Bobby answered his phone halfway through the first ring. "Jim?"
"Yeah. Is John still with you?"
Bobby's gaze flickered to his rearview mirror. "Yep, following behind me. How's Sam?"
Silence met his question.
Bobby frowned, his grip tightening on his phone. "Jim..."
"He just got out of surgery."
"Surgery?" Bobby repeated. "What for?"
"They had to remove his spleen."
"Jesus. That as serious as it sounds?"
"I don't know," Jim answered honestly, his tone relaying his worry and fear as he walked down the hall toward the elevators. "It was an emergency situation, so there wasn't time to explain, and then Sam seized again and they had to put him on the ventilator and – "
"Hold on a minute, Jim. I'm gonna get John," Bobby said as he flashed his truck's signal and then pulled over, tires crunching the gravel beside the road. "He needs to hear all of this."
"I agree, that's why I'm calling."
Bobby narrowed his eyes. "Why isn't Dean calling?"
Jim sighed, the volume and the force indicating his level of frustration.
Bobby nodded, having his answer. He had dealt with a pissed off Dean himself; he knew what the Pastor was up against. "Sounds about right."
Jim chuckled, sounding tired.
"I wouldn't worry about it, Jim. Dean's been pissed at his daddy before."
"Not like this," Jim corrected, as he approached the elevators and pushed the downward arrow button.
Bobby shrugged. "Maybe not, but he'll get over it. He always does when it's John."
"Yeah..." Jim sighed again, quieter. "But I don't know, Bobby. You haven't seen him. I don't think it's going to be that easy this time. It's different..."
"Well..." Bobby's voice faded.
There was nothing to say to that. It was hard to argue with the truth, and he didn't blame the kid, was actually proud of Dean for standing his ground on this one. They had all enabled John Winchester for entirely too long.
There was silence as Bobby watched John pull over behind his truck.
"Alright, hang on..." Bobby's voice was drowned out by an 18-wheeler that passed as he climbed down from his truck. He couldn't help the small smile that twitched on his lips at the sight of John's battered face – serves you right, asshole – as the oldest Winchester closed his own truck door and approached.
"Is that Dean?" John asked urgently, reaching for the phone.
Bobby didn't respond but instead pushed a button before setting the phone on the warm hood of John's truck. "Alright, you're on speaker..."
"Dean, how's Sam?" John asked immediately, staring at the phone and then searching Bobby's face for clues as to whether his fellow hunter already knew the answer to that question.
There was silence.
John felt the rise of panic. "Dean?"
More silence.
"Dean!"
"John, it's me."
"Jim?" John glanced at Bobby. "Where's Dean? What's going on?"
"Sam's out of surgery, and – "
"Surgery?" John yelled. "What the hell? Why are you just calling me now? And where the hell is Dean?"
Jim closed his eyes briefly as he waited for the elevator, drawing on patience that he kept stored just for dealing with John Winchester, especially when he himself was exhausted. "There wasn't time to call before surgery, John."
"Fine," John snapped. "But where's Dean? Why isn't he calling?"
Because he's sick of your shit, Jim silently answered and then smiled, amused at the things that crossed his mind when he was this tired and imagined people's shock if they could hear the thoughts of Pastors.
"Jim!"
Jim's eyes snapped open at the volume of John's voice and the sound of the elevator finally arriving. "Dean was just paged down to recovery. I'm on my way as well."
"What? Why? What happened?"
"Calm down, John," Jim soothed as he stepped on the elevator. "Sam woke up from the anesthesia earlier than they expected and became agitated, especially since he's still on the ventilator, so they called Dean. They've increased his sedation but – "
"Wait a minute...Sam's on a ventilator?"
Jim paused. "Yes."
John looked a Bobby, alarmed. "Why?"
Jim sighed, exiting the elevator and scanning the hall, looking for Karen. "Because he had a seizure – two, in fact – and wasn't getting enough oxygen, so they intubated him before taking him down for surgery."
