Disclaimer: refer to chapter one

NOTE TO READERS: Thanks again for the reviews, PM's and personal emails you've been sending. They are all appreciated! This has been another hectic week for me and I was doubtful I'd get a chapter ready for all of you but here it is for better or for worse. This chapter is around 7 pages and this story has another 2-3 chapters left before it's finished. Happy Reading, I hope!

So Long, Good-Bye

Chapter Thirteen: Letting Go In Inches

By Dawn Nyberg

"Looking back on the memory of the dance we shared beneath the stars above, for a moment all the world was right, how could I have known you'd ever say goodbye … our lives are better left to chance I could have missed the pain, but I didn't have to miss the dance…" Lyric excerpt by Garth Brooks, The Dance

Greene Memorial Hospital, Later that Day, July 4, 2006

"Will the tests hurt?" Dean asked Dr. Finley as he looked into his brother's room and watched Bobby as he sat and talked to Sam keeping the young man company. When they had arrived with Sam the doctor had completed an initial exam and opted to admit Sam for more advanced testing.

"He'll be mildly sedated and shouldn't remember any of the discomfort," the doctor assured.

"But, you already said you're pretty sure he's got some kind of UTI again …"

"The urine sample I obtained through the catheter did show some bacteria but I feel the Cystoscopy procedure will show me if the UTI is causing some other issues that need treated along with the UTI."

"This Cysto thing it lets you go inside and look …"

"Yes, the diagram of the procedure I showed you, I will be able to get a look at his bladder and urethra and identify any issues that might be present."

"So, this is treatable?" Dean asked, daring to hope.

"Yes, but Dean it's also important to realize that some neurological diseases can cause problems in other areas, such as this and it could be a complication to Sam's PSP and if it is then he may need frequent catheterization if he continues to not be able to eliminate his urine on his own."

Dean sighed and rubbed a hand across his eyes. "Fine, do the exam," Dean relented. "I just don't want him scared or in pain," his voice firm.

"I'll have a mild anti-anxiety given to him to help take the edge off and I'll be ready to do the procedure soon and as I said he'll be given something to help with the discomfort."

"I'm going to go sit with him." The doctor nodded and walked toward the nurse's station to make arrangements for a procedure room to be set-up for Sam's exam.

Two Hours Later

"Well?" Dean asked anxiously in the hallway outside his brother's room. Bobby stood at Dean's shoulder and waited for the doctor to speak.

"The procedure went off without a hitch," Dr. Finley. "As you can see Sam is resting comfortably." Dean gave a thankful nod.

"So, did you see anything?"

"Well, the UTI he has this time around has caused some swelling in his urethra which has sort of pinched it off, so that is why he is having problems urinating. I've started him on some antibiotics to correct the UTI and some other meds to help reduce the swelling in his urethra."

"So, he's going to be okay? He'll get to come home?" Dean wanted the knot in his stomach to loosen a little.

"In a few days Dean," Dr. Finley responded. "I'd like to see him go home off of the catheter; although I will send you home with some extra catheters to keep you in stock should he have some issues."

"Issues? He couldn't go because his plumbing is swollen, so he'll be okay, right?"

"Dean, your brother is suffering from a neurological disease and it's a possibility that he could suffer from the urine retention again when it isn't due to an infection. I just want his care nurses to have the extra supplies should they be needed." Dean nodded tightly.

"So, how long do you have to keep him here? Not two weeks again, I hope."

"No, his UTI isn't as severe as the last time, but I'd like to see some progress in reducing the swelling before we remove the catheter and send him home. Maybe, two or three days, let's play it by ear, okay?"

"Yeah, alright," Dean sighed.

"So, doc, if this happens again he can stay home?" Bobby chimed in.

"The urine retention can be treated at the house with the catheter insertion but should he have another infection, of course I'd like to see him and whenever the retention happens, if it does," the doctor added for Dean's benefit. "I'd like to see him just to rule out any other problems but otherwise you can keep him at home." Bobby gave a thankful smile and nodded.

Later that Day

Dean stood down the hall by a window in order to get better reception for his cell phone. He dialed and waited. He half expected voice mail to pick-up but after the second ring a voice he knew well answered. "Hello? Dean?"

"Hey, Dad," Dean answered quickly.

"Are you boys okay? Sammy?" Dean heard the underlying fear when his father said his little brother's name.

"We're good," Dean replied. "Um, Sammy's in the hospital…"

"What? What the hell happened? What's wrong?" his father's questions fired off rapidly like a fully automatic 9mm gun.

"Relax Dad," Dean attempted to reign in his father. "He's got another UTI but this time it caused some swelling inside and he couldn't go, so they put in a catheter. The doc says he should be able to go home in a couple days."

"Do you need me there?" Dean could hear a little relief in his father's voice now but only a little.

"No. How are you and Cole doing? Get what or who you needed?" Dean hedged. There was a sigh at the other end and Dean had his answer and it wasn't what he was hoping for.

