Again, your reviews are inspiring. Thank you so much for taking the time to send them. I've responded to all of them, but the alerts and emails are still not working…I hope you get them eventually.
a/n – This story was finished before I started posting, but because you've been so generous and kind with your reviews, I felt you deserved a better surgery chapter. :-) So I went back and did more research, and hopefully came up with a better chapter. I have no medical knowledge, and like I said in the beginning, it's more fun to inflict than to cure. But I've become so attached to Dean, I thought I'd at least try. Thanks to LP for her help with the vitals. Thanks to GS for the boost.
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He Ain't Heavy, He's My Brother
Chapter Eight
During a storm the trees overlooking the windows in Ellen's kitchen cast shadows that dance with the wind, giving the entire room an ominous feel. This was the first thing Sam noticed when he entered the room with Dean in his arms.
The makeshift operating room had been stripped of anything that wasn't necessary, fewer things to contaminate the patient with, and the only furniture remaining was the banquet table, two stools and a small card table that held the instruments and supplies necessary for the surgery.
Sam carried Dean directly to the table, setting him down gently, soothing and talking to him the entire time. But Dean wouldn't let go, was afraid to put any distance between him and his brother, and looked to Sam for reassurance.
"It's okay," Sam said, his voice a whisper. The walk from the bedroom had felt personal and privileged, and he wasn't ready to share the moment with anyone. To betray any more of his brother's anxiety. "You can let go. I'm not going anywhere. I promise."
Straightening his body against the table brought with it more pain, and Dean clenched his jaw against it, his whole body stiff as he shut his eyes and waited for it to pass.
Sam felt the familiar guilt as he watched his brother steel himself against the pain, and continued to hover, holding Dean's hand as he shivered against the cold table, as the doctor began to speak.
"Sam, you need to scrub."
"Can we get a blanket or something?" Sam asked. "He's freezing."
"There's nothing that's sterilized," Dr. Bates replied. "We can't take any chances."
Sam watched Dean breathe through the cold, frustrated he couldn't even provide his brother warmth.
"You need to scrub."
"What?"
"Come with me," Ellen said, trying to get him to release his brother's hand. "You need to wash your hands with disinfectant and hot water, get a surgical gown on, gloves, mask.
It was then that Sam noticed Dr. Bates, Betty and Ash were scrubbed and ready to go, looking like the surgical team they were, nothing but their eyes showing.
Sam tried to pull away and felt Dean's hand tighten around his own, unwilling to let go.
"It's okay. I'll be right back. I'm just going to wash my hands."
Dean's eyes widened as he looked around the room, unable to recognize anyone besides his brother.
"Stay," he pleaded, his voice low and strained, and Sam knew the Demerol had worn off. The lucid conversation they'd had just minutes before now a distant memory.
Sam could only imagine what was going through Dean's head. He was crazy with pain and fever, in a kitchen, surrounded by people in hospital gowns, whose faces he couldn't see. If he had it in him to get up and run, he probably would.
"I'm not going far," Sam said, in a tone so tender it surprised him. "Look, if you turn your head you can see the sink. I'm just going to walk to the sink and wash my hands."
Dean turned his head, could see the sink, but still couldn't release his brother. There was something he had to tell him, and he was afraid the minute Sam left the doctor would give him a shot and he would be out. Unconscious. Might not wake up. Couldn't take it with him. But the pain had once again rendered him speechless, unable to do anything but suck in air.
Sam looked at Bates. "Can't we put him under now, before I wash my hands?" It was obvious Dean was confused, didn't understand what was going on, and Sam didn't have the heart to deny him anything.
"That's not a good idea."
"Why?" Sam's voice was low, measured, he didn't want his brother to hear him, to sense the fear he was trying so hard to suppress. "For God's sake, we're about to perform surgery in a kitchen. How much contamination can I cause when you stick him with a needle?"
