Disclaimer: refer to chapter one

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Chapter Eleven

Hush

By Dawn Nyberg

"…Once there was a darkness, deep and endless night. You gave me everything you had, oh you gave me light …" Excerpt by Sarah McLachlan, I Will Remember You

Ivy Ridge, Rehab Wing 2 East

Dr. Myer's entered the wing with deliberate strides. Dean followed closely next to her. She spotted the red blinking light above Sam's door as soon as his room was in view. "Dean," she stopped for a moment. "I think it would be best if you wait here in the sitting area. I'll come to get you when I know what's happening."

"I have to see him," his voice insistent.

"Please, just wait." He nodded curtly and remained where he was. Dr. Myers voice was forceful, and she hadn't meant to sound abrupt, but she had to get to her patient. She noticed that the red crash cart that usually sits stationed on the wall near the nurse's station was gone. Her face looked grim. She walked into Sam's room to a flurry of activity. Dr. Robert's, a third year resident was talking to a nurse and April.

"Look just load him up on the Phenabarb, now!" Sam was conscious, and as soon as Dr, Myer's saw what was happening, she knew what she was seeing.

"Dr. Robert's, let me evaluate him," she spoke up as soon as she was fully in the room. "He's clearly having a Jacksonian seizure." She looked Sam in the eyes. "Sam, it's okay, all right. We're going to stop that for you. You need to calm down." Sam's face was filled with fear as his left hand and arm jerked spastically and wouldn't stop. He nodded. He was tense and the more his anxiety grew the worse the seizure in his arm was becoming. "It's okay, Sam," she comforted. "Please, just relax." Dr. Myer's adjusted the dose of Phenabarb and injected Sam. And, within moments she could see the seizure slow and the jerking movements of Sam's hand and arm quiet and completely cease.

Dean paced liked a caged animal just past the nurses station. His mind running every horrible, nightmarish scenario it could conjure up concerning Sammy.

"April, when did this start?"

"During our speech therapy," she began. "The seizure came on without warning." Dr. Myer's turned her eyes to Sam.

"Feeling better?"

"What wrong … with me?"

"Well, I'm going to want to confirm with a scan of your brain, but I'm almost positive Sam that you just had what we call a Jacksonian seizure. It targets a limb, or half of the body sometimes. And, that's why your hand and arm were jerking. It's typically caused by a lesion on the brain, kind of like a scar, and that's why I want a scan of your brain. Now, don't worry, okay. It wouldn't be out of the ordinary for you to have some damage in the area of your brain that was affected by the large bleed you experienced with your head injury. We'll put you on some medication, an anti-convulsive, to help prevent any more break through seizures, until I see your scan."

"No want pills."

"Let's play it by ear Sam, okay? Perhaps, we can try it without meds. A seizure like the one you had can and often does subside on its own, but sometimes they can get very intense, and can lead to the entire half of your body beginning to seize. I'd like to avoid that. So we have a deal? You take the meds and we play it by ear," she suggested. Sam's eyes were glistening with unshed tears, but he nodded. "Good. You're a trooper. And, right now, the medicine I just gave will be enough for now, so pills yet, okay?" Sam met her eyes, and she knew he understood. She looked at the resident Dr. Robert's, "Could you call the MRI and tell them to set up for a scan for the patient Sam Winchester?"

"Sure Dr. Myer's." He paused a moment and she approached while April and the nurse fussed over Sam. "You adjusted the dose I was going to administer … was I wrong?"

"No, it wouldn't have harmed him, but that dose would have had him too groggy to respond to me, and I believe in the less is more theory with drugs. I give enough to have a palliative effect."

Dean saw activity as a male doctor walked out and proceeded to pick up a phone on the wall. And, Dean's heart slammed against his sternum as he watched a nurse exit rolling a red cart, he knew far too well, was a crash cart. He couldn't take it anymore and burst into his brother's room. His eyes met his brother's and Sam looked afraid. "Sammy?" Dean's voice was anxious as he approached his brother. He reached out and cupped a cheek with a comforting hand. "You okay?" Sam's eyes filled with fear and anguish, as Dean watched silent tears well up and cascade down his little brother's face. He stroked the tears away gently with his thumbs. "Will someone tell me what the hell is going on? Is my brother all right?" His eyes were intense as he looked from April to Dr. Myers waiting for someone to answer him.

