The Real Doctor Sexy, for evelyncarver
Title: The Real Doctor Sexy
Recipient: evelyncarver
Rating: Teen and Up
Warnings: Swearing, gore
Spoilers: Up until episode 9.14, ‘Captives’
Word Count: ~9,700 total in three parts
Summary: There is nothing that Dean won’t do for Sam. [Takes place directly after episode 9.13, ‘The Purge’].
Author's Notes: Many thanks to my amazing beta, amber1960, for her quick and wonderful help with the fic!
Prompt: Bunker fic, in 9x11 there's a medical bay/sick bay/hospital in the bunker. And now it's really going to come in handy. Maybe it's already stocked too, only everything is 50+ years old/expired/out of date.
One
Now
Dean feels the wet grass dampen his jeans as he sits against the huge tree trunk, his cell phone pressed against his mouth and his eyes shut. He takes deep breaths and rests his head against the rough bark, reminding himself that he can relax now - that it’s all right. But his mind won’t let him do that. He can see it all; clear as crystal, although it’s been over a week, and his heart flutters, beating madly when he thinks of how close he had come to losing Sam. Again.
After Gadreel, after everything, even after what Sam said to him, about being okay with Dean dying, Dean still can’t give in to the thought, or be prepared for Sam to die. He wonders what Sam’s thinking right now; if he’s thankful at all for Dean’s new attempt to bring him back from death’s jaws, or if he’s just silently cursing Dean. Dean wouldn’t know. Sam hasn’t spoken to him too much. He’s still pissed. Or maybe the pain is just too much.
And Dean probably deserves it too. He didn’t notice Sam’s distress in time and knowing how well Sam can hide his injuries, Dean blames himself this time. He always keeps an eye on Sam, knowing that the kid can get into very tough spots very rapidly and he’s the first to notice any problems going on with Sam. This time, he didn’t. And Sam almost died.
Again.
~o~
Then
It was still early in the evening when Sam retired to bed after the Pishtaco hunt and after dropping his newest bombshell; that he didn’t really care if Dean died. Dean found it odd that Sam was taking a siesta, but he did look pretty tired. He had been knocked about good by the Pishtaco and somewhere, a hurt, angry part of Dean stormed inside him, saying Sam deserved the temporary pain.
Dean made his way to his own room a while later and switched off the lights, but he didn’t sleep. His arm hurt, Cain’s Mark twinging at every burst of anger he felt between the curtains of disappointment and heartbreak, and his throat felt suspiciously painful and heavy. He tried to ignore it, tried to forget, but he couldn’t.
Finally, he found himself reaching for his bottle of Jack and swigging down large mouthfuls of whiskey in the darkness. He vaguely remembered that he was probably screwing his liver irreversibly, but he didn’t care. Maybe, if he died, Sam could be happy again and free from all sorts of burdens. It wasn’t as if Dean’s life meant anything to Sam. Dean had dragged himself on, stayed alive this long, always and only for his brother, because who’d look out for Sammy if Dean died? Turned out, the kid didn’t care anyway.
He watched a few videos on the laptop for a while, not really caring what he was seeing. Time seemed to pass slowly, an hour seeming like an eternity. Dean got off the bed and stretched, preparing himself to get to the kitchen to make dinner. Sam would be awake soon and Dean was getting hungry. He was just about to leave the room, scratching at the back of his neck, when his phone rang. Frowning, Dean advanced to the bedside table and picked it up, only to see Jody Mills’s name flashing on the screen. He took the call.
“Hey, Sheriff!”
“Hey, Dean! How you doin’?”
Dean smiled. “I’m - I’m good. You?”
“I’m good too,” she said. “Listen,” she continued, “I uh… I’m kinda in your neighbourhood and I was wondering if we could catch up.”
Dean had given Jody the bunker’s address the last time they’d met, and asked her to visit anytime. Even under the circumstances, he found himself smiling. “Sure!” he said to the sheriff.
She chuckled from the other side. “I’ll be there in an hour - I just need to finish up something right now. Why don’t I bring dinner and beer?”
“You don’t have to, Jody.”
“Oh, come on. Don’t be a killjoy! Besides, the radio station says there’s a snowstorm forecast for tonight. That’s depressing enough since I can’t get out of here.”
“Does it?” Dean asked her. He hadn’t exactly caught on to weather forecasts lately. It didn’t make much of a difference inside the bunker anyway.
“Yeah, it does. You boys aren’t going anywhere tonight, are you?”
“No. Where are you staying?”
“At a motel,” replied Jody.
“Stay over with us, then,” Dean told her. “This place is good that way. It’s not like you can go anywhere during the snowstorm.”
“That sounds great, but… ” Jody trailed off, seemingly to contemplating something, but Dean pushed her.
“Hey, look who’s trying to be a buzzkill now!”
She laughed. “Okay, okay, I’ll stay over.”
“Great,” said Dean, grinning. “We’ll see you in a bit.”
“Sure!”
They spoke for a while more and after he’d cut the call, Dean made his way to Sam’s room. He was slightly surprised to find the door open and Sam sprawled spread-eagled on the bed, but Dean placed his palm against the wood of the door and knocked thrice.
