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Chapter Four

Borrowed Hope

By Dawn Nyberg

"…I never knew what it was like to be alone … cause you were always there for me…" lyric excerpt by Alter Bridge, In Loving Memory

Three Hours Later, Sam's ICU Room

Bobby sat a silent vigil his mind flitting between both boys … the one in front of him and the one in surgery. Sam had opened his eyes for a moment or two and he had calmed him in his confusion and the boy had quickly drifted off again.

There was a quiet knock on the doorframe. Bobby was up and out of his seat instantly. He saw two doctors and he only recognized one, Dr. Helman. He stepped out into the hallway. "Dean? How is he?" he pushed instantly.

"Mr. Singer, this is Dr. Lefkovitz, he was Dean's surgeon." Hands were extended in polite greetings and Bobby cut right to the chase.

"How's my nephew?"

Dr. Lefkovitz cleared his throat and offered a smile. "Well, I was able to save the spleen but he lost a lot of blood as you already know. He made it through the surgery without any major complications and he'll be in recovery a little while longer …" Bobby interrupted at that.

"Without any major complications but there were problems?" Bobby needed clarification.

"He was in severe shock due to the extensive blood loss and we were fighting with his blood pressure during the surgery. He bottomed out once but we were able to get his pressure back up. We've transfused him with several units of blood. He's in critical condition but he is holding his own," the doctor assured.

"Is he conscious?"

"No, but I don't anticipate him not waking. His body's been through a lot and he needs to be still and rest unless he wants to compromise his condition further."

"He'll be hard to keep still with his brother two doors down."

"Well, if he won't stay still until he's told he can move then I will sedate him if necessary. If he had heeded warnings earlier he could have avoided the OR." Bobby nodded.

"I'll make sure he rests … so, he'll be okay?"

"He's not out of the woods yet, but he's on the right road," the doctor replied.

Forty-five Minutes Later, Dean's ICU Room

Bobby sat watching Dean and examining the young man's features. His face was pale and his lips almost translucent. He looked so young and fragile in Bobby's eyes. He felt protective of both boys but when either of them looked this fragile he ached to make them well and to make sure they were safe and wanted for nothing. "Hey kiddo," he cleared his voice as his words choked up. The oxygen mask misted and fogged as Dean exhaled. "I'm here Dean, its Bobby," he spoke gently. "You went and got yourself into one fine damn mess didn't you? You're too damn stubborn for your own good," he chastised quietly. "Sam's holding his own, so don't you worry about him, okay?"

Bobby reached up cupped the side of Dean's head in his broad calloused hand. "You keep fighting Dean, you hear me!" It was a quiet yet stern command. He moved his hand to grasp Dean's limp one. He stroked the fingers of Dean's left hands with his thumb. He smiled as he watched the fingers curl weakly around his own. "That's it Dean, you fight. I'm here."

Three Days Later, ICU Conference Room

Bobby ran a tired and frustrated hand across his face as he looked at Dr. Helman. "Mr. Singer, I'm concerned that we haven't been able to wean Sam fully off the vent."

"He just needs more time. He's taking breaths on his own … you said so, so what's the problem? He just needs more time."

"Mr. Singer, your nephew's lungs aren't getting any stronger and ideally after a surgical stabilization we like to see patients off the ventilator within 2-3 days after surgery. Sam's on day four which wouldn't be that bad if his pulmonary function appeared to be improving."

"He's trying," Bobby lamented. "What's the big deal anyway? I know he needs off the vent but it's not like he won't get off it soon, he will …"

"The longer he's on the vent we risk displacement of the surgically corrected ribs and his chances of pneumonia get worse and he doesn't need a lung infection at this point in his recovery. It could potentially kill him." The words hit Bobby like a slap in the face.

"So, what do you want to do?" he huffed. "You tried weaning him fully off and you saw how well that went," Bobby complained. "He was struggling for air and that damn machine alarm was going off."

