AN: Again, to everyone who has reviewed. You guys are amazing and so very kind! Unfortunately I'm having some difficulty saying the same thing about the site at the moment. Still no email alerts. I've forgotten what those lovely little things were even like. As I said last chapter, everyone who has reviewed will (once the site starts working again) have a personal response from me. Of course it will be hideously out of date by the time you get it, but please know that EVERY review I receive is appreciated! And, if you survived last chapter and the finger business, then the rest of the story should be plain sailing (wink).

BLOOD ON THE TRACKS

- Chapter Five -

Dean stared blankly at the brightly lit scene. Someone had draped a blanket over his shoulders, sat him down, clamped a blood pressure cuff around one bicep. Said something. Asked him questions. He might have responded, but couldn't remember.

"Did you see her?"

Dean swallowed convulsively and looked up. Ted the stinky drunk hovered right in his field of view. Awaiting a response, all bright eyed and eager. Dean pulled the blanket closer and dropped his gaze. Once again fixed on Sam. Still, silent… and whole. Or mostly. Remembered then. Pushed to his feet and wavered his way across the track to the weapons bag. Pulled out the baggie and wordlessly gave it to the blonde haired paramedic. One of them. They all seemed blonde. Realized then that the light made it seem so. They had kept the train lights on. As well as those from the maintenance vehicle that had met him in the tunnel, taken him back to his brother. That seemed an eternity ago. But could hardly have been more than fifteen minutes.

"We're ready to move out," someone called. Dean stepped back and hugged the blanket tighter. He retreated to the weapon's bag.

"You need to come with us now."

"Yeah," Dean said automatically. He picked up the bag. Almost dropped it. Felt strangely weak. Uncoordinated.

"I'll take it. You can get it later."

Ted, Dean recognized. He stared dumbly at the drunk. Wanted to protest. Needed to protest. Things in that bag that no-one should see. No-one should have. Ever.

His gaze fell to Sam. Whole. Still breathing. Intubated now. Bare chested. An IV in one hand. He turned back to Ted. "How'd you get here?"

Ted grinned. All rotting teeth and alcohol induced guile. "Wanted to see her so I pulled the emergency brake." He shrugged and looked immensely pleased with himself. "Found your brother and scared the shit out of the driver. Bout time those bastards woke up. Should have seen the look on their faces when I tapped on the window. Funniest thing I've ever seen."

Dean stared, slack jawed. Blinked and looked back at Sam, then past him to the train. Closed his mouth then and kept it shut all the way back up the line. Stinky, savior Ted crammed into the tiny maintenance vehicle's rear seat. A second vehicle took Sam, not enough space for Dean, but he kept his eyes on it and suddenly didn't mind that the older man smelled something awful as he sat beside him.

"Thanks," he said once they reached South Central. He clambered onto the platform and swayed drunkenly. Another blonde paramedic came to his side. More brunette, Dean thought as he blinked stupidly.

"You're in shock," the woman said gently. She had kind eyes. He didn't notice her breasts or legs or ass. There was something so wrong about that.

Hugged the blanket even tighter. Frustrated that it did nothing to drive out the bone deep chill. He watched Sam. Couldn't take his eyes off him. Couldn't get the image of what might have been out of his head. Wished he could.

Held that image all the way to the hospital. They took Sam then. The younger man, all quiet and cold, and whisked him behind swinging white doors. Stopped Dean from following. Sat him down behind a curtained wall. Took the blanket, soothed him when he grunted and reached for it. Gave him another instead. A warmer one, and he quieted and watched, wide eyed, as they fed a line into his arm, a sharp sting and then liquid cold.

He woke to an acrid stench. Body odor and alcohol. Screwed his nose up and turned to face the smell. He sat up, groaned as dizziness roiled his gut. "Why are you here?" he said as he peered at Ted.

"Waiting for you to wake up."

"Why?"

Ted licked his lips and dug his hands into his stained overcoat. "Wondered if you'd seen her."

"Who?"

"Melanie."

