Summary: AU-ish Tag to 7.17 – Sick Sam / Guilty Big Brother Dean – It seemed all of Sam's recent health problems had an unlikely source: an untreated tick bite.
Disclaimer: Not mine.
Warnings: Spoilers for 7.09 ("How to Win Friends And Influence Monsters") and 7.17 ("The Born-Again Identity"); usual language
A/N: The opening dialogue (right up to Dean saying, "That's not that bad. And?") is from 7.17 – but then it's all me...and goes very AU-ish, although the symptoms of Sam's condition really could be caused by untreated Lyme disease.
I guess if we ignore it, it'll probably go away. ~ Ataris
"Okay, sir?" the nurse called, trying to keep her tone pleasant and professional as she hurriedly followed behind the guy that had just stormed past her desk like he owned the place. "You can't just barge in here without an appointment!"
Because the hospital had protocols, and it was part of her job to make sure visitors adhered to those protocols...even if the visitors were tall and ridiculously good-looking with a hard, rugged edge.
The nurse sighed as she continued to follow behind the guy while he continued to ignore her and kept walking; his long, determined strides easily outpacing her.
"They said talk to Kadinsky..." the guy announced gruffly as he entered the doctor's office; pushing through the closed door like he owned that place, too. "You Kadinsky?"
The nurse's eyes widened as Dr. Kadinsky glanced up from the paperwork scattered on his desk; staring at the guy in front of him before his gaze flickered to her in the doorway.
"You need to be scheduled!" the nurse sharply told the intruder; her heart racing in her chest from how quickly she had walked down the hall...and from the unreadable expression on Dr. Kadinsky's face.
Because sometimes Dr. Kadinsky was understanding...and sometimes he was an ass.
The nurse swallowed and held her breath as she waited to see which mood the doctor was in at this moment.
But the intruder didn't seem to care about the doctor's mood.
"Well then schedule me!" the guy barked in response to the nurse's insistence that he be scheduled and briefly glared over his shoulder at her before redirecting his attention back to the doctor still seated behind the desk. "He was in a car crash. Why the hell can't I see him?"
The nurse frowned and tilted her head; wondering how the hell this guy expected them to know who he was talking about when every day they had at least a dozen patients admitted due to injuries sustained in car crashes.
And now they were expected to just know about this particular patient without any other identifying information?
The nurse shook her head in annoyance.
But per usual, Dr. Kadinsky seemed unruffled...and also seemed to know exactly which patient this guy was referring to.
"You're Sam Smith's brother," the doctor responded as he stood; not asking but simply stating.
The nurse arched an eyebrow; always amazed when the doctor performed that trick.
The guy nodded, seeming to soften when he heard himself described as that – as Sam's brother.
The nurse felt a faint smile cross her lips despite her irritation; because even if this guy was being a dick, that was kind of sweet – that he would noticeably change at the mention of his brother's name.
"Yeah," the guy confirmed about his relationship to Sam. "What's going on?"
"It..." Dr. Kadinsky hesitated and then glanced at the nurse still lingering in the doorway. "It's fine," he told her and nodded for her to leave his office. "Thank you. Really."
The nurse glanced again at the intruder – glaring just for the principle of it – and then nodded at the doctor before exiting and closing the door behind her.
Dr. Kadinsky watched her go and then sighed; directing his attention back to Sam's brother still standing in front of his desk.
The guy stared back.
Dr. Kadinsky sighed again. "Sam was admitted," he needlessly informed and then quickly elaborated. "He was treated for a broken rib and lacerations."
"Okay..." the guy replied; his expression still concerned but relieved. "That's not too bad." He arched an eyebrow expectantly as the doctor once again hesitated. "And?"
"Well..." the doctor began, not quite sure where to begin his explanation. "I think you should sit," he bluntly advised and gestured toward the two chairs positioned in front of his desk.
The guy narrowed his eyes, seeming to sense further stalling.
"Please…" Dr. Kadinsky added, still motioning toward the chairs.
The guy sighed his displeasure but pulled one of the chairs back and sat; perched on the edge of the maroon cushion; his hands anxiously clasped between his legs as he stared at the doctor.
