Written for the prompt at the Oh Sam LJ prompt
Gen. S1. Sam passes a Kidney Stone... or a series of them (your choice whether there's only one or several of them) - and possibly has a kidney infection on top of it. Just give me whimper-y, tear-y Sam trying to piss and failing and the little he manages to pass feels like shards of burning glass.
"Up an at 'em sleeping beauty."
Sam groaned as Dean's voice called out, instead of answering or getting out of bed he rolled over. He really wasn't feeling so great that morning. He had been up three or four times last night going to the bathroom for some reason and he had sprained a back muscle apparently digging a few days ago and now it was acting up.
"Shit—" He swore as he pillow was ripped out from under his head and someone dragged the blankets off. "Fuck you —" he bit off the words with a yell as icy water dripped down his back.
Dean was already backing away and empty motel cup in his hand. He was laughing so hard he couldn't speak. Sam sat upright, still swearing as his ice cold shirt stuck to his back. To make matters worse his back ached on the left side like he had pulled a muscle or something.
"Score one for me Sammy."
Sam scowled. "We are not starting a fucking prank war now Dean."
Dean smiled, "No need to start it. The prank war is already in progress and I'm winning, that sandwich stunt was nothing compared to this."
He straightened up, giving an involuntary groan as his back stretched and the pain momentarily shifted. Sam already knew what Dean was referring to. Yesterday for lunch they had stopped for food at a diner and Sam had grabbed the to-go orders. Sam got a veggie burger and Dean of course got the artery clogging bacon, cheese monster burger. Once they were back in the car it turned out the woman had gotten the order wrong, and made two veggie burgers. The toppings on Dean's burgers were what they should have been but the expletives he said after biting into his expected meat patty were proof something was wrong. Dean had spat the mouthful out the window and dropped the greasy paper wrapped sandwich to glare at Sam. "What the hell Sam?"
Of course Dean wouldn't believe the sandwich incident was anything but a deliberate plot against him. Cue the current prank war Dean believed they were in.
Sam would have argued more but his bladder was feeling uncomfortably full again, so he contented himself with muttering "jerk" before going in the bathroom. Once there , he tried to go, but he only got a few seconds of stream before it petered off to a dribble. Also, his urine smelled and burned.
For a moment he wondered had he gotten an STD. But he hadn't been with any woman since Jessica and he was positive she had only been with him so that was impossible. Maybe he needed to drink more water or something?
Twenty minutes later he was dressed , showered and had popped a few Tylenol. The pain in his back didn't seem to be getting better though, it was turning from a dull ache to a sharp stabbing cramp.
XXXX XXXX
They stopped off at a diner for breakfast. Last night had been late and dinner had been a few bags of chips and some sodas so Dean was eager for a real breakfast. Sam had thought he was hungry too but now looking at the menu he didn't feel like eating.
He was vaguely nauseated and the pain in his back was distracting. Still he hadn't eaten a real meal in several hours and he needed to some food.
"So what'll it be?" The waitress looked tired and bored. She was trying and failing on the appearance department too. Her makeup was smeared and her hair obviously had been combed and styled hastily in a quick pony tail. Still underneath it all she had hints of being able to fix up well. Sam noticed Dean's smile starting and cut in before his brother could start the lecherous comments and make all of this take longer than it should have.
"I'll have oatmeal and um, some tea." Sam nodded at Dean , after years of diners with brother he knew what he wanted. "And he'll have Bacon, scrambled eggs, and a stack of pancakes….oh, and coffee. "
Dean glared at him, then turned to the waitress and added just to be contrary. "And a grapefruit." He waited until the waitress was gone then added. "I can order for myself bitch, especially after you tried to ruin my religious experience of the best bacon burger this side of the States."
Sam sighed, for Dean every new burger they came across was the holy grail. He had listened to this same speech about thirty times. "Yeah, whatever." Sam stood up, his bladder was acting up again and the pain in his back seemed to have spread to his stomach. He needed to go to the bathroom.
