The Real Doctor Sexy, 2 of 3
Two
Dean pushed the needle through the rubber diaphragm of the vial of ketamine, loading the syringe carefully. “Two mL, Jody,” he told the sheriff as he drew the plunger up to the two millilitre mark. Sam needed an anaesthetic and the only one Dean had on him was ketamine, which was the most appropriate for all the field treatments that he and Sam had to do sometimes when they couldn’t get to the hospital.
Dr Sheikh confirmed ketamine didn’t lower blood pressure or need airway management with a vent so it was the safest anaesthetic for situations like these. Which was just as well as there was no other option.
Meanwhile, Jody gave Dean the syringe she’d been loading and Dean capped and twisted off the needle of his own before transferring the saline, increasing the volume of the anaesthetic to four millilitres. The doctor had got off the phone and had sent notes and links through e-mail. He was on video chat now and Dean prayed that the WiFi reception would stay intact throughout the surgery.
Dean dragged the trolley towards the table where they’d transferred Sam while Jody went to check if the sparse number of instruments they had were sterilised. The infirmary was well-stocked, but unfortunately, those were outdated things from half-a-century ago. There was no drug within expiry date and most instruments were primitive. However, Dr Sheikh had assured Dean that a bare minimum of instruments would be enough.
“It’s done!” Dean heard her say and he headed to the basin to wash his hands. He scrubbed them once with soap and Jody joined him, pouring Betadine on his palms which he scrubbed right up to his elbows, like the doctor had told him to. Once he had washed it away, he walked to the autoclave while Jody turned the tap off.
He had put a couple of his old shirts in the autoclave to use as drapes. Dean took one, bundled up the instruments in it, and returned to his trolley before carefully spreading the drape on its surface and starting to arrange the instruments and dressing material. Jody shook out a pair of sterile, latex gloves on the tray. The doctor watched, quiet, humming approvingly at intervals, while Sam slipped in and out of consciousness.
Sam was connected to an old cardiac monitor - so old, Dean had to squint to see the display. It was all they could find in the infirmary: another relic from the fifties. It was a small brown box with a round display and a separate speaker on the side for the alarm. It gave out a wire which was connected to ten leads instead of the standard three and the doctor had guided Dean and Jody to connect them. There was nothing to count Sam’s pulse, but the doctor had agreed to keep a mental count by listening to the monitor.
“Give him the anaesthetic,” Dr Sheikh’s voice said from the laptop screen. Jody uncapped the loaded syringe and took Sam’s left hand. “Dean, arrange the instruments so that you can pick them up quick and easy.”
There were a total of six kinds of instruments on the tray: the handle for the blade, the sponge-holding forceps, four artery forceps, a needle holder, an old-time metal cautery, and a pair of scissors. Dean had searched in the limited time he had, but none of the other necessary instruments that Dr Sheikh had described were there. Even the needle holder and scissors were from his and Sam’s med kit.
“He’s out,” Jody reported, putting aside the syringe.
Dean sighed, glancing up at Sam, who had stopped moving, and was breathing peacefully. The EKG machine was bleeping periodically, display turned towards the laptop monitor and showing, what Dean hoped, was a normal pattern and rhythm.
“You need to start immediately,” the doctor informed them. “Jody, give him the blade.”
Jody obeyed and Dean attached the blade to its handle. He stared at the straight line he had marked from the place where Sam’s sternum ended, to his umbilicus. Sam was stripped down to just his boxers, which were pulled down a bit low to allow for a longer incision, just in-case.
“Scrub him,” Dr Sheikh instructed. “Pick up a cotton pad with the sponge-holding forceps and scrub his whole abdomen with Betadine.”
Jody retrieved the Betadine bottle and poured some on Sam’s belly and some on the pad that Dean was holding. He put the material to his brother’s abdomen and began to scrub in circles, his mind detached, his wrists starting to ache, until Jody’s voice broke through to him. “Dean, that’s enough.”
He broke out of his reverie and blinked up at the laptop screen where Dr Sheikh looked concerned. “Are you ready for this?”
Dean snorted. “You think?”
