Chapter 16 Marianne
MARIANNE
Marianne's hands trembled over the keyboard, unable to type the words that would end everything.
She had been staring at the blank page for forty-five minutes, the cursor blinking like a heartbeat she was about to stop.
The formal recommendation template sat open on her screen, cold and clinical, with spaces for findings and conclusions and the professional language that would disguise betrayal as due process.
She had drafted this document a hundred times in her head. Had practiced the phrasing, the careful framing, the bureaucratic distance that would make it seem like an objective assessment rather than what it actually was: a knife in the back of the woman she loved.
Based on the comprehensive review of documented protocol deviations, patient outcomes data, and the circumstances surrounding the death of Robert Hendricks...
She couldn't finish the sentence.
The board meeting had been brutal. Shaw presenting his case with barely concealed triumph.
Alexandra watching with the calculating patience of someone who had already decided on a sacrifice.
The external reviewers nodding along, their questions designed to confirm conclusions rather than seek truth.
And Marianne, sitting in the room with her audit data and her careful documentation, watching everything she had built be twisted into a weapon.
She had tried to inject context. Had pointed out that Isla's outcomes data showed significantly better survival rates than departmental averages.
Had argued that the deviations, while numerous, were consistently justified by rapidly evolving clinical situations.
Had attempted to shift the conversation toward systemic support rather than individual punishment.
No one had been interested.
What the board wanted was a scapegoat. Someone to blame for the impending lawsuit.
Someone whose sacrifice would demonstrate institutional accountability to the insurance carriers and the lawyers and the public.
And Isla's file, with its long list of documented deviations, made her the perfect offering.
Marianne thought about Sophie, the little girl Isla had saved weeks ago. About the teenager with the pneumothorax. About the construction worker with crush injuries who had walked out of the hospital on his own two feet because Isla had made decisions that no one else would have made.
Those patients were alive because Isla trusted her own judgment over protocols designed by committees who had never held a bleeding artery in their hands. The same judgment the board was now characterizing as recklessness. The same confidence they were framing as arrogance.
It was wrong. It was unfair. It was exactly how institutions protected themselves from accountability.
And Marianne was going to participate in it anyway.
Now she was being asked to formalize that sacrifice. To write the recommendation that would suspend Isla's surgical privileges pending the investigation's conclusion. To put her professional signature on the document that would destroy everything Isla had worked for.
Recommendation: Immediate suspension of surgical privileges pending completion of external review...
The words appeared on the screen, typed by fingers acting without conscious direction. Marianne stared at them and felt something crack in her chest.
She thought about the woman who had held her through breakdowns and confessions. Who had looked at her scars and loved her anyway. Who had whispered "I've got you" in the darkness of so many nights.
That woman was going to receive this document tomorrow morning. Was going to see Marianne's name at the bottom, her signature endorsing the recommendation. Was going to understand that the person she loved had chosen professional survival over loyalty.
The cursor blinked. Waiting.
Marianne finished typing the recommendation, her vision blurred with tears she refused to let fall. Every word felt like a piece of herself being carved away. Every sentence was a betrayal dressed in professional language.
She couldn't defend Isla without exposing their relationship. Couldn't argue too passionately without confirming Shaw's suspicions. Couldn't sacrifice her career without destroying her only leverage to help from the inside.
Or at least, that was what she told herself. The truth was simpler and uglier: she was afraid. Afraid of losing everything she had rebuilt after Riverside General. Afraid of starting over again with nothing. Afraid that her love for Isla wasn't strong enough to overcome her terror of vulnerability.
She printed the document and signed it with a hand that shook.
Then she picked up her phone and texted Isla. We need to talk. Can I come over?
The response came immediately. I already know what the recommendation says. Tasmin told.
Of course she did. Nothing stayed secret in a hospital. Someone would have told her, warned her, given her time to prepare for the official notification.
I want to explain, Marianne typed. In person.
A long pause. Then: Fine.
---
Isla's apartment was dark when Marianne arrived.
The living room lamp cast a single pool of light across the space, illuminating Isla standing by the window with her back to the door. She didn't turn when Marianne entered. Didn't acknowledge her presence at all.
The silence stretched between them, heavy with everything that had been said and unsaid over the past weeks. Marianne stood in the entryway and looked at the woman she loved and felt her heart breaking in slow motion.
"I tried to protect you." The words came out weak, inadequate. "The recommendation is framed as protectively as possible within the constraints of—"
"The constraints of what?" Isla's voice was flat, cold. Still not turning. "Your career? Your professional reputation? Your fear of having to start over again?"
"The constraints of what the board will accept. If I had pushed harder, Shaw would have used it as proof that I was compromised. They would have removed me from the process entirely and appointed someone else to write the recommendation. Someone who wouldn't even try to add context or nuance."
"So you're telling me this is the best possible outcome?" Isla finally turned, and the expression on her face made Marianne's breath catch. Not anger. Something worse. Disappointment. Resignation. "That having the woman who claimed to love me recommend my suspension is somehow a favor?"
"I'm telling you I was trying to navigate an impossible situation."
"You were trying to protect yourself." Isla crossed her arms, her posture defensive.
"That's what you've always been doing. From the very beginning.
Every time I asked you to fight for us, you found a reason why you couldn't. Every time the pressure increased, you retreated into your professional obligations and your careful boundaries. "
"That's not—" Marianne's voice cracked.
"Not what? Fair?" Isla's laugh was bitter. "You told me you loved me. You held me while I cried about a patient I couldn't save. And then you went to the board and recommended that my surgical privileges be suspended. That’s not fucking fair."
"Because I didn't have a choice!"
"You always have a choice." Isla's voice rose.
"You could have stood up in that meeting and told them the truth.
That their risk management approach is a liability, not a protection.
That punishing excellent clinicians for deviating from inadequate protocols doesn't make patients safer.
That they're sacrificing me to cover their own failures. "
"And what would that have accomplished? They would have ignored me and done it anyway. All I would have achieved was the destruction of my own career."
"At least you would have tried." Isla's eyes were bright with unshed tears. "At least you would have fought for me. At least I would have known that your love meant something more than pretty words in the dark."
The accusation landed like a blow. Marianne felt it in her chest, sharp and precise, cutting through all the justifications she had constructed to protect herself from this moment.
She thought about all the nights they had spent together. The confessions whispered in darkness. The way Isla's hands had trembled when she talked about her father's death. The way she had held Marianne through the worst of her Riverside memories.
All of that, and Marianne had still chosen to protect herself.
"You don't understand what you're asking me to risk."
"I understand perfectly." Isla stepped closer, her voice dropping to something quiet and dangerous.
"I'm asking you to risk the same thing I risk every day.
The same thing I risked for you. I opened myself up.
I let you see the parts of me I keep hidden from everyone else. I trusted you with my heart."
"I trusted you too."
"Did you?" Isla shook her head. "Because from where I'm standing, it looks like you were always holding something back. Always keeping one foot out the door. Always ready to retreat into your professional distance if things got too difficult."
"That's not—"
"You never introduced me to anyone in your life. Never talked about a future beyond the next secret meeting. Never gave me any indication that this was more than a convenient escape from your controlled existence."
"We agreed to keep things private," Marianne said weakly. "You understood why."
"I understood the justification. What I'm only now seeing is that the secrecy was convenient for you.
It meant you never had to commit. Never had to make me real in your life.
You could compartmentalize me, keep me separate from everything else, and when it got too hard, you could just close that compartment and walk away. "
"That's not what I wanted."