Marianne leaned on the desk as she impatiently jotted down the last test results in her patient's file. She'd been working for eleven hours straight and the Head Resident finally allowed her to leave as long as she completed the last of the paperwork before going. She had reluctantly agreed, but still preferring the calm of the paperwork rather than the never-ending flurry of the ER.

She'd been a nurse for a few years now, seeing all kinds of different stories. Mostly, it's her love for people that drove her after ten hours of work and an umpteenth coffee to keep going. But really, she was still only human after all and she did need a few hours of sleep every once in a while.

She rubbed the sleep from her eyes as her vision blurred when she read the same line for the fifth time. It was really her time to go. A few more lines and footnotes and she'd be free.

But tonight she wouldn't get so lucky. Maybe her emotions got in the way, she couldn't tell. But really, there was nothing to make her leave after that.

The doors of the ER had flung open to a team of frantic medics pushing a stretcher. There was a man lying on it. Marianne couldn't see his face from where she stood but she instantly felt a strange attraction to him. Maybe it was from the other man that was following behind the medics pushing that stretcher away. This one must have been a friend… maybe even a family member. No stranger would react the way he did.

She saw how he was pushed out of the way and the distress radiating from him. Instantly, she felt sympathy even though the good looking stranger was proving to be quite aggressive. He just looked so helpless… so broken… and desperate.

She couldn't stand the pain that she saw in his face and something tugged at her stomach. She wanted to know. More than that, she needed to know. She put the file down and followed the frenzy medical team. All possible fatigue had vanished, leaving her with an energy she had no idea she still had in her. Either way, it was late and they were short on staff.

Sam. She learned that this was the guy's name. He was young and rather attractive. Maybe that was part of what was making her stay. The rest of the staff was working frantically. She had to follow. Nobody said anything about how she was supposed to be gone.

"Male, late twenties, suffered a mild concussion three weeks ago. His brother says he collapsed and started convulsing while still being conscious, then fell unconscious and had a full blown seizure. When the paramedics arrived, he wasn't breathing" the Intern stated, reading the paramedic's report.

The Resident nodded at the information. He turned to Marianne and barely hid his surprise at seeing her before barking orders. "Vitals?" he asked.

Marianne turned to the monitors and observed the readout. "Pulse is 50, BP's 140 over 90, sats are 100 % after intubation" she read.

Doctor Hamilton, the best physician on the whole neurological floor walked into the room at that moment. He asked for the report and state of his patient. As he heard the details, his face darkened. He'd been doing this job long enough to be able to tell the prognosis even before making any test. He didn't believe in miracles either.

"Signs of increasing ICP* with possible cerebral edema. What's his LOC*?" the Doctor asked.

The Resident approached the bed and took out his penlight, opening Sam's lids and checking out his pupils. "Right pupil is dilated and non-reactive to light. Left pupil is sluggish. There's no consensual reflex" he announced.

Marianne was already starting her assessment. She positioned herself next to Sam's head and tried calling to him, asking for him to wake up. He didn't open his eyes though. She decided that is was time to change her methods and she sadly found Sam's fingers. She then pressed her own nail to the side of his and started applying a noxious pressure.

In the first seconds nothing happened. Then surely, Sam's muscles flexed but instead of pulling away from the pain, his arm went to his side, turned towards the inside. Marianne sighed. The prognosis wasn't good and she knew it.

"Patient is comatose with a GCS* of 5" she reported sadly. She didn't need to be a neurosurgeon to know what that meant. This Sam guy was not in a good shape. Not at all.

Doctor Hamilton was well aware of that too because he didn't lose any time.

"I want this man up for a CT as soon as right now. Start him on hypertonic saline stat and if the results from the scan confirm what I think, I want him up in the ICU on mannitol" he barked.

And he was right. He was consulting the CT scan results now and cringed when he saw the size of the edema. It was no wonder the guy was unresponsive and Hamilton was amazed that he wasn't dead yet. "Well, Sam, we gotta get that swelling down" he muttered to himself.

SPN

Dean was pacing anxiously. He couldn't shake the images out of his mind and kept replaying the scenes over and over again. He thought his heart would've stopped when he saw his little brother lying motionlessly on the floor. On top of that, Sam had stopped breathing!

After minutes of endless seizing, his brother had finally slumped over to die. If he hadn't known CPR and if he hadn't already called the EMS, Sam would probably be dead now. And it was all his fault. He'd punched his brother, for Christ's sake! Of course, if he had known that Sam would be hurt like that, he never would've hit him in the first place.

