Disclaimer: refer to chapter one
NOTE TO READERS: Thank you for all of the reviews! I appreciate it. I hope you're all still enjoying the story. Many thanks. I had tentatively planned to finish this story before season 2 begins on the CW, and maybe I'll still reach that possible conclusion date, but I'll have to see. Life keeps throwing some curve balls my way, so it's only tentative. Now, this is an uncharacteristic second update in one week, so that means you may have to wait a bit for chapter 23, but I'll still try to have something ready by next week sometime, with luck. At any rate, thanks for your patience between any and all updates.
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Chapter Twenty-Two
Believe
By Dawn Nyberg
"…Our lives are better left to chance I could have missed the pain, but I'd of had to miss the dance … Yes, my life is better left to chance. I could have missed the pain but I'd of had to miss the dance." Lyric excerpt Garth Brooks, The Dance
Thirty Minutes Later, CICU Waiting Room
John felt numb as he waited silently next to his oldest son. Dean sat next to his father feeling the man's tension. He stared at the floor looking up at the sound of every footstep outside the waiting room. "Dad?" Dean's voice was tentative as he tested the waters with his father. John turned his head and looked at his son with expectant eyes.
"Yeah?" Dean opened his mouth to speak, but somehow the perfect words he thought he had to say had disappeared in between thought and speaking. Dean looked down and shook his head.
"Nothing," he said quietly. John clasped a hand over his son's knee and squeezed.
"What is it son?" Dean only looked at his father and shook his head again. John smiled warmly. "I know you're scared," John replied. "I am too." Dean looked at his father with alarm and John shook his head. "Not, so fast kiddo," John chided. "I'm not giving up on Sammy. All I said was that I'm scared, and it's the truth. It's okay to be afraid for your brother, but we both gotta be strong for him now."
"I know. We will." Dean looked away for a moment and then back to his father. "I didn't mean to make you think …"
"It's okay. Even if you had I wouldn't blame you." John conceded.
"John?" The doctor stood in front of the two men who had been so engrossed in their own moment that they hadn't seen him come in. The doctor regarded Dean with a polite nod and Dean did the same.
"What happened?" John's voice was serious. "That code blue was for my son wasn't it?"
"Yes," the doctor answered bluntly. "His blood pressure completely bottomed out, and his heart went into an arrhythmia that we were able to correct with a drug called bretylium tosylate it's a latter group antiarrhythmic drug, but allows me more flexibility than frequent use of lidocaine which has toxicity concerns when used a lot."
John wasn't concerned with drug names and the whys and how's all he wanted to know was that Sam was okay, and alive. "You said, able to correct, so he's fine? His heart didn't stop again?"
"No, it was a close call and we had respiratory paged to verify settings for the constant flow ventilator that we are using in conjunction with the Thumper."
"Can we go sit with him now? I want to see my son." John was standing at his full height looking haggard and stressed, and the doctor knew this man was just about at his parental limit in being kept away from his child.
"Yes, please," the doctor answered. "I just wanted to tell you where we're at right now and that we're being aggressive in his treatment." The doctor looked pointedly at Dean remembering that the young man had bolted from the ER. "The Thumper is in use," he said looking at Dean. "Are you going to be okay with that?"
Dean nodded. "I'm fine."
"All right," the doctor replied. "I'll be in his room shortly to turn the Thumper off and check his heart rate." Both men nodded.
Two Hours Later, Sam's Room
Dean was alone with Sam standing at his bedside. It was a little after midnight and John had gone down to the cafeteria to get some coffee for himself and Dean. Now, the eldest Winchester child stood looking down at his little brother. There had been some good news in the last couple hours and the Thumper had been taken off Sam at 10 PM. When the doctor had returned to Sam's room as promised earlier to check his heart rate and without assistance the young man's heart had continued to maintain a rate of 67 and Sam was still fighting.
"Hey, Sammy," Dean whispered quietly, so only his brother could hear. Also, it was late and it just seemed appropriate to whisper. Dean ran a hand over his brother's head pushing his bangs back. "I wanted to say I'm sorry, Sam … for runnin' out on you earlier. It won't happen again." Dean listened to the slow steady beeps of his brother's heart monitor. The ventilator continued its work of breathing for his brother. "Sammy, listen to your big brother okay," he smiled. "Well, you were never too great about taking orders, but this one you have to listen to okay?" He stared at his brother's pale and silent face. He glanced at his sibling's chest and flinched at the sight. Sam's chest was bruised from the repeated use of the Thumper, manual CPR and the multiple defibrillations he had endured over the last few hours since collapsing. The bruising looked stark and violent against the pale appearance of his brother's skin.
