Title: Survivors
Characters: Sam & Dean Winchester
Rating: T for language
Word Count: 5159
Genre: H/C
Warnings/Spoilers: Indefinitely post-Soul Survivor, so S10 spoilers. Will obviously be AU as the season progresses.

Summary: Old habits are hard to break. While they've moved past the events of S9, they are still Winchesters, and more than ever brothers – and all siblings take out their anger on each other when they're the easiest target. Unfortunately, the consequences of this particular heated argument is going to give them a far bigger scare than anything supernatural ever could.

A/N: Written for the prompt Sam has a heart condition neither brother is aware of. That is, until the day both brothers are fighting at the top of their lungs on LJ's ohsam November 2nd comment-fic meme.

I am in the progress of writing something dealing with Dean's guilt over his time spent as a demon and at first intended to use some of that here, but that's not what this story is really about so expect that one at some later date.

Sam isn't surprised it happens, only that it's a solid five weeks before it does.

Since his brother was cured of being a demon, Dean has gone entirely overboard in what Sam assumes is a pretty sad attempt to make up for his self-condemned crimes. That in itself is unsettling, almost as much as Demon-Dean was; Sam's really not accustomed to being treated like he's fragile, and it's reminiscent enough of the months immediately following his departure from Stanford to be cloyingly suffocating. Neither of them are the (so very) young men they were a decade ago, and it's just unsettling to suddenly go from virtually at each other's throats to mother-henning and hero-worship.

Too much water has gone over that dam for it to be anything but weird, and by the end of a month full of quiet music and first showers and healthy restaurants and honest-to-God lattes in the mornings Sam is rapidly losing patience with Dean's self-flagellation and his – his niceness.

It's now bordering on creepy.

In retrospect, however, that probably wasn't the best way he could have phrased that.

Still busy chopping ingredients for soup, Dean only looks hurt, which is then quickly buried under a mask of silent indifference as he shrugs, dismissing the words as he has every other irritated thing Sam has said for weeks now – never fighting back over the small stuff, and only rarely retaliating when Sam really does deserve it for pushing too hard about the Mark or something similar.

Sam wanted them to learn to be brothers again, not a prison warden and a convict trying to earn parole for good behavior.

When he sees Dean toss two cups of mushrooms into the soup (while Sam likes them, Dean hates the things with a passion rivaling his loathing for pop music), Sam gives up and leaves the kitchen, shaking his head in exasperation.

It's just a couple days later that it finally blows up in their faces.

Sam understands Dean's need for the hunt; even on past good days, Dean has always gotten antsy with too much down time, and these days are nowhere close to good, comparatively speaking. He hasn't protested more than a few worried comments here and there when it looks like Dean's just a little too eager to kill first, ask questions later – but this hunt, they weren't ready for, and it almost just cost them both their lives.

Not long ago, they would have taken care of a mere poltergeist in a matter of hours, the easiest supernatural entity by far to dispatch. But they're just slightly out of sync now, occasionally second-guessing each other – and they weren't ready for this hunt. Dean had been over-eager to get on with it, and Sam had agreed just to avoid an argument, despite his misgivings that he had been missing something in his research.

They had only succeeded in pissing off the poltergeist, and ended by having to burn the entire house down in addition to the cleansing ritual to rid the property of it. Certainly not their finest night's work, and a little embarrassing as well, given that the last time they'd been injured on a mere poltergeist run was a good three years ago.

Sam isn't surprised when Dean finally snaps, although he wishes his brother had at least finished the stitches before going off loud enough to be heard in downtown Topeka.

He isn't even really paying much attention to begin with, because this is familiar territory at last. There's some growling, and some snapping, and then some yelling, and he doesn't even remember what really set him off but at some point he's matching Dean shout for shout despite the pounding in his head, hurling accusations that have been festering deep inside for weeks.

"Oh, and I suppose you would have been more prepared with four more hours of staring at those stupid message boards you were taking all your information from?"

"At least prepared enough to know fire would be necessary to take it out! If we'd known it was partly elemental and drawing power from water, we could have shut off the water to the house before going in and maybe not made a family homeless tonight!" Sam finishes the stitches in his arm, courtesy of going through a French window, and snips the thread viciously. "Nobody deserves that, Dean."

