STAND STILL AND BREATHE
1. Well-Trodden Paths
A few months ago
"What is happening?"
Dean was a little shocked, but relieved at the sound of Sam's voice as he watched the sky, mouth slightly agape, trying to drink in the scene before him. A thousand shooting starts were streaking across the night and racing to the horizon — a beautiful sight indeed. Except, it was uglier than that. These weren't shooting starts. It was something far, far worse.
"Angels," Dean replied to Sam. "They're falling."
"What…?" Sam gasped, wheezing, trying to draw in a breath; and Dean's attention snapped back to his brother as he realised that the angels were the lesser of his worries at this moment. After everything that had just happened, after getting Sam to come out from the brink of death again, Dean couldn't bear to lose his brother another time.
He laid a hand on the younger man's shoulder as Sam clutched at his chest, continuing to struggle. "We'll deal with that later. But right now, we've gotta get you out of here," Dean said to him, trying to remain calm. "You have to stand up, okay? I'll help you. Come on."
Sam didn't argue with Dean. He just nodded and made an effort to stand, and Dean realised that Sam complying so easily was a mark of how bad his condition was. Wordlessly, he supported his little brother and together, they got to their feet. An arm still holding Sam up, Dean stumbled to open the back door of the Impala. It creaked as he pulled the handle, and he struggled under Sam's weight before finally managing to sit his brother on the seat.
"Lie down," Dean instructed him, as he lifted his brother's legs into the car. Sam obeyed him, hugging his chest and coughing again. Minute droplets of blood spurted on the upholstery.
Dean cringed, but he bent over and patted Sam on his knee. "Hang in there, buddy, we'll be in the hospital in no time."
"Not… hospital…" Sam gasped as Dean got behind the wheel.
"I don't think we have a choice there, Sammy," Dean replied sadly as he turned on the ignition. "You good? Shall I start driving?"
"Mmm."
Sam coughed wetly again and Dean shuddered as he began to drive. He definitely remembered having seen a hospital situated about ten minutes from the church, and that was exactly where he was taking Sam. This wasn't the moment for home remedies. The abandoned trial seemed to have hit Sam really hard, and at this moment, Dean just found himself hoping that the damage wasn't permanent or fatal. He'd never be able to live with himself if that happened. But he knew that his hopes were probably too high. They were the freaking Winchesters, and they just had to be in trouble.
The roads were unusually quiet as Dean sped his car through them, the only sounds around him being the purr of the Impala, and Sam's heavy breathing. Dean had read somewhere long ago, that if you could hear someone breathe, it wasn't a good thing. And right now, he could not only hear Sam breathe, he could also hear him wheeze, hack and struggle.
He stopped outside the ER in exactly ten minutes and got out of his car, pulling his brother out after him. Sam was losing consciousness now, his head lolling and his chin to his chest, while Dean walked him into the ER as quickly as he could. "Hold on, hold on, we're almost there. Sammy, you with me?"
There was no response from his brother. Dean hurried and burst in through the automatic doors. "Need help here!"
A nurse took one look at Sam's distress and ran forward to their assistance, as a few of the staff came behind her, pushing along a stretcher. Dean half-lifted his brother onto the gurney and Sam's eyes were rolling in and out of focus as the nurse tilted his chin upwards to allow maximum air inside. When they began to wheel him into a cubicle, Sam coughed, and a spurt of blood alarmed them all.
"Sit him up," the nurse instructed, and Dean propped up his brother's weight as swiftly as he could. The nurse held Sam's head forward so that the blood could drain out of his mouth, and he wouldn't choke on it. Sam coughed again, trying to take deep, gasping breaths in between.
"Hey, hey, easy," Dean said to his brother, placing a hand on his forearm. "You're going to be okay."
They hurried Sam into a cubicle in the ER and the nurse worked quickly, holding a basin out to Dean, who put it in front of Sam's mouth in case he needed to spit again. Sam let out a loud gasp when they placed a suction tube into his mouth in order to aspirate the remaining blood from his previous coughing fit. They hooked him to a nasal cannula, the prongs holding firmly to Sam's nasal septum as oxygen flowed in. He started to cough again, spitting blood into the basin this time. Dean was alarmed at the sudden intensification of the symptom, but he tried to keep the worry out of his face and voice as he handed a tissue to Sam from the cabinet. "Easy, brother."
