Sam's room was empty, and for a split second, Dean felt his heart stop with the customary, all-consuming panic that often set in whenever his little brother wasn't where he was supposed to be.
And then he realized.
Dr. Collins hadn't stopped in the doorway when he did; he had kept walking and even now was continuing down the hall.
Confused and still a little panicked, Dean lingered in the doorway, eyes sweeping the room one last time, before he turned to follow the doctor, long strides bringing him even with the physician.
Dr. Collins glanced at Dean as they turned the corner and then nodded toward the room at the end of the hall. "In isolation," he responded, his tone puzzled. Surely Dean hadn't already forgotten.
"Yeah, I know. But why did you move him?" Dean demanded, annoyed that he was being made to play hide-and-seek.
"Well for one thing..." Dr. Collins began, stopping as he nodded at the glass. "There's a bigger window in this room, not just the small, thin one in the door. Since there's limited contact with our isolation patients, we like to use the rooms on this wing with the large windows. That way the family can see the patient, and the patient can see their family. It usually boosts everyone's morale."
Dean glanced at the sign on the door – "Contact Precautions" – and then at the cart of protective gear against the wall. "Oh yeah." He reached for one of the yellow gowns. "It's a morale booster, all right," he replied dryly, annoyed by the doctor's cheery tone. It was going to take more than a big window to improve his mood. Especially since the blinds on said window were closed, which meant he still couldn't see his brother.
Dr. Collins watched as Dean slipped the gown over his clothes and then stepped toward him to tie it in the back – but stopped when Dean glared at him.
The doctor cleared his throat self-consciously as awkward silence settled between them.
Dean reached behind himself, tying the gown closed and sighed as he then balanced on one leg, stretching the light blue disposable bootie wide enough to cover his boot; then did the same with his other boot. He bent the wired top edge of the white mask over his nose before looping the strings over his ears, securing it before further situating it on his face. He then grabbed a pair of blue gloves from the box on the top tray of the cart, working his fingers into their respective slots as he gave himself a once over – booties, gown, mask, and gloves.
He was set.
Dr. Collins nodded, giving Dean a once over himself. "Remember that for now, only one person is allowed to visit Sam at a time. So if your father wants to see him..."
"He can do so through the big window," Dean finished. "Maybe it'll boost his morale."
Dr. Collins felt a smile play on his lips, knowing he should probably be annoyed by this sarcastic smartass in front of him but feeling amused.
"Maybe," he agreed, knowing better than to meddle in that particular issue. Who got to sit with Sam was between Dean and his father. Period. He sighed. "Do you have any questions before you go in?"
Dean shook his head, already feeling uncomfortable and hot in the protective gear. "No."
Dr. Collins nodded. "Well, if you do, Karen is with him. She'll be in and out, monitoring Sam. And if she can't answer your questions, I can always be paged."
The words had no sooner been said than the blinds opened, revealing Karen, who visibly startled at the sight of them.
Dr. Collins chuckled as relief flashed in the nurse's eyes. "I don't think she was expecting to see us."
Dean agreed but didn't see the humor, especially since Karen had closed the blinds again before he could glimpse Sam. "Why are the blinds closed? What is she doing to him?"
Dr. Collins lifted an eyebrow – surely Dean wasn't accusing her of doing something inappropriate – and opened his mouth to answer when the door opened, once again revealing Karen.
"I'm glad you're here," she stated, her voice muffled by the mask she wore but her concern clear. "I was just about to page you."
"Why?" Dean and Dr. Collins asked in unison.
Karen's gaze flickered between the two of them before resting on the doctor. "Sam's fever has spiked, 105.2." She hesitated, glad they couldn't see her biting her lip under the mask. "And I think it's still climbing."
"Shit," Dean hissed, growling his frustration as he pushed by Karen and entered his brother's dimly lit room, immediately realizing why the blinds were closed on that big window.
Sam was stripped; his gown removed; the single thin sheet folded down to expose the kid's chest and up to expose his legs, barely covering Sam's groin. There was a yellow basin of ice water on the bedside table, a white washcloth draped over its side and dripping onto the table's surface.
Dean glanced above Sam's bed, gaze tracking the various IV lines to their respective origins, bags filled with solutions to battle three of his brother's biggest enemies right now: infection, blood loss, and dehydration. Other lines and wires led to other equipment. The arterial line inserted into Sam's wrist connected to its own monitor; the small, round electrodes on the kid's chest connected to the cardiac monitor; and the pulse oximeter also connected to a monitor.