The suture kit slams back into the table with enough force that it sends the whisky bottle skittering an inch or two, rattling loudly on the polished surface. "Like you would know, Mr. This-isn't-home-it's-just-a-place-where-we-work. Four months I was gone, and you still haven't bothered to even put up a bookshelf or something in your room."

Sam nearly throws the chair back from the table, catapulting out of it. Blood rushes loudly in his ears as he sends his brother the first real glare of fury since he's been back. "Yeah, Dean, I really felt like starting a friggin' remodeling project when I didn't even have a body to bury!"

"Sam –"

"I thought, hey! My brother's dead, so now this whole place is all mine! What can I do to redecorate? Get new furniture, a Persian rug or two, maybe put up some pictures of family and friends – oh, wait. I didn't have any left, Dean!"

Dean sighs, utter weariness draining into his features. "Sam, that's not what I meant –"

"That's exactly what you meant." Anger pounds through him, burning hotter after so many months of being suppressed in favor of far more important things. "You really thought I was going to spend those months just puttering around this place, moving on like nothing happened."

"I thought you were going to get out, Sam! I mean, you've done it more than once already, why was this time any different? Run out of animals to hit?"

It's a low blow, and it's obvious from his pained grimace that Dean regrets it as soon as it leaves his mouth, but Sam is past caring at this point. He freezes, fists clenched, chest heaving with the effort of not breaking his brother's jaw on general principle. Blood rushes to his head, leaving his face burning and then strangely cold.

"Look, Sam, I'm just saying – I was hoping you'd just, I dunno, move on. Four months, man, what the hell were you even doing?"

"I was looking for you!"

"Not very well, you weren't, if you didn't know I was still me until Crowley told you like, a week before you found me," Dean observes candidly, arms folded. "We talking looking like you looked for me in Purgatory?"

His shoulder twinges, only just recently released from its sling, as he finally loses control. Dean grunts as his back slams into the nearby bookshelf.

Sam shoves him again, hard, hands fisted in the fabric of his brother's shirt so that he doesn't do more harmful, physical damage. Anger tunnels his vision into a red and black-rimmed haze. "Don't you say that to me again," he grits through clenched teeth. "Don't you dare, Dean. You have no idea!"

Dean brings up both arms to knock Sam's hands away, then frowns as he sees them start shaking. "Jesus, Sam. Calm down before you have an aneurism."

Sam half-thinks, in the hysterical part of his brain that is still so intensely angry that he can barely see straight, that aneurism might actually be an applicable term; his heart seems about to pound out of his chest, almost skipping beats here and there.

Yeah, okay, maybe he does need to calm down a little.

"Sam?"

Or maybe a lot, because he's trying to do his deep breathing exercises and for the first time in his life they quite literally aren't working. He's wheezing slightly like he's in the middle of Trial sickness again, only the pain isn't everywhere, just localized in his chest. He rubs at it almost absently, trying unsuccessfully to clutch at the vestiges of his anger; but they're slipping through his thoughts like smoke on the wind, and he can't even remember why he was so angry in the first place because he can't. freaking. breathe…

"Sammy, what's wrong?"

Dean sounds a little freaked out, which is never a good sign. Neither is the fact that even though Sam's totally forgotten why they were fighting in the first place, his heartbeat is still pounding in his ears at a frenetic speed, as if his blood pressure hasn't gotten the memo yet that hey, not really that angry anymore so stand down, okay?

His vision suddenly shrinks to a much smaller window, and obviously he can't really tell what is wall and what is floor, because they begin to tilt alarmingly.

"Whoa, hey!" Something warm and solid slows his descent, deposits him gently on his back on the floor. Something squarish – stack of books? – is shoved hastily under his feet, and then there's a cold hand on his face, leeching heat from frantically working blood vessels. "Hey-hey-hey, Sammy. Sam! Talk to me, kiddo. What's happening?"

Sam wants to laugh, because he's over thirty years old now and it's been probably a decade since Dean called him that, and it shows more than anything else how deep his mother-henning has gone in recent weeks. But he can't laugh, because it's hard to just breathe, and he doesn't know what's happening, and he's actually getting a little worried now.