"Sonuvabitch," John hissed, rubbing his hand down his face. This did not sound good. "Why did they page Dean to recovery? Is there a problem?"
"I don't think so." Jim focused on the room at the end of the hall, seeing Karen exit, and then walked in that direction. "Sam's nurse just said she thought it would be best if Dean came down to be with Sam." He nodded as he passed Karen and paused in the doorway of Sam's room, smilng softly. "And I think she was right," he commented at the sight of Dean sitting on the edge of Sam's bed, one hand holding his little brother's and the other gently carding through the kid's dark hair.
Sam stared drowsily at his brother, eyes staying closed longer between each blink.
"Stop fighting it, Sammy." Dean's voice was quiet as he smiled softly, thankful it was sleep his little brother was now fighting and no longer the ventilator. "I'm here. You're okay. Go to sleep."
Sam continued to stare at Dean for a few more seconds before closing his eyes, instantly swept under by the potent combination of exhaustion and sedation.
Dean lightly chuckled, affection shining in his eyes as he gave a final stroke to Sam's hair. "You're a stubborn little shit, you know that, Sammy?"
Jim chuckled as well, and Dean glanced over his shoulder at the Pastor standing in the doorway.
"Wonder where he gets that from?" Jim commented as he approached the bed.
Dean smiled, shrugging and then looking pointedly at the phone Jim held.
Jim swallowed, covering the phone with his palm, hoping to muffle whatever Dean's reaction would be. "It's your dad," he informed and held his breath, expecting the worst, hoping for the best.
He got neither.
Although Dean said nothing, his eyes narrowed, and Jim heard the message loud and clear: Traitor.
Dean held the Pastor's gaze, making his point, and then returned his attention back to Sam, one hand still holding his brother's while the other rested lightly on Sam's chest, his own form of monitoring the kid's vitals. Dean could feel Sam's heartbeat, could measure his breaths; he would know before the monitors did if there was a problem with his little brother.
Jim sighed, a bit unnerved by the lack of verbal reaction – a silent Dean was more worrisome, more alarming than a ranting Dean – and pressed the phone's speaker button.
"John, Bobby...you're on speaker," he reported, holding the phone between himself and Dean.
"Dean?"
Dean remained silent, purposefully making his dad wait; a nonverbal reminder of who had control in this situation.
"Yeah..." he finaly responded.
John sighed harshly. He knew what Dean was doing. "How's Sam?"
"I'm with him," Dean replied, as though that was answer enough, as though it was a given fact that if he was with Sam, then Sam was okay. "Where are you?"
John shook his head, glancing over at the line of trees that bordered the highway as he tried to hold his temper in check. He knew this angle, too. Dean wasn't really interested in his location; the question was a barb, an attempt to not only emotionally wound John with guilt – I'm here...where are you? – but to also lure him into a verbal sparring match, and John wasn't taking the bait.
There would be time for that later.
John directed his attention back to the phone. "We're still about two hours away."
Silence met the response, and Bobby rolled his eyes, irritated by yet another Winchester pissing match. He was getting too old for this shit.
"Dean, it's me."
Dean's tone changed at the sound of Bobby's voice. "Hey, Bobby."
Bobby glanced at John. He felt like a mediating talk show host. "Jim said Sam just got out of surgery."
"Yeah, they had to remove his spleen."
"And what does that mean for Sam?" John asked sharply, looking at Bobby.
Bobby shrugged as Dean answered likewise.
"You don't know?" John repeated, anxiety making his tone harsh and causing his verbal filter to malfunction. "Damnit, Dean! Hasn't Sam suffered enough? Haven't you already learned your lesson about letting your brother have surgery when you don't know?"
The words had no sooner left John's mouth than he wished he could have called them back. That's not what he had meant to say, what he had wanted to say. Not at all.
John shook his head. "Shit..." he hissed, audible only to himself and Bobby.
