Again – don't know what I would do without all your wonderful reviews. Thank you! I've responded to all of them, but the alerts and the emails don't seem to be working, so I hope you get them.
a/n – Pre-op at the Roadhouse. Probably not something Sam and Dean are looking forward to. But hopefully you are…
---------
So on we go
His welfare is of my concern
No burden is he to bear
We'll get there
For I know
He would not encumber me
He ain't heavy, he's my brother
The Hollies
---------
He Ain't Heavy, He's My Brother
Chapter Seven
The tension in the room reached a climax the minute everyone realized what was about to happen. What they were about to do.
Ellen was the first to move, focusing only on the moment, because she knew from experience that thinking ahead in certain situations would only paralyze her. And this was definitely one of those situations.
"Ash," she began. "Where are the supplies from the clinic?"
"In Dr. Bates' car."
"Why don't you go get them, and take them into the kitchen." Turning to the doctor, she continued. "Dr. Bates, what else do you need? Where should we do this?"
"We need to operate on a solid, flat surface. A table, if you have the right size and the right height, would work. We'll need boiling water at our disposal for sterilizing. We'll need some good lighting. Betty will monitor his vitals during the surgery but you may have to hold a flashlight overhead if the light in the room isn't enough. We need…"
The doctor stopped when he heard Dean cry out in pain, followed by a rapid succession of shallow breaths.
Sam was already kneeling before him, trying to get Dean to relax, when Dr. Bates sat on the opposite side of the bed and placed the palm of his hand between Dean's shoulder blades.
"Focus on your breath, Dean. Long breaths, not short ones," he said, exerting gentle pressure as he spoke.
"Breathing…hurts."
"I know, the longer the breath the more painful. But trust me, it'll help in the long run. That's it, easy does it." The doctor worked his hand up and down Dean's spine, rhythmically, in step with Dean's breaths.
"That's right, just like that. One more deep breath, right, perfect. Keep it up."
Dean was still, his breathing even, within seconds, and Sam relaxed a little. Could it be that Bates really knew what he was doing? As much as he had begged for this, for a solution to the nightmare, he was filled with uncertainty.
"Has he had anything for the pain?" He was looking at Sam, but it was Ellen who answered when she realized Sam was somewhere else entirely.
"He took four aspirins a few hours ago."
Dr. Bates turned to his wife, his palm still pressing gently against Dean's back. "Betty, bring me some of the Demerol we picked up at the clinic. It'll relax him before we prep him."
Ellen quietly led Betty to the kitchen, leaving Sam and the doctor alone with a semi conscious Dean.
"Dean, do you have any allergies that you know of?" Dr. Bates asked.
"Hmm." Dean was battling the pain, not strong enough to answer, or cognizant enough to care, and the doctor turned to Sam.
"Any allergies, Sam? That you know of?"
"No, none that I can think of."
"Is he taking any medication?"
Sam shook his head.
The doctor watched Sam carefully. Now that he had agreed to do this, it was imperative that he gain his trust. There could be no second guessing him once Dean was under the anesthetic.
"University of Michigan Medical School, 1937," he volunteered.
"What?"
"Where I went to medical school, the year I graduated."
Sam looked up at the doctor, the questions silently pouring out of him. What could he say? I'm worried that you're almost a hundred years old? That you were born before insulin was discovered? Decades before the polio vaccine and pacemakers hit the market?
"I didn't doubt." Was all he could say.
"I know. I was just offering. I was an Army doctor during World War II."
"Like Hawkeye Pierce in MASH?" Dean loved that show when they were little. So much that Sam had been scared Dean would join the Army the minute he was old enough.
"Not quite as glamorous. But I did spend six months in France, near the front lines."
"Did you do any appendectomies in the field?"
"No. I did a lot of amputations. A lot of sewing." A sharp intake of breath from Dean sent the doctor in another direction. "Just relax, Dean. That's right, deep breath. I know it hurts but not for much longer. That's right, just like that."
"Sam." It was a muffled cry as Dean buried his head in his pillow, another pointless attempt to squelch the misery.
"I'm right here."
Dean didn't say anything else. He just needed to know that Sam was still there. Still with him. The incessant pain was making it difficult to string together more than a couple of words, and when he tried it came out in gasps, an incoherent babble that didn't come close to what his brain wanted to say.
