Sam drops to his knees and gently lays a hand on Dean's arm. "Help's on its way. Just hold on a few more minutes, okay? You're gonna be fine. We'll get you to the hospital and they'll take care of you."
The noise Dean makes doesn't sound like assent. It sounds like pain and terror and it's fucking heartbreaking. Sam blinks back tears and rubs Dean's back. Dean's shirt is damp with sweat and his tense muscles quiver under Sam's hand. When he touches the base of Dean's neck Dean lets out a high-pitched keening moan that makes Sam's hair stand on end. Sam jerks his hand back like he's been burned. "God, Dean, I'm sorry, I didn't mean to," he stammers, words tumbling out in a panicked rush. He wants so badly to be a comfort to Dean but he just doesn't know what he can do that won't cause Dean more pain.
Then Dean uncurls, emits a short, sharp cry and goes into full-on convulsions.
"Shit, shit, fuck, no, please," Sam chants, staring in horror as Dean's body jerks and twitches uncontrollably. Dean's lying on his side on a soft surface, he won't hurt himself; there's nothing Sam can really do until the seizure stops. His extensive first aid training kicks in and he starts counting seconds in his head. At 60 his throat starts to feel tight. At 90 his stomach starts churning. He gets to 117 before Dean finally, blessedly, goes limp and Sam takes a breath for what seems like the first time in hours.
It's two more minutes before Dean stirs and makes a soft snuffling sound. Sam leans forward, reaches a hand up to block the bright afternoon sun. "Dean?"
"Hmmhn?" Dean's eyelids flutter. He finally pries them open with a supreme effort. There's no awareness in them; Sam's not even sure he can see anything. Or understand him. Or recognize Sam as his brother.
Sam hears the first hint of sirens in the distance. Thank fucki-- He can't finish the thought, because Dean starts gurgling and a small stream of liquid streams out of the corner of his mouth. Sam immediately shifts Dean forward and pries his jaw open. He doesn't even flinch when vomit drips over his hand onto the floor mat. He sweeps a finger through Dean's mouth, ensuring a clear airway. When he's satisfied that Dean's not going to choke to death, he grabs a rag from under the front seat and wipes his hand and Dean's chin clean. Then he pulls off his jacket, folds it and puts it under Dean's head. Dean murmurs something indistinct and lets his eyes fall closed. "I've got you," Sam says quietly, brushing Dean's hair off his forehead with a feather-light touch. The sirens are louder now, closer, and Sam lets the relief wash over him.
x0x0x
When the flashing red lights appear in Sam's peripheral vision and the siren peaks at an earsplitting level, Sam's so grateful he could cry. Dean doesn't so much as twitch; he's out for the count. Sam was desperately hoping it was sleep, not unconsciousness, that claimed Dean after the seizure, but luck hasn't gone Sam's way yet and it doesn't seem to want to start now.
The siren cuts out and the ambulance pulls to a halt in front of the Impala. The paramedics, a tall bald man and a black-haired girl who can't be more than 18, jump out and open the back doors. As they're gathering equipment, Sam fills them in. "He just had a seizure, it lasted about two minutes and he opened his eyes briefly but he wasn't responsive and then he vomited and he hasn't woken up since."
The girl puts her bag down and crawls in the back with Dean. She gives a steady litany of numbers and technical terms to her partner, and Sam knows just enough to know exactly how bad it is. They maneuver Dean onto the stretcher and strap him down; they're not even finished before he starts convulsing again. Sam can't do it, he can't watch Dean have another fucking seizure. He stumbles towards the car, grabs on to the door and uses it to hold himself up. Now that the ambulance is here, now that Dean is not solely his responsibility, Sam's starting to feel again, to drown in the guilt and horror and fear.
"Sir?"
Sam turns back with difficulty. He can't see Dean--they've already loaded him into the ambulance and shut the doors. "What?"
"We're ready to leave. You'll be following us?"
"Yeah." He leans over, sees the keys in the ignition. "I will."
"We're going to the Schuylkill Medical Center in Pottsville," she tells him. He nods and closes the back door of the Impala. She gets back in the ambulance. As he's sitting down in the driver's seat, the siren starts shrieking. He brings the car to life and peels out after the speeding ambulance.
*~*~*~*~*
Sam sits in the hard plastic chair and takes another sip of the sludge they call hospital coffee. Beside him, Dean lies motionless, buried under wires and tape and too many damn tubes. They have to stabilize him before they can cut his skull open and fix the aneurysm. The neurologist didn't pull any punches; he's not thrilled about Dean's chances. Even if he survives the surgery, there are all sorts of permanent, life-altering problems he could have. When Dean wakes up--if Dean wakes up--he might not be Dean anymore.
The nurse, a heavyset Latina about Dean's age, pushes the curtain aside. Sam doesn't even look up. Someone comes in every couple of minutes--students, interns, specialists, nurses, residents--and Sam's pretty sure that he's just a piece of furniture to them. He's fucking exhausted, would give anything to be able to go to a decent motel and sleep for about a year, but he's not leaving until Dean wakes up. Bobby's on his way, he promised to grab their stuff from the motel and bring it down.
The nurse bustles around the bed for a few more minutes, then leaves without a word. She comes back with some doctor or other, one he's not sure he's seen before. It's been several hours, though, so the night shifters might be on now. The doctor glances through Dean's chart, then presses some buttons on the ventilator.
"What are you doing?" he asks.
The doctor doesn't look at Sam. "Changing the settings. Stepping down from full assist to partial assist." He takes a step back, makes a note in the chart. "The goal is to get him off the machine by morning." He finally turns around and spares a glance at Sam. "Have you been here the whole time?"
"Yeah."
"No offense, son, but you look terrible. I'll put it to you straight: he's not going to suddenly wake up and be aware enough to know you're not here. Go home, get some food and water and 8 hours of sleep, and come back in the morning. If there's any significant change--for better or worse--we'll call you."
Sam knows the doctor's right. He can get a room in town, no more than a few minutes away, and come straight back if--God forbid--something should happen. The prospect of sleep is ridiculously appealing; it's been a long fucking day. He nods. "Okay."