About those reviews – unbelievable. Thank you so much for every single one of them. Once again I've responded – once again alerts are sporadic. I hope you know how much I appreciate them.

a/n – Since I rewrote the last chapter, I had to rewrite the rest of the story, which meant more research. Hopefully my intent to be as accurate as possible will come through. In between all the gasping and the suffering. :-) Thanks for sticking with me this far – we're down to the wire, only one chapter left. Unless Sam develops sympathy appendicitis…don't even go there. Thanks to GS. She knows why.

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He Ain't Heavy, He's My Brother

Chapter Nine

The implication of Betty's statement registered in Sam's brain in slow motion, as he was trying to figure out why Dean's arms were shaking, why Betty was removing the oxygen mask. By the time he realized what was happening, only seconds later, all hell broke loose.

Dean's movements became a constant. Weak, as if he was swimming against the tide, but enough to prevent Sam from finishing the sutures. From doing anything besides stare at his brother's body, mouth open.

"Shit!" Sam appreciated that Bates was a man of few words, but in this particular instance, he was hoping for something a little more helpful.

"Betty and Ellen, hold on to his upper body. Sam, hurry, finish the sutures." Dr. Bates had both hands on Dean's legs, struggling to keep him still.

"Wait. What?" Sam was trying to sort what was happening. "We're out of nitrous? Don't we have more?"

"That was the only canister at the clinic." Bates was having a hard time controlling Dean's movements. "Sam, there's no time for discussion. If he tears the stitches you've already done it's going to be worse. You have to finish. NOW."

Sam chose denial. "No. No. He can't be waking up. I can see inside. He's still open."

"Nitrous leaves the system fast, Sam. In a few minutes there won't be any left in him."

Sam forced himself to concentrate, to ignore the shaking in his hands, as he tried to continue. But then he heard it. The sound of Dean's voice as he fought against the pain.

"Nooooo. Stop." It was a strangled cry, a plea for help, breathless with every implication of torture. Impossible for Sam to deny.

The urge to run to Dean's side was overwhelming, and Sam couldn't take his eyes off his brother's face.

For a moment Sam was giddy, lightheaded with the knowledge that this latest turn of events was just one in a string of many. What else could he expect in a day filled tragedy and despair if not more of the same. What next? Maybe the generator would go out. Or maybe the house would be hit by lightning and catch on fire. The rain would stop, of course, the minute the house was on fire.

"Sam, you have to finish. The longer the incision is open the greater the chance for infection."

Sam looked from his brother to the doctor, and then at the incision. The delirious thoughts gone, he was still unable to fully grasp what was being asked of him. He was only halfway through the first layer. The first layer of delicate tissue protecting his brother's intestines.

"Hurry, Sam." Bates didn't have a lot of strength, and even in his weakened state Dean was more than he could handle, his legs twitching convulsively underneath the doctor's arthritic hands. Ash tried to help, but he found it impossible to keep the flashlight steady while trying to control Dean's movements.

Sam ignored the screaming in his ears and went back to the sutures, tying off one more stitch as Dean pressed his fists hard against the table, at the same time letting out an obscenity that reverberated around the room.

"Why is he talking? How is this possible?" Sam was in a panic, his hands shaking so badly he had to clasp them together to keep them still. "Is the other stuff you gave him out too?"

"No," Bates answered, looking at the IV line. "But it doesn't block out the pain. It's a sedative, a muscle relaxant, which is why he's still weak and not jumping off the table."

Dean's body jerked violently and Sam instinctively pressed a hand against his chest.

"You call this weak?"

"You have to finish, Sam. He won't remember any of this." Dr. Bates chose to ignore the fact that Sam had just contaminated himself by putting a hand on Dean's chest.

Sam took a shallow breath, all he could manage as he fought against the pressure building in his head. It had been hard enough to operate on his brother when he'd been unconscious. This was impossible.

"Sam." It was Ellen. "Let me finish. You take over for me."

Sam looked at her through a haze and handed her the needle, still attached to the thread, still attached to Dean.

"Betty, I need a pulse." The strain of the physical exertion was evident in the doctor's voice.