The nurse — Melody, as her name tag read, had started an IV like on the back of Sam's palm, and was injecting something through the catheter. Sam gasped once, and his breathing slowly eased as the nurse added another injection. "Just a little bit to calm you down," she said. One of the other staff came to them with a small table fan and Melody quickly switched it on and directed it to Sam's face. "Better?"
He took a deep breath, his eyes half-open, and nodded. "Try to relax. The doctor will be over in a minute," the nurse said, when she had finished attaching Sam to a monitor. She added the pulse oximeter to Sam's finger, and glanced at the numbers flashing on the screen. "How long has he had these symptoms, Mr—?"
"Wilson," Dean replied, remembering the name on his insurance card. "Dean Wilson. This is my brother, Sam."
She nodded. "Like I said, Mr Wilson, I've informed the doctor, and she will be here soon. Before we start treating, though, we will need a history of his symptoms. How long has he had the bloody coughing?"
"A few months…" Dean trailed away as Sam started to cough again. He held the basin under his brother's chin again, watching him spit out strings of blood fearfully, as Melody rubbed Sam's back. Finally, Sam finished coughing, and sagged forward, exhausted. Dean handed Sam a few more tissues and helped his brother recline against the bed as the nurse placed the fan closer to Sam's face. His breathing eased again, and Dean almost let out a sigh of relief.
"Acute dyspnoea and haemoptysis?" a female voice asked, as the curtains were ripped open. A tall woman walked in — a doctor. She wasn't much older than Dean, and she had her dark hair in a tight bun. Knowing brown eyes shone behind thick-framed glasses. The name on her tag read Dr D. Pittman, MD. Her eyes travelled to Sam. "Good, he's stable. Have you taken blood for sampling?" she asked the nurse, glancing at the file.
"No, I was just about to," Melody, replied. "The dyspnoea is a little under control. Is there anything else I should add?"
"We need his tests so I can get to a diagnosis," Dr Pittman replied to Melody.
"Okay, I'll get you a CBC ASAP, then." Melody proceeded to draw out a sample of Sam's blood, but frowned when she lifted his arm. "Dr Pittman?"
The doctor bent over to inspect Sam's forearm, and Dean realised they were looking at the needle marks. Great. That would look very good indeed. Melody also proceeded to remove Dean's bandanna and the other handkerchief from Sam's arm, revealing a cut mark and another bite mark. Both doctor and nurse didn't know how to react to it. Dean noticed it. "Did Crowley bite you?" he whispered to Sam incredulously.
Sam nodded, his eyes half-mast, and before Dean could open his mouth, the doctor straightened herself. "You know what to do," she said to the nurse. The nurse nodded, asked Sam to make a fist, took blood, and was gone.
The doctor turned to Sam. "Okay, Sam, I'm going to check you up now. But before that, you have to tell me what you've been using. It will help me with my diagnosis."
Sam just shook his head.
"Don't worry, you're safe," the Dr Pittman encouraged him. "It will be more helpful if you tell us."
"He wasn't taking anything," Dean replied for Sam.
The doctor looked suspicious, but she reached for her stethoscope. "All right, but Melody is getting a tox screen done, just in case." She put the stethoscope to her ear and tapped the diaphragm twice. "I'm going to listen to your heart sounds and breathing. Ready?" she asked Sam.
The latter nodded tiredly as the doctor bent over, placing the diaphragm on a few parts of his chest first, listening, and then instructed him to take a deep breath. Sam did as she instructed, and Dean cringed slightly at the discomfort on his brother's face.
"Almost done, almost done," soothed Dr Pittman. "Can you sit up for me, just for a minute?"
Dean helped Sam sit up again as the doctor put the diaphragm to the younger Winchester's back, listening some more. After a few seconds, she took the stethoscope off and instructed Sam to lie down. Then she percussed his chest, her face in a frown at the sounds.
"I think we might need to keep you here a while, Sam," she said, once she had finished the percussion. She glanced at his monitor and took the file, before proceeding to write something. "I'm ordering a chest X-Ray for you, and Melody will be back with your blood report in a few minutes. I also want a bronchoscopy done after a while, so I can find out what exactly is going wrong for all that blood to be present in your sputum. In the meantime," she turned to Dean, "Can I talk to you outside?"
