St. Luke's Hospital, Duluth, Minnesota. 2005.

"I've got a 29-year-old woman who's about six weeks pregnant with the main complaint of frequent vomiting. She says it may be hyperemesis gravidarum and she's very adamant about seeing only you," Elliot said.

Carlisle checked the name - Sarah Giordano. Not a patient he's treated before at this hospital. "She brought up the diagnosis?" Sometimes self-diagnosis was right and other times the Internet could blow a mild symptom wildly out of proportion.

Elliot shrugged. "She said she's a doctor."

The self-diagnosis could be right, then. The big question was why did this Sarah Giordano want to see him specifically instead of her primary care physician or OBGYN about it. He knew obstetrics, of course, but he was practicing emergency medicine here. "How adamant is she about seeing me?"

"She said she won't leave without seeing you," Elliot said with a smirk.

"Why are you smirking me like that?" Carlisle asked, not entirely sure he wanted the answer.

"I'm not smirking."

"Okay, why are you not smirking at me?"

"It's just if I didn't know any better, I'd say you have another patient with a crush."

Carlisle rolled his eyes. Elliot thought it was excessively funny whenever there was a patient who stammered and blushed around him. "I could believe that, if I'd have seen this patient before."

He looked over vitals that Elliot recorded as he headed for the exam room. He saw a low blood pressure and elevated heart rate that suggested something was off. He took a breath before knocking to steel himself and opened the door. "Hello, I'm Dr. Cullen. You requested to see me?"

The woman sitting on the exam table let out a relieved sigh. "Thank God," she muttered. Louder she added, "Thank you for seeing me."

Carlisle took in her appearance. Sarah had her dark hair tied up in a messy bun and the rumpled state of her clothes suggested she'd spent a few days in them. She seemed exhausted and had a haunted look in her eyes. There was a definite pallor to her skin that suggested anemia and when he took a breath, he could smell it, as well as the pregnancy. The reported frequent vomiting would do that. It would also cause dehydration, which would explain the low blood pressure and rapid heartbeat. Beyond that, there was something else in her scent that set off alarm bells in his head, but he couldn't place it yet. "You told the nurse that you're pregnant and experiencing frequent vomiting. Is that correct?"

"Yes, but that's not the main reason why I needed to see you."

Carlisle had the distinct feeling that his day was about to get infinitely more difficult before he asked, "Then what is the reason?"

Sarah looked him dead in the eye and said, "I know what you are, Dr. Cullen. You are the only one who can help me."

Her fierce blue eyes had him pinned and he felt much as he had when Elizabeth Masen demanded that he save Edward - exposed and frightened, only more acute this time around. Back then, he only had himself to worry about. Now exposure threatened his entire family, so he couldn't concede so easily. "I'm sorry, but what is it that you think I am?" he finally said.

Sarah suppressed a sigh and seemed almost disappointed. "If you need me to say it out loud, I will, because we're wasting our time on this little dance. Vampire."

Thank God for private exam rooms and noisy emergency departments. "How?" Carlisle asked.

"Because I was in a relationship with one." A flicker of shame passed over her face before the resolved mask went back into place.

"And how do you know he was a vampire?" Carlisle persisted, unable to let go of the notion that she was mistaken.

"He told me," Sarah said flatly. "I didn't believe him at first and then he drank blood in front of me. Also, when he didn't wear colored contacts, his eyes often changed between red and black. He sparkled in the sunlight. His skin was always cold. Is that good enough for you?"

Okay, she wasn't mistaken. Carlisle had to admit to himself that relationships between humans and vampires, despite the law of secrecy that ruled their world, weren't entirely unheard of. Tanya, Kate, and Irina certainly had taken their fair share of human lovers. Before they changed to an animal blood diet, their paramours usually died. Most humans that vampires took as lovers did. In that case, her survival was impressive, especially if this vampire was brazen enough to drink blood in front of her. Sarah saw the recognition in Carlisle's face and said, "You know what I'm talking about, then."

"I do," Carlisle said. And then the implications caught up with him. "Are you saying that this vampire - "

"- is the father of my baby? Yes, I am."

The words flew out of his mouth before he could stop them. "That's not possible."

Sarah hopped off the exam table and she had to steady herself, but that didn't lessen the effect of her vehemence. "I know what's happened to me, Dr. Cullen, and I am telling you that I was in a relationship with a vampire who is the cause of this pregnancy. Do you need me to list out all the sexual partners I've had in my life before you'll believe me?"

Carlisle took another deep breath and he finally recognized the other aspect of her scent - beyond the anemia and pregnancy hormones, there was a faint, but distinct, sweet iciness that only came from a was coming from her blood, not like she had been in close proximity to another vampire recently.

He never had reason to think this could happen. Vampires were not capable of procreating. If they wanted to add to their number, they had to transform a human. A female vampire's unchanging body couldn't accommodate a pregnancy. Since it was true for them, the accepted thought was that male vampires were sterile too. After all, all liaisons with humans usually ended up with them dead. If a woman had been impregnated by a vampire before, she hadn't lived long enough for it to be known.

And yet, Sarah claimed she had.

If this was true - he couldn't stop part of his brain from thinking that there had to be another explanation - this would change everything known about the vampire world.

"No," he said, dazed. "I apologize."

Sarah's eyes narrowed slightly, no doubt catching that him apologizing was not the same as him saying that he believed her. But then her face turned a faint shade of green and she turned for the nearest trashcan to vomit. Or try to, at least. It was mostly dry heaves. "Fuck," she muttered when it subsided.

Carlisle assisted her back onto the exam table. "When did symptoms start?" He felt steadier directing the conversation back to the standard questions he asked patients.