Dr. Kadinsky sat as well; resituating himself behind his desk.
"Let's hear it," the guy ordered; his expression hard...yet also tired and weary as though he was used to hearing bad news.
Especially bad news about Sam...
Dr. Kadinsky tried to smile reassuringly. "First...what's your name?"
Dr. Kadinsky nodded; because he remembered Sam calling that name when he had first regained consciousness in the emergency room.
"Well, Dean. I'm not really sure where to begin..." the doctor admitted, having found over the years that patients and their family members appreciated such honesty. "There seems to be quite a lot going on with your brother."
Dean remained expressionless as though he was continuing to passively, patiently listen.
But the doctor could sense the younger man inwardly snorting at the massive understatement about Sam and bracing himself for whatever was said next.
Dr. Kadinsky clasped his hands on his desk. "As you know, Sam was initially brought into the ER a little over two hours ago with injuries sustained in a hit-and-run."
Dean swallowed; still remembering the phone call he had received from the police officer on the scene...and still berating himself for having slept through Sam leaving their motel room earlier that night.
What kind of shitty big brother did that make him if he couldn't keep track of his own little brother? A little brother who had been steadily spiraling down into the depths of his own personal hell...
But Dean had just allowed himself to fall asleep...like Sam could manage on his own; like the kid could take care of himself.
Dean shook his head in disgust with himself; with whoever had hit his brother with their freakin' car; and with the entire situation they now faced.
Because there was no telling what the doctor had found out through the hospital's tests and evaluations and just general interaction with Sam.
Dr. Kadinsky cleared his throat, attracting Dean's attention. "As with all trauma patients brought to the ER, we ran a series of tests...blood panels and so forth."
Dean nodded; because he had figured that.
"And it was not surprising to find traces of illegal substances in your brother's blood," Dr. Kadinsky continued to report, keeping his tone neutral of judgment.
"Illegal substances?" Dean repeated and shook his head at the incomprehensibility of Sam partaking in such things.
But...desperate times, desperate measures, and all that crap.
Dean swallowed. "Okay," he calmly replied even as his chest felt like it would explode from the mixture of emotions swelling inside. "What kind of illegal substances?"
Dr. Kadinsky sighed. "Rohypnol," he responded. "More commonly referred to as 'roofies' – both on the street and in the general public – and is a sedative similar to Valium but about ten times stronger. We usually see this in – "
" – yeah," Dean interrupted and nodded. "I know about roofies. So...yeah." He shifted uncomfortably in the chair, almost afraid to ask. "Why were they in Sam's system?"
Dr. Kadinsky shrugged. "Hard to say. Depending on where Sam was and who he was with, he might have ingested the drugs without his knowledge. Or if he had purposefully taken them, it's likely he was trying to induce drowsiness or perhaps even amnesia for recent events." The doctor paused. "You're his brother. You know him best. Does that sound like something Sam would try to do?"
Dean swallowed against the urge to throw up; because based on the last few months that sounded exactly like something Sam would try to do in order to escape Lucifer's voice...to forget about Hell and the Cage and Bobby's death...and to finally sleep.
And while his little brother had been buying and taking illegal drugs on the street from god-knew-who...Dean had slept at their motel room like there was nothing to worry about; like he had believed Sam when the kid had constantly insisted that he was okay.
Dean swallowed again; aware that the doctor was staring at him expectantly. "I, um..." He swallowed once more and sighed. "Sam's been dealing with a lot lately."
Dr. Kadinsky nodded but did not pry for details. "I'm sure he has," he responded; his tone genuine and sympathetic. "After all, he is quite sick. And over time, illness can certainly begin to impair judgment as well as negatively impact other behavioral responses."
Dean frowned and tilted his head. "Meaning?"
"Meaning that if Sam did intentionally take the roofies, his decision to do so was most likely caused by his medical condition. And while that doesn't excuse his behavior, it certainly is a valid reason for it," Dr. Kadinsky paused. "...which is why I have reported the presence of illegal drugs in your brother's system to the police as standard hospital procedure, but I have also discouraged them from investigating the issue or pressing charges."