“No, I’m serious,” the man replied. “If you’re not, have Jody wash up. This has to be done right now, Dean. There’s a reason we can’t wait for the ambulance. His BP is low, we have no time to waste.”
“Yeah,” Dean cleared his throat. “Yeah, I know. I-” He picked up the scalpel and clenched his jaw. “Let’s do this.”
Jody adjusted the light and Dean gripped the scalpel, holding it like a pen, just like the doctor had said. “Dean,” called Jody’s voice softly and he looked up at her. Their eyes met and he nodded at her, before placing the blade on Sam’s skin, on the black line. His hand shook but he steadied himself.
“Go,” Dr Sheikh encouraged him. “One swipe, all the way to his umbilicus. No stalling.”
Dean nodded and licked his lip. “I’m sorry, Sammy,” he mumbled, and pressed the blade lightly, drawing a thin stream of blood before going all the way down.
“Good, again,” the doctor said. “Cut and separate the layers. Look for the omentum - it will be golden-yellow in colour, like a scarf.”
Dean drew the scalpel down again, feeling more confident, and then another time, separating the layers with his hands gently, his heart beating fast as he did so. Fuck, fuck, he was cutting his brother open.
But he had to do this. He knew he had to, if he needed Sammy to be alive.
Provided he didn’t kill Sam first.
His gloves were covered in blood, the white invisible through the wet, warm red that coated it. The metallic stench wafted into Dean’s nostrils and he looked away for a moment, remembering he wasn’t wearing a mask, and he realised then how open, how exposed his brother was right now - how vulnerable, and how prone to much, much worse if Dean didn’t do this properly.
“N-No… pl’se… D’n, pl’se. ‘M s’ry, ‘m s’ry…”
Sam had thought that Dean was hurting him for what he’d said. Did Sam believe Dean would do that? That Dean would be angry enough to deliberately cause pain to him? That no matter what Sam said, Dean would ever stop believing, that they were, and would always be brothers?
Dean reached the omentum - a stole of gold covering Sam’s organs, almost protectively (and it was probably protective). He swallowed down sudden nausea as he looked up at the doctor. “Shall I open it?”
“Go ahead,” Dr Sheikh replied. “But be careful. The cavity is going to be filled with blood. Jody, check the BP.”
Jody began to inflate the cuff and Dean looked away from Sam’s ravaged form as he heard her let out the air from the apparatus. “Sixty-five over forty,” she said.
“He needs blood,” the doctor replied. “Increase the speed of his saline drip first.”
Dean had been warned that Sam would need blood but he didn’t have any of the blood bags on him. They hadn’t restocked those in a while.
He blew out a plume of breath as Jody adjusted the rate of Sam’s drip. “Should Jody start taking my blood?” Dean asked. He and Sam had matching blood groups and had given blood to one another before.
“No, actually,” Dr Sheikh replied. “I was going to suggest an auto-transfusion.”
“A what?”
“He doesn’t have an infection,” the doctor explained. “His peritoneum is irritated because of the blood, which is technically clean, since it hasn’t been exposed.”
“Okay, so?”
“You can open the peritoneum, draw the blood out in syringes, and Jody can inject them back into Sam while you work on removing the spleen.”
Dean raised an eyebrow. “And that will work?”
“It used to be a classic method used during field amputations before blood donation became a thing,” said the doctor. “It works in emergencies. Just don’t give back a very large volume. We can try and stabilise him a little with half a pint right now, but later, you’ll have to give him your blood.”
Dean nodded mutely, unsure how else to respond. He just hoped that Sam wouldn’t die. He knew that no matter how the surgery went, he’d be rushing Sam to the hospital as soon as the snow cleared.
“Okay, go on,” the doctor encouraged Dean. “The longer it takes, the more ketamine you’ll have to use, and the side-effects will only get worse from there. He hasn’t even fasted before his surgery. If he starts vomiting there will be a whole new problem. Even though he threw up before, his stomach isn’t necessarily empty.”
