5. Primum Non Nocere

It was an unusually warm afternoon for mid-November. The breeze that blew in the windows of the house was refreshing, carrying with it the scents of smoldering bonfires, wet leaves, and ripening apples. These mingled with the acrid odor of interior latex paint and turpentine to create a strange mixture that left me feeling a little bewildered as I prepared to assist my wife.

Esme had finished with the living room, which was now beautifully appointed with antique Quaker furniture that she’d had shipped in from all over New England. She had now turned her attentions to the kitchen. The room was presently in complete shambles, as my wife had made quick work of tearing out all the anachronistic fixtures and cabinetry. She and I were priming the walls today so that she could layer on a whitewash-like treatment that would restore the walls to their original appearance from almost four hundred years ago.

Painting was an excruciatingly slow process, owing to the fact that the tools for the job had been invented for humans. As it turned out, paint rollers used at vampire speed just didn’t do a very thorough job. So we might just as well have been any other husband and wife in the country as we stood side-by-side, matching in two sets of my old scrubs, slowly applying the primer to the kitchen walls. We worked in silence, our motions in sync with each other’s to the point that we could anticipate the other’s movements and stay out of each other’s way.

Esme and I had had many long, soul-searching conversations in the last several weeks. Despite Edward’s musical extension of his forgiveness, she hadn’t quite made peace with herself about his hasty departure. I did my very best to console her, but it wasn’t enough.

I didn’t blame her for her difficulty; I spent a lot of time second-guessing my own actions these days. Edward had been gone for over three weeks now without a word. I tried to remind myself that this was a good thing; that he would likely only call if he was in trouble. His silence meant he was most likely safe. But I still had to prevent myself from unconsciously speed-dialing him on my cell phone. He wouldn’t appreciate it; and I didn’t want to seem in any way as though I didn’t trust him. So I just worried instead. And so did Esme.

It made our silence rather tense.

The sound of the back door opening caught both our attentions. We each lifted our heads toward the breeze to figure out which of our children had returned from the university. Jasper was enjoying his philosophical studies quite a lot and spent a great deal of time reading every ethical treatise he could lay hands on. Alice frequently went with him; she was working on some major project the purpose of which she had not yet disclosed.

The peal of high-pitched laughter and the low-pitched voice that followed it told us that both of them were back. I looked at my wife.

“Should we go say hello? Or should we leave them be?” It was somewhat unlike them both to have not popped into the kitchen to say hello on their way in.

I was nearly interrupted by the sound of the stereo from upstairs. They were in Edward’s room. I recognized a few bars of Verdi’s “La Traviata,” which was a favorite of Edward’s. It cut off somewhat abruptly, however, to be replaced by a more upbeat piece—“Penny Lane.”

Esme shot me a smile. The Beatles were a favorite of both of ours, a fact that did not escape Alice and Jasper.

“I guess people do usually listen to music when they’re doing something like this,” I mused, putting my roller against the wall and rolling in time to the steady beat. I was surprised, however, when Esme’s hand closed over my wrist after only a few strokes. She pried the paint roller from my hand, letting it drop into the pan below us where hers already lay. Taking my left hand in her right, she wrapped one arm around my waist, wrapped one arm around my shoulder, and began to move us both to the music.

Closing my eyes, I put my right hand on the small of her back and took over the lead of a slow foxtrot. Esme sighed contentedly, her breath tickling my neck as our hips met in time to the beat. It had been decades since we had last danced to this song together. I reveled in the feeling of Esme’s light frame against my own, and for a moment, it was as though the world went no further than the boundary of our embrace. I wasn’t worried about Edward, I wasn’t thinking about work, I was just with my wife and the music.

“See? Dancing,” a delighted whisper said from the doorway, and I looked over to see Alice and Jasper standing in an embrace a few feet away. Alice was smiling broadly, and a small smirk played on Jasper’s lips.

“Thank you,” I mouthed to them, shooting Jasper a particularly pointed look.

He held up his hands, grinning. “I’m not doing anything. We just turned on the music.”

As “Penny Lane” ended, the CD shifted to the more up-tempo “Can’t Buy Me Love.” The next thing I knew, Alice had grabbed Esme’s hands and the two of them were flying around the room in a fast lindy hop. Jasper and I exchanged glances, equally taken aback by our wives’ sudden frivolity.

“Do we cut in?” I asked him in a conspiratorial whisper.

He nodded. “Let’s.”