Dean sighed; releasing a breath he was unaware of holding. "Thank you."
"You're welcome," the doctor responded. "But I doubt the police would've pursued the case anyway. They're more interested in tracking down the hit-and-run driver, as they should be. Plus, unless Sam confesses to taking the drugs – and I doubt he even remembers if he did or didn't – it would be hard to prove they weren't slipped to him in some bar for who knows what purpose. And certainly the dealer who sold the drugs would be hard to pinpoint and most likely reluctant to talk about the transaction."
Dean nodded; no longer wanting to discuss Sam's possible drug use but instead more interested in the doctor's implication that his brother was sick beyond what Dean already knew.
"What else did your tests show?" Dean asked leadingly and tried to maintain a neutral expression even as his heart continued to pound in his chest; having no idea what the doctor would report but knowing it wouldn't be good news.
"Ah, yes..." Dr. Kadinsky remarked at the indirect reminder and reached for one of the files on his desk. "We also ran a serological to check Sam's blood type – which is another standard procedure in our ER – but what its results showed was quite surprising and alarming."
Dean swallowed; vaguely wondering if the doctor was going to report unusually high amounts of sulphur in Sam's blood...or something equally disturbing and hard to explain.
Dr. Kadinsky flipped open the file he held and began shuffling the papers inside before continuing. "Serological tests are often also done for diagnostic identification of antibodies in the blood serum, which are typically formed in response to infection. And as you can see..." the doctor stated, selecting one of the lab reports from the file and sliding it across his desk to face Dean. "...your brother's antibody count is literally off the charts."
Dean stared at the paper in front of him; his eyes scanning over numbers and percentages and a line that soared off the graph in the center of the page. "So, that means..."
"Well, of course, different infections produce different antibodies..."
"And these antibodies are indicative of Borrelia burgdorferi."
"Okay," Dean agreed and blinked, waiting for the English explanation.
"Lyme disease," Dr. Kadinsky informed.
Dean arched an eyebrow. "Lyme disease?" he repeated. "You mean the tick disease?"
"One of many tick diseases...but yes," Dr. Kadinsky confirmed.
Dean shook his head. "I don't understand," he admitted, feeling blindsided. Because out of all the things he had expected the doctor to say, Lyme disease wasn't among the possibilities. "Sam hasn't been bitten by a tick."
At least Dean didn't think he had.
"Well, I doubt the bite happened recently," Dr. Kadinsky replied. "Given the incredibly high levels of antibodies in Sam's blood, it's much more likely the tick bite happened maybe two or three months ago." He paused, once again glancing at the lab results. "Do you know if your brother was in any potentially tick-infested areas over the past few months? Or does Sam have any hobbies that might cause him to spend time in the woods...like hunting or camping or hiking?"
Dean shook his head; because Sam hated camping, and they hadn't been hunting or hiking in the woods since...
Dean froze; literally feeling a chill of shocked realization pass over him.
Because he and Sam hadn't been hunting or hiking in the woods since they had gone with Bobby...only days before Bobby had died...which was about two or three months ago.
Dean swallowed; wondering if Sam had been bitten by a tick then and just hadn't mentioned it...which was likely. It wasn't like he and Sam had been talking a lot lately; not with him too consumed by grief and revenge...and Sam too consumed with trying to stay sane.
Dr. Kadinsky arched an eyebrow at the expression on Dean's face. "Care to share?"
Dean glanced at the doctor; not particularly in a sharing mood – especially since the timeframe they were discussing involved Bobby's death – but knowing the information was important to Sam's health.
Dean sighed. "We were in the woods probably two or three months ago hunting with our uncle," he reported; careful not to mention Bobby's name because he felt like he would probably choke on the word; the pain of that loss still too fresh.
Dr. Kadinsky nodded. "I see. And did Sam mention a tick bite after that outing?"
Dean shook his head. "No."
But then, he and Sam had been preoccupied with other things after that outing – like holding vigil by Bobby's deathbed...and then burning Bobby's remains...and then trying to live one day at a time.
