Fighting to Breathe Ch. 8

Author's Note: Sorry for the long wait. I have been fighting severe bronchitis complicated by a slight case of pneumonia.

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Previously: Pulling up a chair between the two brothers, Bobby sat down to watch over the two brothers mumbling about how they were going to be the death of him someday. Grabbing the old tome he had brought with him to work on translating, he began to write notes in the margin of the book as he kept an eye on both brothers. A few hours later, he noticed that Dean was becoming agitated in his sleep. He was about to shake him awake when the alarms on Sam's heart monitor started blaring.

Hearing the sound of the loudly ringing monotonous tone, Dean was instantly pulled from his sleep as he quickly got up off of the cot and rushed over to his brother's bed. "Sammy!" he cried out in alarm as he glanced furtively over to the heart monitor to see the rapidly squiggling lines suddenly turn into a long straight line. "Oh my God no." He whispered as he threw hand over his mouth just as medical personnel came rushing through the door, a medical 'crash cart' being pushed ahead of them.

"He's straight-lined people, let's get a move on it." Dr. Kelly informed his team as he immediately began CPR on his patient and began calling out orders. "Janice, get Sam off the ventilator and hooked up to an ampubag and start bagging him now. Sarah, bring that crash cart over here and set the defibrillator for 300 jules. Shannon, I need an injection of epinephrine IV push now." Dr. Kelly watched as his nurses followed his instructions quickly and efficiently. Removing his hands for just a second, he allowed Sarah to place the electrodes on Sam's chest before staring up CPR once again.

Once Shannon had injected the epinephrine into the IV, Dr. Kelly stopped his CPR and took the defibrillator paddles that were now being handed to him as Janice squeezed the ampubag, forcing air into Sam's lungs. Placing them in the proper position, he called out "Clear" and waited for just a second before depressing the paddles and watching as Sam's body arched up off the bed. Seeing no change on the heart monitor readout, he called for the machine to be set to 350 jules.

"Come on Sammy, don't you dare give up on me." Dean pleaded as he stood back out of the way, silent tears trickling down his face as he watched the doctor and nurses frantically trying to save his little brother's life.

Placing the paddles on Sam's chest once again, Dr. Kelly called out "Clear" and pressed the paddles to deliver another electrical shock to his patient's body. Focusing his attention on the heart monitor, he breathed a sigh of relief as he watched his young patient finally settle into a more normal sinus rhythm. "Yes, we've got him back." the doc stated as he ran his hands through his hair.

"Shit, that was way too close." Dean gasped just as his knees went weak and he started dropping to the floor, his descent was stopped however as Bobby grasped him by the arms and braced him up.

Leading Dean over towards the cot, Bobby said, "Sit down before ya fall down Ace." He could see how pale Dean was and was worried that the kid might actually pass out on him.

"Thanks Bobby." Dean voiced as he scrubbed a hand across his face and watched as the medical personnel in the room evaluated his brother. "Damn it, why can't things ever be easy for us?" He questioned as he watched his baby brother being placed back on the ventilator.

"Fate just seems to have it in for you Winchesters." Bobby mumbled quietly to himself as if in answer to Dean's question. He couldn't remember a time when they didn't have to fight just to get by in life. Well, if he had any say so about it, things were about to change in that regard. He was going to make sure those boys went home with him once Sammy had recovered enough and the boys were going to take a break from hunting whether they wanted to or not.

Once he had made sure his patient was as stable as possible for someone in his condition, Dr. Kelly, walked over to where his brother an uncle were now sitting. Kneeling in front of the obviously distressed big brother, he placed a supportive hand on his knee. "Dean, you look a little pale, are you feeling okay?" He questioned as he placed his fingers around Dean's wrist and took his pulse, finding it to be a little more rapid than he would have liked.

"I'll be okay just as soon as I know Sammy's okay" Dean answered in response. "What the hell just happened doc?"

"Your brother suffered a life threatening arrhythmia known as ventricular tachycardia just now. What that means is that Sam's heart was working overtime to try and make up for the trauma to his lungs and it led to what is known as sudden death, where the heart quit beating. We we're able to get Sam's heart started again by administering a shock to the heart by defibrillation. I know it all sounds overwhelming right now, but Sam's condition is as stable as it can be for someone in his condition." Dr. John Kelly explained trying to put things in laymen's terms for the hunters. "For now, I want you to make sure you take care of yourself. You're not going to be of any help to Sam if you end up in the hospital yourself suffering from exhaustion."

"Don't you worry doc. I'll make sure he gets the rest he needs." Bobby stated with conviction evident in his voice since the last thing he needed was both of his boys being laid up in a hospital bed.

