Carlisle

I had managed to book Rosalie in at the hospital. She had decided to come with Esme whilst everyone else was at school.

I met them at the entrance to the hospital. Esme had managed to convince Rosalie to use the wheelchair, so I took over and pushed Rosalie to where we were going.

Rosalie was nervous. Her heart rate was slightly faster than usual, and she was playing with her hands as though she was restless.

I had tried to prepare her as much as possible for the tests, but I knew that wasn't particularly going to stop her feeling nervous.

It was a long day and Rosalie was completely exhausted by the end of it. We had done blood work, a full chest x-ray, an echocardiogram and general health checks.

Thanks to my already high status in the hospital, I was able to push to have all of the results back today.

We were in a small room just off the side of the outpatient's department to wait for the results. Rosalie had refused to sit on the hospital bed and was now sleeping in the wheelchair next to Esme. She had done really well, and I couldn't blame her for being exhausted.

Whilst she was sleeping, I took the chance to bolus feed into Rosalie's tube. It was less stressful for everyone when it was done when she was sleeping. We were trying to not draw too much attention to it when she was awake in the hope that she would forget about the tube and thus it would limit her from pulling it out. The bridle was doing the job for now.

An hour later, I was pulled to talk to the consultant about the results. I wasn't surprised with the results, but it made me ponder on what the next steps were to be for Rosalie. We were on a thin line between life and death at the moment and it was imperative she came to the realization how ill she was so we could work on her getting better.

I went back to the room and spoke to Rosalie quietly about the results. She didn't say anything. Her heart rate quickened when I spoke, and she looked down at her hands, but she didn't have anything to say. I was hoping the silence meant she was taking in what I was saying and that she was processing just how unwell she was.

Rosalie was in the early stages of heart failure, which is why she was experiencing episodes of dyspnea where she required oxygen. Her heart was too weak to pump oxygenated blood around her body. Her blood showed that she was low in both B12 and iron, and most of the baseline blood tests for her came back abnormal. This was related to the symptoms and behaviors of her eating disorder, and her subsequent malnutrition.

We were able to pick up more oxygen for Rosalie and she was prescribed a few different drugs to help with her breathing and heart failure. I spoke to an eating disorder specialist about preventing refeeding syndrome and discussed the plan of increasing nutritional repletion. Rosalie wasn't yet at even 50% of her energy requirements because her body wouldn't be able to cope with it. I would have to monitor her closely at home to prevent her getting sicker. I had already booked Edward in for some training at the hospital this week so he could better support me at home. He knew so much about the medical field already, but we had to be careful that Rosalie didn't question why he knew so much when he was still supposed to be in high school.

The journey home was quiet. I had taken the rest of my shift off so that I could talk to the family about the outcome of our hospital trip and to get Rosalie settled into the new medication routine.

Rosalie spent the entire car ride looking out of the window, with Esme keeping a firm hold of both her hands in her lap.

It was extremely important that we were able to keep the tube in place so that Rosalie could have consistent nutrition to prevent her getting sicker.

When we got back to the house, Esme took Rosalie over to the couch to settle down. Everyone had gotten in from school already and were in various parts of the house having time to themselves. Alice was in the living room watching the fashion channel and she made space next to her so Rosalie could sit. It was nice to see Alice being more interactive with Rosalie now. I was hoping Bella would do the same gradually.

I could hear Emmett talking with Edward and Bella about the dynamics of their relationship together when Bella was human, so I didn't want to interrupt that.

I know Jasper, Edward and Bella were due to go hunting later this evening, but they were likely to go when Rosalie was in bed so that she didn't question where they were going.

Esme went off into the kitchen to fill up a water bottle for Rosalie. She had bought one at the store hoping that it would encourage Rosalie to drink after she had asked for one the other day.

I could see Alice eying up Rosalie's hands from the corner of her eye; petrified that she was going to try and remove the feeding tube again.

