Disclaimer: Nothing gained...except personal satisfaction.
A/N: There are no explanations about work schedules, real life events, family obligations or the (literally) 7 times that I've had to rewrite this chapter due to stolen laptops, crashed hard drives or botched Internet connections that can adequately explain the unfathomably enormous delay in getting you, my faithful readers, your next story update. Therefore, I will leave it with a simple, yet humble apology and an assurance that I did not, have not and will not abandon this fanfic. Good or bad, I'm sticking this out until the end, no matter how little time I have to write, how many times I lose my file(s) or how long it takes to finish. So, basically, like it or not, you're stuck with me and this story!
From the previous chapter:
"S-so...are you...? Are you saying that, despite everything...despite all of the symptoms, that Sam doesn't have an infection?"
"Oh, I've no doubt that wound's infected, Debra. It's red, it's swollen..."
"That's right!" Dean broke in angrily. "It's red and swollen and he's got the fever from Hell! I know my brother's septic and if you were any kind of a doctor you'd know it, too!" The eldest Winchester's breaths were coming in the short, sharp rasps of stressed exasperation.
"I don't think sepsis is the issue, here," Jessup countered gently. "His blood smear leads me to believe that Sam's having some sort of acute inflammatory response...but to what, I'm not certain."
"I don't care what you believe! People believe in the Easter Bunny, but that doesn't make it real!" Dean's face reddened markedly and tendrils of veins bulged wildly at his temples as his angry words were propelled outward on small sprites of spittle. "Hell, I believed that some senile, old coot with a medical degree issued in the Dark Ages could help my brother! And you can see where that's gotten him!"
Dean spun in the direction of his baby brother's bed, his arm extended its full length and his finger pointing accusingly at Sam's reclining form. A peculiar stirring swept the younger boy's flushed body, eliciting a singularly curious garroted keening.
Chapter 17: Icarus
In the few seconds that it took Dean to charge across the room to his brother's side, it seemed as though every muscle in Sam's body had tightened to the point where they were in danger of snapping loose from their anchor points. A strangled, guttural scream tore from the hunter's throat as the muscles in his chest and abdomen clenched so tautly that Sam's shoulders were pulled slightly off the bed and the harshly tightened cords in his neck caused his head to be craned awkwardly towards the right.
It's not like Dean hadn't heard the tortured screams of victims as the demonic black smoke had poured from the mouths of the possessed. And there had even been that time that Sam's tormented howl had resounded throughout Bobby's dusty, old house as Meg had exited his body. She had gotten the drop on the younger hunter and been riding him for a whole week before Dean and Bobby had finally managed to break the binding link and exorcise her. But even that terrible bellow paled in comparison to the rough, agonized screech his baby brother was making now.
Despite Dean's urgent shout, there was no response from the youngest Winchester as all of his muscles hitched into compressed knots. His arms drew upward, crossing over each other in front of his body at the same time that large bulges of bunched muscles stood out starkly along the tops of Sam's thighs, seemingly in direct contradiction to the board-flat extension of his legs. Even more odd to Dean, though, was the way Sam's feet flexed dramatically downward, his toes forcefully pointed in a fashion better befitting a petite ballerina dancing in toe-shoes than the hulking frame of his 6' 4" kid brother.
Dean grabbed his brother's flushed face between his hands and felt the insanely overheated skin searing his palms.
The younger boy's eyes were thrown wide open but the pupils were so large that they nearly obliterated the familiar moss-green color of Sam's irises. Dean searched the dark pools that stared back at him but was unable to find any awareness behind them. As he cradled his little brother's face, the boy's lanky frame seemed to strain even harder and Dean could see Sam's knuckles whiten as his left hand fisted harshly before flexing backward at the wrist. The weakened fingers of his right hand were extended stiffly but the thumb twisted sharply across the palm. Simultaneously, Sam's feet pressed unbelievably flatter before turning noticeably inward, the sole of the left foot brushing along the top of the right one as they, too, lifted slightly from the surface of the bed.
"He's seizing!" Jessup yelled as he lumbered across the room to the bedside, his stiff, arthritic knees making him the last to arrive there.
"He's what?" Dean had always been under the impression that a seizure involved violent jerking. That's what he had seen on TV and in the movies, anyway. But, Sam? His muscles were just unrelentingly braced.
"It's the tonic phase of a seizure! Don't try fightin' 'im, Dean! He can't stop this and neither can you! Just keep 'im from fallin' off the bed!" The doctor swept a quick finger in the direction of the nightstand that stood next to the head of Sam's bed. In addition to a small, glass hurricane lamp, it's top was still strewn with supplies they'd been using to care for the ill man. "Somebody move that table! And that pedestal fan, too," he added almost as an afterthought, referring to the fan that they had placed along one side of the bed to help reduce Sam's fever. "He knocks into either one of 'em and he's gonna hurt 'imself!"
Bobby suddenly appeared at Jessup's side, gripping a leather belt that he was still in the process of shucking from the loops of his own pants. "Here!" he cried as he shoved the leather band forward towards the aging doctor. "We can stick this in his mouth so he doesn't bite his tongue!"
"No!" The physician put a firm, restraining hand on Bobby's arm at the exact same time that he hollered at him. "Muscle contractions during a seizure are incredibly strong! He could bite right through that and choke on the pieces!"
The scruffy junk man felt suddenly stricken that his actions had almost endangered the youngest Winchester even more, but he hadn't known that it was such a dangerous thing to do.
Jessup could see the guilt leeching into Bobby's facial expression and tried to take the heat off the well-meaning man. "Too late, anyway," he stated with a nod of his head in Sam's direction. The young hunter's teeth were already clamped shut like a vice, the muscles of his face rippling crazily as the fearsome muscle contractions fiercely ground his jaws together. Thin strings of blood-tinged drool and froth oozed from the right side of Sam's mouth and dripped in a slimy saunter down his face.
