The Heart of Us
Title: The Heart Of Us
Author: verucasalt123
Recipient: spn_summergen*
Rating: PG-13
Wordcount: ~2,400
Warnings: serious illness, angst
Summary: Sam seems to make a little improvement after the trials, but ends up facing something even worse. Luckily, he’s got someone by his side no matter what.
* Where the intended recipient defaulted, stories are posted as gifts for the community as a whole.
Things started to get better after the trials. Sam seemed stronger, a little more robust. No more coughing up blood, no more losing his balance, no more days at a time without eating.
Some things, though…well, they didn’t seem to be going away quite as quickly. Sam still slept a lot. He got tired early in the evening and went to bed, sleeping sometimes twelve to fourteen hours at a time. He woke feeling fairly rested, and with a good appetite. But still. That couldn’t be a thing that was okay. Not when you were thirty years old, no matter what you’d been through before in your life.
It was clear that the illness caused by the trials was gone; Dean and Sam had watched it vacate Sam’s body themselves in that run-down old church out in the middle of nowhere. Back here in the bunker, it wasn’t just Dean’s worries that Sam had to fend off, it’s was Kevin’s and the newly-human Castiel’s too.
Castiel had done an amazing amount of research about anatomy and physiology once he realized his human condition was permanent. He was the one leading the pack of “Team Get Sam To A Doctor”. Sam suggested they have themselves t-shirts made. After a few weeks, he folded, figuring it couldn’t hurt anything to get checked out. Probably.
The internist who was their first stop seemed rather impressed with Sam’s overall health. His lab work looked good; vitamins, blood sugar, cholesterol all where they ought to be. Sam took a minute to give Dean a look that was easily translated (by Dean) as ”should have him check out your triglycerides, Mr. Bacon Double Cheeseburger”. There was, however, something strange in the sound of his heartbeat, could be nothing, but the guy was giving Sammy a referral to a cardiologist anyway, just in case.
The referral to the specialist was weeks away, and Sam had a lot of time to think about it. Yeah, his body had been put under an incredible amount of stress. Going hungry sometimes as a kid, fighting monsters, drinking demon blood, going to hell, almost completing the trials…a tall order, no question. But he’d taken care of it the best he was able to. He ran when he could, worked out. Not that he didn’t love his candy and junk food and beer, but salads and vegetables and grilled lean meats far outweighed any of those things in his diet. Damn it, if one of them was going to have some kind of heart condition…but no. He couldn’t even think that. It was almost like wishing there was something wrong with Dean instead of him. So he rested. He let the guys take care of him; let Dean bring him soup, let Castiel make him sandwiches, let Kevin put on any movie he wanted to see. Chances were they were gonna go to this specialist, find out nothing was wrong, and the days of him being spoiled would be over. So, you know, he’d take what he could get while he could get it.
Before they knew it, the time had come to go to the new doctor, and as much as Sam had protested that he was fine going alone, there was no way out of having Dean drive him there.
It turned out to be a really good idea.
After a cursory physical exam, the physician sent Sam for a cardiac ultrasound, then to a waiting room where they sat around for almost forty five minutes until they got called back to the exam room. The doctor told them both to take a seat, with her little informational pamphlets at the ready. First question, of course, was whether or not anyone in their family had cardiac issues. Easy answer there, it was no, because anyone they’d known who had lived long enough to start developing heart problems, hadn’t. Their dad had no issues, and that one time they’d gone to the past and met their grandparents, they seemed to be in very good health. Henry was healthy, too, but he was also very young for the short time they knew him. Neither of the brothers found it necessary to share that almost everyone in their family was dead at a very young age, that is, the very few of them that they’d actually met.
She went on to explain that Sam’s particular diagnosis was something called pulmonary valve stenosis. One of his heart valves, apparently the one that pumped blood out of his heart and into his lungs, did not open all the way. There was no way of knowing how long the condition had existed, but the doctor’s best guess was that it couldn’t have been more than a year or two. He would have started having symptoms by now, and the ultrasound would have shown more degeneration of the artery if it had been damaged for much longer than that.
Not that any of that shit mattered now anyway. The only things Dean wanted to know were how did they fix it, how fast could they fix it, and how effective was their fix? Sam hadn’t even gotten any chances to ask questions, he was still just sitting there staring at the pamphlet, trying to listen to his own heartbeat, see if it sounded any different to him. Since he’d never really spent any time listening to it before, he didn’t guess there was any way to know. It seemed pretty important right then, though, to listen. It just wasn’t possible over the conversation that was taking place in front of him; was probably supposed to be involving him, if he could just get his brain back online for a minute.
