January 2015
Twenty-Five/Twenty-Seven
Sometimes, he was comforted by the idea that everything had happened for a reason - and the reason was Isabella.
Without her, Edward felt completely rudderless.
Every morning, as he would years to come, Edward Cullen woke up feeling irritable The minute he drew breath consciously, he was flooded with a different kind of foggy, drowsy listlessness.
The feeling didn't leave until he reached the hospital, where it was easy to forget. In the quiet moments between cases, when fatigue made his vision blur, Edward would remember. The way she'd curl into him while reading, her hair tickling his chin. Movements he'd memorized like sheet music. How safe he felt, with the weight of her pressed against the mattress, against his chest.
Isabella.
"You look like shit, Cullen," Ben remarked one morning as Edward struggled to stay upright during rounds. "When's the last time you slept?"
Edward grunted and pushed past Ben. "Fuck off," he barked, sounding eerily like his grandfather.
Caffeinated but still sluggishly drowsy, Edward stepped into the anteroom outside the operating theater. The air smelled of antiseptic and powder, sharp and clean in a way that cut through the fog in his head. He had slept in fits, stops and starts, filled with nightmares he could not remember.
Edward adjusted his scrub cap, tugging it down over his hair, and reached for the sink. The touchless faucet hummed to life with a cold rush of water. He flexed his fingers under the stream, watching the water bead against his skin before turning to soap. The first step of the ritual. One palm cupped the sterilizing soap, and he rubbed it in—nails, knuckles, wrists—scrubbing with a force that bordered on self-punishment.
Edward's mind flickered, traitorously, back to her.
She'd been so thin, and Edward had been fucking paralyzed into inaction. For the first time in his life, he had no fucking clue what to do, and that terror made him procrastinate. Looking back, it was so fucking obvious. Calling his Dad. But he couldn't fucking do not. He couldn't fucking do it. He didn't understand.
Edward wanted to spend the rest of his life with her, but the prospect had made Isabella waste away.
The pain settled in his chest, like a physical weight that he felt with all his senses.
"Are you happy?"
"You make me happy…Most of the time," Edward added jokingly, trying to grin to ease the tension.
Bella lips had turned up faintly at the corners, and she had hugged her knees. "I mean… is this the life you wanted?"
Edward's stomach had lurched, and the frustration and the fear, the fucking fear, had seized him. "I knew this was coming. I know you haven't been happy for a long time now."
"I haven't been happy for a couple of months. And it's not you. It'sthis.I can't – I can't cope with the pressure. This isn't the life I wanted."
That had hurt, so fucking much, that the pain still echoed deep inside him.
Edward gritted his teeth and forced his focus back to the methodical scrubbing.
The surgical brush was stiff against his skin, clearing away invisible threats. He could not afford distraction, not here, not now. Infection started with negligence. He dragged the brush beneath each nail, pressing until his fingertips tingled. His heart pounded in counterpoint to the rhythmic strokes—one, two, three, four—too fast, too unsteady. His breath stuttered, but he willed his face blank, his body obedient. His movements had to be precise. Automatic.
The water turned pink as it spiraled down the drain. Edward had scrubbed too hard, his cuticles raw, but there was no time to dwell on it. Edward let the final rinse cascade down to his elbows, held his hands up—fingers pointed skyward, careful not to let the unsterile water trail back—and stepped back from the sink. The nurse waited with a fresh towel, and he let her drape it over his hands before he methodically patted himself dry, first one side, then the other.
Edward turned to the sterile field, where the circulating nurse held out his surgical gown. His arms slid into the sleeves, his fingers pressing through the cuffs as the gown settled over his shoulders. He did not acknowledge the tightness in his throat as the ties were fastened. The surgical gloves came last, snug against his damp skin, sealing him away from the world beyond the operating table. He took a breath, steadying himself.
XXX
"I think he's just completely immoral."
"You're mad because he disagrees with you politically."
Bella's cheeks flushed, and she grimaced. That grimace she made when she was cornered. Edward had studied her face so intently when they were teenagers – he'd been so fascinated, so lovesick, even then. It had taken him so long to realize it, that was so fucking in love. Edward could read every movement of her lips and brow as if he were reading fucking sheet music.
"It's not that. It's not a political thing."
"You were lecturing him on income inequality – "
"He's a millionaire and he thinks people chose to be poor."
Those days, in the yacht, Isabella had been getting on his nerves. He'd always known to be gentle, to be protective – and his anger burned sometimes, but he held it in. The anger was burning through him these days, merging with his adness. Fuck.
Edward was angry. Fuck. So fucking angry. Annoyed that she was so fucking sanctimonious, so fucking judgmental, self-righteous that she would throw everything away for the sake of… what? Jane Voltaire's dignity? That Felix Musgrave was not a saint? That Edward was – unlike his father – willing to fight to stay ahead?
