Disclaimer: refer to chapter one
NOTE TO READERS: Posting a little early, but thought you wouldn't mind. As always thanks for each and every comment and review. Also, to every reader that has sent me a PM with questions, comments and reviews, thanks! I will make an effort to update at least once a week, and depending on how fast a chapter comes to life maybe occasionally more than once a week. Thanks for your patience between updates! It's very appreciated.
Side Note: Also, please, note there has been a time advance. And, one backward and forward shift, as well. They are all noted
Chapter Twenty-one
To Wish Impossible Things
By Dawn Nyberg
"…The stars are not wanted now, put out everyone; pack up the moon and dismantle the sun; pour away the ocean, and sweep up the woods; for nothing now can ever come to any good." Poem excerpt by W.H. Auden, Stop All the Clocks
Three Months Later, March 2008
"John?" Dan came around the corner of the body shop where John was taping off a car to paint the body.
"Yeah?" John looked up from taping down paper over the windshield.
"You doin' okay?" John smiled and shook his head with amusement.
"Dan … I'm fine. It's not like body painting is that strenuous. Look, the doctor gave me the okay to drive and return to work."
"Yeah, but I'm just makin' sure."
"I'm not running a marathon," John pointed out. "I'm good." John still attended his heart rehab for two hours every Friday afternoon. He had reduced his work week since the heart attack. He worked Monday – Thursday now and gave himself a three day weekend to relax with his boys. Dean had returned to his usual schedule with Larry and things were good.
Two Weeks Earlier, Last Week of February 2008
Sam sat at the bus stop on Webber Street waiting for the bus to his dentist. He was getting over a bad case of the flu and Dean and his dad had tried to convince him he could always cancel his dental check-up and cleaning appointment until he felt better, but he didn't want to mostly because he was taking the bus to the doctor's office all on his own, and he didn't want to pass up the chance. And, since the holidays had passed Dean and John had been true to their word about letting Sam have more roaming space. He only had to tell them where he was going and the route being taken. Of course, every once in a while his cell phone would ring and it was his brother checking up on him, but he wasn't complaining. He still attended his rehab on Thursday's and Friday's and he was really pushing his occupational and speech therapy. Mel did his PT with him to help his reflexes improve and he still tried to run, but that never worked out. But, he would keep trying.
Present Time: The Winchester House, 5:00 PM
"Dean stop looking at your watch," John chided. "You know he was going to the dentist after work for a filling he needed after his check-up and cleaning two weeks ago, and the office is across town. He'll be back soon. He had to transfer buses, remember?"
"Yeah, and that's what I'm worried about dad. I mean, yeah Sammy getting all over town these days, but it's usually from point A to point B and no stops in between."
"I know, but he'll be fine." John handed Dean three plates for the table. "Here, set the table and take your mind off it."
"What are you making?"
"Grilled chicken," John answered. "And some mixed veggies." Dean grinned to himself, but John didn't miss it. "What?"
"Nothing," Dean offered.
"Dean," his father's tone was annoyed.
"I'm not making fun … it's just I'm glad you're taking all that heart rehab stuff seriously. And, I never thought I'd see the day we were eating like this. I mean, maybe fried chicken from KFC, but you grilling the chicken and stuff. Maybe, you oughta have your own show dad," Dean said with a chuckle.
"Ha-ha," John replied sarcastically. "Well, it's either eat like this or watch your old man drop over again." A haunted look passed over Dean's face for a moment and was gone. John frowned. "I didn't mean anything by that son," he offered quickly. "I'm sorry."
"It's fine dad," Dean answered. "I'm good."
"You sure?"
"Yeah." John's attention was drawn away for a second and Dean looked at him.
"What?"
"I think I just heard the front door," he replied with a smile. Dean broke into a relieved smile as he called out from the kitchen.
"That you Sammy?"
"Yeah," came the tired reply. Sam walked into the kitchen and John and Dean both looked at him.
"Damn Sammy, you look like crap," Dean offered.
"Thh…thanks Dean … I fff…feel the love." Sam replied as he sat heavily in the chair at the table.
"You feelin' okay Sam?" John asked looked at his son's milk white complexion. "Was the dentist bad?"
"No, it www…was fine. Just tired." Dean shook his head as he sat down in his seat.
"You did good Sammy," John congratulated. "You didn't have any trouble with the bus transfer?" John felt he should be supportive if Sam's accomplishment.
"Nnn…no it was fff…fine," Sam answered with an exhausted voice and slight grin.
"Leave it to you Sammy to catch the flu in spring. Only you man, only you." Sam rolled his eyes, but chose not to respond to his brother. "I mean, really Sammy, you've been down with this for a while. I thought it was clearing up, but you look more like a corpse everyday."
"It's ggg…going away," Sam retorted. "Not a cor…cor…pse."
"Yeah, whatever you say," his voice not convinced. "Well, maybe you should hit the rack early," Dean suggested.
