It was only a few minutes before the hospital came into view. Carlisle shot me a sideways glance as he waited for traffic to allow him to turn left into a parking lot behind the building.
"I don't suppose you are licensed in Washington?" He turned the wheel, maneuvering between rows of parked cars before pulling into an open spot.
"Funnily enough," I replied, "I am." I laughed when his eyes widened in surprise. "I ran a trauma seminar at the University of Washington about eighteen months ago." Rubbing my temple, I closed my eyes to concentrate on the memory. With everything else that had happened, it seemed like years, not months ago. "Nearly forgot all about that, actually."
"That's fantastic!" Carlisle reached into his pocket for his phone and held up one finger. "Give me just a second." I unbuckled as well, waiting as instructed while he held the phone to his ear, speaking to his supervisor for a few minutes. I tried to ignore the conversation, watching people walking through the parking lot until I heard his phone snap shut. "You won't believe this," he said, shaking his head. "My supervisor attended your seminar. He recognized your name immediately."
Carlisle was right, I didn't believe it. My life was quickly unraveling into a mess of bizarre synchronicities. I laughed nervously, pulling at a loose strand hanging from the messy bun I'd thrown my hair into before we left the house. Within an hour, I was standing with Carlisle in the emergency room, dressed in hospital-issued scrubs, with a temporary badge clipped to my shirt and a borrowed stethoscope around my neck. I was granted temporary privileges as an attending once someone verified my license. The good word from Carlisle's boss expedited the process.
Listening to the interns presenting their patients was like slipping on a familiar sweater; I relished the familiarity of the routine. Carlisle and I took turns asking questions, challenging the newer doctors to predict what their blood tests, x-rays, and scans might reveal.
"Last patient," an intern named Dr. Stevens began. "Mrs. Abrams. Sixty-five-year-old female with a history of hypertension presents today with chest pain that radiates to her neck, back, and abdomen. BP is elevated —180/92, normal breath sounds; has a slight murmur that she says she's had all her life."
"What are you thinking, Dr. Stevens?" I watched him flip through his scribbled notes.
"Er…it's unlikely the abdominal pain is due to appendicitis - she's not febrile; no rebound tenderness. Perhaps menstrual pains, or indigestion, or perhaps an ovarian cyst—"
"Wait, wait wait," I cut him off with a wave of my hand. "Menstrual pains? Ovarian cysts? She's sixty-five. With the elevated blood pressure, and the chest and back pain, you aren't thinking this is cardiac?"
I held out my hand and he passed me the patient's chart. "Stevens, this patient had a total hysterectomy. A decade ago."
Stevens blushed and fumbled with his notes, looking at Carlisle in a silent plea for help. Carlisle, for his part, jerked his head back toward me with an expression that clearly read, you're on your own, kid.
Before I could launch into a lecture about disregarding patient symptoms and how that leads to negative outcomes — especially in women and people of color — a voice called out from behind us.
"Carlisle!"
He turned and I looked back over my shoulder. A silver-haired man in a long white coat was jogging down the hall toward us. His pace slowed to a brisk walk until he reached us.
"I'm glad I caught you," he said to Carlisle before turning his attention to me, extending his hand.
"Dr. Alexander," I said, shaking his hand. I remembered him from the seminar. If I recalled correctly, he was the Chief of Emergency Medicine at Forks Community. "It's a pleasure to see you again."
"I wasn't sure if you would remember me, Dr. Jones." He beamed, clearly pleased that I did. "How the hell did you end up here?"
"Ah." I hesitated, but Carlisle swiftly rescued me.
"Ellie's family and mine go back a long time," he said. I covered my mouth to hide a snicker. The simple statement was as absurd as it was technically accurate. I got a hold of myself quickly.
Dr. Alexander grinned. "And Carlisle thought you'd like to see how a real hospital runs, eh?"
"Absolutely." With the chart I held in my hand, I gestured toward the group of young doctors. "I was just getting acquainted with your interns. And," I paused, nodding at Stevens, "Dr. Stevens here was just about introduce us to a patient with a possible aortic dissection."
