Disclaimer: I don't own Supernatural or the characters …
Warning: A few swear words in this chapter.
Shared Burdens
Chapter 3
The first half hour of waiting he spent weighing up plausible scenarios in his mind that he could use to describe to the doctor how he sustained his injuries. He couldn't tell the truth, and really, tired as he was; it was difficult to come up with a story that didn't sound ridiculous. He just didn't lie as well as Dean.
He spent the next half hour staring off into space in mindless boredom. There was a stack of tatty magazines in the corner, but he knew they wouldn't hold his interest. He wasn't even interested enough to get up and go and get one.
"Sam Adamson" called the receptionist.
It took Sam a moment to recognize the name he'd given on arrival. Shaking his head to clear the daze was a mistake. He knew it the moment it reminded him that his head still hurt like hell. He really needed to hit the doctor up for some painkillers.
Heading in the direction indicated by the receptionist, Sam slowly made his way down a dimly lit corridor, observing the wall sign and switching his phone off on the way. The open door to the Doctor's room was at the end of the corridor.
"Come in …take a seat" motioned the young doctor, closing the door behind Sam.
"I'm Doctor Reynolds."
"Sam"
"How can I help you today Sam."
Sam looked at the doctor hesitatingly, not sure how to start. Doctor Reynolds was young and clean cut, and seemed like the type that wanted to make a difference. It was the only reason Sam could think of that he'd be volunteering in a place like this. His kind face helped though to put Sam somewhat at ease.
"I … ah…"
"Why don't you start by telling me what the problem is?" Doctor Reynolds asked gently, looking earnestly at Sam.
"Couple of days ago I …ah … fell down some stairs… think I've maybe bruised some ribs …and my stomach hurts a bit.
"Okay Sam, I'm going to start by taking your blood pressure, and then we'll get you up on the bed." Doctor Reynolds said, already wrapping the blood pressure cuff around Sam's arm.
"Your blood pressure's a little high" he said, making notions on a file.
Sam sat uncomfortably in the chair and tried not to fidget.
"If you could sit up on the bed; …take your shirt off."
Under the observant eye of the doctor, Sam gingerly pushed himself from the chair and took the few necessary steps over to the high medical bed, its age and worn shape struggling to be disguised under the crisp white sheet. With fumbling fingers he clumsily unbuttoned his shirt, placing it on the end of the bed before hoisting himself up to sit rigidly, facing the doctor.
Doctor Reynolds took in Sam's bruised and scarred body with undisguised shock. It looked as though the kid had come off second best after a run in with a truck. Most of the scars were old and showed evidence of various childhood injuries or traumas. Bruises were mottled over both the abdomen and chest areas, a few extending around the sides. They varied in color from mottled yellow to vivid purple, and he didn't think they'd all happened in the one fall. The fact that his patient had come to this free clinic revealed that he had no money or insurance, but he wasn't one of the doctor's usual patients. He was also too clean and well dressed to be homeless, and too well spoken to be a transient. Taking in Sam's appearance and demeanor, he knew Sam was too old to be a runaway, so he couldn't help but conclude that Sam was possibly being abused by a partner or family member.
"Relax Sam. Can you lie back for me?"
Sam consciously willed his muscles to relax, slumping slightly before easing back on the bed.
Doctor Reynolds moved to the side of the bed and looked directly at Sam. "I'm just going to feel for any tenderness. Let me know what hurts." He wanted to reassure Sam before placing his hands on him.
Sam gave a small nod of his head in reply; reluctantly readying himself for the pain he knew was to follow.
He couldn't hold back a flinch when Doctor Reynolds put a light hand on his side.
Hesitating before commencing his examination, Doctor Reynolds couldn't help the question that escaped.
"Sam, did someone do this to you …is someone hurting you?"
"No" he forcefully stated. "…I told you …I fell."
"Okay Sam. Try to relax … I'm just going to press down …tell me when you feel any tenderness or pain."
Sam couldn't hold back his gasps of pain when the Doctor palpitated the sore bruised areas on his abdomen.
"Yeah, there." Sam whispered when Doctor Reynolds touched a particularly painful spot.
Finishing his examination of Sam's chest and abdominal region, Dr Reynolds made some more notes in his file.
"Okay Sam, you can sit up now" he said. "During this …fall …did you ah….get hit…hurt…any where else?"
"Yeah, my head. …got a killer headache" Sam rubbed his fingers on his temple.
"Let's take a look."
Dr Reynolds then felt the tender raised bump at the back of Sam's head before shining a small penlight in his eyes and checking their dilation.
"That's a nasty knock, but it looks like you escaped a concussion …this time."
"Sam, you can put your shirt back on."
Sitting on the bed, Sam pulled his shirt on, watching as the doctor made more notes in the file. He'd have a novel soon, Sam thought.
"Ah, there's something else…" Sam hesitated, embarrassed, "…there's been some blood …when I take a leak."
