Disclaimer: The characters of "Supernatural" were created by Eric Kripke and are owned by the CW Network. No profit is being made.
NOTE TO READERS: I hope you like this newest chapter story. I expect this one will be around 4-6 chapters long before completion. I've been buried in real-life lately, but I will endeavor to get a chapter a week done to post. Happy Reading, I hope.
SIDE NOTE: This story takes place during Season 2 -- somewhere between the episodes "Crossroad Blues" and "Nightshifter."
By Dawn Nyberg
"… if ever was a heart that longed to fly, if ever was a soul that longed to bloom, if ever was an angel, it was you …" lyric excerpt by Janis Ian, When Angels Cry
October 28, 2007, 7:00 PM – A Street Intersection in Kalona, Iowa
His world came back to him painfully with a cacophony of noises around him … unfamiliar voices near him except for one that broke into his fragmented, hazy consciousness slowly.
"De … okay … you … -wake? Dean!" That brought him into the waking world. His little brother's voice was sounding scared and assertive just like Dad's when the shit was hitting the fan and he was worried about his boys during a hunt. Dean jerked at his brother's insistent voice and quickly regretted it.
"Ah, damn, sonofabitch!" he hissed at the radiating agony centered on his sternum.
"Easy, Dean," Sam's voice shook a little now and Dean's big brother instincts kicked in overriding his own agony and he cast an appraising glance at his brother. "They're gonna get you out Dean, okay? Stay still."
"Sammy?" Dean's eyes widened as he took in the state of his younger sibling in the passenger seat of the Impala, or what used to be the passenger seat – Sam's door was caved inward and it looked like half of the car was sitting on his little brother. Sam's face was covered with small cuts and there was a line of blood running down his left cheek from his temple. "You okay?" he saw the whiteness of his brother's sweaty skin.
"I'm good," Sam took a panting breath and Dean frowned. "Dude ran a red light with his damn truck … guess you'll be fixing her up again." Sam's voice was breathy and pained.
"You're lyin'" Dean narrowed his eyes because any fool could see Sam was hurting but Dean couldn't see under all that debris and metal. Sam smiled weakly.
"I'm good, really, hit my head on the window, broke some ribs, maybe … no big deal man," Sam motioned his head slightly toward the face appearing in his brother's broken out window.
"Sir?" a voice leaned in "we're going to pry your door open, okay? We need to get you out. Stay still." Dean shook his head.
"No, my brother needs help first."
"Dean it's easier to get you out first, okay? My door is screwed to hell," Sam winced in pain and quickly offered a sheepish grin to his older brother. "Please, let them." When the firefighter went to cover Dean with a safety blanket he tried to jerk away not wanting help before Sam. Dean wasn't expecting the white hot pain in his sternum to send him into oblivion as his brother called out his name and the blackness consumed him.
"He's okay. Just passed out," the firefighter quickly assessed Dean.
Ten Minutes Later
"So … he's on his … way to the … hos … pital," Sam's speech was broken as he sucked in air that seemed to pull in slowly and abbreviated. He hated the neck brace they had already put on him as he sat in the car.
"Yes, he was air lifted and will be taken care of, now my name is Gabe and I'm gonna get you fixed up and ready, so just relax, okay," the paramedic put an oxygen mask over Sam's face to give him some air. "They're gonna cut your door off in a second, okay? They had to clean up some leaking gas before they start cutting in case of sparks. "Just take it easy." The paramedic looked at the blood oxygen levels and frowned at the 88 on his meter. He wanted his patient out this car like yesterday. "Slow breaths, nice and easy."
Sam remembered hearing someone screaming and then realized it was him. The pain was all consuming as they pulled the door and metal debris off of his chest and legs. "Oh, Jesus," he gasped. "It hurts…" he took a breath. "Like a bitch."
"Easy," the paramedic soothed as he assessed his patient. "I know it hurts, okay, but I gotta look you over and then we're going to get you on a backboard. Sam wasn't looking good and the medic didn't like his blood pressure or oxygen levels. The heart monitor was showing some abnormalities. "Seth!" he shouted to his partner, "Call AirCare and get another bird here, now!"
"That … bad … huh?" Sam offered his care giver a weak lopsided grin.
"Nah, man, just figured I have you arrive in style, ya know? I can't have your brother up stage you, right? Anyway, we're fifteen-twenty minutes out, and a bird will get you there in five."
