Title: Altered
Author: Mad Server
Rating: T
Word Count: 4000
Summary: Sam's under a spell. When it wears off, he discovers Dean's hurt and hasn't been letting on. Shocky!Dean, first aid in the Impala, a Sammy bitchout, and some angsty brotherly shmoop for good measure.
A/N: This is for the deeply wonderful Enkidu07, who rocks my socks on a regular basis, and who was kind enough to provide me with a kink, er, prompt. Many thanks are due to the illustrious Kona, med student extraordinaire who was my consultant on this fic, also apologies to her and to others in the medical know for at least one medical fact I overlooked; to the eloquent Derek, from whose life I stole this particular injury; and to my insightful beta ispeaktongue, who helped me find the "So what?". Sam's enchantment was inspired by Fitz-James O'Brien's 1858 short story "The Lost Room." Here it is, Phoebe! Kathleen, it's puke-free!
Disclaimer: I don't own these guys, I swear.

It's the Impala, but it's not.

It's really not. It's a horse-drawn buggy. At least, that's what Sam's eyes are telling him. His ass is planted in a seat, his feet are on the floor, and he knows he's in the Chevy. At least he's pretty sure he is. He's telling himself, has been telling himself for what feels like hours, that the doors are still there and the windshield, and the dashboard, even though he can't see them, or for that matter -- he gropes out in front of his face for the dozenth time, feels nothing but air -- touch them.

Goddamn faeries.

The buggy's trundling through a forest, and it's humid, and it's nighttime. There's a brilliant wash of stars overhead and a storm lantern flickering on the floor by his feet. Sam blinks at the horses' tails, swishing at the occasional fly. Dazedly watches their massive, muscular butts, rippling as they trot down the forest lane, which last time he checked, there were none of in Philadelphia -- thank you faeries. The breeze is strong and constant on his face, and he wonders if that much is real and the Impala's window is actually rolled down, or whether the sensation is just another element of the illusion. Either way, he's glad for it: visual dissonance is a bitch, and Sam's feeling a little seasick.

Beside him the seat creaks as his companion adjusts his weight, and Sam glances over at him, the man with the reins in his hands. He looks nothing like Dean -- huge ears, long thin nose, curly black hair under a derby hat -- but Sam knows in his heart of hearts that this is him, has known it for sure ever since the man busted into the buggy and pulled the, uh, overly amorous faery off of Sam. And it's not just that he came charging to Sam's rescue, although that admittedly was kind of a giveaway; in some weird way, Sam just recognizes him.

Dean-but-not turns and catches Sam's gaze. Gives Sam a half-smile, and Sam half-smiles back. They've given up on talking. Gave it up pretty much at 'Hello,' because everything that comes out of this Dean's mouth sounds like Gaelic to Sam. That'd have to be the faeries making a nod to their homeland. Cheeky bastards. Still, Sam and Dean are getting by well enough without words, though it's weird as hell seeing Dean's facial expressions on somebody else's face.

Being spellbound? Is exhausting, and Sam hopes it wears off soon. It's the faery Dean pulled off of him that cast this enchantment, and he saw Dean kill her, so in theory... any time now. Sam just has to wait it out.

He rubs his face. Looking her in the eye had been a rookie mistake, but in his defense -- and it sounds weak even in his own head -- Sam had been caught off guard. Big old house where they'd knocked on the door, and instead of their contact, she'd answered, three or four others crowding out behind her. One look in her eyes and she'd done her thing, and that had been it for Sam. He'd seen the others pulling Dean inside, but he'd been too disoriented at the time to fend off his own faery, or for that matter to recognize Dean in his new guise.

The faery had led Sam back to the Impala -- he hadn't understood at first that that's where they were -- and got all frisky on his ass. Luckily it'd been a slow, play-with-your-food-before-you-eat-it sort of frisky, so she hadn't got far before Dean had shown up and put a stop to it.

