Disclaimer: refer to chapter one

NOTE TO READERS: Thanks as always for the reviews and the wonderful PM's. This chapter is around 8 pages long and I decided to spare you a cliffhanger for this update. I still have some more chapters planned but they still need to be written. I hope you all have a good holiday weekend, if you celebrate. Happy reading, I hope!

So Long, Good-Bye

Chapter Ten: When the Light Settles Low

By Dawn Nyberg

"How long have I been in this storm so overwhelmed by the ocean's shapeless form water's getting harder to tread with these waves crashing over my head …" lyric excerpt by Lifehouse, Storm

Later the Next Morning

"Okay, Sam," Dr. Finely patted his patients leg. "I'll prescribe something to address that infection and we'll get you back on track, okay? Now, next time you're feeling bad or there is pain when you urinate, please tell someone, alright? If Valerie hadn't noticed your discomfort this could have become much more serious, okay?"

"'K," Sam struggled but his doctor understood.

"Sam, I'm going to have Valerie get a urine sample for me just to make sure, but I'm pretty positive were dealing with just a urinary track infection. I know you've had a catheter before, so you know it'll be a little uncomfortable but as soon as she has the sample she'll remove it, okay?"

Sam nodded. "Good, I'm going to go out and talk to the peanut gallery and let them stop pacing." Sam smiled at that as his eyes desperately fought to look at his doctor. Dr. Finley patted his leg again. "I'll be back in a minute Sam."

Dr. Finley let himself out of the library and closed the door behind him to give Valerie and Sam some privacy as she put the catheter in to get the urine sample. "Well?" Dean stopped pacing and went straight to the doctor. John and Bobby waited, too.

"I'm pretty sure it's a UTI but I'm having Valerie get a urine sample to test and make sure. For most people a UTI isn't a big deal but for a PSP patient they can turn nasty and I want to rule out that a kidney infection is starting." Dean looked alarmed and the doctor smile reassuringly. "Dean, relax, okay? I'm pretty sure that it's a UTI and Valerie discovered it pretty quick. I'll run the sample back at the hospital and I'll call in a prescription at your pharmacy and Sam can start his antibiotic."

"How's he gonna take a pill?" Dean looked concerned.

"I'll most likely prescribe an oral suspension that Valerie can put down the feeding tube with one of his feedings. It'll probably be a drug called Macrobid and she can mix it with a liquid feeding or some milk and put it down his tube. It should be taken with food or milk, so she can take care of it and also show you how to administer it should you have too."

"My son," John began. "You said these infections could turn nasty with PSP patients, is he at risk right now?"

"Sam is at a higher risk for infections due to his condition, yes, especially because of his basically bedridden status, but I really do think it was caught early and I think the antibiotic will do the job."

"But, what if the urine sample says he has a kidney infection, too?" John pressed.

"Well, I highly doubt it as he isn't showing other symptoms that would lead me to suspect kidney involvement but if his sample did show the kidneys were involved then I'd prefer to admit him to the hospital for a strong course of IV antibiotics."

"But, you're pretty sure it's just a UTI?" Bobby stepped forward.

"Yes, I'd say 99.9 percent sure," the doctor smiled at the three men. The library door opened and Valerie emerged with a sealed urine sample cup.

"Here, Dr. Finley," she said as she slid it into a bag and closed it.

"Were there any problems with the catheter placement and removal?"

"Other than being a little uncomfortable, no, Sam did just fine," she assured.

"Good, now," he started and looked back at Sam's family. "I told him I'd stop back inside before I head out. I'll have it tested and have the medication called in today, so he can start on it today, okay?" Sam's family nodded.

"Hey, doc?" Dean stepped forward.

"Yes?"

"How's he doin'? I mean aside from the infection, you examined him, right?"

"If you're asking if I discovered any new advancing symptoms with this visit, no, but Dean…"

"I know, okay," he grumbled. "It's aggressive." The doctor offered a soft smile and reached out and squeezed Dean's shoulder reassuringly.