Sam took Dean's hand in his and held it, the heat radiating from it sending chills up his arm. He could see from the expression on Dean's face the unrealistic control he was exerting, the undeniable strength that had sustained his family from one tragedy to another, and he wondered how his brother did it.
With an unexpected force Sam finally understood what a crushing blow their father's death had been to Dean. His brother had spent a lifetime pursuing an ideal, a model of family set forth by the loss of a mother, by an unrepentant and demanding father, by his own desires to be wanted and needed. It was an ideal that was unrealistic in the best of circumstances, impossible in theirs. And yet Dean never realized he was chasing a dream. Not when Sam left for Stanford. Not when his father died. All he saw was failure. An inability to maintain what was expected of him. What he expected of himself. His father's death meant more to him than simply missing the man, it was the end of a purpose. His purpose. Sam felt the tears fall and ignored them.
When he could no longer stand to dwell on his thoughts, when his heart couldn't take it anymore, Sam forced himself to look away. To see something besides his brother's pain. Dr. Bates was gently massaging Dean's neck and Sam was grateful when he spoke to him.
"There's a lot of tension here," Dr. Bates said, pretending he didn't see the tears Sam had yet to wipe off his face. "Probably the most valuable thing I learned from being a medic during the war."
"What's that?"
"Half the battle is helping the patient relax. In cases of extreme pain, like this one, the adrenaline cursing through your brother's body is enough to keep him on high alert. So even when the pain lessens the adrenaline makes it so it doesn't feel any different. If the patient can relax, the adrenaline diminishes, offering marked relief."
It made sense, even to Sam, who had been on his own version of high alert for hours.
"How's he doing?" Ellen had just entered the room with Betty, who was carrying a small tray that held a medicine bottle, a syringe and a few other things Sam couldn't make out from his position on the floor.
"About the same," the doctor offered. "Sam, switch sides with me. You rub his neck while I administer the Demerol."
"And what is Demerol, exactly?" Sam asked as he walked around the bed. He suddenly felt so responsible for his older brother, and he wondered if this was how Dean felt about him all the time.
"It's a narcotic analgesic, pain reliever," Dr. Bates clarified. "Often used on pregnant women, during and after labor." Dr. Bates lowered his voice to a whisper before continuing. He wasn't sure how much of the conversation Dean could follow, if any, but he didn't want to increase his anxiety with more information than he needed.
"Would not be my first choice if I had another option."
"Why not?" Sam asked.
"There's other stuff out there, with better sedative qualities, fewer side effects. Ideally we would put him out of his misery now, administer the versed before transferring him, but we can't risk using any more of it than we have to. I'd rather have it in the back end."
"Versed?"
"It's a benzodiazepine." Sam raised his eyebrows and Dr. Bates tried again. "It's a tranquilizer, a sedative commonly used in pre-op. Quick onset, short duration, halts the formation of memories."
"Halts what?"
"That's the beauty of it. It keeps the patient from remembering anything that happened during surgery."
"So that's the anesthetic?"
"Not by itself. By itself your brother would be writhing in pain the entire time. It's a muscle relaxant, gets us halfway there. In combination with the nitrous oxide, Dean will feel no pain and remember nothing."
"Isn't nitrous oxide laughing gas?"
"Right. On its own it's not strong enough to be used as a general anesthetic, but with the versed it should work out fine."
"Should?" Sam was hoping for stronger words.
"We're making due with what the clinic had, Sam, but don't worry. The combination of the two will do the job."
It was more information than he could process, and Sam wondered how much more was coming. He stopped asking questions and watched as Betty tied a thick rubber band on Dean's arm before searching for a vein. When she had found what she was looking for she rubbed the area with a cotton swab drenched in alcohol and handed her husband the syringe.
Dean didn't have the strength or the presence to hold out his arm, so Betty held it in place for her husband, whispering words of comfort Sam didn't think his brother could hear.
"Excellent vein. Nice and plump," Dr. Bates said right before administering the injection.
Sam held his breath while Bates worked, amazed the man could keep his hands steady long enough to perform the simple task.
"Hmm." It was Dean's attempt to acknowledge the needle.