Fucking incapable of acting like an adult, with adult obligations and interests. He wanted to yell at her – nothing barred – but he was never able to yell. Not when she was in front of him. Something about how fragile she was made him feel so protective -
Edward adjusted his stance, feeling the familiar ache in his lower back that came from standing in one position too long. Six hours into his twelve-hour shift, and this was only his second procedure of the day. He rolled his shoulders beneath his surgical gown, trying to loosen the tension that had taken up permanent residence there.
"Cullen, would you like to perform the appendectomy incision?" Dr. McClenna's voice was calm, eyes steady above her surgical mask.
"Yes, sir," Edward said, feigning a sense of control. His irritation was surging again, making it hard to focus.
As he accepted the scalpel from the scrub nurse, Edward's mind betrayed him. He was hit by a wave of exhaustion and muted grief. Grief for what, he couldn't say. Isabella wasn't dead.
Edward blinked hard, forcing the image of Isabella's eyes away. He positioned the scalpel at McBurney's point, approximately two-thirds of the way from the umbilicus to the anterior superior iliac spine. The patient's abdomen rose and fell in shallow, rhythmic movements under the influence of anesthesia.
"Beginning with a McBurney incision, three centimeters in length," Edward announced, his clinical voice betraying none of the emotional numbness that made him feel exhausted.
His hand trembled slightly as he made the first cut through the epidermis and dermis. The familiar resistance of human skin against cold steel normally centered him, but today it felt distant, disconnected.
"Careful with your angle, Cullen. Remember the fascial layers." Dr. McClenna's voice pulled him back to the present. Irritably, Edward recognized the note of caution. Edward had done this dozens of times. It was a fucking routine appy, for fuck's sake.
Edward nodded, glad his pursed lips were hidden under the surgical mark, proceeding to cut through the Scarpa's fascia, revealing the external oblique aponeurosis beneath. He used retractors to separate the muscle fibers rather than cutting them, following the muscle grain direction as he'd been taught. The scrub nurse handed him cautery tools as he encountered small bleeding vessels, which he addressed with mechanical precision.
As Edward separated the internal oblique and transversus abdominis muscles, his thoughts drifted. To Isabella, like a compass finding north. Obsessively, like they had during their first summer together, his thoughts were consumed.
"I've been wondering for a while – I – We – We – Life brought us together, but maybe – Maybe I – Maybe we weren't meant to last forever. I haven't been – I – We want different things, and – and I don't know you."
It stung again, like a pain receptor burning, hurting almost as much as a drill coming too close to a cavity.
Edward's hand faltered slightly as he cut through the peritoneum, and he almost nicked a small vessel.
"Cullen! Focus, please." Dr. McClenna's voice was sharper now, cutting through his reverie.
"Sorry, Dr. McClenna," Edward muttered. He forced himself to focus.
He carefully identified the cecum and followed the taeniae coli to locate the inflamed appendix, angry and red against the surrounding tissue. The familiar anatomy grounded him temporarily in the reality of the procedure.
"Appendix identified. Significant inflammation present. No visible perforation," he reported, his voice steadying as he settled back into the familiar routine.
He placed clamps to isolate the appendix and mesoappendix, then meticulously ligated the appendiceal artery, double-tying with 2-0 silk sutures. The practiced movements of his hands belied the chaos in his mind. Edward hesitated for a fraction of a second as he prepared to transect the base of the appendix.
"Is there a problem, Dr. Cullen?"
"No, I—" He didn't complete the sentence, instead placing a purse-string suture around the base of the appendix in the cecal wall. As he applied the clamp to crush the appendiceal base, creating a groove for the ligature, his mind clouded again – this time, overwhelmed by irritation.
Edward absently began to cut the appendix before completing the second proximal ligature.
"Dr. Cullen!" Dr. McClenna's voice cracked like a whip across the operating room. "You haven't secured the proximal end! Do you want fecal material in this patient's abdomen?"
Edward froze, catching his near-fatal error. The room fell silent. He could feel the scrub nurse and anesthesiologist exchanging glances over their masks. He'd almost made a first-year medical student mistake—one that could have resulted in peritonitis and potentially the patient's death.
It took all of Edward's scarce humility to muster an apology. "I... I apologize. That was inexcusable," Edward said, keeping his voice cold and steady.
Dr. McClenna's eyes narrowed above his surgical mask. McClenna didn't say a word, but his angry disappointment was palpable. Edward felt it like a physical weight on his shoulders. All his adult life, Edward had sought to excel at Harvard, grudgingly praised by professors and attending physicians alike for his natural surgical talent. Now, with a single moment of distraction, he'd nearly compromised everything.
Edward completed the procedure with painful meticulousness, placing the second ligature correctly before excising the appendix, then inverting the appendiceal stump into the cecum with the purse-string suture. His movements were deliberate, almost robotic, as he irrigated the peritoneal cavity with saline solution.