"I'm going to go say bye to Sam," he left the room and walked back down the hall toward the library.

Two Weeks Later

Sam threw a tissue box at his father and brother and mumbled unintelligibly as Valerie tried to calm him. "Dean. John, maybe you should step out and let him calm down," Valerie urged.

"Sammy, it's okay," Dean attempted. Sam had begun having drooling problems over the last couple days or so and although it was a common symptom that happened to PSP patients it was just one more thing for Sam to endure, one more loss of his control and he hated his brother and father seeing him in this state and he hated being like this. He had had a couple incidents of being disorientated and often would wake and think he was back in the car after the semi had hit them, he'd call out for his Dad, slurred and mumbled and then he'd scream for his brother as best as he could, it often was a screech and Dean's name was lost in the slurred, uncontrolled speech. Valerie and Dr. Finley had tried to explain that disorientation and even dementia type symptoms weren't uncommon for PSP patients, but Dean and John still hated it, always fearing that it wouldn't go away. Those episodes had been thankfully transient but the drooling was becoming more common. "Sam?"

"Dean, please," Valerie urged with a strong tone. Sam became rigid and Dean could see a muscle spasm working its way along his bicep up into his neck. Sam whimpered in pain. Dean and John hated the rigid body posture that had begun happening on and off over the last week but Dr. Finley had sadly stated it was just another symptom and that Sam was starting to acquire more symptoms that fit into stage four than three … Dean, John and Bobby all knew that stage four was the last stage and they found themselves wanting Sam to stay in as many stage three symptoms as possible.

"Sam, I'm going to give you something to help with the spasm and pain, okay?" Valerie went to draw up some medication for Sam that Dr. Finley had prescribed for these episodes. "It's okay," she soothed. Dean felt the nausea and the bile creep into his throat. He turned and pushed past his father and went down the hall. John spared a glance at his youngest as his body began to relax and his eyes close from the medication. He met eyes with Valerie and nodded. He left to look after his other child, the other one falling apart just like his youngest but just in a different way.

Dean was on his knees over the toilet as violent spasms rolled over him. John knelt next to his son and rubbed his back as his child emptied the contents of his stomach. "Easy, Dean," John soothed. John stood and handed Dean a glass of water to rinse his mouth when it appeared that his son was finished. Dean sat on the floor and pushed himself back to the wall and sat there. John decided to sit down, too. "Better?" John asked softly.

"Better? Nothing's better dad," Dean answered bitterly. "Sammy's getting worse," he lamented. "Dad, you haven't said a word about the lead in over two weeks," Dean turned pleading eyes toward his father.

"Cole is still looking, okay? This lead isn't exactly easy to locate, if it …" John quieted and looked away for a moment.

"If it what?" Dean pressed.

"Dean, when I know something more I'll tell you," there was a hint of impatience in his voice.

"No, Dad, this is Sammy's life we're talking about here, and we're running out of time," Dean's eyes held a hint of frantic desperation in them. "Please, just say it, okay? It's not easy to locate if it what?"

John sighed, "If it exists at all, alright? This lead, if it exists keeps a low profile but it's our last option. Cole is looking and you know him … he won't leave a single stone unturned. If he finds even a hint I'll go. I'm not letting your brother slip away Dean, not if I can do anything to prevent it." Cole Waters had been a family friend for quite a while, although Dean hadn't seen him in years, he knew that he and his father still kept in contact with one another. Dean looked away as he brushed an errant tear away with angry frustration.

"Dammit," he hissed at the unbidden tear. "Sorry…"

"Hey," John's voice was soft. "No apologies you hear me," he reached out and cupped his child's right cheek and gently thumbed away another tear that had broken free. Dean looked at his father and in that moment he recalled the father he knew before his mother had died and this was that man, he offered a small smile at his father and John returned it warmly.

One Hour Later

"How's he doing?" Dean asked softly from the doorway to Sam's room. It looked like his little brother was asleep.

"He's resting," Valerie began. "Dean," she started hesitantly. "I know this is hard, I do. But, please, don't think he doesn't want you around, he's just striking out the only way he can really."