Sam wants to know what the score is now. He assumes the faeries are all toast; but what about their victims, the ones he and Dean had come to Philadelphia to help: people stuck in a mental facility, mistakenly labelled "crazy" by those whose vocabularies don't include "spellbound"? No way to find out right now. No way to do much of anything right now, in fact. Which is actually sort of fine, since Dean seems to have them covered, unhurried and unworried at the reins. Uh, wheel, probably.

That does it. Sam's had enough of this hallucination, thank you very much. Besides, his stomach feels better when he closes his eyes. He shuts them now, sighs, and lets himself sink lower in the seat. Feels the lull of the buggy's vibrations under him, the breeze blowing through his hair, and lets it all soothe him into sleep.

When Sam wakes up, the Impala's the Impala again, and it's inching to a stop, gravel crunching under the tires. The heater's on full blast and so it's hot as hell in the car, but through the open windows Sam feels a cool breeze, smells sweet grass. He lifts his head and blinks groggily out the windshield at a moonlit field. Turns, and between the moonlight and the spill-off from the Impala's headlights, makes out that Dean's gone back to looking like Dean, familiar leather jacket and all.

Sam grins in the sweltering semi-darkness. "Hey," he says, relieved.

Dean turns and eyeballs him, but doesn't smile; just cuts the engine and says, "Welcome back."

"How long was I gone?" Sam asks, raking his hands through slightly sweaty hair to reassert order as the heater dies out, the buzz of cicadas rushing in to fill the soundscape.

"Couple hours," Dean says evenly. Then: "Hey Sammy, you up for some stitches?"

Stitches? Sam's been a bit... distracted tonight, but he doesn't remember getting cut. He shifts his focus inward, does a quick inventory. Sure enough, nothing hurts. Which makes no sense. Unless the stitches are for -- "Dean...?"

"Be a peach and grab me the first aid kit, would ya? And the blanket."

Dean's voice is thin, gravelly; Sam hears that now. Suddenly apprehensive, he throws on the overhead light. Takes a good look at his brother, and feels adrenaline wash through his chest.

Dean's white as a sheet, and his face is glimmering damply. He's breathing fast and shallow, and his eyes are narrowed to slits, blinking irritably against the light. It looks to Sam like he's in shock. Probably from blood loss, if he's asking for stitches. Sam doesn't see a wound though, and that could be very very bad.

"Where're you hit?"

Dean looks like he might argue, about the light or about Sam's taking charge, but then just sags a little in the seat, swallows thickly and points to his leg. Sam scoots closer to him, leans forward and oh yeah, there it is: a bloody tea towel tied around Dean's left calf. A second towel, this one clean, is knotted just below his knee. Well, at least it's not the femoral artery; but still, it's got to be pretty bad if Dean's whipped out a tourniquet. His other leg is jiggling, and as Sam watches, Dean scratches restlessly at his eyebrow: physical manifestations of the anxiety that comes with shock.

"OK," Sam says, taking it in stride. "Anywhere else?"

"What," says Dean, his eyebrows drawing together, face ashen but offended. "This one's not big enough for you?"

Sam stares at him for a second, shakes his head faintly in disbelief. "It'll do," he says drily. "When...?"

"Couple hours ago."

"Just two? You sure?"

Longer than that and his leg might be in real trouble: tissue hypoxia, necrosis, amputation. Dean just shrugs though, and presses his fingers into his eyes. Sam stares at him for a second, then figures he probably wouldn't screw around with something like this; which means he honestly doesn't know how long it's been. Dean's confused. Well hey, he's lost a lot of blood; this is par for the course. It's pretty damn inconvenient though, and Sam huffs out a worried sigh. Tries to remember what time it was when they went to meet their contact, but he's still a little fuzzy-headed himself. He wonders where the nearest hospital is.

"Know where we are?"

Dean squints out the windshield, like maybe he can tell from the vegetation. His hands are absently massaging his stomach. "Ohio, I think."

"We pass any big cities?"

"Dude, enough with the Spanish Inquisition already. Let's just do this." Translation: he has no idea.

