Disclaimer: refer to chapter one

NOTE TO READERS: I wanted to thank everyone that sent me very kind condolences over the recent loss of my mother. They are much appreciated. Also, thank you for the reviews that I received. I thank you for your patience in this newest chapter. I know it's been a while since I last posted. This chapter is around 7 pages long and I hope it's a good read. Things are still pretty up in the air for me now, but I will try to post again next weekend at some point. Thanks again for everything! Happy Reading, I hope.

So Long, Good-Bye

Chapter Four: Persistence of Normal

"… I know he's living in hell every single day, and so I ask oh God is there some way for me to take his place … when all you know seems so far away and everything is temporary, rest your head, I'm permanent …" Lyric excerpt by David Cook, Permanent

Three Weeks Later, Bobby's House

Dean stood in the doorway to the library, or what used to be the library. Bobby had moved many of the books out only keeping those on shelves in the room. Sam liked being around the books even if he couldn't read them anymore. The library had been made into Sam's room now. Dean watched the early afternoon light cast across his brother as he slept. Bobby had arranged with Dr. Finley's help long distance with another doctor nearby to have a hospital bed delivered for Sam a week ago when Sam could no longer get up the stairs to his bedroom he shared with Dean even with help. Dean felt a hand land gently on his shoulder and squeeze.

"It's happening so fast Bobby," Dean whispered. "He can hardly walk now."

"The rolling walker is still keeping him mobile," Bobby encouraged. "He can still talk, he's just having more mobility problems but we're still handling things. We haven't had to get a nurse yet, just a visiting one to check on him between doctor visits in town. He's holding his own Dean. He hasn't developed any new symptoms."

"Yet," Dean lamented. "But his eyesight is crap now. He can't read anything, he can't write unless it's one word at a time and even that looks like a chicken scratch. You're right about his mobility. I want to help him Bobby but I don't know how."

"You are boy," Bobby tried to comfort. "You're here for him."

"It's not enough."

"Dean," Bobby's voice was plaintive. "You call your daddy yet?" Dean nodded.

"Sam was pissed," Dean answered flatly.

"You get a hold of him?"

"Just his voice mail … I left a message."

"Did you tell him about Sam?"

"I can't leave that kind of message," Dean's eyes were agonized. "I told him something was wrong and that he needed to call me back as soon as possible. I told him we were staying with you."

"Dean you need to tell him about Sam…"

"I shouldn't have to tell him," Dean looked at his sleeping brother once more and stalked off toward the kitchen. "He shouldn't have to hear the whole story for him to call me back. I tell him something is wrong and he needs to call ASAP, he should dammit!"

"Dean, son, you know your daddy," Bobby commented. "He can be pretty single minded. You should tell him the whole story even if it is to his voice mail." Dean looked at the older hunter, "at least consider it, okay?" Dean nodded.

"I need to fix Sam some lunch."

"Still no swallowing problems that's good news," Bobby offered up something positive for the bleak situation. Dean offered a small smile that didn't reach his eyes.

Thirty Minutes Later

Sam sat in the bed and ate the chicken noodle soup and reached to dip some fresh corn bread into it as he looked over at Dean. "You okay?" Sam asked in an even voice.

"Yeah," Dean replied a little flat. He offered up a small smile. "How you feelin' Sammy? The soup good?"

"It's good Dean. The chicken tastes pretty good in it."

"Well, you can thank Bobby for that he made some chicken breast and suggested I add the chicken to the noodle soup. You should eat more Sammy, you need it."

"This is enough. It's not like I'm burnin' a lot of calories Dean scootin' back and forth to the can."

"Sammy," Dean's voice was soft.

"Don't, okay? I don't want to have this conversation again." Dean nodded. Sam spooned a helping of the soup into his mouth and jerked forward as he swallowed. He coughed loudly. Dean was out of his seat in an instant.

"Sam!" Dean put a hand on his brother's back as Sam coughed. Sam attempted to wave him off and finally forced out between coughs.

"I'm fine … just … went down the wrong pipe," he assured. Dean pulled his hand off of his brother's back and couldn't miss how badly it was shaking. He balled his fist up a moment to try and quell his shaking. Bobby came into the room quickly.