"I'm fff…fine. Not ttt…tired. I'm not …" Dean raised a hand and finished the thought for his brother.
"…a little kid. I know," Dean said with a sigh. "It was just a suggestion. So, how'd the bus transfer go?"
"Fine."
John finished with the food. He didn't mind being the primary food preparer during the week; after all it made sense since he got home before Dean. John and Dean were having a lively conversation about the sportronic transmission in the new Mitsubishi's and in the midst of talking about torque they realized one member at the table was quiet. They both turned their heads to look at Sam and they smiled. Sam had propped his elbow up on the table and leaned into his hand. He was fast asleep as his hand supported his cheek and chin.
"Not tired my ass," Dean whispered under his breath as he exchanged looks with is father. John smiled warmly toward Sam. He reached over and placed his hand on his son's other cheek. The touch woke Sam and he opened his bleary eyes.
"Hey son," John said softly. "Why don't you go get cleaned up and call it a night." Sam knew he had fallen asleep at the table, and it would be pointless to say he wasn't tired, so he conceded.
"Okay," his voice tired. John reached down and patted Sam's hand.
"Geez Sammy your hand is ice cold," he commented as he covered the cool hand with his own warm broad one. "You're a little ice cube," he said as he attempted to rub Sam's hand. He pulled away.
"It's okay ddd…dad. I'm fff…fine."
"Well, look tomorrow is Thursday and I'm thinking you should skip rehab this week. You're still trying to recover from the flu … you can't seem to shake, and you're not looking that great Sammy."
"No," Sam answered. "Ccc…can't miss rehab." John sighed.
"Fine, but if you feel bad I want you to call me and I'll come pick you up early, okay? I can leave work early. I don't mind." Sam smiled and nodded.
Later that Evening
"Still sleeping, huh?" John asked as he looked up from the couch when Dean walked in carrying the hand held monitor.
"Yep, out like a light." Dean sat down next to his dad and put the monitor on the coffee table as they settled in to watch an A&E Crime Mystery special. John eyed the monitor.
"So, he's all hooked up?"
"Yep, I snuck in to make sure."
"Good."
Sam opened his eyes as the early hint of morning sun came in through the curtains of his room. He felt fatigued, and hated that he couldn't shake the flu. He had honestly been feeling a little better a couple weeks ago, but about a week after his dental appointment he started feeling like crap again, but it felt different. Mostly he was just tired, and it seemed in the last few days his arms and legs were always cold. He turned from his side to his back and just stared at the ceiling. He lifted his hand and looked at his pulse-ox clip and rolled his eyes. He reached over and shut the monitor off and removed the clip. A knock at the door brought his eyes toward the noise. "Hey Sleepin' beauty move your ass. Dad's takin' you to rehab before he goes to work." Dean opened the door a crack and peeked in. Sam made eye contact with his big brother.
"I'm up," he groaned. Dean surveyed his brother from across the room.
"Man, Sammy," Dean shook his head. "You need some sun or something. I've seen two day old corpses with more color than you."
"Sss…shut up," Sam complained. "Ddd…don't you hhh…have to be at wor…work?"
"Yeah, yeah," Dean waved an impatient hand in his brother's direction. "I'm goin'" Dean replied. "See you later." Sam waved him off and Dean closed the door behind him. Sam let out a slow breath and sat up. The room swam around for a moment and he closed his eyes against the fleeting moment of light-headiness. It passed and he got up. He took a shower and his meds, and met his dad in the kitchen.
"Morning Sammy," John turned smiling from his glass of orange juice. He looked his son over. "You feeling any better this morning? Cause' you look pretty pale kiddo."
"I'm fff…fine dad." Sam answered.
"Well, eat something I don't want you going to rehab all day without some food on your stomach."
"They fff…feed me lunch dad," Sam countered.
"Yeah, well that isn't until later and you need some food to start the day."
John pulled up in front of the rehab center and squeezed Sam on the shoulder as his son started to get out of the truck. "What?" Sam asked.
"Remember what I said last night," John hedged. "You feel like you want to call it a day early just call me and I'll be here, okay?"
"I'm ggg…good dad." Sam assured.
"Okay, son. I'll see you around 4, all right?"
"Yep." Sam offered a small smile and got out. John watched him until he was inside the building and then he pulled away to go to work back in the city.
Later that Day, 1:00 PM
"Hey, Sammy," Mel welcomed the young man. "Have a good lunch?" Sam shook his head.
"Not ttt…that hun…gry. Had some jjj…juice."
"Still fighting that flu, huh?"
"Yeah," Sam conceded.
"Maybe, we can postpone your PT," Mel offered.
"No," Sam answered simply.
Mel put Sam through his paces on the exercise machine for his legs and upper body. He had him walk on the treadmill for twenty-minutes. And, then he worked out his muscles on the mats to make sure he didn't cramp. "I scheduled you for some pool therapy today, but maybe hydrotherapy would be better. It's nice and warm. Might help you feel a little better," Mel suggested with a smile.