Dean approached the bed, eyes scanning his little brother. Sam's legs looked slightly swollen, and a quick glance at the catheter drainage bag confirmed what he already knew – Sam's urine output was still too low. Under the sheet, Dean could see the edges of the bandage that had been placed over the insertion site of the Greenfield filter. The incision on Sam's left side looked marginally better, but inflammation continued to peek out from beneath the white gauze dressing as Dean gently pressed it back in place. And then there was the clear tracheostomy tube protruding from his brother's neck that was connected to yet another tube – blue and ridged – that connected to the ventilator.
"Ah, Sammy..." Dean sighed, sitting on the edge of Sam's bed. He dunked the washcloth into the water, twisting out the excess, and then gently cupped his brother's cheek with the cool fabric. "You gotta fight this, kiddo." He cupped Sam's other cheek. "No way you're being taken out by a fever." He swiped the cloth under damp bangs. "You hear me?"
There was no indication that Sam was listening or was even on the verge of waking. No fluttering eyelids, no twitching fingers, no classic face scrunch. Nothing but a blank – and strangely peaceful – expression, marred only by the hectic crimson patches of rising fever on his cheeks and the mauve bruises of prolonged illness and exhaustion smudged beneath his eyes.
Dean slipped his hand under his brother's neck and held it there; feeling Sam's damp hair and skin along with the sweat-soaked pillowcase; feeling the lingering coolness of the fabric absorbed by the heat.
He sighed again, returning the washcloth to the basin and swirling it among the melting ice. "You gotta get better, Sam," he murmured, moving the freshly cooled cloth over his brother's bony shoulders and down his narrow chest. "Kick this infection in its ass, huh?" He dunked the rag into the water again and then moved back to Sam, rubbing the fabric up and down the kid's thin arms, carefully navigating the IV lines as he did so.
"I was coming back to do that," Karen commented quietly as she came to stand on the opposite side of Sam's bed.
Dean glanced at her but said nothing, annoyed both by her presence – this was a tender moment between just him and his little brother – and that she had implied this – taking care of Sam, tending to Sam – was anyone's job other than his.
Dean sighed harshly, the volume and force indicating his level of annoyance, as he plunged the washcloth into the ice water and once again wiped Sam's flushed cheeks.
Karen stared at Dean's bowed head as he continued his gentle ministrations, sensing she had unintentionally caused an affront with her words and knowing he still was pissed about what had happened earlier. "I'm sorry," she blurted, eager to make amends, desperately wanting to resume their comfortable working relationship.
Dean paused, holding the rag against Sam's forehead as he turned to look at her, his eyes unreadable.
Karen swallowed, wishing she could see the rest of his expression and thankful that he couldn't see hers. "I screwed up earlier. I know that. I wasn't paying as close attention as I should have, and Sam suffered. And I know you're upset about that. I don't blame you. But all I can say is that I'm sorry."
There was a beat of silence before Dean sighed. "I know."
Karen blinked, surprised he was accepting her apology so easily. "You do?"
"Yeah." Dean nodded. "I just tend to hold grudges when it comes to Sam." He glanced at his brother and smiled softly, even though no one could see. "Drives him crazy."
And it was true. Sam bitched incessantly about Dean's unyieldingly overprotective tendencies, but as the adage went, old habits died hard – or in the case of this particular big brother characteristic, not at all. Sam was his – the only thing he valued in this shitty world – and Dean would protect him even when his little brother was old and gray.
Karen smiled, feeling the mask stretch across her face. "So, you forgive me?"
Dean snorted. "Yeah, I guess...but only 'cause Sam would want me to." He removed the washcloth from his brother's forehead and dropped it into the basin on the table. "He believes everybody deserves a second chance, so..." He shrugged as he wrung out the excess water and started again on Sam's shoulders and chest.
"Thank you," Karen responded, her tone relaying the depth of her gratitude and relief. "I promise what happened before won't happen again."
Dean cut his eyes at her. "It better not."
Karen swallowed, wondering how an 18-year old kid could be so...scary. She had no delusions about what would occur if she screwed up again. "It won't," she assured, shaking her head.
Dean held her gaze, nodding once, before returning the washcloth to the basin, soaking up the cold water and then slipping the rag behind Sam's neck, once again holding it there. He could feel the heat consuming his little brother from the inside, burning through any reserves Sam had to fight the infection that raged through his body.
Dean shifted from where he continued to sit on Sam's bed, the mattress dipping under his weight; one leg bent, his gown-covered knee snug against Sam's bare leg, while his other leg stretched downward, boot-clad, bootie-covered foot touching the floor.
"I don't like this," he stated bluntly, glancing at the monitor that recorded Sam's core body temperature from the bladder thermistor catheter. "I think Sam's beyond the benefit of cool compresses."
Karen frowned at the temperature reading – 105.1 – and nodded. "I think you're right. Dr. Collins gave orders for a cooling blanket, if Sam's temperature didn't decrease to at least 103.9 within the next ten minutes, but do you want to go ahead and – "
"Yes," Dean answered, already standing and pushing the bedside table against the wall. "Get it."
