A/N Thank you all for reading and reviewing and sticking with me through this story. I wish I could say what happens is entirely fiction, sadly it is mostly fact.

A Posse Ad Esse

A Priori

The hospital was quiet. It was the time of night when most of the patients were asleep and even the continual round of checks had slowed. The nurses were gathered at their station, the one time Sam had stepped into the hall, he noticed they were all watching something on a phone. The CNA had been by less than an hour before, but she had disappeared somewhere. The one good thing about the late hour was the smell of food had all but vanished, and Dean was more comfortable. Sam knew when the spasms were bad, and the nausea was worse than usual. Dean's eyes were closed and he seemed to be asleep, but Sam didn't know if he was resting or his body had just given out.

Sam huffed softly, the blacking out was a relatively new thing. Dean refused to mention it to Brian, and Sam was trying to figure out a way to explain it without his brother ending up in another endless round of tests. Dean had a theory and carefully explained it to Sam—it was his body's response to too much pain and the related stress. His brain needed time to "reset" itself and so it just shut down. The black-outs came on without warning, and Dean would be out for anywhere from fifteen minutes to three or more hours. Sam had learned to spot the signs, and Dean knew his body well enough to pull off the road if he was driving.

"Sammy?" Dean said softly, his voice full of pain. "Something's wrong."

Sam turned. Dean was white as a sheet. Without really thinking about it, he glanced at the monitor and watched as his brother's heart rate started to climb. "Dean?" He walked quickly to the bed and grabbed the hand reaching for him. "What is it?"

"Spas…" He stopped and closed his eyes. A moment later a tiny whimper escaped his lips and tears were running over his cheeks. The hand holding Sam's closed down with a crushing force. His brother's heart rate was hovering at 130. About thirty seconds after it started, Dean slowly relaxed, his heart rate dropping back down. It was still high at 90, but much better than 130. "Sorry," Dean said.

"You should be," Sam said, trying to keep his voice light. He went to the sink and wet one of the washcloths and carried it back to Dean, gently wiping the tears and sweat off his face. He was debating calling the nurse when Dean made a funny sound and Sam immediately looked at the monitor. The heart rate was rocketing up again. He grabbed Dean's hand and held on as the spasm wracked his brother's body, ending with Dean gasping for breath and gagging as he tried to swallow. Sam was reaching for the nurse call button as the spasm eased.

"Sorry," Dean whispered, collapsing back onto the bed.

"You should be," Sam repeated. It was their hospital conversation—familiar, routine, and the banter made it almost okay.

"What's going on?" the nurse, Tina, asked as she came into the room.

"My spas.. jus…" Dean stumbled over the words.

"His spasms just got a lot worse," Sam said, Dean nodded.

"He's not quite do for meds yet." She glanced at the clock. "Ten minutes."

"I…" Dean stopped. Sam immediately checked the heart monitor, it was at 115 and going up fast. Dean whimpered and held on as he shook in pain, then gasped for air as he started gagging.

"I'll see what I can do," Tina said, and hurried out.

"Thanks," Sam said, wondering what they could do. As many times as they'd been to the hospital since Dean admitted to the gastroparesis, he'd never seen anything like this—and it was scaring him to death.

XXXXXXX

The television was on—the Food Network was one of the few stations the hospital got that didn't resort to infomercials at midnight. It seemed bizarre, but it was one of Dean's default channels since the gastroparesis diagnosis. Even though the shows revolved around food, they weren't anything he had ever considered eating and he and Sam had spent many hours deciding the baskets for Chopped. What made the channel bearable was the fact that it had fewer ads for restaurants or food he did want to eat than the others. In fact, he watched far less TV than he once had, just to avoid the commercials. Sam had subscribed to an online service and as long as they had wifi, they tended to watch the computer.

Right now, none of that mattered.