Jasper and I took back our partners without missing a step. The four of us whirled around the wrecked kitchen, two pairs in flawless sync. It was a pleasure to watch Alice and Jasper-in fifty years, I couldn’t remember ever really seeing Jasper dance like this. He was incredibly light on his feet and looked fully at peace basking in his wife’s giddiness. Alice sang loudly as she turned in his arms, first to Jasper and then to me and Esme as we sped past each other, comically affecting a deeper pitch to imitate the original artists.

The sound of my own laughter startled me. Esme looked up at me, a broad smile spreading across her face, and I took advantage of a pause between songs to press my lips gently to hers. A part of me was fully aware that the pain and the worry would return as soon as the music died. But for the brief duration of a few songs, I let myself enjoy having a little piece of my family back.

“Triple-shot latte, venti. Skim milk if you would, please.”

The barista, a girl maybe in her late teens, smiled at me shyly as she rang my order. I smiled back politely, then shifted over to wait for my drink.

“Triple-shot? Is that how you do it, Cullen?”

I turned. Roland McLanahan, a pathologist, was approaching. The route from the operating theaters to the patient rooms went directly through the west lobby, where several years previously the hospital had seen fit to allow Starbucks to open a kiosk. Ostensibly for outpatients and visitors, the kiosk instead tended to cater to the sleep-deprived practitioners, their white coats forming a neat, identical queue. I visited it frequently, for as my colleague had just pointed out, Starbucks definitely held the key to my secret.

It just wasn’t the secret that he thought it was.

Coffee was the best tool ever invented for concealing immortality. All of the physicians I knew drank it by the gallon. When it appeared I was imbibing as well, no one batted so much as an eyelash when I pulled a twenty-hour shift or rushed straight from the hospital to the university to teach. And then there was Starbucks’ wonderful invention in the high, white plastic lids that were now the norm for every coffee vendor in the nation. Twenty years ago I’d had to furtively dump coffee out of my cups, or conveniently leave them behind so that I was frequently seen getting another dose. Now I could buy one cup, walk around with it for hours, and no one could ever see that I admitted not a drop past my lips. And the mere presence of the cup would also tinge my scent with Arabica, like so many of my peers. Act like them, look like them, smell like them. It worked like a charm.

The barista set my drink on the counter, giving me another smile. I returned her smile and took the cup, lifting it to my lips as I turned to Roland.

“How are you, Roland?”

“Fine, and yourself?”

I nodded. “Faring well enough.” I pretended to take another sip of coffee. “Long day. Going to be a long night.”

He laughed. “I remember being your age. Thirty-hour shifts, trying for breakthrough discoveries whenever I wasn’t seeing patients…you young doctors push yourselves too hard. But then, I guess we all did it.”

“Everybody does,” I answered carefully. This was the occupational hazard of practicing medicine as an immortal—since I looked like I should be just out of medical school, I was forever tied to the hectic schedule that accompanied being an early-career physician. The CV that I had submitted to the hospital only went back three positions; there was a limit to how much time I could pretend to have lived and still manage to stay in one place for any length of time. At my current falsified age of thirty-one, I was the “youngest” attending on the CMC staff. But I enjoyed the long hours; for me being at the hospital was the epitome of catharsis.

I had pulled many long shifts since Edward left us. In the weeks since, I’d increased my night shifts from ten to fourteen hours, the maximum I could be at the hospital and not run afoul of AMA work guidelines. In between I had the seminar I was teaching at Cornell to keep me busy, and of course helping Esme with the house. Preparations for the seminar rarely tied me up for long, however, as I had lived through all but one of the epidemics that were on the syllabus. Teaching about them mostly amounted to my recounting what it was like to be practicing medicine at the time; talking through the ways in which we had all been stumped by the diseases and the courses they were taking until a cure was stumbled upon. The previous week, after my lecture on the European cholera outbreak, one of my students had commented, “God, Dr. Cullen, you teach this stuff like you were there.” I had simply chuckled and joked that I had a vivid imagination.

“You’re headed to the wing?” Roland’s voice brought me abruptly back to the present.

I nodded. For reasons unknown, the doctors at CMC referred to the east wing of the building, where the patient rooms were located, simply as “the wing.” This had led to a number of other turns of phrase, such as “going to the wing,” which meant doing patient rounds.

Roland and I walked together towards the patient rooms. I looked forward to visiting my patients every day. Trauma surgery was often a head rush, and I enjoyed the distraction, but there was something wondrous in meeting privately with my patients. It reminded me of what medical practice used to be. Sure, now my patients were surrounded by incredible amounts of expensive machinery and privy to a host of synthetic drugs that no physician could have even dreamed of two centuries ago, but this moment was still the same—the doctor at the patient’s bedside, consoling and healing. Even after centuries of medical practice, I still found myself humbled by the trust my patients had in me.