"I can't get to it." Betty was using all the strength in her own frail body to keep Dean's upper body still.

"Here, let me." Sam walked to the end of the table and took over for both Betty and Ellen, placing his own long arms on top of his brother's. Leaving bloody marks wherever his hands rested.

"Hurry, Ellen." It was hard to tell through the coke bottle glasses, but Sam could swear there was fear growing behind the doctor's eyes.

"Pulse is 107."

"Stop!" With a violent jerk Dean's eyes flew open, briefly, registering nothing. His breath shallow, he began moving his head from side to side, a passive movement at first, but gaining strength as the pain intensified. As he tried to get away from it.

"Shhh. It's okay. It's almost over." Sam looked at Ellen, his eyes imploring her to hurry.

Dean was breathless, sweat pouring down his face, and Sam could only imagine what it felt like to have the tissues inside your body pulled together by a needle and thread.

"Dean, it's okay. Relax. It's almost over." Sam wasn't sure his brother could hear him, but he leaned as close to him as possible and began to hum a medley of Metallica songs. A Winchester lullaby.

"Done with the first layer." Ellen's voice was steady as she painted more Betadine inside Dean before stitching the outer layer.

Sam kept humming, exerting more pressure against Dean's upper body when he began to fight again, when Ellen started the second set of sutures.

"Almost done," Sam whispered in between verses.

Dean's eyes were fully open now and their vacant stare sent a chill through Sam. The fact that he wouldn't remember this was a small consolation. It was everything else that had happened during the last 24 hours, the last 24 years, that had Sam worried.

"Saaaaaam!" Dean arched his back violently against the ambush and Sam felt like sinking into the floorboards, his heart pounding in his chest. He's lucid enough to call my name? Sam shook uncontrollably, finding it difficult to see straight. And yet, the pressure against his brother's body remained a constant.

"I've got you. It's okay. It's almost over." Sam's voice cracked with emotion as he bit back tears.

That's when he realized he was a part of Dean's arsenal. Along with the weapons, the holy water, the salt, along with the dry wit and the sarcasm, Sam was part of the armory Dean kept for protection. So even in a semi conscious state, Sam's name spilled out, its promise not necessarily to keep him safe, but to keep him sane. The awareness, and the pressure that came with it, was staggering.

"Betty?"

"125. BP's 70 over 45."

"Ellen." Dr. Bates didn't need to finish, the tension in his voice was clear.

"I know," she replied, calm, steady. "I'm going as fast as I can."

"Stop, please, stop." It was weak, the fire gone as the shaking waned, as Dean succumbed to the overwhelming pain.

Sam brought a hand to Dean's face, to wipe the tears, and regretted it instantly. His hands were covered in blood, and the sight of it on his brother's face made him gag.

Betty didn't miss the reaction and placed her own hand on Sam's arm, her 90 pound body allowing him to lean into her until the nausea passed.

"Please." It was so low only Sam heard it, and he wondered how deep his brother had to go, how far away, to survive the assault.

"Done." Ellen had tied off the last stitch and was painting generous amounts of Betadine on the incision, preparing the area to be bandaged.

As soon as he felt it was safe Dr. Bates released his hold on Dean's legs, the awkward fingers in his left hand jutting out stiffly as he tried to massage some life back into them.

"Betty," he said, his voice low with emotion. "Give Dean the last of the versed. It's right here on the table. That should keep him sedated for a while."

Betty nodded, feeling for a pulse one more time. "Pulse is 110. But his BP is still 70 over 45."

With the stabbing of the needle gone, with the incision closed, Dean settled against the table, eyelids fluttering until they fell.

Sam released his hold on Dean's arms and watched his brother sleep fitfully, his breath catching every few seconds. Every time the pain registered.

Without thinking, Sam took off his bloody gloves and grabbed a wash cloth from the card table, soaking it in the pot of water Ellen had used earlier for sterilizing the instruments.