He felt the intensity of Bobby's stare and took a step back, recognizing his fellow hunter's expression and not wanting to be punched again. He could only imagine Jim's expression. And as for Dean...
John sighed, grateful – not for the first time – that Mary couldn't see what a monumental failure he was as a father. "Dean, I'm sorry. That's not what I – "
"You know what, Dad?" Dean asked, his voice steady and eerily calm. "Fuck you."
Dean glanced up at Jim's sharp intake of breath, but he wouldn't apologize. He had never meant those two words more than he did in that moment, had never been so pissed, had never wanted to punch his own father as much as he did right then.
John had been gone for days, had been indifferent to Sam's initial illness, had offered no input and had left major decisions up to Dean about his little brother's health, and now he wanted to sit in judgment of the results of those decisions?
No.
Hell no.
Fuck that. And fuck him.
Dean snorted his disbelief and disgust and turned away from the phone Jim still held, focusing on his brother, thankful Sam wasn't awake for this conversation...even if – as far as Dean was concerned – this conversation was over.
For once, John was speechless, and Bobby's expression of fond approval at Dean's words as he stared at the phone didn't help.
John inhaled deeply and slowly let it out. He had it coming – he knew it, they all knew it. But to actually hear Dean say it was simultaneously enraging – how dare his son talk to him like that – and heartbreaking. John would do anything for his sons, and yet as good as his intentions were, he always seemed to do the wrong thing, or worse...nothing at all when they needed it the most.
John glanced at Bobby. How am I ever going to make this right?
Bobby shook his head, his expression having changed to slightly sympathetic. He didn't know the answer to John's unspoken question, and he certainly didn't envy the task of figuring it out and carrying it through. Because Jim had been right; this time, it was different.
Jim felt numb, the phone heavy in his hand as he stared at Dean, saddened by the turn of events. They should be coming together, not falling apart.
Dean didn't acknowledge his gaze, and the Pastor knew that John's oldest was done; he had said what he meant, had meant what he said, and that was it. There would be no apology – at least not now – because Dean didn't feel sorry; he felt hurt, and that was always portrayed as anger with John's oldest.
Jim slowly shook his head – at a complete loss for words – and was startled by the sound of Karen's voice.
"Everything okay in here?" she asked from the doorway as she tucked a curl behind her ear.
Jim glanced at Dean, uncertain of how to respond. Had she heard?
Karen smiled, amused at the Pastor's confusion. "Is Sam okay? Does he need anything?" she amended coming into the room to see for herself.
"Oh..." Jim replied, feeling embarrassingly dense. Even now that he knew what she was asking, he wasn't sure how to answer her question. He was ashamed to admit to himself that in the midst of John and Dean's exchange, he had momentarily forgotten about Sam.
But Dean hadn't. Big brother first; everything else second.
"No, he's fine," Dean responded, smoothing the blanket over Sam's chest.
"Is that Sam's doctor?"
Dean glared at the phone as his father's voice drifted into the room.
There was silence, and when no one answered, Karen stepped closer to Jim, raising her voice, as people tended to do when they spoke on speaker phones.
"I'm Karen, Sam's nurse. And you are?"
"Sam's dad."
"Oh."
Karen flushed at the blatant surprise in her tone. Of course Sam had a dad. Why did she feel speechless at that revelation? She had read Sam's chart. His mother was deceased, not his dad. His dad was just...not there.
Karen cleared her throat. "Nice to meet you," she offered, feeling awkward.
Dean snorted, and Jim cut his eyes in nonverbal reprimand at John's oldest.
Karen glanced from the Pastor to Dean to the phone, wary of the tension that permeated the silence, and was thankful when John's voice floated to her again.
"Where's the doctor?"
Karen checked her watch. "He's – "
"Here," Jim reported, nodding toward the door, his words attracting Dean's attention.
Karen turned in time to see Dr. Collins enter the room, coming to stand beside her and Jim and arching an eyebrow at the phone held between them.