"Oh Sammy, man," Dean sighed. "Look at you." His eyes drifted to his brother's face. "You gotta keep fighting Sammy," Dean spoke softly. "That's an order." Dean looked up at the heart monitor and watched as Sam's heart rate went from 66 to 75. He stared at the number for the longest time and then smiled when it was clear his little brother's heart was maintaining that rate. He turned and looked at Sam with a smile and tears welling in his eyes, "That's my boy."
A couple minutes later a noise at the doorway broke Dean's attention from his brother to see his father standing there with two coffee cups. John saw his son's tears, "Dean, what is it? What's wrong?" John felt panic rise up suddenly. Dean smiled.
"Dad, look," Dean pointed to the heart monitor. John's eyes scanned frantically trying to see some problem, but his son's obvious smile seemed a contradiction. And, then it sunk in and John let out a breath he hadn't realized he was holding.
"For how long?" He put the coffees down and went to the other side of Sam's bed.
"A couple minutes now," Dean answered with a grin from ear to ear. "Dad, feel him," Dean instructed as he touched his brother's cheek staying mindful of the ventilator. "His face feels warmer, doesn't it? Look his lips aren't that gray-blue anymore. They're a little pink." John did notice the visual improvement albeit slight. But, at this point in these long hours he'd take any improvement he could get. He reached out and touched Sam's face with the back of his hand. He felt the little bit of warmth that had started to return to his baby son.
"Hey, Sammy," John cooed softly. "That's it son. Come back to us. Keep fighting Sammy. Dean and I are right here with you." Dean smiled and he saw his father's eyes fill with tears.
Later the Next Morning: CICU Waiting Room
Both John and Dean looked exhausted, but they were still feeling elated from the night's events. Sam had maintained his heart rate all through the night and John and Dean were feeling confident. John was hesitant to let himself believe that Sam had turned a corner, but at any rate, he was clinging to hope as he waited to hear from Sam's doctor. Dr. Borsody had been called around 4:00 AM and given a report on Sam's condition and that he still hadn't required the Thumper since 10:00 PM the previous night and was maintaining a heart rate in the 70's. "John? Dean?" The doctor entered the waiting room.
"Well?" Dean asked quickly before his father could even get his mouth open. The doctor allowed a small smile to pull at the edges of his mouth when he met the expectant eyes of Sam's big brother and father.
"Well," he began. "I think the high dose antibiotic IV therapy we started on him while still in the ER and have continued using is finally making some headway. Sam is one tough cookie," the doctor replied. Dean chuckled.
"Yeah, he is," Dean smiled and filled with pride for his little brother who even unconscious was taking this latest setback by the horns and was fighting.
"How is he though? His heart?" John pressed.
"He's maintaining his heart rate as I explained and that's a positive sign. We are helping though with a slew of cardiac meds, but his heart is profusing his body without mechanical help, and that's a big step. Now, as his blood pressure stabilizes I'm forced to start a mild sedation to keep him unconscious. I know you're probably both anxious to see him open his eyes, but right now that wouldn't be advantageous for Sam's well-being. Now, we haven't even reached the 24 hour mark with Sam's treatment yet, so you need to prepare for possible set backs," the doctor offered a comforting smile quickly. "Not that I'm saying there will be, but it's likely.
"What about his kidneys?" John craved more news.
"Well, I'm happy to say that his catheter output has increased, and although his output isn't as high as it could or should be … we are definitely making some headway in helping his kidneys rebound."
"But, you said earlier he was in the first stages of heart failure and multiple organ failure," John replied. "My son is making improvements, but what does that mean? Are his improvements across the board?"
"John, I understand your concern … I'm a father too," Dr. Borsody comforted. "As Sam's heart maintains a good rate and profusion it is helping his overall condition. I did some preliminary blood work earlier, and right now all factors are pointing in good directions. His heart currently is out heart failure and as his organs are being profused they are bouncing back, too. I won't sugar coat his condition John … he is still very critical, but I am optimistically guarded over his continued improvements. Your son's case has been atypical to what I've seen in the past and one of the most severe cases of endocarditis that didn't include heart valve involvement that I've treated in my fifteen year career."
"Can we see him?"
"Yes, both of you feel free to sit with him. I'm scheduling an echocardiogram for him later this morning, but until then by all means sit with him."
Dean and John both walked into Sam's room and both their eyes went to his heart monitor willing it to have a good number. They both smiled when they saw 78 as the current reading. "Hey Sammy," Dean spoke to his brother as he rested a hand on his head. "The doc says you're one tough cookie little brother," Dean leaned in closer to Sam's ear, "but, I all ready knew that." John smiled. He dared to allow himself to feel real hope for the first time since first seeing Sam in the ER.
"Sammy," John spoke softly as he stroked his son's upturned arm avoiding the IV lines. "Hold strong, son," John whispered. "Rest and let the medicine do what it needs to do. You keep fighting Sammy. I'm right here, and I'm not going anywhere." John reached up and stroked Sam's forehead with a thumb, and he smiled. Dean noticed.