Dean nodded, clenched his fingers around the scalpel and cut through the peritoneum, pulling the flaps apart with his hands. He was appalled to see a lake of blood inside, bright red and flooding everything…
He caught himself in time, just before the dizzy spell attacked him. Sam had bled so much, had been in so much pain… how the fuck hadn’t Dean noticed? Fuck, fuck, when had he started getting so out-of-sync with his brother? They’d just been apart for a week, and this is what happened in the meantime? Dean forgot how to look out for Sammy? What kind of a brother was Dean?
“Dean,” Jody was calling out. “Dean, fill the syringes.”
His ears were blocked and her voice was muffled when he looked up at her, sweat breaking on his forehead. Right. The syringes. Sammy needed blood. Dean swallowed and reached for a fifty millilitre syringe. Thankfully, he and Sam had stocked up on enough of these.
“Four syringes for half a pint,” the doctor said. “Don’t give him more, he might have a reaction and there won’t be much you’ll be able to do then.”
Dean nodded - frantically, and got to filling up syringes and handing them to Jody, one by one. His gloves were slick with hot blood and the syringes slipped while he held them but he managed, watching Jody as she started attaching the mouth of each syringe to the IV catheter and pushing in blood.
“BP,” said Dr Sheikh when she was done and Jody began inflating again while Dean waited… praying…
“Eighty over fifty,” Jody reported to them.
“Not great, but we can work with that,” said the doctor. “Give him another shot of the ketamine. And Dean, soak up the blood quickly.”
Dean did as the doctor told him, his stomach turning as he soaked up big swabs of cotton with Sam’s blood and then cleaned the area with some saline from a syringe. Sam’s spleen was just visible under the sheath of peritoneum covering it.
“Open the cavity,” the doctor instructed. “Use your hand and move it along the convex surface until you feel the peritoneal attachments.”
Dean nodded and inserted his hand into the wound, remembering ghosts and demons doing this in a more brutal way. He was hurting Sam - physically tearing at his body, and he couldn’t help but think of how much this was going to hurt and debilitate Sam for the next few weeks.
“Dean, concentrate,” said a firm voice and Dean swallowed, turning his attention to his work. He tried to imagine that this wasn’t Sam; that this was…
“Oh, who are we going to carve today? Will it be Sammy?
Alastair’s voice in his head caught him off guard and Dean stopped abruptly, looking up at Jody. He couldn’t do this. He couldn’t do this. He needed her to take over… he was… he was going to…
He swallowed. No. Sam needed his help. Sam needed to know that no matter what, Dean would always save him. That he’d keep coming back to him. It didn’t matter if Sam didn’t consider them brothers anymore. Sam was still the precious bundle in Dean’s arms when he’d run out of their burning house. Sam was still the one person Dean would give up anything for. He couldn’t lose Sam to this. He just couldn’t.
“Hey,” said a voice, breaking through his thoughts, and he looked at Jody, one hand awkwardly in Sam’s belly. She smiled reassuringly. “You’re doing great, okay? You’re going to save him, Dean. Just go on.”
He nodded, again and again, frantically, and the doctor was silent as Dean finally felt, and gently ripped (if there was anything gentle about it at all) at the various fibrous attachments. At long last, when Sam’s spleen was more mobile, Dean grasped it and moved it towards the incision. He could see the rupture, a dark red blemish in deep purple and he let out a short breath, encouraging himself to calm down.
“We use electrocautery for such procedures these days, but you’ll use your hand,” Dr Sheikh said. “Go along the convex side of the spleen and separate the ligaments. Start with the ones that are holding the spleen to the peritoneum and go lower. If there’s a bleeder anywhere, you’ll have to use the artery forceps or cauterise, so be ready for that.”
Dean nodded as Jody started to set up a Bunsen burner for the cauterisation, in case they needed to cauterise. He took a deep breath and began, again, to move his moving, grasping, and then tearing as gently as he could, while with his other hand, he tried to mop the blood. His body felt detached from his mind as he did it, with just a voice in his head, which coaxed him to keep going for Sammy. He knew he was doing a piss-poor job, and that the doctors would need to open up Sam again, and he wished he could do something more worthwhile than this.
“Now go posterior and dissect those attachments with your hand. Be careful of the splenic artery and vein. Keep the clamps ready for those.”