"That's not it," the doctor replied patiently. The last thing Dean needed was for Sam to lose control. "The longer he's under, the greater the chance of complications as a result of the anesthetic. We can't afford complications."
"Dean." It was Ellen this time, standing across from Sam, on the other side of the table. "I'm right here too. Can I keep you company while Sam washes his hands?" She didn't want to insult Dean by offering to hold his hand, just wanted him to know he wasn't alone.
Dean didn't look at Ellen, instead he turned his head to face the sink, releasing Sam's hand as he did so.
"I'll be right back," Sam said, wasting no time.
Betty was right behind him, showing him the disinfectant he needed to use, reminding him to use hot water, as hot as he could take it. When he was done, she placed the gloves on his hands, and then helped him put on the surgical gown and the mask, which Sam insisted she keep off his face until he could see his brother again.
"Hey, I'm back," Sam said, forcing a smile. "What do you think of the outfit? Not my color, right?"
Dean's lips parted, ready to speak, but the pain in his side was now radiating into his back, creating new spasms that were making him lose focus, lose sight of Sam, and he was afraid that if he tried to speak only screaming would come out.
"What is it?"
Dean tried again, this time allowing air to escape but nothing else. The words were there, in his head.
I have to tell you something. Something Dad told me before he died. I don't want to take it with me.
But he couldn't transfer the words to his mouth, to his voice. Couldn't get them out of his head and off his conscience.
"Dean, I'm going to put the IV in now," Dr. Bates kept his voice low and even. "You will feel a little burning sensation at first, but nothing else."
No. Wait! I have to tell Sam something.
Dean opened his mouth to speak, to form the words once more, but they were interrupted by a series of rapid fire breaths he couldn't stop.
"What's wrong? What's the matter with him?" Sam put a hand on Dean's chest, forcing a connection as he breathed in tandem with his brother's heart.
"He's hyperventilating," Bates answered, taking Dean's hand. "As soon as we get the IV in he'll calm down."
No. No. Not yet. I have to tell Sam.
Dean pulled his hand from the doctor with remarkable strength, the swift motion causing more spasms to wrack his body. He banged his fists against the table to keep from crying out, but it was useless, the pain was too far out of his control, and he groaned loudly in spite of himself.
"Dean, what's wrong? What's the matter?" Sam searched his brother's face for the answer, but couldn't find it. Couldn't see anything other than the anguish he'd been looking at all day.
"Sam, Ash, hold him still so I can get the IV in."
"No!" Sam was adamant.
"Sam," Dr. Bates began. "As soon as we can get the versed in he'll relax. And as soon as he relaxes we can start the nitrous oxide, putting him out of his misery."
"No," Sam repeated, a little weaker than before. "He's not so out of it that he doesn't know what he's doing. There's a reason he doesn't want you to put the IV in. Maybe…" Sam faltered, and looked to his brother for a sign, anything that could shed some light on his actions. "Maybe he's changed his mind. Maybe he doesn't want us to do this."
"Sam, he's out of his mind with pain. He doesn't know what he wants."
"I don't believe that."
Sam put his hands on Dean's shoulders, until he could feel the shaking stop, until his brother looked at him.
"I can't do this if you don't want me to," he said when Dean was listening.
Dean wanted to shout. To scream at the top of his lungs.
No, Sam, no, that's not what this is about. I have to tell you something.
But all he could do was breathe. Anything else was out of the question.
"I need to know, Dean. I need to know you still want me to do this." Sam closed his eyes, for a moment feeling like he was going to pass out. He was convinced his brother would die without the surgery. And yet he was certain he couldn't do it without his blessing.
Oh God, Sam, please don't cry.
"Sammy."
Sam opened his eyes and faced his brother.
"It's okay," Dean whispered. It was too late. He'd waited too long. Weeks if he was honest with himself. He should have told his brother sooner. Now was not the time. He would just have to live through this, make sure he was around for Sam. Around for the storm that was coming. With Sammy at the center, he would have to hold up the rear.