With enormous compassion and care, Sam began wiping the blood off his brother's body. From his face, his arms, his chest. Slowly, methodically, working into a rhythm that dulled his senses, that distanced him from the carnage of the last hour and a half. In his own version of shock, Sam's brain protected him by turning itself off, preventing him from thought, from worry. For a moment, nothing existed besides him and his brother.

Ellen caught Sam out of the corner of her eye, just as she finished bandaging the incision, and bit her lip. An unconscious reaction to the weight she felt in her heart. She understood, from years of treating careless hunters, the meaning of pulse rates and blood pressure. It was a knowledge she didn't think Sam shared. And for that she was grateful. She caught Bates watching Sam and their eyes met briefly, the uncertainty of the situation, the sheer terror of what possibly lay ahead, left unsaid.

"Ash," Bates had regained his composure, his voice even. "Go and check your computer, see if anyone from the hospital has responded. If not, send out new messages to everyone. Give them my name, tell them what we've done, and that we need a medivac helicopter here urgently."

"What?" Sam was still cleaning his brother's body, still focused elsewhere, when he caught the tail end of the doctor's words.

Bates wasn't sure how much to say. How much Sam could handle. In the end deciding that some honesty was necessary.

"Dean's lost a lot of blood, Sam, which is why his blood pressure is so low. If it doesn't come up on its own soon he's going to need a transfusion." Dr. Bates paused, giving Sam an opportunity to process the information. "We've got nothing for the pain." He couldn't go any further. Didn't have the heart to continue with the litany of everything that was wrong, that could go wrong.

"What can we do in the meantime?"

"Henry." Betty was feeling Dean's pulse with one hand, his heartbeat with the other. "Ventricular tachycardia is setting in."

Dr. Bates was by Dean's side instantly, feeling his chest to confirm Betty's diagnosis.

"What does that mean?" Sam watched Dean's chest rise heavily, too quickly, his breathing labored.

"There's not enough blood flowing to his heart, so it's working overtime to compensate." Dr. Bates moved away from Dean to search through the supplies they had brought from the clinic, talking to Sam as he lifted bottle after bottle of medicine. "Tachycardia means rapid heart rate. Too rapid. Damn it!"

Dr. Bates set down the last medicine bottle and made his way back to Dean, his stride brisk.

"Betty, flashlight." As if she could read his mind, Betty had the flashlight trained on Dean's face before her husband finished asking.

Dr. Bates opened Dean's eyes, searching for movement, for anything that told him Dean was still there. Still with them. Satisfied, Bates stared into thin air for several seconds, deep in thought as he tried to figure out the best course of action.

"Betty, stop the versed drip."

"What?" Sam couldn't believe his ears. Wasn't that the only thing keeping his brother unconscious? The only way he could bear to look at him.

"We've got to bring his blood pressure up, Sam. The poor circulation is already affecting his heart." Bates looked at Sam, aware of the tenuous grip he had on his emotions, but he couldn't lie to him. "If it stays this low it's a matter of time before he goes into shock, which will shut down his brain and all his other organs."

"But what good will it do to take him off the drug? Won't he just suffer more?"

Dr. Bates was feeling Dean's neck for a pulse. "Betty, get me a temp reading. Lesser of two evils, Sam."

"What?" Sam still didn't understand. Why were they going to torture his brother?

Dr. Bates stopped his ministrations long enough to give Sam a better explanation. He had figured out that the brothers' strength derived from each other. If Sam faltered now, if he lost the unyielding faith that had gotten them this far, Dean didn't stand a chance.

"Sam, if we were in a hospital, he would be heavily sedated, and we would be giving him intravenous fluids to replenish a million things he lost during the surgery, not just blood but electrolytes, sodium, potassium, magnesium, calcium, that regulate bodily functions. He would have received a blood transfusion, and his blood pressure would be climbing." Dr. Bates paused, waiting for Sam to catch up.

"All we can try now are antiquated remedies that occasionally worked 50 years ago. And pray for the best."

"Antiquated? Occasionally?"

"During the war we used to give wounded soldiers salt water to bring up their blood pressure. It's what I'd like to try now. Actually, Ellen, do you have any Gatorade, or something similar?"

"Yeah, I do."

"That's even better. It's got some electrolytes already in the mix."

