Outtake from Chapter 23 in Carlisle's POV, Part 1

This outtake, divided into two parts, is entirely in Carlisle's point-of-view, encompassing Bella's arrival at the hospital, her treatment, and the meeting with the wolf pack. This part of the story must be told before the coming events in Pinned but Fluttering occur. Thanks for reading, and please enjoy!

Also, I am not a doctor so am taking wild guesses with the medical information just from watching every season of ER. So please forgive any medical mistakes contained herein. ;)

Disclaimer: The Twilight Universe belongs to Stephenie Meyer. This story does not intend to infringe upon any copyrighted material and is written for mere enjoyment, not for profit. The remainder of the story belongs to Cassandra Lowery and should not be copied or reproduced without express written consent.

Carlisle's POV

"There's a van pulled up in the ambulance bay," one of the orderlies called.

It was a rather cold January night at my place of work, Forks Community Hospital. Despite the possible emergency in the ambulance bay, the orderly, a nice young man named Derek, and I pulled on jackets before jogging out to the rather dilapidated van parked sideways, the side door just sliding open as we approached. Not that I needed the jacket as Derek did, but appearances were important, especially when working in such close proximity to humans as I did.

Immediately upon the opening of the van door, a pungent stench, almost as repulsive and wretched as that of rotting meat, filled my head. I took a deep breath, grimacing at the scent, then held my breath. Usually my extraordinary sense of smell aided greatly in diagnostics, but when on rare occasions when an odor this acrid and disgusting hit my nose, I took in just enough air to allow for speech, and then refused to breathe further.

The dark-skinned driver of the van had to be no more than eighteen or nineteen, and he glared at me with unveiled loathing. I ignored him, moving instead to the open side door where another man, slightly older than the driver but with the same odd shade of skin, held a small, trembling form in his lap.

I gathered from the long, dark hair draped over his arm that the person he held was a young girl. As I drew up beside him, he, too, scowled at me and seemed to hold his breath, too. But I was far too concerned by our new patient to puzzle over these strange young men and their apparent antipathy toward me.

Still holding my breath, I reached one hand toward the girl's face, cupping her cheek. Her face was completely covered with partially-dried blood from a laceration along her hairline, and one eye was swollen shut. As I touched her, the coolness of her skin concerned me; she was obviously going into shock, if she wasn't already there.

The young man holding her was saturated in her blood, and he, too, was shaking. His face was set in supreme restraint.

I hurried to assure him, "Sir, just hang on, and we'll help her." Tensing, the man started to slide from the van, trying to hand the girl off to me.

"Here, take her. We have to go," he said through his clenched jaw. He tensed further as he moved to give the girl to me. As he did so, I detected further movement inside the van. A petite girl with the same dark skin and wide dark eyes stared at me, the emotion of fear quite obvious in her features which were lit by the outdoor floodlights around the ambulance bay. Apparently she had been the victim of some kind of attack a year or two before; one side of her face was marred by three deep scars from her hairline to her chin, pulling down the corner of one of her expressive eyes and causing her mouth to remain in a permanent frown.

The girl, who looked to be around nineteen or so, reached out toward the tense man holding the girl, attempting to calm him. "Sam, we're doing this for Bella," she whispered soothingly.

Oh dear Lord! Isabella! my mind screamed.

I gasped, "Oh my god! This is Bella? There's blood everywhere!" Guilt filled me as my eyes scanned her still-trembling form. Her injuries had been such that I had failed to recognize her, and I hadn't caught her scent because I was holding my breath.

The man called Sam was now absolutely rigid with hatred; his eyes burned into mine with the depth of his emotions.

"As if you can't tell who she is, leech!" he growled at me. "You know her scent; I know you do."

Despite Isabella's obvious physical distress, I had to deal with whom I now knew this man...and probably the driver and the girl, too, to be. Quileutes. No wonder their stench had affected me so strongly.

