"I look inside myself and see my heart is black.
I see my red door and it has been painted black.
Maybe then I'll fade away and not have to face the facts;
It's not easy facing up when your whole world is black."
Paint it Black by The Rolling Stones
"The Past is Prologue." Sam's trying to remember which of his classes at Stanford he heard that in, and which professor led the discussion, but mostly he is sitting slumped and uncomfortable in a too small blue plastic chair in a waiting area outside the emergency room of The University of Kansas Medical Center in Kansas City. It seems like he has spent way too much time in his life doing that, waiting for doctors to check out his father or his brother – injured from some hunt or another – with Sam sitting on the edge of the chair praying things would be okay. Sam's pretty sure he's had his fill of being the patient – his final time if he has anything to say about it was his stay in the mental ward; but then again…Dean, his brother…worrying about Dean just might be the death of him. His fingers fumble against each other as he admits to himself that he expects Dean will soon be locked in a psych ward himself.
"Shakespeare, that's it, from The Tempest," Sam surprises himself in remembering his college sophomore English Lit survey course – so long ago now that he really doesn't want to think about that - but at the time the thought had frightened him; he had been hoping to put the past completely behind him. Sure seems like Shakespeare had it right and the present is always affected by the past; and given Dean's past, it is no wonder that he shattered. Dean, his emotionally constipated big brother, has lost contact with reality, and Sam doesn't know if all the doctors and nurses will be able to bring him back. He almost wishes something supernatural triggered this. Sam really wishes he hadn't been the catalyst.
Sam runs his hands through his hair and scrubs at his face tiredly. He wonders if he has waited long enough to ask, again, what's going on. Maybe they gave Dean a shot and he's back to himself. Maybe he snuck out of the hospital, not wanting to see Sam after what Sam said. Maybe he'll never want to talk to Sam again. Sam almost groans at the weight of the guilt that feels like it's compressing his chest and making him unable to breathe. Someone damn well better get out here and tell him what's going on. Last time Sam asked the nurse at the desk for information she told him someone would be out soon to get some information from him.
He has waited quietly long enough, Sam decides, but as soon as Sam stands, the nurse turns toward him; it's like she was watching from the corner of her eye as he became more restless. Fortunately for both of them, the double doors swing open at the same time and a slender middle-aged woman wearing a doctor's coat comes through, no stethoscope, just the white coat neatly buttoned, a clipboard in her hands. Sam's head turns toward her with a questioning look. "Are you the family of Dean Smith?" She asks, head tilted up to make eye contact with the young giant.
"Yes, that's me. I, umm, I'm Sam. Sam Smith. Dean's brother." Sam responds. He and Dean still use the identities Frank Devereaux built for them whenever they do anything mundane. It is the best and most thorough identity either has and they try to keep it spotless, health insurance included. "Is, is he okay? How is my brother? What's wrong with Dean?"
The doctor, whose nametag identifies her as a Smith also, holds up a hand. "Let's go over here to a consultation room. I have some questions for you that will help me understand what's going on. And I think we want more privacy than we are going to get right here." Sam looks around the waiting room, catching other people turning away, and he realizes that there is no way to have a conversation in this room full of people just waiting without eavesdroppers.
"I understand," Sam says, and he follows Doctor Smith over to a small room that has several chairs around an oval table, taking a seat in a slightly larger version of the waiting room chairs. "Please, how's Dean? What's wrong with him?"
Dr. Smith is assessing him, peering at him over the dark frames of her glasses, making him feel like she must think he's going to fall apart, and it is starting to amp up Sam's anxiety. He takes a deep breath and tries to steady his nerves. Exhaling, Sam asks her to explain what is wrong with his brother. "Has there been any change since I brought him in?"
"No. Your brother's condition is unchanged. He is being admitted and moved to a room in the Psychiatric wing. He was brought here in a stupor – with motor immobility and waxy flexibility." Doctor Smith stops, as though what she said is sufficient information for now.
Sam disagrees. "What does that even mean? How is he; why is he doing this?""
The doctor's gaze stays on Sam, still watching him intently. "Your brother, Dean, is displaying catatonic traits. He will not maintain eye contact, does not interact or speak, his limbs are immobile except they will stay in place if someone else maneuvers them into position – that's what waxy flexibility means."
"I knew all that," Sam is getting impatient. Dean has been behind those doors for hours; Sam wants to hear why Dean is behaving this way, not get a recap of the symptoms. He knows the symptoms – tried to snap Dean out of them before giving up and loading him into the Impala for the trip to the hospital. "Why is he doing this? What's wrong with him?"
"We are running tests to rule out possibilities like stroke, encephalitis, or adverse drug reaction." Sam sucks in a breath like he's been punched. Damn it. A stroke? What if he hurt Dean more trying to snap him out of this state he is in? The doctor continues. "What I need from you is a more complete history on your brother in case the cause is an acute stress response." The doctor has said all of this calmly, but even the thought of Dean maybe having had a stroke or encephalitis is making Sam more upset. She tilts her head slightly, still watching him…observing him, Sam realizes.
"Did you hit him?" Doctor Smith asks. "I noticed a large hand-shaped fresh bruise on his face."