Sam nods, resigning himself to the exasperating lack of information. "Yeah, OK." He grabs the keys out of the ignition, climbs out of the car and circles around back, glad for the cooler air out here. He knows now why the car's so hot: shock messes with your blood flow, makes you feel cold. Dean had needed the extra heat even though it's summer, along with the wind from the rolled-down windows to keep him sharp during the drive. Which means, Sam reflects, that the breeze he'd felt in the buggy had been real after all.

He pauses at that, standing on the pavement in front of the popped-open trunk. The breeze had been real, but Dean's soundness had been an illusion; and now Sam finds himself combing back over the evening, wondering whether there'd been indicators and he'd missed them, whether Dean had tried at some point to tell him he was hurt. He thinks maybe he should have been able to tell. There's probably fuck-all he could have done about it, even if he had; but that's not the point. Save it for peacetime, son -- Sam can hear his father's voice in his head -- and he snaps out of it, fishes out the first aid kit and their only blanket, and slams the trunk shut.

When Sam gets back into the car, Dean's leg is still jiggling, and he's readjusting his coat with quick, frustrated movements. Sam winces. The guy's wasting energy; he's got to relax.

"Here," he says in his calmest voice, and lifts up the grey woolen blanket, trying to drape it around Dean's shoulders; but Dean weakly nudges him back.

"It's for the seat," Dean says testily.

Sam stares. "Whaddya mean, it's for the seat?"

"Three words, Sam: original leather interior."

Sam sits still a beat, regrouping. Then he reaches out and presses his palm into Dean's neck; feels the weak pulse racing under cold, clammy skin. It's partly a confirmation for himself, but mostly a demonstration to his bullheaded big brother that he knows what he's talking about. Dull green eyes hold his gaze, dark-ringed and a little surprised. "Hey man, listen to me. You're in shock. You need this on you."

He stares a couple seconds longer to bring his point home, then lets go and lifts up the blanket again; but this time he sees a flicker of panic cross his brother's waxy face, and hesitates.

"It's just a car, Dean."

Features instantly smooth again, Dean reaches up and pats the dashboard. "Don't listen, baby," he croons, his eyes never leaving Sam's. "I won't let the mean man hurt you."

Sam doesn't have time to waste fighting him on this, not if he wants to get at that wound anytime today. He clenches and unclenches his jaw, curses his brother's obstinacy, hates himself just a little, and finally spreads the blanket on the seat between them.

Dean spares a couple seconds to grin in smug satisfaction. Then a series of half-suppressed, agonized contortions pass over his face as he lifts his legs up onto the blanketed bench seat. The effort apparently depletes his resources, because after that he just leans back against the car door, shuts his eyes and pants for a while, which gives Sam plenty of time to examine the makeshift bandage and tourniquet.

"It was a kitchen knife," Dean grates out eventually. "Clean, I think."

"Clean's good," says Sam, his eyes still on the towels. Steeling himself, he reaches for the one acting as a bandage and works the knot loose, then spreads the towel open, red and wet and warm with Dean's blood. Underneath, it's just a mess of red, all down his jeans and probably into his sock. Sam swallows; Dean's punctured an artery for sure.

Sam cracks open the first aid kit and takes out the scissors. Glances up, and his damp-faced brother winks at him. "Never liked these jeans anyway," he croaks.

Sam snorts softly, then slits the jeans open all the way to Dean's thigh. He cuts the material loose and drops it on the car floor, and then screws the top off a bottle of saline, infinitely glad he decided to play sticky fingers the last time they posed as med students.

"You remember what happened?" Dean asks, and then hisses, his whole body jerking as the saline splashes across his calf. He grunts, collects himself. "D'you see who they were?"

"The faeries? They were... our girl's co-workers." Sam can't remember her name right now. He feels bad for a second, but just for a second, because really it's just been that kind of a night.

Another splash of saline, and enough blood's washed off that he can see the cut on Dean's leg. It's only a couple of inches long, but this thing's deep. New blood's already welling up from the wound, in spite of the tourniquet, which must not be tied that tight.