"Sam's dad," Karen commented as way of explaining why there was a cell phone in an area where the devices were usually not permitted.
"And his uncle."
Karen cocked her head, startled by another voice coming from the phone and slightly irritated that she hadn't been told someone else was present on the opposite end of the line. Was it just her, or was it rude to be a silent listener without the other person's knowledge?
Dr. Collins gave a hint of a smile, knowing Karen was annoyed, and then glanced at Dean, noticing he was sitting on the bed with Sam – and knowing he should tell him to move – but thinking better of it.
He directed his attention back to the phone. "Gentlemen, I'm Dr. Collins, and I've been taking care of Sam since he's been here."
"How's my son?" John asked, leaning his forearms against the truck's hood, tilting his ear closer to the phone as another 18-wheeler passed.
"He's a tough kid," Dr. Collins responded, smiling proudly at his patient. "He's been through a lot over the past few hours, but he's holding his own right now."
Dean squeezed his brother's hand. That's my boy, his heart rejoiced. Kick this in the ass, Sammy.
"They said you took his spleen?" Bobby questioned, his gruff voice making his tone seem accusatory, as though next he would demand it be given back.
"Yes," Dr. Collins responded. "We had no choice. Sam's spleen was enlarged and wasn't clotting itself as expected. In fact, his spleen was so enlarged that we were unable to remove it laparoscopically, so we performed an open splenectomy, meaning there's a larger incision and more stitches. We also placed a drainage tube to temporarily drain any accumulated fluid or blood, but we expect to remove that in the next 24 hours."
Dean nodded, eyes scanning Sam's bandaged torso even though he had already noticed and checked the surgeon's work prior to Jim arriving in the room.
"In retrospect," Dr. Collins continued, "we probably should've performed surgery upon Sam's admittance to the hospital, but we didn't realize how massive the trauma was."
Dean frowned. "Meaning?"
Dr. Collins sighed. "The ultrasound showed a small tear anteriorly but failed to show a much larger, more catastrophic tear posteriorly. It makes sense now why Sam's vitals wouldn't stablize and why his condition continued to rapidly decline. His body was dealing with severe hemorrahging and drastic blood loss. It's truly amazing that Sam is still alive."
Silence followed, punctuated by the cadence of the ventilator and monitoring equipment. Jim glanced at Dean as Dean stared at Sam. John and Bobby said nothing, the hum of the open phoneline and the shuffle of boots on gravel the only indications they were still there.
"So..." Jim began, swallowing against his dry throat, preparing to ask the question they all wanted answered. "Now that his spleen has been removed and the bleeding is under control, Sam will start to recover?"
"Ideally, yes."
"Ideally?" Dean and John simultaneously snapped.
"What the hell does that mean?" John demanded, and Dean's sharp glare did the same.
Dr. Collins shifted. This was the hard part of the explanation. Patients and their families tended to think that surgery was magical, assuming all would be fixed following the procedure. But it rarely worked that way.
"While Sam is no longer losing blood, he is dealing with the blood he has lost." The doctor glanced at one of the bags hanging above his patient's bed. "Sam was given FFP during surgery to help with coagulation and is now about halfway through his second blood transfusion. I'm thinking he'll need at least one...maybe two...more, but we'll see how he responds before making that decision. We're also going to keep him heavily sedated for now and probably for the next couple of hours so that he will rest and won't fight the vent."
"When will you remove that?" Dean asked, knowing how much Sam hated it, how much his independent little brother hated having things forced down his throat...literal or otherwise.
"As soon as possible," Dr. Collins responded. "Due to the splenectomy, Sam is already at a higher risk to sustain a pneumothorax, so I don't want to tempt fate. Plus, there's the risk of ventilator-associated pneumonia, so as soon as Sam is able, we'll extubate." He paused. "Also, in addition to recovering from the blood loss and surgery and coming off the vent, Sam needs to bounce back from the acute renal and liver faliure as well as the ARDS."