He struggles to pull in another shallow breath, now barely able to hear above the rushing of his pulse in his ears as his heart tries its best to overpower whatever is happening. Dean is yelling at someone off to his left but skids to a halt in his half-closed line of vision a moment later, throwing a cell phone to the side and tossing two blankets from the couch over him. Sam appreciates the warmth, but at this point he's just confused enough to be pretty scared of whatever is happening.

Dean fusses with the blanket for a second, then looks up as Sam weakly curls his fingers into the hem of his shirt. "Hey." The hand returns to his face, grounding, steadying, totally at odds with Dean's tense, shaky voice. "You're okay, Sammy. 'K? Look at me, you're gonna be okay. I got help coming ASAP, and you're gonna be fine."

His breathing hitches again as his heart stutters alarmingly, and now he's just as freaked out as Dean is, though not hiding it anywhere near as well. "Dean," he mumbles hoarsely, trying to blink his vision clear enough to see.

"I'm here, Sammy. Not goin' anywhere until I hear sirens, then I gotta go out and lead them in. Giving up our bunker secrets here just for you, kiddo." Fingers gently tuck his hair behind his ear, cold against the fire pounding through his eardrums.

Confused, he thinks he should probably apologize, because Dean's given up enough for him for one lifetime, but before he can, his vision finally gives in to the pounding in his head and chest and goes mercifully dark.

He actually isn't unconscious for very long; he wakes up in the ambulance, confused as hell and feeling like he's just been kicked in the chest by a Clydesdale. The paramedics don't appear to be working on him frantically, which he assumes is a good sign, but nor will they tell him anything about what might be wrong with him.

Dean has somehow beaten the ambulance to the hospital, which is not a good sign, since the legal speed limit is only 45 on the roads from the Bunker into town and there is no siren or flashing lights on the Impala.

"Dude, you're awake!"

"Unfortunately…" he mutters, trying to not hurl over the side of the gurney as they jostle and jolt their way off the ambulance into the ER.

Behind him, he hears someone telling his brother that no, he can't park there just because he has a family member being brought in, and somehow she thinks Dean's baby will be just fine in the common parking lot, now please move your vehicle, sir.

A tired smile twitches at his lips; now, after his impromptu nap/passing out/whatever-that-was, he actually is feeling quite a bit better. His heart rate appears to be a little fast but not alarmingly so, or at least is not trying to force its way out of his chest; he can breathe just fine now (though that might be due to the oxygen mask), and other than a lingering nausea and some residual pain in his chest he is starting to wonder if he didn't just have the mother of all panic attacks or something embarrassing like that, something Dean is never going to let him hear the end of when he finds out.

However, the ER doctor's face when the medics describe his symptoms, obviously given in great detail by his very worried brother, does not lend credence to the idea that this was just some freak incident.

Sam sighs, and mentally hunkers down for the battery of medical tests which are sure to follow. At least this time his ambulance ride and hospital stay aren't shared space with Lucifer, or some other angel, for that matter…

"Heart arrhythmia?" Dean asks incredulously, hands wedged tightly between his knees as he leans forward in the chair. "Shouldn't a medical examination have shown that, like, years ago?"

"Not in this case, Mr. Wesson, because the arrhythmia is merely a symptom, a manifestation if you will, of the root problem." The cardiologist looks over the top of his glasses at them, face grave, and Sam feels a sinking sensation in his gut.

"Which is?" Dean's patience is obviously wearing thin, and Sam doesn't remonstrate with him, because he'd rather have the bad news as quickly as possible anyway.

"Mr. Wesson," the physician (his ID says his name is Jackson, Sam sees when he moves closer to the bed) addresses Sam this time, for which small gesture he's grateful, "may I ask what your alcohol intake has looked like over the last…" he consults Sam's age in the paperwork, "ten, eleven years?"

"Call me Sam, Doctor. Um." Sam squints, not knowing where this line of questioning is headed. "We…had a little rough childhood, y'know, and…I don't think it's any worse than the average adult male with some issues?"

Dean snorts. "Doc, if anybody in this family has alcohol issues, it's me. Not Sam."

"That's as may be, gentlemen, but if you could just give me a rough estimate, Mr. Wesson. Sam."