As they closed the incision layer by layer, Dr. McClenna watched Edward's every move like a hawk. The simple closure seemed to take an eternity under scrutiny.
"Whatever is going on in your personal life, Dr. Cullen," McClenna said flatly, as Edward placed the last subcuticular suture, "it stays outside these doors. In here, your patients deserve your full attention. Medicine doesn't care about your personal life."
Edward grit his teeth irritably. "It won't happen again," he promised, meaning it. Medicine wouldn't break him like Isabella had.
"See me in my office after you complete your post-op notes," Dr. McClenna instructed, sharply.
As Edward discarded his gloves and gown in the biohazard bin, he felt his perfect facade cracking. The handsome, privileged doctor who'd never failed at anything stood humbled, knowing how close he'd come to a disastrous mistake.
Edward pushed through the doors of the operating room and leaned against the wall of the empty corridor, taking deep breaths. He pulled out his phone from his scrub pocket, stared at Isabella's contact photo for a long moment—the one he'd taken on their trip to Maine last summer, her hair windblown, glowing. He deleted it and then snorted derisively, scoffing at himself. Like he could ever forget her face.
He straightened his posture, adjusted his scrub cap, and walked toward the nurses' station to begin his post-op documentation, humiliation in his veins burning hotter than his heartbreak.
"From day one," McClenna said, face filled with clinical detachment. "You came in here acting like none of it was worth your time. I can deal with that, Dr. Cullen. I can deal with entitled. I can deal with cocky. I can't deal with distracted. The profession can't do distraction."
For the first time in his life, Edward was shocked into silence.
"Whatever's going on in your private life," McClenna said sharply. "Deal with it outside my operating room."
That night, Edward found himself in the hospital chapel, though Edward had seldom prayed. His relationship with God was tenuous and awkward. Edward was neither a militant atheist, nor agnostic, nor a believer. Edward just sat there, his heart torn.
Bring her back, he prayed, and it was so eerily like his first heartfelt prayer, almost a dozen years earlier. Bring her back.
There was no response from the wooden cross at the altar. A tear slipped down his cheek, and the longing exploded, up anatomy he knew so well. From the cavities inside his chest, into his lungs, his windpipe, his sternum.
It almost broke him.
At midnight, Edward's father was there to pick him up, like a parent going on the school run for a kid.
It had been three weeks since Carlisle Cullen had shown up unannounced at his apartment door, suitcase in hand, concern etched into the lines of his face. Three weeks of his father's quiet, steady presence infiltrating the dark apartment.
His father had burrowed his way into his life, deciding at some point that it was safer to babysit. Edward didn't have the energy to pretend to find it annoying. Carlisle had become a mix between chauffer, nanny and cook – in effect, a parent. Perhaps Carlisle was trying to make up for the absences after Elizabeth died. Perhaps Carlisle was that worried.
Edward didn't give a shit; his father pulled him through that haze of grief.
"You OK, son?" Carlisle asked quietly, stroking Edward's hair back once.
Like an adolescent, Edward grunted.
Edward hadn't expected his father to still be there, weeks after the acutest phase of the break up. It had been three weeks since Carlisle Cullen had shown up unannounced at his apartment door, suitcase in hand, concern etched into the lines of his face. Three weeks of his father's quiet, steady presence, catching the debris of Edward's life.
His father had burrowed his way into his life, deciding at some point that it was safer to babysit. Edward didn't have the energy to pretend to find it annoying. Carlisle had become a mix between chauffer, nanny and cook – in effect, a parent. Perhaps Carlisle was trying to make up for the absences after Elizabeth died. Perhaps Carlisle was that worried.
Edward didn't give a shit; his father pulled him through that haze of grief.
They had settled into a kind of pattern in just a handful of weeks. Edward would leave for the hospital before dawn, often forgetting to eat breakfast until he discovered his father had slipped a protein bar and apple into his bag. He would return in the evening to find his apartment tidied, dinner prepared, and his father settled in the spare room with medical journals or some kind of fucking paperwork.
Initially, Edward had insisted on a timeline—"Just until I get through this difficult rotation" or "Only until I find my footing with Dr. Winters." But those benchmarks passed, and somehow, his father remained.
The arrangement settled into an unexpected harmony. His father drove him to work on days when exhaustion made the drive seem insurmountably dangerous. Carlisle never commented on the punishing hours. He ensured that bills were paid and administrative tasks completed, but didn't lecture Edward about financial responsibility. He prepared nutritious meals but didn't hover to ensure Edward ate them.
It was a safety net so unobtrusive that Edward sometimes forgot it was there—until moments when he needed it most.
"I almost killed someone," Edward muttered darkly, settling into the car.
Carlisle hummed sympathetically. "Almost. What happened, kiddo?"
"I almost forgot to close the proximal end at an appy," he grunted.
Edward was almost irritated by his father's sly chuckle.
"What the fuck?"