"I'll be back in a minute."
Once in the bathroom, Sam tried to go again. This time the pain was worse and he strained, pushing just to get a few drips of urine out. His bladder still ached, but after a few more minutes of trying without success to full relieve himself, he gave up.
Something was wrong, Sam was sure of that. But they had a hunt to get to and Dean wouldn't appreciate stopping. Plus they were out in the hicks and the nearest medical care was miles and miles away.
Sam made his way out, walking like an old man due to the pain. Dean was already tucking into his breakfast and noticed the way Sam was walking. "What's wrong with you?"
"My back hurts." Sam muttered, grabbing his own food.
"You took some Tylenol right?"
"Yeah, I'll be fine." Sam said shortly. He didn't want to talk, he didn't want to be in a car for the next few hours, and he didn't want to eat breakfast. He would rather curl back up in bed with a hot water bottle and probably a trashcan nearby. But that wasn't an option, dad was still missing and there was a hunt to get on before more people died. The oatmeal was a bad idea, it wasn't the cheap diner quality that made it bad, though that was part of the issue. The real problem was the cereal sat like a lump in his stomach. After his first few bites Sam stopped, praying that the food would stay down. He took a few sips of his tea and closed his eyes wondering why the Tylenol hadn't kicked in yet.
"Sam—uh—you sure you're okay?" He opened his eyes to find Dean staring at him.
"I'm good."
"You barely touched your food."
"I'm not hungry."
"You need to eat."
No, what Sam needed was to rest and wait for the pain to go away. "I'm fine Dean." Sam didn't wait for his brother to answer. Instead, he stood up muttering "bathroom."
Once he got there, he was expecting the usual unproductive course, but this time he managed to actually urinate. He hissed as the stream started, it felt like he was peeing shards of glass. Sam closed his eyes and bit lips trying not to cry out at the pain. By the time he had finished, his skin was sweaty and his eyes burned as a few tears reflexively squeezed out. Sam groped for the flush lever and pressed it down without opening his eyes, the acrid foul smell of his urine was aggravating his already tenuous stomach.
He braced himself against the bathroom sink as he washed his hands and tried to figure out what was going on. His best guess was a urinary tract infection, Jess had gotten that once. And he vaguely remembered info from the doctors instructions back they went away on their own other times you needed antibiotics, and it was best to drink plenty of fluid. Sam wasn't a doctor but the symptoms he could remember seemed to fit. Nausea, burning and pain with urination, foul smelling urine, back pain…
By the time he got back to the table, Dean had paid and was waiting impatiently. "What's wrong with you? That's the second bathroom break in like fifteen minutes." Before Sam could respond Dean added. "We don't have time for your fiber induced irritable bowel syndrome, the weather's getting worse and if we don't hurry we're going to be stuck here."
Sam glared at him, any intention he had of telling Dean what was wrong went out the window. Sometimes his brother could be paradoxically caring and sometimes he was just an asshole. It was clear which phase Dean was in now, if he somehow couldn't have already detected it.
XXX XXX
The car ride started out okay. Sam curled up as best he could in the passenger seat and thankfully Dean didn't say anything when he cranked up the heat a few notches. Snow was coming soon, the gray clouds in the sky and the few flurries already starting gave testament to the huge blizzard that was promised. Sam knew that if they didn't get out of the mountains and back to civilization, Dean would make the entire time they were snowed in pure hell. Boredom and Dean Winchester didn't mix well.
However, the pain was spreading more now. His back and stomach hurt, but now the cramping pain also had pooled to his groin. The nausea slowly increased and the slight twinge of carsickness that he always had only intensified.
Sam had snagged one of the water bottles they had from the glove compartment and drank it, hoping the fluids would help whatever was going on. Now, he was beginning to regret it. They had only drive for about half an hour and he already had to piss again. Dean would bitch and complain if he had to stop so soon, knowing that Sam waited, the ache in his bladder growing worse by the minute. Finally, ten minutes later he couldn't take it anymore.