"Um." Sam waves a hand aimlessly in the air. "A beer or two a day – a few more, maybe something heavier if it's a bad day, which happens off and on in our line of work."

"Every day for the last, what, ten years?"

Sam sees his brother bristle at the disapproving tone, and thwaps Dean's knee briefly. "Yes, Doctor. Not the healthiest lifestyle, I'm aware, though I try to make up for it with other things such as healthy eating habits and frequent exercise."

"Goes after salad like a rabbit, Doc. I think he's entitled to a little liquid nutrition –"

Dr. Jackson patiently ignores Dean's rambling; Sam wonders if it's just professionalism or if he knows as Sam does, that Dean only rambles when he's very, very worried or nervous. "Has your intake increased at all recently for some reason, Sam?"

Sam swallows, looks down at the hospital-issue blanket. "About five months ago, yeah, I'm afraid it did. Pretty drastically," he admits quietly, eyes fastened firmly on the fraying edge of the blanket his fingers are currently mauling. "A…a family member passed suddenly, and I went a little crazy dealing with it."

He can feel Dean's eyes burning a hole in his head, but he's too out of practice to know if they're concerned or accusatory.

Jackson nods, not unsympathetically. "That, I believe, would explain your condition, Sam."

"Which is?"

"You have developed a form of cardiomyopathy, known as dilated cardiomyopathy," he replies, and after pointedly meeting Sam's eyes, continues, "or also known as alcoholic cardiomyopathy."

"Cardio my what now?"

"Heart disease, Dean," Sam says softly, and watches his brother turns white as the sterile hospital sheets.

"It's the most common form of the disease and can have many causes, though I'll admit it's not commonly caused by prolonged alcoholic ingestion in someone as young as yourself, Mr. Wesson. Most likely, your recent increase in alcoholic intake was the trigger for the arrhythmia which brought you here yesterday evening, and it was simply triggered by the intensity of what I'm told was a heated argument."

"That's what Sammy's fit back home was, then? A – a complication of this…heart disease, not a heart attack?"

"Gracious, no, it was not a heart attack, though arrhythmia can be quite frightening to someone who has never experienced any cardiovascular difficulties." Jackson glances from Dean to Sam, who is still quietly ingesting this diagnosis, and then back again. "Your brother is quite fortunate, actually, that such a drastic complication developed so early in the disease; by the time most people experience symptoms caused by cardiomyopathy it is already too late to do much in halting the progression of the disease and returning some form of normal life quality to them."

Sam perks up slightly. "So it is treatable, then?"

Jackson gives a cautious nod. "I would certainly say so; there is no reason why the disease should affect your quality of life. However, due to the complications of an arrhythmia developing, this will of course involve some drastic lifestyle changes at least for the foreseeable future, Sam, I will not lie to you."

Sam fidgets with the blanket again, well knowing what is coming. "My brother and I, we're quite regularly involved with some…extreme sports, you could say," he ventures quietly.

"Out of the question. Basic physical activity is indeed encouraged as a healthy lifestyle for those with the disease, but any kind of extreme activity is completely out of the question. Even running would not be preferable, given the state of your arrhythmia at the moment, Mr. Wesson; I would recommend nothing more strenuous than brisk walking, and it would be much safer were you to change your exercise regime to something less physically demanding such as yoga."

Dean has rapidly grown more and more tense as he realizes what this means. Sam can see he's nearly wired now, fairly vibrating in his chair with the tension. "We like the outdoors…fishing, hunting…"

"If that means sitting in a tree stand after no more than a mile walk, certainly permissible."

Yeah, not so much.

"You appear to have healthy eating habits already; I'll have the nurses prepare a nutritional guide of the recommended foods to begin your regime with, and bring them in with the prescriptions for your medications. But the alcohol intake? In moderation only, and preferably less than that. Special occasions, Sam; it should be a choice for relaxation, not a nightly escape therapy."

Sam nods. Fair enough.

"For now, we're going to put you on a mild beta-blocker to lower your blood pressure and help correct the arrhythmia, which is the primary immediate concern. Your lifestyle changes should immediately improve your symptoms and slow any further progression of the disease. Proper sleep, eating habits, and only mild exercise – we'll have you back in a month for a checkup to gauge the effectiveness of your treatment, but if you have any side effects from the medications stop taking them and call me immediately."