"My … brother?"
"Already at the hospital. He was okay, I think," he offered. "Maybe, a mild concussion and I think it's a safe bet he fractured some ribs or his sternum by the looks of the bruising that was on his chest and his pain level." The medic decided that Sam seemed to focus more when he was answering questions regarding his sibling. "He'll be okay," he assured. "His vitals were fine considering."
"Really?" Sam's voice was quiet and his breath staggered a bit.
"Yeah, man, really. So, you the little brother?" He tried small talk as they prepared to move Sam from the car.
"That … ob …vious?" Sam took small concentrated breaths.
"Nah, I just recognize the look that's all … when he wanted you helped first. I think there's a manual that they get you know when we're born."
"You …" Sam didn't finish but the medic knew the question.
"Yeah, I got a big brother, too," he smiled. "He's two years older but you'd think it was ten by the way he still treats me, ya know? I'm surprised he still doesn't try to hold my hand when we cross the street." He jested.
Sam offered a weak knowing smile. "Yeah, I … do," his voice a mere whisper.
"Sam, we're gonna get you out now, okay? We'll take it nice and easy." Sam nodded marginally.
The helicopter was on the way and was two minutes out. It seemed a busy night for accidents and the counties two helicopters were being kept busy. Gabe had cut away Sam's shirt and was able to examine his patient more closely. His partner was adjusting the oxygen flow through Sam's oxygen mask. "How's he doing?"
"In and out man," Mark answered. "The bird's comin'. Mark stepped over to Gabe and leaned in motioning to Sam's chest. "That what I think it is?" Gabe nodded. "I never saw one before except in training videos, you know?"
"Yeah, I already called into base and talked to Dr. Skeete to be prepared for a flail chest."
"Is O2 sats are still crap Gabe even on 100 percent O2."
"I know, but the doc said unless his sat's hit 80 while we're in the field he wants to avoid intubation until he's seen him."
"His chest, though…" Mark looked at the bruising accompanying the flail chest injury. "He's probably got some pulmonary and cardiac contusions."
"Yeah, I know." Gabe answered as he increased Sam's fluid rates from his IV. The night air was broken by the sound of a helicopter a moment later. "Okay, Sam," Gabe leaned over his patient and Sam's eyes opened minimally. "The helicopter is here now." Sam looked at Gabe and blinked unwilling to speak in lieu of still breathing which was becoming increasing tiresome and difficult.
Ten Minutes Later – Iowa City, University of Iowa Hospital, Trauma Room
"This kid's chest is a wreck," Dr. Dionne Skeete complained as she continued her exam.
"Dr. Skeete, his sats are down to 76," Michelle Alpern, the trauma nurse commented. The doctor sighed in frustration.
"Alright, I wanted to avoid intubating this kid but it's clear he needs some help. Get me an intubation tray. His C-spine was clear let's get the collar off of him."
A Few Moments Later
A respiratory technician was squeezing the ambu bag attached to Sam's breathing tube. The flail chest was evident as she ventilated him. She stared at the odd movement. An intern stood nearby and watched, as well. "Weird, huh?" he commented quietly and she nodded. Sam's right side of his chest seemed almost crushed and when she squeezed the bag to give Sam a breath, the flail chest side would curve inward instead of expanding outward when a breath was delivered. His chest moved in the opposite of what was expected … a breath in, his chest collapsed inward but an exhale his chest didn't deflate but expanded. Sam was a contradiction in terms.
Sam began to move feebly on the table as his O2 levels came back up and he woke up. "What's his name?" Dr. Skeete asked into the air.
"Paperwork says Sam … Sam Crockett." The doctor nodded.
"Sam? Sam, listen to me, okay … you can't talk right now we have put a breathing tube down your throat to help you breath. I know your chest hurts and we're gonna help you with that." Sam eyed the woman with pain and fear filled eyes. "Let's try an intercostal block for pain and see if we can get some level of pain control for him without using any analgesic narcotics. His respiratory volume is already shit."
The monitors around Sam's trauma gurney began to bleat out warnings as he moved feebly. "BP's falling, heart rate's up." Michelle, the nurse spoke urgently.
"Sam, I need you to calm down, okay?" Dr. Skeete leaned over her patient and placed a stethoscope on his chest and frowned. "Heart sounds are muffled," she said to no one in particular. She pulled back quickly and looked at Sam's neck, his neck veins were swollen. "Christ Almighty, page Dr. Helman, now! He's in the ER treating the sternum fracture. I need a cardiac needle! I think this kid's in cardiac tamponade."