"Are you sure?"
Dean nodded. "Leave a nice scar…for the…girls."
Dean moved his arm towards Bates, further proof that he was ready to be put out of his misery.
Betty got the go ahead from her husband and wasted no time, once again tying a thick rubber band above Dean's elbow and searching for a vein.
"All right, Dean, here we go." Bates had the needle in within seconds. "Just a slight burning sensation, but that'll pass quickly."
Dean closed his eyes. He didn't care what it felt like, as long as it made the pain go away.
With the IV line in, Dr. Bates put the antibiotic in one port, and then the first dose of versed, the sedative, in the other.
"Count for me, Dean. Backwards," Dr. Bates said. "From one hundred."
You've got to be kidding me? If I could count backwards I could talk to my brother.
"Go on, Dean, try." It was Sam this time. Sam's not looking too hot. Poor Sammy. Maybe if I do this for him he'll feel better.
"99…98…97…" This is so lame. Where was I? "92…91…86…"
While he counted Dr. Bates placed the oxygen mask over Dean's nose and mouth and started the nitrous oxide.
The mask caused a strange sensation, and Dean squirmed under it, his immediate reaction to reach up and take it off. But there was Sam, leaning forward, talking to him. Sam knew. Sam always knew.
"It's okay. Keep counting."
Dean looked at his brother and suddenly felt an overwhelming desire to close his eyes.
He was out, and everyone in the room sighed in relief at the same time.
Dr. Bates wasted no time, the chaos of the last few minutes not even a blip on his radar, and immediately started giving instructions.
"Listen up. From here on out we work quickly but carefully." He had already pulled down Dean's boxers and was painting Betadine all over his right side, the brown liquid soaking into his skin as he went.
"Ellen," the doctor continued. "Are you ready?"
"I am." Ellen came up behind the doctor, scrubbed and covered from head to toe in surgical gear.
"All right then, remember what I said. You need to shave that entire area on the right.
Ellen picked up the shaving cream and her sterilized Daisy razor and got to work.
"Ash, keep the flashlight steady, make sure Ellen has all the light she needs."
Ash took his position on the stool directly across from Ellen, on Dean's left side, flashlight positioned in mid air. Without daylight filtering through the windows, the lighting was dim at best. The flashlight was essential.
Sam could only imagine what Dean would say if he knew what Ellen was doing, and he prayed that the miracle drug really did keep memories from forming, and that there would be enough for him at the end of the day.
Dr. Bates looked at Betty, who was situated further up, by Dean's head, monitoring his blood pressure and pulse. He only needed to look at his wife to get his answers.
"Pressure is 90 over 55. Pulse is 75."
"Not bad. Temperature?"
"104."
"Not so good," he said under his breath. "Can you get his jewelry off? The ring, the chain, those bracelets."
Betty nodded and did as she was told, putting all of Dean's jewelry on the counter behind her.
"Sam."
Sam jumped when he heard his name. He had been watching everyone work as if he were watching a movie, a bad horror film filled with static and bad lighting, and he had no desire to join the cast.
Dr. Bates ignored the expression on Sam's face and took him aside.
"Listen," he said, trying to remember what it was like to have children that weren't grandparents. "I remember my first surgery during the war. This kid I'd had breakfast with that morning, Joe Cooper, was dragged in, right foot hanging by a tendon."
Sam winced at the image.
"Yeah," Bates acknowledged. "It was appalling to say the least. We had to put him out with chloroform. It was all we had. And we operated on a cot, six inches from the ground. Dirt everywhere."
Sam was staring at the doctor, hoping he had a point.
The expression wasn't lost on Bates as he continued. "I was terrified, Sam. I've never been more scared. Not before that day and not after. Joe Cooper was someone I'd met 10 hours before, by chance," Dr. Bates paused, making sure he had Sam's attention. "He wasn't my brother, and I was terrified."
Sam was beginning to understand, even if he didn't think it was helping.
