The first thing to go is his pancreas.

Dean cannot comprehend for the life of him why God would choose such a seemingly random organ to go out of commission. He also has yet to learn that this is just the beginning of a long road leading towards Sam's demise. The pancreas is just the first pit stop on the crippling journey.

The first thing to go is his pancreas and neither Dean nor Sam will know that until hours after bursting through the hospital front doors. But if there is one thing Dean knows for certain, it is that something is seriously wrong. Sam should be asleep instead of weakly withering on the bed looking like poster kid for some kind of charity. It has been six hours since they arrived at the hospital. Six hours since the poking and prodding began to dig up the truth of what had been done to Sam's body during the trials.

The results, of course, hadn't been pretty. Sam's body had been burnt from the inside and Dean had no fucking clue how you were supposed to fix that (can't just slap some cream on it and call it day can you?). With the potential organ damage, painkillers weren't a possibility until more was known about Sam's condition. Everyone, Dean included, had thought Sam would pass out from the pain. Dean suspected that some thought he would slip into a coma.

Yet, here they are. Why oh why does my kid brother have to be so fucking stubborn? Sam is laid on the bed nearly in the fetal position (not quite strong enough to get there) with his arms curled protectively around his stomach. His eyes are squeezed shut and his jaw clenched tightly. His hands grasp weakly at the bedding. Dean doesn't know how much longer he can watch his brother suffer like this.

"Sam," he says softly as he reaches out to pry his hand from the bed sheet and place it in his, "why don't we try those deep breathing exercises again?" For the life of him, Dean never thought he'd be suggesting deep breathing instead of whiskey or morphine for pain.

"Can't do it…" he stutters out quietly.

"Well we gotta try something Sammy. I'm gonna go see if I can track down Cas." Just as Dean is standing up to go, he feels Sam grab his hand more tightly than he should have been able to. He opens his eyes for the first time in at least an hour. They are glassy and full of raw emotion and Dean knows that he won't be able to refuse anything they ask of him. Sam manages enough strength to move his head side to side in a silent plea.

"Okay okay Sammy, I'm not going anywhere I promise."

Sam still grips him even tighter as if to tether himself. Neither man sleeps a wink.

Xxxxx

It isn't until the morning, after the nurses manage to pump through the IV the minimum nutrients required to keep a human alive, that Sam starts to act even odder.

"De, dizzy" he presses his palms into his eyes.

"This is new isn't it Sam? You've not felt dizzy since we brought you in."

He shakes his head and then feels the repercussions of his decision as he presses his palms harder into his eyes. "Sick"

For the first time since he got here, Dean feels a little less helpless. He grabs the trash bin as quickly as possible and has it under Sam's nose just as he leans towards the edge of the bed and starts to gag.

"Easy, easy." Dean rubs his brother's back and tries to forget about the fact that Sam is too weak to even sit up to throw up. He presses the call button instead.

Charlene pokes her head through the door and quickly assesses the situation. "Okay Sam, let's get you sitting up," she says as she rushes across the room to raise the bed. Dean pulls the trash can next to Sam's lap but cannot turn him from his side. Charlene grabs Sam's shoulder when he threatens to topple forward.

"He said he was dizzy after breakfast and now he's throwing up which, duh, is obvious," he rambles nervously, " He wasn't like this last night so I have no idea what's changed."

She frowns and looks at her patient who is somehow curled in on himself and puking his guts up at the same time. Not a good sign. "Sam, can you straighten out for me?"

He eyes her reluctantly and slowly moves to uncurl himself. It's evident to everyone in the room just how much pain Sam is in.

"Ok Sam, I'm going to need to feel around your abdomen. Tell me what hurts."

Dean doesn't know how much more of this he can handle watching. He hates that in order to relieve Sam's pain, they have to cause him more pain. He grabs his hand tightly and places his other in his shoulder. Sam's jaw is still clenched and his body is rigid. "Easy Sammy, try to relax a little." His tension only eases slightly.

Then Charlene starts to prod. Sam grimaces. "'s tender." She frowns and starts to press higher up the abdomen. That's when Sam lets out a stuttered breath. " 'urts" he grips Dean's hand tighter and tries to curl in on himself. The monitor indicates that his pulse is increasing rapidly.

Dean watches in confusion as she stands up from the bed. "What's wrong? Can we give him something?"

"I'm not sure but we are gonna go for some tests."

Xxxxx

It's when the test results finally return that they learn of the news of Sam's failing pancreas. It complicates things quite a bit, considering Sam will now have a hard time with digestion and is considered pre-diabetic. But at least, he finally gets some pain medicine.

The doctor is still in the room but Dean finds it hard to pay attention to her. If it wasn't for his brother suffering so quietly next to him, he would've asked her to leave already.

"His organs were showing signs of being burnt yesterday but the descent into failure was unexpected. Sam, have you had issues with alcohol in the past?"

Dean grimaces as he watches Sam's face turn red. He's seething. God, if one more person suspects Sam of being an addict, he's gonna lose it.

"No. He doesn't drink anymore than your average joe. Besides, he hasn't had a drink since he started getting sick."

Dr. Weismann can tell the tension is growing and places her hands out in a placating motion. "Ok then we have no way of knowing why his pancreas decided to head towards shutting down. He doesn't fit any of the risk factors. We will have to just treat it and hope that none of the other organs decide to follow suit. We will keep the pain medication and the anti-nausea. I'm still concerned that you somehow aren't sleeping so we can provide a light sedative and see how you do."