"What's wrong?" his eyes went from one boy to the other. "Sam you okay?"

"Fine, just swallowed the soup wrong," he tried to assure. "It's my own fault anyway, leaning back while trying to eat soup. Everything's fine." Dean didn't say anything but he reached for the plate that balanced the bowl and the corn bread. "I'm still eating," Sam put his hand on the corner of the plate to stop his older brother from taking the food.

"But," Dean couldn't formulate what he wanted to say, what he feared was that this was a sign of a new symptom. Sam just looked at him and Dean released his hold on the plate. "Bobby why don't you sit a shoot the breeze with Sammy," he stated keeping his voice light. "I'm gonna grab a beer." He left the room quickly. Sam and Bobby watched Dean leave the room.

"He's just worried Sam," Bobby offered quietly.

"I know," Sam's voice was sad. "I just swallowed wrong Bobby, it could happen to anybody," Sam tried to assure not only Bobby but himself, too.

Three Days Later, Greene Memorial Hospital, Outpatient Waiting Room

"Well?" Dean asked quickly as he stood up as Dr. Finley entered. Dean couldn't shake the anxious feeling in his stomach. Sam had experienced more problems swallowing on and off over the last three days and Dr. Finley had agreed that Sam needed a swallowing study to ascertain whether or not Sam was indeed now exhibiting progressive PSP symptoms now involving his ability to properly swallow.

"Hi, guys, you wanna come back," the doctor motioned for them to follow him. Both Dean and Bobby didn't hesitate to follow Sam's doctor.

"How's Sam?" Dean pushed.

"Fine," the doctor assured. "He's down the hall getting out of his gown. The procedure went off without any problems. The swallowing study is complete and there were no complications. Sam will be able to go home today as soon as he has changed."

"Did you get the information you needed during the study procedure," Bobby asked.

"Yes, I've already spoken to Sam. Please," the doctor stopped at a conference room door and motioned for the two men to enter. Dr. Finley looked from Dean to Bobby and back to Dean's intense eyes. "Sam's test was positive for increased Dysphagia, or difficulty in swallowing in layman terms." Dean sat silent, he had known even before the doctor said anything but he had hope, a small ember, and now it had been snuffed out. Bobby leaned forward and placed a hand on Dean's shoulder and squeezed. "I know this isn't what you wanted to hear. I wish I had a better prognosis, I do," Dr. Finley replied with earnest eyes. "This new progressive symptom will put Sam at risk for aspiration…"

"You mean getting it in his lungs," Dean replied quietly as he looked at the doctor. The doctor smiled slightly and nodded.

"Yes, but it isn't so advanced yet that a feeding tube is needed, but his diet will need to change. During the study we have found that liquid and certain consistency's of solid are more actively causing him problems than others. The nutritionist has given her recommendations for food preparations. He'll need things pureed and the pharmacy in the lobby has already received an order from me for some Thick-it powder. The powder will help you firm up liquid food items for Sam and the usage chart is really easy to understand. Also, I will order in for you some Thick-it purees. Here is a list of what is currently available. Dean looked at the brochure from the company:

Great Flavor to Nourish Your Loved Ones.

If you or your loved one suffers from dysphagia, you know that getting proper nutrition in an appealing, convenient manner is an everyday struggle.

Now, from Thick-It, the brand you trust for quality instant thickeners, comes Thick-It Purees, a new line of great-tasting pureed foods designed with your needs in mind—just open, heat and serve. Choose from thirteen delicious, nutritious favorites, like Beef Stew Puree, Sweet Corn Puree and Maple Cinnamon French Toast Puree, Seasoned Chicken Puree, Chicken a la King, Carrot and Pee Puree, Beef Lasagna Puree, Beef and Barbeque Sauce Puree, Omelet with Sausage and Cheese Puree …

Dean's eyes looked away when he read 'Omelet with Sausage and Cheese Puree' is this what his little brother's life was being reduced to with this damn disease.

"Dean, I know it isn't easy to look at this stuff and it makes it more real than you're probably wanting right now but Sam's going to need you."

"I know that," Dean's voice was quiet and clearly bitter. "How'd he take the news?" He already knew the answer but he still asked.