The spasms in his chest had gone from uncomfortable, too painful to whatever this was—agony didn't begin to describe it because along with the pain came the sheer terror of not being able to breath or swallow as his throat closed down at the end of each spasm. Dean knew it was freaking his brother out to the point of "completely calm Sammy" which generally spelled doom. Sam hadn't stepped further away than the sink for the last hour as the spasms increased.

"Dean," Sam said, gently taking his hand. His eyes were fixed on the monitor—they'd figured out that his heart started to reflect the pain several seconds before the spasms really got going. It gave Sam time to get there, and Dean time to try and stay calm.

The calm only lasted until the weird flutter started under his breastbone. It felt like something tapping rapidly against the sternum. The flutter escalated to pain, then it felt like his esophagus was being twisted by unseen hands, the pain moved left, along his ribcage and up his chest, his neck, into his left ear and down his jaw. It increased, staying on the left side for a moment before blasting down his neck and stabbing under his right shoulder blade. He could feel Sam's hand in his and this time he felt a pop in the fingers he was holding. The pain lessened, and that signaled the worst part of the whole thing—his throat closed, and he couldn't get in air or swallow, even though his body was trying to do both. He could hear the weird noises he was making, and was aware of Sam's hand on his back, holding him upright as he gasped and gagged. After an eternity—and what Sam said was actually ten seconds—it all let go at once and he collapsed against Sam's hand and his brother eased him back down to the bed, gently wiping his face with the cool cloth.

"Sorry."

"You should be," Sam replied. They were both taking comfort in that familiar routine, although this was as far from routine as it got. "They're getting worse."

"Yeah," Dean answered, knowing that lying wouldn't help the situation—and Stealth Mode was not even possible when he was screaming in agony every few minutes. The nurses were coming and going, Dean knew they were giving him pain meds, but the meds didn't seem to be helping as much as they should. Or maybe he was too far gone to feel the effects completely. Reality was slipping a little.

"Meds are due in another twenty minutes," Sam said before he could ask.

"How…" Dean stopped the rest of the sentence seemed stuck.

"You start losing the ability to communicate. It's been getting worse too." Sam was at full squinch, his face pale with concern.

"Did… Hurt…" He remembered feeling the pop in Sam's hand during the last spasm—or had that been before?

"Hurt?" His brother frowned. "Oh! My hand. No, it just popped, it was my right hand. You know that knuckle has cracked since the ghost in Wisdom tossed me into the wall."

"Right," Dean said, swallowing. It took two tries to get it down.

"The basket was grape juice, flank steak, marshmallows and baby turnips with greens." Sam sat in the chair beside the bed, leaning his shoulder against Dean.

"Too… Ease…"

"I know," Sam said, as if Dean had completed the sentence. "You could make a gourmet meal with that."

"Hey! I… Good."

"You are. You can make food out of things that these guys would run from." Sam laughed. "Remember that camping trip when I was fifteen? You made the magic hash with dried potatoes, beef jerky and fake bacon bits?"

"Yeah." Dean also remembered the creatures stalking them, but that didn't matter. There had been times during that trip that had been fun, just the two of them hanging out together. Even before their father had left to head up a different part of the valley, it had been special. They managed to catch a few fish and had fried trout, sitting around the fire. It had been a good night, the three of them. Dean had no idea why he remembered that part so fondly, overall the trip had been a disaster.

"That was fun," Sam said softly.

"Yeah."

"And you taught me that the only good marshmallow is one that is completely burned." He smiled. "Then you peel off the burned part, eat it and put the marshmallow back in the fire."

"Only…" Dean answered, nodding. "We… Marsh…" That was getting annoying, it was getting harder to form the thoughts, let alone get them out. The steady pain was getting worse as well.

"We will. Once you're out of here, we'll go day camping."

"Right."

"No overnight camping."

"Never."

"Unless it's in a cabin, with a heater, a solid door, food, flushing toliet and a fireplace," Sam said, listing off Dean's requirements for overnight stays in the forest.