This never meant anything good, Dean realised, as he nodded and got out of the cubicle with the doctor. She shut the curtains behind them and led him to a quiet spot where they could talk. "I need Sam's symptomatic history," she told Dean without preamble. "When did the symptoms start?"
"The… the bloody coughing started a few months ago," Dean replied, glancing at Sam's cubicle.
"How many months?"
"A couple of months, I suppose." Dean replied to her. "I didn't know… I didn't find out for a while."
"So I take it, Sam didn't see a doctor about it?" the doctor asked, putting her hands into her pockets.
"No."
"And the breathlessness?"
"Just now," Dean replied. "About twenty minutes ago."
"Anything else I should know of? Chest pain? Fever? Vomiting?"
"He said his body hurt, but not specifically his chest," Dean replied. "And he had a fever too — a few weeks ago. He wasn't hurling, but he said he was nauseous. He was also quite tired, and – and kinda weak on his legs."
The doctor pursed her lips. "How has his appetite been?"
"It's not all there," Dean said to her truthfully. He hesitated. "What's wrong with him, Doc?"
"I don't know for sure yet," Dr Pittman replied to Dean. "We need to conduct tests to find out." She turned to the closed curtains. "Why don't you fill out some forms for him in the waiting room, while we get his blood results and X-Ray? I'll get back to you in a while."
Dean opened his mouth to argue, but thought better of it, and nodded. He walked to Sam's cubicle and opened the curtain. "Sammy, I'm in the waiting room, filling forms, okay?" he said. "I'll be back when they're done x-raying you. Have the nurse call me if you need anything." Sam nodded at him, his face gaunt and pale.
Dean gave him a small smile and swallowed a lump in his throat before proceeding to the waiting room. He took a seat, running a hand through his hair as he did so. He hoped, once again, that whatever the doctors would find would be curable — treatable, at least. He knew it was expecting too much, since Castiel had said right after Sam's symptoms had started after the first trial, that he was damaged in ways that even the angel couldn't heal.
Angel. Oh God, angels. Naomi had been right about Metatron's plan. It was no wonder that Castiel hadn't heard Dean's last prayer to him — he probably wasn't an angel anymore.
No. Considering what he had witnessed outside the church, Dean was very sure that Cas wasn't an angel anymore.
Cas was human.
Oh, God.
Dean needed to find out where Castiel was. He pulled out his phone, intending to call Kevin, but was surprised to see a few missed calls on it. How hadn't he heard the phone ring? He checked the identity and realised that it was Kevin. He dialled the teenager's number.
"Hello?" said an anxious voice after a single ring. "Dean?"
"Yeah, it's me."
"Did you …? What just happened?"
"You saw that?"
"Yeah," Kevin replied. "These alarms went off in your bunker and… I d-don't know… is something wrong?"
"Wait, alarms? You didn't see the angels fall?"
"The – the angels fell?" Kevin asked incredulously. "What is happening?"
"Metatron lied," said Dean. He paused. "I'll talk to you about it later, okay? Have you seen, or heard from Cas?"
"No, I haven't. Where's he?"
"I have no idea," Dean replied.
"Where are you?"
"In the hospital."
"Is it Sam…?"
"Yeah."
Kevin took a deep breath. "How is he? Did he finish the trial?"
Dean felt guilt weigh down upon him as he remained quiet. Kevin had sacrificed six months of his life, his mother and his girlfriend for the demon tablet, and—
"He finished the trial, didn't he?" Kevin's voice was calmer. "Dean?"
Dean sighed. "No."
"He didn't complete the trials," Kevin repeated, emotion draining from his voice as it became calmer still. "You're kidding me, right?"
"I'm sorry, Kev."
"How come?" Kevin asked, his voice now frighteningly calm.
Dean cringed at the teenager's voice. "He – he… listen—"
"You asked him to stop because Naomi told you he'd die." It wasn't a question. Kevin had deduced it for himself.
"He's my brother." Dean could offer no other explanation. There was silence.