There hadn't been a building since the diner but that didn't matter the woods would do. "Dean, can you stop, I gotta go."
Dean paused mid Metallica song and turned down the volume. His expression was clearly irritated. "We just left Sam. If the snow picks up we'll be screwed. Can't you hold it for a few more miles?"
Sam thought about that, but the insistent pressure in his bladder was deceptive. He couldn't tell if it was just irritated or actually full and the only thing that could make him feel even worse would be pissing on himself.
"No," His brother wasn't stopping the car so Sam added "Dean, come on…please." His face colored and he would have really hated his brother for making him beg but all he cared about was trying to get some relief from the pain.
Grumbling Dean pulled to the side of the road. "Make it fast Samantha, we're not letting a few more people get killed because you have the shits."
Sam didn't bother to correct Dean instead he quickly got out the car. It was freezing outside, patches of ice and snow dotted the ground. He stumbled painfully towards the nearest tree, and with fingers shaky from pain unzipped himself. He was met with similar success as his earlier attempts, a few drops , leaked out to wet the ground and then the flow abruptly stopped but the sensation that he desperately needed to piss was still there.
"Come on, come on." He muttered trying to squeeze out more. He nearly passed out as he strained and a spasm of agony ripped through his body. His knees buckled but thankfully, he managed to keep his balance. Behind him Dean began honking the horn insistently.
Sam got back in the car, and Dean started. "That's the last pit stop… you have to piss again, grab an empty bottle. You're like a freaking betsy-wetsy doll. " Dean pulled back into the road and Sam didn't bother to reply. He fell into a fitful sleep.
XXX XXX
It seemed like only minutes later he was waking up. His first sensation was pain, mind-numbing ripping pain that started in his back and then seared through his to his stomach and his groin. He was nauseated and his bladder felt full again though now he realized that was probably a phantom situation.
The pain was so bad he flt like dying right then and there would have been a good option if it would at least make the pain go. "Dean" He swallowed back acid as his brother turned to him, apparently, he must have looked at least half as bad as he felt because Dean's irritated expression immediately vanished to be replaced by concern.
"What's up?" Dean slowed the car, and spared a glance from the road. "Is it your back?"
Sam bit his lip and shook his head. " it's not just my back…it's my stomach...my groin …everything hurts. " He broke off and let out a hiss of breath as another spasm of pain rippled through.
"Maybe you've got like…food poisoning or something?"
Sam gritted his teeth and shook his head. "Don't think so." He felt cold all over and sweat was pooling on his forehead. The urge to piss was too strong to be ignored, plus it was only a matter of time before the pain made him puke. He groped for the door, causing Dean to swear and abruptly brake. Sam stumbled out only to almost fall over in the snow as another bolt of pain seared his insides. He doubled over, breathing fast, trying to will the pain to diminish.
He heard the car door slam, and then Dean was at his shoulder. "What the fuck Sam? You're scaring me here."
"It hurts." Sam was barely coherent enough to mumble through the haze of pain.
Dean pulled an arm around him attempting to guide him back towards the car. Unlike his irritation over the past few hours, his voice was low with concern and barely concealed almost-panic. "Okay, let's get you back in the car, and there's got to be a hospital or something nearby."
Sam nodded, but when Dean tried to tug on him, he weakly resisted. "I…need to piss." He was in so much pain it took a minute or two just to make it a few steps to the treeline even with Dean's help. By then any dignity was long was gone as he fumbled with numb fingers to unzip his jeans, barely aware that Dean was hovering behind him.
The first drops made tears come to his eyes. It felt like somebody was scraping glass through his urethra. The pain only got worse and Sam couldn't help the whimpers he made. It was so bad he almost blacked out as another wave of agony surged. His legs buckled. His eyes grew blurry and black ate away at the corners of his vision. He turned away doubled over gagging.
"Fuck."