"Okay," Sam replied.
"Here," Mel reached down and pulled Sam to his feet. "Let's get you situated." He turned to head toward the pool area.
"Mel?" Sam's voice sounded strange and Mel turned just as Sam collapsed forward. Mel grabbed him easily and lowered him to the ground. The other staff present in the room ran to help. One staff member hit a red emergency button on the wall to alert a response team. Sam was limp and unresponsive. Mel's hand reached for Sam's neck as he leaned in to listen and feel if Sam was breathing. What he encountered was a contradiction in terms. He felt Sam's shallow exhale, and watched his chest rise slowly, but there was a distinct absence of a pulse beneath his fingers on Sam's neck. "He's breathing, but…"
"Mel? What is it?" Corrine another therapist asked as she kneeled next to Sam waiting for help.
"I can't feel a carotid pulse," Mel replied as he leaned down and put his ear on Sam's slow rising chest. "I can hear his heart, but it's slow … damn slow." The emergency response team came into the gym area and quickly surrounded Sam.
"What do we got?"
"He stood up and passed out. His breathing is shallow, but I can't get a carotid on him. I don't know what the hell is wrong. His heart is beating too slowly." Mel's face was agonized. He kept reviewing in his head if he had missed something during the PT session, a warning sign, but Sam had been okay, he thought. Tired, but fine.
"Get him on a monitor and what's his SAT's?" Marcus, a third year resident ordered. They proceeded to hook Sam up to a heart and oxygen monitor. "Yeah, I can't get a pulse. What the hell?"
"SAT's are 90." One respondent answered.
"Okay, start bagging him," he turned to look at the monitor and his eyes went wide. "Christ," he hissed. "Draw up a high-dose Epi," he barked. "His heart rates only 40. Get the damn meds drawn up. I gotta start supplemental compressions. He's barely profusing his body at this rate."
The meds were administered and by now Dr. Myers had shown up having been alerted there was an emergency in the gym, and then she had heard Sam collapsed. "Heart rate 65 with compressions."
"Hold supplemental compressions," Dr. Myers instructed. She looked at the monitor. "His rate dropped to 52, but is holding. Pulse is weak and thready. Push an amp of Lidocaine. I'm ordering a Life Flight helicopter to take him to Capitol. Keep his rate above 50."
The medical helicopter landed on the helipad the rehab center had in the rear of the building. The crew was apprised of Sam's current condition, as well as his medical history including his current meds. They hurried him to the helicopter. Dr. Myers stood watching as Sam was put into the helicopter. She stood off away from the helicopter blades as they spun to life. And, just before the doors closed she saw the medic leaning over Sam while another one intubated him and began bagging him. She saw a brief moment before the doors closed where they were beginning compressions again as they administered an IV drug. The helicopter lifted off and Dr. Myers knew she had a call to make.
Pro Care Auto Repair
"John?" Calvin, one of his co-workers came around the corner. "You got a call buddy on line 3. Sounds important." John went to the nearest phone and hit line 3.
"John Winchester," he answered. The conversation lasted only a minute or two before John was flying out of the garage. He had called Dean at work and told him about Sam. John knew Dean was rushing from one end of the city while he was coming from the opposite side. He was shocked when Dr. Myers had said Sam collapsed and it wasn't a seizure. He felt this cold weight in his stomach as he recounted everything Dr. Myers had told him on the phone during their brief conversation. His baby boy was in trouble.
Capitol Region Medical Center: Two Hours Later
Dean paced back and forth in front of his father. John reached an arm up and stopped his son. "Dean, please, you're wearing a path. Just sit." Dean sat heavily down into the hard cushioned chair in the ER waiting room.
"How can you be so calm dad? Sammy's been in there for over two hours and we haven't heard word one from those idiots in there." John scrubbed a hand over his weary face, but said nothing. Finally, he looked at his watch a short while later and let out a loud frustrated sigh. He got up abruptly. "Where you going?" Dean asked.
"To get some news on your brother." John walked up to the ER main desk.
"Can I help you sir?"
"Yes, my son, Sam Winchester was brought in by helicopter over two hours ago. I want some news on my son. I haven't heard anything." The desk clerk tapped on the computer, and looked up.
"I'll try to find someone to talk to you. The computer says he's still here in the ER.
"Look, I want to know the condition of my son, now!" John barked. Dean stood next to his father as the clerk went back into the trauma area.
"Dad," Dean put a hand on his father's forearm. "Watch your blood pressure, okay. I can't handle one more thing right now." John nodded.
"I'm okay son." The clerk remerged from the trauma area.
"Your son is still being triaged. His doctor is Dr. Karl Borsody. He'll be out in a bit for you. Please, just take a seat in chairs."