The doctor nodded again. "That's not surprising," he replied about Sam not mentioning a tick bite. "The ticks that carry this disease are often so tiny that they're hardly detectable. So, it's possible Sam didn't even know he had been bitten." He paused. "But the rash they leave behind after they've infected a person is quite unique and hard to miss – a bullseye type pattern with a slightly raised red welt in the center and a surrounding red ring."
Dean shook his head again; feeling increasingly frustrated. "Sam didn't say anything about a rash like that. And I didn't see one, either."
"Huh," Dr. Kadinsky mused, leaning back in his chair. "It would be unusual to be infected with Lyme disease and not have the rash in the early stages of infection. But if Sam was bitten in an area that he could not readily see – like his back – then it's possible he didn't know. After all, the rash is usually painless, so..."
Dean nodded at the implication – that if the rash was painless and in a place Sam couldn't see on his body, then it was likely the kid never knew he even had the rash and would never have had reason to tell Dean about it or to ask him to check it out.
Dean sighed; relieved that Sam hadn't intentionally hidden something from him...and slightly reassured that his own self-absorption over the past few months had not contributed to this situation, either.
It seemed to be just another case of shitty Winchester luck returning to bite them in the ass.
"Did your brother present with any generalized symptoms after your hunting trip?" Dr. Kadinsky asked. "Symptoms such as headache, muscle aches, maybe a low-grade fever..."
Dean shook his head. "I don't know," he replied and felt like shit for having to admit his ignorance on this issue.
Because that was part of his job – to know Sam; to keep an eye on his brother and to make sure he was safe and healthy no matter how old the kid got.
But in the days, weeks, and months following Bobby's death, Dean had felt alarmingly lost and knew he had been too absorbed in himself, in a bottle, or in his quest for revenge to pay much attention to Sam.
"Maybe Sam had other flu-like symptoms or just a general feeling of malaise..." Dr. Kadinsky suggested.
Dean resisted the urge to laugh; because in the months after Bobby's death – and hell, sometimes even now – both he and Sam both felt a general feeling of malaise.
It was the nature of their lives – especially lately – to wake up feeling sick and out of sorts because every day was the same shit storm.
"No," Dean answered. "I don't remember Sam being sick or saying he felt sick after that hunting trip." He paused. "But we've both been kinda quiet lately and keeping to ourselves." He shrugged. "A lot going on..."
Dr. Kadinsky frowned. "I see," he remarked; his tone slightly disapproving. "Well, I suppose none of his earlier symptoms really matter now since Sam's untreated condition has progressed to stage three."
Dean arched an eyebrow; always wary of diseases that were medically described in stages. "Stage three?"
Dr. Kadinsky nodded. "Late persistent infection," he rephrased as if that made it sound better. "Patients who progress to this stage often develop severe and chronic symptoms that affect many parts of the body...including their brain, nerves, eyes, joints, heart..."
Dean stared at the doctor; speechless and terrified.
The doctor nodded at Dean's expression. "It can definitely be as serious as it sounds."
Dean swallowed; finding his voice. "Serious how?"
Dr. Kadinsky shrugged as if he could not possibly be expected to list all the potential problems associated with this level of Lyme disease infection. "Long-term effects can range from chronic fatigue and muscle aches to joint erosion, paraplegia, even death."
"Holy shit!" Dean blurted; his heart hammering in his chest. "Sam could die from this? Or end up paralyzed? Just because of some stupid fucking tick?"
"It's a possibility," Dr. Kadinsky confirmed; unfazed by Dean's outburst. "But let's not get ahead of ourselves and jump to worst-case scenarios."
Dean snorted at the advice; because their entire lives had been one worst-case scenario after another. Why should this situation be any different?
"Then what the hell should we do?" Dean demanded; barely resisting the urge to hit something...hard.
Because he seemed to always react with anger and violence when anything threatened Sam; especially if it threatened to take his brother's life.
"We should discuss treatment options," Dr. Kadinsky replied reasonably and again reached for the file containing Sam's reports.
