Disclaimer: Refer to chapter one.

NOTE TO READERS: Thanks for all of the reviews! They have been wonderful. Keep them coming, as it lets me know how I'm doing.

Also, since I was asked once what "AMA" from chapter one stands for in hospital jargon I thought I'd define it here for everyone: It's short for 'against medical advice', so basically if they make you sign an AMA paper they have told you that they advise you stay under their care until they release you, but if you decline they make you sign a paper, so that you can't sue them should you suffer a complication or die if you refuse further treatment.

Again, this story will be AU since there will be no way the show goes this route. Thanks again for all of the reviews and comments!

Chapter Two:

To Cast All Else Aside

By Dawn Nyberg

"… Though nothing can bring back the hour of splendor in the grass, of glory in the flower; we will grieve not, rather find strength in what remains behind; in primal sympathy which having been must ever be; in soothing thoughts that spring out of human suffering…" poem excerpt by William Wordsworth

Dean had been replaying his last moments with his brother over and over in his head. He had been angry that Sam hadn't come in earlier when he been outside his room, and he was more angry at the entire situation with the demon and the cabin, and that he had actually believed some of what that evil bastard had said to him. He wasn't angry with Sammy. God, how could I have said those things to him? Dammit. He berated himself silently in his head. He had stopped trying to get someone in his room to answer his questions. It seemed like hours since they had wheeled Sam away, but looking at the clock in his room it had only been ten minutes.

"Dean?" Sue, his nurse was at the door.

"What's wrong with my brother?"

"I don't know," she offered. I saw him down to the MRI lab, and just got back. He was still in the scan when I came back.

"Look, I know you know something," his tone serious. "I want some information," he barked.

"Dean, the chief of neurology is with him in the MRI right now, he's the best in this hospital. If your brother is in his hands then he's all ready off to a good start."

"Chief of neurology? God, what's wrong with his brain?" Dean felt the bile creep up his throat.

"There should be some information soon Dean, and as soon as I know something I'll tell you," she comforted. "But, you need to stay calm," she urged.

"Screw being calm! If he was so hurt why the hell didn't you people force him to stay in a bed?"

"I told you that your brother signed an AMA paper. That means…"

"I know what the hell it means, 'against medical advice' but maybe you people should have said, hey, you might drop over any minute."

"He was told that with the severity of his concussion they wanted to admit him for twenty-four hours, but he declined. He was given an MRI and it came back clean."

"Really?" Dean's sarcasm was as thick as molasses. "So, why did he collapse, huh?"

"Sometimes complications don't present themselves right away," Sue answered. "And, had he been admitted we might have been able to treat him in a more controlled manner than the way we had to when he passed out here in your room."

"Don't you dare stick this on my brother," Dean warned. Sue didn't reply. "My dad, does he know?"

"Not yet," Sue answered. "He's still in and out of it from his head injury. He may not be able to be told for another day or two. They'll have to gauge it on his level of alertness." Dean glanced at the clock with irritation.

"They have to know something by now."

"I'll call down to the lab and see if I can get an update for you."

"Thanks," Dean's voice was quiet.

Meanwhile, the MRI Lab

"Damn look at the size of that hematoma. The blood needs evacuated." Dr. Kendrick, chief of Neurology commented. "There," he pointed to an area of Sam's scan. "It's a shift. Man, if this kid didn't have bad luck he wouldn't have any luck at all." The shift in brain position indicated to the doctor that there was increased pressure inside Sam's brain. "Okay, get him out of there I've seen what I have to. He needs a red flag to the OR. Has the family been told?"

"No, but they are all patients here in the hospital. They were all in the same accident," Dr. Greg Masters, Dr. Kendrick's intern answered.

"Man, is this family cursed or something." Dr. Kendrick commented. "Are they stable to be told?"

"I know the older brother is awake, but their father is in and out."

"Talk to the brother. Be straight with him Greg, you know what we're looking at." The young intern nodded solemnly. "Start the kid on a mannitol drip," Dr. Kendrick's ordered to another staff member as they prepared Sam for transport to the OR. The lab phone rang and the technician picked up.

"It's the ICU nurse for his brother. He wants an update."

"Tell her Dr. Masters will be up in a few minutes to talk to him."

Dean glanced over to his door as Sue walked in. He looked at her with expectant eyes. "Well, how's Sam?"

"Dr. Masters is coming to speak to you."

"Is that the Chief?"

"No, his intern, but he's an excellent doctor and is training under Dr. Kendrick the Chief I told you about. He'll be here shortly."

A few minutes later a young late twenties looking doctor walked in. Dean idly thought they were probably the same age give or take a year or two. "How's my brother?" Dean cut right to the point.

"Mr…" he hesitated realizing he didn't know the patients name.

"Dean, tell me about Sam."

"He's headed into surgery. They are prepping him right now."

"Surgery! You're not talkin' brain surgery," Dean felt nauseous.

"Sir, your brother is in extremely critical condition. He developed an extremely large hematoma on his brain,' he paused. "I mean it's like a bruise of sorts that has left a large amount of blood sitting on his brain. And, unfortunately it appears that the intracranial pressure in your brother's head that has most likely been increasing steadily over the last few hours since his initial head injury, and the development of the hematoma has caused a dangerously high pressure in his head."

"What does that mean?" Dean had a death grip on the bed sheet beneath him. "Is my brother going to …" Dean's throat threatened to close. "Could he die?"