"Every year, I get a kid messing up dosages of some potent chemo – like doxorubicin, because they can't wrap their head around the metric systems. I have them double check with me when they're potent drugs, 'cause it happens."
"What happens?" Edward mumbled grumpily.
"Shit, kid. Shit happens."
February 2015
Twenty-Five/Twenty-Seven
The Proximal End incident had woken him up from the haze. Edward threw himself into marathon shifts with a kind of desperate intensity, volunteering to cover holidays and weekends. McClenna, at first suspicious, became increasingly less so. His colleagues whispered about his obsession.
Edward's alarm jolted him awake at 3:45 AM, a full hour before his scheduled pre-rounds. He'd managed three hours of fitful sleep—more than the night before, at least. The darkness of his apartment felt oppressive as he swung his legs over the side of the bed, his bare feet meeting the cold hardwood floor. He scrubbed his palms over his face, feeling the stubble he hadn't bothered to shave for two days.
"Focus," he muttered to himself. It had become his mantra since the appendectomy debacle eight days ago.
In the bathroom, Edward avoided his own reflection as he brushed his teeth. The last time he'd really looked at himself, he'd seen the same shaken expression that had been on his face in the OR—that moment when Dr. Chen had caught his potentially fatal error. The memory made his stomach turn.
Fifteen minutes later, dressed in fresh scrubs, Edward slipped into the hospital through the staff entrance. The corridors were quiet at this hour, populated only by night shift nurses and the occasional resident finishing up notes. He nodded at familiar faces but didn't stop to chat. Socialization had fallen to the bottom of his priority list.
The surgical skills lab was empty, as it always was at this hour. Edward flipped on the lights, illuminating the room with its practice stations, laparoscopic simulators, and anatomical models. He'd practically lived here this past week, arriving before dawn and often staying past midnight. The janitorial staff had started leaving the coffee pot full for him.
Edward set up the vascular anastomosis station, arranging the synthetic vessels, sutures, and instruments precisely as they would be in the OR. From his backpack, he withdrew a worn copy of Rutherford's Vascular Surgery, opened to the chapter on aortic dissection, marked with dozens of colored tabs and annotations.
He glanced at his watch. He had precisely two hours and ten minutes before he needed to be on the ward for pre-rounds.
"Let's go," he said to the empty room, picking up the needle driver and forceps.
Edward had always been technically gifted—his hands naturally steady, his spatial reasoning exceptional. It was part of what had made him so sure he would succeed at a shithole like Baystate in Springfield. But after the appendectomy, he no longer trusted his natural abilities. Now, he relied on obsessive repetition.
He worked through a series of increasingly difficult anastomoses, starting with end-to-end connections of simple vessels, progressing to end-to-side configurations, and finally to complex patch angioplasties. Each suture placement was methodical, each knot tied with perfect tension. When he made even the slightest error in technique—spacing too wide, tension too loose, catching the back wall—he started over.
As the clock approached 6:00 AM, Edward moved to the laparoscopic simulator, focusing on fine motor control and depth perception in the constrained visual field of minimally invasive surgery. His hands moved with increasing confidence as he manipulated the instruments, placing clips and sutures in the virtual environment. The simulator recorded his metrics: time, precision, efficiency of movement. Yesterday, he'd broken his personal record. Today, he intended to surpass it again.
McClenna found him in the surgical skills lab hours later. "Show me what you've got."
Edward selected a 6-0 Prolene suture and began a delicate end-to-side anastomosis on the synthetic vessel. His hands moved with practiced precision, each suture placed at exactly the right depth and distance.
McClenna watched silently, his expression neutral. When Edward finished, the older doctor inspected Edward's work closely.
"Your technique has always been good," he said finally, in a voice that was as dry as hot sand. "But you're becoming more diligent and that's almost as important."
"Thank you," Edward said, recognizing the compliment.
"You're assisting Dr. Winters next week on the Reeves case," he said, changing the subject.
Edward looked up in surprise. "I am?"
"He requested you specifically."
"But... why?" Edward couldn't keep the confusion from his voice. Harold Winters was notoriously selective about his surgical assistants, typically choosing only senior residents or fellows.
"Because I recommended you," McClenna said simply.
Edward was momentarily speechless. "That's... thank you, Doctor."
"Don't thank me yet," McClenna cautioned sternly. "It's a complex Type B dissection. If you want to be ready, you need to know the procedure cold, understand every potential complication, and be able to anticipate Dr. Winters' every move."
"I will be," Edward promised.
"Good." The elder doctor turned to leave, then paused at the door. "And get some actual sleep tonight. That's not a suggestion; it's an order. The best surgeons know that rest is part of preparation."
XXXX
Two weeks after the appendectomy incident, Edward stood at the sink in the surgical prep room, methodically scrubbing his hands and forearms. Five minutes with chlorhexidine gluconate, working the antimicrobial solution under his nails and between his fingers, up to his elbows in practiced circular motions. The familiar ritual calmed him, unlike the thundering in his chest.