Dean wanted to wipe sweat of his brow but he didn’t dare raise a hand to do it. God knew, he was already infecting Sam enough. He placed his hand in the wound and started separating the attachments again with the border of his palm. When he’d done that he moved the spleen towards the wound and pulled it out, his body working on autopilot again and he continued, until a sharp voice disrupted him.
“No!”
By the time Dean had noticed though, it was too late. And all he saw was the profuse blood that was beginning to fill Sam’s abdomen again.
~o~
The ancient EKG was screeching, the sound alien and terrifying in Dean’s ears as Dr Sheikh frantically shouted out instructions.
“It’s his splenic artery,” he said, “Clamp it now!”
The blood came out in great, warm spurts, on Dean’s face and his clothes. He grasped an old artery forceps and grabbed the leaking vessel before clamping it. It locked with a click and the spurts stopped, but Sam was still bleeding.
“His BP is dropping,” Jody informed, taking off the stethoscope.
“He needs blood,” the doctor informed. “Dean.”
Dean nodded, already tying the tourniquet around his arm. He uncapped a fifty cc. “A pint?” he asked.
“Yes,” said the doctor. “But sit down. You need to be careful.”
Dean ignored him as he made a fist and pushed the needle into a prominent vein, drawing out the plunger and watching as dark blood filled it. He handed it over to Jody as soon as he was done, reaching for another syringe, and then another…
“Dean, slow down.”
He didn’t care. The EKG was still wailing and Sam needed blood. He would die if Dean didn’t help.
The fourth syringe shook in his hands. His vision blurred, but he found a new vein and plunged it in, drawing more blood. The injection spots from earlier were painful and bruised. He pulled his glove off and tapped the blue veins at his wrist next, his head spinning and his gut churning, but he didn’t care. He had to keep going. He had to close up Sammy after all this and he couldn’t pass out.
Save Sam, or kill him. You should have killed him long ago.
Same circumstances, I wouldn’t.
Dean took another syringe and carried on. Screw everyone. Sam was his brother.
~o~
Sam feels light and good as he sits in his room, a book propped on his lap while he reads the words. His mind is active and free of burdens and he feels oddly clean - like someone has scrubbed him gently, all over. He looks at his arms, to see that all the scars he’s ever possessed are gone.
Sam sighs, running his hand over the skin, the lack of puckered discolouration feeling odd. Why is he like this? What has Dean done this time? Is he dead again?
He’s about to call out to his brother, when someone knocks at his door.
“Come in,” says Sam in a hoarse voice, and the door opens, as a familiar face peeks in.
“Hey, Sam,” says Kevin Tran softly, giving him a sad smile.
~o~
Voices called out to him.
“Dean, Dean.”
“Dean.”
“Dean!”
He was sweating. He swallowed down bile and his knees buckled at the seventh syringe. He sank to the floor, Jody rushing to his side and folding him over so that his head was between his knees. He took a deep breath, his stomach turning, and handed the syringe to Jody.
“T… Take…”
“Dean, it can wait. I’ve given him six syringes.”
“He’ll d-die…”
“He’ll be fine. Take a breather. We won’t let him die, okay?”
“Can’t… g-give him m-more K. H-He can’t… s’art p-puking. N-Need to…” Dean pushed his head up, trying to ignore the spinning, but Jody’s hand was on his neck, pushing it back down.
“Dean,” she said firmly, sounding like she was someone’s mom. Oh well, she was a mom… or had been…
Dean’s thoughts were spinning in circles too.
He took deep breaths and a few sips out of the glass of salt-and-sugar solution that Jody pushed to his lips. “Drink,” she said. Even though he felt like his stomach would rebel, he was able to finish the whole thing. He took out three more syringes of blood, drank another glass of ass-tasting solution, and Jody brought him a stool to sit on to finish the rest of the surgery.
Dean ligated the leaky vessels next, holding them with old forceps which only worked half and were either too loose or too tight, and with one silk suture here, artery forceps clamping that, and cutting, cutting, cutting until he managed to cut off the spleen. His hands were shaky and he fingers barely worked but he wouldn’t allow Jody to touch Sam.