"He's very unstable at the moment and with all surgeries there are risks."

"That's not what I asked you," Dean was blunt. "Could my brother die?"

"Yes," Dr. Masters was matter of fact. "There is a strong chance that he may not make it off the table." Dean closed his eyes for a brief moment trying to reign in his emotions that were pushing forward. He was scared, and guilt ridden. He needed for Sam to live. He couldn't die.

"If he survives surgery," Dean's voice shook at saying if. "He'll be okay, right?" The look on the doctor's face filled Dean with a gripping cold. He actually shivered.

"The brain injury your brother has suffered according to the MRI scans is a catastrophic injury. The swelling has caused a shift in his brain, meaning it has actually pushed his brain slightly over in his skull pushing it against the inside of his skull. The blood gathered from the hematoma has further compromised your brother's brain." Dean's mind had been reeling at the words catastrophic injury being used in reference to his Sam.

"What are you saying?" Dean's voice was harsh. The doctor took a deep breath; he always hated this part of the job.

"Should your brother survive surgery there is every indication based on current scans and test results that he will suffer from severe brain damage." Dean felt the sickness rise in his throat and the doctor must have noticed as well, he stepped up and handed Dean a small basin just in time for him to vomit into. There wasn't anything on his stomach which made the effort of being sick even more painful. Silently he thought he deserved this pain. "Better?" The doctor moved the basin away and offered Dean a small cup of water. Dean offered a shaky nod.

"But, you don't know for sure, right. I mean he could be fine," Dean rushed ahead while he trusted his stomach not to rebel once again. He had to be strong for Sammy.

"The brain is a complex thing and I have seen some surprising results in the past," but the doctor was hesitate to provide any false hope. "But, your brother's case," he hesitated. "I don't want to give you false hope. It is a devastating injury. He was all ready in a deep coma before he went into the MRI. He is unresponsive, and isn't breathing on his own."

"What kind of damage are you talking about?" Dean was back to business now. He hated people telling him about his brother, and what to expect from him when these people didn't know his little brother. They didn't know that Sam was brilliant, that he was special. He had so much to offer, and he wasn't going to let them define or limit him.

"His scans showed brain activity, but it was of a diffused nature which is indicative of damage. Based on what the scans provided downstairs the damage will most likely leave him unable to care for himself, possibly not communicate beyond infantile responses. But, we can't say for any certainty the extent of damage until he wakes up."

"So, he could be fine." Dean knew he was grasping at straws, but he wasn't giving up on Sammy.

"It's unlikely, Sir. If your brother survives the surgery and comes out of the coma there is little chance that he will emerge from this brain injury without damage." Dean felt like a deflated balloon. He decided in that moment that he would take what he wanted from the medical mumbo-jumbo he was hearing and forget the rest. No one was making him give up on his little brother. Part of him was happy that their dad was still out of it and had no clue what was happening.

"What about the surgery?" Dean questioned. "Are they shaving his head and cutting into his head?"

"No, Dr. Kendrick is working on a new technique that he thinks will be safer for your brother. He's certain that an open skull procedure right now would be a death sentence for your brother's all ready critical condition. He his going in through your brother's left temple with a small drill into the skull bone where the blood has collected, and plans to drain it with a small catheter that can be entered into the brain cavity to drain the blood. And, ideally this should release some of the additional pressure. However, they have started him on some IV medications that are designed to help reduce and/or control brain swelling. But, should the pressure continue to build it may become necessary to open a piece of your brother's skull to allow the brain a place to expand to in order to prevent brain death."

"How long until I hear something?"

"The surgery is delicate. It may be a while." Dean nodded, although he would have been happier with some kind of ballpark figure. "I'll be going into the OR when I finish speaking to you and I'm sure either myself or Dr. Kendrick will be back to talk to you." Dean nodded. "Do you have any other questions?"

"No."

"Well, if you do don't hesitate to ask. I'm a brother, too. I know you must be climbing the walls. But, you need to concentrate on yourself too. You can't afford any set back for your own health." Dean nodded silently. The doctor excused himself.

Meanwhile, In the Operating Room

"Dr. Kendrick his cardiac status is showing distress." An OR tech called out from the telemetry station.

"Push an amp of epi." He ordered the tech manning the IV administrations. "There's just so much damn blood." He commented to another colleague that joined him for the procedure. "Dammit," he grumbled. "This kid's brain is a mess."

An alarm sounded with a steady wail. "He's arrested." The anesthesiologist called out.

"Start compressions," Dr. Kendrick barked. "I've almost got the blood drained. While Kendrick continued to work his colleague took over the resuscitation efforts with the rest of the OR staff.

"Start the clock," Dr. Jaffey barked. A nurse leaned back and started the clock that would keep track of how long Sam was in arrest while they tried to resuscitate him. "Push another epi," Dr. Jaffey called out as he continued to administer compressions while the anesthesiologist handled respirations. "What's his rhythm?"

"Flatline." Dr. Jaffey shook his head.

"Come on kid give us something to work with." He continued to administer compressions. "Down time?" He called out.

"Six minutes."

"Push an amp of lidocaine." He ordered. He pushed vigorously against Sam's chest with his compressions trying to circulate the drugs in an effort to stimulate his young heart into beating. "Holding compressions" he called out. "Rhythm?"

"Still flatline."

"Dammit, come on!" He continued compressions.

The machines continued to wail indicating Sam Winchester's silent heart.

To Be Continued.

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