"Excellent." Dr. Alexander clapped his hands together. "Don't let me keep you." As he turned to walk away, he looked over his shoulder at the interns, pointing at me. "Learn from this one!" He gave a wave over his head and strolled away.
"Dr. Stevens." Carlisle waited until the interns all had eyes on him. "Let's go meet your patient."
When we walked into room 12, a white-haired woman shifted in her bed, grimacing before attempting a smile. I smiled in return, glancing at Carlisle who gestured for me to go ahead.
"Hello Mrs. Abrams," I greeted her. "You look like you're in a lot of pain this afternoon. Can you tell me what's going on?"
Mrs. Abrams' lips twitched, and she raised an eyebrow. "Well, I was rather hoping you could tell me that." She winked, but then the discomfort distorted her face again. "Ugh." She tried to sit up and I stepped quickly to her side, helping her adjust the bed to support her position change. "This morning." She sounded out of breath from adjusting herself; I glanced at Carlisle and knew he caught that too. "I woke up and my back hurt a little bit, but within an hour or so the pain was in my chest as well." She leaned forward slightly to see around me, and I turned to see a younger man sitting quietly in a chair in the corner. "I thought it would get better but he made me come."
"Well," I said, placing a hand on her shoulder and gently supporting her as she leaned back again. "He was right to make you come in. Do you mind if I do a quick exam?" Putting my stethoscope to her chest, I bent my head and closed my eyes, listening to her heartbeat for the swishing sound of her murmur. After a moment I looked up at Carlisle, and he took a turn listening as well. I quickly finished my exam, testing her strength in each arm and each leg; she seemed to have some unusual weakness on her right side. When I stepped back, Carlisle looked over at his interns.
"Stevens, please get a blood pressure reading on each arm if you will." While we waited for that, Carlisle turned to the rest of the observers gesturing for them to exit the room. As he left, I heard him start to question them. "Who can tell me why we want a BP from each side in a patient presenting these symptoms?"
"BP on the left side is 180/92," Stevens said after a moment, "And 160/84 on the right."
"What's wrong with her doc?" Mrs. Abrams' son stood up and approached the side of his mother's bed as I finished scribbling orders onto her chart. I handed it to Stevens and he exited the room.
"Well, we have to do a couple of tests, but I'm concerned about something called an Aortic Dissection. That means we think her aorta may have a small tear." I sat down on a wheeled stool and slid over to the opposite side of the bed, looking straight at Mrs. Abrams.
"We're going to get a chest x-ray to see whether your aorta is enlarged." I made a circle over my chest area with my hand. When Mrs. Abrams nodded, I continued. "Then, we are going to a test called a transesophageal echocardiogram. We will give you a very light sedative, and place a tube in your throat to get some good pictures of what exactly is going on." I stayed for several minutes and answered what questions I could about surgery or medication — if our suspected diagnosis was correct.
Eventually, when they exhausted their questions, I excused myself from the room just as the escort team arrived to wheel Mrs. Abrams to radiology. Carlisle was leaning against the nurses' station, discussing another patient with a woman dressed in dark pink scrubs standing on the opposite side of the station wall. Straight blond hair obscured her face as she bent over the desk, looking over some paperwork while talking to Carlisle. Her badge swung from the v-neck of her shirt.
"Ellie, good. This is Susanna," he said. "She will help get everything set up for Mrs. Abrams echo when she gets back from x-ray."
"Great," I replied to Carlisle and then looked over at Susanna, who had arranged the pages she had been shuffling in a neat pile. "Thank you."
Susanna tapped the pile against the desk before setting it aside, standing straight, and looking over at me. Her straight blonde hair fell perfectly into place, framing her pale face and sitting just above her shoulders.
"Anytime," she said. A wide smile spread across her face, revealing a mouthful of perfectly straight, impeccably white teeth. I could feel the same panic I'd felt on the street earlier stirring in my chest. My fingers curled around the edge of the desk wall as I struggled to unsee the resemblance. Her head tilted to the side as she eyed me curiously. Her eyes were a deep brown; they almost looked unnatural with the rest of her coloring. I closed my eyes, trying to force Jane from my mind.
