He answers Sam's phone while Sam is out getting burgers. It seems like a shitty thing to do, invasion of privacy and all that, but what the hell. Sam can't be mad at him for too long. And if he is, well. He can play the 'almost died' card.

Besides, the call is from his hospital. If Sammy was talking to his hospital about his fucked-up heart behind his back, he has a right to know about it.

"Hello," he says.

"Yes," says a female's voice, "is this Sam Winchester?"

"It is," he says, smiling. Because it's fun. Pulling shit on people is fun, and he's allowed to have a little fun after shaking a goddamn reaper off his tail.

"Mr. Winchester, I'm returning your call in regards to your inquiry about our transplant policy and DNRs?"

He hesitates for almost a full second, because he was hoping she would have kept talking and said something that would have given him more to go on, something that would tell him what the hell she was talking about, but she's waiting for a confirmation from him. So he jumps in on his end with an enthusiastic, "Right! Yes. Thank you. What can you tell me?"

"I understand that your brother is on the donor list for a heart and he's an excellent candidate. I assure you that if a donor match were to become available—"

It occurs to Dean then what this call is about, at least as far as the transplant thing goes. He had this talk with Sam and his doctors early on, realizing that the donor list for a heart was at least five miles long and his chances of staying alive long enough to get ahold of a donor heart were next to zero.

A fresh wave of guilt and nausea swirls over him as he can't help thinking about the young man killed by a chained reaper so that his own damaged heart would beat right again.

The news clearly hasn't made it to her about Dean Winchester's miracle cure yet. He doesn't feel like talking about it.

"I'm sorry," he breaks in. "But this isn't a good time. Can I…?"

"Yes, of course," she answers quickly. "I just wanted to relay the information that ethically there would be no way for us to match a specific DNR with your brother. Even if we had consent of the family, it's simply against hospital policy."

While he's thanking her, he's wracking his brain for the meaning behind the letters DNR.

And then it hits him, and he needs to sit down. DNR. Do not resuscitate. Brain dead. Organ donor.

Someone else to give their life for his.

Dean barely makes it to the bathroom before he vomits, yanking up the lid on the toilet and heaving, breathing hard as the urge to curl up and die passes. No. No, Sam wouldn't do that. It has to be a mistake. Sam would never think to put his life before some innocent. That's not what they do. They save lives.

He pulls a hand towel down from the rack and passes it over his face just as he hears Sam come in through the door.

"Dean!" he calls.

Dean takes a deep breath and realizes he's still clutching Sam's phone. He looks down at it and then looks up again to see his brother standing in the bathroom doorway with a bemused look on his face. "You okay?" he says.

"Take a seat," Dean tells him, gesturing with his brother's cell toward the living area of their room. "Something I need to ask you."

"Okay…" Sam says, looking baffled. "Do you want to eat first, or…?"

"Not really hungry," Dean answers, flinging the phone onto the mattress, his expression impassive. Sam sits, and Dean paces, a hand coming up to rub the back of his neck.

"You want to tell me what this is about?" Sam asks, perching lightly on the edge of his bed, hands on his knees apprehensively.

Dean turns to face him. "DNR, Sam?"

Sam looks down, his fingers digging into the fabric of his jeans. "You know," he says softly.

For a moment, Dean is so stunned that he has no response. He just stands there without comprehension, looking at the brother he raised, the man he thought he knew.

"You could really go through with something like that?" he asks at last.

"Yes, I would have gone through with it in a second," Sam says fiercely. "I said I wasn't going to let you die, and I meant it. You're my brother."

Dean shakes his head. "How…? I don't even know what to say, Sam. How could you even think I would be okay with something like that?"

"Yeah, well." Sam bites his lip. "You weren't exactly supposed to find out. Until after."

Dean closes his eyes, fighting down the urge to be sick again, feeling the weight of what his life has cost already. "Sam…"

"Look, I know it was stupid, all right? I'm sorry. Sorry you found out at all. But I was desperate. You were out of time. I couldn't let you die. It was all I could think of, and I… You've given everything for me, Dean. I figured it was my turn. My turn to save you."

"That's not saving me, Sam," he snaps. "We save lives. We don't kill people."

Sam looks at him, utterly confused. "I know that."

"Oh, you know that."

"Yes!"

"Then who was the DNR for, Sam?"

Dean's eyes go wide as soon as the words leave his mouth, because it's the way Sam swallows and his eyes dart to the floor and his fingers twist into fists against his jeans like that, and oh shit. Dean stumbles to his knees on the floor, beside the bed, in front of Sam, and he's holding Sam's head between both of his hands.

"Don't," he gasps, "don't ever, Sam. Not for me. Not for me, I'm not worth it. I'm not worth your life. I'm not—not worth anyone's life."

"Don't you dare say that," Sam hisses. "Not when you're everything I have, everything."

Dean shakes his head, pressing his forehead to Sam's, tears leaking from the sides of his eyes, and Sam thumbs them away. "You are," Sam assures him.

"I didn't want…" he starts helplessly, feeling the guilt overwhelm him again. "It was my fault, the rawhead. I was careless. The guy who died… he had nothing to do with me. Wasn't fair, Sammy. He didn't deserve to die."

"Hey." Sam runs a hand through Dean's hair, a gesture of comfort left over from their childhood, and Dean lets himself be soothed by it. "I know. Sometimes bad things just happen. Sometimes there's nothing you can do to stop it."

Dean closes his eyes, wishing he could believe that.