“Sam, I know you’re not having any pain, but the pressure in that right-sided valve is high. Higher than is safe, to be honest. Your best shot right now is to have a surgical repair-”
“Wait, surgery?” Sam finally found his voice. “Heart surgery? Isn’t that pretty risky?”
“What I’m proposing is a valvuloplasty. It’s like…well, kind of like a balloon. We insert it into the artery and stretch it out so that there isn’t so much pressure on it, and the blood can flow through freely.”
“So, what about after the procedure? What am I looking at then? A lifetime of meds? Repeat catheterizations? Activity restrictions?”
Shockingly, Dean had kept his silence while Sam asked his questions. “You’re making this sound much more serious than it is. Honestly, a repeat procedure is almost never necessary, and there are no medications you’ll need unless you have complications, which are exceedingly rare. I will recommend activity restrictions for the first six or eight weeks after the procedure. After that, you can go back to your normal level of activity as you feel comfortable.”
And now Dean’s quiet time was finished. “You’re makin’ this whole thing sound awfully easy. One minute you’re saying heart surgery, the next you’re saying he’ll be fine. I have to say I’m not all that convinced.”
“I encourage you to get a second opinion, a third even. This is the truth. I know when you tell someone that they, or the person they love, has a heart defect, it’s a really scary thing to hear. But in this case, we’re lucky. Sam, your condition is not causing you debilitating symptoms right now, and it’s easy to treat. Dean, you got your brother here for treatment before anything did happen. Right now, everything’s looking up. I’m not saying there aren’t risks - any medical procedure has risks - but this one has very few.
“Thanks, doctor. I appreciate all the information. Let me talk to my brother for a few minutes and we’ll come back, if you’ll be around.”
She looked at her watch. “I’ve got at least another hour’s worth of dictation to finish. Take your time.”
Dean and Sam went back to the now-empty waiting room and sat. “Dean, I know you’re skeptical, and worried, but I’d really like to get this done, preferably as soon as possible.”
“It’s your decision to make, Sam. It’s my job to do the worrying. I trust your judgment. And to be honest, we might as well get this handled while we’ve got a safe place for you to recover. I’m not saying I think anything’s going to happen, but right now we’ve got a roof over our heads and a place to call home. If we’ve got to do this, now’s the time.”
“Yeah, you’re right about that. And as much as I will admit to enjoying being spoiled and waited on, I’m sick of feeling exhausted all the time. I had just started feeling better after the trials when this started. I want to get back to being me again.”
“All right, then. Go on and let her know.”
The doctor said she’d have the hospital scheduling department call Sam the next day to work out a date for the surgery, and they headed home to break the news to Cas and Kevin. Kevin took it pretty much in stride - it’s not like this was the worst thing that had happened in his life in the past year or so. Probably didn’t even make the top ten. Castiel, though, didn’t say much. Just slunk off to his books and spent a few hours reading.
The next day, though, when Sam came into the library, Cas stopped him.
“Sam, I’d like to show you what I’ve read here.” And damn if Cas hadn’t been in there all that time studying the structure and physiology of the human heart, the ways in which it supplied blood to the rest of the body. “So this one here,” he said, “is the one that’s giving you trouble. The one that goes out the back and takes the blood through the pulmonary valve into the lungs. That’s why they want to put in the balloon and stretch it out, so it’ll take some of the pressure off. But they’ll have to go in through an artery in your groin instead of straight into your heart.”
“Cas, Dean and I told you all of this yesterday.”
“I know, I just - I wanted to see it for myself. How it works. And the doctor you saw, she was right. Almost no one has complications from this procedure, it’s very rare. I believe she is correct in her assessment that you will make a full recovery,” Cas finished with a wide grin.
Now that was something that would never make Sam sad about Castiel’s human condition; that smile that he’d never seen when Cas was an angel. “Thanks, Cas. I appreciate you looking into all this, and reassuring me. I got a call today from the hospital, the surgery is a week from tomorrow.”
Sam definitely enjoyed his last week of being pampered and spoiled (well, he did have his whole recovery to look forward to), then left Kevin and Cas at the bunker with solemn promises that Dean would call the minute there was any news.
There was some waiting around and filling out of paperwork at the hospital before they headed up to the catheterization lab. Their doctor had not mentioned before that this was a procedure that was normally done under local anesthesia. Sam had already been sedated through an IV when Dean took her aside and gave her a completely believable story about a previous medical procedure gone horribly wrong and convinced her that even though local anesthesia was normally considered safer, they would go with general anesthesia in this particular case. Dean couldn’t even begin to imagine what it would be like for Sam to be awake during that procedure, even if it were completely pain-free (which it wouldn’t be). Once they were ready to get started, Dean squeezed his brother’s hand one more time and stepped out into the surgical waiting area, sending a text to Kevin to let him know the surgery was underway and should be finished in a couple of hours.