"I'm sure you will, the boys are lucky to have you in their corner." The doctor stated before reaching out to shake Bobby's hand. Checking Sam's vitals once more, he quietly charted his pulse and blood pressure readings before leaving the room.

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Returning to his office, Dr. John Kelly sat down to take a breather from all of the excitement in the ICU. He was looking forward to kicking up his feet and laying down on the couch in his office for an hour or so of rest before having to make his rounds again. Removing his doctor coat, he tossed it on a hook and had just sat down and was about to remove his shoes when he heard a quiet knock upon the door. Heaving a sigh, he called out "Come on in."

Glancing towards the door, he smiled as he saw Shannon approaching with a medical file in her hands. "I take it you have the results of Sam's tests?" He inquired as he reached out to take the file.

"Yes doctor. I knew you would want to see them right away with everything that's happened." Shannon answered as she handed them over.

Opening the files, Dr. John Kelly began to scan the results of the labwork and X-rays. "Son of a bitch, I was afraid of this." He said as he threw the file onto his desk and hung his head. Damn but he hated delivering news like this to the family of his patients. He couldn't help but feel like he was partly to blame when incidents such as this happened under his watch.

"John, are you okay?" Nurse Shannon asked in concern seeing the agitation upon the doctor's face.

"Yeah, I'm fine. I just hate having to inform Sam's family that the measures we have taken to save Sam's life have also put him in even greater jeopardy." John answered as he reached over and read through the file once again to obtain all the information before trekking back to his patient's room to give his family the results of the test.

Walking into the Intensive Care Unit once again, John took a deep breath before entering Sam's room to find that Dean and Bobby had taken up their positions on either side of Sam's bed as the kept a watchful vigil over their youngest. Clearing his throat, John said, "Dean, I have the results of your brother's test."

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Once the doctor had rechecked Sam's vital signs and left the room, Dean and Bobby pulled up chairs beside his bed needing to feel close to their youngest after having nearly lost him. Reaching out to card his fingers through Sam's hair, Dean shivered knowing that it was still a distinct possibility since Sam was on life support and that there was no guarantee that he was going to survive the fight. "Sammy, I know you're tired little brother, but you've got to keep fighting. You can't give up man. I need you here with me. I can't do this without you by my side dude." Dean whispered as he lay a hand on Sam's chest to feel the rise and fall indicating his brother was breathing, even if it was mechanically by ventilator.

It nearly broke Bobby's heart in two as he sat and watched Dean pleading with his brother to fight. Dean was always the tough guy, acting strong in front of everybody, afraid to let his emotions show fearing they would make him look weak. So at moments like this, when he did allow those walls to fall, it made them much more heart rending to see. Closing his eyes, he said a little prayer to the God that Pastor Jim so fervently believed in and asked him to watch over Sam and give him the strength he needed to overcome the trauma to his body.

Hearing the sound of someone approaching, Dean and Bobby both looked over towards the door in surprise to see Sam's doctor entering the room once again. "Doc?" Dean questioned wondering why the man was returning so soon.

"Dean, we've got Sam's test results back and I knew you would want to hear them." John stated as he rubbed the back of his neck with his free hand in nervousness.

Leaning forward in their chairs, Dean and Bobby both focused their attention on the doc, waiting to hear what he had to say.

"The blood work and x-rays that we did earlier show that Sam has contracted ventilator-associated pneumomia which is more commonly known as VAP." John said as he delivered the diagnosis which was the cause of Sam's fever and ultimately the cardiac arrest earlier.

"Wait a minute, what the hell is that?" Dean asked the doctor having never heard of the illness before.

"It's a sub-type of hospital-acquired pneumonia which occurs in some patients when they have been on a ventilator for at least forty eight hours, sometimes more." Dr. Kelly answered in response to the question.

"So you're telling me that Sammy got sick and is even worse off now because of that damn tube that's stuck down his throat?" Dean gritted out through his teeth as he clenched his fists wanting to hit somebody or some thing.

"Dean, I understand you're upset and you have every reason to be since normally, things like this don't happen very often. But there are times when microorganisms attach themselves to the endotracheal tube and make their way into the lungs with each breath the patient takes. Because Sam's lungs are so weak right now, the bacteria was able to set in and caused an infection in his alveoli or the air filled sacs that line Sam's lungs. We're going to do everything we can to fight the infection and hopefully with a little luck, we'll be able to get a handle on it quickly and Sam will soon start improving." John voiced hoping his words would be prophetic.

"And if you don't get a handle on it?" Dean questioned irritably.

"Then Sam's chances of surviving the next forty eight hours drop dramatically." John answered honestly feeling he owed it to the family to be truthful.

TBC