Dennis peered intently at his afflicted guest. He'd never witnessed a seizure and really didn't know what to expect, but he didn't think what he was seeing...or rather what he wasn't seeing...was good. "I-...I...don't think-...I haven't seen him take a breath, guys!"
"We need to do something!" Cameron yelled as he looked nervously back and forth between Sam and Dr. Jessup. "He's not...he's not breathing! We can't just stand here! What about-...Shouldn't we start rescue breathing?"
"Doc?" Bobby looked expectantly at the silver-haired medic. All he needed from the physician was affirmation that it was the right thing to do and Bobby would be all over it in a second.
"It's not gonna do any good," Jessup tried to explain quickly in order to defuse the group's rapidly escalating fears. "You'll never be able to work against those muscle spasms. Even if I had an Ambu bag and oxygen, his chest muscles are clamped down way too tight to get him adequately ventilated! If he doesn't start breathing again on his own once the seizure ends, then we do mouth-to-mouth!"
Debra quickly grabbed a wad of facial tissues from the box that had gotten knocked to the floor when the nightstand had been carelessly shoved from it's position too near the seizing hunter. It wasn't much, but if they were going to have to do mouth-to-mouth, the portly innkeeper was going to do what she could to give them the best seal and, therefore, the best chance at giving good breaths.
She bent in and hurriedly dabbed the trail of slobber from Sam's face but frowned when it was quickly replaced by yet another. She was just leaning down to clean away the newest batch when Sam's tensely braced muscles began to jitter lightly. Before she was exactly certain that she was seeing it, the faint tremors had transformed from something nearly imperceptible into powerful, lurching spasms that rattled the young man's entire body.
Sam's arms and legs jolted harshly; a wild, uncontrolled frenzy of sharp limb movements and quickly snapping joints. Each paroxysm was accompanied by a harsh, rasping grunt as the spasms forcefully expelled what little air remained in Sam's lungs. The passing seconds saw the youngest hunter's face turning a deep shade of crimson that Dean couldn't seem to take his eyes off of until his attention was grabbed by Debra's panicked shout.
"Oh, my God! The IV!"
The rest of the group turned as a whole to find that each surge of muscle contractions was sending Sam's left foot smashing violently across the other one. The fierce energy of each powerful thrust threatened to dislodge Sam's jury-rigged IV from its tenuously placed insertion site on the top of his right foot.
Dean would never have believed that a man of his advanced age could move so fast but, in the blink of an eye, Jessup had launched himself towards the foot of Sam's bed, his right hand closing tightly over the IV where it entered the skin of the hunter's foot. A half second later, the silver-haired physician was on his knees, both hands clamped around the youngest Winchester's right foot. Instead of trying to restrain the limb, Jessup kept his own muscles soft. In an effort to protect the fragile intravenous line, he allowed his arms to move in time with Sam's spastic tremors.
It was obvious that Jessup was doing his best to gamely ride out Sam's powerful motions, but Bobby could see that the geriatric was taking quite a beating from Sam's other foot. The jerking and twitching limb flailed repeatedly, often striking the elderly doctor's arms and chest. The gruff-mannered salvage man made a move towards Jessup after a particularly vicious kick buffeted the medic's jaw, partially knocking him from his kneeling position.
"I'm ok! I'm ok!" the centenarian cried out as he quickly regained his balance and resumed his hold on Sam's quavering ankle. "The headboard! His head's gonna hit the headboard!"
At the physician's shout, Bobby turned back and grabbed the bed's dislodged pillow. He tried to stuff it hurriedly between the headboard and Sam's thrashing form but, before he could get it shoved into place, Sam's head had forcefully connected several times with the hard, solid oak bed panel.
"How long is this gonna last?" Bobby shouted as he struggled to keep Sam's violent movements from once again dislodging the pillow he was using to protect the boy's head.
Jessup craned his neck so that he could view the face of his watch without having to relinquish the protective hold he had on Sam's IV. "This violent jerking is the clonic phase of the seizure! He goes any longer than three minutes and we're in real trouble!"
"Three minutes! What the hell is causing this?" Dean figured it was probably one of the more ridiculous questions he'd ever asked. Considering that his brother's skin felt hotter than the sand on a sun-baked beach Dean figured that it was probably one of the more ridiculous questions he'd ever asked. Afterall, it was a pretty easy and safe assumption that Sam's fever was behind the manifestation of the seizure. Still, with the way that everything with Sam had been going contrary to what Jessup expected, there was always the chance that the question was actually quite a bit more valid than it appeared on the surface.
"I don't know for sure!" Jessup bit out as another of Sam's violent spasms threatened to jerk him off balance again. "Could be his fever, could be the IV's not runnin' fast enough to correct a critically low sodium level!"
"Well-...well-...," Cameron stammered, a look of sheer panic on his face. "You need to do something!"
"It's not like there's anythin' I can do 'til he's done seizin'! I let go'a this IV and we'll lose it for sure...if we haven't already!"
As if to drive the doctor's point home, a strong tremor smashed the heel of Sam's left foot into the top of Jessup's hand so forcefully that the grip the doctor was using to safeguard the IV was broken. Before the physician could regain his hold, several more convulsions had already jarred the foot haphazardly back and forth across the IV site.
As quickly as he could, Jessup wrapped his time-gnarled hands back around the limb but it concerned him that he thought he could feel a hint of dampness under his palm. He really didn't have time to think about it, though, as four or five more incredibly powerful spasms wracked the young hunter's body before Jessup felt a discernible reduction in the tension that had flooded Sam's muscles. Several more weak muscle contractions rippled through Sam's frame and then he stilled.
"Sam? Sammy?" Dean ran his hand across his brother's forehead, pushing back dampened tendrils of chocolate-colored hair that had flopped into Sam's face during the most violent part of the seizure. During the height of the spasms, Dean had thought that the way his baby brother's body jerked uncontrollably was the worst thing he could ever see. Now that the convulsions had ended, though, the unnatural stillness that had settled over the younger hunter seemed decidedly worse. Even in sleep, Sam was never still – especially not this still. The hunter was so still that Dean's hand automatically settled on Sam's chest, subconsciously feeling for the rise and fall that he knew should be there.