"What?" He asked with a curious smile.
"It's nothing," John began. "It's just when he was a baby and would wake up restless at night I would stroke his forehead with my thumb and he'd quiet down and watch me with his big eyes and then drift off to sleep. I hadn't thought of that in years," John commented with a warm smile as the memory filled him up. Dean grinned.
"Was I that easy as a baby to calm down?" John snorted quietly.
"Hell no," he answered bluntly with a broad smile. "Son, you would have nothing to do with me trying to comfort you. You only wanted your mom for about the first three months, and then I guess you decided you were stuck with me and decided to cut me some slack. Man, I remember when your mom had a bad cold, and was laid up for a few days … it was a couple days past your four month birthday. She wasn't nursing you then because she was sick, so I had to go the formula route with you. You didn't like formula that much and you especially didn't like getting it from me." John looked at Dean and saw how intently his son was listening and continued.
"Well, I got the formula made and kept you downstairs with me because you were carrying on something fierce and I wanted your mother to get some sleep. I remember I finally looked you in the face and said, 'Dean you gotta cut your old dad a break here. You're stuck with me for the long haul,' and then you just stopped crying and stared at me like you were measuring me up," John paused as the memory returned.
"And, then what?" Dean asked with expectant eyes. John smiled and a light chuckle escaped his lips.
"And, then you spit up all over me," he said with a smile. Dean grinned. "But, you took your bottle and then let me burp you, change your diaper, and never cried once. Finally, I took you back upstairs and sat in the rocking chair with you until you fell asleep, and from that day on … I felt like you had finally accepted me as your father." John laughed. "I know it must sound crazy, but that's how I felt."
"Dad?" Dean spoke quietly.
"Yes, son?"
"Thanks for that." John reached up and cupped the side of his firstborn's face. Dean found himself leaning into the touch.
"I know I've been a hard ass on both you boys since…" he paused. "Since your mom passed, and I wasn't the father you boys deserved. Sometimes I think back to the man I was when your mother was still alive, and the father I had been, and I find myself wishing to undo the years and give you and Sammy the lives you should have had even if we didn't have your mom. I'm sorry Dean."
"Dad, you did the best you could. I know losing mom was hard on you more than I could understand." John shook his head.
"No, Dean," John began. "You know how I felt." And John inclined his head toward his youngest child and Dean looked at his little brother. "You love your brother so much. You always have even from the moment you first saw him. Hell, I think you loved him even before he was born," John replied. "Do you remember how you used to talk to your mom's stomach? Man, you'd have whole conversations with Sammy before he was even born." Dean looked at his father and nodded with a Dean Winchester smile.
"I remember," he said quietly as his eyes surveyed his unconscious brother.
"I'm glad you remember that," John conceded. "And, always know that you do understand the feelings of loss Dean, so never think you don't understand because you do." John reiterated.
Five Days Later
John and Dean had decided until Sam's condition was upgraded from the CICU to the CCU neither of them would decide who was going to return to work on a limited basis dependent on Sam's recovery, but they knew at least one of them needed to return. They were able to go back and forth at home for a couple hours in the morning and evening during rounds and shift changes when visitors weren't allowed in patient rooms. Dean sat reading through Sam's chart that was kept at bedside. He looked at the pages and pages of medications he was either on or had been on since coming to the ER almost six days ago. The list read like some foreign food shopping list: Vancomycin, epinephrine, atropine, calcium chloride, sodium bicarbonate, dobutamine, dopamine, lidocaine, bretylium tosylate, lasix, nipride. The list seemed to go on and on and some meds were marked current while others said suspended or discontinued. He looked at the various IV fluid bags around his brother, as well, and saw words like: D5W, Lactated Ringers he shook his head at the sheer volume of medicine and fluids and every one of them he was silently thankful for because they were saving Sam's life. And, he also noted that he was receiving IV injections of his seizure medications, too, and was thankful that they were following his dosage schedule for those meds.
Sam's heart rate had been between 75 and 84 most of the time with only small variations now and again. Sam hadn't needed any supplemental compression in almost six days. Dr. Borsody had pulled Sam off his sedative early in the morning and Dean and John had both been waiting for him to open his eyes. "Interesting reading material," John commented as he walked into the room indicating the chart.
"Nah, it's all Greek to me, but I like to look anyway."
"Yeah," John replied. "Here … it's juice." He handed Dean a styrofoam cup.
"What? No coffee?"
"I want you drinking something healthy. Look I got one too," he conceded. "Anyway, coffee on an empty stomach doesn't sound appealing. Has he moved?"
"No, not yet." Dean grinned. "I think he knows we're waiting on him, and he's just making us sweat it out." John chuckled lightly.