Dean sat next to his father waiting for word on Sam. His mind telling him this was just all something blown out of proportion. Sam was fine. Yeah, his father had told them there was something funky happening with Sam's heart, but they'd fix it. Sam was going to be okay. John's hand darted over to Dean's thigh and tapped him. "Family for Sam Winchester." Both men stood to meet the doctor. "I'm Dr. Borsody." John shook his hand.
"I'm John his father and this is his brother Dean. What's wrong with my son?" John cut to the chase.
The doctor led them to a family conference room. "I understand you've been waiting for quite a while, but I had to run some tests, and we've been fighting to keep him stabilized. Look, I'm going to say this as quickly as I can, and I hate to rush, but I'm going to give you a lot of information in a short amount of time because I need a consent paper signed."
"Just tell us," John spoke firmly as his eyes passed briefly toward Dean and then back to the doctor.
"I was called in to consult your son's case, and I have taken it over. I'm a cardiologist here in the hospital. Your son presented with a barely profusing heart rate. We have started him on multiple cardiac medications to help improve his heart rate and pumping. He isn't responding as quickly as we'd like. We are having trouble keeping his heart rate up and we're having to provide supplemental compressions to help him profuse his organs and body." John's face was unreadable. Dean felt his palms start to sweat.
"I don't get it," Dean spoke suddenly. "His heart's beating, right? Why are you doing compressions? I thought you never did that."
"As a standard no you don't, but your brother's heart rate isn't maintaining a rate that will keep him alive for long. His heart isn't beating strong enough to get blood to his brain, his vital organs, so we're helping him."
"Please, just tell me what's wrong with my son."
"I've done an ultrasound of his heart and I've found no congenital heart valve defects," the doctor paused.
"No, he doesn't have any. Sam was a healthy baby. Both my boys were." John replied.
"Well, the lack of valve defects spurred me on for a diagnosis. I was perplexed. Has your son been sick recently?"
"Yes, he had a bad case of the flu. It hung on for a while. He was still trying to shake it." John answered.
"Has he had any recent medical procedures or doctor visits?"
"Ugh," John's mind was reeling. "Yes, two dental appointments. He had a cleaning and check-up about 2 or 3 weeks ago. I think 2. And then the other day he went back for a filling. Why?"
"Well, I ran some tests and more than one blood test, and although your son's case it a bit atypical because of a lack of tachycardia, and no history heart valve problems or defects. But, as I said his case is highly atypical with his current cardiac response. I think the infection has had a chance to take hold, and has ultimately ended up compromising his ability to maintain a profusing heart rate," the doctor took a breath. "I think his immune system was fairly compromised by the flu and during his cleaning some oral bacteria entered his bloodstream, and ultimately ended up infecting the lining of his heart."
"What are you saying? My son has a heart infection?"
"Yes, it's called Endocarditis. And, his case is acute. I need to get your consent to engage the use of a machine we call the Thumper." The doctor placed the consent form out in front of John.
"What is it?"
"Normally this machine is only used on patients who have no pulse or heart activity and I'll be honest it is contradicted for this use, but I see no other option. Your son keeps requiring supplemental compressions as we struggle to keep his heart rate up. I will have the Thumper halted every five minutes to look at his cardiac status. We can't keep doing manual CPR and the Thumper will provide more adequate compressions to better help your son profuse his body. And, if we are able to get your son's heart rate to maintain over 50 then we will hold off the Thumper. It's my hope that the cardiac medications we are using will begin to take effect."
"Dean?" John turned toward his son. "Do you want me or you to sign?"
"You do it," Dean answered as his voice shook. "So this machine will do CPR?"
"Yes, and it has a sequenced ventilator, too. It will be placed over your brother and turned on. It will compress his chest just as manual CPR would provide only the Thumper is more effective and precise. And, quite frankly, it's a machine and won't get tired."
"I want to see my son," John replied.
"As soon as we have him more stable. When I feel there is a good moment I'll let you in to see him. I want to stabilize him here in the ER as best we can before I have him moved to the CICU." John nodded and signed the paper.
"Dr. Borsody?"
"Yes?"
"What are my son's chances?"
"The acute nature of his endocarditis and his blood work and other tests indicate the infection is quite severe." John knew the man was stalling.
"Just tell me," his voice strong.
"He's young, so he has that going for him. The mortality for this particular strain of infection ranges from 45 to 73 percent. It all depends on the nature of the infection and on any complications that could arise."
"And, my son," John urged. "Where does he fall in this range?"
"I can't stick a percentage on him just yet. But, your son," the doctor paused. "Mr. Winchester your son is in grave condition right now."
"But, this machine will help him. His blood will get pumped to where it needs to, right?"
"Mr. Winchester, I'll be honest this machine is basically providing gap coverage of sorts. If the cardiac drugs don't kick in, and his heart can't maintain a profusing output there may come a time when we'll have to have a different kind of conversation. But, I don't want to cross that bridge yet, okay?" John felt his world shift at that final comment. He nodded absently at the physician. The doctor excused himself and Dean felt a chill run through his body. John saw the small shiver work through his son. He leaned over and wrapped an arm around his firstborn and pulled him against himself.