"He's okay Dean," Dr. Myer's assured. "I'm taking him for a scan in a few minutes."

"Scan? Why? What's wrong?" Dean's eyes looked panicked.

"As I explained to Sam I think what he was experiencing when I came into his room was a form of a simple seizure called a Jacksonian seizure."

"Seizure!" Dean's voice was raised in alarm as he turned his eyes to his little brother.

"Dean … it okay," Sam tried to give his brother some sort of relief.

"Sammy," Dean's voice was filled with relief at hearing his brother's voice. "Look," he said turning his attention back to the doctor. "And, since when is a seizure ever simple?" Dean voice was firm. Dr. Myer's smiled.

"I know the word seizure sounds scary, but this form usually happens to one side of the body. This form of seizure most commonly occurs either in the face, arms and hands or some combination. But sometimes it can move from an appendage like an arm to increase an effect the entire half of the body. Sam's seizure was localized to his left hand and arm."

"What causes it?"

"As I told Sam I'll have to see his new scan to be sure, but I'm fairly certain I'll find that he's most likely developed a small lesion, like scar tissue in the area of his brain that was most heavily affected by the large hematoma he developed with his head injury."

"Is he in danger?"

"No," she assured. "I gave him some medication that stopped the seizure, and he may require maintenance medication in the form of an anti-convulsive, but Sam isn't too keen on the idea. So, we're going to play it by ear and see if he experiences any more break through seizure activity, and if he does we'll try to let it run its course without meds, but depending on the severity or if it progresses to body involvement beyond the hand and arm … I'll have to intervene with medication." Dean nodded.

An attendant came to help Sam into a wheelchair and take him to the MRI. "Okay, Sam," Dr. Myer's patted his shoulder. "Now, let's go take a look at that head of yours." Sam turned nervous eyes to Dean.

"Hey, Sammy, no worries," he assured. "I'm walking down with you and I'll be waiting for you when the scan is done, okay?" He saw his little brother relax. Dean took a moment to look at April. "Thanks for staying with him and helping." April smiled.

"Don't thank me," she spoke softly. "Dean," she whispered as Sam's wheelchair turned to go. Dean stopped.

"I'll be right there Sammy. I'll catch up before you're even all the way down the hall."

" 'kay." Sam answered quietly.

"Dean, I was here for the whole thing," April confirmed. "Look, I know you're worried, but it scared him more than anything and that made him panic. I'm familiar with this kind of seizure, so try not to worry too much. I know easier said than done, but I just wanted you to know that at no time was his life at risk, okay? I think it happened so fast and the lack of even more control in his life just sent him into panic mode."

"Thanks," Dean answered. "I better go."

"Sure. Take care of yourself."

"Yeah, thanks. You too." And, Dean scooted out of the room and as promised caught up before they were all the way down the hall.

Two Hours Later, Dr. Myer's Office

"So, this lesion you found, it's like a scar you say?" Dean leaned forward.

"Sort of, but I'm certain it's what caused the Jacksonian episode. It's benign in nature. I mean it's not life threatening to him. It's actually relatively small which is a good thing."

"What about his recovery? Does this set him back?"

"No, he'll be able to proceed normally. Now, I have written orders that he's resting today, so no more therapies today. In fact, I gave him a mild sedative before the MRI, so he should be able to rest peacefully for a good chunk of the day."

"Could it get worse?"

"Well, I'm optimistic that this will only be a transient problem for Sam, but with head injury cases such as his there is always the possibility that he could develop other seizure activity that will manifest itself in other forms. But, I don't want to cross that bridge unless we have to."

"What are you saying? He could develop something else down the line, something that could hurt him?"