"The bartender," Dean says huskily, and starts jiggling his unhurt leg again. "And the waitress, our waitress. And the piano guy."

That jiggling? Is so not going to help with the sutures. Sam drops a firm, steady hand onto Dean's good ankle, stilling it; catches his eyes and says, "Hey. I've got you." Dean rolls his eyes but nods, takes as deep a breath as he can manage. Sam gives his ankle a light squeeze and then lets go. "I never liked the piano guy," Sam goes on smoothly. "There was something creepy about him. Looked too much like Billy Joel. ...Hold this."

He's already cleaned out the wound, but Dean pretty much needs all the blood he can get at this point, so Sam puts the tea towel back over it, and gets him to sit forward and press on it while he rummages in the first aid kit for the lidocaine and a syringe. When he's found both, he draws up a shot, then switches needle tips and gives the thing a cursory squirt. "Lift."

Dean lifts the towel away and Sam eases the needle into the injured leg, near the wound. He plunges the anesthetic home and hears Dean inhale sharply.

"OK," says Sam, and Dean resumes his pressure, half-suppressing a grunt. Sam steals a look at his face and notes the sickly grey pallor, the tight mouth and sunken eyes, the overall impression of strain. Dean needs a warm bed and a fuckload of Gatorade. But first, he needs to stop bleeding.

"Did they get our girl?" Sam asks, screwing the top off a bottle of disinfectant.

Dean looks blank for a second, and then nods, licks his lips. "Yeah," he says. "But she should be fine now. You're fine now. They should all be fine."

Sam thinks again of the mental facility, and of the fourteen patients in Ward C who'd been under faery spells when he and Dean had been in to investigate. It'd been an article on the ward's four most recent admissions that had drawn the brothers to Philadelphia in the first place, but on Ward C they'd found ten others who'd been spellbound for years, some of them for decades. Dean's probably right -- they're probably fine now, or as close to it as a couple of hunters can get them -- and the thought warms him a little.

When he figures the lidocaine's had time to kick in he says, "Up," and Dean lifts the towel away again so he can pour on the disinfectant, rinsing away the new blood and eliciting nothing more than a flinch and a soft grunt from Dean. Sam scrubs his hands with some liquid sanitizer, then pulls the crescent-shaped suture needle out of its package and nods at Dean. "Here we go."

Sam feeds the needle into Dean's calf a few millimeters from the edge of the wound. He pictures a rectangle like the textbooks all say to, and tries to get the needle to follow its edges: down, under and across, back up and out the other side. Carefully he tugs the needle free, then glances up at Dean, who's been utterly silent. Dean's eyes are shut and he's resting his head against the window, nostrils flaring with each labored breath, his skin a glistening grey. Sam ducks his head again, ties six throws just to be safe, then trims the suture's edges. Three more stitches, he figures. He pours some more disinfectant onto the wound, clearing away the blood.

Dean stays oddly still throughout the procedure, his body braced against the car door, eyes screwed shut, hair sticking damply to his head. With each suture it seems to take longer to thread the needle, and longer to tie the throws, and, forcing a sharp object through the texture of Dean's leg? Not a sensation Sam wants to dwell on. He knows that if their positions were reversed Dean would be talking him through this, spinning some shit to distract him and make him laugh, and that the sutures would still come out perfectly; but stories aren't really Sam's strong suit, and anyway a set of good, clean stitches is going to take all his concentration.

Once number four's all tied off, Sam rinses Dean's calf with some more of the disinfectant, and then smears on some Polysporin, just in case. He winds some gauze around the wound, secures it, and then looks up at Dean. His brother's face is drained white, his eyes are squeezed shut, and new sweat's standing out on his forehead. He looks like complete shit; and Sam twinges, because he isn't going to like what comes next.

"Tourniquet's gotta come off," says Sam.

Dean cracks an eye open, looks at him, and nods.