Dean watches as she grabs her clipboard and leaves the room. He hates how she says hope, as if hope has ever worked out for them. The Winchester's had never been good at sitting and hoping.

"Hope my ass…" he mutters, "I'm going to find Cas. Organs shutting down are serious business and I'm not screwing around waiting for these people to figure it out."

"Dean, stop". And leave it to Sam, his fucking pancreas is failing but it's the first time in the 18 hours they've been there that he's been able to construct a full sentence. "It's a mess out there. Cas is probably working on cleaning it up. We don't need him to worry about me. If he doesn't contact us soon, you can go look for him but don't go because you're worried about me."

Dean cannot believe what he's hearing.

Sam looks up at him with his eyebrows raised and a gleam in his eye, lips pursed. It's the same look he gets when he arguing case details. The one that screams at Dean that he's being unreasonable. Some might call it a bitch face , which Dean wouldn't dispute. But to Dean, it's always meant that Sam had his mind set. "This is it. It's just the pancreas, not my heart or lungs. People can live without these if they really have to. Dean, it's ok."

In a few days, Dean will look back on this moment and wish that Sam had his mind set on some other conclusion. He will wonder if either of them fully believed Sam in this moment and then he'll wish it was all just that simple. Because Sam had never been more wrong and Dean had never wanted to believe him more badly. A toxic combination.

Dean huffs, "Fine, ok. But if he doesn't call soon, we will have to figure this out."

"Good. Thanks."

Sam leans back in bed and starts to relax. Dean notices the same lines of pain on his forehead. His arms are still curled around his stomach, albeit more loosely. He notices the dark circles under his eyes and the slump in his posture. Sam is nowhere near as miserable as he was last night but now that Dean can see through the curtains of his pain, he can tell just how tired Sam is. Damn, he's tired too.

"Think you can sleep tonight little brother?"

Sam closes his eyes and lets out a slow breath, seemingly trying to control his emotions. This is how Dean knows he has to be tired. Sam can get emotional when he's tired and in pain. Also, clingy but not admittedly so until more drastic situations. Dean puts his hand on Sam's knee.

"God, I hope so."

"Me too. Although on second thought, maybe not. Your damn snoring will keep me up all night." Dean knows his attempt at humor is poor but he has to do something. He has always dealt with his pain through laughter. If he can get Sammy to laugh or even smile, he figures it'll be a win-win.

Sam looks up at him with watery eyes and bites his lip in the way that people do when they are afraid that any slight motion will break the fragile floodgates they have built to protect those around them from an onslaught of emotions. He looks down and swallows slightly and when he returns to his brother's, he is only slightly more put together. He cracks half a smile, "My snoring? At least, I don't talk in my sleep. I don't care how amazing you think Carmen or whatever her name is. Some things a brother should just never know."

"Ok, quite a few people would pay good money to hear about that encounter," he smiles and looks of in the distance, pretending to be lost in a memory just because he knows it will annoy Sam. That's what brothers are for, right? "Besides, the pain medicine plus the sedative they have you on will have you out like a light."

"Yeah…" Sam seems worried about something but Dean isn't sure what.

"Cmon, I can put on one of those shows that always puts you right to sleep and I'll get comfy right over here."

Sam nods his head and twenty minutes into Bonanza, he's asleep. Still, even in sleep and loaded with drugs, Dean can't help but think that he looks in pain. His forehead is wrinkled like a headache has followed him into his dreams. Dean had every intention of going to sleep as soon as Sam dozed off but now he can't find it in himself. He keeps two fingers on the pulse point on Sam's wrist, not quite trusting the machine, and wishes he could've found a different old western to put himself to sleep.

On the tiny hospital TV screen, Little Joe has found himself in another patch of trouble. See, Dean always saw Sam in Little Joe. Both always find themselves in troubling situations, whether by their own fault or unfortunate circumstance. Both have good hearts and lots of trust but little sense.

So Dean watches as Ben, Adam, and Hoss Cartwright ride up the mountain to save their son/brother from where he is being held at gunpoint because he tried to save a child who had run away. Dean always liked Bonanza because the Cartwright family was so close knit and they always managed to save Little Joe from the predicament of the week. They reminded him of the Winchesters, deceased mother and all.

That is, until now. Because Dean was damn well sure that in all his watching Little Joe's pancreas never shut down and he didn't nearly complete heavenly trials designed to kill the unfortunate soul who wanted to save the world. No, they didn't make those kinds of shows in the 60s. Little Joe always had his two brothers and his father to save him as well. Sam only had Dean and right about now, Dean wished there were at least two more of him so that they could have a conference to figure out what the hell to do.

But there was only him. And Sam. Both people very real and nonfictional, unlike the characters on the screen. Dean shakes his head to snap himself out of his daze and quickly grabs the remote and turns the TV off. He spares one more look at Sam who is sleeping as peacefully as possible given the circumstances. He feels his pulse one more time. He wants so badly to brush the hair from his eyes, maybe even give him a kiss on the forehead. However, if he were to wake Sam up, he'd never forgive himself so he refrains.

Instead, he leans back in his chair and decides to keep Sam's pulse under his fingers. He falls asleep to the steady thrumming of his brother's heart, telling himself that it'll still be there when he wakes up. Hoping that it will still be there when he wakes up.