Dean rubbed at his eyes in a vain attempt to scrub away the fogginess. He scanned the small curtained room, took in the bustle of activity beyond it and the plethora of medical equipment that surrounded him. Aside from an IV into the back of his hand, he remained otherwise unencumbered.

"Your brother is in surgery."

"Surgery? What for?"

"They said something about his fingers."

Dean averted his gaze as a wave of dizziness came over him. Ted seemed not to notice and scratched at his beard in self absorbed contemplation.

"I told them that I'm your father."

Dean's eyebrows threatened to hit his hairline. "What the hell did you do that for?"

"So I could stay. I need to stay. I need to know what your brother saw."

Dean slid his legs over the side of the gurney and planted them on the floor. He deflected the conversation, ill prepared to deal with Ted's watery eyes and trembling lower lip. "How long have I been here?"

"Not long."

"Minutes. Hours. How long?"

"Bit over an hour."

Dean scowled, yanked the IV, palmed the resultant blood and padded to the curtain. "Where's the surgical waiting room?"

"Doc doesn't want you moving around."

"Screw the doc. Which way?" He pushed the curtain aside and peered down the hall.

"Doc's gonna be pissed."

Dean glowered over his shoulder at Ted. "What'd you do with the bag?"

"What bag?"

"The weap…." Dean drew in a breath and pursed his lips. "The bag I had with me. The one you found with Sam."

"Uh, I've got it."

"Where?"

"It's safe."

Dean swiped his palm onto the white gown, leaving a long red smear. He cast an irritated glance at the older man then marched down the hall.

"Dean, the waiting room is this way, and…."

Dean spun on his heel and tracked Ted's pointing finger. He stalked back. "And what?"

Ted gestured downward. "You're putting on a bit of a show. Might want to cover up… son."

"Watch it." Dean's raised hand cut off any further words.

Sam was blue.

Not grey, not white, not unconscious and pale, though he was all those thing as well. No, Sam Winchester was blue. Technically cyanotic: oxygen deprived. It sounded bad and looked worse.

Dean stood by his brother's bed and stared down at his unconscious and intubated sibling. After five hours in surgery for his hand, another two in isolation in ICU, Dean had been granted access to his brother. Aside from his face being a pale shade of blue, Sam's chest bore no evidence of injury and Dean struggled to understand how he had come to be this way. So it seemed, did the thirty-something year old doctor who had been assigned Sam's case.

"We are going to put him on nitrous oxide. We expect that will help with the oxygen uptake."

"You don't sound confident." He gave the doctor a sidelong glance and noted the stiff posture, thin lips and contemplative crease to the older man's brow. "You don't look it either."

Doctor Tanner teased a pen from the medical chart and twirled it between his perfectly manicured fingers. "Mr Wilson, as I explained to your father, what we have here is… unique."

Dean's fingers tightened around the rail that edged Sam's bed, aware that Ted the drunk still loitered outside. Disbarred from entry because of the risk his considerably unsanitary condition posed to Sam's health, and the fact that Dean would kick his ass if he even tried to step inside. "Explain it again." Dean leaned over and peered at the man's nameplate. "Fergus." His gaze lifted and he arched one eyebrow. "Fergus?"

The man's lips tightened. The infuriating twirling ceased. "Mr Wilson—"

"My name is Dean. His name is Sam, and you're Fergus. Out there is Ted." Dean waved absently toward the window. "Now, what is wrong with my brother."

"Mr…" Fergus caught himself, tucked the pen onto the chart and straightened his shoulders. "The symptoms are suggestive of severe hypoxia. The blue discoloration of the lips, fingernails and toes occurs when haemoglobin in the blood is not bound to oxygen due to an inadequate supply of it to the body. There are several causes, the commonest of which are pulmonary disease, carbon monoxide poisoning, respiratory arrest."

Dean leaned forward. "It's none of those."

Fergus caressed the chart and raked an impassive gaze over Sam's body. "This kind of respiratory deterioration is relatively common in the late stages of Cystic Fibrosis."

"Sam doesn't have that."

