A/N 1: Sorry to leave everyone hanging last chapter. Did anyone really think that Sam would be completely fine after almost drowning? I couldn't resist having some complications thrown in the mix since complications are a Sam's best friend :) I know it's been a ridiculously long time since I updated this story. It actually has been done for a long time since it was written for a summer challenge. There is no real excuse for the wait other than the fact that I was losing hope in the show. I wasn't too happy with the beginning of season 8 although lately the show has been better. The last four episodes have renewed some of my faith and given me hope. I have really enjoyed the brotherly moments and especially the limp!Sam and Protective!Dean. Here is to hoping that the "bromentum" continues.
A/N 2: Thanks again to everyone for the reviews. I did not get a chance to respond to all of them yet so if you haven't received a thank you, Thank you for the support!
Sam? Sammy!" He shouted frantically. "No, no, no! We're not doing this!"
He flipped Sam on to his back and began CPR as Sam's skin went from pale to the insidious gray pallor that it held at the pool.
"Come on! Wake up!" Dean shouted. He saw more of the pinkish liquid being expelled from Sam's nose and his panic ratcheted up a notch.
He lost count of how many chest compressions and breaths he gave when he heard the sirens in front of the door. He let the paramedics in.
"He's not breathing!" he informed them immediately.
They walked over to Sam on the bed and placed two fingers on his pulse.
"No pulse," the paramedic stated.
They quickly moved Sam to the floor and continued the chest compressions where Dean had left off. Dean just stood there in the small hotel room, waiting for a sign that Sam was still alive.
He watched again for the second time as Sam was intubated and hooked up to a heart monitor.
"He's in VFib!" The paramedic shouted, grabbing the defibrillator.
"Charge to 300 and clear," the paramedic said as he shocked Sam.
Dean jolted himself as Sam was shocked three more times. Finally after the fourth time, a slow beating could be heard on the heart monitor.
"Let's get him ready for transport," the paramedic said, as they lifted Sam on to a stretcher.
Dean followed quietly behind, biting his nails in agitation.
He was grateful Sam was alive but he didn't know how tentative his hold was on life or if he'd make it at all.
He couldn't believe for the second time in less than 48 hours he was riding in the back of an ambulance with his barely breathing brother.
The paramedic in the back listened to Sam's lungs and the said something into the radio clipped to his shoulder. Dean wasn't sure what it was but it sounded like rales.
"Rales? What is that? Dean asked, staring at his brother.
"It's medical terminology."
"I know that jackass, but what is it?" He wasn't going to stand idly by this time not having a clue to his brother's condition while they rode to the hospital.
"It's a sign that your brother is having an issue with his lungs which is affecting his breathing," the paramedic said, ignoring Dean's flippant behavior.
"Do you think he'll be okay?" Dean asked, looking at Sam.
"I can't tell you that. I'm sorry. He has a heartbeat right now so that's the important thing."
They arrived at the hospital and the paramedics rushed to get Sam through the ER doors, leaving Dean behind once again.
He went in the waiting room, but this time his wait was definitively longer. He watched the doors, anticipating the doctor every time someone walked out. However, no one approached him. Several hours passed and he did what he could to control his frustration, feeling as if he was a pot on a stove. Each minute the temperature was being raised until he was ready to reach the boiling point.
Finally he couldn't take it any longer. His anger took over and he irately approached the front desk demanding information on Sam.
Eventually Dr. Ames appeared to speak with Dean but only after he was forced to wait another hour.
"Is Sam alive?" Dean asked. It was what he needed to know, first and foremost.
"Yes he is, but I'm not going to lie to you. His condition is extremely critical."
"What's wrong with him? Did he have some kind of reaction to the medication?"
"No, Sam was a victim of secondary drowning."
"Say again?" Dean asked, genuinely confused.
"Sam essentially experienced another drowning episode," Dr. Ames explained.
"How is that even possible? He wasn't even in the water. He took a shower, but that's about as close as he got."
"When Sam was submerged the first time, he ingested water which unfortunately absorbed into the alveoli or pores in his lungs. His lungs filled with fluid and restricted his breathing," Dr. Ames clarified.
"But you said he was fine, that he could leave the hospital."
"Sam did appear to be well enough to go home."