"But." Sam had seen Betty turn off the versed drip and kept looking over the doctor's shoulder for any sign that Dean was stirring. "Won't waking him right now be worse?"

"He's going to be in a lot of pain, Sam," Dr. Bates replied gently. "But he needs to be awake in order to drink the salt solution."

Sam clenched his jaw against the information and nodded, steeling himself for what was to come.

"Temperature's 104.1."

"Ellen, Betty, wipe him down with some wet wash cloths, try and get the fever down before he wakes up."

Too late. Dean was stirring, groaning lightly, before Sam could reach him.

"Hey."

Dean stared at his brother through eyes so clouded with pain Sam flinched.

"Talk to him, Sam," Bates whispered behind him. "It takes a while for the medication to wear off, and the low pressure will make him dizzy and disoriented, but we need him alert enough so he can drink, so he can swallow."

Sam nodded and looked at his brother again. He was pale, with deep, dark circles under his eyes. He took Dean's hand and squeezed it, his heart stopping when he got nothing in return.

"His hand is freezing," Sam said, certain it wasn't a good sign.

"That's because the arterioles are constricting." Dr. Bates replied, busy making the salt mixture.

"Henry!" Betty gave her husband an exasperated look. "As if Sam knows what an arteriole is."

"Sorry," he said. "The arterioles are small, muscular branches of arteries. They're trying to compensate for the low blood pressure by contracting, which increases resistance to blood flow, increasing the blood pressure in the arteries. The process makes the skin cold.

Sam had no idea what the doctor had just said, and turned to Betty. "Is it painful?" he whispered.

"It could be," Betty replied softly. "But it's probably the least of his problems right now."

"Can we get him a blanket at least?"

Ellen looked to Dr. Bates for approval.

"That's fine," he nodded. "Sam, speak to him. If he's too out of it to drink anything we can't help him."

"Hey." Sam was at a loss, unable to think of one meaningful thing he could say to his brother.

"Sa…m." And there it was. Dean was showing up for Sam, because Dean always knew when his little brother needed him to step up to the plate.

"Hey, man, how are you feeling?"

Dean was breathing in short gasps, and it took him a minute to answer. "Chest…hurts."

"That's the effect of the tachycardia," Betty whispered to Sam. Something about these brothers had touched her, and she felt a need to hover, to stand by just in case. "Put your hand on his chest, Sam, see if you can get him to breathe through the pain."

Dean felt Sam's familiar touch but couldn't connect it to the rest of him. Sam was a blur he could only focus on for seconds at a time, so he relied on memory to paint the picture of the brother he so desperately needed.

He couldn't remember what they'd been hunting, but by the way he felt he figured it was a nasty son of a bitch. His chest felt like it was caving in on him, more painful with every passing second.

"Try and take a deep breath, Dean."

"Did we…get it?"

It took Sam only an instant to realize that Dean was on a hunt.

"Sure did," Sam said gently. "You did. One shot. Perfect aim. Ugly bastard too."

"You…okay?"

Dying. His brother was dying and he wanted to know if he was okay.

"I'm fine."

"Dad…okay?"

Dean's breathing was ragged, and Sam looked to Betty for reassurance.

"Keep talking," she whispered.

"Dad's okay too."

"Thank…God." The words were spoken only in the exhale, the reverse irregular and painful, allowing nothing to escape.

"Deep breath, Dean."

Dean tried, for Sam, battling to stay conscious with the effort it took to breathe.

"Henry, we're losing him."

Dean was listless, going in and out of consciousness, and Dr. Bates tried to rouse him by gently slapping his cheeks.

"Stay with me, Dean, come on, open your eyes. Betty, vitals."

Dean's eyes fluttered and immediately rolled into the back of his head. Bates slapped him harder, causing Sam to jump in place.

"Pulse is 120. BP is 65 over 50."

Ellen was back with a blanket she was draping over Dean when Bates caught her eye.

"Ellen, do you have any ammonia?"

"Ammonia? You looking for smelling salts?"

"Yes. You have smelling salts?" Dr. Bates couldn't hide his surprise.