'Don't deny the fear, Sam," Dr. Bates continued. "It's a waste of time and energy. It's not going away. Work through it, and before you know it you and Dean will be on the other side of it."
"What if," Sam could barely get the words out. "What if I can't do it?"
"Look around you, Sam. This entire Twilight Zone episode in Ellen's kitchen is your show. You've made it happen. I've never seen a will like yours, or your brother's for that matter. You will not let Dean down, and more importantly, you will not let yourself down."
"Put this on," Bates added, when he thought he'd lectured enough, and handed Sam what looked like a shower cap. "The last thing your brother needs is all that hair of yours near the incision. And get a new pair of gloves from Betty, you contaminated those when you put your hands on Dean's chest."
"Done." Ellen had barely wiped off the last of the shaving cream when Bates was beside her, painting more Betadine on Dean's side. When he was satisfied he took a surgical marker and made two small exes, roughly three inches apart, on the lower right side of Dean's abdomen.
"All right, Sam. He's ready for you."
Miraculously, Sam felt his feet moving beneath him as he made his way around the table to stand between Dr. Bates and Ellen. Looking down at his brother's body he couldn't help but notice how still and lifeless it was. Helpless in its ability to defend itself. In its ability to survive on its own. Sam shook when he realized his brother's survival depended on him.
Conscious of the minutes ticking away, Bates handed Sam what looked like a bread knife with a slightly curved blade on the end.
"It's a scalpel," Dr. Bates was saying, and Sam willed the pounding in his ears to go away. He couldn't afford to miss any information.
"It's very sharp," Bates continued. "You don't have to push too hard. Start with the tip, where one of the exes is, and push in, about half an inch at first and then slide it over to the other x."
Sam was certain his eyes were bigger than his head as he tried to come to terms with what he was about to do. What was he thinking? That was it, he wasn't thinking. Hadn't been thinking straight all day. All he'd been focused on was Dean, and making him feel better, making the pain go away. His brain had somehow tricked him into believing that he could really do this, could save his brother's life. But what if he didn't? What if he killed him instead?
You can do this, Sammy.
Dad?
Just follow directions, you were always good at that in school.
What if I make it worse?
You won't.
But…
You need to take care of Dean, Sammy. It's your turn right now.
"Sam, we don't have a lot of time," Dr. Bates urged, interrupting his thoughts. "Remember, he can't feel anything, you're not going to hurt him."
"It's my turn," Sam whispered to no one in particular. He took a deep breath and made the first incision, his hands surprisingly steady. The blade went in easily and he was amazed how effortless it was to get from one x to the other. He was starting to relax when he saw the first of the blood oozing from the incision.
"You're doing great, Sam. Now go back in and slide through to the next layer, about a quarter inch, that'll be the rectus muscle."
The idea of cutting through any muscle didn't sound good, and Sam wished the doctor would give him the bare minimum. Save the lengthy explanations for someone who could handle them.
More blood as he went deeper, and Sam could feel sweat pouring down his face, his feet shifting uncomfortably underneath him, his legs heavy.
"Here, take these." Dr. Bates took the scalpel from Sam and handed him a pair of long, thin scissors. "But wait until the retractor is in place before using them."
Dr. Bates reached across Sam to Ellen and handed her the retractor. "Do you remember how to use it?" he asked.
Ellen nodded, recalling what Betty had taught her less than an hour before. Squeezing the retractor into the incision, Ellen pushed it open and clamped it in place, giving Sam a good view of the tissues lining his brother's stomach.
"Okay, Sam, now the scissors," Dr. Bates began. "You need to cut through the peritoneum, it's very thin, and it's what holds the intestines, the guts, the bowels, so you want to make sure you don't go deeper than you have to, or you could damage any one of those."
Again, too much information, Sam thought, as he reached up to wipe the sweat clouding his eyes.
"What are you doing?" Sam jumped at the doctor's tone.
"What?"
