Sugar Me Sweet Chapter 2
Dean snapped his phone shut and slipped it back in his pocket. "What's goin' on with you kiddo?" he whispered. And then "Woah easy there!" as a strangled gasp came from the back of Sam's throat and he vomited. Dean immediately flipped him on to his side to prevent him choking, one hand cupped under Sam's neck whilst the other rubbed his stomach in circling patterns, murmuring to him softly. The bout seemed to go on forever and Dean winced a little.
When Sam appeared to be through, Dean rolled him on to his back and started checking for head injuries. He soon drew a blank and leaned back to stare at his brother.
Sam was breathing too fast and deep for Dean's peace of mind, as though his body was starving for air. "Sammy come on wake up, you're scaring me here!"
But Sam appeared to be deeply unconscious, maybe not even aware of his brother's presence.
Trying not to let his fear take over, Dean gently hauled Sam into his arms and tilted his head back to keep his airway open. "Sam please, wake up and tell me what's wrong." Desperation had crept into Dean's voice by now, and he was shaking Sam lightly, begging his little brother to talk to him.
But it soon became obvious that wasn't going to happen and Dean had the nasty suspicion that Sam was in serious trouble.
He glanced at his watch praying that Dr Carpenter got here soon. Dean liked and trusted the MD, after she re-set his shoulder following a dislocation. She'd been surprisingly gentle and he had barely felt a thing.
Just as he was about to give in and drag Sam to the car, a small ambulance, more like an estate car than a van, screeched to a halt by the clearing.
Hearing a door slam, Dean called out "We're over here!" And Harry Carpenter appeared at a run, a large EMT lumbering along beside her holding on to a collapsible stretcher. She carried a large green medical case, and was frowning in fierce concentration, already barking out questions.
"How long's he been out?"
"He collapsed right before I called you."
"Symptoms?"
Dean thought back over the last couple of hours. Sam had seemed quiet and irritable on the run up to the salt and burn, but Dean had just put that down to what seemed to be Sam's permanent excessive tiredness. At least Sam had stopped complaining he was thirsty, but his frequent trips to the bathroom had amused Dean a little, even cracking a joke about it at Sam's expense.
Jeeze Sam. You got the bladder of a four year old
To which Sam had just scowled at him and said nothing. Looking at his little brother lying unconscious on the ground, Dean couldn't really blame him. The joke, such as it was, hadn't been that funny.
With this information in mind, Harry already guessed what the problem was as she pulled out a small blood glucose meter. Her patient was pale and perspiring, not to mention severely hyperventilating. Pricking Sam's finger and letting the blood well up, she touched a test strip to the red liquid then slid it into the meter. A small bleeping noise indicated it had finished its task and when she checked the readout her eyes widened.
Dean glanced up at hearing her swift intake of breath "What is it? Is he going to be ok?"
Harry ignored him for the moment as she checked Sam's pulse.
"His breathing's all wrong and his pulse is too fast." Dean watched as deep concern marred her attractive features when she spoke to the EMT.
Sensing Dean's anxiety the doctor explained. "It's called Kussmaul respiration and sometimes happens during a DKA if it goes untreated for too long." Harry muttered, hoping that Dean would stay calm.
"It's called who and sometimes happens during a what?" Dean's face was twisted with worry and confusion.
"Kussmaul's respirations are the body's attempt to remove carbon dioxide from the blood, and that combined with Sam's unconscious state and stonking hyperglycaemia tells me he's in the late stages of a ketoacidosis."
Dean's own eyes widened. "He's what!?"
"You're brother's in a coma, Dean, because his blood sugar levels are too high." The doctor responded as she slipped an oxygen mask over Sam's face then attached a pulse oximeter to his finger.
"Tom, he's badly dehydrated. We need to get some fluids into him."
"I'm on it. How's his BM lookin'?" Tom, the giant of an EMT indicated the glucose meter as he quickly and efficiently set up an IV in Sam's arm.
"38" Harry removed a phial of insulin from the medi kit along with a syringe.
"Jesus! No wonder the kid's out of it!"
Dean was reeling with shock. "Coma? What?! But….how?! I don't understand…"
Harry spoke as she injected the insulin in to the IV port.
"My best guess it that Sam skipped a couple doses of insulin." Harry realised Dean had gone quiet and glanced over at him.
"What?" Dean asked again, but this time his voice was cold and deadly.
Ah. So Dean didn't know. Sam still hadn't found the courage to tell him and now he was seriously ill. She sighed.
Sam, this is just what I was trying to warn you about…
"I'll explain later." Harry gave him a sympathetic smile. "Right now I want to get Sam to the clinic and run some arterial blood gases on him, and check his urine for glucose and ketones. I just gave him a shot of insulin to bring down his glucose levels but we need to monitor him. Sam may need another dose in an hour or so, but he could easily go hypo, and that's just as dangerous. Tom,we ready?"
"Yep." Between them they lifted their patient on to the stretcher and carried him over to the small clinic ambulance.
Dean followed on, anger bubbling away under the surface of the hard, cold front he now presented to the world.
"Dean? There's not enough room in one of these things for more than two people in the back. And that includes the patient…" She was interrupted as Sam started choking and gasping.
"Shit! He's in respiratory distress. We're gonna have to intubate."