Sam starts working the knot loose, as slowly as possible. As soon as the towel starts to loosen though, Dean's back arches, and he huffs out a strangled growl. Impulsively Sam leans in and grabs his shoulder, starts kneading it, his thumb working into the muscle in an effort to distract his shocky brother from the agony of reperfusion.

A long moment passes with Dean fighting to control his breath, tears leaking down his face. Then gradually he starts to settle back against the door. Eventually he sniffles and wipes his blanched face, opens his eyes. "That's it?" he rasps.

"That's it," says Sam, letting out a breath he hadn't known he was holding. "Come on, man, let's get you into the back."

Dean's forehead creases and he looks upset for a split-second. Then his face smoothes into blandness, still red-nosed and tear-stained. "Nah," he says.

"You'll be more comfortable," Sam says, a little perplexed.

Dean shrugs. It looks like it takes effort. "I'm comfortable here."

"Well you're sure as shit not driving, Dean."

"So move over."

Sam sits still a beat, weighing his options; then he just nods, packs up the first aid kit and gets out of the car. He hovers by the passenger door as Dean re-positions himself, his movements excruciatingly slow.

Finally the driver's side is clear, and Sam gets in. He picks up the blanket and turns it around to the dry side. Tries to drape it around Dean's shoulders, but Dean holds up a hand to stop him.

"Leather seats, dude," he croaks. "Dry side out."

Sam's jaw drops. He snorts incredulously, but then complies -- what the hell, wool still insulates when it's wet -- and soon Dean's pulling the thing snugly around himself, settling back in the passenger's seat. Sam switches off the overhead light, starts the ignition, cranks down the heater and flicks on the high beams -- and then hesitates, staring first down the stretch of paved highway in front of them, then at the farmland sprawling out on either side of it, and finally at the dense spray of stars overhead.

"Dean," he says. "What are we doing in Ohio?"

"Making ourselves scarce." In the semi-dark, Dean wipes his sweaty face with the blanket. His voice is hoarse.


"Killed off all the faeries," he says. "They all worked at the same pub. Mass murder, dude. Cops'll be on it like flies on dookie."

"Oh," says Sam. Fair enough. "So, now that we're scarce..."

"Next bed you see."

Sam pulls out, guides the Impala down the highway. The field gives way to forest and then back to field, and Dean slouches lower and lower in the seat. Now that the pressure's off and Sam's got time to reflect, the concerns he'd shoved down earlier resurface. Something's been bugging him ever since he woke up in the car, and suddenly he knows exactly what it is.

"You didn't try to tell me you were hurt, did you," he says.

He hears Dean stir next to him. "Huh?"

"When I was under the spell," Sam says, his eyes on the road. "Your face. It didn't look like you exactly, but in a way it did. And it looked like you were fine. I thought you were fine. Because, you didn't let on."

Sam hears his brother sigh.

"Sammy, come on. I feel like I'm gonna hurl. Can't this wait?"

"Why didn't you?"

He hears Dean snuffle, then some soft shifting sounds, and in his peripheral vision he sees him pushing himself up higher in the seat. "What could you have done?" Dean asks at last, his voice still thin but stronger now, game.

"Maybe I could've helped you, before you lost so much blood."

"How?" Dean asks, gentle but matter of fact. "You were out of it, Sam. You couldn't even talk. You think I wanted you operating on me like that?"

He's got a point; but Sam's not satisfied. "At least I would've known," he says, shooting a sidelong glance at his brother. "You never tell me when you need help. I just, even if there's nothing I can do... I need to know."

"Are you kidding me?" Dean asks, and he sounds tired, but also like he's smiling. "You always know. You're like, Sherlock Holmes over there. Think I can fool you? I can't even hide a headache from you. These faeries, man, they had you turned around, that's all. And you still came through for me. So what's the big deal? Why you gotta be so hard on yourself all the time?"

And Sam just shakes his head, because, Dean's in fucking shock and he's still trying to make his uninjured, unharmed little brother feel better. And also because, it's working.

"Just... let me in a little, all right?"

Dean sighs again, and settles back. "Trust me, Sam. You're in."