"You cannot touch your face with your hands. We've got enough to worry about without you contaminating the incision."
Sam blinked back the sweat. "I've got, my eyes…"
"Ellen, here," Dr. Bates said, handing her a surgical cloth. "Wipe the sweat off of Sam's face. Keep an eye on him and do it as often as you need to."
"You're doing great," Ellen offered, and Sam took a deep breath.
"All right, Sam, you need to cut through that thin layer of tissue."
Sam leaned forward and began cutting, not prepared for what happened next. Blood and fluid gushed from the incision, forcing him to step back, staring at Bates for answers.
"What's wrong? What did I do?"
"Nothing. This is to be expected." The doctor was prepared, and was instantly suctioning out the excess blood and fluid with a small hand held pump.
While Bates worked Sam stole a glance at his brother's face, what he could see of it under the oxygen mask, and said a silent prayer.
"Betty, what are his vitals?"
"85 over 50. Pulse is 70"
"Is that good or bad?"
"It's fine." Bates finished suctioning and put the pump aside.
"All right, Sam, we're back in business."
Easy for you to say.
"See the bowel right there?"
Sam looked inside his brother and back at the doctor, eyes wide.
"Trust me, that's his bowel. The appendix is right behind that. You need to pull the bowel aside to get to the cause of all this trouble." Bates handed Sam another instrument. "Use this to pull aside the bowel."
Oh God. I have to do what to his bowel? Sam felt Ellen wiping the sweat off his face. He wanted to sit down. To grab the side of the table to keep from falling over. He took a breath that caught in his throat and hesitated. What was he doing? Who did he think he was?
"Sam, you're doing great. But we don't have a lot of time."
Sam nodded, placing the instrument inside his brother and gently pushing the bowel out of the way.
Dr. Bates leaned forward, inches from Dean, and peered inside.
"I'll be damned."
"What? What is it?" Sam had stopped breathing.
"For one thing, we made the right diagnosis, his appendix is inflamed. See all that fluid around it?"
Sam looked down and stared at Dean's appendix, surprised at how something so tiny could have caused so much trouble. It looked like a worm, about an inch and a half long and a quarter inch wide, and it was covered in a thick fluid.
"That's exudate," Bates continued. "It escapes from the blood vessels as a result of inflammation. Pus, really."
"What does that mean?"
"It means, my boy," Sam could see the doctor's smile through his eyes. "The appendix is on its way to rupturing."
"On it's way? You mean?"
Bates nodded. "I would have bet my retirement that puppy had ruptured."
"So it didn't rupture? That's good, right?" Sam didn't dare relax, not yet.
"It's great news," Bates said, hesitating. "But it makes no sense."
"What makes no sense?"
"The high fever, the pain. It's rare for an appendix that's not gangrenous, that hasn't ruptured. Unless…"
"Unless what?"
"His immune system must be off. A healthy immune system would have offered more protection. Has he been sick recently?"
"He was in a car accident not that long ago."
"Was he hurt?"
Sam nodded, the memory too recent, too painful.
"How badly?"
Sam thought about the accident. Pictured Dean in the hospital. In a coma. Flat lining.
"Pretty badly." He left out the part about the demon. The torture. The blood loss.
"That's it," Bates said, shaking his head. "His immune system must be a mess. I should have been more thorough." Bates was beating himself up for not asking more questions during his examination. But if he had doubted Dean's immunity, his ability to fight off infection, he most likely would have refused to do the surgery.
"Let's get the appendix and close him up," he said, a sense of urgency in his voice. "I'm afraid his immune system can't cope with much more."
Sam felt lightheaded. For an instant, when he realized the appendix hadn't ruptured, he was elated beyond words. But now Bates was talking immune system, in an anxious tone, and Sam was sick to his stomach.
"Sam," Bates prodded, trying to get his attention. "We have to hurry. You need to cut out the appendix and then do a stitch at the cecum."
"The what?" Sam was having a hard time focusing.