"I do," she said. "By the way, Ash hasn't received any response to his emails. He sent out new ones and is searching other avenues to try and get some help."

Sam watched in horror as Dr. Bates slapped Dean again. As his brother was forced to endure more agony, more misery than he thought humanly possible.

Dr. Bates held the smelling salts in front of Dean's nose until he gasped, his eyes opening slowly, his breath quickening when he saw the doctor. When he didn't see Sam.

"Sam," the doctor's voice had an urgency that made Sam shake. "The salt mixture's ready. Talk to him. We need his help."

"Hey, Dean, are you thirsty?"

Dean parted his lips and the words caught in his throat.

"Good," Sam said, pretending that was a yes. "I have something for you to drink."

Dean's chest was rising in tandem with his breaths, and Sam was afraid he was going to hyperventilate.

"Take it easy, man. Slow down."

"Chest…hurts…Sam."

Sam rubbed his eyes, finding it unbearable to watch his brother suffer any longer.

"Get him to drink as much as he can," Dr. Bates said, handing Sam a small plastic cup with a straw.

"Dean, I know you're thirsty. Here's that drink I promised." Sam was hoping the psychology would work as he tried to lift his brother's head.

"Let me,' Ellen said, going behind the table, out of Dean's view, and lifting his head. Dean groaned loudly, the slight movement putting pressure on his chest, on the incision, and Sam forced himself to ignore it.

"Here you go," Sam whispered, afraid that anything louder would hurt his brother. He put the straw in Dean's mouth and nothing happened. Dean couldn't close his mouth around it.

"Dean, I need you to drink this."

Dean looked at Sam, eyes pleading to be left alone.

"You've got to drink this, man. Just a little."

Dean moved his lips around the straw, his throat working as he tried to obey his brother. The mixture had the consistency of syrup, and made him gag as soon as it entered his mouth. The simple reflex sent another crushing blow to his body, but he didn't have the strength to scream in pain, only to shake, and whimper, and make that low humming sound Sam had been trying to forget for hours.

Sam looked at the doctor, not even trying to hide the tears.

"Try again."

"Hey, Dean. I know this stuff tastes awful, but you've got to get some in you, man. Come on."

The humming got louder.

Sam looked at Ellen, who was still cradling Dean's head. She had nothing to give him. Nothing to say that would make any of it better.

Sam put the straw in Dean's mouth and closed his lips around it, determination etched on his face.

"Dean." It was no longer a whisper. No longer gentle. "You need to drink this. And you need to drink it now. That's an order."

Ellen winced with the recollection. With the memories.

Dean stirred and the humming stopped.

The knowledge of what he was doing made Sam cringe. Nothing had bothered him more about his father than the way he talked to his sons. The way he bossed them around. And yet, in this very moment, he understood the man a little better. He had spent the last 20 years of his life running towards the thing that destroyed his future, while at the same time trying to make sure his sons had one. If they couldn't follow orders, how could he protect them?

Sam closed Dean's lips around the straw again.

"Now, Dean. Drink this now."

True to form, Dean followed orders, sucking on the straw and swallowing. At least he tried to swallow. But it was no use. What he could drink again made him gag, and as much as he wanted to do as he was told, he couldn't. The red liquid oozing out of his mouth and down his chin.

Sam nodded at Ellen and she gently lowered Dean's head.

Dean sounded like he was having an asthma attack, and Sam felt his own chest tighten as he wiped the liquid from his brother's mouth and chin.

"What now?" Sam asked, unable to face the doctor. To look away from his brother's eyes. What if he closes them and I never get to see in them again? Even unfocused and filled with pain, Sam was able to gain strength from Dean's eyes. From the way his brother saw him.

"Betty, start what's left of the versed."

"That's it? We're giving up?"

Dean was humming again, and Sam put a hand on his cheek.

"Hey, hang in there, okay."

Dean turned his face into the palm of Sam's hand and whispered something so low Sam couldn't hear it.

"What?"

Sam leaned closer.

"O…kay."

By the time Sam pulled back Dean's eyes were closed. But the humming continued.