I was just glad that Derek had sucked inside to bring out a gurney for Isabella so that he or any other human would not overhear our low argument.

"Apparently your stench masks human scent," I snapped, angry with myself that I had been so weak as to hold my breath when I could have helped Isabella that much sooner.

I bent over Isabella, so still and fragile in this hulking man's arms, and gently patted her face with my fingers as I called, "Bella, sweetheart, what happened?" No response. I tried again, patting her cheeks more insistently, "Bella? Bella?"

Still no response.

I gently shook her shoulder as I called her name again, but she did not respond. I was worried about trying the sternal response with her possible injuries, but it needed to be done.

As gently as I could, I pressed my ice-cold knuckle against her sternum; usually patients roused into consciousness when this method was applied.

But Isabella did not respond.

Derek and another orderly drew up behind me with the gurney. I spoke over my shoulder to them, "No response to stimuli and no sternal response to pain."

Derek nodded in understanding, his young face very serious.

"Here, help me transfer her to the gurney," I said coldly, approaching Sam to take her from his arms.

Sam stiffened, holding Isabella's limp form closer to his body. Heat seemed to radiate from him which was a good thing for Isabella; it may be helping to mitigate the shock she was in.

But his delay in giving her into my care could be a matter of life and death for Isabella.

"Give her to me now, dog," I growled in a voice low enough not to reach the ears of the two orderlies. I was angry; I wanted to know who had injured Isabella so seriously. It took great control to insist somewhat calmly, "I have to assess how badly she's injured. Look at her face! There's blood everywhere! What the hell did you do to her?"

Sam's temper flared. "I didn't do anything! I am trying to save her life! Why else would I bring her here, bloodsucker? To you, of all...people!"

I glanced over my shoulder at the confused orderlies. "We'll discuss this later. At the eastern end of the boundary beside the lake. I'll send a delegation before dawn; I doubt I'll be able to leave Bella before then." I lowered my voice to a menacing hiss, "And you will tell us exactly what happened, mongrel. How dare one of your kind harm this girl?"

Sam bared his teeth at me in challenge. He stepped nearer to me, his face nearly in mine as he scathingly inquired, "Can you control yourself, leech? You've mentioned her blood more than once tonight-"

The nerve of him, asking about my control when someone from his tribe had attacked Isabella in the first place.

"Bloodlust hasn't been an issue for me for two centuries, and I have never consumed human blood. Satisfied?" I hissed, baring my teeth in return.

Sam nodded reluctantly, and the girl released him. She scooted near to Isabella, then leaned over to kiss the top of her head. "Be safe, Bella Swan," she murmured quietly. Glancing up at me, she smiled tightly, and I sensed her trust. She may be young, but she was wise. I returned her smile grimly, nodding.

I then turned my back on the large Quileute, ignoring the steady growling from the driver as I called over my shoulder, "Get that gurney over here," I directed calmly, my voice contradicting my roiling emotions.

Derek and the other orderly came forward to help with Bella. I could easily have lifted her myself, but one must keep up appearances for the humans. "On my count...one, two, three." We lifted her gently from Sam's arms and onto the gurney.

We immediately moved the gurney toward the wide double doors of the ambulance bay and into the emergency room. The nurses had prepared Trauma Room Two for Isabella, and we quickly wheeled her in. The nurses began gently cutting off her clothing, being careful to not exacerbate her injuries.

Cathie, my favorite nurse to work with, pulled an oxygen mask over Isabella's mouth and nose to help increase her oxygen saturation levels.

Once her clothing was removed, I started examining for the most likely injuries: the rapid bruising on her side indicated the very real possibility of internal bleeding. I was fairly certain that I caught the scent of internal bleeding; blood had a slightly different smell when not exposed to air, such as when people bled externally. I smelled a more potent scent, as if blood were pooling somewhere inside her torso.