Sam woke up with a start. “Whaaa?”
“Jody is coming to visit,” Dean told him. “She’s bringing dinner. Thought you’d like to know.”
Sam rubbed at his eyes and pushed his hair back, grimacing slightly as he sat up. “Okay, sure.”
Dean turned to walk away, not giving Sam a second glance before returning to his room and his bottle. He wondered if Sam would at least stop being a bitch in front of Jody, because he honestly didn’t want a lecture from her, or for her to notice anything, but apparently, there was no way of figuring out what Sam was capable of saying these days.
~o~
Sam felt kinda bad about what he’d said to Dean, but he knew he wasn’t about to apologise. If Dean wanted to be childish about this, he could go ahead and behave a little girl. Or he could be mature about it and try to understand what Sam meant. Dean, in all probability, had misinterpreted what Sam had meant to say and Sam knew he should, perhaps, clear it up, but right now, but he wanted Dean to be hurt. Sam was in pain and he was pissed and guilty and fucking miserable; and Dean deserved to feel at least a part of the betrayal that Sam felt. It was only fair.
If Dean wanted to wallow in self-pity for the next few days, he could. Sam wasn’t going to go around explaining anything. Dean was an intelligent person, completely capable of basic understanding and Sam was just fucking tired right now, of the mess that his life was. So yeah, Dean could go and cry someone else a river. Sam had had enough.
When Dean left after waking him up, Sam could see the hurt written on his brother’s face and he felt sick satisfaction take over. However, Jody coming over would hopefully take his mind off this whole mess, and Sam found himself starting to anticipate her visit. He would be happier, though, if his shoulder weren’t killing him.
It was funny, because he couldn’t exactly remember getting hit there, but he reckoned he might have knocked it somewhere. There was no other explanation for it. His belly was tender too, near the spot that the cabinet had fallen on him and the Pishtaco had aimed his kick. It had been tender through the whole ride from Minnesota and he could feel dull, throbbing pain near his left. It seemed to be increasing slowly, but steadily. Right now, Sam was stiff and tired even after napping for an hour. His heart was also beating faster than normal - palpitations fluttering against his chest, making him feel anxious.
He winced as he got out of bed, swayed a little, trying to clear the black spots from his vision, indicating just how tired he was. Then he collected a fresh pair of clothes to change into, so he could shower, and wouldn’t look as wretched as he felt when Jody arrived. He bumped up the thermostat on the way because it was getting slightly cold, and once in the bathroom, he let the shower run warm against his bare skin, steam rising in white plumes and filling the stall. There was a large bruise on his left side, no doubt from that beating he had suffered, , and Sam knew he was bound to have trouble with it over the next few days.
He felt a little better once he was done showering and he towelled himself dry before putting on his clothes and going to the library. Dean was already sitting there with the laptop, researching something.
“Hey,” Sam said.
Dean looked up, raised his glass of whiskey to acknowledge Sam, but didn’t reply. Sam didn’t push him to talk. Well, fuck you very much, Dean, because you’re not allowed to have a bitch-fit about this.
“So are we picking her up from somewhere?” asked Sam.
“Just from the usual place where we meet Charlie,” Dean muttered. “She said she’d call when she got there.”
“Okay.” Sam dragged out a chair and joined Dean at the table. He raised the back of his palm to his mouth as he felt a yawn coming on, and grunted a little at the pain in his shoulder. He wished he could divert his mind from it so it would hurt less. Dean, however, seemed unperturbed by Sam’s restlessness and Sam sat there, staring at his brother for what felt like an eternity, until mercifully, Dean’s phone rang.
And when Dean left the bunker with his jacket draped around him so he could go get Jody, Sam was thankful for all the dissipating tension. But he knew that no matter how much Dean sulked or pouted, he wouldn’t be taking back his words. It was time Dean accepted certain facts for a change.
~o~
Dean knew from Jody’s sceptical gazes at dinner that she’d smelled a rat. He tried to keep cordial conversation with Sam, he really did; but it was hard to do that when looking at Sam just reminded him of what Sam had said to him a few hours ago. But he stayed civil, unlike Sam, who wasn’t even talking much.
They settled in front of the TV with their beers, which Sam swapped, surprisingly, for water. It turned out that Jody loved Game of Thrones as much as Sam and Dean did, and they’d not had much time to finish the first season yet, since their lives had pretty much been a non-stop fiasco for the last few months. Dean and Jody expressed their sympathies out loud for the Stark family, wondered about Cersei and Jaime while agreeing that Tyrion was their favourite Lannister. Sam was still relatively silent, only giving forced smiles and nodding occasionally, and when they’d finished the episode and their beers, Sam excused himself to go to bed.
Jody looked shocked as she watched Sam stumble to his feet and walk away. She turned to Dean. “Is he okay?”
“Peachy,” Dean scoffed. “He’s better than just ‘okay’, Jody.”
“No, you know, he didn’t seem well, Dean. He was swaying when he walked.”
“Was he, now?” Dean asked her. He shook his head. “It’s been a long day. He’s probably just tired. He’ll be fine.”
She frowned. “What’s going on between you two?”
“It’s nothing,” Dean replied, waving his hand. He reached for the remote. “Wanna watch some more?”