"Okay Sam, when you're ready, I'll need a urine sample."
Dr Reynolds retrieved a small plastic container from a drawer and handed it to Sam.
"Bathroom's right next door."
"Right." Sam replied, taking the offered container before leaving the room.
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Sam returned to the room a few moments later, specimen container concealed in his large hand. He placed it on the edge of the doctor's desk before taking a seat.
Doctor Reynolds took the specimen over to a bench running along the far wall. "I'm running a quick dipstick test for blood in your urine" he informed Sam.
Sam waited impatiently for the test to be carried out; watching as the doctor finally removed his gloves and washed his hands before returning to sit behind his desk.
"Okay Sam. Well, the good news is that your ribs aren't cracked or broken. It's obvious though that you've got extensive bruising, and these areas are going to be very tender until the bruising goes down. After feeling your abdominal area, I'm concerned that you may have bruised a kidney, or the surrounding area. The small amount of blood in your urine, which I've confirmed with the dipstick test, also points to this possibility."
Sam nodded his understanding and waited for the doctor to continue.
"Haematuria, which is blood in the urine, tells us that there may be something wrong with a kidney which needs further investigation. In your case, as I can see the external blunt trauma that you've suffered to that area, so we already know the cause. Internal damage from this trauma is a real possibility. …unfortunately, we just don't have the facilities here to carry out further tests. I'd like to refer you to the hospital across town for some blood tests and scans."
Doctor Reynolds noticed that Sam seemed uncomfortable with his suggestion.
"Sam, I realize that you probably don't have insurance, but it only takes a couple of hours for the tests to be conducted by the hospital, and it can be done with you as an out-patient. I can't stress enough how important it is to rule out any renal tears or further bleeding. If there is only external kidney damage and minor bleeding, this may be able to be treated non-surgically; including bed rest for one to two weeks or until the bleeding is reduced. You would however need to be closely observed to make sure that you don't show any signs of kidney failure… and make sure that you don't have any more trauma in that area, …any area."
"Yeah, okay"
"Sam, do you have anywhere safe to go where you'll be able to rest for a couple of weeks."
The doctor was looking at him intently. Sam felt really uncomfortable, well aware that the doctor thought he was being beaten or abused. Did he really look that pathetic, he wondered.
"You should be able to get seen at the hospital out-patients clinic this afternoon if you go there straight away, before it gets busy with the late afternoon rush. I'll ring them and let them know to expect you. I'm also going to prescribe you something for the pain and to help reduce the swelling. If you take the prescription to the drug store a couple of doors down, they'll fill it out for a very reasonable price."
"Thanks." Sam gratefully took the offered prescription from the doctor.
"Sam, it's really important that you take things easy and get the rest."
"Yeah, I will" he said, nodding his thanks and leaving the room.
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The sun was blinding as Sam made his way back out on to the sidewalk. Searching his pocket, he fished out his phone, switching it back on. It started beeping immediately, and scrolling through the menu, he saw that he'd missed quite a few calls from Dean. He was still checking the missed calls when the phone suddenly rang. He answered it, instinctively knowing the caller would be Dean.
"Hey" he said.
"Sam, where the hell have you been? I've been trying to get hold of you for ages. …Why the fuck haven't you answered your phone?"
Sam interrupted the tirade. "Dean, I …"
"Whatever Sam. I really don't give a fuck."
Sam snapped. Dean was really starting to piss him off. "Yeah Dean, right back at you."
"You're a real asshole Sam. Always thinking about yourself, ..what you want. Well I've been waiting here for you to show …"
"Dean, if you'd just listen for a sec" Sam cut Dean off. "I was wondering if you could come pick me up, I…"
"You've got to be fucking kidding me Sam. You…"
"Doesn't matter Dean" he said resignedly. "I'll see you back at the motel later."
Sam disconnected the call. When it rang again a moment later, he switched it off.
Sam tucked the doctor's prescription into his jeans pocket. He doubted he'd have enough cash for both a cab and the pain killers, and he didn't have it in him to make the long trek to the hospital on foot. As it was, he was going to have to use the only credit card he had at the hospital. He really should have tossed the card already, as it was nearly maxed out. He hoped he'd be out of the hospital before they ran it.
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Sam spent three hours in total at the hospital out-patients clinic. The doctor's phone call seemed to help expedite his movement through the queue of waiting patients, and Sam was grateful. There was little he hated more than hospital waiting rooms.
He was compliant through the numerous tests and scans the doctors conducted, hoping to get out of the hospital as quickly as possible. As he was prodded and moved during the last scan, he had to swallow back the nausea that washed over him from the pain that he was forced to endure. There was nothing gentle about the ultrasound probe pressing into his abdomen, and he couldn't wait for it to be over.
At last, he was able to get dressed back into his clothes, before he waited to meet with the attending doctor. Sitting carefully on the hard molded plastic chair, he fervently wished he'd had had enough money to buy those pain killers. He could really use them about now.
