Disclaimer: refer to chapter one

NOTE TO READERS: As always thanks for the reviews, PM's and emails! This chapter is around 11 pages long. Well, this story was going to have one more chapter left but it looks like it may be another chapter or two longer than I expected. Happy Reading, I hope!

Side Note: I have a SN story coming out with Ashton Press in a fanzine. I'll post the link on my profile page for anyone interested.

So Long, Good-Bye

Chapter Fourteen: Nothing Gold Can Stay

By Dawn Nyberg

"Nature's first green is gold, her hardest hue to hold. Her early leaf's a flower; but only so an leaf subsides to leaf. So Eden sank to grief, so dawn goes down to day. Nothing gold can stay" Poem by Robert Frost, Nothing Gold Can Stay

Two Hours Later, Greene Memorial Hospital, ICU

Dean sat with his hand's folded in his lap, stretching and clenching his hands in fists. Bobby sat stoically beside the young hunter watching him out of the corner of his eye. His mind still reeling from the frantic phone call Dean had made after Sam's crisis. Now, the youngest Winchester lie behind two automatic doors since being transferred from his regular ward room to the ICU.

"Men?" Dr. Finley stepped into the medium sized ICU waiting room. The doctor had been paged and arrived to assess Sam.

"How's Sam?" Dean stood quickly.

"Let's have a seat," the doctor encouraged but doubted they'd take him up on the offer.

"No, just tell me," Dean's eyes were intense.

"Well, let's start off with the minor issues," the doctor began. "The NG tube had a faulty segment and was slightly kinked, so that is why he was having the discomfort and the slightly distended abdomen. The tube has been replaced and is working fine. Now, the removal as you know did have a complication … Sam vomited and aspirated into his lungs. The aspiration wasn't small and his lungs became quickly compromised and his oxygen levels dropped swiftly causing the seizure from a too low oxygen level in his blood."

"Doc," Dean's eyes were pleading. He wanted the details but he needed to know one thing and Dr. Finley knew the words.

"He's alive Dean," he said softly.

"But?"

"Dean, we've suctioned what we were able to but stomach fluid and although he hadn't had a feeding within an hour of his tube removal there was some feeding fluids in his stomach and he deeply inhaled during the vomiting and with his swallowing issues .... He isn't breathing on his own at all right now. And, respiratory has increased his vent settings to help keep up his oxygen levels but they are having problems."

"Problems? Do whatever you have to," Dean stepped forward. The doctor shook his head slightly.

"We will Dean I assure you but Sam's condition is very critical. He has a fever and I'm certain a lung infection is already setting in with his weakened immune system. I've started him on an aggressive IV antibiotic treatment, but…"

"But, nothing, Sam will get through this, he will," Dean's voice was forceful.

"Dean," the doctor began softly. "We've talked about this and you know that aspiration is the leading cause of …"

"Don't," Dean's voice held venom in it. He knew the facts, he'd read the literature. The most common cause of death among PSP patients was aspiration pneumonia with various other infections as secondary causes. The doctor sighed.

"Doc," Bobby began. "Can we see him?"

"Sure, he's unconscious but until he regains consciousness from the seizure episode we won't be able to fully assess his neurological function. So, talk to him try to bring him around. Maybe, if he's awake he'll fight more," the doctor offered and Dean looked at the man and offered a soft smile of thanks.

Dean sat at his brother's side and looked over at Bobby. "I should call my Dad," Dean said absently as his eyes went back to Sam.

One Hour Later

"I can do it," Bobby answered easily. "You stay with Sam." Bobby started to stand and a slight stirring from Sam stopped him. Dean stood quickly and was standing over Sam. His hand gently pushed back his little brother's bangs in a soft, soothing motion.

"Sammy? You in there kiddo?" he kept his voice soft. Sam puckered his eyebrows slightly as he shifted toward waking. Dean and Bobby both waited, the only noise in the room was the slight rustle of the sheet and the constant click and whoosh of the ventilator. Sam's eyes opened slowly and his eyes were hazy and distant. "Sam?" Dean made his voice a little more sure, a little more forceful and it worked, Sam focused his roaming eyes for a moment. "Hey there Sammy, I'm here. Bobby's here," he soothed. "You're going to be okay, alright?"

Sam felt the intrusion in his throat and how his lungs felt forced to fill and release, he wanted to fight it, but he was so tired and his body weak that his efforts to buck the vent were fruitless. "Easy, Sammy," Dean urged as he detected his brother's unease with the breathing tube. "It's helping you right now," he continued. "Don't try and fight it, just let it help. The doc will take it out as soon as he can, okay? You got sick when your feeding tube came out and you got some stuff in your lungs. They're giving you some medicine and you're going to be okay. I'm here and I'm not going anywhere."