“You should check on him, Dean,” said Jody, not really replying to Dean’s question.
He sighed. “Trust me. I’d know if he was hurt. He’s just in one of his moods. Let him be.”
Jody rested back against the couch they were sitting on and pursed her lips. “You two seemed okay the last time I saw you.”
Dean found himself shrugging. “Shit happens, Sheriff. But right now he’s just being a bitch. He’s fit as a fiddle because Cas fixed him up good before he left, so don’t worry.”
“Where did he cut his lip?”
“We finished up a case earlier today,” said Dean.
“I still think you should check on him. He didn’t even eat much.”
Yes, Dean had asked Sam about that, but Sam had just pushed away his half-eaten plate and said that he wasn’t hungry, and then proceeded to drink water as though he were living in a desert. Dean hadn’t really questioned him about it. And now that he thought of it… had Sam seemed a little pale?
“He… he looked okay,” said Dean, not very sure of himself now.
Jody nodded. “Even so, nothing wrong in checking on him, right?” she encouraged.
Dean bit his lip. “I guess not. But he’s - he’s kinda really pissed.”
“He isn’t going to be angry at you for trying to help him, Dean.”
Dean didn’t know whether to laugh or cry at that.
~o~
Sam was sleeping soundly when Dean entered his room. Once again, he was spread-eagled on his back and in the darkness, Dean couldn’t make out his brother’s face much. Sam’s breathing, however, seemed weird… different.
Too fast.
Dean frowned. “Sammy?” he murmured, switching on the light, only to be greeted by his brother’s pale face with his eyes pinched shut, his mouth open, drawing in rapid, shallow breaths. A fine film of sweat coated Sam’s white face.
“What the fuck?” Dean whispered, stepping ahead and reluctantly placing a hand on Sam’s forehead. He hissed at Sam’s cool skin. He had expected quite the opposite - a fever or a building cold. Not this. Immediately, Dean’s mind calculated all of Sam’s visible symptoms and settled on the most obvious answer.
Sam was in shock.
Dean grabbed Sam’s wrist with one hand and shook him awake with the other. “Hey,” he said, pushing at Sam’s shoulder. “Hey, wake up.”
“Mmmm,” Sam mumbled, hissing and flinching at Dean’s touch. Dean let go of his wrist and stepped back.
“Okay, bitch, I won’t touch you.”
“Nhhh,” Sam said, eyes opening slightly and swivelling over to Dean. “Sh-should’r…”
“Shoulder?” Dean asked him. “You hurt your shoulder?” Dean began to pull out his phone. They needed an ambulance. Sam was bleeding somewhere on the inside, although, Dean wasn’t sure if someone could bleed like that from a shoulder injury.
Sam nodded. “Should’r… sss’mach…”
“Shit,” Dean swore, things coming into perspective. If Sam was hurting on his belly and was going into shock, it definitely meant organ injury. They needed the hospital, but first, Dean needed to have a look for himself.
“Okay,” he told Sam. “I’m gonna try and see where you’re hurt on your stomach, all right?”
Sam didn’t reply, but Dean was already pulling up his t-shirt. What he saw, though, just sent his heart hammering. A large, dark bruise decorated the left side of Sam’s belly, indicating spilled blood on the inside, which confirmed Dean’s suspicions. Tentatively, he put a hand on the bruise and Sam yelled out, his body arching against the bed.
Dean immediately recoiled, swearing again. There were two organs on that side: the stomach and the spleen. And if Sam’s stomach had been bleeding, Dean knew that he’d be puking up blood like nobody’s business. Which meant…
“Sam, we’re getting you to the hospital,” said Dean, dialling 911 on his phone. “I think your spleen has ruptured.”
~o~
“No ambulance. No ambulance. What the fuck do they mean by no ambulance for the next few hours?” Dean vented, pacing about the infirmary as Jody sat on a chair next to Sam’s bed, her eyes on him.
“What are we supposed to do?” he asked her. He’d gone out to see if he could take out the Impala to take Sam to the hospital but there was a full-blown blizzard and the road outside the bunker itself was blocked with snow.
“You heard Dr Sheikh,” replied Jody. “For the time being, we can just keep an eye on Sam and keep his fluids up. That’s what they do in hospitals for ruptured spleens these days anyway. And the fact that it took him over twelve hours to actually get to this stage-”
“I know he said that, Jody,” Dean replied, eyeing Sam, who lay with IVs up both hands, leaking saline into his body. Jody’s doctor had confirmed Dean’s suspicion of splenic rupture. Apparently, the shoulder pain, coupled with left abdominal pain was a dead giveaway. The doc had suggested some management for the shock and had told them to just keep Sam stable until help arrived.
“He’s a good doctor,” Jody told Dean.
“He hasn’t even seen Sam.”
“Yeah, but based on the information you gave him, he reckons Sam is pretty stable.”
Dean sighed, wondering how Jody was so calm. He took the chair next to her. “I should have noticed…”
“You couldn’t have,” she said. “I don’t even think Sam knew that there was something really wrong.”
“Or he didn’t want to tell me,” Dean scoffed. “Don’t blame him.”