"Yeah." Even though it hurt, he smiled, thinking about it. They hadn't caught a break in a long time. Maybe they needed to make one. The world could wait.

"Dean." Sam stood and took his hand.

The flutter started, the pain started climbing. Dean was lost to everything but the agony pulsing through his body. He could hear someone screaming, and Sam's hand on his back. The points of contact with his brother was the only thing keeping him from shattering apart. The eternity without air, trying to swallow went on even longer. When it finally let him go he fell sideways, his head resting against Sam's chest.

"What's going on?" a female voice demanded.

"They're getting worse," Sam answered, his voice cold. "He can't breathe right."

"We can get him some oxygen. Does he have panic attacks?"

Dean felt every muscle in Sam's chest tighten. "This is not a panic attack," Sam growled. "This is not anxiety."

"He has had a lot of pain meds. How often does he use them at home?"

"What?" the soft whisper might as well have been a shout. Sam was vibrating with anger. Dean's eyes started to sting. The "drug-seeking behavior" diagnosis haunted them through every hospital visit anymore. Even when he was in an ER for something other than the GP, the questions still came. It was too much. He knew he shouldn't cry, there was no need, but it was all too much and tears were leaking down his face.

"How often does he use narcotics at home?"

"Are you…" Sam broke off and took a long slow breath. Dean shifted so he was lying in bed, but didn't let go of his brother's hand. Hurricane Sammy was about to blow again. "Are you accusing him…"

"The doctor has expressed concern."

"Not his doctor. We are here on orders from his doctor. You can look it up in the records. We came here precisely because of this bullshit."

"The in-house…"

"I. Don't Care. His doctor knows what is going on, your gastroenterology department knows what's going on. And this…"

"Never like this," Dean managed to gasp out, opening his eyes.

"It's never been this bad. My brother does not scream, even when his leg is half off."

Dean nodded. Sad that Sam knew that, but… Wait did Sam say he'd been screaming? That was his voice he'd heard? Oh, shit, Sammy, I'm sorry.

"I'll see what I can do." She reached behind him and slid the oxygen on, then turned to leave. "I'll call Dr. Seir."

"No, you will call Dr. Brian Gleason, or your GI department."

"I have to follow procedure."

"Fine," Sam said, his voice without tone. She smiled and left. Dean bet she believed she'd won the fight. "I'll take care of this." Sam met his eyes, the worry and fear clear in them. "Oh no!" He grabbed Dean's hand.

The pain came so fast that time, Dean didn't even have the warning flutter. It went on forever, pulsing through his body, then the horrible gasping for breath, the gagging. When it finally released him, Dean realized Sam was on the bed, and it was his shoulder that had supported him through the last part of the eternity. He stayed where he was, trying to breathe through the mounting pain in his chest. The flutter was starting again, and there was no way he was ready for it.

Dean focused on the sensation, tying to will it away. He could hear Sam talking to someone, his voice angry, but the words had ceased to make sense. When the massive spasm started again, Sam was there, holding on, helping to anchor him. It was all he had left. The pain was out of control. He could barely form a coherent thought and he heard his voice screaming.

It finally let him go. He was trembling as Sam ease him gently back on the pillows and a moment later the cool cloth was on his forehead. Dean opened his eyes and looked at his brother. Sam was even more freaked than he'd been before. "What… Happened…?"

"It's not true, Dean."

"What?" Dean frowned, trying to figure out what Sam was talking about.

"You're in the hospital." There were tears on Sam's face.

"Huh?"

"It's not Hell, Dean. You're not in Hell." His brother took his hand, holding tight. "You were screaming you were in Hell and to make it stop. You're here, not in Hell."

As the flutter started in his chest again, he looked at his brother's tear streaked face. "Are… Sure?" The pain was spiraling up again."

"I'm sure."

"I'm…" He clamped down on Sam's hand as the twisting pain began. "I'm… not…." The last word dissolved into a scream.

To Be Continued