"He appeared? Maybe you shouldn't have let him the hell out of here," Dean said, angrily.
"Generally these issues show up in 24 hours but that's not always the case. Sam was watched for nearly that amount of time."
"Yeah, nearly that amount of time. I seem to remember you saying you would have liked him to stay a few hours longer. Look, I hope you didn't let the kid go because he was griping when something was up. He hasn't been in the right frame of mind lately."
"I don't believe this has anything to do with Sam leaving the hospital when he did. I said secondary drowning appears in 24 hours but that is not always the case. It can appear up to 72 hours later. Obviously it occurred later in Sam. Doctors can't predict the outcomes of these cases."
"Well you should have noticed something before you let him leave here!" He couldn't help his irritation even if the doctor was trying to be patient with him.
"Sam didn't have any signs of distress when he was released. His lungs were clear. Generally we look for signs such as shortness of breath, coughing, chest pain, exhaustion, and agitation. Did Sam display any of these signs when he returned home? I also gave you the paper with symptoms to watch out for."
Dean froze. Actually Sam had displayed those symptoms and he hadn't even looked at the paper. However, he didn't like how this was being flipped around on him, even though he knew he saw some of those signs. Sam was agitated and tired. He was coughing and his chest hurt. How was he to know though? He still thought the doctor should have noticed something though. He wasn't a doctor and he thought Sam was just being a pain in the ass.
"Look," Dr. Ames continued. "I don't think it's a good time to play the blame game. I understand you are upset but we are doing what we can to control the fluid buildup in Sam's lungs and keep him breathing."
Dean felt like an expert at the blame game lately. In fact he thought he was the champion. It was so easy to place the blame lately. It actually felt good because it gave him something, or someone, to direct his anger at. He knew he found it quite easy to place the blame on Sam lately but he wasn't sure how justified he was in his resentment any longer.
"You called an ambulance and got Sam here when he was in distress. That saved his life right there," Dr. Ames finished.
"So he'll recover?" Dean asked.
"Hopefully," Dr. Ames answered truthfully.
"As with a regular drowning, we have to worry about brain damage seeing the amount of time that Sam was without oxygen. Unfortunately, the pain killers also most likely suppressed his breathing. I know he stopped breathing prior to being brought here and he also briefly stopped breathing in the ER. Only time will tell. If you'd like I can take you to see him now."
Dean held his tongue, wanting to lash out again about Sam being given powerful drugs that made him worse, but he followed numbly behind the doctor once again down the hall. He noticed however that this time he was being escorted to the doors of the intensive care unit. When he walked into the room, he wasn't prepared for what he saw. It was such a stark contrast to the annoying little brother itching to get out of the hospital a little more than 24 hours before.
Sam was flat on the bed, his skin so pale that Dean questioned whether he was actually still alive. A tube was inserted into his mouth, down his throat mechanically doing the breathing for him. Dean also noticed the other tube inserted into Sam's nostril.
"Right now Sam is hooked up to a ventilator to give his lungs a chance to rest and heal. We also have inserted a nasogastric tube due to the fact that Sam aspirated some sputum from the endotracheal tube," Dr. Ames explained, when he saw Dean looking questioningly at Sam.
"Sputum? Was that the pink stuff Sam was choking on?" Dean asked.
"Yes, it's common with pulmonary edema or the buildup of fluid that Sam is suffering from. It's fluid mixed with blood. We have Sam on a drug called Lasix which is generally used in heart patients."
"Does Sam have something wrong with his heart?" Dean asked, alarmed.
"No, the drug is used for a variety of reasons but that is the most common. The drug is a diuretic which controls the fluid. We are trying to clear Sam's lungs."
Dean just nodded, his eyes affixed to Sam in the bed. Dr. Ames seemed to sense that Dean wanted to be alone and he quietly excused himself, promising to return later.
At first, Dean just sat in the chair by the bed, listening to the various beeping sounds around him. He didn't want to admit it but he felt afraid to approach Sam. It scared him to think how bad things had become between them that he no longer felt like he knew big brother protocol or how to comfort Sam.
It was hard to imagine all they had been through in the last few weeks. He had watched Sam suffer in the panic room to detox off the demon blood, writhing in agony and being tossed about the room. Bobby had to prompt him to help him when Sam was in the throes of the seizure. He couldn't handle it. He couldn't handle it now looking at Sam in the bed, most of his face obscured by tape and tubes.