Unfortunately, there wasn't much of a solution to prevent Rosalie from pulling the tube out. The bridle insertion made it harder for her to do it and it prevented the tube from accidentally getting pulled out, but it was still possible.

We couldn't be on edge forever watching to see if Rosalie would pull out the tube. I would need to look into alternative ways to help.

The evening passed relatively slowly. I had managed to tell everyone about Rosalie's results and what that meant in terms of her treatment going forward.

Rosalie appeared disorientated and tired but was fighting sleep. She was focused on the TV – trying to pay attention to the film that Alice had put on.

Emmett and Esme had popped out to the shop to stock up on some stuff for Rosalie and the others had decided to start their hunting now that it had gotten dark. Rosalie was too disorientated to really grasp who was in and out of the house. It left just me and Alice in the house to watch Rosalie.

I was sifting through my medical journeys from my perch at the bay window. I was reading them in a different light to how I had ever done before – trying to search for answers in regard to helping Rosalie.

It was peaceful and quiet in the house, until Rosalie moved suddenly; she shifted position and then pulled with all her strength at the tube. Unfortunately, with the force, the nasogastric tube stretched and consequently slipped out of the bridle. I shouted at Alice to alert her to the situation, but infuriatingly we were unable to use our vampire advantages that would have completely prevented Rosalie from actually pulling it out.

Alice grabbed Rosalie's hands to stop her pulling at the bridle as well. It would need to be carefully removed and pulling it with force could cause Rosalie severe damage.

I had made my way to them now and Rosalie's nose was bleeding excessively. The displacement of the tube shouldn't have caused any severe damage but with Rosalie's anemia, she would bleed and bruise more easily and it's likely the blood was coming from where her nasal passages had been irritated with the force.

Rosalie was starting to thrash and scream. Alice shifted position so that Rosalie's back was against her chest. She wrapped her arms around her and stabilized both of Rosalie's hand at her lap. This was an effortless move for Alice, but she exaggerated it to make it look like it was difficult. If Alice was human, she would struggle with this task because of her stature. At the moment, we had to think of the best way to keep Rosalie safe regardless of the consequence.

I walked quickly but at human pace to the kitchen where I'd left my medical bag when we got home. I grabbed a cloth and went back to Alice and Rosalie.

Rosalie was starting to tire so her thrashing was easing. This made it easier for me to hold the cloth firmly to her nose to help with the bleeding. When she gave up thrashing, her body was heaving as she fought to take in air. Thankfully the bleeding had stopped, and I was able to work on taking out the bridle. Rosalie didn't resist against this as she knew it would cause more pain and discomfort if she did. When I was done, I shone my penlight in each nostril to check for damage. There were small cuts in the nasal passage, but Rosalie would be okay.

By this point, Rosalie had collapsed against Alice in exhaustion. Her breathing was fast and rapid, so I secured a nasal cannula to help her get more oxygen.

Alice moved Rosalie around so that she was resting in her arms like a baby. She put a pillow next to her crossed legs to support Rosalie's head. Not much phased Alice but in this moment, she appeared terrified. She was looking at me with concern and question.

"We need to rethink this situation, seriously." I dropped my voice so only Alice could hear me. "We will leave the tube out for tonight, so I can think of a plan of action. Unfortunately, we're likely going to have to resort to a situation where Rosalie is completely immobilized. It's the only way to ensure she urgently gets the nutrition she needs to recover. If we keep seeing a repeat of these behaviors, she will die."

Alice closed her eyes for a second, acknowledging my words. It was not easy to accept that we would have to resort to extreme measures, but Rosalie was the biggest danger to herself at the moment.

The oxygen was helping Rosalie and slowly her breathing settled to a much normal pace. Her eyes were rolling and heavy and she was close to sleep although not quite there yet. She was trying to focus on me in front of her – perhaps worried that I was going to insert another tube there and then. "We're all done for tonight, Rosalie." I said gently, moving to sit in the armchair so she wouldn't be worried.

A few seconds following this, Rosalie was asleep again.