"This location didn't pan out but we have some more leads. Look, son, I'm going to go with Cole to one more lead location and if that doesn't pan out, he's going to keep looking and I'll come back, okay? Dean, I have every reason to believe at this point what we're looking for does exist but like I said they keep a low profile."

"What is it Dad? A creature? What? I need some answers, I deserve it." Dean couldn't keep the frustration out of his voice. He wanted to know what his father was going to bring around his brother and was it safe.

"It's a human Dean," John finally answered after a long moment. "Well, mostly, okay? Please, it's hard enough for me to accept what Cole has turned up … what I've heard from some people that say they've met one of these special people before. I'm not keeping you in the dark to hurt you son, but until I find what I'm looking for I'd rather not say more. I wouldn't put Sammy in danger, you know that," he comforted.

"Dad…"

"We'll get this done Dean," John assured. He had to sound sure to give his child hope. "We aren't losing him … you hear me?"

"Yeah," Dean forced out through his tight throat.

"Good, now you tell Sammy to hang tough and if you boys need anything, anything you call me, okay?"

"Yeah, Dad," Dean replied.

A short while later Dean sat next to Bobby at Sam's bedside. "Is your daddy coming home?" Bobby asked quietly not wanting to wake Sam.

"I told him he didn't have to … he's still looking…" Bobby nodded because there was no need to make Dean say more in regard to the fact the possible saving grace for Sam had yet to be located. "Bobby, you've got deliveries to the salvage yard today you don't have to stay. Sammy's gonna sleep a good chunk of the day probably and you heard the doc he's coming home in a couple of days." Bobby gave Dean the look and he smiled. "I'm sure Bobby, if anything changes, I'll call," he assured.

"Okay, but if you boys need me…" he left the sentence unfinished.

"I know," Dean replied with a soft smile.

Later that Day

A nurse had already come and gone to change out Sam's various IV bags and gave him a mid-afternoon nutrition bolus. Dr. Finley wanted to keep Sam on the same feeding schedule he had at home and didn't want to disrupt his system anymore than necessary.

Sam shifted and opened his eyes. Dean was thankful that one PSP common problem hadn't happened to his brother. PSP patients often had trouble closing their eyes near the end stages and would have to utilize drops and eye ointment to help with dry eyes and would have to have their eyes taped shut at night. Sam could still open and close his eyes and Dean was thankful this one thing had avoided his sibling. "Hey kiddo," Dean kept his voice light. "You in any pain?"

Sam's eyes roamed in his big brother's general direction. He opened his mouth to attempt a word but saliva dribbled out and he swallowed deeply to try and quell the fluid. He coughed suddenly as the saliva went down the wrong way. He tried to sit up but couldn't and arched his head back trying to clear his airway. Dean stood up abruptly and grabbed Sam sitting him up and pushing him slightly forward. "Easy Sammy, easy," he soothed. "I need some help in here," he called out. Sam's nurse came in quickly when she heard Dean calling out for while she was at the nurse's station. Sam's face was red as he continued to cough. Dean was urged aside as the nurse grabbed a suctioning tube from the bedside and flipped a switch on. "He was drooling and just swallowed wrong," Dean commented absently as he watched Alice help his brother.

"Sam, I'm going to help with that, okay? I need to help clear some of the fluid this may feel uncomfortable. I'll be quick," she tried to calm her patient. Sam coughed and gagged as she suctioned his mouth and slightly down. He felt like he was having a strep test and gagged at the intrusion. She pulled back and he gave one final cough that turned him beet red and then it was over. His chestnut bangs were damp with sweat from the ordeal. "There you go," her voice cheery and calm. She adjusted a couple IV items and looked at Dean. "If you need me, let me know. I'll be back in a little later; Dr. Finley has added a couple additives to one of Sam's IV's."

"Thanks Alice," Dean was back at his brother's side as soon as she walked away. "It's okay Sammy it just went down the wrong pipe," he comforted. "It happens to the best of us. Remember that one time when I swallowed that beer wrong n that dive bar in Georgia? I sprayed the floor with PBR," he chuckled and knew Sam had found humor in the memory because Sam's mouth quirked on one side and Dean could see the attempted smile light his brother's eyes for an instant.

Two Hours Later, Sam's Room

Sam had dozed off an hour ago and the sleep didn't appear restful. Sam was moving slightly and didn't look comfortable as he slept. Dean watched him and couldn't help but notice his brother's cheeks seemed slightly flushed. He reached up and felt his forehead and his brow wrinkled in concern. He felt a little warm, not burning up but warm. He slipped out to the hallway and walked the short distance to the nurse's station. Alice was doing her change of shift notes with the nurse that was taking over her patient for the remainder of the night. "Hey Alice?"

"Yes?"

"Sam's looking uncomfortable and I think he's starting to get a fever." Alice stood up.

"I'll be back Lori, give me a sec'."

