Disclaimer: Supernatural and its characters were created by Eric Kripke and are owned by the CW Network. No profit is being made.
NOTE TO READERS: This story has both Dean and Sam angst and could be considered AU. This is a season 1, pre-pilot story. Sam has only been at Stanford a few months and hasn't met Jessica yet. In the series Sam was with Jessica for a year and half before she died. She died on the show November 2, 2005, so I put their meeting around April 2004 give or take. So, this story takes place beginning in July 2003. This chapter isn't huge … around ten pages, but chapter 2 should be longer.
I hope you enjoy this newest chapter story. I'm hoping to get in finished in five chapters, but I'll have to see how it evolves, could be a little longer. Happy reading, I hope!
SIDE NOTE: MELD scoring information: The Model for End-Stage Liver Disease (MELD) is a numerical scale, ranging from 6 (less ill) to 40 (gravely ill), used for liver transplant candidates age 12 and older. It gives each person a 'score' (number) based on the urgency he or she needs a liver transplant within the next three months. The number is based on three routine lab test results and those results garner a specific number to be assigned to the patient.
UNOS: stands for United Network for Organ Sharing
Shadow and Light
By Dawn Nyberg
"When the hour is upon us … and when the day has all but ended and our echo starts to fade, no you will not be alone … you will not be afraid … I will not let you down…" Excerpt from Rob Thomas, Now Comes the Night
July 2003, University of Washington Medical Center, Seattle, Washington
"Mr. Winchester," Dr. Sadikov began. "As I've said I have never seen such an aggressive case of viral hepatitis C in someone as young as your son."
"He's getting worse," John hissed. "He's so yellow he's practically orange."
"I know the jaundice is bad," Dr. Sadikov relented. "We're doing everything we can right now."
"You said he was placed on the UNOS list for a transplant, right?"
"Yes, I had him placed last week based on his MELD score … the scoring system I mentioned to you previously," John nodded.
"But, you evaluate him everyday, right?" John hedged.
"Yes, I have to in order to see if he qualifies to be moved up on the list or has to be moved down further. He was responding to treatment up until last week when his liver function decreased further. Are you sure that a living donor transplant is still out of the question?" Dr. Sadikov studied John Winchester.
"No, he won't let me call his younger brother. He doesn't want my youngest to know he's even sick."
"Mr. Winchester, how you deal with your family isn't my concern, but Dean is my patient and I need to reiterate that his condition isn't improving and with his rare blood type and tissue type it's highly unlikely we'll find a perfect donor liver." John nodded.
"And, you're absolutely positive I can't donate a lobe of my liver to Dean?" The doctor shook his head.
"I know you were hopeful you'd match, but you're simply not a possible candidate. His brother might likely be the godsend Dean needs, although he would need to be tested in order to be sure."
"Dean forbid me to call Sam. He doesn't want to put his little brother in any danger or risk his health. I tried to talk to him about it again last night, but he wouldn't hear of it and he only became more agitated and I don't want to upset him."
"I understand, but it could become necessary for you to go against your son's wishes and call his sibling. For the most part living donor transplants usually go well for the donor, although I would be remiss to imply there aren't some donors that have had complications. Mr. Winchester I don't need to tell you how sick your son is …"
"But, he's holding his own right now?"
"Yes, but should his MELD score increase further and as aggressive as his strain of Hep C is … I'm worried he may be running out of time quicker than expected, but for now unfortunately his score is low enough that he is currently only 43 rd on the regional UNOS list."
"43 is pretty good, right? I mean there has to be thousands of people on that list waiting for a liver … 43 is good," John hedged.
"Not really, when there are two other waiting recipients with his same blood type ahead of him."
"So, if a liver becomes available one of them gets first dibs, right?" The doctor nodded.
Twenty-Minutes Later, ICU
"Hey sport," John spoke casually as he walked into the room. Dean looked at him with tired eyes and offered a thin smile.
"Hey Dad," he replied as he let the remote to his TV rest on his stomach. "You talk to the doc?"
"Yeah, same old same old. He told me your 43 on the UNOS list, so that's good news," John didn't want to tell Dean what Dr. Sadikov had said about it not being a good placement. "We're going to get you better in no time," he encouraged. He looked at his son. Dean's normally healthy looking skin was a bold yellow-orange from the jaundice from the liver failure. There were multiple IV lines and wires snaking away from and into his eldest child. His heart monitor beeped steadily. There was a blood pressure cuff attached to his left bicep and a blue pulse-ox clip on his right index finger. Dean looked exhausted and incredibly fragile in John's eyes.