Dean sighed, trying to pull himself together; knowing that losing his shit in the doctor's office wouldn't help Sam. "Fine," he agreed evenly. "What are our options?"
Dr. Kadinsky glanced at Dean and then back at the file he held; once again shuffling the papers within the folder. "Well, after the antibodies showed up in the serological, I ordered an IgM antibody test, an IgG antibody test, and a Western blot test to obtain a more complete and thorough idea of what we were dealing with."
Dean nodded; not really caring what tests had been ran but wanting to know the next step. "And...?"
The doctor studied the lab reports; reminding himself before he spoke. "The results further confirmed a late stage infection of Lyme disease, which explains all of Sam's other symptoms." He paused. "I'm sure you've noticed your brother's difficulties with concentration and short-term memory as well as him experiencing profound fatigue and depression."
Dean nodded. "But I thought that was just...life."
Dr. Kadinsky nodded his agreement. "Most patients do," he confirmed. "Especially if they've been under a lot of stress or are going through a lot of personal issues at the time these symptoms occur. Since the symptoms are so generalized, it's difficult to tie them to Lyme disease, especially if the patient doesn't remember being bitten by a tick or never saw the bullseye rash...both of which apparently happened in Sam's case, along with the personal struggles you implied earlier."
"But the antibody tests all indicate that those symptoms were caused by Lyme disease?" Dean asked; wanting to understand...and feeling guilty that he had just assumed the fatigue and depression and other issues Sam had been dealing with were because of the Cage memories leaking through his brother's shattered wall.
"Yes," Dr. Kadinsky answered. "But I think the most fascinating part of this is Sam's apparent psychotic break."
Dean clenched his jaw at the use of that phrase being used in relation to his brother; wondering if the doctor would find it fascinating if he was suddenly punched in the face.
Dean exhaled slowly; flexing his fingers to prevent them from balling into fists. "How is that fascinating?"
Dr. Kadinsky arched an eyebrow; hearing the barely controlled anger in Dean's voice. "Because I don't think Sam has had a true psychotic break," he replied, soothing the older brother. "There have been cases of untreated Lyme disease that have resulted in psychosis, which is then often misdiagnosed as either schizophrenia or bipolar disorder...both of which would apply to Sam's current condition, especially given his hallucinations."
Dean swallowed; wondering what Sam had said when his brother had been brought to the ER for the doctor to know about the kid's hallucinations.
"Some patients with late stage Lyme disease have also experienced panic attacks and generalized anxiety as well as shown signs of delusional behavior and reported feeling detached from themselves and reality as a whole."
Dean nodded as the doctor continued to explain; his mind buzzing; his chest tight with a mixture of emotions – because all of those symptoms described Sam over the past few months as his brother had quietly but steadily spiraled down.
And to think all of that was potentially caused by an infection that neither of them even knew about...
Dean sighed; remembering a time when he noticed everything – especially if it affected Sam – and silently vowed to return to those days.
Because Sam deserved that kind of attention – and truthfully, Dean missed giving it to him; missed the days when his strength and purpose came from taking care of his brother and from knowing his brother had his back as well.
In fact, they were long overdue to return to the basic foundation of their life together and their relationship as brothers...which was watching out for each other.
Dean sighed; refocusing on the doctor. "So, now what? How does Sam get better?"
Because Dean would accept no other outcome except Sam's full recovery.
Dr. Kadinsky smiled as he continued to sit behind his desk. "Well, this is where I get to tell you the good news..." he replied. "Save the best for last, eh?"
Dean arched a surprised eyebrow. "Really?"
"Really," the doctor confirmed. "As serious as Sam's condition is, even late stage Lyme disease usually responds well to antibiotics."
"Antibiotics...that's it?" Dean asked; hopeful and relieved yet feeling like the news was too good to be true.
"Yes, that should be it. Although we're not talking about Sam popping a few pills and then being all better," Dr. Kadinsky warned. "His condition is still serious."
Dean nodded. "So, what are we talking about?"