"We're getting through this Dean. Sammy too. You hear me?" Dean leaned into his father and nodded his head. His eyes were burning with unshed tears.
"Dad?" Dean's shaking voice betrayed him.
"Yeah?"
"He's gotta be okay. Why is it always Sammy dad? This isn't fair."
"I know." John felt at a loss. "He's going to pull through Dean. We have to believe that. We aren't going to lose Sammy." Dean nodded. "Now, let's go back out to the waiting room and hopefully they'll let us see Sammy soon.
Another Two Hours Later
"Mr. Winchester?" John's head shot in the direction of the voice. He and Dean had both been staring off into space trying to forget how long it had been since they had spoken with the doctor. John and Dean both stood up and faced the physician.
"Hi, Doctor. How's Sam?"
"I'm going to let you both in to see him. It's going to have to be a quick visit. I can give you a couple minutes or so. We have been fighting to get him stable enough for transport. The Thumper is helping to profuse him much better. I'm worried that the cardiac drugs aren't having the desired effect as yet in helping to maintain an effective heart rate and cardiac output. I need to tell you that at one point when we stopped the machine at its five minute check your son had slipped into a cardiac arrest, but we were able to shock his heart and we had him back quickly." John's face paled. Dean felt like he'd been suckered punched in the gut.
"So, his heart is beating," John reiterated to the doctor.
"Yes, although currently we are still providing him supplemental compressions."
"Has his heart rate been stable at all?" John felt desperate.
"He did hold a heart rate over 60 for about 30 minutes before he decompensated once again and needed help profusing his body."
"I just want to see him" John relented.
"Of course. I want to prepare you," the doctor began. "Sam is surrounded by a lot of equipment and IV's. He is on a specialized gurney and his arms are each positioned on arm boards out to the sides. His arms are rotated palms up and each arm is held in place by a loose Velcro strap. Each arm has an IV line and we've started a multi-port central line on your son, and you'll see that near his neck. The Thumper will be on and it isn't quiet. It makes an air piston noise as it operates. And, you'll notice a large flexible hose near Sam's feet under the sheet," the doctor explained. "It's attached to a patient warmer. We are trying to warm him up with heated air. You can touch him just be mindful of the equipment and IV lines." John nodded.
"I just want to see my son." The doctor nodded.
John and Dean followed the doctor back to the trauma room that had Sam. They noticed multiple staff around monitoring machines and administering injections. John saw Sam first. Sam was lying on his back exposed from the waist up. His head rested not on a pillow, but a circular foam support similar to ones used during surgery. There were wires and tubes that seemed to be coming from everywhere on his baby son. Sam's arms were outstretched like the doctor had explained. Sam slightly resembled the capitol letter 'T'. The Thumper was compressing Sam's chest at a regular rate, and the ventilator was hissing in conjunction with the timing of the CPR assistance device. John's stomach felt cold and heavy as he approached his baby boy. As John stepped out of Dean's way and his little brother entered his field of vision Dean stopped instantly and stared at Sammy in abject horror. He felt the bile rise in his throat.
Sam was deathly pale. The white sheet covering his brother's legs stopping short at his bare feet had more color than Sam. Dean couldn't break his eyes away from the machine compressing his brother's chest. He watched Sam's rib cage compress and decompress with the rising and falling piston action of the machine. It looked barbaric to him. John had walked over to his young son's side and touched his shoulder. The skin was deathly cold to the touch. He looked over at Dean who still stood in the doorway. "We can touch him Dean. It's okay."
Dean didn't move he just stared at Sam. His senses were being assaulted more than he thought was possible. His brother looked more dead than alive. "Dean," John spoke again. His son still stared. "Dean?" Finally, Dean tore his eyes away from his brother and looked at his father. John saw something in Dean's eyes he couldn't quite place as he had never seen it on his oldest child before. "Dean? Son?" John urged still not leaving Sammy's side. "It's okay come see your brother." Dean's eyes shifted to his brother's prone lifeless body and then looked at his father with stricken eyes. He shook his head slowly back and forth.
"I…I…" he attempted as he took a step back. "I…I can't … I can't do this," his voice trembled as he took another step back. "I can't…" and Dean suddenly turned blindly and escaped into the hustle and bustle of the busy ER trauma area.
"Dean!" John called out after his son, but remained with Sam.
"It can be overwhelming," a nurse near John replied. He looked at her for a moment and then back to the empty doorway. He understood the look on his son's face now because he had seen it in his own mirror when he had believed Sam was lost to them after his head injury. He wanted to find him and tell him it was going to be okay, but he honestly didn't know. Dean had dealt with so much over the past year and handled it with such strength and grace that John took it for granted that his oldest would handle this the same way. He had been so wrong to see Sam as his only fragile child. Dean was fragile too, and John feared that Dean seeing Sam in this current state may have finally been the straw that broke the camel's back.