My sole aim was to be sure that trust was not misplaced.

I had fourteen post-op patients in the hospital currently, recovering from everything from an appendectomy to a kidney transplant. I visited the appendectomy first; she was a young woman, a student at the university. I saw her eyes light up as I entered.

“Dr. Cullen. Hi!”

I smiled. “Hello, Miss Robbins. How are you this evening?” I made my way to her bedside, and made a show of picking up her chart from the end of her bed. Of course, I remembered everything I had written on it yesterday, and the only entries since then had been her temperature and blood pressure measurements from throughout the last twenty-four hours.

“Good! Mostly,” she answered, gazing at me searchingly. When Edward had assisted me informally some decades ago, he would often rib Esme in the evenings about the thoughts my female patients had in my presence. That my wife actually found these unchaste musings funny was a huge testament to the bond we shared. Just to be on the safe side, however, I held my patient’s chart with my left hand as I read, letting my wedding ring catch the light. All of her entries for today looked good; I could probably authorize her to go home.

“May I have a look at the incision?”

She nodded, shifting her hospital gown to one side. The tiny wounds were healing well; the redness and swelling had reduced considerably since I had last seen her during yesterday’s shift. I shook my head, marveling at the significance of such a simple surgical procedure. A hundred years ago, appendicitis had been almost universally a death sentence. Even those whose organs we managed to remove were almost always claimed by sepsis. Now I could have a nineteen-year-old present with an advanced case and have the organ out in a matter of hours in a laparoscopic surgery that left incisions hardly bigger than my fingernail. It was nothing short of miraculous.

“This all looks good,” I commented, replacing her bandage. “I can discharge you tonight, if you’d like.”

Her face lit up. “Really? I can get out of here? That was fast.”

I laughed. “They don’t call it drive-by surgery for nothing. You’ll need to take it easy,” I admonished. “Hold off on the partying until at least next weekend.” Although Cornell students were, for the most part, very serious about their studies, I knew they weren’t immune to the beer-driven culture that seemed to dominate the modern American college scene. Yet another reason that it was nice to live as far out of town as we did.

She flushed red, grinning. “I will, Dr. Cullen.” Looking at me hopefully, she asked, “What about school?”

“Classes are sedate enough that it shouldn’t cause a problem,” I answered with a wink. “Neither should sitting and studying.”

She groaned good-naturedly.

Learn. Doctor’s orders.” I smiled at her, and she grinned sheepishly. “Do I remember that your mother is here?” I always felt obligated to inquire after who would care for my patients once I was no longer with them. Otherwise, I felt ill-at-ease.

Nodding, she answered, “Yeah. She can take me back to school. Or her hotel, probably.” She rolled her eyes. “She’s been ridiculous about this.”

I smiled. “Well, we parents tend to err on the side of overboard, that’s true.”

My patient’s eyebrows raised. “We parents?” Her eyes flickered to my wedding ring again, and back to my face. I could see her trying to reconcile parenthood with my youthful appearance. I chuckled.

“I have five adopted children. Two of them are your age,” I told her, putting her chart back in its slot at the end of her at least, they were her age physically—my “youngest” son was actually over seventy. “And if one of them had to be rushed to the hospital for emergency surgery, I would probably be a little ridiculous about it, too.”

Talk about an understatement. I was driving myself halfway crazy as it was; knowing that my virtually invincible son was merely out of range for me to immediately assist him. If I were put in a situation where I knew Edward or any of the others to be in real danger, I would be beside myself. For a brief moment I entertained the thought of calling Edward before I went on to my next patient, but I immediately put myself in check. He would call if he needed me. My son might be stubborn, but he wasn’t stupid.

Sighing, I smiled gently at my patient. “At any rate. I’ll get your discharge papers written up, and I’ll have a nurse in here to help you get ready to go with your mom. You seem to be healing very well, but if there’s any pain, a dose of ibuprofen—Advil—should help. And if you notice serious pain, especially if it gets anything like what it was when you came in, I want to see you back right away, okay?”

She nodded solemnly.

“Then is there anything else I can do for you, Miss Robbins?”

She shook her head, grinning back at me. “Thanks, Dr. Cullen.”

“It’s been a pleasure treating you, Miss Robbins.” This I said when I discharged all of my patients; and I meant every word. Nothing brought me more joy and peace than to be here, attending to my calling. I exited her room and headed for the charting station at the end of the hallway to formally approve her discharge.

No sooner had I completed the papers, however, when my pager sounded. Peering at it, I frowned. It was Roland. What on earth did he need me for? Although I understood pathology, the endless hours in the laboratory without patients were not my preference, and I did not list it as a specialty of mine. No one at this hospital had any inkling that I had any particular acumen in the area. This was very curious.