"We're talking about aggressive treatment," Dr. Kadinsky informed. "Because Lyme disease is more difficult to treat in its later stages due to the bacteria disseminating throughout the body unchecked and thus sometimes crossing the blood-brain barrier, we've got to hit this bitch right where she lives."
Dean gave a startled laugh at the doctor's unexpected expletive to describe Sam's infection but nodded his approval. "Hell yes," he heartily agreed.
Dr. Kadinsky nodded and smiled. "So to begin with, Sam will be receiving high doses of antibiotics intravenously. In fact, we're currently administering his first dose of ceftriaxone right now."
Dean nodded. "Then what?"
"We'll most likely stick with ceftriaxone for about four weeks and see how Sam responds. After that, we'll run our tests again as well as generally evaluate his overall condition," Dr. Kadinsky further explained. "If antibiotics are still indicated, we'll probably switch Sam to an oral dose of minocycline for several more weeks and then repeat our testing and evaluations."
Dean nodded again. "You said that Sam has to receive the first round of antibiotics intravenously...which means he has to stay here?"
Because while Dean would do whatever Sam needed, he hoped they wouldn't have to stay in one location for four weeks...especially with the Leviathans seeming to constantly be on their trail.
Dr. Kadinsky shook his head. "No," he answered. "A peripherally inserted central venous catheter has been placed in Sam's left arm in order for him to receive his antibiotics at home over the next four weeks. The nurses will train you on how to administer the meds through the line."
"I already know how," Dean informed casually but did not elaborate; instead politely smiling when the doctor arched a surprised eyebrow.
"I see," Dr. Kadinsky replied. "I guess that means Sam will be in good hands."
"Damn straight," Dean agreed and nodded; because it was definitely time to resume his big brother responsibilities.
Dr. Kadinsky chuckled and stood behind his desk. "Well, it seems we're done here. Would you like to see your brother?"
"Absolutely," Dean eagerly responded and stood as well; freshly overwhelmed with the need to see Sam and assess the kid's condition for himself.
"I thought you'd say that..." Dr. Kadinsky quipped and smiled. "Follow me."
Dean needed no further encouragement; instantly falling in behind the doctor and following him to the elevator.
"We originally had Sam in the psychiatric ward on the fifth floor," Dr. Kadinsky admitted as he pushed the elevator's upward arrow. "But as soon as the test results came back and showed the real problem, I ordered him to be moved to a regular room on the third floor."
"Thank you," Dean replied genuinely; not sure if Sam could endure being locked in a psych ward...or if he could endure seeing Sam there.
Dr. Kadinsky nodded, accepting Dean's gratitude, and stepped onto the elevator as it arrived with a ding.
Dean followed; watching as the doors slid shut.
"If Sam is doing well and has completed his first round of antibiotics..." Dr. Kadinsky began as the elevator lurched upwards. "I see no reason for him not to be discharged this evening. You seem capable of maintaining the proper level of care and vigilance now that you're aware and informed of everything going on with your brother."
Dean nodded appreciatively at the praise. "I can take care of Sam," he assured the doctor as the elevator dinged its arrival on the fifth floor and slid its doors open.
"I have no doubt about that," Dr. Kadinsky returned and stepped off the elevator.
Dean smiled and followed the doctor; his eyes scanning the hallway as they walked toward Sam's room.
"Here we are..." Dr. Kadinsky announced and motioned toward the room at the end of the hall.
Dean nodded and sidestepped the doctor; entering the room and instantly feeling more at ease now that he could see his brother.
"Sammy..." Dean called as he approached the bed; giving the kid a visual once-over; taking in the pale skin of sickness and the dark circles of fatigue beneath Sam's eyes.
Sam turned his head in the direction of Dean's voice and blinked; his smile weak but genuine. "Dean. Hey."
Dean returned the smile. "Hey yourself, Mister I-Do-My-Own-Stunts," he lightly teased and noticed the IV line protruding from his brother's left arm; assuming that was the one that would be left in for the antibiotics. "Since when do you run out in front of cars in the middle of the night?"