"All done," the doctor said gently, feeling Dean's wrist for a pulse. "That should make you feel better in a few minutes."
Sam stood still, trying mindlessly to ignore the early signs of dread. Just seeing the needle go in his brother's arm had made him lightheaded and nauseous. Did he really think he could cut him open and take out his appendix?
"Sam," the doctor said, interrupting his thoughts. "Rub his neck, the way I was. We need to relax him as much as possible before moving him. That's going to be a bitch."
"What?" The doctor's choice of words seemed so out of place coming from the little wrinkled man before him.
"We are going to have to get him into the operating room, wherever that's going to be, soon. And moving him isn't going to be a pleasant experience."
Sam rubbed his eyes with the palm of his hand. Could they torment his brother any more?
Ellen moved closer to Sam and stood directly in front of him. Dean wasn't the only one she had been worried about all afternoon, and it wasn't the first time she had wondered if Sam was going to be okay. As solid as he appeared in his quest to protect his brother, she knew the fear was just beneath the surface, threatening to derail his best intentions.
"Hey, you all right?"
Sam brought down the hand from his face, but avoided her gaze.
"Yeah, I'm fine."
"Listen, you're not doing this alone. I'm going to be right there with you, okay?
Sam nodded, looking into her eyes for a brief second, long enough to know she meant it.
He moved back to Dean's side, to follow doctor's orders and begin rubbing his brother's neck, when Dean called out to him.
"I'm right here."
"Going to…throw…up."
"What?" Sam looked up at the doctor and back at Dean, who was gagging, his hand over his mouth.
Betty sprung into action immediately, grabbing a trashcan from the corner of the room that she placed as close to Dean as possible, while her husband shouted instructions.
"Lift his head, Sam, his upper body. Hurry."
Sam did as he was told, wincing with the effort it took to maneuver his brother's nearly dead weight. With the effort to ignore Dean's cry of agony as his body was yanked up and thrust forward.
Dean shook violently, his body refusing to cooperate, to stay in one place unless Sam held it there. He gagged once, twice, three times, and each time nearly passed out from the effort. By the fourth time it was obvious there was nothing in him, nothing he could get rid of that would make him feel better. The dry heaves that followed only confirmed the obvious.
By the time the nausea had passed several minutes later, Dean's body sagged against Sam's, his head leaning forward, his skin clammy. He was listless and barely conscious, the only sign of life a low whimper that sounded like humming.
Sam held on with sheer will, his head buried against Dean's neck, unable to let him go. Even his own breath was shallow as he closed his eyes against the overwhelming warmth of his brother's skin.
"Side effect of the Demerol," the doctor was saying, trying to get Dean away from Sam, into a more comfortable position.
But Sam had other plans, and the grip on his brother was more than the doctor could handle on his own.
"Sam, it's okay. Let him go." Ellen was tugging at his arm.
Sam pulled his head back gradually, all eyes boring into him as he slowly released his brother, carefully placing his head on the pillow before pushing himself off the bed and standing.
Dr. Bates immediately leaned over the bed and checked Dean's pulse. It was fast and thready, a sure indication that shock was setting in, but he kept the assessment to himself. Elevating Dean's feet above his heart might help a little, but the trauma of moving him would most likely cancel any of the benefit.
"This is bullshit!" Sam said, his emotions tightly held, the anger in his tone. "We cannot waste any more time. Ellen, please help Dr. Bates figure out where we should do the surgery, set up what he needs, whatever you have to do so we can get started as soon as possible."
"Right." Ellen was pleased with the shift, with the fury in Sam's voice. It was the only emotion he could afford to have right now, anything else would be dangerous. She moved quickly, ushering the doctor and his wife out of the room, but not before Dr. Bates turned around with a list of instructions.
"Sam, be alert for any respiratory problems. I doubt he'll have any, but it's another side effect of the Demerol. And work on relaxing him. Talk to him. Reminisce about something you did that was fun when you were younger. Anything to distract him."
Sam almost laughed out loud. Anything fun that happened in their lives happened before his six month birthday. And he was hard pressed to remember what that was.
"Sam." It was so low Sam almost missed it.
Sam took a deep breath and forced a shift. He did not want his brother to see him this way. Angry and frustrated. Scared.