"I think you may be right son. It would fit… after all, like I said your brother was a good baby and very easy to comfort, but as he got older, well … I shouldn't have to say this, but I don't think you'd disagree, but our Sammy, he's what you'd call contrary by nature." Dean smiled and laughed. Both men looked at Sam for a long moment and resumed their conversation.
Sam's arms were no longer outstretched like they had been, and were at his sides now, and his gown which had spent most of its time peeled down to expose his chest had been returned and covered the slowly yellowing bruises that had begun to fade. And, a thin sheet and woven cream colored blanket covered him. There was a rustling noise that caused Dean and John to stop talking and they were instantly at Sam's side. "I think he moved his leg." And, then as if on cue the blanket moved slightly as Sam shifted toward consciousness.
"Sammy?" John spoke softly and he stroked his bangs. "Sammy, can you hear me? Open your eyes son."
It seemed like an eternity, but it was only a couple minutes and John and Dean were rewarded with Sam's dark eyes. They went from his father's face to his brothers. They looked tired, and confused. He suddenly started gagging against the intrusion he felt in his throat. Dean held his arms down as his brother's heart monitor beeped rapidly. "Sammy, hey, hey, little brother, it's okay. Calm down. It's your breathing tube Sam. Stop fighting it. Shh …. It's okay." Dean attempted to assure. Sam turned panicked eyes from his brother to his father and John smiled warmly.
"Listen to Dean Sam," John confirmed. "You're okay, stop fighting the tube and relax." John and Dean both reached for one of Sam's hands, and were rewarded with a weak squeeze and he calmed down and stopped rebelling against the tube.
Three Weeks Later, CCU
Dean and John had debated about who would return to work for half days while the other stayed with Sam at the hospital and finally John had decided he would return to work for a modified schedule. Sam had made marked improvements and had been upgraded a few days ago to CCU and the Winchesters were ecstatic. Sam had been taken off the ventilator two days after waking, and his heart infection continued to show improvements with the IV therapy. He had been taken off all of his cardiac supportive drugs except two, and they were tapering those off a little each day since his transfer to CCU.
"Doc, when can we take Sam home?" Dean asked out in the hallway near the CCU nurses station.
"Well, he's been in the hospital almost three weeks. He's stable, but as we discussed his IV therapy should be for a total of 4 to 6 weeks. Now, ideally, I'd like to keep him here through week four, but I'd be willing to send him home on a home IV therapy program where a visiting home IV infusion nurse will come in and provide the antibiotic treatment for his final two weeks of therapy. He's on an every 12 hours dosage schedule, so a nurse would visit twice a day … once in the morning and once at night. I'm sure your insurance will cover the home infusion, after all, it's cheaper than additional hospital stay time."
"He wouldn't have to keep getting stuck with an IV needle would he?" Dean didn't want to see his brother go through anymore discomfort if he could avoid it.
"No," Dr. Borsody replied. "He'd be sent home with an IV port. He may have to endure one new IV stick, so that we can give him a fresh port and change veins. The antibiotic he's on can be rough on the veins and they have tendency to collapse. So, we'll start a new line on him before he leaves the hospital."
"Okay, so you just want him to stay through next week, and if I can get the insurance to say 'yes' than he can go home with his medicine?"
"Yes, and he'll be off his cardiac meds before he's discharged home, as well."
"So, who do I speak to about this insurance stuff?" Dean rubbed a hand across his face. The doctor smiled sympathetically.
"I can't stand the bloodsuckers either," he commented with a wry grin. Dean smiled in return. "Your brother is assigned a patient liaison while here in the hospital and you'll need to speak with that person. They are basically from the financial office and can handle all billing and insurance questions or requests." He pulled Sam's chart off the chart rounder behind the nurse's desk. "Let me see who he assigned to," the doctor replied as he looked the first page of admission information for Sam. "Here it is," he grabbed a piece of paper and wrote the information down for Dean. "His liaison is Laura Bertram, and her extension is # 1120, but her office is on the first floor in Patient Financial Services. You take the elevator to the lobby and make a left and that office is just past the employee benefits office. You'll see a big blue and white banner with an arrow. You can't miss it."
"Thanks."
Dean stopped in to see Sam, but when he saw that he was asleep not an unusual activity for his little brother since all of this happened. He left word with his brother's nurse Leanne that he had to go down to financial services, so if his brother asked he'd be back soon.
Patient Financial Services Department
God, I hate bean counters, Dean grumbled in his head. He rubbed his temple with a free hand. He looked at the clock on the woman's desk and he rolled his eyes. He had been in here crapping around for over an hour. This woman was giving him a headache.
"Look I still don't get how I could owe anything after the co-pay?" Dean complained. "My brother is insured on my policy and he has complete coverage. It's like $500,000 coverage per person per year."
"Yes, but there are contingencies in your policy that are in the small print, and your brother has required some additional medical care this year all ready, and based on the small print of your policy and the previous care this year. The available per year max out for your brother right now is $100,000."