"Yeah, 43 is good," Dean answered lethargically.
"Dean …" John began.
"Don't Dad," Dean's voice warning. "You're not callin' Sammy."
"No But," Dean ground out. "Now drop it," he picked up the remote and went back to watching television. John let out a quiet sigh as he dropped a comforting hand on his child's forearm. He still fought to make peace with how everything developed. John recalled two months ago when Dean's fatigue was beginning to effect his abilities on a hunt and then the abdominal pain had started. John blamed himself for not forcing Dean to a doctor sooner, and then the doctor had admitted Dean almost immediately because his liver enzymes were high and it was just a couple days later that jaundice had begun to set in. John sighed and rubbed a tired hand across his eyes. All of this from a damn hunt and a fucking dirty needle in an alley, John's mind screamed silently.
Ten Months ago, October 2002, New York City, an alley in the Bronx
"Dammit!" Dean hissed as he ducked behind a dumpster.
"Are you hurt?" John barked as he crouched down next to his son looking in the alley trying to see if he could locate the spirit they were hunting. The spirit had been haunting an abandoned textile building and its adjacent alley. Unfortunately, the alley was a frequent hangout for junkies who had a weakness for heroin. The alley was vacant tonight, but the tall tale signs were lying all about … used dirty syringes, make shift tourniquets left behind and a few dirty spoons discarded all showing signs that junkies had been cooking their drugs.
"No," Dean complained as he pulled a syringe out of his leg and tossed it. John looked down.
"You get stuck with that thing?"
"Nah, it got stuck in my jeans Dad, I'm good … let's get this bitch." John smiled at his eager son and nodded. Dean watched his father stand up from behind the dumpster and walk into the alley. He frowned as he rubbed absently at his leg. Why tell his Dad he was stuck, it was a stupid little needle, he'd clean it up with some alcohol later on tonight at the motel… no big deal, he thought to himself.
Ten Months Later, Present Day, the ICU
John sat by his son's bedside and watched him sleep. They sedated him at night, so that he would rest. Dean's sleep wasn't very restful since he became ill and the hospital staff kept him medicated for pain and gave him a mild sedative at night to insure he had as restful a sleep as possible. John watched his child's chest rise and fall slowly. He studied Dean's sleeping features and his chest ached at not being able to take this suffering from him. Dean needed his brother in more ways than one and John wanted desperately to call his youngest. They hadn't spoken since their last big fight when he told him if he were going to leave then never come back. It had been a mistake the moment the words left his mouth and that was almost a year ago.
He shook his head as he thought back to how they had got here. He know knew Dean had lied to him about getting stuck by the dirty needle. If he had told him about it then, maybe none of this would be happening. He could have had the needle analyzed had Dean put on medications that would have prevented the viral hepatitis from taking over his son's liver. There were a lot of should have and could of thoughts that ran through his head. He had told the doctors that he was a private investigator and that Dean was in training for the family business. He had explained there had been a case that they had worked on where Dean came into contact with a used, dirty needle. He was so angry with himself and that hunting had put his first born at death's door.
Two Days Later, ICU
John glanced over the doctor's shoulder at Dean as the doctor talked to him. "His condition is getting worse," the doctor announced.
"He's not been making much sense," John replied distractedly.
"He's running a fever and his body is becoming more toxic everyday, Mr. Winchester, he's delirious. I was able to reclassify him this morning and he has moved up on the UNOS list … he's at 20 now."
"Twenty? He's out of his mind when he's conscious," John hissed. "He keeps asking for his mom and she died when he was four. He's mumbling about stuff that happened when he was little. How can you justify twenty?"
"I'm sorry, I know this is frustrating, but the numbers are based on his lab tests and as sick as he is Mr. Winchester he still isn't able to be ranked higher in relation to others who are waiting and he isn't a Status 1 candidate yet, and frankly I hope we aren't at that point anytime soon, but..."
"Once a patient is classified Status 1 they are moved to the top of the regional list and the national list … status 1 usually means we feel the patient has seven days or less to live if they don't get a transplant. But, there are other status 1 patients, so unfortunately the patient still has to wait his or her turn for an available and appropriately matched organ."
"Seven days or less…" John's voice trailed off as he stared through the window into Dean's ICU cubicle.
"I think it's time you called your other son. I can arrange for him to be tested at Stanford University Medical Center … he's a student at the university, isn't he?"