Today was different. The patient, Martin Reeves, a 57-year-old, had been admitted with a complex Type B aortic dissection that had originated in the descending thoracic aorta and extended to the abdominal aorta, just above the renal arteries. The case was challenging enough that Dr. Winters, the Chief of Vascular Surgery, had been called in, and would be leading the procedure. Somehow—perhaps as a test, perhaps as punishment for his near-miss two weeks prior—Edward had been selected as first assist.
He dried his hands with a sterile towel, backing into the OR as the scrub nurse helped him into his surgical gown and gloves. The operating room was already a hive of activity—anesthesiologists monitoring vital signs, nurses arranging instruments, the perfusionist preparing the cardiopulmonary bypass machine.
"Nice of you to join us, Dr. Cullen," Dr. Winters said, his deep voice carrying across the room. At sixty-three, Harold Winters was a legend in vascular surgery circles, known for his steady hands and innovative techniques. "I hope you've reviewed the imaging."
"Yes, sir," Edward replied, stepping toward the light box where Mr. Reeves' CT angiogram was displayed. "Type B dissection extending from just distal to the left subclavian artery down to the juxtarenal abdominal aorta. False lumen partially thrombosed in the descending thoracic segment. True lumen compression at the visceral segment."
Dr. Winters nodded, apparently satisfied with Edward's assessment. "And our approach?"
"Left posterolateral thoracotomy through the fifth intercostal space, sir. Partial cardiopulmonary bypass through the left femoral vein and artery." Edward felt a flutter of nerves, but his voice remained steady. The memory of his mistake with the appendectomy had haunted him these past two weeks. He'd thrown himself into study, reviewing vascular procedures until 3AM most nights, determined never to falter again.
"And the critical steps?" Dr. Winters was clearly testing him.
Edward took a breath. "Proximal and distal control of the aorta, sequentially clamping the intercostal arteries. Longitudinal arteriotomy along the dissection. Excision of the intimal tear and primary repair with a Dacron graft. Reattachment of significant intercostal arteries to prevent spinal cord ischemia."
A flicker of approval crossed Dr. Winters' face. "Very good. And your concerns?"
"Paraplegia secondary to spinal cord ischemia during aortic cross-clamping, renal failure from inadequate perfusion, coagulopathy from prolonged bypass, and respiratory complications from the thoracotomy approach," Edward recited, having memorized the major complications.
"Let's not witness any of those today, shall we?" Dr. Winters said dryly. He turned toward the anesthesiologist. "We ready, Dr. Patel?"
"Patient is stable, intubated, arterial line placed in the right radial artery, central venous access obtained via right internal jugular, cerebrospinal fluid drain in place. MAP at 65, heart rate 72, SpO2 100%," Dr. Patel replied.
"Let's position the patient." Dr. Winters moved toward the table, and Edward followed.
Together with the surgical team, they positioned Mr. Reeves in the right lateral decubitus position, his left side elevated. Edward helped secure the patient's shoulders and hips with tape, then assisted in prepping the surgical field from the left posterior axillary line to the midline of the back, extending from the scapula to the iliac crest.
Once the patient was draped, Dr. Winters made the initial incision with confident precision. "Scalpel," he commanded, and Edward watched as he created a curved incision starting at the posterior axillary line, following the fifth intercostal space, and extending posteriorly and slightly upward.
"Retractor," Dr. Winters called, and Edward moved swiftly to assist, helping to expose the layers of tissue. They worked through the latissimus dorsi and serratus anterior muscles, then carefully entered the pleural space through the fifth intercostal space.
"Rib spreader," Dr. Winters said, and the scrub nurse handed him the Finochietto retractor. Edward helped position it, gradually opening the intercostal space to provide adequate exposure.
As they approached the aorta, Edward's focus narrowed to the surgical field. No thoughts of Isabella entered his mind; his entire consciousness was centered on the pulsating vessel before them and the life that depended on their precision.
"We'll need to identify and preserve the recurrent laryngeal nerve," Dr. Winters remarked. "Dr. Cullen, can you identify it for us?"
Edward had been anticipating this. He carefully traced along the aortic arch, identifying the delicate nerve as it looped under the ligamentum arteriosum. "Here, sir," he said, pointing with a forceps to the nerve.
"Good. Now help me mobilize the descending thoracic aorta."
Edward worked methodically, assisting in the dissection of the mediastinal pleura and the careful isolation of the thoracic aorta. They identified intercostal vessels that would need to be sacrificed or reimplanted later.
"The perfusionist is ready," the circulating nurse announced.
"Let's establish partial bypass," Dr. Winters decided. "Dr. Cullen, you'll assist with the cannulation."