"Okay, if he's got a $100,000 left on my policy for hospital coverage then what's the problem?" The woman's mouth turned up into this sarcastic smile that Dean just wanted to put duct tape over.
"Sir, your brother's current hospital charges are over $175,000." Dean's eyes went wide as he coughed against the sudden dryness of his throat.
"You're kidding right?" Dean couldn't believe what he was hearing. "So, you're saying 75 grand isn't paid for?"
"That's correct, and based on your brother's physician care plan he intends to keep him through week four and wants to discharge him on home IV infusion therapy for another two weeks." Her fingers started tapping away on her calculator, and then she looked up at Dean. "Now, this is simply a ball park quote because I can't factor in any additional meds or procedures that may come up in the next week. And the home infusion nurse rates vary, but you're most likely looking at a minimum total bill left to be paid over at least $110,000. It'll probably be closer to $150,000."
"You're out of your mind," Dean couldn't wrap his mind around the numbers this woman was giving out."
"Mr. Winchester, your brother spent three weeks in the CICU … his room alone was just under $2,000/day, and the equipment that he required: the ventilator, the numerous meds and IV fluids, the PMCPRD…" Dean cut her off.
"PMC… what?"
"Oh, that is how my office abbreviates the device," she commented dryly. The total item description is Portable Mechanical CPR System: Thumper Model 1007 was used and allocated to your brother's room for his sole use."
"Yeah, so he wouldn't die. And, you're charging him to be kept breathing? He needed the ventilator to breathe." Dean was angry.
"Sir, medical machines cost money to maintain. And, of course, a patient will incur the cost of using a medical device. Even now his doctor still has him on a heart and oxygen … these things cost money. Your brother's life has been benefited by the use of these machines. Now, I could provide you a detailed bill summary of every charge."
"Yeah, you do that," Dean grumbled.
"We should probably go about setting up a payment plan unless you plan on paying for the bill in full at discharge."
"Do I look like the Federal Mint?" Dean hissed.
"I'm only doing my job," Ms. Bertram replied curtly. "If you want to go the payment plan route the hospital requires a minimum of a 5 percent good will down payment." Dean shook his head.
"This is ridiculous," he complained.
"Well, we aren't a charity hospital. Perhaps, if your brother requires anymore medical assistance you might consider taking him to county. If you can't pay they find ways to write it off." Dean's eyes were blazing.
"I don't think it's your place to tell me where to take my brother for medical help."
"It's merely a suggestion." Then Dean had a light bulb moment.
"I need to make a call. I'm going to have you talk to someone after I speak."
"Uh…" Dean put his hand up to shut the woman up. She bristled in her seat. He opened his cell phone and dialed.
Meanwhile, Sam's CCU Room
John sat watching Sam sleep. He had arrived at his son's room shortly after getting off work. He had run home to shower and change and had come straight to the hospital. Sam's nurse had told John that Dean was downstairs with Financial Services and would be back when he finished. He had also run into Sam's doctor and been filled in on Sam and the proposed discharge after next week. Sam moved in his bed and John leaned forward anticipating his son's waking. Sam's eyes opened slowly and he saw his father.
"Hey, Ddd…dad," he said with a small smile.
"Hey, kiddo. How ya feelin'?"
"Tired," his voice was quiet.
"Yeah, well, it's been a long rough three weeks son. Your doctor said you may be tired for a while. He said you'll probably feel back to your old self in another month or two."
"Where's Dean?"
"He just had to run an errand downstairs he'll be back when he can." Sam yawned and his eyes blinked slowly. John smiled. He reached up and gently grasped Sam's hand. "Why don't you rest a little more Sammy," he suggested. Sam offered a weak squeeze.
"'Kay," Sam sighed quietly and was quickly back to sleep.
John Winchester sat and watched his baby son sleep, and listening to him breathe pulled his mind back to many a night when he and Mary had first brought Sammy home he would wake up at night just to go in and watch and listen to him breathe. He had done it with Dean, too. It seemed whenever either of his son's had been too quiet at night in their cribs he felt compelled to check to see if they were all right, and was always comforted by the sound of their gentle breathing. A glimmer of a smile crossed his mouth as he remembered that both of his son's as little babies… As different as his son's were from the other in personality they had both shared one common thing as babies … they would both purse their little mouths and suckle empty air while they slept, and even now it was such a warm and endearing memory to him.
Patient Financial Services Department
Dean held his cell phone as the line rang for a second time and then a voice answered. "Lena Salvino."
"Lena, its Dean."
"Dean! Oh, how is Sam doing? I've been getting updates from Dr. Myers. She's been keeping tabs."
"He's doing a lot better. He's not a hundred percent yet," he paused. "Won't be for a little while yet." Dean let out a sigh over the phone. A Lena picked up on it.