"Just as Sam's has taken everything else, he's clearly upset but he's handling it."

"So," Bobby leaned forward injecting himself in the conversation to allow Dean a moment to assimilate the new diagnosis for his brother. "Until the actual food puree stuff comes in what do we do so Sam can eat?"

"There are detailed directions with the Thick-it powder. It will help give some food a consistency that he can swallow with limited difficulty. The dietician suggests and I concur that anything with a consistency of pudding or even a firm baby food puree will work. She has provided a detailed preparation booklet to make some meals for him in the interim that you can use the Thick-it powder with. We can have the Thick-it purees ready for pick-up as soon as tomorrow afternoon if you provide us with an order. I've given Sam the same brochure, perhaps speak with him before leaving and I can place it with the pharmacy and once that order is in we can arrange for the company to deliver to your doorstep directly from the manufacturer. We'll keep tabs on his weight and watch for malnutrition. He may require some additional vitamin supplements, but we'll see." Bobby and Dean nodded.

"I want to see Sam."

"I'll wait for you boys in the waiting room," Bobby stood and walked out with the doctor.

"He's down the hall. Procedure room 4," Dr. Finley replied as he saw Bobby out to the lobby.

A Few Moments Later

Dean knocked on the door. "Yeah?" came the quiet voice of his brother.

"It's me Dean."

"You alone?"

"Yeah, dude Bobby's in the lobby waiting on us," Dean shook his head.

"Okay," and Dean took that quiet reply as an invitation to enter. Sam sat on an exam table and was clearly frustrated with his shirt. Dean frowned.

"The nurse didn't help you?" Dean couldn't hide the frustration.

"I told them I could do it," Sam tried to work a button on his shirt again and dropped his hands and smacked the table in anger. "Dammit," he barked under his breath.

"Hey, hey," Dean stepped forward. "It's okay man, here," Dean reached up to help his brother and Sam batted his hand away.

"No," Sam said quietly.

"Sammy, man its okay, let me help."

Sam raised his head and looked at his brother and Dean saw the tears building in his little brother's eyes. "Well, I could let you go out there with your shirt open, give the ladies at the reception desk a thrill for their day, but…." Dean attempted some light humor. "I mean most of the guys they see all day or old dudes with a spare tire in the middle instead of a six-pack."

"Dean…" Sam couldn't suppress a small grin and his cheeks dimpled ever so slightly despite being on the verge of crying.

"Well, I'm just saying kiddo…" Dean grinned back. "So, what do you say?"

"Fine," Sam conceded and allowed his big brother to button his shirt. "No more button shirts Dean."

"Hey, you're the layer dude," he jested. "We'll get some more pull-over shirts, okay?" Sam nodded. "Dr. Finley talked to us," he offered quietly.

"Yeah, I figured."

"So, this new diet," Dean began, "it's gonna be okay. The dietician chick gave us a big booklet with recipes and stuff …"

"Dean, maybe it's time…"

"No," Dean's voice was firm and it brooked no argument. "So," he began quickly changing the subject as he glanced at the Thick-it Puree brochure next to his brother. "I saw they have Caramel flavored Apple Pie Puree, Mmm … pie." He smiled at his little brother as he buttoned the last button. Sam shook his head.

"You've got issues man," he smiled. "We're talking' Pie puree … puree," Sam accentuated the word puree. Dean cocked his head slightly and smiled.

"Yeah, so, it's still pie, man…"

"Like I said … issues…" Sam smiled at his brother and Dean ached at the dimples. "Dr. Finley wanted me to place an order today, so could you …" Sam hesitated.

"What?" Dean pushed gently.

"I can't circle the ones I want … can you?" Dean knew how incredibly hard it had to have been for his brother to say that simple sentence to admit he needed help and especially with a task as simple as circling what he wanted in a brochure. It made the bile threaten to rise in Dean's throat that his brilliant little brother no longer had the ability to circle with any sense of hand control in a brochure. He swallowed the lump in his throat and squeezed his brother's shoulder.

"Sure, Sammy, what sounds good," he smiled and kept his voice light being careful to hide his emotions deep under the surface. He'd be strong for Sam, he had to be, and he would be.

To Be Continued