Cas doesn't exactly look co-operative, but Sam's expression is downright hostile. "We aren't going anywhere."

Carter takes a couple of paces closer to him, her eyes narrowing. "You want your brother to get the treatment he needs or not? I need you out of my way."

"If you expect me to just stand around waiting while you crack open my brother's chest and start carving into his heart, I'm going to need more of a reason to trust you first."

A look of indignation crossed with annoyance passes over Carter's face. "Look, sunshine, if I wanted to harm your brother I've had plenty of opportunity, and there's fuck all either of you could do to stop me. I take pride in doing my job well, so you damn well better believe he'll be fine."

The conflict's making Dean anxious. He glances over at Cas, who makes eye contact, gaze calm and reassuring. It helps a little.

"Well, where's your assistance?" Sam continues. "Normally you need a whole team of people to make a surgery successful, yet the only person I see here is you."

"Because I know what I'm doing," she practically snarls. "You want someone else in the room for surgery? Well how about you show me your diploma from med school. Otherwise, get the fuck out of my way."

"I don't need an MD to know you need more than one person performing major surgery."

Lord knows Dean wants Sam to stay, but he doesn't want this. "Sam…" he chances an interruption, but neither of them seem to hear.

"Well, I don't know what you think you'd be bringing to the table if you just loitered while I…"

As Dean exchanges another pleading look with Cas, the angel finally decides to intervene. It doesn't exactly defuse things, but Dean feels the knot in his stomach unwind just slightly. "I may not have a medical degree, but I do have all of human history's worth of medical knowledge to hand," he offers. "I can assist you, if it would be beneficial to Dean."

His tone is calm, but Carter rounds on him with an expression no less agitated. "Oh, so you're an expert in medicine?" she retorts. "That's just great! Why am I even needed? Why don't you just go heal him yourself? Oh, that's right. You can't."

It's brutal. Moreso than she even realises, and Dean could swear he sees Cas flinch. He knows how useless the angel feels, and how much he loathes it.

"I don't want to antagonise you. I only want what's best for Dean." The angel's self-control is remarkable.

There's a beat, Carter briefly looking like she wants to prolong the argument, but then Dean tries speaking up again. "Doc, please…"

She glances back at him. "You want him here?" It's a sincere question, not a challenge.

"I do."

Another pause, then she sighs and nods. "Alright. Angel Cakes can stay, But you," – she turns back to Sam – "You need to find somewhere to wait. You're too angry and ask too many questions, and I can't trust you not to interfere. I suggest you check out that 24 hour café I mentioned."

Sam grits his teeth, unconvinced, but a glance exchanged with Dean pacifies him. It's alright. Cas will be here, the look seems to say, and finally he lets out a breath as he concedes. "Alright."

Carter gives a nod and then crosses over to one of the tables, picking up a set of keys. "If the pair of you want to be useful, you can go run this errand for me. There's a black van in the parking lot; got a heart-lung machine in the back. It's kinda big and I hadn't figured how to get it down the steps into the apartment compound on my own, if you could go fetch it." She dangles the keys if front of Sam, and he purses his lips briefly before accepting.

"Fine," he says, glancing back at Dean to check it's okay for them to leave before he and Cas make their way out of the apartment again. Carter returns to prepping for the surgery, not even looking at Dean.

Somewhat awkwardly, he repositions himself back on the side of the table and clears his throat. "I could be wrong, but you seem pissed."

She doesn't even give him a glance. "Not at all."

"Try that again without scowling."

Now that gets a reaction. She rounds on him, full on glare aimed in his direction. "Alright, I'm pissed. I agreed to see you, not anyone else. You didn't even think to mention they'd be coming down with you."

"I didn't realise it would be such a big deal. I mean, why is it? I just want my family here."

She gives a huff, throwing her hands up in the air in frustration and then letting them drop. "You know what? I…I don't even know. It's just not how I'm normally used to doing things." She goes to fetch a folded up piece of material from one of the tables and then crosses back to him. He notices her expression has softened somewhat, although in place of the scowl there's now an almost-smirk. "Actually, I think I just like having you to myself."

"Oh?" He can't help the blush that spread across his cheeks, and she chuckles.

"Go put this on." He glances down at the hospital gown she's holding out to him, and turns even brighter crimson.

"There's a screen over there, if you're gonna get all shy on me." Now that Sam and Cas are gone, she seems positively amused. "I'll start to get things set up."

He accepts the garment without a word and goes to get changed.

It takes a couple of minutes for Dean to emerge from behind the screen again, looking decidedly uncomfortable in the thin hospital gown. Carter doesn't say anything, but she still has that perpetual not-quite-smirk on her face as she invites him to lie back down on the exam-doubling-for-operating table. He shivers slightly as he gets himself in place. The new apartment is still no warmer than the last.

"Nervous?" she asks, wheeling over a cart of monitors as she continues with the surgery prep.

He shoots her a scowl. "Do you really need to ask?"

"Not really. Just curious." She slips the cuff round his arm to monitor his blood pressure, then moves onto the EKG stickers for his chest. "So…does having Angel Cakes and Brother Dearest here really make you feel better?"