"It was going off because his oxygen levels were dropping below what is healthy, so we had to raise the setting again. Mr. Singer, he is trying but his inspiratory effort is very weak." The doctor saw the quirked eyebrow from Bobby. "His breathing in effort is weak," the doctor clarified and Bobby nodded. "I'd like to try him on a CPAP machine. I think it may provide enough supportive help that we can take him off the vent and if it doesn't," the doctor sighed.

"What's this CPAP thing? Another kind of vent?"

"No, not a vent. It's a mask that will cover Sam's nose and will be strapped onto his head to form a seal and won't move. It's a machine prescribed commonly for people with sleep apnea. It stands for continuous positive airway pressure. I think I'd like to try a different model on Sam that he may not want to fight …"

"What kind of different model?"

"I'd like to try a VPAP, it a bit different because it allows for both spontaneous and timed inspiratory effort and ensures the patient receives a minimum number of breaths per minute." Bobby pinched the brow of his nose.

"I feel like Dean should be makin' these decisions …"

"Well, if he were able I would be consulting him on his brother's care plan but it's not possible right now." Bobby frowned because it was truth. Dean had developed a post operative fever and had only regained consciousness once since his surgery three days ago. He was on IV meds addressing the fever and suspected post-surgery infection. It had been a trying three days for the older hunter.

A Day and a Half Later, Dean's Room

"Dean?" Bobby questioned gently as the young man moved his legs a bit under the hospital covers. The older hunter was tired but he wouldn't leave his post between the two boys. He would visit Sam and then Dean. "You hearin' me Dean?"

Dean scrunched his face and lifted his hand aiming for the obstructive oxygen mask. "Bobby?" his voice was weak and scratchy.

"Dean, no, leave the mask alone," Bobby stopped Dean's feeble attempt to remove the mask. He felt relief when Dean opened his eyes.

"What happened?" Dean tried to remember his last recollection.

"What do you remember?"

"Sittin' with Sam … damn I feel like I got hit by a truck," Dean complained.

"Serves you right you damn, ignorant idjit," Bobby chastised. Dean blinked at him in confusion. "You pushed yourself just like the doc warned you not to do. I came into Sam's room, at first I thought you fell asleep on his arm but then you looked off and you stupid ass … you damn near died, you were bleeding out, your heart even stopped. You had surgery and have been fightin' a fever. They got you on a whole slew of meds and your fever finally dropped a couple points today, so they think the meds are kicking in." Dean listened to Bobby and could easily see the man's stressed and haggard face.

"Sorry," he offered quietly. "Sammy? How's Sam?" He started to move and Bobby jumped up. He put a restraining hand on Dean.

"Listen here Dean, there is no option on this until the doc gives you the green light. Your ass stays put until the doc says so, otherwise you're just going to end up back in surgery or worse the morgue. So, don't even think about trying to get out of bed."

"But Sammy?" Dean pushed. "I gotta be there for him …"

"No, you gotta live for him and not keel over dead, ya idiot." Dean let out a small sigh. Bobby relented. "Sam's doing … okay," Bobby skirted.

"Okay …" Dean drawled the word out as he detected subterfuge on Bobby's part. "I asked, how Sam was … what the hell does 'okay' mean?"

"You need to keep yourself calm," Bobby warned as he wanted to prevent the young man from over exerting himself. "Dammit, all right," he lamented. "They were having trouble getting Sam off the vent but they were able to put him on this breathing mask that pushes air into his nose yesterday and he seems to be doing okay on it but they are keeping an eye on his oxygen levels."

"Is he awake?"

"On and off," Bobby relented. "They are sort of keeping him a little sedated because he was fighting the mask and his breathing gets a little erratic. He asked about you late last night, just once, but he fell asleep again as soon as I said you were holding your own."

"Well, well…" Dr. Helman said from the door. "Look who's awake." He smiled kindly from the doorway. "Sorry, to interrupt but I came to examine Dean while I'm on rounds."

"Hey Doc," Dean mustered. "How's Sam?"