Three hours later, the doctor came out looking exceptionally satisfied. “It couldn’t have gone better. Not a single complication. Your brother’s being taken to recovery, where he’ll be given fluids and checked on from time to time throughout the night. I don’t know why I’m wasting my breath, but if you want to just come back in the morning-”
Dean just laughed. “You know us that well already? Yeah, I’m not goin’ anywhere. Just get someone to point me in the direction of the recovery rooms, all right? And thanks. For everything.”
Once he made sure Sam was comfortable and still asleep, he slipped down to the cafeteria for some food. On his way back up, he called the bunker and got Cas. “Hey, just wanted to check in, man. Everything’s all right here. Sam’s surgery went off without a hitch and he’s in recovery until tomorrow, then I can bring him home.”
“Glad to hear it, Dean, and I’m sure Kevin will be, too. I wanted to come visit, assured Kevin I was perfectly capable of stealing a car and driving it there-”
“All right, Grand Theft Auto, just stay there. Sam’s asleep anyway, and he’s gonna be a little out of it for a while, even after I get him home. Make sure you have everything set up for him like we talked about - pillows, remote, blankets, TV tray, laptop, all that.”
“It’s taken care of. All just sitting here waiting for Sam, just like the rest of us.”
“He’s gonna be fine. We’ll be home tomorrow and everything’s gonna be just fine.”
Sam he had to take blood thinners for a little while, no big deal. Keeping the wounds clean was a bitch, but he didn’t really want anyone else messing around near his groin, thank you very much, so he learned how to do it on his own. He felt better every day, even as the spoiling started to wear off and sometimes he had to get up and make a bowl of cereal for himself in the morning. Sam wouldn’t trade it for the world. And it was just another reminder (as if he still needed them) of how much Dean cared about him, helping him through the recovery and slowly getting him used to normal movement again.
The doctors did what the doctors did, but of course, Dean did what Dean did, every time - took Sam’s broken heart and fixed it. This time it was just more literal.
Author: verucasalt123
Recipient: spn_summergen*
Rating: PG-13
Wordcount: ~2,400
Warnings: serious illness, angst
Summary: Sam seems to make a little improvement after the trials, but ends up facing something even worse. Luckily, he’s got someone by his side no matter what.
* Where the intended recipient defaulted, stories are posted as gifts for the community as a whole.
Things started to get better after the trials. Sam seemed stronger, a little more robust. No more coughing up blood, no more losing his balance, no more days at a time without eating.
Some things, though…well, they didn’t seem to be going away quite as quickly. Sam still slept a lot. He got tired early in the evening and went to bed, sleeping sometimes twelve to fourteen hours at a time. He woke feeling fairly rested, and with a good appetite. But still. That couldn’t be a thing that was okay. Not when you were thirty years old, no matter what you’d been through before in your life.
It was clear that the illness caused by the trials was gone; Dean and Sam had watched it vacate Sam’s body themselves in that run-down old church out in the middle of nowhere. Back here in the bunker, it wasn’t just Dean’s worries that Sam had to fend off, it’s was Kevin’s and the newly-human Castiel’s too.
Castiel had done an amazing amount of research about anatomy and physiology once he realized his human condition was permanent. He was the one leading the pack of “Team Get Sam To A Doctor”. Sam suggested they have themselves t-shirts made. After a few weeks, he folded, figuring it couldn’t hurt anything to get checked out. Probably.
The internist who was their first stop seemed rather impressed with Sam’s overall health. His lab work looked good; vitamins, blood sugar, cholesterol all where they ought to be. Sam took a minute to give Dean a look that was easily translated (by Dean) as ”should have him check out your triglycerides, Mr. Bacon Double Cheeseburger”. There was, however, something strange in the sound of his heartbeat, could be nothing, but the guy was giving Sammy a referral to a cardiologist anyway, just in case.
