Summary: AU tag to 6:11 – One minute Sam was screaming...and the next, he wasn't even breathing. He had lost consciousness the instant Death had disappeared from the panic room, and how they had ended up in the emergency room was still a blur to Dean.
Disclaimer: Not mine.
Warnings: Just the usual for language. Also obviously contains spoilers for episode 6:11
Author's Note: I know I've already done an AU tag for 6:11, but that was before I actually watched the episode. I had just read a couple of reviews and watched the ending clip on YouTube. But after I finally watched the entire episode yesterday, this came to mind.
A white blank page and a swelling rage
You did not think when you sent me to the brink.
~ Mumford & Sons ~
Okay, here's the question: What are you doing when you aren't doing anything at all?
Most people will answer "nothing," and while they will have aced a test in logic, they will have flunked a test in neuroscience.
Because even when you're doing nothing, you're doing something, though you won't realize it until it's gone. Blocked by an injury or an illness or...say, a wall.
But we're jumping ahead of ourselves.
Let's back up.
When people perform mental tasks – comparing, contrasting, categorizing, problem solving – different areas of their brains become active, as evidenced by brightly colored squares on brain scans.
That's no surprise.
But researchers have recently discovered that when these areas of our brains light up, other areas go dark. This so-called dark network – comprised of regions in the frontal, parietal, and temporal lobes – is off when we seem to be on, and on when we seem to be off. When you think you're doing nothing, the dark network within your brain is as active as a beehive; but the moment you begin a task, the bees will freeze, and the network will fall silent.
So, even when we appear to be doing nothing, we are clearly doing something.
The answer, it seems, is time travel.
Just not in the way that you expect.
The human body moves forward in time at the rate of one second per second whether we like it or not. But the human mind can move through time in any direction and at any speed it chooses. We have the ability – unparalleled in the animal kingdom – to close our eyes and imagine the pleasures of Super Bowl Sunday or remember the excesses of New Year's Eve. We are a race of time travelers, unfettered by chronology and capable of visiting the future or revisiting the past whenever we wish.
At least most of us are.
But if our neural time machines are damaged by illness, injury, or age...or blocked by something else, something unidentifiable...we may become trapped in the present. The dark network becomes incapacitated, stranding many of its victims in an endless now, unable to remember their yesterdays or envision their tomorrows.
Such would be the case.
"He's had a what?" Dean asked sharply, certain he had heard wrong. His brother wasn't even 30-years old. No way that could be his diagnosis.
The doctor pointed again at the CT scan printout within the folder positioned between himself and Dean as they stood in the hall of the Intensive Care Unit. "A hemorrhagic stroke."
Dean said nothing, too stunned to react.
You're playing pretty fast and loose with my life here, don't you think, Dean? It's my life. It's my soul. And it sure as hell isn't your head that's going to explode when this whole scheme of yours goes sideways.
There was silence.
Bobby cleared his throat. "What caused it?"
"What the fuck do you think caused it?" Dean growled, his body practically vibrating with the rage that ran through it as he remembered standing passively by a different door a few hours ago, watching as Death restored Sam's soul.
Sam, I'm your brother. I'm not gonna let you get hurt. I know what I'm doing here.
And what if you're wrong?
I won't let it go wrong.
And yet it had gone wrong.
One minute Sam was screaming...and the next, he wasn't even breathing. He had lost consciousness the instant Death had disappeared from the panic room, and how they had ended up in the emergency room was still a blur to Dean.
"Well..." the doctor began, answering Bobby's question as though Dean hadn't asked his own. "In patients Sam's age, we often suspect physical trauma to be the cause of intracranial bleeding. But since Sam has not sustained a head injury traumatic enough to cause this, we would suspect nontraumatic causes, such as a ruptured aneurysm. But even that doesn't seem likely in this case, since Sam does not present with a subarachnoid hemorrhage."
"A sub...what?" Dean asked distractedly, too busy staring at his brother through the door's thin window and plotting ways to kill Death.
"A subarachnoid hemorrhage," the doctor repeated. "It's characteristic of a ruptured aneurysm, but the CT scan doesn't show that." He pointed to the printout again, as if the black and white images meant anything to anyone other than himself. "As you can see here, there's an intracerebral hemorrhage – meaning bleeding within the brain. We typically see that in patients with chronically high blood pressure, when a small artery is weakened over time, causing it to burst. But again, that condition is rare in patients who are your brother's age and in his excellent physical condition." He paused. "Does Sam have high blood pressure?"
Dean shook his head.
No, Sam didn't have high blood pressure...except if the doctor wanted to count that time a few hours ago when the combination of physical, emotional, and psychological trauma most likely sent his little brother's heart rate and blood pressure off the charts.
Getting your soul forcefully restored would do that to you every time.
Dean squeezed his eyes shut.
"I didn't think so," the doctor responded, making a note in the chart he held. "Like I said, patients Sam's age and in his condition usually don't." He paused again, glancing between the two men in front of him. "Is Sam..." He cleared his throat. This next part always got a reaction. "Is he an addict?"
"Not anymore," Dean responded defensively, not even realizing how quickly he answered. "Sam's clean."
The doctor's eyebrows raised, creating deep wrinkled grooves across his forehead. "But he has been a user in the past?"
Dean didn't reply; didn't want to talk about it; didn't like the judgment he heard in the doctor's tone that he had once heard in his own. What was done was done, and Sam had more than paid for it.
Bobby glanced at Dean, knowing this was a sensitive topic with the older brother; knowing Dean wasn't going to answer by the stubborn set of his jaw. "Yeah," he confirmed himself with a sigh, because this is what Sam wanted. "He used to have a problem."
The doctor nodded, poised to jot more notes in the folder he held. "What did he use?"