Fergus tapped his fingers on the chart. "Hypoxia may also be caused by cerebral ischemia where the blood is oxygenated but restricted from reaching all areas of the body. For instance in cases of strangulation."

"He was not strangled." Dean peered at Sam's unmarred throat, needing confirmation as his own airway suddenly painfully constricted. He touched Sam's hand, the one closest to him. The pads of his fingers hit the bandaged paw and his stomach churned.

"The surgery to reattach the fingers went well," Fergus offered, his words measured. "All digits were reattached. There should be minimal nerve damage."

Dean nodded as bitter sourness tightened the glands in his mouth. "Why was there blood on his neck? When I found him, there was dried blood, like he had been bleeding from the mouth."

"Yes."

Dean gestured in expectation. "And?"

"It's resolved itself."

"I can see that." Dean nodded to Sam's bare chest. "But what was it? What caused it?"

Fergus glanced toward the door. "I've ordered a nitric oxide regime to dilate the blood vessels in the lungs. It will assist in oxygen uptake. Ah, here it is now."

Two women stepped into the room, one a nurse that Dean recognized and the other shorter, fatter and just as sour faced as Fergus. An intern, Dean surmised. She nudged him aside. When he didn't take the hint, she faced him and said, "You need to step back."

"You're taking him off the ventilator?"

"Temporarily, while we set up the nitric oxide," Fergus said.

"Why? What's wrong with him?"

"Mr Wilson."

"No. What's going on here? What aren't you telling me?"

"Let's step outside. Your father—"

"He's not—" Dean stopped himself and blew out a heavy breath. He scrubbed a hand across his face, alarmed at how badly his hands shook. "I won't leave Sam. Tell me in here."

"In deference to Ted, we need to step outside. Laura won't be long in here."

Dean twisted his hands into the hem of his shirt as the two women unhooked the ventilator. Sam subconsciously tensed and made soft gasping sounds.

Fergus placed a warning hand on Dean's arm. Dean shrugged it off, his chest heaving. "I'm not leaving him."

Dean found himself under the cool stare of the dark haired doctor. Measured and assessed, psychologically categorized, he suspected, sorted and slotted into a neat box. Where he came in on the man's intelligence and affluence measure would determine how much of Sam's medical condition he would be told. He lifted his chin, wondering just how and when Sam's care had become a battle of wills with this silver spoon fed son of a bitch.

"What is wrong with my brother?" he said, carefully enunciating each word, his tone giving no doubt about where on the physical violence measure Dean sat.

Sam made soft sounds of distress and Dean steeled his jaw to ignore them.

Fergus lifted his chin, as though challenging Dean to acknowledge his brother's suffering. Dean narrowed his gaze, his nostrils flared as he ignored Sam. "Tell me what is wrong with my brother," he said venomously.

"Initial diagnosis suggested Primary Pulmonary Hypertension, a progressive disease that results in elevated pressure within the lungs. It can occur at any age, but has a progressive onset and a predictable outcome."

"Which is?"

"Death unless a heart-lung transplant is successful."

Dean swallowed convulsively as Sam continued to gasp for air. "You said initial diagnosis. So what's your diagnosis now?"

"Persistent Pulmonary Hypertension of the Newborn. PPHN," Fergus bit out at the same moment as Sam's intubation tube was clipped back in to the ventilator.

Dean bit his lip, his hands clenched as tension dissipated. "What is that?"

Fergus shifted his weight, glanced at his Swiss Rolex and smoothed imaginary creases from his perfectly pressed baby blue shirt. Gold studded cufflinks glinted beneath the fluorescent light. "PPHN is a condition wherein a fetus' respiratory system does not adapt to breathing outside of the womb. It's an uncommon condition, with an unfavorable outcome."

Dean stared, open mouthed as the doctor straightened his tie.

"Before birth, a fetus exists in a liquid environment within the mother's womb. Oxygen and carbon dioxide exchange occurs via the placenta. The pulmonary artery bypasses the lungs and sends blood directly to the heart through a fetal blood vessel called the ductus arteriosus. When a baby is born, the circulatory system switches over to send blood to the lungs. The lungs inflate and the ductus arteriosus closes."