The referral to the specialist was weeks away, and Sam had a lot of time to think about it. Yeah, his body had been put under an incredible amount of stress. Going hungry sometimes as a kid, fighting monsters, drinking demon blood, going to hell, almost completing the trials…a tall order, no question. But he’d taken care of it the best he was able to. He ran when he could, worked out. Not that he didn’t love his candy and junk food and beer, but salads and vegetables and grilled lean meats far outweighed any of those things in his diet. Damn it, if one of them was going to have some kind of heart condition…but no. He couldn’t even think that. It was almost like wishing there was something wrong with Dean instead of him. So he rested. He let the guys take care of him; let Dean bring him soup, let Castiel make him sandwiches, let Kevin put on any movie he wanted to see. Chances were they were gonna go to this specialist, find out nothing was wrong, and the days of him being spoiled would be over. So, you know, he’d take what he could get while he could get it.
Before they knew it, the time had come to go to the new doctor, and as much as Sam had protested that he was fine going alone, there was no way out of having Dean drive him there.
It turned out to be a really good idea.
After a cursory physical exam, the physician sent Sam for a cardiac ultrasound, then to a waiting room where they sat around for almost forty five minutes until they got called back to the exam room. The doctor told them both to take a seat, with her little informational pamphlets at the ready. First question, of course, was whether or not anyone in their family had cardiac issues. Easy answer there, it was no, because anyone they’d known who had lived long enough to start developing heart problems, hadn’t. Their dad had no issues, and that one time they’d gone to the past and met their grandparents, they seemed to be in very good health. Henry was healthy, too, but he was also very young for the short time they knew him. Neither of the brothers found it necessary to share that almost everyone in their family was dead at a very young age, that is, the very few of them that they’d actually met.
She went on to explain that Sam’s particular diagnosis was something called pulmonary valve stenosis. One of his heart valves, apparently the one that pumped blood out of his heart and into his lungs, did not open all the way. There was no way of knowing how long the condition had existed, but the doctor’s best guess was that it couldn’t have been more than a year or two. He would have started having symptoms by now, and the ultrasound would have shown more degeneration of the artery if it had been damaged for much longer than that.
Not that any of that shit mattered now anyway. The only things Dean wanted to know were how did they fix it, how fast could they fix it, and how effective was their fix? Sam hadn’t even gotten any chances to ask questions, he was still just sitting there staring at the pamphlet, trying to listen to his own heartbeat, see if it sounded any different to him. Since he’d never really spent any time listening to it before, he didn’t guess there was any way to know. It seemed pretty important right then, though, to listen. It just wasn’t possible over the conversation that was taking place in front of him; was probably supposed to be involving him, if he could just get his brain back online for a minute.
“Sam, I know you’re not having any pain, but the pressure in that right-sided valve is high. Higher than is safe, to be honest. Your best shot right now is to have a surgical repair-”
“Wait, surgery?” Sam finally found his voice. “Heart surgery? Isn’t that pretty risky?”
“What I’m proposing is a valvuloplasty. It’s like…well, kind of like a balloon. We insert it into the artery and stretch it out so that there isn’t so much pressure on it, and the blood can flow through freely.”
“So, what about after the procedure? What am I looking at then? A lifetime of meds? Repeat catheterizations? Activity restrictions?”
Shockingly, Dean had kept his silence while Sam asked his questions. “You’re making this sound much more serious than it is. Honestly, a repeat procedure is almost never necessary, and there are no medications you’ll need unless you have complications, which are exceedingly rare. I will recommend activity restrictions for the first six or eight weeks after the procedure. After that, you can go back to your normal level of activity as you feel comfortable.”
And now Dean’s quiet time was finished. “You’re makin’ this whole thing sound awfully easy. One minute you’re saying heart surgery, the next you’re saying he’ll be fine. I have to say I’m not all that convinced.”
“I encourage you to get a second opinion, a third even. This is the truth. I know when you tell someone that they, or the person they love, has a heart defect, it’s a really scary thing to hear. But in this case, we’re lucky. Sam, your condition is not causing you debilitating symptoms right now, and it’s easy to treat. Dean, you got your brother here for treatment before anything did happen. Right now, everything’s looking up. I’m not saying there aren’t risks - any medical procedure has risks - but this one has very few.
“Thanks, doctor. I appreciate all the information. Let me talk to my brother for a few minutes and we’ll come back, if you’ll be around.”
She looked at her watch. “I’ve got at least another hour’s worth of dictation to finish. Take your time.”
Dean and Sam went back to the now-empty waiting room and sat. “Dean, I know you’re skeptical, and worried, but I’d really like to get this done, preferably as soon as possible.”
“It’s your decision to make, Sam. It’s my job to do the worrying. I trust your judgment. And to be honest, we might as well get this handled while we’ve got a safe place for you to recover. I’m not saying I think anything’s going to happen, but right now we’ve got a roof over our heads and a place to call home. If we’ve got to do this, now’s the time.”