Jody remained silent. They could still hear Sam breathing shallowly and when Dean put a palm to Sam’s forehead again, it was still clammy. He frowned. “How long ago did you call the doc?”
“About an hour ago.”
“Isn’t Sam supposed to be at least a little better?” Dean asked her. “Shock-wise?”
“He said we should wait two hours,” Jody replied. “Maybe we should just give Sam some time.”
“Yeah, we probably should.” Dean had a bad feeling about this, and hoped he was wrong. He reached for the blood pressure apparatus and inflated the cuff, listening on the stethoscope during deflation.
Sam’s blood pressure was low. It was standing at ninety over sixty, his systolic pressure at least ten lower than what it had been an hour ago. Dean drew out a breath. “His systolic is lesser than a hundred,” he said, his heart beating restlessly.
Jody pulled out her phone just as Sam let out a moan. Dr Sheikh had asked to call if Sam’s systolic BP went lower than a hundred. In the meantime Dean frowned, watching his brother’s eyes move beneath their lids. Sam let out a low moan and Dean stood up. “Sam?”
His brother moaned again in reply and opened his eyes, his glassy gaze swivelling everywhere, expression pinched with pain. Dean leaned forward, putting his hands on the mattress. “Hey. What’s happening? Talk to me.”
“S-S’mmch…”
“I know. I know, Sam. But we gotta keep you stable until the ambulance-”
Sam shook his head, coughing, his face blanching even more. He swallowed a couple of times, and Dean recognised the signs. “Okay,” he said. “Okay, okay-” He hurried to collect the trash can. “Jody, I think-”
Jody was already getting up from her chair and exiting the room with her phone in hand. Sam winced as Dean rolled him over to his right, holding the dustbin below Sam’s chin. The retching that followed was painful to hear and Sam gasped and moaned in between heaves, unable to pull in breaths or bear the pain. Jody poked her head in, her expression worried. “Dean, where is it hurting him?”
“Every-” Sam started to reply but he gagged again, and Dean’s heart clenched. “A-All o’vr…” Sam said, surfacing for a moment.
“All over your stomach?” Dean asked him. Sam nodded miserably.
Jody went back to the phone and Dean waited for Sam’s nausea to abate before laying him straight and handing him some Kleenex. When Jody returned a minute later, she looked anxious. Dean swallowed. “What did the doc say?”
“You should speak to him,” she replied, putting the phone on loudspeaker and placing it on the bedside cabinet.
“Doc?” Dean called out.
“Yes,” Dr Sheikh replied. “Can you tell me about his new symptoms?”
“His BP is ninety over sixty,” Dean replied. “And he just threw up. Is that supposed to happen?”
“He said he has pain all over his abdomen?”
“Yeah.”
“Okay, I need you to do a few tests.” Dean rubbed his palms together as the doctor continued, “First, I need you to just palpate his abdomen. Touch it and tell me what it feels like.”
Dean pulled up Sam’s t-shirt and when he placed a hand on Sam’s belly his brother gasped, causing Dean to move back, but that wasn’t before he felt the rigidity of Sam’s muscles underneath his palm.
Is it firm?” Dr Sheikh asked, as though he were reading Sam’s mind.
“Yeah, it kinda is,” Dean agreed.
“Okay, then, ask him where the pain is maximum, and push that part down lightly.”
“He’s already hurting-”
“Trust me, Dean. You have to do this if you want me to reach a diagnosis.”
Dean swallowed. “Sammy… where does it hurt most?”
“S’mach…” Sam hissed, pointing at his left again and Dean bent over, only to have his brother recoil. “N-No… pl’se… D’n, pl’se. ‘M s’ry, ‘m s’ry…”
“Just - just a moment, man, I’ll be done in a moment… promise.” Dean thought he knew what Sam was apologising for, and he felt his heart sink. Sam still flinched when Dean approached him and Dean pushed a palm down at the tender spot, making Sam sigh lightly, but when he withdrew his hand, Sam screamed, shutting his eyes and beating his fists against the bed.
“He’s hurting when you withdraw your palm?” the doctor asked, obviously having listened in on the phone. “And he seems reluctant to let you palpate him.”
“Yeah, yeah, what-?”
“One last thing,” the doctor said. “Listen to his abdomen on the stethoscope. Tell me if you can hear his bowel sounds.”
Dean put the earpieces on before the doctor had finished and gently placed the diaphragm of the stethoscope on his brother’s belly. He couldn’t hear anything. He put the instrument aside.
“Can’t hear ‘em, doc,” he said, his heart hammering against his chest.
Dr Sheikh let out an exhale. “His peritoneum is irritated. He needs surgical intervention.”
“Surgical?” Dean asked him. “He needs his spleen removed? How long can this wait?”
“Not long,” said the doctor. “He’s bleeding out faster than I estimated. He ideally needs to have his spleen repaired, but…”
“But?”
“It needs certain equipment that you may not have.”
“We have a stocked infirmary. Try me.”
“Okay, you need sutures, a sterile mesh to wrap up the spleen, absorbent haemostatic agents and several instruments.”
Dean had plenty of sutures on him but the rest…
He sighed. “I have just the sutures and possibly the instruments. Is there another way? Without the fancy stuff?”