"I know," Dean offered quietly.

"Dean, he indicated to me earlier when I was changing him that," she paused as if trying to steel herself for the rest of the sentence. Sam's communication was hit and miss these days and as of late mostly miss, but he would struggle to make himself understood as best as he could and he had spoken one word today and reached for her hand earlier after she finished pulling his blankets back up after changing him.

"Sammy said something?" Dean looked at her intently. His brother still spoke to them but lately it was few and far between.

"One word," Valerie spoke evenly.

"What?" There was a pause as she met his eyes firmly.

"Hospice," Dean's jaw clenched and Valerie could see the muscles tightening. She watched his eyes dart toward his brother's sleeping form and she saw the agony in them. He shook his head ever so slightly.

"Not yet," Dean's voice barely audible.

"Dean, you're never going to be ready for that day, it will always be 'not yet,' she offered as she put a hand lightly on his forearm.

"He doesn't need a place like that," Dean started, keeping his voice low. "He can have that care here, right? I mean he doesn't have to go, right?"

"No," she offered easily. "But, it's what he wanted when it came down to this … Dean, the disorientation could become worse," she started. "You've read the literature and you know that often hallucinations begin, as well. He doesn't want to subject you and the rest of his family to that, and now with the drooling and the continued communication problems. There will come a time, I fear much too soon that he will not be able to speak at all. You know he's likely to withdraw even more."

"I know, okay, I've read all the information, I know … you don't think I haven't noticed that he can't even watch TV anymore, it's like his attention span is almost gone and he can't keep his eyes on anything except for the rare couple seconds or so, but he likes music," Dean added quickly. "He can still smile and I know he likes for me or my Dad and Bobby to sit and talk with him even if he can't look at us or talk."

"Of course, he likes having you nearby and loves for you to talk to him. He's still in there Dean, he's still every bit your little brother, but his brain is betraying his body. He doesn't want you to have to wake up every morning to knowing that he's in this room and …" she paused and decided she needed to say it for Sam, "Dean, I think he most fears passing away here because it will always be with you and he doesn't want to take this place away from you. He wants you to remember the good times here not his death. Dean, there may be some morning when he looks at you and doesn't even know you for a second or so; he wants to spare you that." Dean turned away as he felt hot stinging in his eyes. He took a breath and turned around facing Valerie again.

"It doesn't matter if he's here or at a hospice," his voice grabbed. "I'll remember everything anyway. He should be here and not some place with strangers and it's not like I wouldn't be there every minute anyway," he reasoned.

"You agreed to his living will Dean," she said gently. "You'd take that decision from him, one he made when he could still express himself." Dean shook his head sadly.

"No," his voice shook. "But, it's not time. I'll talk to him."

Later that Day

Valerie had excused herself for a break and Dean wanted to talk to his brother. He walked in and closed the library doors behind himself. He carried a brown envelope with him. Sam watched him enter and his eyes roamed around the general direction of his brother. Dean sat down on the side Sam was laying. "Sammy, we gotta talk, okay?" Dean reached for the terry cloth towel near Sam's head and gently wiped the drool from his brother's chin and cheek. He could see his brother tense. "Easy, Sam, see all dry, no worries." He opened the envelope and slid a manila file out and put the papers on the rolling bedside table. "This is your stuff," Dena started and stopped, he took a breath, "I mean your living will and a copy of your advanced directives for the hospital. My medical power of attorney is here, too," he fought to keep his voice level and without tremor.

"Val, told me you mentioned the hospice today, that true?"

Sam nodded.

"If you still want to go after I'm done saying my peace then I'll find a place, but you hear me out first, deal?" Sam hesitated. Dean reached up and grasped his brother's arm. "Deal?" he said once again.

"Ddd … llll…" slurred out but Dean knew what his little brother was saying. He smiled reassuringly.