"Whoa, whoa, whoa...renal and liver failure?" John asked, his heart in his throat. "And what the hell is ARDS?"
"One thing at a time," Dr. Collins patiently responded. "Due to the massive blood loss, Sam's organs were beginning to shut down, hence the renal and liver failure. But both were in the acute stages, so there's a good chance they can both be reversed. As for your other question...ARDS is acture respiratory distress syndrome, which effects Sam's breathing and – "
"Then why are you taking Sam off the ventilator?" John interrupted.
"Because it isn't worth the risk to leave him on it if we can maintain his O2 sats with an oxygen mask." Dr. Collins paused. "Any more questions?"
Jim felt the pressure of anxiety in his chest. Sam had so much to overcome. "What's the prognosis?"
"Guarded," Dr. Collins answered simply. "Needless to say, we'll be monitoring him closely over the next 24 to 48 hours."
Dean and Jim exchanged glances, absorbing the information.
"So even though he's come a long way, the kid still has a fight ahead of him."
Dr. Collins nodded at the sound of Bobby's voice. "Yes. Absolutely."
"Story of our lives..." Dean commented quietly and saw Jim smile sadly in response.
A sudden loud beep directed four pairs of eyes to Sam.
"What's that?" Dean asked, alarmed.
Dr. Collins glanced at Karen and shook his head. "I don't – "
"What's going on?" John demanded.
The beep came again, not from anything hooked up to Sam, but from the phone Jim held.
Jim sighed as Dean briefly closed his eyes in relieved realization, before taking the phone from the Pastor's grasp.
"Just the phone. It's losing its charge. We'll see you when you get here," Dean said bluntly, ending the call and powering off Jim's phone.
Jim arched an eyebrow. He could imagine John Winchester's reaction to the abruptly ended call, battery issues or not.
Dean shrugged – it was the least of his worries...did the Pastor forget his earlier exchange with his father – then directed his attention back to the doctor.
"So, what now?"
Dr. Collins sighed. "Well, our primary concern is the next 24 hours. We'll be monitoring Sam closely, keeping a check on his vitals, of course, but also on the incision and drain tube."
"When will you remove that?" Dean asked, reminded of a bad experience John encountered with one of those a few years back. "They're breeding grounds for infection."
"They certainly can be," Dr. Collins agreed. "But this drain is inserted away from the primary incision to help prevent transmission of infection between the operation site and the exit site. They can be dressed and managed separately, and Karen will keep a close watch."
Karen nodded. "We won't leave it in place a second longer than it's needed, I promise."
Dean knew she meant well but wasn't soothed; experience had taught him not to believe anyone's promises but Sam's.
"When will Sam be out of recovery?"
Dr. Collins glanced at Jim. "Barring any complications, we're planning to move Sam back to his room in the Intensive Care Unit within the next hour or two. We'll then decrease his sedation, wait for him to wake up, and start weaning him off the vent. As I said before, the sooner we can get him off, the better."
"Whenever you're ready, Sam will be ready," Dean assured. "He hates that thing."
"Yes, I gathered that." Dr. Collins chuckled, thinking that was an understatement given Sam's violent reaction when he first regained consciousness. "If it wasn't for you being here to soothe and distract him long enough for us to further sedate him, I'm sure he would've removed it himself earlier." He turned toward the door. "Well, I have other patients to see. I'll check on him later, but if you have any questions or concerns before then, ask Karen or have her page me."
Dean nodded, hearing rather than seeing the doctor and nurse leave the room as he continued to stare at his brother.
"Well..." Jim sighed, the relief and hesitant hope they both felt summed up in one word.
"Yeah," Dean agreed and swept his brother's bangs aside, pleased that Sam didn't feel as warm as he did earlier. "Keep fighting, Sammy. So far, so good."
TBC…not sure when
FFP = fresh frozen plasma