"Pulse is 110. BP is 65 over 45."

"What's next? What do we do now?"

"Sam." What could he say? Your brother's dying? Pray?

"There has to be something else."

"He needs blood, Sam, to replenish what he lost."

"Okay." Sam was biting his nails, pacing the length of the banquet table. He looked from Bates, to Betty, to Ellen, their expressions blank.

Dean was humming.

"We have to get him out of here."

No one responded.

Sam looked outside, the rain wasn't letting up.

Dean was humming.

"Blood. He needs blood. We have to get blood."

No one responded.

Sam rubbed his hands through his hair, over his face.

The humming stopped. The quiet a deafening roar. A frantic screaming, pounding, beating inside Sam's head he couldn't bear.

Sam picked up a stool and threw it across the room, making a dent in the wall a foot deep.

Dr. Bates was scratching his head, deep in thought, oblivious to the bits of plaster falling on the floor. "Sam, do you know if you and Dean have the same blood type?"

Sam looked away from the wall, from the release he'd needed for hours. "I've given him blood before. Yes. We do."

"We could try that. If you're up to it."

Sam had given Dean blood once, right before he left for Stanford, after a hunt gone bad that left Dean in the hospital for two weeks.

"Doesn't my blood have to be processed, things added to it, before giving it to him?"

"Nowadays it does, because it's rarely transferred from the donor to the receiver quickly enough. But the first successful transfusions were done directly from donor to patient."

"Why didn't you suggest this right away?"

"It's risky. With some substantial complications."

"Like?"

"Once blood is out of your system, it coagulates fairly quickly."

"Coagulates?"

"It clots, making it unsafe to inject into someone else. We have no way of knowing if the blood we take from you, and inject into Dean, is clotting. All we can do is act fast, and hope it works."

"And if it doesn't?"

"A blood clot will kill him."

Sam looked at Dean, unconscious, his breath coming in short bursts as his heart worked to compensate for the low blood flow.

"This is it, isn't it?" Sam asked.

"What do you mean?"

"Short of getting out of here in the next hour, this is our only chance, right?"

Dr. Bates didn't miss the fact that Sam said, our only chance, not Dean's only chance. The implication being that if Dean died, Sam would too. Perhaps not physically, but Sam's soul would leave the minute his brother's did, the doctor was sure of it.

Bates nodded. "He was weak to begin with, Sam. The pain he suffered through all day took its toll, and we know his immune system is out of sorts. He's just not strong enough for the fight."

"Let's do it."

"There are other risks."

"I don't want to know what they are."

Dr. Bates turned to his wife. "I'm going to need you to do the extraction." Betty nodded.

"Ellen, have you ever administered an injection?"

"A few times."

"Good. You will need to inject Dean with Sam's blood. It has to be done slowly, or you risk an air embolism, but fast enough that the blood doesn't have time to clot."

"What's an air embolism?" Sam didn't like the sound of that.

"It's when air gets into the blood circulation. A bubble of gas can get lodged in the heart and…"

Sam put his hand up. He'd heard enough.

"Ellen," Dr. Bates continued, "I need you to boil some water, in a small pot so it doesn't take long, about five inches deep."

Dr. Bates busied himself looking for syringes in one of the boxes from the clinic. "Sam, I'd like to give him at least a pint of your blood to start with, it's what you would donate if you went to a blood bank. Is that okay?"

"Whatever he needs."

"Unfortunately, we don't have anything bigger than a standard syringe. I have to do the math, but we may have to poke you quite a few times."

Sam nodded. Could anything compare to the torture his brother was going through?

Right on cue, Dean began humming again, and Dr. Bates and Sam reached him simultaneously.

"Hey." Sam took Dean's hand in his and waited for a response.

But there was nothing, just the agonizing whimpers to remind him that his brother was in pain. Suffering through a fog of unimaginable proportions.

Dr. Bates was checking the IV bags, shaking one to make sure it was working properly.

"Please don't tell me we're out of versed."

Dr. Bates tapped on the tubing going into Dean's arm. "It's just a clog. But there isn't a lot left. We should hurry though. Every time we poke you we have to turn around and do the same thing to him."