“Yes. An open splenectomy.”
Recipient: evelyncarver
Rating: Teen and Up
Warnings: Swearing, gore
Spoilers: Up until episode 9.14, ‘Captives’
Word Count: ~9,700 total in three parts
Summary: There is nothing that Dean won’t do for Sam. [Takes place directly after episode 9.13, ‘The Purge’].
Author's Notes: Many thanks to my amazing beta, amber1960, for her quick and wonderful help with the fic!
Prompt: Bunker fic, in 9x11 there's a medical bay/sick bay/hospital in the bunker. And now it's really going to come in handy. Maybe it's already stocked too, only everything is 50+ years old/expired/out of date.
One
Now
Dean feels the wet grass dampen his jeans as he sits against the huge tree trunk, his cell phone pressed against his mouth and his eyes shut. He takes deep breaths and rests his head against the rough bark, reminding himself that he can relax now - that it’s all right. But his mind won’t let him do that. He can see it all; clear as crystal, although it’s been over a week, and his heart flutters, beating madly when he thinks of how close he had come to losing Sam. Again.
After Gadreel, after everything, even after what Sam said to him, about being okay with Dean dying, Dean still can’t give in to the thought, or be prepared for Sam to die. He wonders what Sam’s thinking right now; if he’s thankful at all for Dean’s new attempt to bring him back from death’s jaws, or if he’s just silently cursing Dean. Dean wouldn’t know. Sam hasn’t spoken to him too much. He’s still pissed. Or maybe the pain is just too much.
And Dean probably deserves it too. He didn’t notice Sam’s distress in time and knowing how well Sam can hide his injuries, Dean blames himself this time. He always keeps an eye on Sam, knowing that the kid can get into very tough spots very rapidly and he’s the first to notice any problems going on with Sam. This time, he didn’t. And Sam almost died.
Again.
~o~
Then
It was still early in the evening when Sam retired to bed after the Pishtaco hunt and after dropping his newest bombshell; that he didn’t really care if Dean died. Dean found it odd that Sam was taking a siesta, but he did look pretty tired. He had been knocked about good by the Pishtaco and somewhere, a hurt, angry part of Dean stormed inside him, saying Sam deserved the temporary pain.
Dean made his way to his own room a while later and switched off the lights, but he didn’t sleep. His arm hurt, Cain’s Mark twinging at every burst of anger he felt between the curtains of disappointment and heartbreak, and his throat felt suspiciously painful and heavy. He tried to ignore it, tried to forget, but he couldn’t.
Finally, he found himself reaching for his bottle of Jack and swigging down large mouthfuls of whiskey in the darkness. He vaguely remembered that he was probably screwing his liver irreversibly, but he didn’t care. Maybe, if he died, Sam could be happy again and free from all sorts of burdens. It wasn’t as if Dean’s life meant anything to Sam. Dean had dragged himself on, stayed alive this long, always and only for his brother, because who’d look out for Sammy if Dean died? Turned out, the kid didn’t care anyway.
He watched a few videos on the laptop for a while, not really caring what he was seeing. Time seemed to pass slowly, an hour seeming like an eternity. Dean got off the bed and stretched, preparing himself to get to the kitchen to make dinner. Sam would be awake soon and Dean was getting hungry. He was just about to leave the room, scratching at the back of his neck, when his phone rang. Frowning, Dean advanced to the bedside table and picked it up, only to see Jody Mills’s name flashing on the screen. He took the call.
“Hey, Sheriff!”
“Hey, Dean! How you doin’?”
Dean smiled. “I’m - I’m good. You?”
“I’m good too,” she said. “Listen,” she continued, “I uh… I’m kinda in your neighbourhood and I was wondering if we could catch up.”
Dean had given Jody the bunker’s address the last time they’d met, and asked her to visit anytime. Even under the circumstances, he found himself smiling. “Sure!” he said to the sheriff.
She chuckled from the other side. “I’ll be there in an hour - I just need to finish up something right now. Why don’t I bring dinner and beer?”
“You don’t have to, Jody.”
“Oh, come on. Don’t be a killjoy! Besides, the radio station says there’s a snowstorm forecast for tonight. That’s depressing enough since I can’t get out of here.”
“Does it?” Dean asked her. He hadn’t exactly caught on to weather forecasts lately. It didn’t make much of a difference inside the bunker anyway.
“Yeah, it does. You boys aren’t going anywhere tonight, are you?”
“No. Where are you staying?”
“At a motel,” replied Jody.
“Stay over with us, then,” Dean told her. “This place is good that way. It’s not like you can go anywhere during the snowstorm.”
“That sounds great, but… ” Jody trailed off, seemingly to contemplating something, but Dean pushed her.
“Hey, look who’s trying to be a buzzkill now!”
She laughed. “Okay, okay, I’ll stay over.”
“Great,” said Dean, grinning. “We’ll see you in a bit.”
“Sure!”
They spoke for a while more and after he’d cut the call, Dean made his way to Sam’s room. He was slightly surprised to find the door open and Sam sprawled spread-eagled on the bed, but Dean placed his palm against the wood of the door and knocked thrice.
Sam woke up with a start. “Whaaa?”