Alice walked into Sam's room and examined her patient. She took his temperature and noted it was 100 and his blood pressure was slightly elevated. Sam was moving in his sleep and she could see the discomfort. She pulled back the blanket and sheet and felt Sam's stomach and felt that it was slightly distended. She pushed ever so slightly and Sam grimaced in sleep. "I'll page the Dr. Finley at home to let him know what's happening but he turned over his patients for the night to Dr. Remmy, so I'll have him paged to come take a look at Sam."

"What is it?"

"I'll let the doctor take a look. His fever isn't high just slightly elevated at 100 his blood pressure a little up but it isn't dangerous … it's just letting us know that he isn't comfortable."

A Short While Later

"Okay, Sam," Dr. Jerry Remmy's voice was soft. Sam was awake now and was clearly in discomfort and not happy about all of the attention. The doctor listened to Sam's heart and lungs and then moved to the slightly distended abdomen. "He had a choking episode earlier?" he looked at Alice who was still present to inform the doctor about Sam before she left.

"His brother stated that he was drooling and swallowed wrong. I suctioned and helped him clear his airway. The coughing stopped and didn't occur again."

"Did you check for tube displacement?"

"I… I didn't think to since he hadn't pulled on it or vomited. The tape wasn't dislodged on his face. The tube appeared in place." The doctor nodded. It was true the tube placement on Sam's face didn't appear changed but that didn't mean there wasn't a possible problem with the tube.

"Sam this may hurt a little but I need to push on your stomach a little, okay?" The doctor pushed slightly and Sam moved under his touch. "Easy," he soothed. He tapped around Sam's stomach and stopped. "Okay, Sam just one more push, okay?" The doctor stepped back and wrote something in Sam's chart. "I think there may be a problem with Sam's NG tube. I think it may have become slightly displaced or perhaps there is a malfunction with it, so I'm going to pull it and we'll replace it with a new one. I think this will help."

Dean stepped forward, "That's an easy fix right?"

"It's fairly routine replacing items like this Dean. I'll pull the tube and we'll give him an hour or two to relax and then we'll insert a new NG tube." The physician looked at his patient. "Sam, we'll get you fixed up, okay? It will be a little uncomfortable but we'll give you something to help with the discomfort." Sam's eyes roamed in the general direction of the Dr. Remmy and his hand reached out, bobbing in the air and Dean knew instantly what his little brother wanted. Dean grabbed his brother's hand and held it firmly and rubbed a thumb comfortingly across Sam's knuckles and proceeded to trace calming circles on the top of his sibling's hand. "I'm here Sammy. I'll stay with you through it, okay? Just like last time. You've done this before kiddo," he urged. "You're okay," he soothed and Sam relaxed.

The doctor ordered some materials for the routine removal and Sam's evening nurse, Lori entered the room to help with the tube removal. "Okay, I'll make this as quick as possible. The medicine should help a little with the discomfort, alright? Here we go." Dean felt Sam squeeze his hand with more strength than he thought his little brother was capable of these days. He smiled in pride at his sibling.

"I'm here Sammy," Dean's voice soft and comforting. "Just relax and let the doc do his thing."

The removal was a relatively swift process, yet Sam arched against the pain and then proceeded to vomit violently as he felt the tube pass by the back of his throat and slide up into his nasal cavity as it exited out his nose. "Damnit," the doctor hissed. "He's vomiting!" The room suddenly erupted into a tense and hectic atmosphere and Dean felt himself yanked away from Sam as two more nurses and a young intern entered the room. Sam coughed wetly and gagged against the vomit.

"What's happening?" Dean called out anxiously.

Sam was suddenly rigid and all the color had drained from his face. He appeared almost grey. "Sonofabitch!" Dr. Remmy barked. "He's aspirating! What are his O2 SAT's?" Sam was struggling for air and getting very little. His gown had dropped down and Dean could see his brother's chest literally caving in and out to try and breathe. "Dammit! I asked what are his SAT's?"

"Sorry, he knocked off his pulse OX," Lori hurriedly answered and then read the new reading, "80," she answered urgently and just as the numbers dropped to 79 Dr. Remmy was already having respiratory paged STAT to Sam's room. "Jesus, get me an intubation tray, now! He's barely moving any air."

Dean watched in agony as Sam's eyes rolled back in his head and he began to seize. "He's hypoxic! Get 4mg of Ativan in this kid; we got to get this seizure under control." Dr. Remmy shouted. Within moments Sam's seizure had abated under the help of the medication pushed into his IV line. "I need that intubation tray," he barked as the tray was torn open and the materials handed to the doctor. He arched Sam's head back as he slid in the metal tongue blade preparing to intubate Sam. "And, where the Hell is respiratory!"

Dean stared at the scene in horror his mind still trying to catch up to how quickly everything had gone so bad, so fast, his mind focused on one thought, please breathe Sammy, just take a breath …

To Be Continued