"About two weeks ago." At Carlisle's raised eyebrow, Sarah added, "It didn't start out this bad. It's gotten progressively worse. At first, I thought it was food poisoning but then I decided to take a pregnancy test, which was positive. It's only gotten to the point of not being able to keep anything down, even water, in the last two days."

"Okay, let me get you started on some IV fluids and Reglan." There were more questions burning in his mind – especially about Sarah's vampire lover and if he was someone Carlisle knew – but he needed to step out to clear his head enough to sort out what to do.

The medication room was blessedly empty. His mind kept going in every direction, torn between what was the right thing to do for his family and what was the right thing to do for Sarah. The Cullens lived under the protection of Aro's fondness for Carlisle. He didn't know that taking in a human that knew of vampires and also claimed to be pregnant with a half-vampire baby would do to that protection. He preferred to live in a more egalitarian fashion regarding his family, but he acutely felt the weight of being coven leader now. It was his duty and his duty alone to protect them.

But he also couldn't see how leaving Sarah to her own devices was the right thing to do. It could hardly be expected that the pregnancy would be a normal one and once the baby was delivered, how could a half-vampire exist in the human world? To keep the secret – the paramount law of the vampire world – it seemed the best thing to do would be to help her.

Another thought chilled him to the bone. Would the baby be anything like the immortal children? For everyone's sake, he hoped not.

His phone started buzzing in his pocket, breaking him out of his thoughts. It was a pair of concerned texts from Alice and Edward.

Alice: Why is your future all fuzzy all of a sudden?

Edward: Alice is upset over your future being weird. Are you okay?

To Alice he replied: You know how your visions work better than I do.

To Edward: I'm fine. I'm just dealing with an interesting patient.

Alice: I don't like it.

Edward: Interesting how?

Carlisle sighed and pocketed his phone. He'd deal with them later, after he had a chance to talk to Esme. When he returned to the exam room, IV kit and Reglan in hand, Sarah reclined on the exam table, massaging her forehead. "Are you all right?"

"Oh, just peachy keen."

Carlisle half-smiled and began prepping the IV. "Headache?"

"Yeah." It came out in a sigh as she sat up.

"I'll get you some Tylenol too. Do you have an arm preference?"

Sarah held out her right arm. "This one has all the good veins."

He applied the tourniquet and she automatically made a fist to help the vein pop out. She didn't flinch when he touched her. He felt an odd sense of satisfaction that he didn't have to explain what he was doing or make an excuse for his cold hands.

"I heard you're also a doctor," Carlisle said, wiping an alcohol swab over the vein.

Sarah nodded. Nothing showed in her face in reaction to Carlisle inserting the needle.

"What specialty?"

She let out a short laugh. "Hematology."

"That's –"

"Ironic?" Sarah interrupted with a raised eyebrow. "I know. He thought it was funny too."

There was an edge of bitterness in her voice and Carlisle wanted to ask who he was, but he had enough experience with Esme to know that it was better to tread lightly. Instead he asked, "Where do you practice?"

"Columbia University."

"You've come a long way."

"It was a hellish bus ride. Truly, whoever named it 'morning sickness' should be sued."

"It wasn't me, I swear," Carlisle joked. It got a small smile out of Sarah. He asked a few more standard questions you would ask a pregnant patient as he started the IV line and administered the medication, mentally filing away her answers. Finally, he felt that the question he'd been burning to ask could no longer be avoided. "May I ask who the father is?"

"His name is Mark Thompson." Sarah sighed. "Or, at least, I'm sure about his first name being Mark."

Carlisle frowned, feeling like he should know the vampire by that name, but he could not come up with a face that went with it. He mentally went through all the vampires he met in North America, but none of them went by Mark Thompson.

Sarah continued, unaware of his disquiet. "He told me about you – how you're a bit famous in the vampire world for only drink animals and being a doctor. He said it was the most ridiculous thing he ever heard. No offense."

"None taken. It's nothing I haven't heard before." He couldn't shake the feeling like he should know Mark. "You found me based on that description?"

"I spent way too much time on Google until I found your name attached to this hospital."

The Internet did make it harder to keep a low profile. Jasper did his best to scrub their identities, but sometimes it wasn't possible. "Does he know you're pregnant?"

"No." Sarah stared at the floor and blinked furiously against tears. "He left me before I learned that I was," she added in a shaky voice. "God, it's like I'm a hormonal teenager again."

Carlisle handed her a tissue. "I'm sorry."

Sarah dabbed at her eyes and then balled the tissue tightly in her fist. "It's not your fault."

Carlisle could see that there was more to the story but she did not want to talk about it further, so he asked, "I admit I am wondering what exactly you want my help for."

Sarah frowned. "Dr. Cullen, I don't think regular human doctors are equipped to deal with this."

"And you think I am? This has never happened before."

"Never?"

Carlisle shook his head.

Sarah was quiet, looking more frightened than he'd seen her so far. "Well…shit."

Shit certainly described the situation. He had no idea what to expect with a vampire pregnancy, let alone how his family would react and what Aro would do if he found out… He had to mentally shake himself from dwelling on that right now. "But you misunderstood me. I meant did you want my help to terminate or did you want to go through with the pregnancy?"

Sarah put a hand to her stomach. "Part of me thinks I should terminate. Given the symptoms I have now, I imagine carrying to term would be risky." She sighed. "I don't know. I don't how to justify it to myself or to you, but I want to go through with the pregnancy. I know I'm probably asking a lot of you."

"You are." There was no point in lying to her about that. He already knew he was committed to helping her, despite the potential consequences.

"I'm sorry."

Carlisle waved the apology off. "Well, seeing as I am the only vampire doctor, who else could you go to?"