With extreme care, I palpated her chest, her abdomen, her sides, and immediately detected abnormal rigidity beneath her rib cage. In a low voice I asked Marcy for the ultrasound machine, and after she applied the gel on Isabella's side, I checked her organs.

I was certain that several ribs were broken, and one of them could have perforated an organ. And sure enough, I detected a liver laceration via ultrasound. A perforation such as this can cause death if not treated immediately as the liver bleeds copiously when lacerated.

I forced away the fear I felt for Isabella's life as I calmly informed the staff of her lacerated liver and broken ribs. Under my direction, Cathie ran a liver function panel while Marcy hung four units of typed-and-crossed blood.

But my usually unflappable voice rose slightly as I completed my commands with an imperious "Now!" Cathie stared at me, shocked by my tone.

I tried smiling apologetically at her, and she shook her head in confusion.

Then Isabella's heart fluttered into an abnormal rhythm. The monitors beeped in warning, then quieted as her heart shifted back into a normal rhythm on its own. I let out a long breath, not realizing that I had held it in while her heart fluttered.

I just hoped that the abnormal rhythm did not indicate issues during the surgery.

"Bella, you stay with me," I told her quietly. I knew that people could often hear us despite their bodies appearing be unconscious. I hope that she did listen...and that she would stay alive. I had lost her mother far too soon; I couldn't lose Isabella as well.

"Carlisle?" Isabella whispered faintly, her eyes not opening.

I took her hand, grateful that we could exchange a few words. "Yes, sweetheart, it's me. Just rest now. I'll take care of you," I assured her softly.

I turned to the ER team. "She's bleeding internally; her liver's been ruptured. Get those units of O-Neg on the rapid infuser, NOW. And add two more units. We have to get her to the OR immediately. She's bleeding out. Let's move, people!" I ordered urgently.

"Carlisle?" Isabella sighed. I gripped her hand, pressing gently. "You'll be all right, Bella. We're taking you to the OR for emergency surgery. We'll repair the liver laceration and make sure you have no other internal injuries." My voice broke slightly on the final word.

This poor girl...and it was my fault that Isabella lay here, broken and bleeding, because I did not insist that she leave La Push and stay with us. Logically I knew that I couldn't have forced her, but the guilt I felt was still unmitigated by my feeble logic.

We started transporting her to the OR speedily, moving her gurney at a quick jog.

Isabella opened her eyes for a moment, managing to focus her uninjured eye on me as she whispered my name again. When she saw the concern on my face, she tried to smile weakly, whispering so faintly that I knew I was the only one of the trauma team to hear her say, "It's okay. It doesn't even hurt."

As she finished speaking, her heart gave one off-kilter beat, then halted. "Stop the gurney!" I ordered, panicked.

"She's flatlined. I'll start compressions. Cathie, keep squeezing in that blood. Marcy, run ahead and get the intubation kit ready. STAT!"

As the team flew into concise action and I hopped onto the gurney, carefully compressing her chest for fear of causing additional trauma due to her broken ribs, I began to pray earnestly for Isabella's fate. My father's Anglican faith had been passed down to me, and, like many humans and very few vampires, I relied on my faith at times of great stress.

We rolled her swiftly into surgery, myself seated atop Isabella's body, doing CPR to force her heart to circulate blood.

Once she was in the OR, I jumped off the gurney while Cathie took over CPR and Marcy placed a mask over her face, squeezing the bag to force air into her lungs. I quickly intubated her as Cathie continued the compressions, attaching her to the ventilator which would breathe for her.

Then I grasped the paddles of the defibrillator to shock her heart back to life. "Clear!" I called, and everyone backed away from her body as the electricity coursed through her heart.

Immediately her heart regained sinus rhythm, and I breathed a sigh of relief and a prayer of thanksgiving.

I left the OR to scrub in preparation for Isabella's surgery as the trauma team left and the OR team prepped her for surgery. After I scrubbed carefully, I backed into the OR, not touching the doors with my now-sterile hands. A surgery nurse tied my mask on me and helped me into the operating gown and gloves, then I approached Isabella's still form, praying earnestly as I chose the scalpel to open her side and repair the liver laceration that was threatening her young life.


