What a difference, Gayle thought, between the Nurse's Office in an elementary school versus the high school. She'd spent her first ten years as a school nurse in various elementary schools where skinned knees could be fixed with a Scooby-Doo band-aid and everything else could be fixed with an ice cube. When she was transferred she didn't think she'd enjoy working in the high school half as much, particularly since Sex Ed was now on her duty roster, but she found that she liked working with older students who could actually carry on a conversation and didn't get hysterical when she took out the peroxide.
Because she was attached to a regional high school the population of students was very large and Gayle was one of three nurses who were always on campus. There was literally always something to do, and in the rare moment when the office was empty of students there was a mountain of paperwork to catch up on. Gayle was taking advantage of one of those rare moments when Coach Tyler walked across the threshold with an extremely unsteady student.
The gangly, brown-haired kid looked like he was ready to pass out and was only on his feet through sheer force of will and a steadying hand from the coach. His eyes were sunken and unfocused and he was swallowing hard like he was trying not to throw up. Coach Tyler maneuvered the boy to a cot just before his legs gave out under him.
Gayle was up out of her chair and around the desk in a heartbeat. She knelt on the floor on the boy's left side and tried to catch his eye. The boy didn't look familiar to her; he wasn't one who'd been through the office for real or imagined reasons. It happened like that in a school this size; sometimes there were kids you never saw except for eye exams and random lice checks.
"What's his name?" she demanded of Tyler.
"Winchester. Sam Winchester."
Gayle turned slightly toward the coach and mouthed Drugs?. The coach shook his head in the negative.
"Sam. Look at me, Sam." Gayle put her hand on Sam's cheek to turn his head toward her. Gayle informally assessed a number of things and it wasn't adding up to a good picture. His skin was dry to the touch and his lips looked excessively dry as well. Sam had a fever flush and was warm under her hand, but it was hard to tell if it was because of physical activity or internal temperature.
Gayle pulled the stethoscope from around her neck. "What happened?" she asked Coach Tyler as she listened to Sam's heart and took his blood pressure.
"Presidential Fitness Exam. 12-minute mile. The kid's never had any trouble doing anything physical in my class. It's an easy run for him. But after a lap he was looking gray and I pulled him off the track."
Gayle listened to the coach with half an ear. Sam's heartbeat was rapid – more rapid than it should've been after a chance to cool off between running one lap and getting to the office. His blood pressure was low and the color of his skin was waxy.
"One of the other boys said that he was absent yesterday. Stomach bug."
And that was the final piece of the puzzle. Gayle crouched so she could speak into Sam's face again. "Sam." Sam dragged his gaze from the middle distance to focus on her.
"Have you been sick, Sam? Vomiting? Diarrhea?"
Sam swallowed hard as if even the thought of it made him nauseous.
"When did it start?" Gayle knew that short, direct questions were the way to go.
"Friday night." Sam croaked out. He took a deep breath.
"How long did it last?"
"All day Saturday. Little bit on Sunday."
That sounded about right. This particular stomach bug that was rampaging through the school was nasty for about 48 hours.
"Did you throw up yesterday? Any diarrhea?"
Sam grimaced and his eyes drifted to half-mast. "No. Just tired."
"Why didn't you stay home today, Sam?"
Sam's eyes popped open and she got the first clear-eyed response from him. "Math test period six."
Gayle had to laugh. Most boys Sam's age would've played the sick card for the extra day off, maybe even milking it into Wednesday if they could, and here was this kid running himself into the ground so he wouldn't miss a test. Sadly, he was going to miss it in spite of his best efforts.
"Are you thirsty, Sam?" Sam nodded his response, and all of the clarity he had a moment before seemed to drain out of him.
"Don't know if I can keep it down," he mumbled.
"Just take it slow. Small sips."
Gayle stood up, internally cursing her aging knees, and waved Coach Tyler over to the water cooler. "Can you stay for another minute? I need get Judy back from lunch and make a call."
Tyler took the paper cup from Gayle's hand. "Is it that bad?" he asked quietly.
Gayle didn't answer him directly. "Better to be safe than sorry." She swiftly moved back to her desk as she hit the page button on her phone. Judy was just going to have to cut her lunch short. Then she called 9-1-1.
Gayle had been a practicing nurse for most of her adult life and was not one to hit the panic button, but the symptoms Sam was displaying were a little too serious to treat with a cup of water and a cold compress. He had obviously lost and not replaced a large amount of bodily fluids over the weekend; either the nausea from the illness or nausea from being dehydrated prevented him from taking in enough water to reset the balance. Chances were that he'd had very little to drink the day before and the run in PE sent his body over the edge. What he needed was intravenous salt and fluids, and that was not something she could provide in her office.
Gayle kept an eye on Sam as she spoke to the dispatcher. She ran down all of his symptoms as she looked up his information on the computer. Since this wasn't a life-or-death emergency the ambulance wasn't going to roll in with sirens screaming, but she knew they'd haul ass to get to the high school.
As Gayle was speaking Judy returned from lunch. Gayle waved her over and wrote on a notepad "severe dehydration" and "EMS". Gayle gave the phone over to Judy so she could relay Sam's personal information to the dispatcher and she returned to the patient.