"Screw you, Dean," said Kevin bitterly, breaking it. "What do I look like I am? Some sacrificial lamb? I – I lost my mom and my girlfriend over translating that tablet for you! You couldn't have Sam complete one more trial?"
"He'd die, Kev—"
"Yeah, yeah, and what about me losing my mom? That was okay?"
"I know, I know," said Dean. "And I'm sorry. But…" he trailed away. What could he tell Kevin? That he couldn't, for the life of him, bear to lose Sam? But Kevin already knew that. "I'm sorry," Dean reiterated, knowing there was nothing else he could say except for that.
"Just… stop, okay?" Kevin sighed. "Screw you," he repeated, and disconnected the call abruptly.
Dean held the phone to his ear for a few more seconds before pushing it back to his pocket. He washed a hand down his face. He would have to talk to Kevin again. And where was Castiel?
Son of a bitch, he thought, burying his face in his hands. Sammy, just be all right now. Please.
~o~
Castiel's eyes were still trained on the sky, even though the lights had stopped streaking across a while ago. He stared into the night, fists clenching and unclenching the material of his trenchcoat as he did so. He could barely make out the wetness on his cheeks. All he knew was that his brothers and sisters had just been banished out of heaven; cast out of their homes, and that his gullibility had caused it. How could he have trusted Metatron, when he knew what angels could be like? How could he believe that Metatron was any different, when he was aware of the kind of games that his kind was used to playing?
His kind. That didn't exist. He was not an angel anymore. He was a human being.
His knees hurt, and he realised that he had been kneeling on the hard ground. He had no idea for how long, but the physical sensation of the ache; the visceral sensation of hunger, emanating deep in his stomach, and another strange sensation — an emptiness, were indicative of his humanness. There were so many perceptions in him at once — so many nerve synapses firing away different kinds of signals — physical and mental— that Castiel didn't know how humans dealt with them on a regular basis. It was no wonder his father loved them so much; they were stronger than they looked. They bore more than what was visible.
He stood up from his place and wiped his eyes. Dean was going to be looking for him. The Winchesters would know of what had just happened. He needed to get to them.
He started to walk, wondering at the same time if Sam was all right. The last he had seen the man, he was able to detect an irreparable damage in him. The damage was small after the first trial, but after the second one, it had got worse. Much worse. Castiel had sensed the sheer change at once, but decided not to tell Dean unless asked, because he knew Dean would be worried, and he didn't think the elder Winchester could bear to take up any more worries. Either ways, he knew Dean would be worried enough — even if Sam wasn't dead already. And he wanted to be there for his friend.
His feet were heavy as he found his way through the woods. The leaves crunched under his shoes and he kept walking, listening dully to the rustling, cracking sounds. He was tired in a way he'd never been before. And the only times he'd felt close to this were the times that he was almost human a few years ago. However, at the moment, the exhaustion was different. It was not only his body that was fatigued. It was his mind too.
He reached a road once he had walked some, and a little ways down, he could see a grocery store. His stomach let out an involuntary rumble. He was familiar with food, with his vessel's craving for red meat at the time when Famine had attacked, but he was not familiar with this intense, basic human perception that was hunger. At this moment, he realised, a sandwich and some coffee would very much please him.
Castiel rummaged the pocket of his trenchcoat and extracted a few crumpled bills that he had remaining from the shopping expedition a few days ago. He didn't care about the hunger at this moment; he just wanted to get to Dean first. And for that, he'd have to call the other man.
There was a tinkle as Castiel opened the door to the store. He headed straight to the cashier. "I need to use your phone," he said.
The other man looked up. "Excuse me?"
"Your phone?" Castiel asked, pointing to the landline.
"Uh… yeah, sure," the man replied, running his eyes up and down Castiel's form. He gestured to the phone. "Go ahead."
Castiel picked up the receiver and dialled the foremost phone number in his mind.
~o~
Dean's phone was ringing. Hoping it was Castiel this time, he removed it again. It was Kevin.
"Kev?" he asked, accepting the call.
"Dean…" the teenager paused. "I… just called to say… I'm sorry."
Dean sighed. "It's okay, Kev, I—"
"No, you were right to do what you did," said Kevin. "I'd have done it too. Sorry I got all pissy on you. Hope Sam's fine."