"Actually, yeah." It strikes him as a strange question. "Just knowing I'm not alone helps."

"Hmm." She seems sceptical, inexplicably so to him, but she doesn't elaborate. "Alright, needle again," she says as she prepares to insert his IV. "Since I feel obligated to warn you every time now."

He clenches his jaw, but knows he doesn't really have a right to retaliate as it pushes in with a sharp sting. It's hard to tell if she's being deliberately rough with him or not.

"Your heart's racing," she remarks with a glance at the monitor screen. "I'll give you a sedative before we start. It will help if you're more relaxed." She collects a syringe from one of the carts and inserts it into the end of his IV line. "And after this, I'm gonna need to do your catheter."

He frowns. "I thought you just…?" His puzzled look turns to horror as he sees the smirk on her face.

"I wasn't talking about the intravenous one."

"Oh fuck…" he grumbles, letting his head fall back and closing his eyes. "Can't you just let me use your bathroom or something?"

She goes to fetch the kit over, switching out her gloves for a fresh pair. "Minimum eight hour surgery, then you're gonna be bedbound for a week. Trust me, you'll be grateful for this." He tries not to think about it as he feels her hands push up the gown and slide between his legs. He's starting to realise why she did well to get Sam and Cas out of the room. "I'm gonna assume you weren't stupid enough to eat anything recently." She continues talking even as she has the tube slid halfway into him, and he grits his teeth.

"Not since last night. Followed your instructions."

"Good." When she's finished, she smooths the gown back over his thighs again and goes to change her gloves. He's still a shade of scarlet by the time she returns. "You comfortable?"

"As I'll ever be."

Satisfied, she glances over at his monitor screen. "The sedative should be kicking in, now. Your heart rate's dropping."

A look towards the monitor tells him it's in the nineties. Not exactly what he'd call steady, but he's not aware of it pounding in his chest anymore. Everything seems strangely calm.

He watches curiously as she continues to set things up, erecting a tripod by the bed and then fixing a camera to it pointing towards his chest. It takes a while for him to finally pass comment. "You gonna explain what that's for, or…?"

"It's for my research." She replies, adjusting the focus on the lens. "I don't get to perform surgery like this often, so it's good to keep a record. That okay with you?"

"If I said no, would it stop you doing it?"

"Nope."

"Oh." He gives her a slightly disgruntled look. "Then I guess I may as well say I'm fine with it, then."

"I appreciate that." She goes back to some trays of equipment, lining up the items she needs and sterilising them one by one. He watches silently for a few more moments, wondering how long it will take Cas and Sam to fetch the bypass machine. He guesses they're having trouble.

"Can I ask you a question?" he says after a couple of minutes.

"You just did."

"Right. Well, I want to ask another one."

"Shoot."

"So…say I'm a demon. My meatsuit gets busted up to the point it doesn't work anymore, so instead of smoking out, why do I come to you?"

There's a beat. It briefly looks like she's debating how to answer, then she says. "Do you have another question?"

That only piques his curiosity further, but he rolls with it. "Do you have a first name?"

Her only response is a mocking laugh. A sardonic look crosses her face as she reverts to his previous question. "Alright. How about this: they come to me for upgrades."

"Upgrades?"

"I told you: I research the applications of alchemy in medicine. I can usually achieve a little more than just restoring basic functionality. Like if you took your crappy 2001 Dell to an IT shop for repairs and walked away with an i7 and 12GB of RAM upgrades."

"So why is it that you only deal with dead meatsuits, then?"

"Because I won't do the procedures if there's somebody else in the body."

That surprised him. He didn't exactly have her down for the moral type. "That what you tell people?"

"Yeah. I've turned demons away for it before."

"What's to stop them just going away and…" It galls him to say it, but now he's opened up the can of worms, he has to ask. "Killing the vessel themselves and coming back?"

She doesn't turn to look at him, but he notices her suddenly go very still, putting down the pair of forceps and sterile wipe she'd been using to clean it. "I won't pretend it hasn't happened."

Not knowing what to say, Dean falls silent. She doesn't offer any further explanation, but glances over to see the troubled look on his face. "You don't like the way I operate, nobody's making you have the surgery." Her tone is firm, but he wouldn't call it angry.

"No, I just… I wanted to know. I'm sorry I asked."

The next few seconds pass awkwardly. There's something else Dean wants to say, and it's making him nervous. "Carter…" His voice is uncertain when he chances to speak again.

"What?"

"Before they get back…if I die on the table…"

She cuts him off. "You're not going to die."

He swallows nervously. "Just trying to be realistic. If I do…if I come back as a demon again…"

There's something in his voice that seems to grab her attention. She stops what she's doing and walks over to him, her expression unreadable. "Then I'd say it would make you more the type of patient I'm used to treating."

He has no idea what to make of that statement. Instead, he just licks his lips and glances down at the familiar restraints on the side of the table. "I'm just saying, these might be a good idea."

She glances down, deliberating for a moment, and then nods. "Alright. One thing first though…" A hand goes to the string securing the gown around his neck and she pulls it loose, folding the thin fabric down to his waist. "Put your hand on your chest."