The doctor cast a look at Bobby and smiled ruefully. "Sort of single minded isn't he?" he mused toward Bobby. The older hunter chuckled lightly.

"Yeah, you could say that." Bobby replied.

"Really doc how's my brother?"

"I'll make a deal with you … let me examine you and then I'll fill you in on Sam. I just came from his room." Dean looked at the doctor with doubt.

"Dean…" Bobby warned you let the doctor take a look at you and then we'll both hear about Sam, okay?"

The doctor proceeded to examine Dean and check his charted vitals over the last couple hours. "Well, I'm happy to say I think that mystery fever and undefined infection is resolving itself with the meds, so I'll keep you on the antibiotic meds for a few more days to be safe. How's the pain from your sternum?"

"Not as bad as it was but the meds are workin' wonders," Dean admitted. "So, what about Sam?"

The doctor looked at both men and could see the concern in their eyes. "I ordered a chest X-ray on Sam and I should have the results soon…"

"Why? What's wrong?" Dean and Bobby spoke in unison. They spared each other a glance and looked at the physician.

"His lungs sounded off to me and I'm worried that despite our best efforts Sam may have pneumonia."

"But you said if he got pneumonia…" Bobby stopped himself quickly having forgotten for just a moment that Dean was in the room. Dean glanced at Bobby and the doctor.

"If he got it … what would happen?" Dean demanded and winced as his sternum reminded him he was injured and his throat rebelled against the excessive use.

Dr. Helman sighed and looked Dean squarely in the eyes, "Sam's lung function has been weak and I'm sure your uncle has told you we had difficulty weaning him from the vent…"

"Yeah, you got him on some kind of mask that pushes air in or something…"

"Yes, it's called a VPAP and it has been useful but with the possible pneumonia I'm concerned that Sam's lung function will be further compromised. His lungs were severely bruised in the accident, and if his chest X-rays confirms my worries then …"

"Then what?" Dean pushed his eyes intense.

"Sam's life could be in jeopardy," the doctor offered up the blunt response. "I want to avoid intubating him once again, so we've been pulling out all the stops to try and get his respiratory efforts where they should be without assistance. I noted during my exam of him a short while ago that he appears to be working harder to breathe than he should have to even with the VPAP, so I'm guarded."

There was a sudden flurry outside the door and nurse's feet were padding by quickly, followed by an intern and a resident that was covering for the afternoon. Dr. Helman stepped back trying to see what was going on. He felt his gut clench just minutely when he saw from his vantage point it appeared the flurry of activity was heading into Sam's room … two doors down. "What's going on out there?" Dean asked.

"It's an ICU Dean there are crises in here everyday unfortunately." He hoped he was wrong about the direction of the staff, but when Roseanne stepped into the doorway he knew the truth.

"Dr. Helman, you're needed," she said quickly. He nodded.

"No, wait," Dean tried to shout but coughed. "Is it Sam?" he recovered his voice through the cough. The doctor looked at him a moment. "Dammit, is it my brother?!"

"Yes," he offered quickly. "I'll be back to speak to you both when I know something. You stay in bed," he pointed at Dean and left at a fast clip.

"Bobby?" Dean's voice sounded scared and choked. He looked to the older hunter for some kind of reassurance. Bobby felt cold at the many possibilities of what could be happening down the hall.

"He's gonna be okay Dean," Bobby tried to comfort. "He's as a stubborn as you," he added. Dean offered a weak smile to the older man. He cast his eyes toward the empty doorway straining to hear any voices drift from his brother's room. He heard nothing.

"Sammy…" he said quietly and tried not to let complete desperation consume him. His little brother was in trouble, maybe dying and he wasn't there, he should be there, he thought angrily to himself. Bobby and Dean sat in worried silence, both waiting …

To Be Continued

I hope you enjoyed that chapter. I will make every effort to update this coming week at some point. My schedule is going to be a mess this coming week, but I'll see what I can do. Thanks for reading, I appreciate it!