He remembered their various fights and thought how odd it was that he could barely count how many arguments he and Sam had lately because there were so many. Too many. It wasn't supposed to be like this.
Finally he got up and stood over Sam, folding his hands over the railing.
"Look Sam, I'm sorry okay," Dean began. He half expected to hear Sam apologize back. Sam had done so much of it lately and what had he done? He told him to stop, told him he didn't want to hear it. Now he'd give anything to hear Sam say something back to him.
"I know you are always doing the apologizing around here lately, but you don't need to," Dean continued. "I wasn't exactly Mr. Perfect myself. If I hadn't set the whole apocalypse ball rolling, we wouldn't be here in the first place. I broke the first seal and you broke the last one so we're even okay? We collaborated on making the mess and now we'll work together on cleaning it up. Deal?" Dean looked hopefully at Sam's face expecting to see some sign of approval but there was none.
Dean walked dejectedly back to his chair to resume his watch. He had evened out his breaths to match with Sam's and immediately noticed when something was amiss. He saw Sam was struggling again, his breaths not in sync with the ventilator. Was he fighting the vent? He wasn't sure.
He pushed the call button and true to his word Dr. Ames came in to see what was wrong. He looked at the numbers on Sam's heart monitor and then listened to his lungs.
"His sats have dropped," Dr. Ames said, frowning. "The crepitations have worsened in his left lung."
"Crepi what?" Dean asked. He was losing patience with the amount of medical crap being thrown out around him lately with no explanation behind it.
"Crepitations or rales are caused by the fluid in Sam's lungs. I can hear them with my stethoscope. We are going to increase his meds and increase the amount of PEEP, or positive end-expiratory pressure, through his ventilator, to open up Sam's lungs more to increase his oxygen."
Dean had thought—wished-Sam was waking up so he was startled by the latest complication. However, he was relieved when Sam's sats improved after treatment.
It was two days of sitting vigil beside a still unconscious Sam before Dean left the hospital room just to stretch his legs. Dean briefly walked out down the hall to grab a drink. He was walking to the vending machine for a coffee when he accidentally bumped into a woman.
"I'm sorry, miss," he said, about to walk away.
"Sir? Dean?" She said, causing him to turn back.
"And you are?" Dean asked questioningly. She looked familiar but he couldn't be sure.
"My name is Shannon Adams. I'm Rex and Will's mom."
Instantly Dean knew who she was.
"Look I shouldn't even be asking you this because I'm not supposed to have the information in the first place but how is Sam?"
"He's…hanging on," Dean said hesitating.
"I just had to know who saved Rex like that," she said, tearfully. "The hospital wouldn't give me much information and I know what your brother sacrificed to get Rex out of there. The doctor said if he hadn't blocked the drain with his own body like that that Rex would have never gotten out."
Dean took in the information, not sure what to do with it. He'd known Sam had freed the kid but he never realized that Sam had been willing to give up his own life to get the kid out. Then again should he really be surprised? Sam was always willing to put his life on the line to save others. He started to see the change in how he viewed Sam, less as a savior but more as someone in need of saving from himself. Yet he wondered why Sam would be so quick to give his life like that? Did he think he was even worth it anymore?
"I'm so sorry. I have a friend who works in admitting and she told me Sam was released but then he had a relapse. Rex is getting out today and I was hoping to get the boys to meet him, thank him. Lord knows he'd probably be a good role model. The boys don't have a dad. They depend on each other quite a bit. They look like they'll kill each other at times, but yet I know they'd kill for each other."
Dean couldn't help the sudden burst of moisture in his eyes. She might as well been talking about the two of them. Or the two of us in the past, Dean thought sadly.
I'm sorry I'm rambling, but please give Sam my best," She walked off down the hall.
When Dean walked back toward Sam's room, he noticed that there was an alarm blaring in the hallway calling a code. He rushed faster when he realized it was Sam's room.
"What's going on?" He asked as a nurse blocked his path.
"Sam spiked a fever and his sats plummeted."
Dean watched as a defibrillator cart was rushed down the hallway. He knew instinctively that Sam was slipping away.