Nearly three hours later, I ripped off my gloves and mask as I left the OR; meanwhile, Isabella was wheeled directly into the Intensive Care Unit (ICU) for critical care.

Although it was impossible for my immortal body to actually tire, I had never felt so close to exhaustion in my almost four centuries.

Isabella had arrested twice more on the operating table, and the third time it had taken five minutes of defibrillating her heart, doing compressions between attempts to shock her back into sinus (or normal) rhythm.

I had rarely prayed so much in my entire existence as I had during the past three hours since Isabella had been brought in.

And I still had a major meeting with the Quileutes ahead.

I looked up at the clock. 3:17 A.M. I had another three hours of night before sunrise. Thinking over all I needed to accomplish, I decided to meet with the pack in two hours.

"You look exhausted, Dr. Cullen," remarked Marcy as I made my way back into the ER.

I merely nodded.

"How did Isabella do?" she asked solicitously.

I sighed. "Arrested twice. Took five minutes to get her back the second time. She's being settled in the ICU now. It's touch-and-go."

Marcy sighed, too, patting me on the shoulder as I walked past her. "We're all praying for her, Dr. Cullen," she spoke quietly. Marcy knew of my faith, and we had often discussed theology during the long, often boring night shifts.

"Thank you," I smiled weakly, part of my mind still praying for Isabella.

In the relatively unstable condition she was in, I worried greatly about leaving the hospital, but the meeting with the Quileutes could not be delayed.

I walked slowly back to my office, rubbing the back of my neck tiredly. I had never felt so physically or emotionally drained before, and I didn't like it.

I opened my office door, switched on the light out of habit, then immediately realized that I wasn't alone. I turned toward the familiar scent seated on the black leather sofa against the office wall.

"Alice," I greeted her quietly.

"Carlisle," she returned just as quietly.

Seating myself behind my desk, I looked at my daughter's grim expression. I rubbed my eyes, then raised them to hers again. "What have you seen?" I asked, almost afraid of her response.

"Isabella will remain stable for the next twenty-eight hours, then she suddenly disappears from my view. I can't see her future beyond that." Sadness permeated Alice's voice. She had told me how she looked on Isabella as a friend already, and I hated seeing this friendship so brutally ripped away from my sensitive daughter. Not to mention what this vision meant for Isabella...

I dropped my head into my hands. So Isabella would only survive for just over a day from now.

Alice cleared her voice delicately, then continued, somewhat ascerbic. "Carlisle, I can't see anyone's future in a couple of hours from now. Would you care to explain?"

"We're meeting with the Quileutes at the eastern boundary near the lake," I responded tiredly.

"They're the ones behind Bella's injuries?"

I nodded. "We need to get to the bottom of what happened."

Alice glared at me. "You realize, of course, that I can see nothing at all when the Quileutes are involved."

"I gathered that."

"I hate going into a situation blind," she complained.

"We'll have Edward's and Jasper's gifts to help us," I reminded her, feeling slightly encouraged by this thought.

"Well, we'll have Jasper's, anyway," Alice huffed, annoyed.

"What do you mean?" I asked her, too sharply.

"Edward will have nothing to do with Isabella Swan," she responded. "I see him refusing to leave for the meeting with us in a couple of hours."

I rested my head in my hands. This meeting with the volatile Quileute tribe was going to be difficult enough with Alice's visions blinded, but without Edward's gift of reading their minds?

We were going into this too-dangerous meeting with an unknown number of volatile wolves completely and utterly blind.

Part 2 of this Outtake will be published next week. I hope you've enjoyed it! :)

I'll be updating sometime next weekend; I hate promising a certain day because my writing often slops over into Sunday.

So let me know what you think, okay? :) Please review! :)

Love to you all,

Cassandra :)