An eternity seemed to pass as Dean stood, his own breath held in concentration and his heart hammering against his ribs, before he felt a faint, shallow expansion of his brother's ribcage. He's breathing. When his brother's next breath proved to be a little deeper, Dean could feel the tension start to seep from his own body and a sense of relief washed over him as the following breath was even deeper still. Thank God, he's breathing.
"Ok, gang," Jessup intoned quietly as he carefully maintained his hold on the foot into which he'd inserted Sam's IV. "Let's get him rolled onto his side. He might vomit after all that and we don't need him aspirating it."
Initially, Dean thought that it was the group's efforts in rolling and positioning Sam's limp form that had caused the change in Sam's breathing pattern. After all, when he had been conscious, even the tiniest movement had seemed to cause so much pain that the usually stoic hunter had whimpered and panted pitifully until he was allowed to still again. This was different, though. Sam's breathing didn't quiet once he was settled.
Instead, Sam's respirations continued to increase in depth, intensity and frequency until the sound of his breathing resembled the huffing noises of an antique steam engine. Equally unnerving was the way that every round of unnaturally labored breaths caused Sam's lax cheeks to suck dramatically inward during inspiration before puffing strangely outward with each expiration. Strings of bloody spittle slithered from Sam's mouth, dancing and twisting in the vortex of his forceful breaths, before silently forming a pool of slimy, pink dampness on the delicate floral sheet beneath him.
"What-...? Is he-...?" Dean's eyes were wide and, although focused on Sam, they would bounce briefly and questioningly towards Jessup before rapidly returning to the sight of his brother's distressed breathing. "Why is-...?"
"He's ok, Dean," Jessup quickly assured. "Altered breathing patterns often occur during the post-ictal period."
"Post-ictal?" Bobby had picked up a lot of useful medical information over the years, as did most in their 'profession'. Heck, if you planned on surviving longer than your first hunt, learning to be your own doctor was just part of the job description. And Bobby had learned early on that a smart hunter never stopped learning. You just never knew when the most inane bit of knowledge was going to save your ass...or someone else's.
"Simply put, it's the brain's recovery time after the seizure. Think of your nephew's brain almost like a car with a bad timin' belt," the physician explained patiently in terms he figured that Bobby and Dean would understand. "Brain's runnin', but the timin' belt's all wrong. As long as the belt's slippin', he'll have trouble firin' all eight cylinders and can't idle smooth, if ya get what I mean." Bobby shook his head in understanding and the elderly doctor went on. "Seen people do all sorts'a wild things while their brain function is Swiss-cheesed in the post-ictal period – cry, scream, bite, punch, talk nonsense, have coordination problems, even partial paralysis...you name it. Once the brain rests, it'll get back to firin' all cylinders, systems will reboot all proper-like and it'll start purrin' like a kitten again."
"Gotcha." Although Jessup's explanation made sense and he believed the elderly physician when he said that Sam would be ok, Bobby also knew that he wouldn't stop being creeped out until Sam quit breathing as though each breath might be his last.
The sterling-haired physician nodded tightly and glanced at the boy's older brother. He wasn't necessarily convinced that Dean suddenly trusted his skills or his judgment. After all, the young man hadn't exactly been his number one fan up to this point...and hadn't worried all that much about hiding that fact, either. Still, Dean wasn't his priority right now and he wasn't going to waste another moment worrying over his popularity status with the rather surly young man. He had more important matters to attend to, especially since he was now certain that he could feel a trail of wetness caressing his fingers where they curled their way around Sam's Achilles' tendon. He prayed that the moisture was from nothing more than his own sweating palms but, in his heart, he knew that wasn't likely to be the case.
Jessup lifted only a small portion of his right hand from its protective position over the IV and tried to assess the insertion site the best that he could. He knew there was a possibility that Sam could unexpectedly seize again and he just wasn't willing to further increase the risk of losing their only intravenous access by completely releasing his hold on the tenuously placed medical device.
Dennis could see the concentration on his friend's face as he contorted himself this way and that. From what he could tell, Jessup was struggling to catch a glimpse of the spot where the jury-rigged set-up penetrated the skin on the top of Sam's foot. "How's it looking, Gene?"
"Hey, Bobby," Jessup called out, intentionally avoiding the innkeeper's question. The group was already on edge enough as it was, he wasn't about to let them know just yet that he suspected there was a problem – especially until he could figure out just how much of a problem they faced. Why go adding to everyone's anxiety until he knew what he was dealing with? "Do me a favor, will ya? While we've got 'im over on his side like this and he's not fightin' us, we need to get a rectal temp to see what his fever's doin'."
"Sure thing, Doc."
"It's ok, Sam," Debra cooed softly from her position at the stricken young man's head. Her fingers ghosted tenderly along the angle of Sam's jaw before lightly raking through his hair, neatly rearranging the sweat-dampened strands that the seizure's violent movements had strewn haphazardly. "You're gonna be ok, Sam. We're gonna take care of you. You'll be feeling better in no time. You will, I promise."
Jessup paused another minute as he surveyed the scene before him and then turned his attention back to Sam's IV. Now relatively certain that another seizure wouldn't immediately be following on the heels of the first one, Jessup relinquished his ironclad hold over the IV site and got down to the business of assessing its condition.
As he moved his hand away, it was obvious that the site had taken a beating in the frenzy. The two by three inch patch of clear tape that he'd placed directly over the insertion site to secure the IV should have been like a second skin – smooth, dry, well-anchored and nearly invisible. But, while a small section of the transparent tape remained affixed and smooth, as it should have been, the larger portion of it was puckered and scrunched into a crumpled, ineffective wad.