He rushed over to the small window of Sam's room, peeking in. He could see Sam's ventilator being removed so they could bag him. He saw Sam's pillows being pulled away and his head hitting the hospital bed. He wanted to say something about how roughly Sam was being handled but he knew they were just doing what they could to save his life. Then he watched as Sam was shocked again. He didn't have time to see the outcome as the blinds were drawn quickly.
Dean just stood there in shock, still holding on to the coffee cup from the vending machine. He didn't register how hot it was, the cup scalding his fingers until his contact was cut off from Sam.
He dropped it to the floor, cursing in pain.
"Damn it!" He yelled.
Just then, a nurse walked out of Sam's room and immediately approached him.
"We got him back. Dr. Ames said he'll be out shortly to speak with you. I'll call someone to clean that up."
Dean had barely registered the mess the coffee had made all over the floor as well, standing there in the middle of it, the sticky mess not the only thing keeping him rooted to the spot.
Dean paced the small expanse of the hallway near Sam's door, making squeaky noises as he walked until Dr. Ames appeared once again.
"How is he?" Dean was getting sick of asking the same question over and over.
"Sam's pulmonary edema caused what is known as a pleural effusion which means a pocket of lung was filled with fluid. We managed to aspirate it with a needle."
"Are you saying you stuck a needle into my brother's chest?" Dean asked, horrified.
"Yes. It was the only way to restore Sam's oxygen levels. He bottomed out and his heart stopped again. Unfortunately we think your brother also developed an infection which is common with fresh water drowning."
Dean listened intently having a sinking feeling that the doctor hadn't given him the whole story yet. He still hadn't told him how Sam was.
"Dean, unfortunately Sam has slipped into a coma," Dr. Ames continued, confirming Dean's worst fears. "His heart stopped beating again and it took us awhile to get him back. He is no longer breathing on his own. The ventilator is doing all the work. We are doing what we can, but with the infection and complications—"
"Save it!" Dean said, loudly, interrupting the doctor.
He brushed past him quickly, returning to Sam's side. He looked the same as before. It wasn't clear that Sam was in a coma but he knew now his brother was much further away than before. Somehow he felt it.
"Sam, you had a visitor," Dean began. "Well this girl wanted to see you. You know that kid you saved? Well I guess he's doing really well, but his mom sounds like she is really into you. If you don't wake up soon, I'll snag her number before you do," Dean finished with a mirthless chuckle. He felt stupid. The words hardly seemed right to share with someone in a coma but he didn't want to just sit there.
"The doctor says you have some kind of infection. I think you probably want to wake up before I tell you I told you so because I did say the pool was teeming with bacteria," Dean said, attempting to make another joke. However, he was sick of it.
"Look Sam, we need to talk," Dean said, becoming serious and desperate. "I have been doing a good job of being the victim lately but it isn't right."
He looked up at Sam again as if seeing him more clearly than he had in a long time. Sam was no different than before. His face was still the same, impossibly young looking despite all they'd been through. His hair still had a mind of its own, wisps sticking out in different directions. Most importantly though, deep down Sam still was the loving caring person he always was. The fact that he was at death's door in a hospital bed was proof of that. So why did he see him differently? Was it because of the demon blood? Was it because he drank so much of it that his eyes turned black? He wasn't certain but Sam was still Sam, maybe not the same as he had always been but could he really blame him for that? Sam had been sentenced to watch him die and then left alone. He couldn't deny that he'd be just as angry, just as vengeful.
"Sam. Sammy," Dean continued. "We were both expected to play certain roles in this whole Armageddon mess, but we both got lost."
Dean wanted to say more about how they both had forgotten their most important roles of all which were big brother and little brother but he couldn't do it unless Sam was awake. It would mean more that way.
Dean was forced to watch as Sam's fever persisted and his temperature rose so high, he could swear that felt the heat emanating off Sam's body. He could barely keep up with mopping the sweat off of Sam's forehead. Dr. Ames had trouble keeping Sam's lungs clear and was forced to insert a chest drain when the fluid persisted. He also had to increase Sam's dosage of antibiotics.
Dean wasn't sure how much Sam, yet alone himself, could take. He began to doubt himself that he would ever get to have the much needed conversation with his brother when Sam's fever finally broke. He began coming around, breathing on his own, and triggering the vent. It was day six when Sam opened his eyes, sluggishly and haltingly.