Dean looked at Bobby for a moment and the older man could see that Dean was trying hard to believe that his brother would get through this but him letting Sam think anything else wasn't an option. Sam had to believe this wasn't it that there was another side to come through with this setback.

"I'll call your Daddy," Bobby spoke up. He reached down and cupped Sam's right cheek avoiding the breathing tube. "Listen to your brother Sam," Bobby coaxed. "I'll be back in a bit. Just rest," he urged with a gentle tone. Dean offered a warm and thankful smile toward the older hunter.

Outside the Hospital

Bobby needed some air and knew he had to call John. It was one thing he could spare Dean from doing. He knew the boy was hanging on the razor's edge, as it was, so he wanted to take on what he could for the young man. He pulled out his cell phone and selected John's name. The phone rang and Bobby soon heard his friend's voice.

"Bobby?" John had seen the caller ID. "Are the boys okay?"

Bobby cleared his voice. "John," Bobby began and he could hear his friend's breath catch in his throat. "Sam had a complication when his feeding tube was removed…"

"Dean said Sammy would be home in a couple days or so, what the hell happened?"

"He vomited when they pulled it," he paused. "He aspirated again." The line was silent for a moment.

"How bad?"

"He had a seizure from low oxygen when it happened," Bobby decided John wanted and needed nothing held back. "He's on a vent again. He wasn't breathing on his own earlier, but he's awake now. The doctor says it's a bad aspiration and Sam's already running a fever and they are treating him for a lung infection…"

"Pneumonia?" John's voice was tight.

"Yeah, that's what I was hearing without the doc out right saying it."

"Bobby?" The older hunter heard the unvoiced question John was asking, is Sammy getting through this … do I need to come home.

"John," Bobby started. "I'll give him a couple days see how it's going and if he isn't doing any better, maybe…"

"I'm coming back," John blurted. "Cole can follow up on the search, he'll call …"

"You have another location?"

"Yes," John replied.

"Follow it up John. I'll call if Sam gets worse, okay?" There was another long silence on the phone.

"Fine, but if this one doesn't pan out I'm coming back and Cole can take care of this. The next lead is a couple states away and it'll put me a good two days drive from you, so…"

"I'll call the minute I think you need to come," Bobby assured. "If you have to fly … I'll get you at the airport, alright?"

"Yeah, tell the boys…" he paused. Bobby smirked despite the dire situation. He understood what John wanted to say that he loved them.

"I'll tell them, just do what you need to for Sam.," he paused. "We're getting close to the wire."

"I know," John agreed. Bobby could hear the stress in his friend's voice. "How's Dean holding up?"

"You already know the answer to that one Johnny."

"Yeah, I do. Take care of them," he asked. "We'll get this done," John assured. He had to believe they would and Bobby was more than willing to believe John, too. He couldn't imagine losing Sam anymore than John or Dean.

Meanwhile, Sam's Room

"You gotta fight this Sammy," Dean stroked his brother's forehead. "You beat this and we can go home and Dad will fix this when he gets back," Dean whispered near Sam's ear. Sam was still partially awake but his roaming eyes were distant and Dean knew his brother was only partially there but he knew Sam could hear him because his fingers curled around those of Dean's left hand. "I'm right here Sammy." He could feel the fever burning inside his brother. He pulled his hand away and brought over a cool cloth to run across his brother's forehead.

A technician came into the room. "Hi, I'm Charlie from respiratory. I'm just here to check his vent settings and do some things. You don't have to leave," he replied. Dean nodded. "Hi Sam, I'm Charlie. I'm just going to check some things with your ventilator, okay?" The tech proceeded to check settings and write numbers down. "Sam, I'm going to check your tube near your mouth, all right? I need to adjust the tube holder." The tech was quick, gentle and efficient and Dean appreciated that. "Okay, that's it Sam. I'll be back later before my shift changes, okay?"

"Thanks," he offered quietly as the man turned to leave.

"No problem, you're more than welcome."

Dean smoothed the cool cloth across Sam's forehead again and allowed it to rest there. His hot, dry skin sucking up the coolness and quickly turning the cloth warm. He felt Sam lightly squeeze his fingers once again. "I'm here kiddo," he soothed. Dean watched Sam's features relax and his eyes slide closed.