"Dionne," David Helman, a Cardiothoracic surgeon began. "His vitals are circling the drain and the pericardiocentesis is just a stop gap. The fluid resuscitation and cardiac drugs are just buying time. The echo showed damage to his pericardium, I gotta go in a repair the rip before he tanks on us. His ribs are going to need surgical stabilization. The vent ain't going to provide enough stabilization for the rib cage all on its own and it's a jagged rib edge that I'm sure was the cause for the tamponade. He's got some pretty extensive pulmonary contusions, too. The kid needs a thoracotomy."
"Yeah, I know. I'll try to find some family for this kid." Dr. Skeete said with a sigh.
Within moments Sam was already being wheeled out of the trauma room and was headed to the OR. "Okay, look I'm gonna be in there for awhile with this kid and I've paged Doctors Iannettoni and Dewing to join the surgical team for this."
"Yeah," David Helman watched his patient start to leave. "Gotta go. Find some family for this kid." Dr. Skeet nodded.
"Yes, Sam Crockett is there family in the waiting room for him?"
"No, is brother was in the same accident he was in. He was the sternum fracture, minor concussion and mild internal contusions."
"Is he conscious? In and out. They had to give him something for the sternum pain. Where's the kid's belongings?"
"Here … wallet and cell phone that was all that was on him."
"Let me see the phone." Dr. Skeete looked at the contact list and there under emergency were two names: Dean (605) 555-1224 and Bobby Singer (H) (605) 555-4896 (C) (605) 555-4743 . "I got two names for contact a Dean and a Bobby."
Michelle nodded, "the brother's ID in the other room said, Dean Crockett, so do you want me to contact this Bobby Singer?"
"Yes, and come find me when you do. See if he can get here."
Ten Minutes Later, Singer Salvage Yard, 10:15 PM
The phone ringing pulled Bobby from reading a ritual book. It was late and could be one of the boys, so he picked up. "Hello?"
"Hello, I need to speak with a Bobby Singer; I'm Michelle Alpern, a nurse calling from the ER at the University of Iowa Hospital."
"This is he," his heart hammered inside his chest. An evening call from hospital was never a good thing. "What's wrong?"
"Sir, are you a relation to a Sam and Dean Crockett." Bobby felt nauseous at the question.
"Yes, they're my nephews," he answered quickly. "Are they okay?"
"There has been a serious accident and we need a family member here, if possible."
"What happened? How bad are they hurt?"
"We can discuss everything with you Mr. Singer when you arrive. Can you come?"
"Yes, yes, of course, but … are they … they are both alive aren't they?"
"Yes, Mr. Singer," Bobby wasn't stupid and he heard a 'but' in her statement.
"Please, tell me how bad," he begged which wasn't something he'd normally do but he was feeling pretty desperate right now.
"Dean is currently stable but Sam is critical and has been taken into surgery. When can we expect you?"
"University of Iowa, you said? That's Iowa City, right?"
"It'll take me about nine and a half hours to drive it from where I am now. I'll leave immediately."
"Thank you Mr. Singer. When you arrive go to the information desk and I'll leave a notation on Sam and Dean's computer file to direct you where you need to go when you arrive."
The conversation ended and Bobby scrambled to throw some things into a large over night bag and grabbed a map off his large directory shelf in his library. Bobby's heart was in his throat, his mind racing at the implications of what the nurse had said. She said Dean was currently stable; would he still be before he got there? Sam was critical and in surgery, would he be alive when he got there? He pulled out onto the long dark road headed toward the boys, they were hurt and vulnerable. He pushed on the accelerator barreling down the asphalt.
To Be Continued
I know I've been gone awhile since my last story, but time has not been my best friend and it still isn't. I will make an effort to update at least once a week. I'm not sure how long this story will be, but most likely 4-6 chapters long.
I hope you like this one. I have a ton more ideas but I'm trying to get the shorter story ideas out of the way before I take on the longer ones.
Pericardiocentesis – a procedure that involves inserting and needle and catheter to remove fluid from the sac around the heart.
Cardiac Tamponade – (simple lay explanation) it occurs when the pericardium, the sac around the heart is injured (penetrated, torn, etc.) and it allows fluid to build up reducing the heart's ability to beat effectively.