"It's the first portion of the large intestine. The appendix is attached to it. When you remove the appendix you'll need to do a stitch there to stop any bleeding."
Sam nodded, the fear threatening to spill into his hands, the same ones he was using to save his brother with, and he forced himself to concentrate. To ignore the panic slowly taking hold.
Ellen was wiping his face again, and he took the opportunity to look at his brother. He wanted to tell him his appendix hadn't ruptured, he wanted to share the good news with him, hear whatever smartass remark would be at the tip of his tongue. He wanted to pretend all he had was good news. They would deal with his immune system later.
Bates was handing him another instrument. "All right, Sam, here you go."
Getting the appendix out and tying the stitch on the cecum was painstaking, and on more than one occasion Sam questioned his sanity. He felt as if he was painting by numbers underwater, holding his breath as he worked in slow motion, following every direction Bates threw his way.
He was checking the stitch as instructed when Dean's insides turned a bright red, blood pumping out in every direction.
"What's happening?" Sam looked at Bates, who was off the stool and on his feet instantly, the suction pump already in his hand.
"Damn. You may have nicked a blood vessel."
"What? How?" It was all Sam could do not to rub his hands across his face, over his eyes, as he tried to erase the image of blood gushing from his brother.
Bates was pumping out the blood as fast as he could, but it wasn't fast enough. "Sam," he said. "Take over. My hand is cramping. Betty, what's his heart rate?"
"118."
"Damn it! Come on, Dean, don't do this. We're almost done. Come on." For the first time since his arrival Dr. Bates raised his voice, as if Dean could hear him if he shouted. As if he had any control over the bleeding.
"124."
"Sam, keep your hand steady. Just get the blood out. Make sure you don't touch any organs."
"130"
Sam was underwater again, finding it difficult to breathe. Certain it was pure adrenaline that was keeping him standing, keeping him in the room as it filled with his brother's blood.
"Pressure is 80 over 45."
"Sam, get out of the way."
Sam barely had any time to move, to pull out the pump, when Bates took over, placing two fingers inside the incision as he searched for the source of the bleeding.
"Sam, Get the hemostat. Quick."
"What?"
"It looks like scissors, on the edge of the table. It's a clamp. Hurry."
Sam went to hand Bates the clamp when he realized the doctor's good hand was inside Dean, and his left hand was incapable of holding it.
"Pulse is 135"
"I've got it," Bates was saying, his voice unusually high. "Sam, you need to clamp right here, as soon as I move my index finger. It's a blood vessel. You ready?"
What the hell is a blood vessel? What does it look like? Sam didn't think he could see it even if he knew. All he could see was red.
"Sam! Are you ready?"
"Ready."
Dr. Bates moved his finger and Sam leaned forward, nervously following the doctor's frantic instructions. The blood making it impossible to see what he was doing.
"NOT THERE!" Bates shouted, and his voice echoed throughout the room.
Sam wanted to run. To drop everything and run into the pouring rain. Into oncoming traffic. Into a hail of bullets. He was positive anything would be better than living through this. Because if he did, and his brother didn't, how he died wouldn't matter. Only when would have any meaning.
"Right there, Sam. You've got it." The doctor's voice was impossibly high, and Sam felt himself shrinking away from it.
"Clamp, Sam. Now! Clamp now!"
Sam closed the instrument on the blood vessel and immediately the blood stopped flowing.
"Betty, vitals?" Dr. Bates looked like he had seen a ghost, but to his credit, he regained his voice instantly, providing Sam with some reassurance.
"Pulse is 140. Pressure is 65 over 40."
"Is that…"
Bates didn't wait for Sam to finish. "Pulse is too high, pressure's too low," he said, looking at the clock on the wall. "Heart's on overdrive trying to pump enough blood to keep him alive. We have to repair the vessel. Quickly."