"Can't we put the blood in an IV bag?" Ellen asked.

"It would enter into his bloodstream too slowly, increasing the chance of clotting."

Dean quieted down, but Sam could tell by his breathing that he was barely out.

"Water's ready," Ellen said.

"Good, just keep it boiling."

Bates found the box of syringes he was looking for. "40 cc," he mumbled. "Let's see, 30 cc is one fluid ounce, so 40 cc." Dr. Bates stopped talking and began calculating in his head. "Twelve," he said, startling Sam.

"Twelve what?"

"How many syringes we have to fill before we get to a pint."

Sam took a deep breath, the thought of it making him lightheaded. To his credit he said nothing as he took off the surgical gown he was wearing and rolled up his sleeve.

"Where do you want me?"

"Ellen, can you bring in one of the chairs that was in here?"

Ellen was back a few seconds later with a high backed chair Dr. Bates positioned in the middle of the kitchen.

"All right, Sam, you sit here." Dr. Bates had lined up the 12 syringes on the counter, and Sam tried to ignore them.

Betty tied a thick rubber band on Sam's right arm and looked for a vein, happy to see he had good veins that were easy to find. She only hoped they would last through the 12 extractions.

Sam took a deep breath and held it when the first needle went in, deciding right away not to look.

When the syringe was filled with blood Betty took it out and handed it to her husband, who immediately dipped the needle in the boiling water. Handing it back to Betty, she rubbed it with alcohol and squeezed out a tiny bit of blood, hoping to get rid of any trapped air bubbles. Ellen took the syringe while Betty tied another rubber band on Dean's right arm, getting him ready for the transfusion.

"Come on, Dean," Betty whispered, tapping his arm as she searched for a vein.

"What's the matter?" Ellen asked.

"Without his blood flowing properly his veins have shrunk. Here, here's a good one." Betty tapped Dean's arm once more for emphasis.

"All right, Ellen," Bates said, practically breathing down her neck. In the years since the arthritis had kicked in, he had never cursed it as much as he had in the last few hours. The frustration at not being able to properly take care of Dean himself was maddening.

Ellen waited while Betty rubbed more alcohol on Dean's arm, then began, having trouble finding the vein, finally getting the needle in on the third try.

Dean moved his head to the side with the prick of the needle.

"Slowly, that's it, perfect." Bates hovered while Ellen worked, counting in his head as he watched the blood disappear. "Excellent. Betty, how are you doing over there?"

"Here," Betty said, handing her husband another filled syringe.

By the third time, it was nearly impossible to find a vein in Dean's right arm, taking Ellen five attempts before successfully injecting the blood. Dr. Bates was monitoring Dean closely, and it was obvious he could feel every stab of the needle.

With the IV in the left arm, Dr. Bates had Ellen begin using the veins in Dean's left hand.

Two extractions later, and Sam's own arm gave out as he let out an involuntary cry when the sixth needle couldn't find anything.

"Sorry," Betty said gently.

Sam rolled up his other sleeve and said nothing.

Dean's hands were good for two injections each, and while the doctor pondered the location of other veins, he took a wet wash cloth and began rubbing Dean's chest with it. An attempt to break the fever and soothe the anxiety that was just underneath the surface. That was causing him to twitch and gasp every few minutes.

From Sam's vantage point he could see Dean's chest rising, could hear the muffled breaths, and he was finding it difficult to stay where he was. Twice he had tried to stand up, to go to him, and both times Betty had held firm, insisting he stay put until they were finished. Until he'd gotten something in his stomach to keep him from passing out.

"I'm afraid we have to go to the inner thigh," Dr. Bates said. "There are some good veins there.

Sam cringed at the thought, but kept his mouth shut.

Betty pulled the covers off of Dean's right leg and together with Ellen searched for yet another vein. By the time they found one Dean was not happy, and Dr. Bates had to place a firm hand on his forehead to keep him still.

"Is he awake?" Sam asked, forbidden by Betty to move.

"No," Bates answered. "But it's not the most pleasant place to get an injection."