Forty-Five Minutes Later
John sat in the ER waiting room alone. He hadn't seen Dean at all. He thought about calling him on his cell, but something told him that his son needed to come back on his own terms, so he'd wait. John saw the doctor approach. "Mr. Winchester, I just wanted to tell you that we're preparing to move Sam upstairs to the CICU. We've taken him off the Thumper and right now his heart rate is holding at 65, so I think the drugs may be kicking in a little. They are putting him in the larger special procedure room, so you'll be able to sit with him unless there is test or exam happening, okay?"
"Thanks. What if his heart rate drops in the elevator?"
"I'm going up with your son. Should he have any problems we are taking an assortment of life support drugs with us, a portable defibrillator, and if necessary we will provide supplemental compressions with manual CPR."
"What about the Thumper? You're not taking it with you?"
"No, the CICU unit has two devices up there and one has all ready been allocated to Sam's room and is ready should it be needed. We're moving him in a couple minutes why don't you go ahead and wait up there in the CICU waiting room. Do you need directions?"
"No, I'm familiar with the unit."
The CICU Unit, 8:00 PM
John sat in a chair against the wall in Sam's room. Sam was in the same position as he was in the ER with outstretched arms. There was always so much activity that John just remained on the wall and watched. And, when he wanted to see Sammy up close he'd stand and walk the short distance to his son. He was comforted by the fact that Connie his nurse from a few short months ago was Sam's care giver. He couldn't help but notice the distinctly empty seat next to his chair. Dean had bolted from the ER over two hours ago and John still hadn't seen nor heard from his oldest son. Sam's heart rate had been holding in the 60's for the better part of an hour now and John was elated for this small feat. He got up and stood by Sam. He touched his son's face. He avoided the ventilator and other tubes. His face was cold to the touch and he didn't move. John wished Sam would open his eyes, but the doctor had explained that Sam was deeply unconscious, not in a coma, but unconscious. The doctor had assured him it was for the best right now, and that if he were to start to wake they would most likely sedate him into a drug induced coma to help take the stress off his body. John leaned down and kissed the top of his son's head. He smiled. Sammy's hair smelled like vanilla and John ached.
Two hours later an alarm sounded at Sam's bedside that brought a large medical staff flooding in. John was wide-eyed. The sound he knew what it was because that hideous blaring noise cut off the slow, but steady beep of his son's heart monitor. "You'll have to leave Mr. Winchester." Connie spoke quickly moving John out of the room. He stared through the glass window into his son's room. He watched them start compressions on his son. He saw a nurse disconnect the vent from Sam as they attached a bag and began ventilating him. And, just before he was ushered away from the window toward the CICU waiting room he saw the doctor apply the defibrillator to Sam's chest and watched his young son's chest convulse upward from a shock.
One Hour Later, CICU Waiting Room
Dr. Borsody came into the waiting room, and when John started to stand he motioned him to sit back down. The doctor was thankful the small room was empty except for the two of them. John looked at the doctor and he felt dread. "How is my son? I've been waiting an hour to hear."
"Mr. Winchester," the doctor began. John interrupted.
"Please, just tell me he's alive." John's voice was desperate.
"He is," the doctor answered solemnly. "But…"
"But, what?" John blurted.
"Your son experienced a sudden cardiac arrest. He went into ventricular fibrillation or VF as we call it. It's where the heart isn't pumping, but instead sort of quivers. It isn't a life sustaining activity. We used cardiac stimulating drugs and shocked his heart to try and reestablish activity to the heart. However, he slipped into an asystole rhythm or flatline if you will." John felt his heart clench inside his ribcage.
"He was down for almost fourteen minutes before we were able to reestablish a pulse." The doctor shook his head. "Mr. Winchester…"
"John, please," he urged. The doctor nodded.
"John I wish I had better news for you right now, but we've had to put Sam back on the Thumper, and we've started him on some more aggressive cardiac drugs to help increase output, but take the strain off his heart at the same time. It's a delicate dance we're in right now. He isn't responding the way I would like right now. I'm sorry, but right now Sam's heart is starting to show the first stages of heart failure and I'm working very hard to reverse it. And, his kidney output is dropping. I'm trying to address that with some more drugs." John looked stricken but remained silent and the doctor wished he had some comfort to offer, but there was none. "John, Sam's body has been working so hard and his body and heart are simply getting tired. And, his heart because of the acute nature of the infection isn't profusing his organs like it should…" John interrupted.
"But, that's what that Thumper thing is for," his voice desperate. "It's helping improve his heart rate, right? So, his organs and brain can get the oxygen and blood they need."
"It's helping, but as I said in the ER the Thumper is gap coverage and actually Sam is the first patient I've ever used the Thumper on that wasn't in a full arrest. I'm not giving up on Sam," the doctor assured. "But, I need to put all the cards on the table for you now in the event decisions are needed later."
"What? Take my son off life support?" John snapped.