What was he thinking? Of course Sam was still recovering. They'd taken him out of the Hospital AMA after that incident at Bobby's. In normal circumstances, Sam should have stayed in the Hospital but with all those Leviathans running around and eating people, Dean couldn't let that happen and risk blowing the cover when they were weakened and vulnerable.

Now it was taking so much time before anyone came in to tell him something, anything about Sam. He really hated it and would've gone crazy if he weren't so scared of being kicked out.

He spotted a nurse coming towards him. He'd noticed her at first but he hadn't really paid attention. He was too worried and angry that they wouldn't let him follow his brother to the examining room.

But as she approached, he realized she did look familiar. She was young with long blond hair wrapped in a pony tail. Dark smudges under her eyes testified of her dedication and long hours of work. But her smile was comforting. He found himself wanting her presence.

She finally reached his side and cleared her throat. Dean honestly didn't know what to think.

"Hm, were you the guy that came in with Sam Deyoung?" she asked softly. Her eyes were bright and for a second, Dean was too dazed to remember the alias they were using this time.

"Ye… yeah. Sam's m… Sam's my brother. How is he? Do you know anything about him?" he blurted out. Swallowing compulsively at his own discomfort and rubbing the sweat away from his palms.

She pulled her lips up into an attempt at a smile.

"Well, I do. My shift's over and I'm not his physician but I was there with him and when I saw you two together earlier… I don't know I just figured you'd want to know how Sam… your brother – is doing" she rambled.

He looked at her with a puzzled look but finally registered that she really wanted to help. Besides, he'd do anything to have a word on his brother's condition. He could simply nod in response to the long and blurry confession. He was so tired after his last bout of adrenaline had died down.

"Sam's received quite a hit. His latest concussion probably weakened him actually. The slightest hit could have been fatal and he's lucky to still be alive" she started. Dean was trying to decipher the underlying meaning of her words.

"There's a but coming" he murmured. She sighed.

"He's fighting. But he's got a long road ahead of him" she confessed.

Dean swallowed. He didn't like the sound of that. Not at all.

"What do you mean?" he asked, his voice reaching a lower tone and Marianne found herself shivering.

"I'm afraid Sam's injury is quite severe. He'll need you more than ever now" she admitted.

Dean's eyes were wide with shock. What was she saying? Of course Sam had bashed his head but they did all the time. This was just another hit they'd take together and deal with it.

"I hope to see you again. I don't know why but I want to know what happens to Sam. If ever we meet again, I'd love to have news from you two" she said hopefully.

Dean frowned.

"I'm Marianne" she greeted, handing her palm out for a shake. Dean returned the handshake but he was still visibly perplexed. Besides, knowing Sam, he'd be dopey for the night and then he'd call Bobby and manage to get his kid brother out again. The girl better not get her hopes up too quickly.

"I'm Dean" he finally replied, deciding that being nice wouldn't hinder his plans in any ways.

She smiled and wished him goodnight before leaving. She seriously intended to call the nurses office and manage to get shipped into the ICU. She really wanted to take care of this patient now. Sam had totally mystified her and she wanted to know more about those two attractive brothers.

Dean sighed with impatience as he could only rely on the nurse's words about his brother. What did she mean anyway? Of course, he had the fright of his life when he saw Sam lying there unmoving but the paramedics had taken care of it. Sam would be okay. He always turned out okay. Even with Lucifer hanging around, Sam was supposed to turn out okay.

Movement brought him out of his thoughts when he saw a man in his mid forties walking towards the waiting room. It wasn't really crowded now considering it was in the early hours of the morning.

"Family of Sam Deyoung?" the man asked. Dean's head snapped up and he almost ran to the Doctor's side.

"He's my brother, how is he?" he blurted out.

The man sighed deeply. "Please Mr. Deyoung, let's have a seat in my office" he proposed. Dean frowned. Offices never meant anything good. It meant that doctors had bad news to deliver and didn't want to do it in the middle of a room with other people to not disturb the common peace with the pain of receiving bad news.

He clenched his fists in anger but didn't complain any further as he followed the man down to the neurology department. The plate outside the door read Dr Hamilton. Dean somehow knew that he didn't like what he was about to hear and the waiting game was actually causing him physical pain.

"Please, sit down" the man invited.

Dean obliged but he looked at the Doctor with eyes full of apprehension.

"What I'm going to say is not going to be easy, Mr. Deyoung" he started.

Dean had a nervous chuckle. "Well then let's just cut to the chase, shall we. How's Sam?" he asked coldly. Beating around the bush would do nothing to appease him.

"At the moment, he's stable. It's the best we can offer for now" he admitted. Dean frowned. Weren't Doctors supposed to tell you that everything would be okay? But then Dean wanted nothing but the truth.