Dean was kneeling next to him, but Sam was retching too hard to care. Dean was saying something now, the words hardly seemed important compared with the acid forcing it's way of his throat and the pain tearing apart his body. As he leaned over more he saw what had Dean worried. There painted on the snow was spatters of red, along with smaller drops of pink.
He had pissed blood.
Sam knew that something was seriously wrong but at that moment he didn't care about anything but getting the pain to stop. "Dean." Sam moaned the name, reduced to pleading like somehow, someway Dean could fix this like he always did.
"Okay, Sammy, let's just get you back to the car."
XXX XXX
Dean hit the road, doing well over 70 miles in a fifty mile zone. Once they had gotten to the car Sam had curled up in the back seat, almost in the fetal position from pain. Dean could hear him periodically moaning or gagging and at that point, he didn't even feel irritated with the thought of puke on his car's upholstery. All he cared about was finding a hospital, where they could fix whatever was wrong with Sam. Snow was coming down faster, and the nearest big town had to be at least a good hour away if not more. Desperately, Dean stopped at a gas station. The place had one pump, and a tiny shop.
A bored older man was standing behind the counter , smoking a cigarette. He took a puff and then drawled out. "What can I help you with?"
"Where's your nearest hospital?"
The man scratched his ear, taking his time in answering. "Well down near, Bear Creek they have a clinic that's about fifty miles South…and in Pines—"
"Just tell me where a damn doctor is!"
The man frowned, and bristled at the comment. "Son, obviously you're not from around these parts, but there's no need to—"
"Please, something's wrong with my brother. " Dean put all the desperation he was feeling into his plea and watched as the older man's face softened.
"What's wrong with him?"
"I don't know. His stomach hurts, he's throwing up and peeing blood."
"Sounds serious." The man frowned and appeared to be thinking. "Try Doc McKay. He runs a clinic a few miles down, usually closed it being a Sunday and all…but doubt you'll be able to make it much farther in this weather. I'll phone ahead so he'll know to expect you."
Dean listened impatiently as the man reeled off direction. By the time he got back to the car the weather was even worse. Thick gouts of snow fell and visibility was down to only about twenty feet. Sam was the same as when he left except he had thrown up again, though thankfully he managed to use the plastic bag Dean had gave him.
The clinic was a poor excuse for one in Dean's opinion. It had once been a house (or maybe still was), it was well kept up but obviously older. Still nobody would have mistaken the building for a medical facility. The lights were on so Dean assumed someone was still there. He could only hope the supposed Doc inside was the real deal and not some backwoods hick masquerading as a physician.
With difficulty, he managed to get a very pale Sam from the car. By the time they made it to the clinic door, Sam was barely managing his own weight. Dean fumbled with the door handle while trying to support his brother's 6'4" frame. Finally he got it open.
The man who met him was older probably sixties or seventies, he had thick white hair and a lined face. But his eyes were quick as he looked over them. Dean blurted their names and mentioned the man back at the gas station.
"Names Doc McKay, Bill told me to expect you." He was surprisingly strong as he slipped an arm under Sam's shoulder. "Let's get you back to an exam room son. You look ready to pass out."
Dean could hear barking from somewhere in the back and distractedly wondered what health codes said about dogs on the premises of a medical facility. Then again he doubted they got that many health inspectors so far off the beaten path as this place was. The exam room was clean but definitely old. The linoleum of the exam floor was cracked, wall paper peeled off the walls in several areas and worst of all as the exam table.
It was cold, metal, more like a slab you would lay a body on for autopsy than something for a human. The doctor had snatched a quilt from a cabinet and padded the table with it before they eased Sam down, but Dean doubted whether it was much more comfortable.
Anxiously he hovered nearby as the doctor pulled on a pair of gloves in preparation to starting his exam.
XXX XXX
"So what happened Sam?"
Sam felt like he was drifting in an out of awareness of waves of pain. It was hard to concentrate on what the doctor was saying. His voice was shaky and he had to stop every few words. "I woke up—this morning and my back hurt.—It's just gotten worse, plus—my stomach hurts and my groin—" He broke off and let out a hiss of breath as a particularly bad stabbing jolt seared through his back.