"We aren't at that point yet John, but right now you need to understand that your son's heart isn't profusing as it should. His kidney output is decreasing, and unfortunately some preliminary blood work is showing other organ involvements."
"What are you saying?" John's eyes were panicked.
"I'm doing my best to address every issue to try and get ahead of it before it snowballs, but as I said right now your son is showing the first stages of heart failure and unfortunately recent blood work and tests are indicating that Sam is beginning to show early signs of multiple organ failure." John paled and he felt an involuntary shiver work through him.
"Is…" John cleared his voice. "Is he dying?" The doctor dropped his eyes from Johns gaze for a moment and looked back up into the desperate father's eyes.
"We're doing everything we can," he tried to comfort. "I'm hoping the IV antibiotics take hold on the infection soon and it's my hope that once that happens his heart will rebound with the assistance of the cardiac drugs. And, I'm doing everything I can to manage the other complications. I believe if we can get the infection to respond to the meds we'll be able to reverse the other problems."
"When can I go back in?" John was scared shitless, but he wasn't running from this and as much as he wanted to block out everything he knew he had to face this head on. Jesus, how did Dean handle all of this on his own, John thought to himself.
"It may be another hour. I want to run some tests. I'll send Connie for you when you can come back in, okay?" John nodded.
"Thank you," his voice sounded hollow even to his ears and it seemed right because he felt hollow.
Meanwhile, Route 50 outside Osage City
The lights of the oncoming traffic were blinding to Dean's tear filled eyes. He gripped the steering wheel tightly. He clung to it like a life preserver in a storm tossed sea. His cheeks were streaked with hot tears. Some had dried leaving behind visible paths. He had abandoned his brother, no he had not just abandoned him, but run away from him and he hadn't looked back. He had run to the parking lot outside the emergency room and had gone to the Impala and left. He had no direction or plan. He just drove.
"Sammy," he choked out loud to an empty car. "I…I…" his bottom lip quivered as he tried to hold in the sob threatening to escape. His mind was frantic. He had seen his little brother through brain surgery, a coma, and seizing, but some how tonight was too much to bear and he had collapsed under the weight and magnitude of this crisis. "I'm not strong enough Sammy," his voice shook. "I can't …" a choked sob escaped despite his best efforts. Then the memories came:
"Dean, honey, meet your new little brother Sam," his mother cooed. His father picked him up and put him next to his mother in her hospital bed. He looked inside the bundled blanket and saw his pink faced little brother looking at him wide-eyed.
"Hi Sammy," he chimed. "I'm your big brother Dean." His young four-year old hand reached down and touched his brothers bobbing little hand. He smiled as his new baby brother gripped his finger and squeezed. "Look Mommy he knows me." Mary smiled warmly at her oldest child.
"Of course, he does sweetie."
"Daddy?"
"Yes?"
"When can Sammy play in the yard with me?" John laughed.
"Not for a while little man," he replied. "But, he'll be big enough to play with in no time at all. But, in the mean time you've got me."
"Okay," Dean smiled.
The memory shifted and he smiled at the mental picture of his sixteen year-old little brother. He was a gangly teenager and was all ready showing signs of how tall he was going to be. Dean thought back to that time … he was twenty and Sam was almost as tall as him.
"Dean, come on man, Dad said you had to," Sam complained from the kitchen of a small house their father had rented.
"Yeah, but he didn't say when," Dean countered.
"Come on. I got my learner's permit. I gotta practice. Dad said you're supposed to teach me."
"Fine, but you scratch my car, and I'm going to kick your ass little brother." Dean warned. Sam smiled knowing full well it was an empty threat.
"Dad, gave you the car," Sam countered.
"Yeah, well, it's a classic, and I don't want her damaged by some kid who doesn't know how to drive."
"I can drive," Sam offered. "Pastor Jim let me drive his truck up and down his long driveway." Dean rolled his eyes.
"Yeah, when you were fourteen, and up and down a driveway doesn't mean you can drive. Hell, I know how to stitch a cut, but that doesn't make me a surgeon." Dean replied. Sam resorted to the puppy eyes and Dean was at his mercy. Those damn eyes of his kid brothers had been a horrible weakness for him for as long as he could remember. Sammy eyes held the power of wrapping Dean around his little brother's pinky finger.
The memory shifted again and Dean felt the emotions threaten to drown him.
His brother fought to stand in rehab and he made his first step and his brother had kept pushing himself and Sam had walked into his arms. Sam had battled through so much and had come back from the brink of death. His little brother was amazing and he felt proud to be Sam's big brother. Of course, he had always been proud, but his brother's will to walk and talk again had taken Dean's breath away. Sam had endured the personal loss of so much of his self and really never complained that much. It was only when he was frustrated or felt held back by his own limitations or his family's over protectiveness that he did rebel and complain. Sam had always fought and now he neededDean to fight his way back from the dark place he slipped into while standing in that doorway of Sam's trauma room.