"Please doc, don't sugar coat it" he replied. The man's face pulled into an annoyed frown. He wanted this over with as much as Dean did. He never enjoyed giving bad news.

"I wouldn't know how to so here it is. Sam suffered a traumatic brain injury. He has what we call a class III concussion or – in other words – a severe brain trauma. When we receive unconscious patients in the ER, we use a scale called the Glasgow Coma Scale to assess their level of awareness. A fully awake person like you and me would probably have a score of 15 for this test while patients with mild injuries might have a score of 13 or 14" the Doctor explained.

Dean was happy that the man was making it clear and everything but he wished that he could skip to the point and tell him more about Sam. He didn't care about statistics.

"What about Sam? How much did he score? With that geeky brain of his, he probably scored high!" Dean joked, trying to alleviate some of his discomfort. The unknown was still too scary.

The Doctor sighed deeply. He pulled his glasses off his nose and started rubbing the bridge of it. Instantly, the eldest Winchester knew something was up. His chest tightened painfully.

"When we tested him earlier, Sam had a score of 5" the physician announced unhappily. He expected Dean's shock and bowed his head when he saw the reaction in Dean's eyes.

"Sam is in a deep coma as we speak. The force of the impact brought on a condition called cerebral edema. Basically, when your brother hit his head, his brain started swelling rapidly. The swelling compressed the areas in his brain that control respiratory function. The lack of oxygen to his brain and the high blood circulation most definitely triggered the seizure you've witnessed before calling the emergency department" the physician described and explained.

Dean was at a loss of words. His stomach was flipping inside his ribcage, making him nauseous. From his hand, from his punch, he'd caused so much pain! He'd hit Sam and caused a swelling so bad it almost killed his brother. It would've actually. Sam was technically dead when the paramedics found him. But now there was no bouncing back from it either. His little brother was in a coma. Would he even wake up? And severe brain injury? Did that mean that if his brother ever woke up, he'd be handicapped?

The Doctor seemed to read his mind because he went on.

"Of course we will be taking high measures to reduce the brain swelling. Speaking of which, I need to have you sign a consent form so that we can start your brother on ventricular CSF* monitoring. I'll explain it more thoroughly to you when we get there. Sam's intracranial pressure is too high from what we can tell with the results of the CT scan we've just performed. We need to get it down before some more serious damage occurs" the professional continued.

Dean swallowed. He was leaking cold sweats now. Hearing what he had inflicted to his brother hurt him more than it did Sam. "More serious damage?" he stuttered, trying hard to keep the bile down.

"Possibly permanent disability or, in the worst case scenario, brain death… but that's why we want to start monitoring him as soon as possible. We've already started treatment to get the swelling down" he replied.

Dean nodded but he felt his stomach rebel. He was going to be sick if it went on like this. He swallowed compulsively. The idea of finding Sam injured beyond repair was nauseating.

"If you do manage to get the swelling down, does that mean that he'll recover fully?" Dean dared to ask. He wasn't sure if he wanted to hear the answer though.

The Doctor shrugged. "There are multiple factors that will influence Sam's recovery so really, it's too soon to tell. You have to consider the severity of your brother's injury, though. With an injury of that extent, the chances of a full recovery are very slim. If Sam wakes up, he might manage to have a good quality of life after a number of sessions through rehabilitation. But there is a possibility that he'll stay dependent for the rest of his life. And that's if he wakes up…" he replied.

Dean's stomach tied itself into knots and almost made him choke on his breath. "If?" he repeated softly.

Doctor Hamilton sighed and bowed his head as if to apologize for the fact that he had nothing more positive to say.

"Your brother is strong to have made it this far, already. But you have to know that the more severe the injury is, higher is the risk of complications and subsequently – of death" he stated.

Dean's hands were twitching from the buildup of emotions raging inside of him like a fire. No way could this be happening! And now that Castiel was gone, he couldn't summon the angel and make him heal his brother. Sam was truly hurt and there was nothing he could do to help.

"Do you think he'll pull through?" he finally asked shyly, afraid of a negative answer.

The Doctor attempted to offer a sympathetic smile.

"I'll do everything in my power to help him and I'd advice for you to have faith" he tried.

Dean's jaw clenched tightly. After the news he heard, faith was the lowest thing on his list of things to take care of. He knew who was listening on the other side and who "faith" referred to.

"I'm not sure praying is what's gonna help my brother right now" he said through gritted teeth.

"Then if you don't pray for yourself, do it for him" Hamilton proposed.

Dean wanted to bite but he had to keep in mind that this man was the one who was taking care of his brother.