"Okay, I'm going to press down on your stomach and I want you to tell me when it hurts."
Sam nodded, his eyes half closed and his body as still as he could make it in a futile attempt to make the pain ease. He felt the doctors hand on his skin and then the slightest pressure, after that everything disappeared in a flash of white hot agony. He screamed…he couldn't help it.
Acid surged up his throat and Sam twisted to the side, heaving onto the yellowing floor.
"Sorry—'m sorry." He mumbled as the retching subsided, the pain was dimming down too, but he knew within seconds it would be back.
"Fuck this." Dean came into view his face pissed as he glared at the doctor. "Can't you just give him something for the pain and play twenty questions later? "
The doctor was unperturbed. "Before I give your brother something for the pain, I'd like to know what's causing it."
Dean huffed, but fell silent.
"Have you had any other symptoms? Vomiting, diarrhea…." The doctor continued questioning and Sam did his best to answer. A few moments later McKay straightened up. "Sounds like a kidney stone based on your symptoms. I had a horse last week with the same thing."
Dean frowned. "You take care of animals too?"
The man didn't turn around as he pulled off his gloves. "No, I take care of people too. Around these parts sometimes the hospital's too far away. I may be a vet but I had most of the same schooling as a regular doc."
Sam closed his eyes as he heard Dean swear again, but thankfully he didn't say anything else. The man may have been an animal doctor but it wasn't like they had any other options right now.
"Sam. I'll need a urine sample, and I'm gonna take you back for a quick X-ray. A CT really would be better but I don't have that kind of equipment."
Sam nodded, but he didn't miss Dean's mutter of "because this is a freaking vet's office."
Twenty minutes later, Sam pain was better, down from a searing agony to a dull roar, courtesy of the Toradol shot Dr. McKay had given him.
He watched as the man looked over the X-ray. Finally he brought it over and pointed to several areas. "See those dots?"
"Yeah."
"Those are kidney stones. About five of them as far as I can see. There's non-obstructing which means we don't need to get them out immediately and they're small enough to pass on their own which is a good thing."
Dean came closer peering at the film. "So what caused all this?"
McKay shrugged. "Could be a number of things, some stones are caused by an infection and your urine does show you have a UTI. But not drinking enough fluids, certain foods, or even just genes can all be factors in kidney stones forming."
Thirty minutes later they were on the road. "That was a low down dirty thing to do Sam."
"What?" Sam glanced up from where he had been reading his prescriptions. The doctor had given him a painkiller, an anti-inflammatory and an antibiotic.
"I thought we agreed after the prank war of 1994 faking symptoms was off limits."
Sam turned to stare at his brother incredulously. Did he seriously think he had faked all that.
"You had me thinking you were dying the way you were carrying on." Dean's hands tightened on the wheel and Sam realized his brother was making a poor attempt at a joke to mask the worry he must have had.
"Well, I feel a lot better now, felt like I was dying before." It was true the pain was nearly gone, just faint twinges now and then. Though the Vet had warned him when he started to pass the rest of the stones he was in for more pain, not as bad as before but definitely no picnic either. He tried not to think about that, hopefully the storm would have cleared by then and they could make it to a hospital if need be.
"Does that mean you learned your lesson about your eating healthy?"
Inwardly Sam groaned, Dean was never going to stop now he had ammunition.
"The vet said sometimes that could be the cause, not that was for sure the reason." Before they had left the vet had mentioned certain foods, nuts, spinach etc could contribute to kidney stone formation. Never mind that the man had also mentioned red meat could be the cause, Dean was sold hook line and sinker that if Sam adopted changed his eating habits he wouldn't be having these problems.
"I'm telling you stay away from the rabbit food. That veggie burger you poisoned me with the other day, could…"
Sam sighed as Dean continued…The impala rolled down the snowy road, the sounds of two brother's arguing filling the cramped confines.