Three Days Later, ICU

Dean scrubbed a hand over his tired eyes. He stretched in the lounge chair he had next to Sam's bed. He wished he had said something more to his brother three days ago, if he'd known that when Sam closed his eyes that he wouldn't open them again, he'd had said more than I'm here kiddo. Sam had slipped into unconsciousness three days ago and his body was weakening against the fever that wouldn't let him go. Dean tried denial but he knew the signs of what was happening … Sam was losing this fight. His body too weak to fight back from this one. He was taking breath's on his own but not enough to survive off the vent for very long. He hoped that would change. The med's were working but not fast enough and the truth was Sam's lungs might be too damaged to bounce back from this one.

There were a slew of IV bags around Sam. His glucose levels were off the last day or so and Dr. Finley was having that addressed. His blood pressure was having trouble staying up so IV meds had been ordered to help combat that issue but they were already on their second different medication, as the first stopped being effective and the dosage was maxed out, so they switched and this one seemed to be working for now. "Sammy? I need you to listen to me, okay? I know you're tired and I know you're hurting, " his voice caught with emotion and he swallowed it back down hitting his gut as if he'd just choked down a cold stone. "You can call me a selfish bastard if you want but I need you to fight a little longer. I need you to open your eyes." He stroked his brother's right arm gently. "I need you to hold on, please…" his voice caught once again but he couldn't hold back the emotion any longer. He bowed his head and silently cried.

Bobby stood in the hospital atrium and tried John once again. He had tried calling more times than he could count over the last couple days when Sam took a turn for the worse but he wasn't picking up and hadn't returned any of the voicemail messages he'd left. He was half worried and half pissed. He hoped the lack of response meant John was out of cell range, maybe somewhere where there were no nearby cell towers for service, maybe John had found what Sam needed, what they all needed. "Dammit, John," Bobby hissed under his breath, snapping the phone closed without leaving a message. After all, he'd left more than ten and called at least fifty times and still nothing.

Bobby patted his jacket pocket to make sure the letter he went home to get was still safe inside, it was. He had locked up this letter months ago when he'd helped Sam with it. His mind recalled the day Sam had asked him to write a letter for him, to write what he said. Dean had gone out that afternoon to pick some things up for Sam and the young man had used the opportunity to dictate a letter because he couldn't write it himself. Sam had still be able to communicate verbally then and this letter was something he pleaded with Bobby to help him with and to keep it from Dean until Bobby knew the time was right to give it to the older brother. He walked inside the hospital with a heavy heart.

"How's he doin?" Bobby asked from the room threshold. Dean looked up.

"His fever is down a couple degrees," Dean's voice was hopeful. "Respiratory said they were able to lower the vent settings a little."

"Really?" Bobby stepped forward daring to hope. He glanced at the vent and could see the numbers were only slightly changed. "Is he taking any more breaths on his own?"

"A couple here and there," Dean offered honestly. "But, the doc still says he wouldn't last a long time off of the vent, maybe a few hours or less." Bobby heard the sadness in that statement. He dropped a hand on Dean's shoulder. "My Dad picking up yet?"

"No, but I'll keep trying."

"If he isn't picking up, maybe he's found what Sammy's needs and just doesn't have the cell on him … could be out of range," he threw out as he stroked his little brother's arm.

"Yeah," Bobby answered lightly. "Dean?"

"Yeah," he turned and looked at the older hunter.

"I have something for you," he pulled the letter out of his jacket pocket. "I feel like I should give it to you now." Dean looked confused.

"A letter? Who's it from?"

"Sam," Bobby answered softly. Dean's eyes went wide. "He had me help him a few months back when he could still communicate pretty well but couldn't write. He made me promise not to tell you about it or give it to you until I thought I should. He extended his hand with the letter.

Dean stared at it, as if it were an instrument of torture and as if reflex a drew away from it. "No," his voice ground out low. "I don't want to read it. This ain't some death bed crap and I'm not doing it." Dean stood up abruptly and walked out of the room. Bobby followed.

"Stop," he reached out a hand as he caught up with Dean as the young man hit the automatic door button at the ICU exit door. Dean kept moving forward and Bobby jogged a few steps and grabbed Dean by a shoulder. "Dammit boy," he grumbled and spun Dean around and what he saw took his breath away. Dean was crying. Bobby simply cupped a hand firmly around the back of Dean's neck and pulled him forward roughly and held him. "I got ya boy. I got ya," he assured roughly. Dean wrapped his arms around the older man and buried his face. "I got ya," Bobby said once again as he patted Dean's back.

"But nobody has Sammy," Dean choked out. "This shit he's been going through for month's now … I can't help him, I can't … I can't say good-bye," Dean choked. Bobby fisted Dean's shirt in his hand and held him firmly.