It was ten minutes before a tired middle aged doctor entered the room. He took a final look at the file in his hand before addressing Sam.
"Mr Adamson."
"It's Sam"
"Well, Sam, I've spoken with Dr Reynolds, who you saw earlier, and gone over your test results. I'm concerned about the slight bleeding which is originating from your left kidney. The initial x-ray showed a thin rim of fluid around your apparently normal left kidney, however, the CT scan has showed up an anterior tear in the upper half of the kidney, with bleeding into the perinephric and retroperitoneal fat. Both fragments are perfused."
Sam looked at the doctor in confusion, unsure of how to take the news.
"So, what does that mean?" he asked, needing more information and clarification.
"Your kidney may return to normal function without needing any surgical intervention. I stress, may return. It's in no way a sure thing. To start with, I would prefer to manage the injury conservatively, and see if the haematuria …blood in the urine, resolves itself over the next week or so. This will mean complete bed rest, and follow up tests to closely monitor your condition."
"Okay. When do I need to come back?" Sam asked, relieved at hearing the doctor's words.
"I'd actually prefer that you were admitted to the hospital, so that we can monitor your recovery and ensure you get total bed rest."
"No …I don't really need to stay. I can get plenty of rest, and come back for the checkups."
The doctor knew it was useless to argue. Sam clearly didn't have any insurance, and was obviously not in a position to pay for medical care. The doctor felt that he could have gotten Sam a bed in a ward if he pushed, but Sam was plainly unwilling. He encountered Sam's type on a regular basis, and knew that stubbornness and pride would force his patient to take the hard route, regardless of the help being offered.
"Total bed rest means only getting up to use the bathroom. Have you got someone to stay with; someone to help you with daily necessities, cooking, meals, laundry, shopping?
Sam hesitated for just a moment. "Yeah."
"You're going to continue to be in a fair bit of pain, so take the medication prescribed by Dr Reynolds as directed. You may feel nauseous for a few days and very tender, but this will hopefully lessen as you heal. If you need something more for the pain, come back and see me. In fact, if the pain gets worse or your condition deteriorates in any way, you really need to come back to the hospital immediately. If the bleeding worsens, or becomes more profuse, it could be life threatening, requiring surgery. This isn't something to mess around with."
"I'll be careful."
"I'll make an appointment for you to come back in a few days."
The doctor wrote down some details on a card. "This has your appointment time and the hospital number on it. I've also written my direct telephone extension number on the back. I want you to call if you have any concerns; otherwise I'll see you in a few days."
Sam took the card, looking at the details. He realized that until now, he hadn't known, hadn't even thought to ask, the doctor's name.
"Thanks Doctor Hartman".
Leaving the hospital, he considered switching his phone back on and calling his brother. He was exhausted, his head throbbed, and he was still feeling slightly nauseous. Thinking back to his last conversation with Dean, he realized that he wasn't yet ready to go another round with his brother. He just wasn't feeling up to it.
He felt the doctor's prescription in his pocket, desperate to have the relief offered by the pain medication. He'd used nearly half his cash getting to the hospital, and doubted he'd be able to afford to purchase what he needed. Making his was to the drug store across the street; he approached the counter and handed over the script.
"Would you mind telling me how much this would cost." he asked, illogically hoping that it was within his budget.
On hearing the reply, he felt disappointment even though he'd anticipated the answer. He took back the prescription, electing instead to buy a cheap packet of Tylenol. He swallowed two dry on his way out of the drug store.
There were plenty of cabs outside the hospital, and Sam had no trouble hailing one to take him back to the motel. After paying the driver, he had just enough money to get a cold bottle of water from the motel vending machine before going to the room.
Entering the quiet room, he noticed with surprise that Dean hadn't yet returned. Wearily, he emptied his pockets onto the dresser, retrieving his phone. Turning it on, he saw three waiting messages from Dean.
He expected the first message.
"Sam, I can't believe you fucking hung up on me. Turn your God damn phone back on…"
He deleted the rest of the message, not needing to listen to it to know that Dean would be ranting and swearing for a few more minutes.
"Sam, turn on your phone. How the hell…"
He deleted the second message mid stream, reluctantly waiting to hear the third.
"Sam. …I'm sorry. …Just turn on your phone. …Call me when you get this."
Sam smiled tiredly, deciding to have a quick shower before returning his brother's call.
Desperate to lie down in the bed, he showered only long enough to wash the grime and sweat from his body. Returning to the bedroom, he let his damp towel fall to the floor and carefully dressed in loose sweats and a t-shirt. The day's exertions had taken their toll, and it was now a struggle to remain standing. He grabbed the bottle of cold water and his phone before sitting on the edge of his bed. Taking a long swallow of the water, he composed himself before dialing Dean.
Lying back on the bed, he waited for his brother to answer.
TBC.
A/N: Thanks for all the reviews, they're inspiring. Please, keep them coming!