A mental picture of his little brother's lopsided grin assaulted his mind, and he squeezed the steering wheel until his knuckles were white. His eyes looked at the empty seat next to him and he felt cold. And, he felt the chill down to the very core of what made Dean Winchester who he was … he knew why he was cold … he had traveled to far away from his sun, his sole source of light, he was too far away from Sammy. His eyes darted to the road and he saw an opportunity. He made a wide U-turn and headed back toward Jefferson City. "I'm comin' Sammy." He drew in a steadying breath and pushed down on the accelerator.
The CICU Waiting Room, 10:00 PM
John looked at his watch and he hadn't heard from Dean, as yet, and he still hadn't been allowed to see Sammy since his most recent crisis, and the hour the doctor had proposed had come and gone and he still waited. John's seat gave him a vantage point to activity in the hall as staff came and went through the automatic doors of the unit. He looked at the clock on the wall and was about to stand up and go see what the hold up was for him seeing Sam when Dr. Borsody came in and sat down. John saw the man's tight facial features and could see the man was tired. "Why haven't I been able to see my son," John voice sounded accusatory, but the doctor didn't take it personally.
"John," his voice tentative, and there was something in it that made John stand up.
"No! I don't want to hear it. I want to see my son. I want to see Sam." His eyes were desperate and the doctor recognized the signs of a parent on the ragged edge that was frantic to make their child okay, to make them healthy.
"Please sit," the doctor encouraged. John felt his legs shake as he sat back down. "There's been a complication."
"What! What complication?" The timbre of John's voice was shaking.
"His kidneys are starting to show more signs of shutting down, and his output is becoming dangerously low, and we're doing everything we can right now. I can't have him getting septic on top of everything else. I may be forced to put him on dialysis until his kidneys rebound, but I'm not prepared to do that just yet. Sam is very weak and right now I think dialysis would be too much of a strain."
"What are you doing to help him?"
"I'm trying different drugs to help his kidneys, but if his output continues to drop I may need your permission to start dialysis."
"But, the infection in his heart," John replied. "If you get a hold on that then will the other complications correct themselves? His kidney's will start working better?" John was desperate for answers.
"If I can get a hold of the system wide damage that is actively happening … his kidneys should recover. But, should his kidneys fail the dialysis will take over their job."
"What about his heart?"
"We were able to withhold the Thumper for about ten minutes until his heart rate dropped into the 40's. I've upped his IV antibiotic dose and I'm trying different cardiac med cocktails."
"When can I see him?"
"I need to do another exam and run a couple tests. As soon as the room isn't so full of staff, I promise you'll be able to see your son." John nodded.
CICU Waiting Room, 10:30 PM
John felt the emotions finally break through as he sat alone in the waiting room. Sam was literally fighting for his life, and right now he was losing. John leaned forward placing an elbow on each knee and putting his face in his hands John Winchester did what he never allowed himself to do he wept … sure he allowed tears and had even cried, but this time his heart and soul were devastated with the thought of losing a child, his baby boy. He wept into his hands and didn't care who heard him.
Dean turned down the hall toward CICU. He had been directed to his brother's whereabouts from the lobby information desk. He was anxious to see his brother and to see his father. And, as he neared the waiting room that's when he heard it, and he knew without seeing that it was his father, and he was sobbing quietly. Dean had a feeling grasp him all at once Sammy has to be okay. He's not gone. He's not! His mind raged.
"Dad?" Dean's voice was tentative and shaky. John's face rose suddenly from his hands.
"Son?" He stood and before Dean could even anticipate John pulled his son into a bear hug. "You okay?" John asked as he still held his oldest child.
"Me? Dad what's wrong?" Dean pulled back and looked at his father's tear streaked face. "Sammy, he's not…"
"No, he's alive." There was something behind that short sentence that spoke volumes to Dean. He was alive, but in trouble. "Where did you go? You sure you're okay?" John asked.
"I'm fine. I'm sorry I left," Dean answered quickly. "I just had to get my head on straight it won't happen again."
"Dean, son, never apologize you got it? I understand," John assured. "And, you're here now."
"Dad, tell me," Dean urged. "What happened?"
John explained everything to Dean about what the doctor had said: the stages of heart failure, the organ failure, the possible need for dialysis … the list had seemed to go on forever, but now both men just sat numbly waiting for word on the youngest member of their family. The Winchester men felt like the center of their universe was askew without Sammy. Both men needed the warmth of Sam's light and right now they both felt cold and hollow without it.
Code Blue CICU … Code Blue CICU … Respiratory Stat … Respiratory Stat
John and Dean both looked at each other as the announcement echoed from the hallway paging system and they knew without being told … their light, their sun was slipping away in the dark embrace of an eclipse. John reached a hand out and covered one of Dean's and squeezed leaving it firmly covering his firstborn's hand.
Both men were cold as they felt their light flickering and fading into an abyss they could not follow, and in the icy confines of this small room they waited.
To Be Continued
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