Upon closer inspection, Jessup could see that the IV had only been slightly dislodged from its place, but even that small disruption had been enough that the soft, pliant nature of the short pediatric catheter had caused it to kink crazily. Worse yet, a small, soft lump had begun to form under Sam's skin and the physician could see a thin trickle of fluid oozing from around the bent device.
Grasping the mangled tape, Jessup pulled at the tiny portion that had tenaciously managed to remain anchored to the skin along the top of Sam's foot and tugged it loose. The silver-haired doctor took a gentle hold of the IV, slowly retracting it until the crinkled catheter had straightened once again. Using traction from his other thumb and index finger, Jessup stretched the skin taut before carefully trying to thread the flimsy device back up the vein to where it belonged.
As he tried to advance the newly-straightened IV cannula, the thin, teflon-coated plastic tube immediately began to fold over onto itself in the exact location where Sam's spastic movements had previously kinked it. Jessup ceased his delicate pushing motion, pulling back slightly and re-straightening the catheter, before repeating his attempt to slip the IV into its proper position.
Several additional efforts at righting the catheter using the same method passed with equally unsuccessful results. Deciding he should try something else, Jessup softly turned the IV between his fingers. He hoped the rolling motion of the damaged catheter would work it in past the kinked area, but sighed dejectedly as the device immediately crumpled over on itself like an accordion. It was obvious that no matter how much he wanted it or how much he tried, he was not going to be successful in returning the IV to it's proper position.
As far as the country doctor could see it, he only had two options. Option one, in no uncertain terms, sucked. He could pull the damaged device and find a new insertion site with a fresh cannula - a prospect that his experience starting the first IV had taught him would be easier said than done. After all, they'd had a hard enough time getting the slender pediatric one in so Jessup had no reason to think a new IV would be any easier. Complicating matters was the fact that the only IV needles that the physician had left were large bore, adult-sized catheters that would make accessing a new site in Sam's dehydrated veins extraordinarily difficult, if not downright impossible altogether. If he couldn't get another one in, or used the last of his supplies trying, then they were well and truly screwed.
Their only other choice was just about as bad. Jessup could straighten the beleaguered children's catheter in its current location, secure it the best that he could, and resume the flow. Without a drip chamber, though, it would be hard to know if the abused IV was even running. If a critically low sodium level was the root of Sam's seizure, he'd be wasting a LOT of valuable time sitting around waiting to see if the fluid level in the bag was dropping - a lot of time in which the boy could seize again.
The time-worn physician took a deep breath and blew it out again. So far, nothing about this case had been easy. Neither option was great but, the more he thought about it, gambling that the IV could be salvaged seemed much more inviting and wise than pulling the only one they had. After all, it was better to have crappy IV access than no IV access at all.
It was a long shot, but it was one he was willing to take so Jessup reached to his right and opened the clamp that allowed the IV to flow once again. Snagging a nearby roll of medical tape, he tore off a four inch length. As he turned back to secure the mistreated catheter in place, it was immediately obvious that the soft swelling under Sam's skin had grown larger and fluid had begun leaking from the insertion site again. With a wry huff and a shake of his head, Jessup knew that the decision had been made for him – the IV would have to go.
The doctor rolled the worm gear shut to stem the flow of fluids and, pressing a small folded gauze over top of the insertion site, gave a quick flick of his wrist. Seconds later, the crazily crimped plastic cannula was carefully set aside and Jessup had secured the gauze to the top of Sam's foot with the length of tape.
Looking up, the healer was caught by Debra's watery gaze. "I'm sorry. I tried. I really did, but I just couldn't save it," he explained apologetically, giving the portly matron a weak smile. Jessup had intended for the facial expression to be a form of tender reassurance, some shred of comfort that Debra could hang onto; could gain strength from. In the end, the elderly man was fairly certain that it had actually appeared less as an inspirational gesture and more as a plea for personal absolution.
Praying that he would somehow find strong veins where none had been before, Jessup gathered up the tourniquet and quickly fastened it around the calf of Sam's left lower leg. As he drew his hand back, something caught his eye. There, on the plantar margins of Sam's foot, where the softer skin on the side of the foot blended into the tougher skin of the sole, Jessup thought that he saw an odd, wavy-appearing rash.
The doctor gently rotated Sam's left foot so that he could see the opposite side. He hadn't been seeing things! The unusual rash was there, also. He popped the tourniquet loose and then quickly moved to inspect Sam's right foot. That foot, too, was lined with the same distinctively rope-y eruptions.
Jumping up, the centenarian grabbed Sam's left hand, turning it to and fro like some frenzied lunatic, as he scrutinized the skin between the young hunter's fingers and along the edge of his palm. Although it hadn't been there hours before when he'd done his initial exam of the young man, the evidence was there now. Just as on the borders of Sam's feet, there were lesions snaking all along the edges of Sam's hands, as well as ones that were coiled like tiny red serpents in the warm spaces between his fingers.
Jessup snatched the dampened sheet from over his patient's body, carelessly flicking it downward where it settled in a rumpled heap at Sam's waist. It wasn't quite as red or well-defined, but there was no denying that the same peculiar rash was now covering the boy's abdomen and chest.
Dean's eyes widened. He remembered Sam squirming in the Impala, complaining of being itchy and even accusing Dean of lacing his clothing with itching powder. He also remembered giving his baby bro the compulsory big brother hazing by teasing Sam, in front of Bobby no less, about having fleas. But they'd already determined that it was simply a result of being sensitive to the aloe they'd been using, hadn't they? He'd been expecting Sam to break out in at least a few hives, but this-. This just didn't look like any case of hives he'd ever seen...certainly not like the hives their Dad had gotten from the stuff.
"A rash?" Cameron's words snorted out on a light chuckle. When compared to everything else, the concern that Sam's newest symptom generated on the faces of the others seemed incredibly laughable. "What? It's not like it's any big deal." The athlete peered incredulously around at the serious faces around him. "I mean, come on, it's a rash. How significant can a rash be?"
