A/N: I've been craving some cancer!Sam fics for a while, but I couldn't really find what I was looking for so I wrote one myself. Not as angsty as I had originally anticipated, though of course Sam gets put through the wringer. There's even some cute brotherly bonding! Sam is 16 and Dean is 20. I did my research in Brunner & Suddarth's Textbook of Medical-Surgical Nursing, twelfth edition because I crave some semblance of medical accuracy and now I can even say I "studied" over the summer.
Hope you enjoy :) (reviews are a reason to get out of bed in the morning)
Sam stared out the window of the Impala, picking at the plastic hospital bracelet dangling from his wrist.
Acute Lymphocytic Leukemia occurs when immature cells multiply in the blood; inhibiting the normal growth of other blood cells. The leukocytes, while numerous in the blood and bone marrow, are undeveloped and unable to function. They can also spread to other organs, creating serious and often deadly complications.
Dean had gallantly offered to let him ride shotgun, but Sam had refused; preferring to curl up in the back seat, his long legs crunched against the door on the opposite side.
They'd thought at first that it was probably just growing pains. But then there'd been the sleepiness (typical teenager), the fevers (stop being such a wimp, Sam) and finally, a nosebleed that wouldn't stop. Dean had found him half-conscious on the bathroom floor, which qualified him for a trip to the emergency room.
Symptoms of ALL include fatigue, infection, and bleeding. Bone pain and tenderness in the liver or spleen may also occur as the result of infiltration of leukemic cells.
Sam brushed at the large bruise just under his hairline, put there by a poltergeist over a week ago and still an angry, livid purple. He'd done all the research for that hunt while Dad and Dean were off interviewing the family under the guise of electrical engineers.
I did my research this time too, Sam thought. Late-night google searches of epidemiology, treatments. Gotta know what we're up against, just like any other case. He'd read all the pamphlets through four times, until he could recite the information verbatim.
ALL commonly occurs in young patients, peaking around four years of age. It is uncommon in patients over fifteen.
Lucky me. Guess I'm special.
Sam could feel Dean eyeing him in the rearview mirror. Ever since he'd been diagnosed, Sam felt like a bomb about to go off. Dad and Dean tiptoed around him, the air filled with awkward pauses and throat-clearing.
He'd tried to tell them that he was fine. ALL is highly treatable, with a remission rate of 98% in children. He could beat this. Just another hoop to jump through before he could get to Stanford (well, he didn't tell them that part).
It wouldn't be easy; Sam wasn't a total idiot. Words like cranial radiation and intrathecal chemotherapy had floated across the pages. He'd tried to joke about it to Dean, how maybe having all that radiation and crap around his brain would turn him into a superhero, but Dean had paled.
"Wait, are you serious?"
"Yeah Dean, I'm gonna be Gotham's next Ghostbuster."
"No, about that stuff… in your head?"
"Mhmm. Itrathecal chemotherapy. They inject the drugs into the space between the brain and spinal cord. Pretty cool, huh? It's to prevent the spread of the leukemia into the brain"
"That's not funny Sam! Those drugs are basically poison."
They didn't think he was strong enough. He'd prove them wrong.
Sam imagined the chemo buzzing through his system like a million wasps. I'm not gonna let it slow me down. I'm not gonna be sick. Dean and Dad, they'll see. I can handle this.
They pulled up to the motel twenty minutes later. Dean scurried around to the side door, holding out his arm to help Sam out of the car, but his brother pushed him away.
"I'm not an invalid," he muttered. "Look, I can even get up the stairs by myself!"
For a second, Dean looked like he wanted punch the false enthusiasm right back down Sam's throat, but then he shrugged and turned to help John unpack the trunk.
"You feeling okay?" Their father called, eyeing his youngest carefully. "Your stomach and everything?"
There was a soft thump as Sam knocked his head against the doorframe in exasperation. "I'm fine."
And he was, surprisingly. A little tired and foggy, sure. A light nausea swooping behind every exhale, but it wasn't like he'd expected from the books and movies he'd seen.
"Can someone throw me the keys so I can get inside?"
Sam caught them one-handed, jangling them triumphantly at Dean, and rolling his eyes when his brother didn't respond.
Maybe we can get an apartment now that we'll be here for a while- But not too long! Sam quickly admonished himself. Just need a little time to get back on my feet is all. His eyelids seemed to be sinking further with every step he took,
Bed, yeah bed sounds good.
Sam awoke a few hours later. The room was dark, but he could hear canned laughter from the TV filtering in through the thin walls. Bile burned viciously at the back of his throat. I'm not gonna puke. I'm not gonna puke. I can fight it.