Sam's reaction to the question was immediate; his eyes misting with tears. "I don't know," he whispered and inhaled a ragged breath; his expression implying he had spent a lot of time thinking about it...and had come up with nothing. "I don't remember. M'sorry."
Dean shook his head and patted Sam's chest like he used to do when his brother was upset as a kid; wondering if Sam didn't remember because of fatigue, trauma, the roofies...or a combination of all three.
"It's okay," Dean soothed...because none of that really mattered at this point. "Shit happens, huh?" he further excused and offered his brother a forgiving smile. "We'll talk about everything later. But it's over now, Sammy. I'm here. And you're gonna be okay."
Sam sighed shakily; soothed by Dean's words and presence.
Because if Dean said he was going to be okay...then Sam believed him, even after everything that had happened.
There was a beat of silence as Sam and Dean stared each other.
Dr. Kadinsky cleared his throat. "The police will find whoever ran over you, Sam," he assured as he approached the opposite side of the bed with his patient's chart in hand.
Both brothers glanced at the doctor and nodded.
But even if they were still in town to press charges, they had bigger issues to deal with now.
Dean sighed; glancing back at Sam as his brother lied listless on the mattress – obviously exhausted and ill – and wondered how the hell he could've missed the signs of Sam's sickness over the past few months.
Sam shifted uncomfortably on the bed; his face scrunched in pain.
Dean frowned. "What's wrong? Are you okay?"
Sam nodded but then winced again; holding his side as he shifted once more on the mattress.
"Well, kinda okay..." Dean observed, instantly remembering Sam's broken rib and also allowing his gaze to take in the numerous scrapes, cuts, and bruises that covered his brother's body. "Are you in pain?"
"Not much," Sam answered truthfully; knowing he was heavily medicated. "Only sometimes when I move."
"Then don't move," Dean advised cheekily and winked as Sam weakly glared at him.
Sam swallowed and then vaguely motioned at the doctor still standing beside his bed. "Did he tell you?"
Dean nodded, knowing what Sam was asking. "Yeah. Who knew a tiny tick could take down your gigantic ass, huh?" he teased.
Sam snorted and shook his head; a faint smile crossing his lips as he heard Dean's masked worry hidden within his words.
Dean's smiled lingered and then faded. "Sounds like Lyme disease sucks, man."
"It certainly can," Dr. Kadinsky agreed, still shuffling through Sam's chart. "But you should be fine, Sam. You'll be tired and achy for a while, so you'll need to rest. But after a few more doses of antibiotics, you should start being able to tell a difference in your overall condition."
Sam nodded. "I think I feel better already," he responded as his eyes dipped closed. "S'quiet. Finally..."
Dean exchanged glances with the doctor; both knowing what Sam meant – that he was not currently hearing voices – but only Dean knowing whose voice Sam usually heard.
Dr. Kadinsky sighed. "Well..." he began and nodded his satisfaction as he scanned one of the reports from Sam's chart. "From what I see here, I feel comfortable discharging you and allowing you to go home, Sam. Are you good with that?"
Sam blinked his eyes open. "Yes," he eagerly responded and glanced at his brother. "Dean can do whatever you can," he added, sounding like the bragging little brother he was. "He can do the IV meds."
"Damn right I can," Dean replied and then nodded at the doctor. "We've already discussed that, Sammy."
Dr. Kadinsky nodded as well. "We certainly have," he agreed and closed Sam's chart. "Alright, then...I'll go start the discharge process. The nurse will be in later with paperwork and instructions and go over administering the intravenous antibiotics."
"Sounds good," Dean replied and watched as the doctor left the room.
There was silence.
Sam sighed tiredly and stared at Dean. "D'ya think he's really gone?"
Dean glanced back at his brother and arched an eyebrow. "The doctor?"
Sam scowled weakly.
"Oh..." Dean remarked as he realized which he his brother was referring to – Lucifer.
"D'ya think he's gone?" Sam pressed; obviously desperate for reassurance that the silence in his head would last.
Dean sighed. "I don't know, Sammy," he answered honestly. "I hope so. But if he's not, I can promise you that I will do everything I can to make sure he gets gone. You hear me? You don't have to deal with this alone anymore. We're gonna kick Lucifer – and Lyme disease – in their ass."