"Yes, but Dean still …"
"Mr. Winchester with all due respect you're the parent and yes your son is an adult, but he signed over medical power of attorney to you."
"I need to talk to him. He's been lucid some of the time." The doctor sighed.
Later that Afternoon
Dean's breathing had become more labored and they had removed the nasal cannula and replaced it with an oxygen mask. ICU staff were in and out frequently changing IV bags and injecting various meds. Dean looked horrible. He was dying and John was sure of this cold hard fact. "Son?" he spoke softly. "You have to fight, okay?" John encouraged. He reached up and stroked Dean's forehead gently with a thumb. "Dean, please," his voice grabbed in his throat.
"Dad?" the voice was a mere whisper and John looked into Dean's weary eyes. "Dad?" Dean spoke into the oxygen mask causing it to fog slightly.
"Hey, there kiddo," John answered with a soft smile. "It's good to see you awake. How are ya doing?" It was a stupid question, he knew, but asked anyway.
Dean offered a thin smile. "I'm good," he reached feebly up at his mask. John caught his hand easily.
"No, son, you need that, okay? I can hear you just fine."
"Thirsty," Dean whispered.
"Okay, the doc said you could have some ice chips," John answered as he stood up and grabbed a plastic spoon and filled it with some ice chips left near the bed. He gently lowered the oxygen mask and lifted Dean's head gently. "Easy, kiddo," he encouraged as he slid the spoon into Dean's mouth. "Enough?" Dean nodded. John gently returned the oxygen mask.
"Thanks Dad," Dean's voice was weak.
"Dean," John began tentatively. "The doc thinks it's time we …"
"No," Dean tried to sound forceful but it came out sounding like a loud whisper. "I'll wait for a donor … they aren't touching Sammy." His eyes blazed protectiveness for his little brother despite his weakened state. John felt such pride for his eldest child and complete frustration all at the same time for his stubborn nature he could only blame himself for … the apple didn't fall far from the tree.
"No, I don't wan…" Dean's voice cut off suddenly and a monitor began to beep wildly. John stood up alarmed and a few seconds later he watched Dean's eyes roll back into his head as he began to seize violently. John felt himself physically pulled from the room as staff poured into Dean's ICU room. Before a curtain was pulled he heard four words that chilled him to his soul, dammit, lost his pulse and then he was moved out of the unit by a staff member that led him to the ICU family waiting room adjacent to the unit and was left there to wait.
Two Hours Later, ICU
"Mr. Winchester we're out of time," the doctor rubbed a tired hand across his face. "We almost lost him in there. I've run the lab tests twice now and as I've said before your son's case has been very aggressive. Dean suffered a seizure that brought on the cardiac arrest. He was down almost twelve minutes before we got his heart beating again. He's lapsed into a coma and is ventilator dependant now. He's officially at a level 1 status now and the one thing he has going for him is that the other patients on the list with his same blood type in this region aren't level 1's yet, and there is only one other on the national level 1 list, but the chances are poor that we'll find a donor in time. I'm sorry…"
John stood up from the chair, his mind made up. "Can you call Stanford and make arrangements for my youngest to get tested?"
"Yes, of course, but he'll have to agree…" John stopped the doctor from talking.
"Sam will come. It's his brother, he'll do anything for Dean. Just make the arrangements and I'll call my son at school. When you have the details let me know and I'll tell Sam where to go and who to see." The doctor nodded and left. There were preparations to be made if a living donor transplant was going to happen.
John walked out of the ICU after briefly stopping to see Dean and touch his child. He stepped outside the unit and took a steadying breath. He took out his cell phone and made the call to his youngest son. The phone rang three times and an unfamiliar voice answered, John assumed it must be that Zach kid Sam was roommates with on campus in the dorms.
"I need to speak with Sam Winchester," John was all business.
"One sec," Zach replied.
"Hey, Sam, phone," he shouted.
Can you take a message? I'll call back in a minute… John's chest ached when he heard that distant voice in the background. It was his Sammy, his baby boy.
"Can…" John cut Zach off instantly.
"No, he can't call me back," John barked. "Tell him there is a family emergency."
"Sam, sounds important … family emergency," Zach sounded serious.
"Dean!" Sam voiced barked into the phone a quick moment later. "You okay? Dad alright?" John couldn't help the smile that crept across his face at his son's voice.
"Dad? Where's Dean? What's happened?"
"Sammy …" The soft nature to his father's voice shook Sam to his core. Something was wrong, terribly wrong.