"There is a chance with head injuries such as his producing seizure activity on a petit mal or grand mal level. I'm hoping for neither. And, so far his scans don't lead me to believe that he is currently at risk of either."

"Not currently … but he could?"

"Unfortunately, he could, I can't rule the possibility out," Dr. Myer's tried to assure the worried young man, but he had always wanted the straight facts when it came to his younger sibling, so she was being straight. "As his brain recoups from the injury he could develop other lesions, one's that may start bigger problems, but right now, I see no evidence of that. It's a waiting game Dean," she started. "As he continues to recover through rehab there could be other concerns that arise. So, we'll just wait it out, and see what happens."

"These seizures you mentioned that you don't want to see him get, ah … the petit one, and the grand something … are they bad?"

"Well, the petit mal isn't debilitating, and rarely life threatening unless the person is hurt while the seizure is occurring because of where they are when it occurs. A petit mal," she began to explain knowing Dean would want to hear it. "It's a small attack or seizure if you will, where the patient has a brief lapse of contact with their surroundings, after which they resume usual activities. He'd just sort of blank out. Sometimes this kind of seizure could be accompanied by a twitching hand or even drooling. Now, a grand mal, is much more severe, and if not controlled early could result in respiratory arrest or even cardiac arrest, also further brain damage could result. It basically equates to a generalized convulsion. Most lose consciousness and can be slightly altered for a short period of time when they awake. It's the one seizure I don't want to see Sam develop. Now, there are some instances where a grand mal could be triggered that does not necessarily dictate that he will suffer from them forever, but at any rate, it's a seizure I would like to avoid."

Dean sat and digested the information. He wanted to get back to Sam, but he had a question that had been burning a hold in his head for a few weeks now. "Dr. Myer's," he began.

"Yes?"

"Has my father called about Sam recently?"

"No, he hasn't."

"How many times has he called?"

"Well, he can only get information about Sam from either you or myself," she started. "And, I've only spoken to him twice. Once, before Sam's transfer to the center, and he called the Monday following his transfer to see if he had been settled, and was being taken care of. I haven't spoken to him again."

Dean nodded. "Thanks." He stood up. "I think I'd like to get back to Sam. I know he's probably sleeping, but …"

"I know. Say no more," she smiled. "Now, remember if you have any questions don't hesitate to ask or have me beeped, all right?" Dean nodded. "And, the staff knows to have me paged if Sam should have another episode. I only live a ten minute commute from here, so should I be needed while I'm not here … don't worry, okay?"

"Thanks, Doc."

Sam's Room

Dean grabbed a chair and pulled it over to his brother's bedside. "Hey Sammy," he whispered quietly to his sleeping little brother. "You scared the shit out of me," his voice hushed. He reached up and pushed back Sam's unruly bangs. "I don't know what …" his voice caught and he felt the hot sting of tears. "I don't know what I'd do if I lost you kiddo. I can't …" Sam stirred and slowly opened his sleep heavy eyes. Dean met his brother's gaze and smiled warmly. "Hey, little brother," his voice was gentle. "How ya feelin'?"

"M' kay," Sam's sleep inflected voice answered. Sam opened his eyes a little more fully and studied Dean. "You okay?"

"I'm good, Sammy. You don't have to worry about me, all right?" Sam frowned.

"You worry … about … me. Why I … can't worry?"

"Because you keep forgetting who the big brother is here," Dean answered with a wide smile. "It's my job to worry about you."

"Not care what you say," Sam's face determined. "I worry 'bout you, too. My job." Dean chuckled.

"Okay," he conceded. "But, I promise, I'm all right." Sam nodded.

"Not like jerk … ing." Dean looked at Sam for a second trying to work out the sentence in his head, and then it hit him that his brother couldn't verbalize the word 'seizure.'

"You mean the seizure?"

"Yes. Not like."

"Were you in pain?" Dean eyes were intense.

"Not really hurt. Mus…" Sam's brow creased as he couldn't form the word he wanted to say.

"Muscles?" Dean suggested, and Sam smiled. "So, it doesn't hurt, but what about your muscles?"