"As for treatment, I want to let you know what we're going to do with Sam. As soon as you've signed the consent forms, I want to insert a drain in Sam's ventricle. The catheter will help decompress your brother's brain and it will also allow us to monitor his intracranial pressure. As soon as we got a number, will we know how aggressively we have to treat him to increase his chances of a positive recovery" the physician explained.

"Then we will be administering salty solutions to decrease the fluids in his body, which should reduce the swelling. We'll also keep him on anticonvulsants at first to prevent the risk of seizures. We'll also have to make sure we keep his blood pressure high enough and for the next day or so, we will be hyperventilating him with a ventilator. This is also to help decrease the swelling. If it doesn't work, we'll meet again and decide on more aggressive methods of treatment" he finished.

Dean nodded at the amount of information he was given since none of it really mattered more than knowing if Sam was going to be okay or not.

"Do you have any questions?" Hamilton asked.

Dean shook his head and his eyes fixated on nothing. "Where do I sign the consent forms?" he asked on a monotone, never taking his eyes off an invisible spot he'd laid his eyes on.

SPN

Dean decided to take a breath of fresh air while Doctor Hamilton was driving a catheter through a hole in his brother's head. The simple idea of it made his stomach churn again. Cold shivers racked through his body despite the rather warm air. His knees buckled and he stumbled over to a bush where he crashed and emptied his stomach.

Knowing that he had caused his brother's pain was the most excruciating sorrow. His body was weak from all the stress and the lack of sleep taking care of his brother had brought on him.

When he finally regained his composure, he managed to dig his cell phone out of his pocket and speed dial Bobby's number. The gruff voice finally broke through the ringing in his ears and emotions filled him instantly.

"Bobby, it's me" he stated, his voice shaking. His lower lip trembled and he had to hold on to something before completely falling apart.

"Dean? What's wrong? Is everything ok, boy?" the old hunter asked.

"No it's not. Sam's hurt. I did this to him, Bobby. I hurt him" he cried.

"What happened?" Bobby asked calmly. He knew upsetting Dean even more would only make things worse.

"I didn't mean to" Dean breathed. His guilt was hard to hear and even through the phone, Bobby's heart was breaking for the boys he'd come to love like his own sons.

"I know you didn't, Sport. Sam's a strong kid, he'll pull through" Bobby tried.

Dean was almost in tears now and he was having a hard time catching his breath. Panic was rising inside his chest at the many possibilities that ran into his mind. Sam would either die from this or end up brain damaged and he'd be the one responsible for it.

"Not this time, Bobby. I really screwed up. I failed him" he stated sternly.

"Do I need to come over, kid?" the old man proposed.

Dean realized how at a loss he was without family around and that's when it hit him just how much Bobby meant to both Sam and himself.

"I you can make it here, yeah I could really use the support. I don't think I can do this on my own" he admitted sadly. Confessing to his weakness wasn't something he enjoyed either.

"It's okay, I understand. You don't have to go through this alone either. I'll finish tracking the lead I have on the Leviathans and then I'll meet you as soon as I can!" he promised.

"Okay. Thank you, Bobby. You take care of yourself, will ya?"

"You do that too, kid. Sam needs you so don't do anything stupid" Bobby replied with a smirk. He knew the boys too well but that's why he was so fond of them in the first place.

They ended their conversation. Dean noticed for the first time that the sun was starting to rise. He took several deep breaths of fresh air and let the bright light burn at his retinas. He could've been trailing Leviathans now. He could've been on the road in his beloved Impala and with his healthy brother riding shotgun.

But that had died as soon as Sam collapsed in that hotel room.

Nothing was ever going to be the same after this.

And he was the one to blame.

TBC

*LOC = Level of consciousness

*GCS = Glasgow Coma Scale

*ICP = intracranial pressure

*CSF = Cerebrospinal fluid

I'm so happy with the reviews and favorites I got for the last chapter! Thank you guys, it means so much to me and I'm glad you've liked the first chapter! I hope you liked this one as well and the ones to come. This one didn't have a lot of story content aside from setting the medical facts straight before moving on in the story. All medical facts are thoroughly researched and I hope they are accurate enough. It took me forever because I'm such a perfectionist!

Also, it focused a lot on Dean's guilt. Don't forget that he doesn't know about Amy yet. He thinks he's to blame when he just accelerated the symptoms. Even though his guilt may be present at first, I'd like to get him to overcome that by being really present for his brother. Sammy's gonna need it!

Lol don't forget to leave feedback and let me know what you thought. I'll try to keep updating regularly if you still want me to keep going. Thank you for reading !