"Dean? What is it? Has something happened?"
"My insurance isn't covering all of Sam's expenses since he's been to the hospital all ready this year. Um, his doctor wants to keep him for one more week, but he's willing to let Sam come home if I can arrange home IV therapy for another two weeks. Lena, they're saying his remaining bill is all ready $75,000 and that's just as of today." Lena could hear the frustration in Dean's voice and the exhaustion.
"Are they giving you trouble?" Lena sounded ready to do battle. Dean smiled at the woman's reaction. He had liked the woman from the first moment they had been introduced when Sam had been admitted to Ivy Ridge from the hospital. She was his assigned social worker. She was a feisty woman in her mid 40's and she had been a great help to Dean when he was trying to sort things out for Sam when he still wasn't speaking and was unresponsive. She had arranged for some state money for Sam, and Dean had put that money away always in preparation for Sam's home coming when he was released.
"Yeah, you could say that," Dean hedged. A secretary came to Laura Bertram's office door indicating she was needed at the front desk for something. She stood and excused herself while Dean continued on the phone. "Lena," Dean hesitated. "Look, I can't cover the bill. I mean, I can make payments, but they want 5 percent down and depending on the bill total I know I'm looking at a minimum of $5,000 …"
"Dean," Lena interrupted. "Don't worry okay. Look, Sam has coverage by the state. I know you don't like the 'special needs' label the state has given him, but it's only a label," she paused. "It doesn't define Sam as person, at least not to me."
"I know," Dean lamented. "But…"
"Don't Dean, I remember how long I had to go round and round with you to just take the monthly stipend check the state provides for Sam. Now, let me institute his medical coverage."
"But, he's covered on my policy."
"Dean, Sam is classified as a 'special needs' dependant adult under your supervision. He has state coverage. Look, let me talk to that pencil pusher. I will fax the hospital finance department the paperwork for the state coverage. The remaining bill will be taken care of, and I will make arrangements for the home infusion therapy to be covered, as well."
"But, what about max outs?" Dean complained. "I have plenty of coverage, but this woman kept saying my coverage for Sam was maxed out."
"Sam's medical history with the state dictates that he may require frequent hospital visits or stays during his lifetime based on the previous head injury and seizure disorder requiring medication. His condition is considered chronic; there aren't max outs for his care." She heard Dean sigh into the phone. "Dean, I know you don't like this or hearing what the state has to say about Sam on paper, but be glad for it. Now, you can focus on your brother and get Sam home in another week."
"It's not that I'm not grateful," Dean offered. "It's just … I wish Sam didn't need any of this stuff, and I hate the way they make him sound on paper."
"I know you do, but things are the way they are, and at least this has a solution. And, Dean, I know you and your father are probably both missing work or something … I want you to know that Sam is entitled to home health care should you need someone to stay with him while he is still on bed rest, and you need to go back to work. A registered home care RN would be there for him during the day while you and your father are at work."
"Really?"
"Yes," Lena assured. Dean felt a sense of relief at the thought a trained medical professional could actually look after Sam while he was home healing. He knew that although the IV therapy was for only a couple weeks once he was home the doctor had explained that Sam would need at least two months to be completely back on his feet. The doctor had all ready been clear that Sam could have his speech and occupational therapy continued after his IV therapy was completed, but Sam wasn't cleared for PT or to return to the library for at least two months.
"I'll keep it in mind," Dean replied.
"Good," she answered. "Now, put that busy body of a number puncher on the phone."
"Hold on."
Dean walked outside the office door and made eye contact with Sam's patient liaison and motioned her back. "Here, she would like to speak to you."
Now, Dean hadn't heard what Lena was saying, but he heard Ms. Bertram's stammered responses that had been flowing since she introduced herself to Lena.
"Well, yes, I…" she stammered. "I was just…"
Dean tried to hide a smirk behind a hand he put over his mouth. The fax machine hummed to life in her office as a few pages of documents came over. Dean watched Ms. Bertram look at them while she still clutched his cell phone. "Yes, everything is in order, but he should have just told me that his brother…" her words were cut off as apparently Lena continued to talk over her. "Yes, I have your contact information on the cover page … yes, yes, fine. I apol…" she frowned as she was cut off again. Dean was fighting a laugh. He could literally see the woman squirming as she was reprimanded like a small child. The conversation ended abruptly. "Here," Ms. Bertram grumbled. "She wants to speak to you." Dean took his cell phone back.
"Lena?"
"It's taken care of Dean. And, if she or anyone else in that financial office gives you any problems call me, all right?"
"Thanks Lena."
"No problem," she assured. "Just get Sam better and home. The home infusion will be paid for and I'll leave the arrangements up to you and Sam's doctor, okay?"
"Thanks."