"I, uh...," Jessup struggled to express himself while mentally running through the myriad causes of rashes; desperately trying to ferret out a diagnosis that would connect all of the dots of Sam's incongruous symptoms. It wasn't necessarily the rash that was throwing him. It was the rash in combination with the other symptoms that just didn't seem to fit.
Despite his advancing years, and possibly because of them, Jessup had long prided himself on maintaining an intellect that was incredibly sharp. It had probably been a good sixty years – back in the earlier days of his career - but he could still recall caring for patients with the same characteristic skin reaction. Trouble was, as keen as it was, his mind failed to conjure memories of any of those patients being as critically ill as his current one. There was just no way that this could be the same thing...was there?
"I...I," Jessup stammered clumsily, "...don't really know for sure."
"Well, I know somethin' for sure," Bobby proclaimed, holding up the digital thermometer where everyone could see it. "I ain't the type to just panic over nuthin', but I'm pretty damned sure that 107.2 ain't nuthin'."
"Goddammit," Jessup swore loudly, "That's more than a degree and a half higher than it was before we gave 'im the Tylenol!" He scrubbed his hand over his eyes, pinching at the bridge of his nose as frustration played across his features in the way that his jaw clenched tightly. "Guess we know where that seizure came from now," he ground out sardonically.
Things were urgent before, but they were downright dire now. His patient was severely dehydrated and had just seized, their only IV access was gone and the boy's already-high fever was skyrocketing to unbelievable levels. Worse yet, the diagnosis that Sam's rash seemed to be suggesting just didn't jive with his other symptoms. Nothing was making any sense. It was as though someone had mixed the pieces of several different jigsaw puzzles together then expected Jessup to make one, coherent picture from them. No matter which way he turned the pieces, though, he just couldn't seem to get them to all fit together.
Jessup shook his head and pushed the thoughts aside. At this point, a diagnosis was less important than the symptoms. It really wouldn't matter all that much if he knew what was causing the fever if he didn't do something to bring it down. Sam's brain was quite literally in danger of stewing to death in its own overheated juices and they needed to come up with a more successful cooling plan. If not, the next thing they'd be planning was the young man's funeral.
"Cameron," the doctor began urgently, "I need you to scour this house, the grounds, the barn, the cars, everywhere. I need a length of hollow, plastic tubing about that long." Jessup held his hands up about two feet apart. "It needs to be firm, but not too firm. I've still got to be able to bend it."
"W- well," the blonde stammered, his eyes wide at the sudden, anxious change in the physician's demeanor. "H-how will I know when I've found the right thing?"
"Just bring everything you can find that's the same diameter as a garden hose or smaller. Dennis," Jessup intoned, turning to the innkeeper, "I need you to go downstairs and find every container of chilled water you can find, throw it in a cooler of ice and bring it to me."
"Does it need to- ?"
"No, it doesn't need to be sterile," the physician interrupted in a rush, "so it won't need to be boiled first."
"Debra, I need you to put a couple of the boiled pots of salt water in the 'frig to cool. Make sure they stay covered and sterile." The innkeeper's wife turned to go but Jessup's voice stopped her. A large syringe would be great right about now and he was hoping the bed and breakfast's well-equipped gourmet kitchen held some treasures. "Any chance that husband of yours has a meat injector?"
"I-...it broke...at the base...where the needle attaches...a few weeks ago. He's been meaning to get a new one at that shop in Worland," Debra admitted, her voice holding a hint of guilt that they didn't have what the doctor needed, "but we just couldn't see making the 260 mile round-trip for one item. Why?"
"A big syringe would'a come in real handy, that's all."
"Wait a minute," Debra crowed, her features suddenly lightening as an idea dawned on her. "It's not a syringe per se, but would a turkey baster work? I think Dennis has an old one down there, tucked away in the back of a cupboard or drawer, somewhere. Haven't seen it in a while, but I'm almost certain it's still around."
"You find it," Jessup encouraged, " and I'll make it work."
"Come on, Dean," Debra called out as she headed for the door. She'd seen the lost look on the man's face and figured the scavenger hunt might help to take his mind off things a bit. "The search'll go faster with two of us."
Dean made a move towards the door but Jessup's hand captured his shoulder and stopped him. "No, I need you and Bobby here with me. Sam seizes again and I'll be needin' all hands on deck to keep 'im from hurtin' 'imself."
It wasn't the awkwardly slumped position of his body or even the restraining pressure across the aching muscles of his chest that had brought him to a jolting awareness so much as the low, rumbling growl just behind his right ear. Whatever it was, it was close enough that he could feel the warmth of breath against his skin and, in Sam's experience, awakening confined and to the strains of menacing snarling had never been good.
His body tensed instinctively and his heart hammered in his chest as his mind whirled in a foggy and fruitless attempt to work out just what beast they'd been hunting. Although the beast's identity eluded him, he was pretty damned sure he'd come out on the losing side, at least so far, because every cell in his body seemed to be screaming with pain and he had no idea how he'd gotten here. Hell, he didn't even know where here was.
He'd always been a brain guy - the go-to guy for research, the analytically-minded Winchester who had been far more comfortable stalking a good reference book than some bad-ass monster. Right now, though, the brain refused to come out to play and he had to work hard to push down the rising sense of panic that threatened to overwhelm him.
Sam stilled his emotions and tried to allow his instincts to give him the information that his brain would not. He could sense that there was someone, some thing, moving softly not too far in front of him. He strained to focus but his surroundings remained a dim and fuzzy kaleidoscope. He blinked several times to try to clear his vision but the indistinct shapes and smeared colors refused to coalesce into anything that his aching head could even begin to comprehend.
The more he tried to make sense of it all, the more his head pounded and the more exhaustion threatened to pull him under. If Dean were here, he'd be telling him to stop. Telling him to conserve his energy. Telling him to hang on. Dean.