Alice and I sat in silence until Esme and Emmett arrived home with the shopping. Alice refused to move Rosalie from her lap and wouldn't take her eyes off her. I was deep in thought about our next steps.

"Somethings happened," Emmett announced as he walked from the kitchen into the living room. He quickly laid eyes on Rosalie in Alice's lap. "Where's her tube?"

"She pulled it out." I said flatly, moving to stand. "I've checked her over and she's okay – no injury, but we need to seriously think about how we are going to move forward with this. She will die if she doesn't get the nutrition she needs."

Esme had heard the conversation and wrapped her arm around me to seek comfort. "Oh Rosalie," She whispered, "What can we do?"

"How did she even get a chance to pull it out?!" Emmett was angry now. He started pacing the living room. I am sure he was worried that Rosalie was going to die.

"Keep your voice down, Emmett or she'll wake up. She's quick." I dropped my voice again so Rosalie wouldn't hear if she did happen to wake up. "There was no way we could move fast enough to stop her at human pace. It's frustrating because we could have prevented it, but it would have exposed us to Rosalie."

Emmett didn't speak. He was too angry to muster up a reply.

It was a long night. Emmett had taken a long time to calm down, but he settled to sitting with Alice as she held Rosalie on the couch. It was safer to leave Rosalie where she was for now to let her get some rest.

When morning rolled around, I encouraged Alice, Jasper, Emmett and Bella to go to school. Emmett was the hardest to convince but it was going to be a difficult day and I didn't want Emmett to be there. I kept Edward home to help me, and Esme would be able to comfort Rosalie.

Esme carried Rosalie from the couch back up to Emmett's bed. She was still in a deep sleep and didn't stir.

Whilst she continued to sleep, we secured the pinel restraints.

The hardest part was yet to come. I lightly shook Rosalie from her slumber and waited for her to come around. She appeared confused but didn't fight the restraint.

"Rosalie, you need to stay in the restraint to make sure you get the nutrition you need. This means that I need to reinsert a feeding tube and you will be immobilized and bed bound initially so that we can give the nutrition time to work. You have options in regard to whether you want to remain awake during the entire time or whether you would rather be sedated." Rosalie listened to my every word, and it didn't take her long to answer me.

"I want to stay awake." Her voice was shaking and appeared weak, but she was determined.

I nodded, I had to respect her decision. "Okay. The girls will remain professional and respectful when supporting you with personal care. It's a situation out of your control and will hopefully just be for the very short term so your body gets a bit stronger than it is now."

Rosalie just simply nodded, looking away from me.

"Do you want me to sedate you whilst we get you sorted, or do you want to stay awake?" I was hoping she would opt for the first option as her staying awake during the nasogastric tube was likely to be distressing considering she had cuts along her nasal passage.

Rosalie agreed to be sedated. The needle only took a few seconds before she was asleep. I hooked her up to the monitors to keep an eye on her vital signs.

Edward and I worked together to ensure a smooth insertion of the tube. Esme tended to ensure the personal care aspects were set up and sorted. When the feeding tube was in place, I was able to hook Rosalie back up to the oxygen. The sedation would have an effect on her breathing, and we needed to make sure she remained stable.

Esme placed a thin comforter over Rosalie and then I used medication to bring her round from the sedation.

Rosalie was tearful when she woke up, but she had gone back to being silent as though she had retreated into herself.

I left her in the hands of Esme and Edward and attempted to call her parents. It took a few attempts, but I was eventually able to get through to her mother to explain the situation. I struggled to gather my feelings when the call ended.

Rosalie's parents had abandoned her. They no longer wanted parental responsibility of her.

Esme had heard the conversation and came into my office. "We need to adopt her, Carlisle. There's no question about it."

Rosalie's mother had already said she would sign adoption papers during our phone call.

"I think that's for the best, but we need to talk to Rosalie about it. This will come of a shock to her." I didn't know when the right time would be to tell Rosalie, especially in her fragile state, but we would figure it out.