"Tight when happen. Not hurt … but, not like."

"So, you're uncomfortable, but not in pain."

"No pain." Dean felt a little relief at that, but it was cold comfort.

"Dean?"

"Yeah, Sammy?"

"What … happened?"

"Huh?" Dean looked confused. "You had a seizure Sam, remember?"

"Not jerk …ing. Head … what … happened to me?" This was the moment Dean had dreaded because part of him wondered what Sam did remember, and whether or not his little brother recalled any of the events of the hospital and what his father and he had said to him before his collapse.

"What's the last memory you have?"

"Cabin. Demon. Then car. Going to hos…hos…" his eyes closed in frustration.

"Hospital." Dean supplied. Sam opened his eyes and nodded. "You remember you were driving Dad and me to the hospital?" Sam nodded. "Then what?"

"Nothing," he spoke slowly making sure the word came out correctly.

"We had a wreck," Dean offered. "A semi truck hit the Impala. Plowed into us pretty good. You hurt your head. They said you had a severe concussion. You signed out AMA from what my nurse told me. You basically told her to mind her own business, and then the next thing I know … when you started to leave my room you grabbed the door …" Dean was assaulted by the memories of that moment. He blinked his eyes rapidly as if that would rid his mind of the images. "You collapsed and then the next thing I know you're taken into emergency surgery because you had a complication. You were bleeding in your brain and it was swelling. You were in a coma for a while, and then I moved you here."

"D… dad?" Sam looked at Dean.

"He was at the hospital while you were in the coma. But, you know dad he can't stay anywhere too long," Dean felt like he had to keep up the lie. He wouldn't tell Sam the truth about their father and that he had given up on him, and left. He stayed until you came to the rehab center."

"He hurt … in car?"

"You know dad Sammy," Dean assured. "He got banged up, but he bounced back. He was perfectly fine when he headed back out on the road." Dean smiled at his brother and decided to change the subject. "So," he began. "What's your next memory after everything is a blank?"

"You," Sam supplied softly.

"Me?"

"You fix sheet and smile." Dean remembered that day he had come in to visit Sam still flying high over the previous weeks improvement when Sam had begun to notice and engage his environment. He recalled tucking the sheet and blanket around Sam and talking to him about nothing special, and then looking down and seeing his brother looking at him, actually seeing him for the first time in months. Dean felt his throat tighten, and he turned his face abruptly. "Dean? What wrong?" Dean didn't know whether to feel happy or upset that Sam had no recollection of the events right before his collapse. Part of him had hoped Sam wouldn't remember the harsh words he hadn't meant, and the other part of him wished he did remember because he felt he shouldn't get off so easy.

"Nothings wrong, Sammy. Nothing at all," Dean no longer holding pretenses, leaned forward and grabbed Sam and pulled him against himself. "Everything is fine Sammy." Sam lifted his arms and returned the impromptu hug.

"Ch … fick," was all Sam could verbalize and the pronunciation was off, but Dean knew what he was saying.

"Is not," Dean chided. "That was definitely not a chick flick moment." He sat trying to put on his most serious face. Sam snorted a laugh. Dean broke into a smile. "I don't know what it was," he offered. "But, it was most definitely not a chick flick moment." Sam just continued to grin like a Cheshire cat. Dean rolled his eyes, "bitch."

"J… Jerk."

Dean stayed until Sam was asleep. He had wanted to stay with Sam tonight especially after the days turn of events, but when he mentioned to Sam that he wanted to stay. His brother had been adamant that he go to his place and get some sleep. Dean walked out into the parking lot, and as he drove out onto the main road. He drew in a shaky breath and let it out slowly his fear for his brother not disappearing, but lessening a small fraction. Today had scared him more than he wanted to admit. And, the thought of losing Sammy after everything that has happened over the last few months made his stomach clench. He fought the feeling off, he'd be strong for his brother, and he'd push the overwhelming and paralyzing thoughts of losing Sammy, losing his light, out of his mind, at least for tonight he'd try, if not for his sake, for his little brother's.

To Be Continued

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