Dr. Ames had warned him that the longer Sam stayed under, the more chance he would suffer permanent effects so Dean wasn't sure what to expect.
Dr. Ames rushed in to examine Sam as soon as he was awake. Sam's tubes were removed, save for the chest drain which needed to stay in awhile longer. Then Dean was allowed back in the room. He edged his way closer to Sam's bed, relieved to see the tape and tubes gone, just a nasal cannula under Sam's nose.
"Sor…sorry," Sam whispered. It was barely perceptible and Dean had to put his ear close to hear it, but Sam's words confirmed it for Dean that Sam was fine.
"Sam's weak and tired and his lungs still need time to heal," Dr. Ames said to Dean as Sam's eyes began to slip closed once again. "I do think he will be okay though. Miraculously, I don't think he suffered any cognitive effects. No early release for him though," Dr. Ames said jovially to Sam who was already asleep and didn't hear him.
It was another two days before Dr. Ames removed the chest drain and Sam seemed completely coherent. Dean knew it was growing closer to the time that he and Sam had to talk. He had been eager before but now he was unsure. He walked back into the hospital room after briefly leaving to grab a shower back at the hotel to see Sam propped up in bed, blowing into a small plastic apparatus attempting to keep a small ball elevated in the air.
"Lung exercise," Sam said sheepishly, haphazardly tossing it onto the bed.
An awkward silence passed between them as if they were both daring the other to speak, two chess pieces awaiting the next move.
"Dean, I want to apologize for what I said before," Sam began first. "When I said I didn't want the reunion, I didn't mean it the way it sounded."
Dean sighed heavily. The last thing he wanted was Sam to start apologizing yet again.
"Sam, you don't need to explain. I understand and I don't blame you for not wanting to be around me. I haven't exactly been the best companion."
"No I didn't mean it like that. I meant I just wished I hadn't—"
"Lived? Made it?" Dean finished for him.
Sam was stunned into silence, surprised Dean had figured it out, that he wished he had died.
"The kid's mother stopped by and she told me that you sacrificed yourself."
"It's not that I was suicidal Dean. I just wanted…redemption," Sam stuttered as if looking for the right word.
"So you think you have to die to get it? You dying won't fix anything."
"Dean, I know. I know I can never make up for what I did."
"That's not what I mean, Sam," Dean said, slightly flustered. "I'm saying that you can't die to make it right. I think you are actually doing the world a disservice by not being around. How else are we going to fix this mess? We need to work together Sam. We got turned around. We are back to back—"
"Instead of side by side," Sam finished.
They locked eyes for the briefest of seconds, each one feeling the connection as if completing a circuit.
They both were pulled from their reverie and turned in surprise when they heard a small knock at the door. They looked up to see Shannon come in, followed by her two boys.
"We heard you were doing better," She said, winking at Dean.
The older boy was on crutches, and hobbled over to Sam's side.
"You're Rex, right?" Sam asked him.
The boy nodded.
"How are you?" Sam asked him.
"I'm fine. I sprained my ankle from the drain but I guess I got off easy."
"What were you doing in the drain anyway?"
"Rex lost his action figure so I took the cover off and it pulled me in."
"The things we do for our little brothers huh?" Dean said, looking at Rex and then Sam.
"Yeah, Willy drives me crazy but he will always be my little brother."
"It's Will! I told you I hate when you call me that!" Will interjected.
Dean couldn't hide the chuckle. It was like looking into a mirror.
"Someday you are actually going to like when he calls you that," Sam said wisely. "It will make you feel safe," Sam looked Dean in the eye and smiled. It also helps when you grow taller than him. Then you can hold it over his head, literally."
"I wanted you to have this," Willy said, handing Sam a red Power Ranger action figure.
"He was my hero, but now you are. You saved Rex. Thanks!"
Dean smiled. He knew that this was just what Sam needed most of all. He needed to know he was still a hero. He had made mistakes but ultimately what he did mattered. He knew he and Sam still had a lot to work out with their trust issues and a devil to send back to hell but he had his brother by his side. He'd trust in that for now.
Thanks for reading! I'm actually working on a blizzard fic that I'll be posting soon. Hope to see you then :)