"I was trying to get him to snap out of it. I found him just sitting on the side of his bed, not moving, not responding. I, well, I didn't mean to hurt him. I was just trying to …." Sam trails off realizing he is repeating himself. Great, now they'll think I'm the violent one. Sam and Dean had been arguing, and yeah, maybe he got a little mean, said things he regrets. Maybe he should have realized that Dean was holding too much inside. Maybe he could have been a little more sympathetic about Benny's death. About Cas's leaving. About everything Dean's been holding back. But Sam's tired and feeling sick. It's hard not to lash out sometimes, and Dean has always taken it in stride before.
"Dean has quite a few bruises and scars. Maybe you could tell me how he got those. Additionally, I need to know about his physical and mental health histories." She brings out a small digital recorder from the coat pocket. "If you don't mind, I'd like to record the conversation so I can have it transcribed. I need to know if he or anyone in your family has ever exhibited a stress response like this – stupor, mutism, psychotic break. Has he ever been diagnosed with or exhibited symptoms of depression, anxiety disorders, ADD or ADHD, drug or alcohol abuse; and if he has experienced a recent trauma or loss of a loved one. From my personal assessment, I can say that while we will test, I expect this is a mental, not physical health issue."
"When will you know something?" Sam asks, wanting her to say it will be soon, but he can tell by her clinical and detached look that she is more interested right now in whatever background he can give her than in what he wants. Her face softens slightly at his hang dog expression. "The background may help." She offers.
Sam starts with early childhood, the scrubbed-free-of-supernatural version. Dean's mother died in a house fire a couple months before his fifth birthday. He may have seen it. Dean carried his little brother, Sam, to safety. According to stories, Sam believes that Dean stopped speaking to anyone except Sam for several months after the fire. There followed a childhood of Dean taking much of the responsibility of raising his sibling and himself while their alcoholic father moved them frequently – for work - and sometimes left them alone for weeks with Dean in charge.
"How old was your brother the first time that happened?" Doctor Smith doesn't look detached any longer. She is enmeshed in the narrative. Sam admits he doesn't remember, but it was commonplace by the time Dean was ten. Sam says as far as he knows Dean was never diagnosed with ADHD or a learning disorder, and that he quit school to hold a job and support the family after his father was injured during Dean's senior year. "But he got his GED." Sam hates how defensive that sounds. "My brother is very smart, even if he isn't overly educated in a traditional sense. He reads a lot, and is a genius with mechanical things. Anyway, Dad died about six years ago."
Inhaling noisily, Sam wipes his forehead. He's sweating, and their childhood was the easy part of their backstory. Doctor Smith encourages him to continue. Sam thinks he has hit on a plausible lie, something close enough to the truth that it will give the doctors something to work with to help Dean.
"My brother and I are like bounty hunters. We hunt down the ones that are too dangerous for most other people like us. That's why he's got so many scars. Dean was caught up in one case and was swept into a war zone for a year. Our mentor died right before Dean went to the combat zone. Dean escaped and came home about seven months ago. I noticed some changes in him, survivor's guilt, and some symptoms of depression. But I think it actually helps with his drinking problem – he had been drinking way too much. As far as recent losses, yeah, one of the guys who was with him in the combat zone just died. The other, well, he, uh, beat my brother up before taking off for points unknown. That's what we were fighting about. Dean lets people get away with stuff he shouldn't. Self-esteem problems."
Sam's afraid he has said too much now, but he really wants Dean to get help.
"Is that an issue? His self-esteem, that is? Can you tell me why? Has he ever been abused or beaten, and by whom?" The doctor's matter-of-fact tone actually helps soften the question. It's like she's not judging, just looking to fill in pieces of the puzzle that is Dean. But Sam knows the answer - the truth – is going to sound awful if he has to leave out demon possession and demon blood addiction.
Sam decides to answer anyway. "My brother has been through hell." Well, that was the truth, literally and figuratively. "Who has ever beaten him up? My dad, our mentor Bobby, his friend that he was in combat with, me." The last is said very softly.
The doctor is jotting notes on the paper as Sam falls silent again. She looks up with what Sam assumes is a purposely neutral expression and prompts him. "Is there a significant other in his life? Spouse? Children?"
Taking a minute to gather his thoughts, Sam starts again. The doctor's questions are making Sam hurt. He knows Dean went through all of this, but living with the guy day to day, Sam doesn't think about it. "Dean was living with a woman a few years ago, but they broke up. Sometimes I think he misses her son more than he does her. He was like a son to Dean, and Dean loves kids. He's not allowed to see Ben anymore." A deep breath, then Sam starts again. "Dean had a daughter too. He, umm, he didn't really know her or her mom well, mom was a one-night stand, but the girl showed up a couple years ago to say hello, you're my father. She was in her mid-teens." Sam checks the doctor's face. "She, I mean Emma, died in front of Dean."
The doctor taps her paper with her pen. "Has your brother ever gotten any help with any of this? Professional or even just someone to talk to?" At Sam's strangled no, the doctor tries again. "Does he have any other friendships, social or religious organizations to sustain him?" Sam shakes his head again. "Hobbies or other outlets for his stress?" she persists.
"No. Dean doesn't…he isn't like that. He's usually self-sufficient, kind of a loner, even though he's outgoing enough, I guess. He, he, hides stuff inside and won't talk about his feelings. Mostly it's just me and Dean. He takes care of me." Sam is tired of the questioning. He's back to running his hands through his hair, stressed. "When can I see him?"
Doctor Smith gathers her digital recorder and her clipboard as she stands. "Mr. Smith, I am very sorry, but given what you have told me, I don't think it would be in your brother's best interest for us to let you see him."