Dean's gaze flicked to Sam, then back to Fergus. His pulse sped up and sweat slicked his hands.

The older man shifted his weight again, the polished leather shoes squeaking against the floor. His tone remained clinical and detached, reciting as if by rote. "In rare instances the fetal circulatory system doesn't switch over at birth. The newborn's lungs, though functional, are ineffective and the child's blood is not properly oxygenated. The abnormal lung pressure places excessive strain on the heart, which unless resolved will cause the organ to fail."

Fergus nodded to the intern as she left the room. The nurse followed, her skirt swishing against her legs, her shoes making soft scuffing noises. It chorused well with the rhythmic whoosh of the ventilator that fed Sam air.

"What does this have to do with Sam?"

"The respiratory system here mirrors that of a fetus."

A headache blossomed behind Dean's right eye. "You mind repeating that?"

Fergus checked his Rolex, then his cell phone. The second device looked just as disgustingly expensive as the first. "The condition is abnormal and unique. I've contacted some colleagues from Boston, they're flying in."

Dean's head swiveled to his brother laying silent and motionless. Vulnerable. The younger man looked impossibly still, tragically unanimated and Dean's gut twisted as his flight instincts kicked in – told him to get Sam and run. But he did nothing of the sort, because his first miserable attempt to save his sibling had left Sam with a mangled left hand. "Sam's lungs have collapsed?" he blurted out. He looked at Fergus, dismayed at how pathetically needy he sounded.

"No, the lungs are functional."

"Then I don't understand."

"The oxygen taken in to the lungs cannot reach the bloodstream because the artery that takes oxygenated blood to the heart is not in the right place."

Dean suddenly felt cold, as though the temperature had plummeted, sucking the air from the room at the same time. "Not in the right place. How?"

Fergus looked at him as though he were a two year old. "I have just explained."

"You spurted some mumbo jumbo crap about wombs and fetuses and things not changing over. Sam is an adult. A fully grown man. He is not a freakin' baby."

"No. But his respiratory system is functioning as if it were still within the womb."

"Are you out of your mind? That is not possible. He's…. Sam is twenty three years old. You're telling me he has a condition that affects kids when they're born."

"Mr Wilson, if we're finished here."

"What's the long term prognosis? That shit you're pumping into him," Dean waved haphazardly toward Sam's bed, "that'll fix him, right?"

"It will ease the symptoms in the short term."

"But it'll eventually fix him."

"We can't say for sure. PPNH is difficult to treat in newborns, but failing any other abnormalities, the respiratory system is often able to come on line as it should. However, this is an adult. The lungs fully formed. Uncharted territory, you might say."

Dean's knees weakened, his mouth went dry. "Are you telling me Sam may be... dying?"

"Yes." Fergus barely paused to take a breath. "We will administer various remedial measures as we would if this were a newborn."

The slick comb-haired doctor prattled on but Dean no longer heard him above the pounding of his own blood against his ears. He stood glued to the spot as Fergus moved to the bed, checked the monitors and then flattened a palm across Sam's bare chest.

"An adult that has had its respiratory system reverted to a fetal state," Fergus said, his voice breathily soft and edged with contemplative awe. "Impossible and amazing. Simply amazing."

The doctor's tongue flicked, teasing his lower lip. It hit Dean then, somehow registered through his horrified mind that aside from the non-existent bedside manner, Fergus had not once referred to Sam by name. As though Sam was some kind of lab rat, an experiment… a subject.

Dean barely repressed a snarl as he moved to his brother's side and placed a protectively possessive hand on Sam's bare shoulder. Fergus glanced up and their gaze locked.

"Truly amazing," Fergus said slowly as he withdrew. His eyes sparked with unabashed curiosity and awe. "It's as though he's been reborn – recreated and reformed – and during the process a malfunction occurred. But that's impossible. Absolutely impossible."

Dean forced a vapid smile. "Yeah, impossible."