"Yeah, yeah, he's better," said Dean. "They've taken him for an X-Ray, and they say he might have to spend a couple'a days here, but I guess he's going to be okay." False hopes, said Dean's mind again. He had a nasty feeling it wasn't about to stop at that.
"That's – that's good," said Kevin. There was brief silence.
Dean's phone suddenly started to beep and he took it off his ear to see an unknown number flashing on his screen. He told Kevin he'd speak to him later, and took the second call.
"Hello?"
"Dean."
The voice sounded shaky, worried and scared. It sounded sad and relieved. Dean, however, was happy just at the sound of his name. "Cas? Cas, where are you, man? You okay?"
"I…" Castiel paused, and Dean could hear him take a deep breath. "I…" He just sighed. Castiel had never sounded this way to Dean, and the latter felt a pang of sympathy for the former angel, despite all the anger he had felt against him in the last few weeks.
"Hey, I know," said Dean. "I saw what happened. I'm sorry. Where are you? Can you get to the bunker?"
"Are you at the bunker?"
"No, Kevin's there. I'm in a hospital. With Sammy."
"How is he doing?"
Dean bit his lip as he felt it tremble. "Not good, Cas. But they say he's going to live…"
Castiel seemed to have nothing to say to that. Instead he said, "I'm coming to the hospital. Give me the address." His voice sounded stronger this time.
"You don't—"
"I want to, Dean."
"Okay." Dean paused, and narrated the name of the hospital and address to Castiel. "Do you have money?" he asked the other man.
"Yes, I have some in my pocket," Castiel replied. "I will catch a bus and get there as soon as I can."
Dean nodded. "Thanks, Cas—" The phone, however, was disconnected and Dean leaned back against his seat for a minute before bending over and filling the rest of Sam's forms.
~o~
Sam was moved to a room upstairs after his X-Ray, since Dr Pittman insisted that she wanted to monitor him awhile and conduct a few more tests. He felt a little better from how he had been feeling at the church. Breathing wasn't very easy, but he wasn't struggling for his breath anymore thanks to whatever cocktail the nurse had given him (he thought he'd heard morphine). There was, however, a dull ache in his chest. He felt extremely tired too, and his head throbbed slightly as nausea trailed the corners of his senses.
"They've called your brother here," his nurse, Tammy said, adjusting an IV bag on the stand. "Your X-Ray result should be out in a few minutes."
Sam swivelled lazy, exhausted eyes to her. "What's wrong with me?"
"Well, your doctor will be talking to you about that once your test results come through. How are you feeling? Still breathless?"
"Not really, better," Sam replied, just as there was a knock on the door. Tammy opened it to let Dean in, who immediately pulled up a stool next to his brother's bed.
"How are you feelin', Sammy?"
"Same as I was fifteen minutes ago when you left," said Sam, cracking a weak smile, as Tammy left to give them their privacy.
"Don't be a smartass," Dean scolded him. He paused. "Kevin called."
"And?"
"He hopes you get better," Dean said, "He's probably getting back to working on the angel tablet."
"He wasn't pissed?" Sam asked him.
Dean didn't reply to that. Sam sighed. "You should have—"
"No."
"Dean." Sam paused. He wished Dean would understand. He wished Dean would realise. There was no use now. No use for coming to the hospital, or discovering whatever it was that had been plaguing his body for the last few months (if it wasn't something supernatural and inexplicable, that is). Sam could feel the damage inside him. He could feel the change, and he knew it wasn't something that could be chased out by a couple of drugs, or scooped off by some scalpel.
"I wasn't going to let you die," Dean said. "I'm not going to let you die."
"Everybody dies."
"Not you. Not on my watch."
Sam gave up, breathing a little at the nausea that seemed to have intensified slightly. There was no use for having this conversation with his brother. He knew Dean was smart enough to make out from Dr Pittman and Nurse Tammy's expressions that they weren't exactly happy with Sam's condition.
A pang of fear passed through Sam. No matter what he said to Dean, he didn't want to die. Not now, after abandoning the trials, and after the renewed reconciliation with Dean.
"Cas called too," Dean said again, breaking the silence.
Sam turned to him. "Is he…?"