“Jody is coming to visit,” Dean told him. “She’s bringing dinner. Thought you’d like to know.”
Sam rubbed at his eyes and pushed his hair back, grimacing slightly as he sat up. “Okay, sure.”
Dean turned to walk away, not giving Sam a second glance before returning to his room and his bottle. He wondered if Sam would at least stop being a bitch in front of Jody, because he honestly didn’t want a lecture from her, or for her to notice anything, but apparently, there was no way of figuring out what Sam was capable of saying these days.
~o~
Sam felt kinda bad about what he’d said to Dean, but he knew he wasn’t about to apologise. If Dean wanted to be childish about this, he could go ahead and behave a little girl. Or he could be mature about it and try to understand what Sam meant. Dean, in all probability, had misinterpreted what Sam had meant to say and Sam knew he should, perhaps, clear it up, but right now, but he wanted Dean to be hurt. Sam was in pain and he was pissed and guilty and fucking miserable; and Dean deserved to feel at least a part of the betrayal that Sam felt. It was only fair.
If Dean wanted to wallow in self-pity for the next few days, he could. Sam wasn’t going to go around explaining anything. Dean was an intelligent person, completely capable of basic understanding and Sam was just fucking tired right now, of the mess that his life was. So yeah, Dean could go and cry someone else a river. Sam had had enough.
When Dean left after waking him up, Sam could see the hurt written on his brother’s face and he felt sick satisfaction take over. However, Jody coming over would hopefully take his mind off this whole mess, and Sam found himself starting to anticipate her visit. He would be happier, though, if his shoulder weren’t killing him.
It was funny, because he couldn’t exactly remember getting hit there, but he reckoned he might have knocked it somewhere. There was no other explanation for it. His belly was tender too, near the spot that the cabinet had fallen on him and the Pishtaco had aimed his kick. It had been tender through the whole ride from Minnesota and he could feel dull, throbbing pain near his left. It seemed to be increasing slowly, but steadily. Right now, Sam was stiff and tired even after napping for an hour. His heart was also beating faster than normal - palpitations fluttering against his chest, making him feel anxious.
He winced as he got out of bed, swayed a little, trying to clear the black spots from his vision, indicating just how tired he was. Then he collected a fresh pair of clothes to change into, so he could shower, and wouldn’t look as wretched as he felt when Jody arrived. He bumped up the thermostat on the way because it was getting slightly cold, and once in the bathroom, he let the shower run warm against his bare skin, steam rising in white plumes and filling the stall. There was a large bruise on his left side, no doubt from that beating he had suffered, , and Sam knew he was bound to have trouble with it over the next few days.
He felt a little better once he was done showering and he towelled himself dry before putting on his clothes and going to the library. Dean was already sitting there with the laptop, researching something.
“Hey,” Sam said.
Dean looked up, raised his glass of whiskey to acknowledge Sam, but didn’t reply. Sam didn’t push him to talk. Well, fuck you very much, Dean, because you’re not allowed to have a bitch-fit about this.
“So are we picking her up from somewhere?” asked Sam.
“Just from the usual place where we meet Charlie,” Dean muttered. “She said she’d call when she got there.”
“Okay.” Sam dragged out a chair and joined Dean at the table. He raised the back of his palm to his mouth as he felt a yawn coming on, and grunted a little at the pain in his shoulder. He wished he could divert his mind from it so it would hurt less. Dean, however, seemed unperturbed by Sam’s restlessness and Sam sat there, staring at his brother for what felt like an eternity, until mercifully, Dean’s phone rang.
And when Dean left the bunker with his jacket draped around him so he could go get Jody, Sam was thankful for all the dissipating tension. But he knew that no matter how much Dean sulked or pouted, he wouldn’t be taking back his words. It was time Dean accepted certain facts for a change.
~o~
Dean knew from Jody’s sceptical gazes at dinner that she’d smelled a rat. He tried to keep cordial conversation with Sam, he really did; but it was hard to do that when looking at Sam just reminded him of what Sam had said to him a few hours ago. But he stayed civil, unlike Sam, who wasn’t even talking much.
They settled in front of the TV with their beers, which Sam swapped, surprisingly, for water. It turned out that Jody loved Game of Thrones as much as Sam and Dean did, and they’d not had much time to finish the first season yet, since their lives had pretty much been a non-stop fiasco for the last few months. Dean and Jody expressed their sympathies out loud for the Stark family, wondered about Cersei and Jaime while agreeing that Tyrion was their favourite Lannister. Sam was still relatively silent, only giving forced smiles and nodding occasionally, and when they’d finished the episode and their beers, Sam excused himself to go to bed.
Jody looked shocked as she watched Sam stumble to his feet and walk away. She turned to Dean. “Is he okay?”
“Peachy,” Dean scoffed. “He’s better than just ‘okay’, Jody.”
“No, you know, he didn’t seem well, Dean. He was swaying when he walked.”
“Was he, now?” Dean asked her. He shook his head. “It’s been a long day. He’s probably just tired. He’ll be fine.”
She frowned. “What’s going on between you two?”
“It’s nothing,” Dean replied, waving his hand. He reached for the remote. “Wanna watch some more?”