Edward's heart raced, but his hands remained steady as he helped Dr. Winters place the arterial cannula in the left femoral artery and the venous cannula in the left femoral vein. The perfusionist gradually initiated the bypass, diverting blood flow from the lower body.
"Proximal clamp," Dr. Winters requested.
Edward handed him the aortic cross-clamp, which Dr. Winters skillfully applied just distal to the left subclavian artery. "Distal clamp," came the next command, and Edward provided another clamp, which was positioned just above the diaphragm.
"Starting intercostal artery ligation," Dr. Winters announced. "Dr. Cullen, I want you to help me identify and mark the Adamkiewicz artery if we encounter it."
Edward nodded, aware of the crucial importance of preserving the artery of Adamkiewicz, which typically supplied blood to the anterior spinal cord between T8 and L1. A spinal cord infarct would be catastrophic.
They proceeded with the arteriotomy, a longitudinal incision along the lateral aspect of the aorta. As the vessel was opened, Edward could clearly see the intimal tear and the false lumen, partially filled with thrombus.
"There's our culprit," Dr. Winters muttered. "Extensive tear. We'll need to excise this section and replace it with the graft."
For the next hour, they worked in tandem, excising the damaged section of aorta containing the intimal tear, carefully preserving critical intercostal vessels. Edward anticipated Dr. Winters' needs, providing instruments before they were requested, maintaining optimal exposure, and assisting with suture placement.
"I'm going to let you place the distal anastomosis, Dr. Cullen," Dr. Winters said suddenly.
Edward's head snapped up in surprise. This was unexpected—a significant vote of confidence from the senior surgeon.
"Yes, sir," he replied, accepting the needle holder and the running 3-0 Prolene suture. His fingers felt the familiar weight of the instruments, and a sense of calm focus descended over him.
With meticulous precision, Edward began the anastomosis, connecting the Dacron graft to the distal end of the native aorta. Each suture placement was exact, maintaining appropriate spacing and depth, creating a hemostatic seal without narrowing the lumen.
"Excellent tension," Dr. Winters commented as Edward worked. "Not too tight, not too loose."
Edward completed the anastomosis and tied off the suture. Dr. Winters examined his work carefully, then nodded in approval. "Well done. Now let's do the proximal anastomosis together."
They completed the proximal connection with similar precision, then prepared for the critical moment—the release of the clamps and restoration of blood flow through the repaired vessel.
"Release the distal clamp slowly," Dr. Winters instructed.
Edward held his breath as the clamp was gradually opened. The graft swelled slightly with blood pressure, but held firm with no leakage at the suture lines.
"Proximal clamp coming off," Dr. Winters announced.
As full blood flow was restored, Edward watched intently for any sign of bleeding. None appeared.
"Protamine," Dr. Winters called to the anesthesiologist, requesting the heparin reversal agent as they prepared to wean from bypass.
The next hour was spent carefully closing the thoracotomy, reapproximating the ribs with heavy sutures, closing the muscle layers, and finally the skin. Two chest tubes were placed to evacuate air and any fluid accumulation.
As Edward placed the final subcuticular skin suture, he felt a profound sense of accomplishment wash over him. There had been no complications, no moments of uncertainty on his part. He had been present—fully present—throughout the complex seven-hour procedure.
"Nice work today, Dr. Cullen," Dr. Winters said as they disposed of their gowns and gloves. "A hell of an improvement over what I've been hearing."
So Dr. Winters knew about the appendectomy incident. Of course he did. Edward flushed slightly but met the senior surgeon's gaze directly.
"Thank you, sir. I appreciate the opportunity."
Dr. Winters studied him for a moment. "Dr. Al Farouk tells me you've been practically living in the surgical skills lab these past two weeks."
Edward nodded. "I had something to prove."
"Keep it up."
As Edward left the OR, exhaustion finally started to seep into his bones. The adrenaline that had sustained him was fading, replaced by a bone-deep fatigue—but also a quiet satisfaction. He stopped by the surgical waiting room, where Mr. Reeves' wife and daughter were anxiously waiting.
"The procedure went very well," he told them, watching relief transform their worried faces. "Dr. Winters was able to repair the tear in Mr. Reeves' aorta. He's being transferred to the ICU now, and you'll be able to see him soon."
Mrs. Reeves clasped his hand, her eyes brimming with tears. "Thank you, Doctor. Thank you so much."
XXX
After the Reeves incident, Edward went back to the chapel.
That night, he broke down in the locker room, sobbing until his throat was raw.
At night, he'd find himself reaching for his phone, thumb hovering over her number. He'd composed a thousand messages in his head: I miss you. I'm sorry. I love you. Please come home. He never sent them. She'd asked for time, and what was left of his
But God, how he missed her. Missed her smile, her laugh, the way she'd call him out on his bullshit. Missed shit that made him feel like a whipped idiot - the way the sunlight slanted across her face in the morning and made her eyes glow. The way her little hand felt nestled inside of his. Missed their quiet moments, when words weren't necessary and just being together was enough.