Where was Dean? Was he here? Dean was always there for him. But what if he'd been hurt? What if Dean was hurt and Sam was his only hope? He had to know if Dean was ok? He tried to stir, tried to move away from the unknown entity that threatened him, but his body felt leaden and searing pain washed over him from everywhere. Using the last of his energy, Sam's throat convulsed, calling out his brother's name.
Another long, rolling growl roared in his right ear and he blinked in surprise as a blurred figure suddenly lurched in close in front of him. His body instinctively pushed backwards at the unexpectedly abrupt invasion of his space and the thing roared menacingly in his face. He blinked again and, although his vision improved marginally, he realized that he still couldn't identify what kind of monster or demon that he was dealing with. In fact, he was pretty damned sure he'd never seen a monster or a demon like it and, if he ever got out of here, he figured he'd have to do some research on it. There was only had a split second to consider the thought before a white hot agony exploded in his nasal cavity as the creature's needle-like appendage probed its way inside.
From that moment, all conscious thought was gone as his mind retreated and his body's impulse for self-preservation took over. Desperate to escape the torment of his unknown adversary, Sam tapped into energy reserves he didn't know he had and arched back forcibly, slinging his head from side to side. With each attempt to break free of the creature's probing, the angry roars of the creature grew louder in his ear and the bonds that held him tightened. Incongruously powerful tentacles wrapped themselves ever tighter, first around his chest and then around his head, holding him still as the probe drove deeper and deeper.
A searing pain flashed through Sam's head as he struggled even harder but his efforts did nothing to stop the invasion of his body. Just as he thought the creature's horn-like spike would penetrate straight into his brain, the shaft scraped viciously on his tissues as it made a sudden downward turn. Tears sprung to his eyes and he gagged repeatedly as it chafed along the back of his throat. In an effort to free himself from the painful sensation, he wriggled and pushed with everything he had until he could finally get his head thrown back.
The relief he felt from his new position lasted only an instant before he started coughing violently. Air rushed out with each paroxysm but seemingly refused to find its way back in. Sam felt the room begin to spin as the burning in his lungs increased and he could feel his will to fight start to wane. As though his body had been waiting for the slightest of cracks in his resolve to grant their permission, his oxygen-starved muscles shut down and his body fell limp. As he willingly surrendered himself, he could feel a strong pressure pushing at the back of his head and hoped that he would be sucked into the painless depths of the encroaching darkness before the creature could snap his neck.
"It's ok, Sammy. I've got ya," Dean murmured softly into Sam's ear, his large arm curling reassuringly across his baby brother's chest in an effort to give the afflicted boy a sense of comfort and safety. With Bobby's help he had gently eased his brother's upper body off the bed and slipped in behind him. Sam's back rested heavily against Dean's muscular chest as the older boy supported his torso in a sitting position – or at least as close an approximation as Sam's flaccid form would allow. "You're gonna be ok. You'll see. 'Cause, you know, what kinda big brother would I be if I couldn't make things better, right?"
The hunter felt his brother's body stiffen against him and he leaned in slightly trying to get a look at the boy's face from over his shoulder. Seeing Sammy's eyes open again after that god awful seizure was paramount in Dean's mind. Not until he saw for himself that Sammy was awake would he believe for even one second that the excruciating violence of that seizure hadn't somehow permanently damaged his baby brother.
"Come on, Sam," Dean mumbled quietly. "You know me. I like to see things for myself. Open your eyes and prove to me that your college-boy braincells can still get their 'geek' on. Hell, prove it to the doc over here."
"Dean," Jessup began in a gently admonishing tone. As he sat in front of the cradled siblings, his hand moved up to rest reassuringly on Dean's knee. "We've talked about this. There's just no other choice at this point."
"I-...I know. But...." Dean felt Sam's head roll slightly against his chest and peered down at him. His eyes had opened to slits, pain and confusion etching themselves into the lines furrowed on the boy's brow. "Look. He's waking up a little. Can't we just give him a little?"
"With a fever like that, we don't have time, Dean...and you know it." Bobby's gaze was stern as he looked at the older Winchester. Dean needed him to be strong and if that meant he'd have to channel John Winchester, the hard-hearted bastard that he could be, than so be it.
"Well, maybe that seizure..." Dean stammered hurriedly, "...maybe it was because his fever's breaking. And...and if we just wait...then his temperature will just come down on its own."
"Look, I know you don't want to do this. I understand. I don't think any of us want to do this," Jessup commiserated, "but he seized precisely because his temp is spiking dangerously high, Dean, not because it's going down."
Dean knew Jessup was right. They'd already been over it before. And, sure, like preventing Sam's brain from frying like an egg wasn't just about the best reason anybody could come up with. But, holy hell, you just shouldn't have to do something like this to your baby brother. You shouldn't have to restrain your brother while someone hurts him, even if it is in the name of helping him. Dean sighed in resignation. He understood that there was no other option, but that still didn't mean that he had to like it.
"Fine," he spat out. The sooner they started, the sooner they were done torturing his kid brother. "Can we just get this over with, then?"
A pained groan slipped from Sam'slips as he shifted once again in Dean's arms. To the others, Dean was certain the moan was just an incomprehensible sound, but he could have sworn he heard his own name buried deep within the slurred noise. "I'm sorry, Sammy," he crooned closely into Sam's right ear. "...I'm so sorry."
"Alright, let's get on with this," Jessup intoned as he slid in closer to the huddled pair. In his grizzled hands he held a length of small, plastic tubing.
As Jessup moved in closely, Sam's upper body jerked backwards and his now-fully opened eyes blinked repeatedly in what appeared to be unabashed surprise. With the recent seizure and a fever as high as Sam's, Jessup doubted that the boy would comprehend any of his words, but he still felt an obligation to try to explain to him what was taking place. "It's alright. Everything's gonna be ooookay. I'm just gonna hold this tubing up next to you for an approximate measure. I'm not gonna hurt you, Sam."