Ten Minutes Later, CCU
Dean turned down the hallway leading to the CICU/CCU Unit. He was still frustrated over that bean counter woman Laura Bertram. She had tried to chide him like a child after he hung up with Lena. His mind went back to that moment.
"You should have said your brother was special needs," she complained. "The hospital could be fined for this mix-up."
"I shouldn't have to say anything," Dean barked. "Did you even care to read his file? Look," Dean had pointed at his brother's paperwork. "See, that diagnosis from one of your quacks," Dean tapped the paper with anger. "Says, right there, by your own Chief of Neurology: profound brain injury. Persistant unresponsiveness. No chance for meaningful recovery. Recommendation: long-term care facility." Dean took a breath. "Of course, your quacks didn't have it right. My brother didn't turn out like that," he felt he had to assert. "Like I said, quacks."
"Quacks, sir," Ms. Bertram bristled. "It appears they were completely right. Your brother is clearly impaired if he is eligible for state assistance."
"You don't know my brother, so don't presume to talk about him," Dean warned. "You understand me?"
Dean's mind locked down not wanting to waste one more moment on that banshee of a woman downstairs. He walked through the automatic doors, and felt happy to be able to walk straight into the CCU unit rather than take that small left turn that led into the CICU side of the large cardiac unit. He walked into his brother's room and quickly spotted his father sitting bedside reading the USA Today while Sam slept. John looked up when he heard movement. "Hi son," he smiled. "Leanne told me you had to speak with Financial Services, everything okay?"
"It is now," Dean replied. "I had to call Lena and she had to get things situated."
"What happened?"
"Oh, stupid asses down there said Sammy's coverage for this year has maxed out, and I had a balance to pay…" John interrupted him.
"We, Dean," John replied. "We have a balance to pay." He reiterated with a warm look. Dean nodded as he understood what his father was saying without saying the actual sentiment, we're a family, and we'll handle this as a family. "So, what did Lena do?" Dean pulled a seat over and sat down roughly.
"She went ahead and put Sam's through on state coverage. Well, I guess he always had it, but I never used it because I had him on my insurance. But, you know since the state considers him…" Dean's words drifted off as he cast a loving glance at his sleeping little brother.
"I know," was John's simple reply.
"Well, anyway," Dean continued. "Sammy has coverage now, and there are no max outs because they consider him chronic," Dean sighed heavily. "I hate the way that sounds … like he's some kind of…" Dean didn't finish his sentence. John reached over and dropped a hand on his son's shoulder and squeezed trying to convey his unspoken understanding and support. Dean understood and smiled.
"Anything else?" John asked.
"Lena says Sam's entitled to home health care while he recuperates," Dean began. "She said if you and I gotta both return to work on a regular basis the state will supply Sam with a home care RN that can look after him until the doctor clears him for a complete return to activities."
"How do you feel about that?"
"I'm not gonna lie," Dean hesitated. "Part of me doesn't want to have anybody taking care of Sammy, but me or you when he goes home, but then there's the other part that knows I need to get back to work." He smiled. "After all, money doesn't grow on tress does it?" John chuckled quietly making sure not to wake Sam.
"Where did my son go?" John asked. "The one that thought a 9 to 5 life was worthy of putting a bullet in your head. I believe there was a time you considered it a fate worse than death." John mused.
"I grew up," Dean answered solemnly and found himself looking at Sam's peaceful face as he slept. John followed his firstborns gaze.
"I'm sorry," he offered quietly not knowing what else to say. Dean looked at him.
"Dad, I don't have any regrets. I'd do anything for Sammy," he offered bluntly. "And, there isn't much I wouldn't do for you either," he replied with a half grin. John understood the implication of the sentence. Dean would do just about anything for him as long as it didn't contradict or try to override Dean's big brother internal code or alarm system. John nodded with an understanding smile.
The two men sat in silence for a few minutes. "Dad?" Dean hedged.
"Yeah?"
"I don't want you going back full-time, okay? I want you to keep your current schedule. You know your heart…" John shook his head in an amused manner.
"My ticker is fine son. I'm doing my cardiac rehab, and I'm taking my meds and eating right. I'm not going to screw this up."
"I know," Dean conceded. "But, I still want you to not work full-time. We're not poor Dad we're doing okay."
"I know, but I don't want to see you working all the time either. You need a life Dean. How about dating or something? You're not a eunuch," John offered with a wry smile. Dean laughed quietly.
"My work schedule isn't that bad Dad. I haven't taken on anymore hours than we I started. I get a three day weekend. I'm doing okay." John leveled a look on him. "Okay, maybe I could go out now and again," he agreed.
"Then why don't you? What about that April girl? You still talk?"