Numb, Sam can only nod again.

"You've still six hours until your twenty-four hour observation period is over, Mr. Wesson. I would suggest you discuss this with your brother and begin deciding how to implement any immediate lifestyle changes. I'll be back in about an hour with your prescriptions and dietary information."

Sam nods again, and tries to be polite by saying thank you, only for the words to not come out before the physician nods understandingly and leaves the room, closing the door behind him.

He slumps back in the inclined hospital bed with a sigh, eyes closing. Dean is going to be so pissed. After all this, Sam has basically removed himself from hunting altogether, unless he wants to be dead next time something startles him and jacks up his heart rate. He really can't take another argument with his brother, not now – not still reeling from this completely unexpected diagnosis (like, come on, if one of them was going to have complications from alcohol abuse Sam would not be first likely candidate!).

What are they going to do now?

He's only just got his brother back, Cas is still dying though it's been staved off a little – and now he can't hunt anymore? Dean is going to get himself killed hunting alone, and Sam –

Sam has no idea what he's going to do. He can't tell if he wants to laugh or cry at the bitter irony; he tried so hard, held out hope for so long that someday he might be able to stop hunting; only to now be forced to stop, just when he truly doesn't want to, doesn't want to leave his brother alone, not when they just found each other again, are still trying so hard to be brothers again…

A squeak of heavy plastic scooting across the floor, and then he feels a gentle hand in his hair. "Hey. Stop freaking out in there, Sam." Dean doesn't sound angry, or even annoyed – only concerned…and sad, somehow. "Heart monitor's starting to warm up for a bad trip, it looks like, so just take it easy."

Sam blinks rapidly, hoping the tears disappear before Dean sees them, and then looks silently up at his brother, helplessly begging for something Dean can't give; he can't fix this, no matter how much he wants to, no matter what kind of magic big brothers possess.

"Jeez, not the eyes, Sammy," Dean sighs, gets up to perch on the bed instead of in the chair. "It's gonna be fine, okay? We'll make it work, like we always do."

A bitter laugh crackles hoarsely from Sam's lips. "Somehow I doubt it this time, Dean," he whispers. "I'm never going to be able to hunt again, not actively."

Dean pats his chest almost absently, and leaves his hand over Sam's heart, as if to assure himself Sam's not going anywhere. "Thought you'd be happy about the chance to do something you wanted for a while, Sam," he ventures quietly, not confrontationally. "If you want out, I promise – for real, man, swear on my baby – I promise I'll help you."

"Why can you not understand I don't want out? I was doing something I wanted, Dean!" The heart monitor beeps warningly as he passes a shaking hand over his face. "I wanted to save you, for once – for once! – and then just go back to fighting evil instead of each other. That's what I wanted, Dean. I wanted to wake up in the morning in the same bed, in a safe place, I wanted to come back from a supply run and find you making a mess in the kitchen because that's what makes you happy. I wanted to have a base to come back to when we screw up a hunt or it screws us over, I wanted to try again to make that place a home, Dean. That's what I wanted!"

His voice breaks on the last sentence, betraying him once and for all, and he covers his face with his hands, breathing slowly in an effort to calm his racing nerves (and hide the fact that he's about two seconds away from crying, which is highly embarrassing even if he can blame it on stress and medication).

"Wait, wait, hey…" Dean pulls his hands down, holds them firmly, warming icy fingers. "Sammy, this is all on you, dude. You're acting like I'm gonna kick you out just because you can't hike six miles and then gut a vamp nest anymore."

Sam shakes his head helplessly. "You can't go alone, Dean, you just can't – and now I'm worthless at hunting, there's no way I can go with you anymore. Dean, you need someone to have your back!"

"SAM." Dean squeezes his hands in a vise-like grip and leans over him, looming in his personal space with intensity burning in his eyes. "You know what I need, Sam? I need you. Alive. Healthy. Safe. That's what I need, Sammy." Dean looks down for a second, jaw working tightly, and then glances back up, defiantly meeting Sam's protesting gaze. "And if that means standing down, both of us, then that's what we'll do."

Sam's eyes widen in total surprise. "Dean, you need the hunt, we both know that."