So Edward didn't mind her random calls. When one finally came, he wasn't too pathetic to take crumbs. "I – I'm sorry," she would croak, and her guilt would saturate her voice. "I – I wanted to hear – "
"The sound of your voice," Edward finished for her, quiet and desperate and raw.
They both stayed silent for a long moment, just breathing together through the phone. Edward closed his eyes, remembering how she used to fall asleep against his chest, her breaths evening out into a gentle rhythm.
"How are you?" he asked finally, keeping his voice soft, as if speaking too loudly might break whatever fragile connection this was.
"I'm...okay," she said hesitantly, and her voice was shaking with tremors, and he felt so protective he wanted to scream. He could hear the tremor in her voice, could imagine her fingers twisting in her sleeves the way they did when she was anxious. "I found a place to stay. Angie's letting me sublet."
It was a shard of ice that pierced him. Hurt. Like she was splitting them further apart.
A therapist had once told him he responded with anger when he was sad.
Edward had called bullshit.
His voice was low, and he clamped his teeth over his bottom lip with anger. "You can stay at our – at the apartment."
"I shouldn't," she whispered. "Angie agreed to let me sublet for a bit, and…"
And we're still done.
"Why are you doing this to us?" Edward asked - voice hot, and raw, and torn. Like a fucking skin graft.
The silence stretched again, heavy with all the things they couldn't say. Edward pressed the heel of his hand against his eyes, fighting back tears. And then, pathetically, in a murmur that came from the raw, most vulnerable part of him: "Please come back."
"Edward. I –"
"Please."
"I should go," she whispered finally, her voice cracking. Edward could hear her tears. "It's late, and you probably have surgery tomorrow."
"Yeah," he agreed, though everything in him screamed to keep her on the line. "Take care of yourself, Bee."
He heard her sharp intake of breath at the nickname. "You, too," she murmured. "Take good care of yourself, too."
Edward sat in the dark for a long time afterward, phone clutched to his chest, remembering how it felt to hold her. Tomorrow he would go back to his self-imposed exile of endless surgeries and sleepless nights. But for now, he let himself remember - the weight of her in his arms, the scent of her hair, the sound of her breathing.
It wasn't enough. It would never be enough. But it was all he had left.
"You're back early," his father remarked, not looking up from the cutting board where he was methodically dicing an onion with the precision of a surgeon. Despite having specialized in oncology rather than surgery, Carlisle Cullen handled a kitchen knife with remarkable skill.
"Surgery finished sooner than expected," Edward replied, dropping his messenger bag by the door and slipping off his shoes. The apartment smelled of garlic and herbs, reminding him of his mother. Reminding him of Isabella.
His father nodded, scraping the onions into a sizzling pan. "How was the thoracoabdominal aneurysm repair?"
Edward paused in the act of loosening his tie. "How did you know about that?"
A slight smile crossed his father's face. "Winters and I were residents together at Rutgers. We still talk."
Of course they did. Edward should have known.
"It went well," Edward said simply, though in truth, the procedure had been a triumph. "Finally."
His father turned to face him fully, wiping his hands on a dish towel. "Harry said you were exceptional."
Edward felt an unexpected flush of pride at the praise, though he kept his expression neutral. "He's a good teacher."
"He also said you've lost weight."
And there it was—the real reason behind the impromptu lasagna his father was preparing, the container of protein shakes that had magically appeared in his refrigerator, the grocery deliveries that arrived like clockwork every Monday morning.
"I've been busy," Edward said, a defensive edge creeping into his voice.
His father didn't push. Instead, he turned back to the stove, adjusting the heat under the pan. "Dinner in twenty minutes. You have time for a shower if you'd like."
The suggestion was gentle, but Edward recognized it for what it was—his father's diplomatic way of saying he looked like hell. He ran a hand through his hair, aware that he'd been so focused on reviewing charts for tomorrow's cases that he'd neglected basic grooming.
"I'll be quick," he conceded.
In the shower, as hot water poured over tense muscles, Edward reflected on his father's extended presence in his life. Edward had to admit there was comfort in returning home to a clean apartment, prepared meals, and laundered scrubs. His father moved through his space with quiet efficiency, anticipating needs before Edward himself recognized them.
By the time Edward emerged from the bathroom, his father had set the small dining table with actual plates and silverware, rather than the disposable options Edward had been using when he bothered to eat at home at all.
"Wine?" his father offered, already pouring a glass of cabernet.
Edward hesitated. "Early shift tomorrow."
"One glass won't compromise your performance." His father set the wine at Edward's place setting.
"I know what you're trying to do, Dad," Edward said quietly to his lasagna.
"Hhm? What am I trying to do?" Carlisle was using his Uncle Carlisle voice – when was playful with Isabella.
"You know what I mean," Edward said, almost shyly. "Thanks."