Sam didn't think he could move, much less repair anything. He looked at his brother and tried to focus. Tried to gain strength from him. But Dean's unconscious form couldn't give him what he needed. Only Dean could do that. With a sarcastic comment, a trademark expression. Dean always knew what to say to get through the bullshit. To get through to him. But Dean was most likely dying right in front of him.
Sam forced a breath that turned into a strangled sob.
"We're almost there, Sam. Don't let him down now." Bates knew it was callous. Knew that Sam was probably watching his brother die. But there was no time to coddle him. Not if they stood a chance of saving Dean.
Sam tried breathing again, and again he choked. There was blood everywhere. His brother's blood, and he was having a hard time seeing anything else.
"Sam." It was Ellen. "Do you want me to do it?"
Sam looked at Ellen but didn't really see her. Could only see his brother. When he shot the Shtriga. When he set the Wendigo on fire. When he broke the mirror. When he wouldn't let him go back inside the house in Salvation. When he shot the demon that was beating him to a bloody pulp. Sam could have stood there forever, watching Dean save him time and again.
"Sam." It was Bates this time. "It's you or Ellen, but we have to do this now."
Sam blinked and felt the tears. "What do I need to do?"
Ellen wiped the sweat and the tears from his face, her own breath caught in her throat as she watched Sam's inner struggle. As she tried to ignore the blood that was everywhere.
"You need to stitch up the torn blood vessel."
Sam nodded his understanding, unable to say anything else.
Dr. Bates wasted no time, now worried about both brothers, and began giving instructions immediately. But in spite of the pressure to hurry he recognized from years in the trenches, he gave his instructions slowly, methodically, repeating himself every few seconds, the only way he knew Sam could manage. Until the blood vessel was repaired and he could remove the clamp.
"Perfect," Bates said, admiring Sam's handiwork. "Now pour some of this cauterizer in there, and then this alcohol, that should kill any bacteria that's in there."
Sam cringed while pouring alcohol into the open wound, even if his brother couldn't feel it, the act seemed unnatural and cruel.
"Now let's paint his insides with Betadine and close him up," Bates said, some of the tension in his voice gone.
As hard as he tried, Sam couldn't ignore what had just happened, what he had just done, and found he was shaking.
"He's okay, Sam." Ellen was wiping the sweat off his face again. "You're almost done."
Sam looked at Dean for reassurance and remembered once again that it was his turn. His turn to take care of his brother. It was the grounding he needed as he took the brush from Bates and liberally spread the Betadine.
"Betty, pulse? Pressure?"
"Pulse is 105. Pressure is still 65 over 40."
"Why hasn't his blood pressure changed?" Sam wanted to understand what was happening, even if he wasn't sure he could handle it.
"He's lost a lot of blood," Bates said, no emotion in his voice. "Let's get him closed up and see if we can bring it up." Truth was, Dean had lost a tremendous amount of blood, and if they were monitoring everything they should be, his vitals would be even more frightening. But Bates needed Sam to concentrate. To finish the job. So he opted not to tell him just how hard his brother was fighting to stay alive.
Dr. Bates took the brush from Sam and exchanged it for sutures.
"Okay, then, we're in the home stretch," Dr. Bates said. "You need to sew him back up in layers. Obviously, from the inside out.
Sam was finally back in his element. Sutures he could do. Even if he was starting a couple of layers deeper than usual, he had stitched Dean up so many times, he could do it in his sleep.
For the first time since the surgery had started Sam felt like he was taking in enough air, not just the necessary bits to keep him standing. He was halfway through the first internal layer when he caught a slight movement out of the corner of his eye. He blinked and went back to work, his hands steady, no instructions from Dr. Bates necessary.
And there it was again.
"Henry."
Sam looked up and saw Betty, her hands on Dean's shoulders, eyes wide as Dean's body shook underneath her fingertips.
"We're out of nitrous."
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NOW are you still with me? I know it's a cliffhanger…sorry…I couldn't resist. But be kind – this was such a hard chapter for me to write. PLEASE let me know what you think.