Dean and Bobby watched silently as the geriatric physician held the end of the tubing in his right hand and coiled out the length until it reached the area next to Sam's right ear. Shifting his right hand to the area of tubing next to the hunter's ear, Jessup slid out more length with his left hand until it was long enough to reach to the center of Sam's stomach.
"Ok, everybody ready?" Jessup's clear blue eyes bounced quickly from face to face, registering the looks of apprehension, but also the tiny nods of agreement. "You sure you can handle this, Dean? I could have Dennis or Cam..."
"Just do it," Dean growled. No one should ever have to put their baby brother through this but, by God, there was no way he was going to step out of the way, no matter how much he hated this, and let someone else, some virtual stranger, take his place caring for his sick little brother.
Jessup nodded silently before using a heavy pair of scissors to slice off what his measurements had determined was an extra, unneeded length of tubing. As he jammed the point of the turkey baster onto the cut end he couldn't help but think that he should write a book once this whole mess was over. After all, how many healthcare providers cared for patients using an athletic hydration bag for an IV, a mish-mash of electronics parts for a microscope and a gasoline siphoning line as a stand-in for a nasogastric tube.
"I'm pretty sure I don't hafta tell ya," Jessup admitted, "but he ain't gonna like this all that much."
The elderly medic had found a nearly empty tube of lubricating jelly at the bottom of his pack and, after milking out the barely adequate squirt that was left, dipped the opposite end of the siphon tubing into the gel. Moving in even closer to Sam, Jessup positioned the end of the tubing just below Sam's right nostril. "Ok, Sam. This is going to be very uncomfortable. I need you to hold as still as you can and swallow, swallow, swallow."
Jessup slid in even closer to the pair but frowned when he saw what he could have sworn was a hint of fear on his patient's face. Whether Sam really understood what was going to happen, or not, they were just going to have to go for it before the kid became any more upset than was necessary.
Jessup began advancing the slender, lubricated tubing inside Sam's right nostril as gently but as quickly as he could. It had barely passed halfway up the nasal passage when the youngest Winchester reared back, his body slamming harshly against his older sibling in his effort to escape the painful intrusion.
"Hold 'im, Dean!" The physician had been expecting such a reaction and had even warned the others of it. Even still, they couldn't prevent the tubing from slipping from its position inside Sam's nose. What had started in Sam's lungs as a small, gurgling moan had now blossomed into a full-on tortured scream like Dean had never heard before and it cut through him like a knife.
"Please, Sammy, please," he begged. "Just hold still and let him do this. I know it doesn't seem like it, but we're trying to help."
Dean looked up at Jessup through moist eyes and sharply nodded a "go ahead". The silver-haired medic re-inserted the device, his hand quickly feeding the tube in despite the way Sam jerked his head from side to side while arching back against his brother's strong chest.
Dean tightened his hold around his little brother. Sam had lost a lot of his bulk and muscle while being hospitalized but Dean still marveled at just how much power his sibling still possessed. Normally, Dean would be proud of Sam's ability to protect himself, especially when he wasn't one-hundred percent. But the same power that would usually have Dean crowing like a proud Pappa now made him nervous as he realized just how dangerous Sam's strength really was.
Jessup had cautioned that under the best of conditions there was a risk of perforating the delicate tissues of Sam's throat as they passed the NG tube down into the stomach. They weren't even close to being under the best of conditions and everyone here knew it. If they caused a tear in Sam's esophagus and they remained trapped here without proper medical intervention, well, things wouldn't look good for Sam. Having his little brother flailing around like he was doing was only going to increase that risk exponentially and it scared the hell out of Dean. Not sure what else to do, but desperate to keep him from harming himself, Dean kept one arm wrapped tightly around his brother's torso while moving the other to grasp him securely in a headlock.
"That's it, Dean!" Jessup's hand continued to work the tube in but he could feel resistance in its movement as Sam continued to struggle against them. "Keep his head still! He keeps writhing like that and we'll perf 'im for sure!"
Sam's screams grew louder as he bucked even harder against the restraining grip surrounding him. Although Dean knew that what he was doing was actually meant to help his kid brother, it sure didn't feel that way listening to Sam's pitiful keening and he found that he had to tune it all out and disconnect from what was going on in order to keep his sanity. He was jerked back to full awareness, though, when Sam's cries were suddenly cut off by the harsh, involuntary gagging that Jessup had said would signal the tube's passage down the back of the ill hunter's throat.
The gagging grew in intensity and tears sprung to Sam's eyes. Dean clung as tightly to his struggling brother as he could but the tears that rolled in crazily erratic streams down Sam's fever-chapped checks was making his grip increasingly slick. Dean was in the process of readjusting his hold when Sam jerked back, slipping from Dean's compromised grasp and tossing his head back as far as he could possibly get it in an attempt to free himself from the painful procedure.
Seconds later, Sam's coordinated struggles ended as his body involuntarily jerked in time with the sudden onset of deep, rough coughing. An irregular series of labored, raspy breaths was interspersed amongst the harsh, painful sounding hacking. Sam's hands shot upwards and grappled at his throat. His face turned from fever-flushed to beet red in seconds and his mouth gaped, fish-like, in its hunger for air.
"Get his chin down, Dean! The tube's headed into his lungs 'cause he's got his chin up!" Jessup was yelling and desperately withdrawing the tube at the same time. The physician had recognized that Sam was choking by the way in which he was frantically grabbing at his throat. If Jessup continued feeding the tube inward it would enter the main bronchus of the lung, severely impeding the young man's breathing and putting him at increased risk for pulmonary complications. At this point, that was the last thing they needed.
Dean placed one of his large hands behind Sam's head and pushed forward. In complete contrast to the powerful struggle his brother had just put up, Sam's body went suddenly limp, his head lolling forward with the pressure from Dean's hand and his eyes falling shut. A sudden wash of heat rolled over the older Winchester's body and his stomach seemed to drop out from underneath him as the adrenalin rush of sheer panic hit him. His brother had been fighting and gasping and very much alive. Then, in a blink of an eye, he'd gone completely limp and motionless.