"Meth," Bobby answered without a blink – because that's the way they had practiced it – and yet he still saw Dean flinch at the word.
In the time after Lucifer was free and before Famine paid a visit, Sam had done research, determined to figure out which illicit drug matched the effects of demon blood, determined to find a way to list his past addiction on medical history forms in case it ever mattered in his care.
And Sam had decided on methamphetamine.
"When methamphetamine is injected – or in my case, ingested – it immediately produces an intensely pleasurable sensation known as a 'rush' or a 'flash' by releasing high levels of dopamine in the brain," Sam had read to them from the laptop screen one night at Bobby's place.
It had been important to Sam to make a comparison between a drug and the demon blood, but it had been incredibly difficult to listen to him rattle off the effects they had all lived through – increased wakefulness and physical activitiy, decreased appetite, prolonged insomnia, irritability, violent behavior, anxiety, paranoia...and the list went on.
The doctor shook his head in frustration. "I've seen so many kids get mixed up with meth..." he commented. "How long did he use?"
"Longer than he should have," Dean snapped. "What does it matter? That's not what caused this."
The doctor shrugged. "Most likely not – especially since you say Sam is clean now..."
"He is," Dean assured, his tone leaving no room for doubt.
Besides, Soulless Sam was psychotic enough; he hadn't needed the extra boost of demon blood. And weren't they all grateful the two had never mixed?
"Good for him," the doctor responded sincerely. "I just needed to ask because meth can cause increased heart rate and blood pressure, sometimes leading to intracerebral hemorrhage." He sighed. "But since all usual suspects in this condition have been ruled out, we'll have to start considering less common causes such as other blood vessel abnormalities, tumors, vasculitis, bleeding disorders, or..."
"...having your soul shoved through your chest into your body," Dean finished, once again staring through the thin window at his brother.
The doctor frowned and shook his head. "Say what now?"
Dean didn't respond – finished with this conversation, needing to be with his brother – and instead sidestepped around the doctor and entered Sam's room, leaving Bobby to cover.
The doctor glanced over his shoulder as Dean closed the door and then turned his attention back to Bobby. "What did he say?"
"He's just thinking out loud," Bobby replied, then realized that probably wasn't a good answer since Dean's suggested cause didn't even exist in the doctor's mind.
"Thinking out loud?" the doctor repeated, clearly confused and a little concerned.
"You know how stress can make you say crazy things," Bobby commented, even as he knew Dean was right.
Just as Sam had been right.
When Dean shoves that soul back in me, think how bad that could really be.
Death's magic show with Sam's soul – now you see it, now you don't – was, without a doubt, the reason Dean's little brother was, ironically, at Death's door.
Or was he?
Bobby sighed. "So...prognosis?"
The doctor closed the folder, holding it in the crook of his arm as he rubbed the tension from the back of his neck. "As a rule, intracerebral hemorrhage is more likely to be fatal than ischemic stroke since the hemorrhage is usually large and catastrophic. In fact, more than half of the people who have a large hemorrhage die within a few days."
Dean doesn't care about me. He just cares about his little brother Sammy burning in Hell. He'll kill me to get that other guy back.
Bobby swallowed. "Is Sam in that half?"
"Not likely," the doctor answered, shaking his head. "Sam seems to be the rare exception to the rule in that although his hemorrhage was large and certainly catastrophic, he is stable, has a high Glasgow Coma Score, and is already showing signs of regaining consciousness."
Bobby glanced through the door's thin window, seeing Dean perched on the side of his brother's bed, grasping Sam's hand. "So Sam will be okay?"
"If by 'okay,' you mean Sam will be like he was prior to this...no. That's unlikely. Those who survive usually recover consciousness and some brain function over time. However, most do not recover all lost brain function."
Bobby swallowed again, thankful Dean wasn't in the hall to hear this right now. "Lost brain function?"
"Yes," the doctor confirmed, his casual tone indicating how many times he had had this conversation over the years. "The CT showed the most damage in Sam's left temporal lobe, so we can certainly expect problems with memory if nothing else."
Bobby felt his stomach clench. "Memory?"
"Yes," the doctor responded. "The temporal lobes are highly associated with memory skills, especially long-term memory. Left side lesions can also result in decreased recall of verbal and visual content, including speech perception. But the functions of the left temporal lobe are not limited to low-level perception; functions also extend to comprehension, naming, verbal memory, and other language functions. Memory for words can be drastically impaired, as can the ability to understand language – an impairment called Wernicke's aphasia – and as I'm sure you can imagine, this becomes extremely frustrating for patients, and they often exhibit aggressive behavior."
Bobby nodded, not surprised that Death had turned out to be one tricky sonuvabitch, and they had once again been screwed. The devil is in the details, as the saying went, but apparently...so was Death.
The wall he had erected in Sam's mind wasn't so much a concrete structure – keeping this over here and that over there – as it was a condition; a brain injury resulting in loss of brain function, which resulted in the loss of memory. And even if Sam did remember one day, his ability to not only understand language but to use it had also been damaged, which meant he would have memories he had no way of expressing; which would lead to intense levels of frustration – don't scratch – that often led to aggression.
Dean's got a way to make it safe.
What a fucking joke. And the only one that had laughed, that had recognized it for the bullshit it was, was Soulless Sam.
He didn't know what happened now.
The doctor shifted in the silence that had settled between them. "I know this is a lot to absorb," he said, his tone annoyingly gentle and sympathetic. "But the good news is that Sam is alive and will most likely pull through this. Everything else is dealt with one day at a time."
Bobby snorted. "That's easy for you to say."
"You're right," the doctor agreed patiently. "But that's where we are at this point. I'm sorry." He paused. "I'll be back in a few hours to check on things..."
Bobby nodded as the doctor left him standing alone in the hall.