"Dad?" the one word held such desperation and vulnerability that John wished he could reach through the phone and comfort his son. He sounded like a scared child. He took a breath and spoke.
"It's Dean …"
"He's okay, right?" Sam's voice shook.
"Dean's been sick," John began.
"Been sick? How long?" Sam barked. "Why the hell didn't you call me sooner?"
"He begged me not to call Sammy …"
"Where are you?"
"University of Washington Medical Center."
"How long Dad?"
"A little over a month."
"Jesus!" Sam hissed. "How sick is Dean? What's wrong?"
"It's a long story on the why Sam, but he has hepatitis C, a really aggressive version and his liver is failing. The doc says he needs a transplant but his blood type is rare and…"
"He's dying?" Sam's voice shook.
"Sammy, he had a seizure earlier and his heart stopped. He's in a coma now and the doc thinks he's only got about a week unless he can get a new liver."
"There has to be something they can do," Sam replied in a hurried voice. "I gotta be with him."
"Sammy, there is something, maybe…"
"Dean's eligible for a live donor transplant…"
"Yeah, the liver apparently can be donated in sections or something and it regenerates. I was tested but I didn't match…"
"Would I?" Sam asked quickly.
"That's what the doc is hoping but you need tested?"
"What do I have to do?" Sam fought the hot sting of tears at the thought of his big brother lying in some ICU unit hooked to machines keeping him alive. John looked up when he heard the ICU doors open and saw the doctor with a notepad.
"I see the doctor now he was supposed to see about setting up testing at Stanford for some of the preliminary tests."
Three Hours Later, Stanford University Medical Center
Everything had happened so quickly the moment Sam arrived at the hospital. He'd been met by a Dr. Bloom who quickly began explaining tests and having him sign consent papers. Sam's blood and tissue type were checked and verified against the faxed results from Dean's file. He went through with an x-ray and EKG, so the doctor could rule out any heart or lung disease. Sam also underwent a procedure called an arteriogram that the doctor explained would be a simple injection of a liquid that is visible under x-ray and the liquid goes into the blood vessels to view the organ to be donated. Sam knew there was more complicated aspects to the test, but he just wanted the basics and for everything to add up to being able to help his big brother. The doctor had said that if everything checks out on this end he will be approved as a living donor for his brother, however he would have to undergo two final blood tests in Seattle that they would have to directly compare with a blood sample from Dean. Sam was told his blood would be cross matched to Dean's and would also receive an antibody serum test.
"Okay, Sam," Dr. Bloom walked into the exam room. "Everything is a green light on this end."
"I match? I can donate to my brother?"
"Well, at least on this end you're a perfect match … it doesn't get any better," the doctor looked confident.
"But, the two blood tests I have to do in Seattle…"
"Relax Sam, I really don't think there will be a problem with them. I've already faxed the result of the tests to Dr. Sadikov, your brother's transplant physician. "He gave you the thumbs up and there has been a medical helicopter allocated to fly you directly to the hospital from here. In fact, as strange as it may seem they have dispatched an organ procurement team to pick you up and get you to Seattle."
"When?" Sam's stomach was in knots, but not out of fear for himself but getting there quickly knowing that each minute was one less Dean had to left to live.
"Ten minutes until they land here."
Twenty Minutes Later, the helipad on the roof of Stanford Medical Center
"Mr. Winchester, just relax and we'll be in Seattle in 60 to 70 minutes," Sam nodded and leaned back against the leather seat he was sitting in. He looked down at the helipad as the large medical helicopter lifted off and Palo Alto came into view and he saw the university a short distance away.
Meanwhile, University of Washington Medical Center, the ICU
"Charge to 360!" Dr. Sadikov barked as the paddles hovered over Dean's exposed chest. "Clear!"
"No conversion," a nurse called out.
"Dammit, Dean come on," the doctor ground out. "Push an epi/lidocaine bolus," Dr. Sadiokov ordered and he began compressions. "Holding CPR …" he glanced at the monitor.
"No pulse. He's in V-fib."
"Charge to 400," the doctor ordered. "Come on Dean," he encouraged. He lowered the paddles to Dean's chest, "Clear!"
To Be Continued
I hope you liked chapter one. It wasn't very long, but there will be another chapter coming soon and it should be longer. I'm going to try and update once or twice a week depending on the time I have to write. I was going to finish this story first and then post, but decided to try and at least post at a minimum once a week, but maybe twice if time permits.
Chapter Two is being written and is coming along and when its ready I'll update.