Sam tried to take slow, steady breaths, but his stomach was churning violently, the nausea blooming inside of him like a living thing, demanding his attention. Breathe. Control. Stay strong.
He leapt out of bed, barely making it to the miniscule bathroom before collapsing onto the gritty tile in front of the toilet.
"You alright?" John had appeared in the doorway, trying to keep his face neutral.
"Fine." Sam managed to grunt out, wiping his mouth with the back of his hand. "Close the door."
John hovered for a moment, shifting his weight uneasily before he left without a sound.
Dean grunted, massaging the crick in his neck that came with dozing off in front of the television. The couch sagged deeply in the middle, as if perhaps a very large man had made a habit of jumping up and down in the exact same spot. Not ideal sleeping arrangements, but Dean supposed that everyone was worn out after today.
No sign of his father, meaning that he'd decided to go to bed rather than drink himself to sleep in the armchair. Good for him, Dean thought, mildly surprised. Unless he's at a bar… A quick peek out the window revealed that the Impala was still around, and by extension, John.
Better go check on Sammy. Dean heaved himself off the couch, hissing as pins and needles raced down his arm.
He'd almost reached the bedroom, where John's grunting snores emanated, when he realized that light was spilling out from under the crack in the bathroom door.
Dad said he'd been sick earlier… Dean blanched, but that was hours ago, he can't be still-
Casually, Dean sidled up and pressed his ear against the worn wood. Running water, and a low groaning, interspersed with hitched breaths.
"Sammy?" He called, knocking lightly.
"Go 'way." Came the muffled response. Dean could tell from the way Sam's voice constricted that he was trying not to cry.
"I gotta take a piss."
No answer.
Dean tried the knob, which was mercifully unlocked.
Sam was turned away, crouched over the toilet with his arms hugging his middle. He retched again as Dean entered, back arching, shaking like a leaf. The heavy, sour stink of vomit permeated the tiny room.
"Hey," Dean knelt down beside him, even as Sam tried to shrink away. A thin sheen of sweat coated his face, which was ghastly pale.
Red-rimmed eyes glanced sideways at him before he ducked over the bowl again.
"Take it easy," Dean murmured, feeling his heart twist savagely inside his chest. He reached over, brushing his fingers against the back of Sam's neck. Cool and clammy to the touch.
Sam's stomach finally stopped trying to turn itself inside out and the younger boy rocked back on his heal, completely spent.
"Water ?"
Sam shook his head wordlessly, burying his head in his arms, which rested crossed on his knees.
Dean shifted awkwardly, attempting to find a better position on the floor. Finally he gave up and perched on the lip of the tub.
The silence stretched like a gulf between them. Sam stayed huddled on the floor, his shoulders trembling slightly.
"I-I can't do it, Dean." Sam's voice cracked in the middle of the sentence, his voice clogged with tears.
Dean paused, searching out the right way to phrase what he wanted to say, knowing he was treading on thin ice.
"This ain't a sprint, you know." He said finally. "We're in this for the long haul." Another pause for emphasis. "All of us."
"I don't want you to have to take care of me. To be… stuck dragging me to the hospital, staying up with this." Sam croaked, freeing one hand to gesture around the room. "I tried, Dean, I swear. I thought I could fight it-" he gasped suddenly, lurching over the toilet, eyes closed, lips moving silently. The spasm passed and he spit into the bowl, finally scooting over to sag against Dean's leg.
"I'm surprised you lasted as long as you did." Dean forced a chuckle, ruffling Sam's hair. His stomach dropped as he realized that the chemo would soon rob him of that simple gesture. He took a few deep breaths to stabilize himself before he could continue.
"Look, Dad and I are new to this too. It's gonna take a while for the dust to settle and we're gonna make some mistakes. It's gonna suck for everyone. Mostly you, though-" he tried to crack a smile. "-But we believe in you, Sammy. You're gonna kick cancer in the ass. Just don't try to do it on your own, okay?"
Sam nodded, his cheek rubbing against his jeans. "Thanks," he mumbled. "Can you treat me like a person though? You and Dad have been staring at me like I've got three heads ever since I got back from the hospital. I'm not radioactive. Yet."
A genuine laugh bubbled up in Dean's throat. Sam started to giggle too, wincing at his aching abdominal muscles.
The two brothers shook with mirth for several minutes, releasing the hurt and worry and tension in a borderline hysterical display.
"Oh man," Dean gasped, wiping his eyes. "This leukemia shit doesn't stand a chance."
"Laughter is the best medicine," Sam replied with a weak grin, and the hilarity began all over again.
John found them fast asleep the next morning; Dean's head tilted back, mouth agape. Sam resting against his brother's leg, half his face rubbed raw with the imprint of the fabric.
He allowed himself a small smile. Everything was going to be alright.