"You don't have to thank me," Carlisle murmured, sounding almost tortured. "Sometimes I think… If Isabella – Isabella took care of you when you were kids, but…"
Edward flinched, as if the sound of her name was a wide-open flame to bare skin.
"But I was supposed to do it. And I failed at it. And I'm never going to abandon you like that again."
"Dad," Edward said, his throat tight. He felt tears burning his eyes. "It's OK. You were really – well, fucked up over it, and I –"
For the first time in his life, Edward meant those words.
"I was, but you – you were the most important thing to both of us, and I left you out to dry. I'm not doing that again."
"I'll be fine. I am fine. You've been here for so long. You don't have to stay here."
His father took a sip of wine, his expression carefully neutral. "I've taken a sabbatical from my practice. Six months, potentially extendable."
"Six months?" Edward set his fork down with more force than intended. "Dad, you can't—"
"I most certainly can," his father interrupted mildly. "I have competent partners who can handle my patient load, and enough accumulated leave to take a proper break for the first time in ten years."
Edward stared at him, realization dawning. "You're not here because of a sabbatical. You took the sabbatical to be here."
His father met his gaze steadily. "Is that so difficult to believe?"
"But the hospital – you're attending oncologist –"
"Will survive without me," his father finished. "But I don't want you to survive without me again."
Six weeks after his father's arrival, Edward faced one of the most challenging days of his internship. A routine aortic endograft had turned catastrophic when the patient—a 62-year-old professor of linguistics—developed an acute dissection during the procedure. Despite four hours of heroic efforts by the entire surgical team, they couldn't save him.
Edward had performed CPR until his arms ached, had assisted with the emergency thoracotomy, had held retractors until his fingers numbed. And still, they had lost the patient. The first death where Edward had been directly involved in the surgical team.
He had maintained his composure through the death pronouncement, through the solemn task of closing the incisions on a body that no longer needed repair, through the devastating conversation with the man's family. He had written his notes with clinical precision, attended the mandatory debriefing, and changed out of his bloodied scrubs with mechanical detachment.
It wasn't until he stepped outside the hospital, the cool evening air hitting his face, that he felt something crack inside him. His hands began to shake, his breath coming in short gasps. He fumbled for his phone, unsure who he planned to call—though he was aching for Isabella, who had once been his emotional anchor but was slipping away.
Before he could dial, a familiar car pulled up to the curb. His father's sedan, idling precisely where Edward had emerged from the building.
Edward slid into the passenger seat, not questioning how his father had known.
"Bad day?" his father asked simply, pulling away from the curb.
Edward nodded, unable to trust his voice.
His father didn't press for details, didn't offer platitudes about how death was part of medicine or how Edward would grow accustomed to losing patients. Instead, he drove in silence, one hand occasionally squeezing Edward's shoulder.
When they reached the apartment, his father guided him inside and poured him a beer They sat in the living room, the only sound the occasional clink of ice against glass, until Edward found words again.
"We did everything right," he said finally, his voice hoarse. "Everything by the book. And he still died."
His father nodded. "Sometimes they do."
"How do you handle it? Year after year, watching cancer patients—"
"Some days, not well," his father admitted. "Those were the nights I came home late, after you were in bed. Your mother understood. She would sit with me, much like this, until the edges softened." He looked down at his empty, amber-hued bottle. "I miss Mom the most when I lose a patient."
Edward realized with sudden clarity that his father's presence wasn't just about ensuring he ate properly or paid his bills on time. It wasn't even entirely about fulfilling a promise to his dying wife. Carlisle Cullen was there because he, too, needed someone. The widower and the jilted fiancé, both navigating losses of different kinds.
"Thank you," Edward said quietly.
His father's smile was small but genuine. "That's what fathers are for, even when their sons think they're hot shit."
The gentle teasing broke something loose in Edward's chest, and he found himself smiling for the first time that day. "I'm not that bad."
"You're exactly that bad," his father countered. "But you come by it honestly."
March 2015
Twenty-Five/Twenty-Seven
Edward had been nineteen the first time he entrusted a secret to Alec Voltaire. It had been the least fragile of his secrets – that his mother had died. It was Edward's litmus test: the day after, Edward had searched for signs of betrayal, in the faces around him. Seeing none after a week, Edward – lost and lonely – had settled into a farce of a friendship with Alec.
"Meghan is pregnant," Alec said, without further ado, in an inscrutable voice.
Edward didn't make a sound, confused at Alec's tone.
Unbidden, it exploded in him. The What If, in capital letters. The urge to step into his shoes. What it would feel like to know Isabella was pregnant with their baby. The emotion would've been too explosive to keep it out his voice.
"Fuck, man," Edward said, just as dryly. "Congratulations?"
"Yeah," Alec sneered. "Congratulations."
There was a silence that settled between them – comfortable to Edward after many such silences.
"Meg's letting me have a last week of freedom. Mustique, again."