With the tenth injection, while working on the left thigh, Ellen hit a nerve, causing Dean to throw his head back as he cried in agony.

Sam was on his feet and by his side in two steps, his hands barely reaching the table as the room began to spin, as his brother became a blur.

"Sam!" With remarkable agility Dr. Bates grabbed the chair from the middle of the room and shoved it behind him, arriving just as Sam fell into it.

"Get your head down, Sam, come on, between your legs."

The doctor's voice was a distant drawl, and Sam couldn't make out what he was saying, he was trying so hard to stay conscious. He felt someone pushing his head down, and he had no resistance, nothing in him for the fight.

"Breathe, Sam. Come on, take a deep breath."

Sam started to sway, the floor moving beneath him, and he closed his eyes. Big mistake. He opened them again. He felt a hand on his neck, pushing him down again, holding him steady.

Sam was in a cold sweat as he fought the dizziness, as he fought for the control he needed to help his brother. His head in his hands, he tried to look up, but gave up when he thought he was going to fall over.

"Doc."

"Yes."

"Don't stop if I…pass out. Get the rest of it…Okay?"

"No problem, Sam."

Instinctively, Sam put his hand out until he could feel his brother's arm, wrapping his fingers around it as he tried to regain his balance.

Dr. Bates watched in amazement as both brothers were able to settle themselves, to calm down, with the connection.

"Doc," Sam said, his head still between his legs.

"Yes."

"We've got two more to go." Sam stretched out his other arm.

"We need to get your blood sugar up first."

"No, do that…later."

Ellen was done with injection number 10, the only one she had been able to administer without Dean stirring. The only one he had received while Sam was holding on to him.

Ellen poured Sam a glass of Gatorade and added two tablespoons of sugar.

"Hey, Sam, can you sit up and drink this?"

Sam pulled his head up slowly, ignoring the walls that were closing in on him. He took the glass from Ellen, but she had to take it right back, his hands were shaking so hard.

"Let's try a straw."

Sam drank the sweet mixture while Ellen held the glass, feeling slightly better by the time he was done.

"Let's go," he said to Betty. "Let's do the last two."

Betty looked to her husband, who nodded. This was Dean's last chance. He was certain Sam would recover.

Sam refused to budge from where he was, from his position holding Dean's arm, and Betty worked from there.

Fifteen minutes later they were done.

Betty was monitoring Dean's vitals when Sam noticed the IV bag holding the versed was almost empty.

"How's he doing?" he asked, his voice still shaky.

"His blood pressure is up a little, 75 over 55. His pulse rate is at 102. Better. He's actually doing better." Betty offered Sam a smile that he had a hard time returning.

"I, I'm going outside for a minute," he said, suddenly feeling claustrophobic.

"Sam, it's pouring. You just gave a pint of blood." Ellen's maternal instincts had been put to the test all day, and in this moment she wanted nothing more than to take care of Sam. The way he had been taking care of his brother. The way his own mother would if she was there.

"I, I have to go outside." Sam could barely get the words out.

Ellen nodded. She understood. He didn't have a mother. Only a brother was left that could take care of him. And he was on the verge of losing him too.

Sam was out the back door, out of the house that had suddenly become stifling, before Ellen could reply.

If it was possible, the rain was falling harder than before, its intensity a welcome relief against Sam's body. He stood there, in the rain, for long minutes, almost in a meditative state, no thoughts coming in or out, nothing to disturb the wet and the cold surrounding him.

Eventually, the bitter cold brought him back, brought the memories back until they filled his head, his body. Until his nostrils ached from the stench of skin and fluid and antiseptic. Until his hands twitched under the strain of scalpels and scissors and sutures. Until his throat gagged compulsively at the sight of blood squirting in every direction. Until he couldn't stand on his own two feet, his knees buckling, his body giving way as he crouched against a wall, his insides pouring out of him convulsively.

With nothing left inside, Sam slid the rest of the way onto the ground, curiously watching the vomit as it was swept away by the rain. He shuddered against the cold, grateful for the numbness, and pulled his knees up, his hands wrapped around them, his head lowered against them. And he cried.

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