“You should check on him, Dean,” said Jody, not really replying to Dean’s question.
He sighed. “Trust me. I’d know if he was hurt. He’s just in one of his moods. Let him be.”
Jody rested back against the couch they were sitting on and pursed her lips. “You two seemed okay the last time I saw you.”
Dean found himself shrugging. “Shit happens, Sheriff. But right now he’s just being a bitch. He’s fit as a fiddle because Cas fixed him up good before he left, so don’t worry.”
“Where did he cut his lip?”
“We finished up a case earlier today,” said Dean.
“I still think you should check on him. He didn’t even eat much.”
Yes, Dean had asked Sam about that, but Sam had just pushed away his half-eaten plate and said that he wasn’t hungry, and then proceeded to drink water as though he were living in a desert. Dean hadn’t really questioned him about it. And now that he thought of it… had Sam seemed a little pale?
“He… he looked okay,” said Dean, not very sure of himself now.
Jody nodded. “Even so, nothing wrong in checking on him, right?” she encouraged.
Dean bit his lip. “I guess not. But he’s - he’s kinda really pissed.”
“He isn’t going to be angry at you for trying to help him, Dean.”
Dean didn’t know whether to laugh or cry at that.
~o~
Sam was sleeping soundly when Dean entered his room. Once again, he was spread-eagled on his back and in the darkness, Dean couldn’t make out his brother’s face much. Sam’s breathing, however, seemed weird… different.
Too fast.
Dean frowned. “Sammy?” he murmured, switching on the light, only to be greeted by his brother’s pale face with his eyes pinched shut, his mouth open, drawing in rapid, shallow breaths. A fine film of sweat coated Sam’s white face.
“What the fuck?” Dean whispered, stepping ahead and reluctantly placing a hand on Sam’s forehead. He hissed at Sam’s cool skin. He had expected quite the opposite - a fever or a building cold. Not this. Immediately, Dean’s mind calculated all of Sam’s visible symptoms and settled on the most obvious answer.
Sam was in shock.
Dean grabbed Sam’s wrist with one hand and shook him awake with the other. “Hey,” he said, pushing at Sam’s shoulder. “Hey, wake up.”
“Mmmm,” Sam mumbled, hissing and flinching at Dean’s touch. Dean let go of his wrist and stepped back.
“Okay, bitch, I won’t touch you.”
“Nhhh,” Sam said, eyes opening slightly and swivelling over to Dean. “Sh-should’r…”
“Shoulder?” Dean asked him. “You hurt your shoulder?” Dean began to pull out his phone. They needed an ambulance. Sam was bleeding somewhere on the inside, although, Dean wasn’t sure if someone could bleed like that from a shoulder injury.
Sam nodded. “Should’r… sss’mach…”
“Shit,” Dean swore, things coming into perspective. If Sam was hurting on his belly and was going into shock, it definitely meant organ injury. They needed the hospital, but first, Dean needed to have a look for himself.
“Okay,” he told Sam. “I’m gonna try and see where you’re hurt on your stomach, all right?”
Sam didn’t reply, but Dean was already pulling up his t-shirt. What he saw, though, just sent his heart hammering. A large, dark bruise decorated the left side of Sam’s belly, indicating spilled blood on the inside, which confirmed Dean’s suspicions. Tentatively, he put a hand on the bruise and Sam yelled out, his body arching against the bed.
Dean immediately recoiled, swearing again. There were two organs on that side: the stomach and the spleen. And if Sam’s stomach had been bleeding, Dean knew that he’d be puking up blood like nobody’s business. Which meant…
“Sam, we’re getting you to the hospital,” said Dean, dialling 911 on his phone. “I think your spleen has ruptured.”
~o~
“No ambulance. No ambulance. What the fuck do they mean by no ambulance for the next few hours?” Dean vented, pacing about the infirmary as Jody sat on a chair next to Sam’s bed, her eyes on him.
“What are we supposed to do?” he asked her. He’d gone out to see if he could take out the Impala to take Sam to the hospital but there was a full-blown blizzard and the road outside the bunker itself was blocked with snow.
“You heard Dr Sheikh,” replied Jody. “For the time being, we can just keep an eye on Sam and keep his fluids up. That’s what they do in hospitals for ruptured spleens these days anyway. And the fact that it took him over twelve hours to actually get to this stage-”
“I know he said that, Jody,” Dean replied, eyeing Sam, who lay with IVs up both hands, leaking saline into his body. Jody’s doctor had confirmed Dean’s suspicion of splenic rupture. Apparently, the shoulder pain, coupled with left abdominal pain was a dead giveaway. The doc had suggested some management for the shock and had told them to just keep Sam stable until help arrived.
“He’s a good doctor,” Jody told Dean.
“He hasn’t even seen Sam.”
“Yeah, but based on the information you gave him, he reckons Sam is pretty stable.”
Dean sighed, wondering how Jody was so calm. He took the chair next to her. “I should have noticed…”
“You couldn’t have,” she said. “I don’t even think Sam knew that there was something really wrong.”
“Or he didn’t want to tell me,” Dean scoffed. “Don’t blame him.”