"Did you need anything else?" Opening my eyes, all I could see was the tiny sadistic vampire. "Dr. Jones?"
Backing away from the desk, I shook my head. "No," I responded with barely more than a whisper. I couldn't trust my voice not to shake. "No, that's all, thank you."
I walked swiftly down the hall, looking for somewhere I could disappear. Or, more accurately, anywhere I could make everything else disappear. I stared straight ahead as I walked. My peripheral vision taunted me with shadows and movement that reminded me of a swell of black capes surrounding me. Carlisle caught up to me, taking me by the elbow and directing me around the corner into a less crowded corridor.
"What happened?" His voice was urgent but quiet. "What's wrong?"
"I am," I gasped.
"What?"
"I think I'm wrong. Something is wrong with me." I looked up at him, squinting as if my eyes couldn't focus. The fluorescent lights in the hallway felt unnaturally bright; I didn't remember them being so bright a few minutes earlier. Before Carlisle could respond, a realization left me horror-struck. "This isn't real."
Carlisle adjusted his position to block me from being visible to people walking further down the hall. "What's not real?"
"You, Carlisle. Christopher. This hospital." My breath came in gasps; My hand flew to my face; I felt like my head might suddenly disconnect from the rest of my body. "What if this isn't real." My voice cracked as a sob swelled in my throat.
Carlisle's put his hands on my shoulders, they were gentle but firm. I felt my feet moving as he guided me into a small office. I heard the door close behind him.
"Ellie, take a deep breath."
I shook my head. "You're not here. I'm in Volterra. This is just Corin, or Chelsea, messing with my head. None of it is real."
"Ellie!" Carlisle shook me this time. Hard. The surprise was enough to get through the mania in my mind. My eyes snapped into focus on his face. "You are real, I am real, Christopher is real. You are not in Volterra." He waited until my breathing slowed before letting go of my shoulders. "When was the last time you slept?"
A few hours later, I was standing in the bathroom that adjoined one of the Cullen's guest bedrooms combing through my freshly washed hair. It turned out that Esme and Alice had gone shopping for some essentials. When Carlisle and I returned from the hospital, I was surprised to find the guest room stocked with a few sets of clothes and toiletries.
I knew Carlisle had already filled them in on what had happened at the hospital. When I finally calmed down, he performed the test on Mrs. Abrams and we tended to a few other patients with minor issues. I moved through the rest of the shift numbly and was grateful when Carlisle came to quietly tell me we could leave. When I got into his car to go back to the house, he stood outside for a few moments murmuring quickly into his phone. Mercifully, no one interrogated me when we arrived. Esme hugged me and whispered in my ear that I could rest in the guest room, and stay as long as I liked.
"Thank you," I had managed to choke out while struggling to hold back tears. I could not deny the weight of mental and physical exhaustion, so I didn't try. I didn't protest when Esme put her arm over my shoulder and started walking me upstairs. When she showed me around the newly-stocked room, I babbled my thanks, stumbling over myself as I tried to insist that she needn't have gone to such trouble. She only smiled, told me to get some rest, and drew the curtains closed before heading for the door.
"Esme?" I called to her weakly before she could close it behind her. She smiled knowingly.
"Alice says he will be back soon."
Sitting on the bed, wrapped in a warm towel, I was deeply moved by their thoughtfulness. I didn't know how long I sat there, unmoving in the darkened room. I considered climbing into bed just as I was; getting up and opening the dresser drawers seemed daunting. I was still summoning the will to move when a soft knock came at the door. Before he spoke, I could feel the strange pang I had successfully ignored all day throb deep within me.
"Ellie?" I was already opening the door before he finished saying my name. In my haste to see him, I had forgotten I was only dressed in an oversized towel. He looked me over with a long glance before his eyes rose back to meet mine. "Should I come back in the morning?"
"No!" I laughed awkwardly, opening the door wider. "I mean, don't go. Please."