Karen nodded, crossing to the far wall and moving yet another machine toward Sam's bed before turning and pulling an extra sheet from one of the cabinets and what looked like a cross between a clear shower curtain and a floor mat used under rolling desk chairs.
Dean narrowed his eyes. "What the hell is that?"
Karen smiled. "The cooling blanket." She paused and nodded toward her patient. "We're going to need to slide this under him. Just be mindful of the trach..."
Dean nodded in response and gently rolled Sam toward him, holding his brother on his side as Karen covered the cooling blanket with the extra sheet and then maneuvered both halfway underneath Sam.
"Okay..." Karen pulled down the cuff of her right glove. "Let's switch sides."
They did so wordlessly and repeated the process, ending up with Sam lying on top of the sheet-covered cooling blanket.
Karen glanced at the monitors, pleased that everything remained stable, and began hooking up the various lines and tubes than ran from the machine to the blanket. "You'd make a good nurse," she commented, hoping Dean could see the smile in her eyes.
Dean snorted, brushing back the bangs that had fallen across Sam's eyes during all the shifting and movement. "Yeah."
"The hospital's hiring," Karen informed, enjoying the banter as she adjusted the temperature control setting on the machine.
"Nah." Dean continued to stare at his brother. "I already got a job."
Karen felt that familiar flutter in her chest as she glanced up, wondering if she'd ever tire of witnessing these touching moments between the brothers. "Yeah," she agreed quietly. "And you're pretty good at it, too."
Dean raised his eyes to hers and held her gaze for a few seconds. "You're not too bad at yours, either."
Karen felt tears sting her eyes. She had been told numerous times by numerous patients that she was a good nurse – and she believed it, knew it to be true – but nothing compared to hearing Dean tell her in his own unique way, especially after everything they had been through over the past few hours. "Thanks," she whispered.
Dean shrugged – moment over – and returned his attention back to Sam, once again perching on the side of his bed, careful not to sit on the cooling blanket.
Karen sighed. "We should start seeing a change in Sam's temperature in the next ten to twenty minutes." She glanced at the clock. "I have another patient down the hall that I need to check on, but I'll be back," she promised as she gave one final check to the cooling blanket and its machine as well as to the other monitors before crossing to the door and exiting into the hall.
Dean nodded and settled in for his vigil.
Almost two hours passed.
Karen came and went several times, reporting that his dad and the others had arrived outside Sam's room.
But Dean continued to sit on Sam's bed.
After another hour passed, Dean realized he was hot and uncomfortable, his clothes actually damp from the sweat-inducing yellow polyester gown that covered them. His hands were slick inside the gloves; he could feel beads of sweat under the mask and knew that he would have a red indentation across his nose and cheeks when he finally removed it. His back hurt; his butt and legs were numb; and his neck and shoulders ached from holding one position so long. But he continued to sit there beside his little brother, small hand protectively enveloped by his larger one.
Dean sighed, glancing at the infamous big window. Although Sam's fever had dropped to a manageable level – thank you, drugs and cooling blanket – and he was once again wearing a gown and covered with a light sheet, the blinds on the window remained closed. Even so, Dean could still see the silhouette of his father pacing in the hall and wondered idly where Bobby and Jim were that he couldn't see their profiles as well.
It would suck to be in the hall, and Dean wasn't looking forward to his turn, wasn't sure when he would give up his spot beside Sam.
He was certainly in no rush.
Karen had decreased Sam's sedation twenty minutes ago, and there was no way Dean would even consider leaving until he saw Sam's eyes open.
Dean knew John, Jim, and Bobby were getting updates from Karen and Dr. Collins, so they were not in the dark about all that had transpired over the past few hours. He knew – even without Karen's not-so-subtle comments – that John wanted to see Sam, wanted to see for himself that his youngest was indeed okay for now.
But Dean just couldn't leave his brother.
The fever crisis may have passed hours ago but not the danger. Sam was alarmingly weak, and if Dean was honest with himself, he was frightened by his little brother's fragility. Sam was a tough kid, but even a tough kid could only take so much, and his strength was inexorably fading.
Dean sighed again as he gently stroked Sam's hair, allowing his hand to lightly trail down his brother's temple, along his jaw until he was cupping the kid's cheek, feeling a faint thread of pulse move beneath his fingers. Sam's skin was still too warm, his face too pale beneath the fading flush of fever.
"You gotta get better, Sam," Dean murmured, having lost track of how many times he had said that over the past few hours. But there was nothing else to say. "You hear me?" Dean lightly squeezed his brother's hand. "You gotta get better."
There was a soft flutter of motion beneath the sheet as consciousness communicated itself through the thick fog of medication and bone-weary fatigue.