"Yeah, he's human," Dean replied, running a hand down his face. "He's coming here."
"He didn't have to."
"I asked him to go to the bunker, but he said he wanted to come."
Sam swallowed again at the rising nausea. "That's incredibly nice of him, then. Considering… ugh," he groaned, swallowing again.
"What is it?" Dean asked him, alert.
"Feel a little sick," Sam admitted to him. "No, I'm not about to throw up," he told Dean when he began to reach for the emesis basin.
"Okay, hang on, I'll call the nurse," Dean replied, getting up and leaving the room. He was back in a couple of minutes with Nurse Tammy following him. She came up to Sam and felt his forehead.
"Queasy?"
"A little," Sam said to her.
"Hmm," she glanced at the IV bags. "They gave you low-dose morphine to ease your breathing. That could be it. It's just transient. You'll feel better, but I'm informing the doctor anyway. Let me know if you vomit."
Sam nodded and just as Nurse Tammy was about to exit the room, Dr Pittman came in, X-Ray in hand. "I just got your results," she replied, hanging up the film on the light box and switching it on.
"Your tox screen is clean and your blood work wasn't bad," she said. "You're slightly anaemic, but not all that much — it's mostly because of the chronic bloody sputum. I can't find signs of an infection right now, so it's probably trauma. Anyway—" she frowned at the X-Ray, "You have a pleural effusion, Sam. Know what that is?"
"Fluid in my pleural space," Sam replied, nodding.
"Yes," said Dr Pittman. "Now you say that the chest pain just started before you came here?"
"That's right."
"Hmm…" she paused. "Pleural effusions actually take time to show extreme symptoms, and I can't figure out why yours was sudden, but I can extract some fluid and get it tested. That way, we'll catch the actual culprit behind all these symptoms."
Sam nodded, swallowing again through the nausea. Dr Pittman turned to Tammy. "Can you get me a tray for his pleural tapping? I'll be sampling some for the labs before I drain him."
The nurse nodded and left as Dr Pittman took a stool on Sam's other side. She looked at Dean. "You can get a coffee if you want to. The procedure isn't very pretty."
"I'm good," Dean insisted, and Sam felt unexpected relief at that. Nurse Tammy came back with a tray. Dr Pittman loaded a syringe. "Okay, Sam, you need to sit up, lean forward and face your back to me."
Sam obeyed her, and Dean helped him sit up and turn. As Dr Pittman undid Sam's gown to bare his back, Dean put his hands on his brother's shoulders to support him as he leaned forward. Sam, for once, didn't swat Dean away. He knew Dean was as confused and scared as he was, and was only trying to do whatever he could within his power to help Sam. He decided to let his brother have that liberty.
"You ready?" Dean asked Sam. The latter nodded, and the doctor took that as her cue to swab an area on Sam's back.
"I'm going to anaesthetise the area, so you won't feel the bigger needle," she said, and Sam inhaled sharply at the tiny prick. Dean's fingers squeezed his shoulder slightly, and Sam felt numbness spread over a small part of his back, slow and steady. Then he felt a prodding, pulling sensation, that he could only guess was the needle being withdrawn, and then pressure.
"Give me the syringe," said Dr Pittman's voice and Sam heard the nurse move to obey. The doctor's breath hitched slightly, but she didn't say much else, except for, "Collection bag."
Sam immediately felt some of the pressure in his chest relieve and he took a deep breath, feeling better and better as he realised that the fluid was draining away. There was silence, and Sam wondered why the doctor wasn't saying anything. Then Nurse Tammy spoke.
"He was nauseous. I assumed it was the morphine."
Sam wondered why she sounded low. Dr Pittman didn't reply for a few moments. "Get me serum electrolytes," she said thoughtfully. "And I'm scheduling him for a CT scan."
Sam saw Dean look up at this. "Wait, what's wrong?"
"I think I missed something in the chest X-Ray because of the fluid clouding his lungs. I'm ordering a CT just to know if it's really there."
"Really what is there?"
She crossed over, to Sam's line of sight, and placed a hand on Dean's shoulder, and Sam saw that the syringe in her other hand was filled with bloody fluid.
"We will take care of him as much as we can," she promised, before giving the syringe to the nurse and leaving the room.