"Good," he let his hand settle on his brother's right calf that was covered up. "Look, I get why you think you have to go to a place like that Sammy, but you're not protecting Dad or me from anything … you'd just make us worry even more. I'd just stay with you practically 24/7 anyway," he stated flatly. "I want you here, Dad and Bobby want you here for as long as you can be … I get that you might need some extra medical care that can't really be done here and then a medical facility would be needed, but a hospice Sammy … you belong here and not in some place with strangers."

"Nnn … tttt… ea ….y … tttt ooo hhh…hard fff…for," Sam stopped and tried to concentrate. "Too hard fff…for you and Dddd…dad," he struggled out. Dean looked at Sam with intense eyes.

"You're worried about this being too hard on Dad and me?" Dean gently squeezed his brother's calf. "Sammy, this isn't easy for any of us and it isn't this," he motioned to his brother's bedridden status and even waved the cloth towel that he reached for yet again to wipe a bit of saliva as it escaped his brother's mouth. "Taking care of you no matter what, it's what family does for one another. It's not easy watching you try to be strong for us and it's not too hard Sammy," Dean tried to make his sibling understand.

"It would be too hard if you weren't here Sammy … I'll honor your wishes I will, but, please reconsider and stay here at Bobby's," Dean's voice had an almost begging quality to it. "I read over your advanced directive for the hospital," he admitted with a little sadness. "I, ugh … gotta admit Sammy that I never really got all the way through it before 'cause I couldn't sit there and read how you wanted to …" his voice shook now and he stopped. He took a breath, "I couldn't sit and read how you wanted to …" he just couldn't say it.

"Die," Sam slurred out and Dean looked at him.

"Yeah," he admitted. "But, I read it all today. I knew about you not wanting a surgical feeding tube but I read the stuff about how you want the vent removed if you have no chance of recovery and that about all of the heroic measures stuff … I know you agreed to IV hydration and nutrition and pain relief … I get that you don't want to be stuck on machines, okay?" Dean sighed. "I promise I'll do what you want and I won't fight the doc in obeying your wishes."

Sam reached out and placed his hand where he felt his brother's hand resting and he took hold if it and squeezed. "Thh…thank you," he garbled out.

"Don't thank me Sammy, I don't want thanked for this. "So, you'll stay no hospice?"

"Fff … for now, bbb…but…"

"I know, if it comes to it … I mean you get sicker or you go into the hospital and they say there isn't anything they can really do you want to go, right?" Sam nodded. "So, you'll stay?"

"Yyy…yes … fff…for now."

Dean looked at his watch, "Look at the time Sammy, it's about time for a feeding. The doc added some more supplements for you to start taking, I'm gonna let Valerie back in here and I'll get your stuff ready, okay?" Sam nodded.

Sam watched his big brother leave the room and despite not being able to really keep his eyes on him he could see the sorrow that hung heavy on Dean's shoulders and he blamed himself for that burden but he now understood that staying here until he absolutely couldn't any longer was what his big brother needed, so he'd give him that, he'd give him as much as he could. He raised a shaky hand in an attempt to wipe the saliva he was just now realizing had begun to slide across his jaw line. "Here Sam," Valerie's voice was soft. "Let me help you with that," and she picked up the towel and cleaned off Sam's face. "So, you and Dean have a good talk?" she asked lightly. He nodded. She smiled. "Good."

Dean stood at the kitchen counter preparing the syringes with the liquid feedings that Valerie would hook to the port end of Sam's NG tube. His brother took two large syringes for his liquid feedings and supplements. His hands were shaking as he capped the last one. His mind reeling from the conversation he'd just had with his baby brother … Sam dying wasn't an option and the thought of his brother not being here anymore suddenly overwhelmed him. He began to shake but before he could lose complete control he felt a hand on his shoulder and he turned and looked into his father's eyes. John had been outside most of the day helping Bobby with a transmission problem. There were no words … John gently took the syringe out of Dean's shaking hands and placed it on the counter. He looked Dean in the eye and offered a warm, silent smile, there wasn't anything to say, no fatherly advice or words of support that were going to help, so John did what made sense, he pulled Dean into a hug and held his son.

To Be Continued