Dean watched helplessly, anger, shock and fear a swirl of emotions inside of him, as Harry and Tom fought to keep Sam breathing.
Come on Sammy…
The terrible choking stopped once Harry managed to force a tube down into Sam's throat. It didn't look pleasant but at least he could breathe now, Dean thought to himself, taking a deep breath of his own.
"Ok. Let's get him to the clinic." Harry stayed in the back with Sam as Tom raced over to the driver's side and slid behind the wheel. "We'll meet you there Dean. Ok?"
Harry watched Dean with a certain amount of concern until he nodded and headed towards the Impala. She knew he'd lost his dad recently and he and Sam had both been struggling to cope, but now Sam was in trouble and she wondered if it wasn't all becoming too much for the older brother.
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Dean sat in the waiting room staring at the wall. He wasn't sure how long he sat there but he was pretty sure it'd been a while because his ass had gone numb. Holding on to his temper was quite the battle and he was getting tired.
Sam's diabetic.
What the hell?
Dr Carpenter had briefly explained as they were transferring Sam from the ambulance to the clinic. She'd diagnosed Sam only recently and his little brother was struggling to come to terms with it.
"I think that's why he hadn't told you yet. He was worried about you, told me you'd been through a lot since your father's death and didn't want to burden you."
Replaying that conversation in his head made Dean even madder and he wanted to punch something. Sam had stupidly risked his life to protect Dean, and that's not supposed to be the way it works Sam!
Getting abruptly to his feet he started pacing when Harry poked her head round the door.
"Dean? I've just got him settled. You can see him now." With a small smile she beckoned him to the room.
And the instant he saw his brother all anger melted away. Dean sat in the chair at Sam's bedside and visibly deflated. Reaching out, he grasped Sam's hand and rubbed his thumb over the calloused knuckles. His little brother looked so young and dejected lying there with that hateful device in his mouth.
"Is he ok? Can he hear me?"
Harry fiddled with Sam's IV. "The treatment's going well but he's not out of the woods yet I'm afraid….in fact, I think he's given up."
Dean stared at her.
Harry hated herself for saying it but Dean needed to know. "He told me…" she paused, trying to gather her thoughts. "You wouldn't talk to him about your dad and grew angry when he tried. He thinks you hate him."
Dean looked like he was going to throw up. "What do you mean?" Equal doses of pain, grief and anger were roaring through his mind.
He thinks I hate him? Godamnit Sam how could you be so stupid!
"I'm not saying he missed his insulin shots intentionally, but there's a possibility that may be he couldn't cope with this on his own and he just forgot." Harry watched Dean closely, regretting the guilt that swamped his face. "I'm so sorry Dean. I'm not saying this to hurt you or lay all the blame on your shoulders. But it's important you understand how this may have affected Sam if we're to help him. And yes, I think he can hear you so keep talking to him."
Harry moved to the door. "I'll be in my office if you need me."
Dean nodded.
And found himself alone with Sam.
"Aw Sammy. Why didn't you tell me you were sick huh?" Dean whispered softly. "God you make me so damn mad."
He watched the rise and fall of Sam's chest as the respirator did its job.
Then it hit him.
"Oh god. You did try to tell me, didn't you? And I just pushed you away…"
Dean? We need to talk about something
Another time Sammy ok?
I'm sorry Dean but this can't wait, there's something….
Well it's gonna have to Sam.
Dean covered his eyes with his hand for a second, then slowly dragged it down his face.
"I wasn't there when you needed me…you were struggling, I could see that. And instead of
helping you I shut you out and left you to deal with this on your own. Oh god Sammy I'm
so sorry." Tears finally rolled slowly down Dean's face as his heart broke for his little
brother.
It hurt to think about it but Dean figured he deserved that much.
Sam must have felt so lost after the accident. Dean had sensed his loneliness but turned his
back on him, trying to deny his own grief.
Dean had once told Sam he was a selfish bastard, and that couldn't have been further from
the truth, because now Sam was desperately ill and all because of some misguided sense of
saving Dean anymore pain, because he thought Dean hated him
"I never hated you little bro." Dean sniffed and leaned in closer to Sam. "I love you Sammy.
There are times I wanna strangle you, and more often than not I really feel like kicking your
stubborn ass. But I could never hate you. And you're going to have to believe that because
I'm asking you to fight. Fight hard. Fight for me Sam because if you go I go. It's that
simple."
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Authors notes:
More to come soon.
I've pretty much skimmed over the tackling of DKA, mainly because I was trying to avoid
bogging the reader down with too much medical jargon. The "38" in reference to Sam's
blood glucose levels is in English units because those are the ones I use at work, rather than
the American units so I apologise if anyone was confused by that. Rest assured its damn
high! (Though I have seen higher).
This obviously isn't an accurate or by any means even complete account of the development and treatment of DKA, but I just didn't want to harp on too much and lose the drama of the moment.
Oh and my apologies if the ending was a bit mushy. I was giving in the desire to see Dean go
all soppy on Sam.
Ya gotta admit it was pretty cute eh?
Many thanks for all your reviews, and I promise I will get round to answering them all
eventually. I think that if someone has taken the time and effort of leaving some kind words
about one of my stories then it's only polite to at least reply.
Kind regards,
ST.xxx.