my baby sister. I couldn't when we were kids and I still can't now." She started sobbing on the couch.

Damon held his eyes as if that could stop the tears. "How can I let this happen?"
"You don't have a choice." Caroline said in a shaking voice. "Neither of us do. We just need to be there for her."

Damon slammed his back into the wall and let himself sink down so that his knees were drawn and his head was in his hands. "I don't know if I can come back from this, either."