After scooping out the clots like the doctor told him to, Dean started working on the cauterisation. He had to hold the metal cautery against the Bunsen flame before applying it to the bleeders. The sizzle of Sam’s flesh, followed by the stink of it burning made him want to throw up. Sam stopped bleeding, though, and that was all Dean needed for now.
While closing his brother up, Dean could barely get the sutures right. The hand holding the needle holder trembled too much and Dean had to use his fingers to twirl the sutures around the forceps before knotting them. The sutures went slow - too slow, because they kept slipping but Sam was relatively stable, with blood inside him, although they needed another shot of ketamine.
When the sutures were done, Dean could barely just hold himself together to request Jody to dress the wound and he ignored her concerned face as he staggered to the basin, his hands still gloved, and he braced the sides of the sink before leaning over and throwing up again and again, losing all the rehydration solution and his dinner, and God knew what, with tears streaming down his face, although he didn’t know if it was from the effort of puking, or if it was for the fact that he was thankful, so fucking thankful that Sam was alive.
~o~
Sam doesn’t understand what’s going on. Kevin has left and he’s alone again, but this time, he doesn’t feel half as good as how he’d felt earlier. He is in a white, empty room, in white clothes, and all his scars are back. He can feel the itch of stubble on his jaw and he raises a hand to scratch at it.
“Saaaam.”
The voice is familiar, the tone sing-song. It comes from behind him.
“Sammy,” says the voice again, the caress in it sickening. Sam takes a sharp breath and turns around, only to see Lucifer standing there with a satisfied grin on his face. Something twists in Sam’s gut as pain flares up his abdomen. He winces and looks down, only to see blood spurting out of a gaping wound on his belly.
“He’s waking up. Jody, he’s waking up.”
The pain intensifies. Lucifer smiles wider and extends a hand, pushing it through Sam’s already-wounded abdomen, twisting it. Sam yells out in pain.
“Sammy, Sammy, hey, it’s okay, it’s okay.”
“He’s in a lot of pain, Dean. I’ll ask the doc…”
“No, no, I’ve got something for him. No need to ask the doc. Hang on, Sammy!”
Suddenly, Sam realised that he wasn’t with Lucifer anymore. He was on a firm, flat surface, pain coursing through his abdomen like nothing he’d ever felt. He could hear a familiar, female voice, soothing him, and he couldn’t place it. But he’d heard Dean before that, and Dean had said he’d make it okay…
He heard footsteps, and something tugged at his palm, followed by something cold running up his vein.
“That’s it, Sammy, relax, relax, it’s morphine…”
Dean’s voice tethered him from drowning in pain and he held on, frantically, until a tidal wave of agony crashed into him, worse than anything he’d ever felt his whole life. Cold sweat broke out on his forehead and before Sam knew, he was screaming, vomit crawling out of his stomach and getting caught in his throat, choking him.
“Sammy!”
The voice calling his name was frantic and someone moved him hurriedly on his side, causing more pain to flare up as he coughed up bile miserably, letting it leak out of his mouth. He retched again. And again, and again, his sore gut convulsing in unstoppable agony.
“Hey, hey,” a hand was on his neck and another softer hand was rubbing his back but he couldn’t stop gagging. The pain rose and fell, and Sam’s stomach rolled with each spasm, his nerves screaming for mercy and his mind pleading for death.
“It’s over, honey,” the woman promised him. “It’s over. Relax.”
But it wasn’t over and Sam couldn’t stop heaving. The pain wasn’t going either. He felt himself go lax, weak retches still issuing from him. A calloused hand held his forehead and Dean’s voice was laced with worry. “Sammy. Sammy, stay with me.”
But he couldn’t. He wanted to go. He wanted to die. He couldn’t take any of this pain for a minute longer.
Please, Dean, let me go, said a small voice in his head. He finally felt the heaving start to taper off and Dean’s hand went from Sam’s forehead to his hair, thick fingers carding through it gently. And Sam leaned in to the gesture as he finally felt his consciousness leave him again, feeling safe with Dean close by.