Before Dean could even breath his brother's name, Jessup already had the earpieces of his stethoscope in his ears, the bell resting against the young hunter's chest and he was listening intently. " 'S ok, Dean. He's breathing. Just passed out, is all." The silver-haired medic continued to hold the makeshift NG tube in place with one hand while methodically moving the bell of the stethoscope along Sam's chest and ribcage. "Not hearin' any gurgles in his lungs. That's good. 'Kay, Bobby," Jessup asserted as he quickly repositioned the stethoscope bell to the squishy area just below Sam's breastbone. "You're up."
Jessup continued to steady the nasogastric tube where it entered Sam's nostril as Bobby picked up the turkey baster that was jammed onto the opposite end of the tube. After getting a go-ahead nod from the country doctor, Bobby's large hand squashed every last ounce of air that he could press from the bulb of the baster. A satisfied smile crossed Jessup's face and he nodded sharply before removing the stethoscope from his ears.
"Just like a baby fartin' in a bathtub," Jessup quipped of the characteristic sound made by a syringe full of air gurgling in the stomach. "I'd say we're in the right spot but I'm not all that keen on makin' matters worse, so how 'bout we double check? Let go of that bulb, Bobby; see if we get back any gastric contents."
"He hasn't eaten anything since last night," Cameron interjected. "Is he even going to have anything in his stomach to get back?"
"Not much. Little stomach acid, mostly." Jessup's trained eyes watched the clear plastic tubing as Bobby released the pressure and the collapsed bulb re-expanded. "There! Some clear fluid with tiny flecks in it. We're in. Gimme that tape and let's get this puppy secured in place."
"You're sure we're in his stomach?" Dean couldn't help but feel uncertain and anxious. After all, Jessup's warnings had been pretty darn clear. Right place – they pour chilled saline solution down the tube and into Sam's stomach to cool his core and reduce his fever. Wrong place – Sam drowns as the liquid gets poured straight into his lungs. Definitely one of those times that Dean could see that a triple check could be considered a "charm".
"We've confirmed it twice," Jessup stated matter-of-factly, "but I suppose it don't hurt to check a third time."
Jessup went to grab for the baster bulb when Dean stopped him. "Isn't there another way? You know, just so we know for sure...know that the other tests were right." Jessup paused for a second and looked into the elder sibling's pleading eyes. "Please?"
The doctor nodded. "Sure, kid." Time was of the essence in getting Sam's critically high temperature down and re-establishing an IV, but one more check wasn't going to take that long. "Hand me that cup of water."
Dean grabbed the liquid-filled vessel from the small stand to his left and passed it to Jessup. The old-timer wiggled the turkey baster free of the NG tubing and set it aside. "I'm gonna stick the end of this tube into the water," he explained quickly. "If we're in a lung, you'll see water get pulled into the tube as Sam inhales and air bubblin' back out as he exhales."
Jessup dunked the tubing's end into the fluid and waited through several cycles of Sam's repirations. "Everyone agree? No bubbles and no fluctuation of the water level?" Receiving unanimous nods, the centenarian pulled the tubing from the water, tapping off the remaining drops on the lip of the glass. "We're gonna need to work as a team. Dean, you keep hold of him from behind like you are in case he comes around. He fights us and manages to pull on the tubing while we're dumping water in and he could still get a lungful."
"We need to instill half a liter over a five minute period," Jessup continued as he popped the bulb off the end of the turkey baster. "Bobby, it's gonna be you're job to adjust how fast or slow the chilled saline flows in by raising or lowering the turkey baster syringe like this." The country doctor poured a small amount of fluid into the baster while holding it very low. The group watched as it trickled in slowly, but then gradually increased in speed as Jessup raised the syringe higher and higher.
"Cameron, you and Dennis are going to make sure that Bobby's got a continuous supply of saline. You'll want to reload the baster syringe before it completely empties to keep the amount of air going into Sam's stomach to a minimum. We get too much air in there, he's probably gonna vomit and we risk him aspirating into his lungs. Debra, I need you to keep watch of the time and the amount of fluid we're giving. No more than half a liter over five minutes. Then we wait five more minutes and siphon it all back out by reattaching the bulb. We'll do six cycles, then recheck his temp. Everyone clear?"
Jessup's eyes jumped from person to person, making certain that each member understood their specific job before getting started. "Ok, then, let's get started."
To be continued...
A/N: Before someone sends me a flaming review, yes, it is entirely possible to have, as well as survive, a fever of 107.2. In my career, I've directed care for many patients with critically high temps, but the two highest temperatures I've ever seen were 108.3 and 109. The first patient survived without any lasting effects. The second patient was eventually pulled from life support because the sustained, critically high temp had caused brain death.
My chapter title choice this time actually has a literary origin as well as my usual classic rock origins. First and foremost, of course, is the literary origin in the form of the Greek myth of Icarus. In this story, Icarus and his father, Daedalus, attempt to escape their exile on the island of Crete by using wings made of wax and feathers. Overcome by the joy & power of flight, Icarus ignores his father's warning and recklessly flies too close to the sun. The sun's extreme heat causes his wings to melt and Icarus crashes to his death in the sea. It didn't take much effort to make a comparison between Icarus' behavior and Sam's own recklessness in ignoring his health & the resulting extreme fever.
In the world of classic rock, the Greek myth brings to mind the 1983 song, "Flight of Icarus", by Iron Maiden and my personal favorite, the 1975 Kansas song, "Icarus (Borne on Wings of Steel), from their album Masque. As a note of interest, Kansas has recorded three songs with references to the mythological character - "Icarus (Borne on Wings of Steel – 1975), "Icarus II" (a track about a wartime pilot – 2000) and "Carry on Wayward Son" ("...I was soaring ever higher, but I flew too high..." - 1976).