Dropping the discharge forms at the nurses’ station, I went to answer the page.

A half hour later found me in the lab, looking at slides of blood. I whipped through them frantically, hoping against hope that there would be some way to disprove my initial diagnosis. Things weren’t looking good.

Roland had met me in the hall and quickly ushered me into his office. “Carlisle. I’m glad you could come so quickly. I need a consult.”

I raised my eyebrows. As far as Roland knew, I was a perfectly average young doctor, perhaps a little advance d by virtue of having entered medical school a little early. He knew nothing of the years I had practiced; he had no reason to believe I would know anything particular about his specialty. So why on earth was he looking to me for help?

“You need a general surgeon for a consult?”

“No,” he replied quickly, “I need a hematologist. Dr. Andrews isn’t in today, and his lab rats are stumped by this one.”

So naturally I was the next line of defense? “Since when am I backup to Andrews? Hematology is not my specialty.” For very good reason.

He shot me a withering look. “That case of von Willebrand’s you caught last week put you on the map, Dr. Cullen,” he said slowly.

I cursed myself silently. The previous week a middle-aged man had been brought into the ER from a car accident which had caused multiple internal injuries. He had been sent for a CT which had confirmed massive internal bleeding and he had been on his way into the operating room when the PA had finally brought his gurney to me.

Usually, I was very careful with my diagnoses; if I knew something that a human doctor would not be able to sense, I took the time to back it up with a recognizable diagnostic test. But I was only assisting on this surgery, and I couldn’t stall it to give me time to confirm the diagnosis that my nose had made instantaneously. So I had decided to make my evaluation known to my colleague; von Willebrand’s, a fairly rare bleeding disorder. Its scent was incredibly distinctive; it set off all sorts of alarms in my mind telling me that he would be easy prey. If we sliced into this patient without regard for this problem, he would undoubtedly die on the operating table from blood loss. When I had immediately been pressed, I made up an unlikely explanation involving the patterning of the bruising on the patient’s abdomen, and my colleagues were rightfully suspicious. But my certainty had bought me enough time to run a few tests, which of course confirmed my diagnosis. Because of that, the patient was upstairs recovering from his surgery instead of at the undertaker’s.

However, that didn’t mean it might not have been a mistake. I looked at Roland very carefully. Did he suspect anything was amiss, or did he just think I was some sort of wunderkind?

His jaw was set. “Word gets around,” he said. “Everybody knows you’re the blood guy, Carlisle.”

I almost laughed at his choice of wording.

“Okay,” I said carefully, still appraising Roland for any sign that he might think my skill was anything other than medical in nature. “What’s the problem?”

“Fifteen-year-old male, presented with flu-like symptoms,” he began. “White cell count is elevated, but consistent with the flu. Patient claims no possibility of exposure to HIV; tests came back negative. Mononucleosis also came back negative.”

I shrugged. “Then he has the flu. What do you need a consult for?”

Roland shook his head. “We sent him home with the flu already. He came back two days later feeling worse. His fever’s higher; his white cell count is lower. He was referred to me because they thought it might be some new strain of something, but I’m stalling out. Do you think you could have a look at his slides?”

I frowned. I doubted I would have insight that my colleagues did not. Not every blood disorder smelled as distinctive as von Willebrand’s. But I could humor Roland by at least giving this the once-over.

“May I see the chart?” I asked, reaching to take it from Roland’s desk.

If I’d taken a moment to prepare myself, perhaps I might have been able to think rationally about this case; to insulate myself from the feelings that a mere name could evoke. But I did not know to give myself that time, and thus was caught unawares by the emotions that entered my body as I read the name on the file. I looked quickly to the smear of red on the slide that Roland held out. Even in the dim light of the office, I could still see the sign that Roland and the lab techs had missed: the single aberrant cell that would multiply and ravage this boy’s blood, stealing his life unless we managed to stop its progress.

Acute Myelogenous Leukemia.

All of the worry, all of the pain, all of the fear that had weighed on me for the past two months came crashing down on me again at once. Had it really only been earlier today that I had danced so freely in my kitchen? It might as well have been decades. I forced myself to look back at the name on the file, all the while willing it to read differently than what I had seen at first glance. But it remained unaltered—the disturbing homonym to a surname I knew only too well. It drew my mind back almost ninety years, to a different hospital, to a different disease, to a different boy whose life my medicine had proven inadequate to save.

MASON, ANTHONY, screamed the barcode label at the top of the file.

And he was dying.

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