There's no point pretending he isn't puzzled, but he humors her. "Okay…"

He brings his left hand to rest over his sternum and she places her own on top of it, holding it in place. "This is the last time you're going to get to feel it like that. Try to remember it. The next time you're going to be able to do this, there's going to be a scar."

Now that she's said it, it's a strange thing to contemplate. He can feel his heart thumping faintly beneath his palm, in a way it won't be beating after this is all over. His fingers trace the skin: still smooth, unbroken. By rights, there should already be a scar. An angel blade has already ripped his flesh apart and punched deep into his heart, yet the only evidence that remains is hidden from view. If the universe worked the way it was supposed to, he shouldn't even be alive.

"I'm no stranger to those," he says quietly.

For a brief second, they share an awkward moment of eye contact, and it's Carter who's first to look away. A few heartbeats pass in silence before she removes her hand and wordlessly begins securing the restraints.

"Would you like me to tell you what's going to happen, or would you prefer not to know?" she asks when she's finished, once again refusing to look at his face.

"Did you ever plan on giving me chance to read the file you brought?"

"No."

"Then I think I'll stick with not knowing."

"Works for me."

She's going to fetch rolls of paper to cover the parts of him not intended for surgery when he at last hears the screech of wheels on tiles in the corridor outside, their axles rattling under the load."Looks like Tweedledum and Tweedledee are back," Carter remarks drily.

Sam and Cas reappear in the room a moment later, wheeling the machine between them. Sam shoots Carter a glare. "You had the van backed up into a corner."

She smirks. "Reduced the chances of it getting broken into though, didn't it? I see you got the machine out in the end." She takes over from Cas wheeling it over beside the bed. Dean notes the strategically placed paper sheets hiding his bound wrists and ankles from their view. That's probably for the best.

"Alright, you can go now," she shoots at Sam, "And you, lose the coat and jacket and put one of these on." She's pulling on a polyester apron as she instructs Cas to do the same. It hardly seems like the most sterile setup, yet Dean's still feeling perfectly calm.

Sam, on the other hand…

"You want me to go drink coffee and eat pancakes while my brother's having open heart surgery?"

"Something like that, yeah."

Sam's eyes narrow. "What's with the camera?"

"What do you think? I'm recording." She barks out the reply tersely.

"Why?"

"Why not? How do you think medical advances are made?"

It's not helping the situation, and Sam's look of suspicion and discomfort deepens. "Really? That's what this is about? You do that to all your patients, or are you just getting a kick out of the fact you get to carve up a human for once?"

Carter rounds on him and throws her hands up in exasperation. "See, this is exactly why I don't want you here. You bitch like this during surgery and your brother will be dead within the hour."

It's already growing heated, and Dean doesn't want the fighting to start up again. "Sam, it's okay. Cas will be here. You can come back in a few hours and I'll be just fine."

That doesn't exactly seem to put Sam at ease, but Dean never expected it would. He knows just how distraught he'd be if their positions were reversed. "Alright, just get better okay?" he says, walking over to give Dean a comforting pat on the shoulder before he makes to leave. He shoots Carter one final glare before exchanging a look with Cas. "You take good care of him."

"I will, Sam. I promise."

It seems to be enough to convince Sam to leave, walking back out into the hallway and closing the door behind him. Dean turns to watching the two who remain.

Carter's tying back her hair while Cas has shed the trenchcoat and jacket and is rolling up his sleeves. He shoots her a dubious look at the complete lack of any other hygienic precautions. "Yeah, I know it's not ideal," she says with a roll of her eyes, "But in his case, I really don't think infection's what we have to worry about." There's a sink in the corner of the room which she crosses to to start scrubbing down, and Cas follows her lead.

When she heads back to Dean, wearing a fresh pair of latex gloves and pushing the equipment cart, he sees the tray of perfectly ordered instruments glint beneath the yellow strip lights overhead. Were it not for the sedative, he suspects he'd be feeling a lot more nervous by now.

"Alright, Hot Wings, you good at taking instructions? We need…" Carter cuts off as she sees Cas has already taken the initiative and is bringing over the surgical lamp and the carts of anaesthetic gas and betadine. Dean swears he can see the hint of a smirk.

"Yes, I did think these would be necessary."

Carter pulls a face, then seems to have a change of heart as she instead grins. "Looks like you might be useful after all. Alright, let's get him under."

She takes the lead in connecting the gas tanks to the flowmeter and adjusting the mix, and then brings the mask up to hover in front of Dean's face. "Alright, in ten seconds I'll tell you what my first name is."

Apparently, that seems to be his warning that consciousness will be leaving him very soon. He thinks he can taste the sharp smell of the gas as it floods his mouth and nose, mask pressed securely over his face to seal off the outside air. Fuzziness begins to pervade his awareness, making his body feel light, almost incorporeal while his eyelids simultaneously grow heavy. His instincts are telling him to fight it, yet it's just so nice that he doesn't want to. He doesn't last five seconds.

Carter chuckles softly as she lifts the mask from his unconscious face and prepares to intubate. "I guess you'll never know."