"Hey." Sam sat directly across from Dean and lowered his head to meet his brother's gaze. It was remarkably clear and focused and Sam blinked back his surprise.
"You sure…you want…to do this?"
Sam had to lean forward to catch everything, Dean's voice a breathless whisper.
"What?" Sam knew what he meant, where he was coming from, but couldn't deal with selfless Dean just then.
"You…don't have…to."
"Yes I do." Sam put his hand on Dean's head, the warmth for an instant making him feel better.
"If something…happens…not your…fault."
And there it was. If something happened, if Dean died at the hands of his brother, Dean couldn't bear the thought of what that would do to Sam.
Sam took a deep breath, hoping it would give him the infinite amount of patience he needed to continue the conversation, to allay his brother's fears.
"Nothing is going to happen, Dean. Dr. Bates knows what he's doing. He worked as a medic in the front lines, during the war."
"The…civil…war?"
And at that Sam really did laugh out loud. He didn't think Dean had been coherent enough to notice Bates was prehistoric. It's what made him such a good hunter. Nothing got by him.
"Very funny. I'll have you know he's got a very firm handshake."
"Thank…God."
Sam could actually see some of the pain dissipating, Dean's features not so strained, his jaw relaxed. Maybe the Demerol had taken the edge off after all.
"And why…is…Grandma Moses…with him?"
"Betty?" Sam laughed again and marveled at his brother's ability to help him relax.
"That's his wife. I think she might have been a nurse or something. She seems to know what she's doing."
"I hope so." It was the only morsel Dean offered that showed any apprehension, any fear.
"It's going to be okay."
It felt so good to be having a real conversation with his brother, and Sam hoped his voice carried enough confidence for both of them.
Dean looked at Sam for a long moment, focused on the fear his brother was trying desperately to hide. He wanted to tell Sam that he trusted him, that he knew he was in good hands. He wanted to reassure him. But only one word kept repeating inside his head.
"Sorry," he finally said.
"For what?"
He wanted to apologize for being distant and hard to talk to, when he knew it was the only thing Sam ever wanted from him. For a million things he'd said and done during a lifetime of dysfunction. Mostly he wanted to apologize for keeping secrets. For honoring his father and not his brother.
"What are you sorry about, Dean?"
"For getting sick." He couldn't do it. Didn't have the strength or the energy to bare his soul. To betray his father. So he could relax again. So he could look his brother in the eye again.
"Like you could help that. What you should be sorry for is pretending that you were okay when you weren't." Sam couldn't stop himself. "You should have said something, man, we might have avoided this whole back roads medicine stuff."
"Only had a headache when we got here, Sammy. Who knew?" Dean's eyes were fluttering, and he was having a hard time staying awake, his voice soft and sleepy.
Sam was almost sorry to see it. For the first time in hours he could breathe, think straight. The energy he gained from a lucid conversation with his brother surprising him.
"Dean."
"Hmm." Dean forced his eyes open.
"Never mind." It was selfish, he knew, trying to extend the conversation to build his reserves for what was to come.
"Sam?" There was so much Dean wanted to say, needed to say, but he could barely keep his eyes open, the lids falling helplessly against his will.
"Yeah."
"Thanks." That would have to do for now.
"Don't mention it."
Sam watched his brother sleep, and found it hard to believe that a year ago he wasn't sure if or when he would ever see him again. He had missed him, deeply in the beginning, but then, with time, with the memories fading, with Jess' help, he had felt whole again. Now he knew it had been an illusion. Jess had filled a gaping hole, but nothing could replace the space his brother filled. The sheer volume of shared tragedy and hope made that impossible.
"Sam, we're ready for him." Ellen was at the doorway. She looked so small, her voice so low. It hadn't occurred to him that she was probably terrified.
"Hey, Ellen, I, we, we never even discussed this. I mean, I didn't even ask if it was okay, to do this here. In your house." Sam was stumbling. Now that the time had actually come his mind was all over the place, asking Ellen for permission was just one of many things short circuiting his brain.
"It's fine, Sam. Don't worry about that. If this had to happen I'm glad I could be here to help." She knew Sam was having second thoughts, questioning his every move. It was impossible for him not to.