Dean held his breath, releasing it on one word. "Sammy..."
Sam shifted again, and Dean watched as faint cognition slowly surfaced through the deep well of darkness that harnessed his brother to the bed, imprisoning him in the numb existence the sedation had imposed on him for so long.
Sam's fingers twitched in Dean's hand, and he moved his head weakly, struggling to free himself from the fierce hold of the medications. In the next instant, Sam's face scrunched, and Dean chuckled softly.
It wouldn't be long now.
"C'mon, Sammy..." Dean spoke softly, continuing to stroke the kid's damp hair. He didn't want to rush his brother, to yank him mercilessly from the cocoon of dulled pain into the unkind reality of the hospital room.
Pale eyelids fluttered open, a thick glaze coating the hazel eyes; the pupils dilated widely from the cocktail of pain medications, masking the rim of color on the iris.
For a moment, Sam stared blindly up at his brother, trying to orient himself, overwhelmed by sensations.
Dean waited patiently, knowing that Sam's vision was blurred and that all of his brother's focus would be internal, taking a mental inventory of his body, of what still hurt.
Sam winced, wrinkling his nose and blinking his eyes as he shifted minutely on the bed. He stared at the hazy figure above him, only able to see the person's eyes since the rest of the face was covered with a mask.
And yet he knew.
Sam's lips moved to form a word, but there was no sound. Dean.
"I'm here, Sam," Dean reassured, gently squeezing his brother's hand. "Right here, kiddo."
A ghost of a smile flickered on Sam's lips as his eyes dipped closed. He knew it. Dean was there. And that was all he ever needed to hear.
Sam attempted to turn his head more toward Dean but stopped when he felt resistance, felt a tug in the center of his neck.
Dean felt himself tense during the beat of hesitation – Sam was trying to figure out what he felt – and wasn't surprised when his brother's eyes snapped open in realization at the same instant his left hand was reaching for the trach tube.
"Whoa. Hey...stop," Dean ordered, grasping the kid's hand and holding it. "Leave it alone. I know you're freaked out, but you need it to breathe right now, okay?"
For a moment, panic flashed in Sam's eyes, and then they closed suddenly. His respiration quickened as a phantom of pain crossed his bleached face. Something like a sob tore from his throat as his fingers clenched Dean's hand.
Dean held his breath, stealing himself against the assault of Sam's pain and confusion. "It's okay, Sammy," he soothed, squeezing his brother's hand before placing it back by his side on the mattress and gently patting the kid's chest. "You're okay."
Sam's eyes opened as suddenly as they had closed and focused on Dean. Fear shone in his gaze, and Dean knew Sam understood how sick he was, how precarious and desperate their lives had become.
Sam's eyes filled with tears, suspended on the rims, glimmering in the dim light. Then, as if time had released its hold on the moment, the tears spilled freely over the end of his lashes and swept down his cheeks as he squeezed his eyes shut.
A sharp and bitter agony ripped through Dean's heart, tearing away the last vestige of his own control. His eyes misted, filled, but he refused to allow Sam to see his pain. He thumbed the tears from his little brother's cheeks and leaned forward, arching his back to avoid the trach, and pressed his forehead to Sam's as he tightened his grip on the kid's hand.
"I know, Sam," Dean whispered and then swallowed, almost choking over the lump of emotion that rested in his throat, the tightness making his voice hoarse. He sighed. "I know..."
They stayed that way – forehead against forehead – for several minutes until Sam slowly opened his eyes, staring straight into Dean's unwavering gaze.
Dean lifted his head, easing back so he could see his brother better, and then rested his hand on Sam's forehead before sliding it down to cup his cheek. Sam leaned into his touch, and Dean smiled affectionately, wondering how it was possible to love one person so much.
"You remember our deal?"
Sam's head bobbed in Dean's grasp.
Dean's thumb brushed away the remaining moisture on Sam's cheek. "You still gonna hold up your end?"
Sam nodded again, weakness making the movement barely perceptible.
"That's my boy," Dean responded automatically and smiled when Sam leaned even deeper into his touch, blinking drowsily up at him. He nodded. "It's okay, Sammy. Go back to sleep."
Sam seemed to understand but continued to fight the lingering effects of sedation until his eyes slowly closed. But the hand in Dean's held fast, communicating a need all its own.
Dean gently lifted his little brother's hand and held it to his own chest, releasing a shuddering breath as he closed his eyes. He did not consider himself to be religious, to believe in anything he couldn't see. But the adage was true – desperate times called for desperate measures, and in his heart he prayed one word.
Since it's been over two weeks since I've updated this story, I guess you've figured out that the posting schedule I once adhered to has completely gone out the window. My apologies. As always, thanks for reading and reviewing. Hope 2011 is treating you well thus far!