Instead of crouching on the floor, Gayle took a seat next to Sam on the cot. Coach Tyler had been trying to administer water, but Gayle could see that Sam hadn't taken much in; she knew she made the right call. In the few minutes he'd been sitting in the office he looked even shakier than when the coach brought him in. Gayle turned her knees towards Sam's and laid her hand on his back.
"Sam, you're really dehydrated and you need more help than I can give you."
Sam's brows creased in a frown, but Gayle was pretty sure he wasn't processing what she was saying. She rubbed her hand in circles on his back.
"I've called the EMTs and they're going to come to take you to the hospital."
Sam's reaction made it clear that he had definitely processed what she was saying. Gayle was expecting a typical, adolescent male response including embarrassment, machismo, mortification and denial at the idea of being taken out of school in an ambulance; she was not expecting fear.
Sam tensed with adrenaline and though he couldn't push himself up off the cot he did try shift backwards away from her. "No! Not the hospital!"
Gayle let Sam pull away from her; it wasn't like he really had anywhere to go. She placed her right hand on his right leg and continued trying to soothe him. "Its okay, Sam. No big deal. What you really need is an IV and I can't give that to you."
Sam was swallowing hard again, this time trying to fight down panic, not nausea. "I'm fine. I'm okay." Sam shook his head in the negative the whole time. "Can't I just lay down here? Sleep it off? I'm just tired."
"You need more help than that, honey."
Sam rubbed his forehead fretfully making him look six instead of sixteen. "If you just call Dean he can come take me home."
"Who's Dean, Sam?" Gayle prompted.
"M'brother. Dean's my brother. He can drive me home." Sam continued to push himself back until his shoulders hit the wall and he wedged himself into the corner where the cot hit the wall. Gayle let him stay there since he was supported on two sides and if he did finally pass out he wouldn't fall.
"Okay, Sam. We'll do our best to contact Dean. Is he at home or is he working?"
Sam's shoulders seemed to deflate. "Working. He's working with Dad. They were gone all weekend." Sam met Gayle's eyes miserably. "They're not home yet."
She responded calmly. "No problem, we'll see if we can reach them. Do they have mobile phone numbers?"
Judy, who had been following the conversation called out from behind the desk, "I've got the numbers here."
"Call Dean. He can drive me home." Sam slipped into a monologue that revolved around Dean, promising to drink more water and pleading to be sent home. Gayle was a little concerned that Sam seemed to have lost the thread of his thinking, but semi-conscious was better than blank oblivion.
Loud footfalls in the hallway announced the arrival of the EMTs. The sudden appearance of uniformed figures galvanized Sam. He lurched to the side reaching for Gayle's hand. Sam's hazel eyes were huge in his face. He pleaded with her in a hoarse whisper, holding on to her like she was the only lifeline of a drowning man.
"I don't want to go to the hospital…I just want Dean!"
He just about broke her heart.
Gayle waved off the EMTs in the doorway. She shifted a little so she could take Sam's face in both of her hands. She prayed that her words would reach through his fear and delirium. "Sam, every person here just wants to make sure that you are well. That's all we want to do."
Sam lifted his hands to cover Gayle's, but his grip was weak. "We're all going to help you get better. And you're going to let us do our jobs." Sam almost seemed ready to nod an assent, so Gayle made a snap decision. "I'm going to go with you, Sam. I'll stay until Dean comes to pick you up. Okay?"
Sam closed his eyes and nodded.
The EMTs moved forward and repeated all of the assessments Gayle had already done – heart rate, blood pressure, temperature. She was glad that Mike and Leo were the guys on call; they were efficient but also very good with spooked kids. Mike in particular had a tone that put people at ease. He introduced himself to Sam and before he did anything he explained what he was doing and what it was for. Sam did his best not to let go of Gayle's hand, and Mike didn't make him.
The assessments were swiftly completed, medical forms were photocopied by Judy and handed over and Mike started an IV in Sam's arm. Though Sam wouldn't feel the effects right away, Gayle felt much better once the fluids started pumping.
"Okay, buddy, we've done all we can so it's time we get on out of here. You ready?"
Sam blinked wearily and nodded his head. Mike walked around Gayle so he could support Sam under his right arm; Leo helped Sam scoot forward away from the wall and supported him on the left. It was a little bit of a ballet getting Sam onto the gurney particularly because the change from sitting to standing did not agree with Sam's blood pressure and his legs gave out. Fortunately Mike and Leo were well practiced and slid Sam and his gangly limbs easily into place.
The moment of vertigo brought Sam's anxiety crashing back to the forefront and being strapped to the gurney made it worse. Gayle reclaimed his hand and tried her best to reassure him with her words and with her presence. What she wouldn't give to make this Dean of his materialize and give Sam a little peace.
The ride to the hospital was uneventful. Mike razzed Sam about going to school so he wouldn't miss a calculus test, and Gayle was pleased to see that Sam was able to smile a little at Mike's jokes. She was keeping an ear out on the information Mike was calling out to Leo; although Sam's blood pressure was on the rise thanks to the increase in fluids, anxiety was keeping his heart rate uncomfortably high.