“Yeah, you’re right about that. And as much as I will admit to enjoying being spoiled and waited on, I’m sick of feeling exhausted all the time. I had just started feeling better after the trials when this started. I want to get back to being me again.”
“All right, then. Go on and let her know.”
The doctor said she’d have the hospital scheduling department call Sam the next day to work out a date for the surgery, and they headed home to break the news to Cas and Kevin. Kevin took it pretty much in stride - it’s not like this was the worst thing that had happened in his life in the past year or so. Probably didn’t even make the top ten. Castiel, though, didn’t say much. Just slunk off to his books and spent a few hours reading.
The next day, though, when Sam came into the library, Cas stopped him.
“Sam, I’d like to show you what I’ve read here.” And damn if Cas hadn’t been in there all that time studying the structure and physiology of the human heart, the ways in which it supplied blood to the rest of the body. “So this one here,” he said, “is the one that’s giving you trouble. The one that goes out the back and takes the blood through the pulmonary valve into the lungs. That’s why they want to put in the balloon and stretch it out, so it’ll take some of the pressure off. But they’ll have to go in through an artery in your groin instead of straight into your heart.”
“Cas, Dean and I told you all of this yesterday.”
“I know, I just - I wanted to see it for myself. How it works. And the doctor you saw, she was right. Almost no one has complications from this procedure, it’s very rare. I believe she is correct in her assessment that you will make a full recovery,” Cas finished with a wide grin.
Now that was something that would never make Sam sad about Castiel’s human condition; that smile that he’d never seen when Cas was an angel. “Thanks, Cas. I appreciate you looking into all this, and reassuring me. I got a call today from the hospital, the surgery is a week from tomorrow.”
Sam definitely enjoyed his last week of being pampered and spoiled (well, he did have his whole recovery to look forward to), then left Kevin and Cas at the bunker with solemn promises that Dean would call the minute there was any news.
There was some waiting around and filling out of paperwork at the hospital before they headed up to the catheterization lab. Their doctor had not mentioned before that this was a procedure that was normally done under local anesthesia. Sam had already been sedated through an IV when Dean took her aside and gave her a completely believable story about a previous medical procedure gone horribly wrong and convinced her that even though local anesthesia was normally considered safer, they would go with general anesthesia in this particular case. Dean couldn’t even begin to imagine what it would be like for Sam to be awake during that procedure, even if it were completely pain-free (which it wouldn’t be). Once they were ready to get started, Dean squeezed his brother’s hand one more time and stepped out into the surgical waiting area, sending a text to Kevin to let him know the surgery was underway and should be finished in a couple of hours.
Three hours later, the doctor came out looking exceptionally satisfied. “It couldn’t have gone better. Not a single complication. Your brother’s being taken to recovery, where he’ll be given fluids and checked on from time to time throughout the night. I don’t know why I’m wasting my breath, but if you want to just come back in the morning-”
Dean just laughed. “You know us that well already? Yeah, I’m not goin’ anywhere. Just get someone to point me in the direction of the recovery rooms, all right? And thanks. For everything.”
Once he made sure Sam was comfortable and still asleep, he slipped down to the cafeteria for some food. On his way back up, he called the bunker and got Cas. “Hey, just wanted to check in, man. Everything’s all right here. Sam’s surgery went off without a hitch and he’s in recovery until tomorrow, then I can bring him home.”
“Glad to hear it, Dean, and I’m sure Kevin will be, too. I wanted to come visit, assured Kevin I was perfectly capable of stealing a car and driving it there-”
“All right, Grand Theft Auto, just stay there. Sam’s asleep anyway, and he’s gonna be a little out of it for a while, even after I get him home. Make sure you have everything set up for him like we talked about - pillows, remote, blankets, TV tray, laptop, all that.”
“It’s taken care of. All just sitting here waiting for Sam, just like the rest of us.”
“He’s gonna be fine. We’ll be home tomorrow and everything’s gonna be just fine.”
Sam he had to take blood thinners for a little while, no big deal. Keeping the wounds clean was a bitch, but he didn’t really want anyone else messing around near his groin, thank you very much, so he learned how to do it on his own. He felt better every day, even as the spoiling started to wear off and sometimes he had to get up and make a bowl of cereal for himself in the morning. Sam wouldn’t trade it for the world. And it was just another reminder (as if he still needed them) of how much Dean cared about him, helping him through the recovery and slowly getting him used to normal movement again.
The doctors did what the doctors did, but of course, Dean did what Dean did, every time - took Sam’s broken heart and fixed it. This time it was just more literal.