His brother laughs bitterly, a harsh, unhappy sound. "Maybe. But right now, Sam?" Dean's eyes are sad, almost haunted. "I'm drowning, man. And I need you." He swallows, eyes darting to the heart monitor at the side of the bed. "I mean that, man. I need you, 'cause I've got no idea how to cope with – with everything, right now."

Sam's lips twitch. "Not with the Men of Letters' stash of alcohol, let me tell you," he mutters wryly.

His brother snorts, a little wetly, and lets go of Sam's hands to scrub wearily over his own face. "Still have a hard time believing that. What the hell, Sam."

"If I'd thought you were in Hell, I'd have found a way to tear it apart," he whispers. "This was worse."

"I know, Sammy. Believe me, I know."

Three weeks later

Having already yelled twice and not gotten a response, Dean swears under his breath and leaves the perfectly-cooked casserole on the stove, stalking down the corridor toward the archives. He has three hours before he's supposed to pick up Cas and head to Missouri to check out what looks like either genuine black magic (freakin' witches, he is not looking forward to that) or else something nasty that some idiots probably not even old enough to smoke had summoned.

Sam, about a week prior, appropriated one of the smaller archive rooms and promptly announced that it was going to be his office and no longer public domain, thank you very much. Now, Dean pokes his head around the door just in time to see his brother shouldering the receiver on one of the old rotary phones while he flips dizzyingly through a set of journals from somewhere Dean still hasn't seen in the library.

"No, it doesn't – I said no, you idiot, you go after something like that with a sword, iron or not, and all you'll do is piss it off. Oh my God, just because it worked in Harry Potter does not mean it's accurate lore!"

Dean's eyebrows crawl up his forehead.

"It isn't going to – ah. Here we go. Besides the mirrors and rooster crowing, some Cantabrian mythology suggests a weasel is the only animal that can look at it and live. I have no idea, I didn't write it." Sam's eyes roll ceiling-ward as he spins in the desk chair, still oblivious to his brother's presence. "Try mirrored sunglasses at least, if you go after it in the day. Might kill it before you get caught in its stare. Mmhm. Oh, and if it really is a basilisk make sure you email me pictures, we have like no visual records of the thing in any hunter's journal I know of. No problem, man."

The phone is replaced in its cradle, second in a long line of those old-fashioned phones Sam has culled from various rooms in the Bunker to line up on a side table. Dean smiles as he sees them all labeled with various names like FBI and CDC, just like Bobby's lineup used to be.

"Hey, Man of Letters, did you not hear me yelling for you to get your nerdy ass in there for dinner five minutes ago?" he quips dryly, while Sam scribbles a footnote in the journal.

Sam starts in surprise, and glances up, hair falling into his face. Dean receives a sheepish, almost shy grin. "Sorry. Must've been too caught up in my own head."

"Careful, a guy could get lost in that much empty space."

Sam sends him a withering scowl, to which he smiles innocently. Success.

"I'm coming," Sam sighs, putting down the pen and leaning forward to stretch like a gargantuan cat.

Then the phone marked FBI starts ringing again.

"Uh. I kinda need to get that…"

Dean flaps his hands in a gesture of exasperation. "I'll bring you a plate before I leave to meet Cas," he mouths as Sam picks up the receiver, and receives a grateful nod in return.

Two hours later, Sam jolts awake when a soft sound disturbs the impromptu nap he had apparently decided to take atop a pile of journals. It looks as if Dean has just brought him dinner; it was probably the clink of silverware or something which awoke him.

A plate of vegetable casserole, still steaming, sits at his elbow, along with a smaller plate of apple slices. Next to it, a perspiring water bottle stands, three sticky notes from Sam's desk pad stuck to the cap.

SAM
Pill. Take it.
Food. Eat it.

Work yourself into the
ground with this, and I
will cut all the phone
wires.

For what it's worth,
I'm proud of you, dude.
See you in a few days.

Sam carefully sticks all three post-its to his new corkboard, the first thing he's put up to personalize this new room, his room.

Now, he has to decide if he wants to hurt his brother's feelings, or suck it up and continue to stare at the jumbo-sized Hang-in-there-Kitty poster Dean had apparently stuck to the wall behind the door before leaving…