Jody remained silent. They could still hear Sam breathing shallowly and when Dean put a palm to Sam’s forehead again, it was still clammy. He frowned. “How long ago did you call the doc?”
“About an hour ago.”
“Isn’t Sam supposed to be at least a little better?” Dean asked her. “Shock-wise?”
“He said we should wait two hours,” Jody replied. “Maybe we should just give Sam some time.”
“Yeah, we probably should.” Dean had a bad feeling about this, and hoped he was wrong. He reached for the blood pressure apparatus and inflated the cuff, listening on the stethoscope during deflation.
Sam’s blood pressure was low. It was standing at ninety over sixty, his systolic pressure at least ten lower than what it had been an hour ago. Dean drew out a breath. “His systolic is lesser than a hundred,” he said, his heart beating restlessly.
Jody pulled out her phone just as Sam let out a moan. Dr Sheikh had asked to call if Sam’s systolic BP went lower than a hundred. In the meantime Dean frowned, watching his brother’s eyes move beneath their lids. Sam let out a low moan and Dean stood up. “Sam?”
His brother moaned again in reply and opened his eyes, his glassy gaze swivelling everywhere, expression pinched with pain. Dean leaned forward, putting his hands on the mattress. “Hey. What’s happening? Talk to me.”
“S-S’mmch…”
“I know. I know, Sam. But we gotta keep you stable until the ambulance-”
Sam shook his head, coughing, his face blanching even more. He swallowed a couple of times, and Dean recognised the signs. “Okay,” he said. “Okay, okay-” He hurried to collect the trash can. “Jody, I think-”
Jody was already getting up from her chair and exiting the room with her phone in hand. Sam winced as Dean rolled him over to his right, holding the dustbin below Sam’s chin. The retching that followed was painful to hear and Sam gasped and moaned in between heaves, unable to pull in breaths or bear the pain. Jody poked her head in, her expression worried. “Dean, where is it hurting him?”
“Every-” Sam started to reply but he gagged again, and Dean’s heart clenched. “A-All o’vr…” Sam said, surfacing for a moment.
“All over your stomach?” Dean asked him. Sam nodded miserably.
Jody went back to the phone and Dean waited for Sam’s nausea to abate before laying him straight and handing him some Kleenex. When Jody returned a minute later, she looked anxious. Dean swallowed. “What did the doc say?”
“You should speak to him,” she replied, putting the phone on loudspeaker and placing it on the bedside cabinet.
“Doc?” Dean called out.
“Yes,” Dr Sheikh replied. “Can you tell me about his new symptoms?”
“His BP is ninety over sixty,” Dean replied. “And he just threw up. Is that supposed to happen?”
“He said he has pain all over his abdomen?”
“Yeah.”
“Okay, I need you to do a few tests.” Dean rubbed his palms together as the doctor continued, “First, I need you to just palpate his abdomen. Touch it and tell me what it feels like.”
Dean pulled up Sam’s t-shirt and when he placed a hand on Sam’s belly his brother gasped, causing Dean to move back, but that wasn’t before he felt the rigidity of Sam’s muscles underneath his palm.
Is it firm?” Dr Sheikh asked, as though he were reading Sam’s mind.
“Yeah, it kinda is,” Dean agreed.
“Okay, then, ask him where the pain is maximum, and push that part down lightly.”
“He’s already hurting-”
“Trust me, Dean. You have to do this if you want me to reach a diagnosis.”
Dean swallowed. “Sammy… where does it hurt most?”
“S’mach…” Sam hissed, pointing at his left again and Dean bent over, only to have his brother recoil. “N-No… pl’se… D’n, pl’se. ‘M s’ry, ‘m s’ry…”
“Just - just a moment, man, I’ll be done in a moment… promise.” Dean thought he knew what Sam was apologising for, and he felt his heart sink. Sam still flinched when Dean approached him and Dean pushed a palm down at the tender spot, making Sam sigh lightly, but when he withdrew his hand, Sam screamed, shutting his eyes and beating his fists against the bed.
“He’s hurting when you withdraw your palm?” the doctor asked, obviously having listened in on the phone. “And he seems reluctant to let you palpate him.”
“Yeah, yeah, what-?”
“One last thing,” the doctor said. “Listen to his abdomen on the stethoscope. Tell me if you can hear his bowel sounds.”
Dean put the earpieces on before the doctor had finished and gently placed the diaphragm of the stethoscope on his brother’s belly. He couldn’t hear anything. He put the instrument aside.
“Can’t hear ‘em, doc,” he said, his heart hammering against his chest.
Dr Sheikh let out an exhale. “His peritoneum is irritated. He needs surgical intervention.”
“Surgical?” Dean asked him. “He needs his spleen removed? How long can this wait?”
“Not long,” said the doctor. “He’s bleeding out faster than I estimated. He ideally needs to have his spleen repaired, but…”
“But?”
“It needs certain equipment that you may not have.”
“We have a stocked infirmary. Try me.”
“Okay, you need sutures, a sterile mesh to wrap up the spleen, absorbent haemostatic agents and several instruments.”
Dean had plenty of sutures on him but the rest…
He sighed. “I have just the sutures and possibly the instruments. Is there another way? Without the fancy stuff?”
“Yes. An open splenectomy.”