Sam smiled at Dean's determined tone; having missed his kick-ass big brother over the past few months. "I like that idea."
Dean nodded his agreement and then paused; still disturbed by how sick Sam looked. "How do you feel?"
Sam shrugged. "Kinda crappy."
"Yeah?" Dean smiled as he prepared to once again tease his brother. "Well...you look kinda crappy, too. Seriously. The beard thing worked for Dad and for Bobby...but it ain't workin' for you, man."
Sam laughed softly; wondering if Dean realized he had just said Bobby's name without choking over it. That had to be progress...
Dean's smile lingered – because it felt good to smile and laugh and actually mean it – but then paused; feeling a fresh stab of guilt at how exhausted and sick his little brother looked lying there in that hospital bed.
Dean sighed and then cleared his throat. "Sammy...I'm sorry."
Sam frowned. "For what?"
Dean snorted humorlessly. "Where should I start?" he asked incredulously. "I'm sorry for having my head up my ass these past few months. I'm sorry I didn't notice that you were sick. I'm sorry that I let you try to handle Lucifer by yourself...and all the crap that went with him. I'm sorry that I was fucking sleeping while you were out getting hit by a car. I'm sorry that – "
" – shut up," Sam ordered softly, interrupting Dean's rant.
Dean blinked. "What?"
"Shut up," Sam repeated. "I know you like to hog the blame. But it's not all yours this time, Dean." He sighed. "I didn't know about the tick bite. And I didn't know I was sick. But I wasn't completely honest about Lucifer and the hallucinations." He paused. "It's hard for you to help me if I don't tell you what I need help with."
Dean shook his head. "That's not an excuse. I should've known, Sam. It's part of my job to just know and then to call you on your bullshit."
Sam quirked a tired smile. "I'm a good bullshitter."
Dean chuckled his agreement. "Yeah, you are. And you seem to get better with age..." he commented and then paused. "Of course, you had a damn good teacher..."
"The best," Sam praised; his smile widening; wondering if Dean realized all the other things he had taught him over the years.
Dean smiled as well.
There was a beat of silence.
"I am sorry, Sam," Dean told his brother; his tone and expression serious and genuine. "I really am. I never should've ignored you. But you said you were fine...and although I knew you weren't, I guess I just hoped that maybe the problem would go away by itself." He quirked a self-deprecating smile. "And for that, I'm sorry. You know I would never do anything to purposefully put you in danger."
Sam nodded as his eyes once again misted with tears; touched by Dean's uncharacteristically open show of love and concern. "I know. S'okay."
Dean shrugged; not sure if he would ever let himself believe it was okay or if he would ever forgive himself as easily as Sam forgave him.
But...enough of that.
What was done was done, and all they could do now was move forward...together; taking care of each other like they used to.
And truthfully, Dean was looking forward to it.
Dean smiled and then sighed; shaking off the weight of their conversation and deciding to lighten the mood as he glanced at his brother. "Of course, you know what this means now...right?"
Sam frowned as he shifted on the mattress. "What?"
"Well, we can't risk either of us being bitten by a tick and not knowing about it," Dean explained reasonably. "Obviously bad shit can happen. Which means I guess we'll have to start checking each other for ticks..."
Sam cringed and then laughed softly at the suggestion; hearing Dean's affection and lingering worry in his seemingly flippant teasing. "Dude. No."
Dean arched an eyebrow. "Are you vetoing my idea?"
"Definite veto," Sam responded and chuckled; wincing again as pain flared in his side.
Dean rolled his eyes. "Bitch," he remarked dryly but then winked good-naturedly at his brother.
Sam smiled; swallowing against the emotion that rose in this throat from hearing Dean say that. "Jerk," he replied; wondering how long it had been since he and Dean had exchanged those words of brotherly love...and deciding it had been entirely too long.
Dean returned his brother's smile; squeezing Sam's shoulder – the familiar touch communicating all that words could never say – before settling into the chair beside the kid's bed as they waited to be discharged.