"Dad, I'm not lookin' for some lifetime commitment. I mean…" he mused. "And, I don't want to use April dad. She's been too good to this me and Sammy. If it wasn't for her Dr. Myers would never have known about Sammy's case. Look, I'm good, okay, and anyway, I mean…"
"Son, I know where this is headed," John replied. "You're thinking that Sammy's always going to need you, need us, but I've been thinking he may want to get out on his own." Dean turned shocked eyes to his dad.
"What are you talking about? Sammy can't live on his own." He kept his voice low, but the incredulous sounding reaction couldn't be missed.
"It's just," John began. "I was talking to Dena a couple months ago since Sammy started taking the bus, and managing some of his life decisions." Dean interrupted his father.
"Dena? His occupational therapist… what did she say?
"She said that was the whole point of occupational therapy was to give Sam back his life," John paused and looked at Sam. "Or as much of it back as they can help him get. She said there are options out there for Sam that could eventually let him live on his own." Dean shook his head vehemently.
"No, no way," he replied. "Dad, with his seizure disorder it's not safe," Dean suspected his father was no longer convinced that Sammy couldn't eventually get a life of his own, one that meant he could live alone if he wanted, so his mind raced to find something else to deter his father's support of Sam out there alone. "He can't live on his own Dad. He'd be a sitting duck. Come on, I mean …" he looked around and lowered his voice to a mere whisper. "The demon, have you forgotten?"
"No, son, I haven't," John face was hard. "It's never out of my mind…never." Dean softened his eyes as a silent apology to his father for implying even slightly that John had forgotten about the evil that wanted Sam, as some sort of prize for himself, and the remaining Winchesters dead and out of the way as obstacles for his plans for Sammy. John understood the look in his son's eyes, and his face quickly softened. "Son, it will still be a while before Sammy's ready to be on his own," John held up a hand to stop Dean from interrupting him. "Just hear me out… when I say on his own I don't mean out there completely alone in the world Dean. It's just if Dena is right and there are options available that may allow Sam to have his own place one day how can we take that away from him if it's something he wants?" Dean sighed and scrubbed a hand over his face. There was a long silence between the two men until there youngest family member broke it.
"Dean?" his voice was sleep inflected.
"Hey, Sleeping beauty it's nice of you to wake up," Dean kidded with a warm smile.
"Dad sss…said you hhh…had to go ddd…downstairs," he paused. "Every…thing okay?"
"Yep, everything's perfect. I got some good news," he sat on the edge of his brother's bed and patted a covered leg. "Can you guess?"
"I'm ggg…going hhh…home to…mor…row," he said hopeful. Dean laughed.
"Ah, not so fast there sparky," Dean smiled. "The doc's gonna keep you for one more week, but then he said he can send you home on IV therapy for your last two weeks of antibiotics. Sound good?" Sam smiled. His young features were tired and drawn as Dean looked at him. His little brother had been to hell and back these past three weeks, and it showed, but Sam was rallying a little more each day. And, Dean felt something he couldn't even describe when a genuine Sam Winchester lopsided-dimpled smile broke across his face. Dean smiled in return. "I take that look as a 'yes,' huh?"
"Yeah," Sam replied. "I jjj…just wish it was sss…sooner."
"Hey, hey, Sammy," John chimed in as he stood up to approach his baby boy. "Let's not put the cart before the horse, okay. You'll go home when the doctor says you can and not before." John reached out and ruffled his son's long hair. "This is a certifiable mop, Samuel," John chastised, but with no anger. "You should get it cut or at the very least trimmed." Dean shook his head with amusement.
"You're preaching to deaf ears dad," Dean commented with a chuckle. "I've been trying to get him to do something with that brown mop for a while."
"I lll…like my hhh…hair ttt…this way," Sam replied as he ran a hand through his hair. "No cut…ting." John rolled his eyes at his youngest child.
"Losin' battle dad," Dean supplied.
"Yeah, I guess I better pick my battles wisely," he conceded. Sam laughed out loud at his family. And, the sound of Sam's healthy laughter filled up the cold hollowness that had settled inside John and Dean's souls three weeks ago when Sam was fighting for every heartbeat, and now they both felt a grace and warmth cascade into them, and they both knew as they exchanged silent looks between themselves that this grace and warmth they felt had a name … Sammy.
Early Evening, Sam's Room
Sam's dinner tray arrived, and John and Dean had brought up their dinner from the cafeteria and they ate with Sam. As the sun set behind the trees outside Sam's window John and Dean were both loathe to leave Sam, but he had insisted they sleep in their own beds and to go home, and had been insisting this one point since he was moved to CCU. Sam was sound asleep and each Winchester took a moment to say their goodnights to the youngest Winchester, and they slipped out quietly.
To Be Continued
Okay, I thought you might like a chapter that ended peacefully. I appreciate all the reviews. FFnet had some real issues with review responses for chapter 21, and I tried to get to everyone, but it was a big mess while the review reply was down for the count. Thanks to everyone that takes the time to share their comments with me.
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