The ER staff was ready and waiting when they arrived. More shared information, more assessments – this time involving blood work and more sophisticated machines - telling them what they already knew; Sam was seriously dehydrated. All the while, Gayle held Sam's hand, and when she couldn't, at least she stayed in his line of sight. She wasn't family and she wasn't staff, but her position as the school nurse gave her some credibility and she used it to Sam's advantage.
That's not to say that she wasn't keeping her eye out for other things. Sam's adverse and intense reaction to going to the hospital sent up all sorts of red flags in Gayle's mind; that and the fact that he was desperate for his brother, not his father, caused her some concern. Sam hadn't been wearing much in gym class, just a t-shirt and a pair of sweats, but when the ER nurses stripped him down to put him in a hospital gown, Gayle wasn't above scanning for scars or bruising that might need to be investigated. She was relieved when she didn't see anything of note.
After a period of intense activity with Sam as the center of a whirlwind of doctors and nurses, they were left blessedly alone. All of Sam's personal information has been passed off to the hospital administration staff and Gayle knew they were diligently working to contact his family. Sam's eyes were closed, he was the picture of exhaustion, but he wasn't sleeping. At first any time it seemed like he was close to the edge of sleep he would snap himself out of it and look around asking for Dean. Gayle rubbed his hand, whispered reassurances and prayed that someone tracked Dean down fast. Eventually Sam lost the battle against exhaustion and fell into a fitful sleep.
About an hour passed with Gayle holding Sam's hand, keeping an eye on his increasingly stable vital signs and listening to the strangely routine sounds of the emergency room. It had a sound and rhythm of its own from the slide of vinyl curtains on steel rings, to the steady beeping of monitors to the rumble of equipment being rolled to and fro; babies cried, parents soothed and low voices spoke in tones pitched not to carry and pierce the imaginary privacy afforded by cotton sheets hung between the beds.
Then a voice of a different quality got Gayle's attention. It was urgent and insistent and accompanied by a bass rumble. She caught the phrase "my brother" and smiled. Rising from the chair where she was seated, Gayle waited, looking at the door. She didn't go out into the hallway because she made a promise and she intended to keep it.
A moment later a handsome and anxious young man materialized in the doorway. He didn't see her at first; he only had eyes for the boy in the bed.
"Sammy." The look on his face was just as heartbreaking as the one on Sam's face hours earlier. That look alone would've marked him as Sam's Dean.
Dean moved across the threshold into the room and finally noticed Gayle standing by the bed. He hesitated, not sure who she was or what kind of authority she had. She waved him closer. "You're Dean?" It was more of a statement than a question.
She raised her hand which still held Sam's. "I said I would stay until you got here."
Dean moved even closer. "He's okay?"
Dean smoothly slid his right hand into the space Gayle's hand vacated. He shifted closer to the head of the bed. Gayle placed her hand on Dean's shoulder. "He'll be okay. Fluids and rest will get him back on his feet."
Dean searched her face like he didn't believe her. Sam shifted on the bed and Dean's attention became laser focused.
"Hey, Sammy." Dean dropped his left hand onto Sam's head. Sam reached over with his left hand to grasp Dean's forearm.
"Dean!" Gayle didn't like how agitated Sam was getting, but Dean calmed him right down.
"I'm right here, Sammy. I'm right here. Just relax, you're gonna be fine."
Sam's whole body relaxed; even the brief rest he'd gotten didn't ease him as much as the presence of his brother did.
"Handling the paperwork." Sam sighed deeply and Dean leaned closer to the bed, his light head hovering above Sam's dark. "Not your fault Sammy. Shit happens. Literally."
Dean raised his eyebrows suggestively and Sam groaned. Then he started to chuckle. Careful of his IV, Sam rolled onto his side facing Dean who took up residence in the chair Gayle had so recently vacated.
"I've never seen anyone work so hard to get out of taking a math test," Dean teased.
"I wanted to take that test," Sam complained as he yawned. "Rispoli's make-up tests are a bitch. All word problems, no multiple choice!"
"When in doubt, pick "C" Dean declared in a knowing voice.
"There is no choice "C" in a word problem, Dean." Big brother was there all of two seconds and already Sam was exasperated; it sounded wonderful to Gayle. She smiled as she headed toward the door.
Before she left the room Gayle turned back toward the bed. Sam had already relaxed enough to fall truly asleep; Dean crowded the bed, with his knees up against the guard rails searching Sam's face. She felt as compelled to reassure the older brother as she had the younger.
"He's really going to be just fine, Dean. He just needs a little time to get back on his feet."
Dean nodded, his eyes never leaving Sam's face. Then he turned to look at Gayle and raised his free hand. "Thanks. Thanks for staying with him."
"I'm glad I could help…" she smiled softly, "but I'm no Dean."
Dean ducked his head and turned his attention back to Sam. Gayle quietly stepped into the hallway, encouraged about Sam's recovery; in spite of all the medicine available in the ER, Sam finally had what he really needed the moment Dean walked in.