"Listen," she continued. "I know you're scared. I'd be scared if you weren't. And I have to say, I had my reservations about Bates, the guy's ancient, but he's sharp as a tack. And Betty was his nurse for most of his career. I just saw them in action, and they're in sync. They know what they're doing, and they're not scared. Truth be told, I think you've put a little spring in their step. This is probably the most exciting thing they've done in 30 years."
Sam had to smile at that.
"You're in good hands," Ellen added. "Dean's in good hands. And I will be next to you the whole time. If you get overwhelmed, at any point in time, I will be there to help. Okay?"
Sam took a deep breath and nodded, looking at his brother as he spoke. "If anything happens to him."
"Don't, Sam. Don't do that to yourself."
Sam nodded again, wiping his eyes with the back of his hand.
"So," he said, forcing himself to the present. "Where are we doing this?"
"The kitchen. I found an eight foot banquet table in the garage that's perfect. We cleaned it with boiling water and then drenched it in Betadine."
"Betadine?"
"It's a disinfectant you can apply to the skin. According to Bates, it's almost always used on surgical patients. Ash must have nabbed a year's supply from the clinic, because we've saturated just about everything in the stuff. We boiled all the instruments for about 10 minutes, and then soaked them in Betadine for good measure."
Sam stopped listening as the reality of what they were about to do began to sink in.
"Sam?"
"Huh?"
Ellen was looking at him with a funny expression, and Sam wondered how many times she had called his name.
"Dr. Bates feels the least painful way to move Dean would be to carry him in your arms. But if you can't, if he's too heavy, Ash said he'd help."
"No, I got him."
"Okay then, whenever you're ready." Ellen was still focusing on the moment, not a second ahead.
Sam bit his lower lip and searched his brother's face for any clue that he was awake, that he was listening. There was nothing. Only the warm glow from the fever betraying just how sick he really was.
Gently, praying silently that he wouldn't wake up, Sam pulled back the covers and slid his arms underneath Dean's body, behind his knees and behind his shoulders, careful with the injured arm, and lifted him up. Dean's solid frame was all muscle, and Sam was making every effort not to grunt under the weight. He didn't want to give his brother any reason to stir.
Unfortunately, Dean's appendix didn't share Sam's compassion, and the sudden movement sent Dean gasping and out of his drug induced slumber.
Disoriented and groggy, Dean thrashed in agony, trying to get away from the hands that held him, that were causing him so much pain.
Sam was doing his best to hang on to him, terrified he was going to drop him.
"Dean, stop, it's me, Sam. Dean, calm down."
But Dean couldn't hear him above the crushing wave of panic.
Ellen stood in front of Sam, her body pressed against Dean's, her hands sliding under him, beside Sam's, attempting to control the flailing, the thrashing. She left the talking to Sam. If Dean was going to hear anyone, it was going to be his brother.
"Dean, please. Stop."
Dean swung an arm in the air and caught Sam squarely in the jaw, forcing him to stumble backwards. The lingering pain did nothing to ease Sam's fears, but he swallowed it and tried again, tightening the hold on his brother. Where was all the strength coming from? Shouldn't he be weak with fever? Pain? Was it adrenaline wreaking so much havoc?
"DEAN! STOP!"
Sam? Sam, is that you? Run, Sam, don't let them get you. They've got me, Sam. Run.
"DEAN!"
"Sam." It was said through a gasp, on the run, to no one in particular, and Sam realized his brother was lost.
"Dean, look at me. It's me. I'm right here. I've got you."
Dean's eyes were wide, unfocused, darting back and forth between Sam and Ellen. Trying desperately to find their way back. Their way to Sam.
"Look at me, Dean."
The breaths came quickly as the spasms intensified and the frenetic energy disappeared, leaving Dean spent, limp, against his brother's arms.
"Sa…"
"It's okay. I've got you. I'm right here."
Sam looked at Ellen and nodded, her signal to step back, to give them both some privacy.
Dean's face was tortured with confusion, his eyes wet, and Sam held him closer.
"Hurts." It was faint. A mild rumble against Sam's chest.
"I know. We're on our way to make it stop." Sam was gentle, and calm, and Dean clung to him as they made their way to Ellen's kitchen, to the operating room.
---------
Still with me?
Please let me know your thoughts, your comments. I so need to know you're ready for Dr. Sam. :-)