"No one is asking you to Dean," Bobby assured. "This letter is your brother talking to you … it's a gift Dean."

"He's not going to beat this Bobby," Dean stepped back and wiped at his face. "Dad should be here and not chasing some wild goose chase. Sammy'd want him here. That letter is some damn swan song and I can't…"

"Now, listen here, you're not giving up on your brother Dean … it's never too late until it is too late. He's down that hallway and he's still fighting dammit … don't you give up on him. He'd never give up on you and you damn well know it," Bobby's eyes blazed.

"I'm not giving up on Sammy … I can't do that, not now not ever, but…"

"No but's Dean. Look I'm not living in a pipe dream here kiddo and I know this story is edging toward it's final chapter but the last page hasn't been written, not yet, okay? You hearin' me?"

Dean offered a tight nod. His hand extended and Bobby knew he was ready for Sam's words. Bobby handed him the sealed letter. He looked at the envelope and frowned, he recognized the handwriting albeit messy, it was Sam's. "He wanted to write your name on it and he signed it, too." Bobby answered without being asked the question. "Go on, take a walk," he urged. "I'll stay with Sam. I have your cell number if I need you back up here sooner, okay?" Dean nodded and walked away without another word.

He sat in a quiet corner of the empty first floor chapel. The wood pew creaked as he sat down. He took a breath and opened the envelope:

Dean,

If you're reading this then it must mean things haven't gone the way either of us wanted. If Bobby is giving you this then I must be losing this fight. Look, I know trying to be supportive of my Living will and Advanced Directives aren't easy for you since they go against every big brother instinct you have where I'm concerned. This isn't your fault you know? You didn't fail me, you never have. You've been there for me my entire life and you've never let me down and as selfish as this sounds … I'm counting on that now.

I don't want my last days to be in some damn sterile hospital room. Dean, if I can't communicate for myself and the directive hasn't been enforced yet then, please do it for me. Dr. Finley has always been a straight shooter, he'll tell you if there isn't a chance for me to get well enough to go back home. I know it's asking a lot, I do, but I need you to accept when enough is enough. I'm losing so much with this disease, please don't take my final wish away from me. I'm not asking you to stop being my big brother, you'll always be that no matter what, but I am asking you to help me let go.

You know what I want, what I need … I wish I could thank you for all the years that you've been there for me while growing up but time seems to have slipped away and you always say, 'no chick-flick moments'.

This isn't a good-bye Dean … there is never truly a good-bye between brothers.

Sam

Dean's hands shook and the paper wobbled in his fingers. Hot tears cascaded large and unchecked down his face. He understood in this very moment what it felt like when your soul fractured.

Two Days Later, ICU

Sam had regained consciousness but was very weak. The IV's were helping to fight the infection and his fever was all but gone, however, his body had been severely weakened and his lungs continued to have issues from the latest aspiration. Dean sat at Sam's side, the letter weighing down like a stone in his pocket. "Sammy?" Dean's voice was tentative and Sam's eyes opened fractionally at his brother's voice. "Kiddo, I need you to wake up for a little bit, okay. We gotta talk," Dean squeezed his brother's hand and Sam returned the squeeze. Dean smiled as his little brother's fingers curled around his own.

"Sammy, I read your letter," his voice was quiet and he fought to keep it from wavering.. Sam's eyes roamed and settled on a Dean for a few precious seconds. The breathing tube was still aiding Sam but he had given into machines timing and only bucked it once in a while.

"Sam," Dean stroked his brother's forehead with his free hand. "I'll do … I'll…" his voice dropped off and he felt his brother lightly squeeze his hand. He looked up and smiled. His little brother was giving him support, even in his weakened state he was being strong for him. "I''ll do what you asked, alright?" He forced out as his jaw tightened involuntarily at the words. They went against every in him where Sam was concerned. "But, I want you home Sam, no hospice. You belong home. Please…"

Sam turned his back toward his brother and his fingers wrapped harder around his. He wasn't sure if that was his sibling protesting or agreeing. "Sammy, squeeze once, if it's okay or twice if you want the hospice." There was a long moment where Sam did nothing but Dean could clearly see the battle waging behind those warm eyes and then it happened … a single squeeze, firm and as strong as it was able to be. "Really?" Dean dared to hope.

Another squeeze to affirm Dean's hope. Dean stood up and bent over his brother. He pushed back Sam's chestnut bangs and gently kissed his brother's forehead. He rested his own forehead on his little brother's for a moment, "thank you Sammy," his voice rough with emotion. Sam moved a hand up and touched the tubing leading to his breathing tube. "I'll talk to the doc, okay? You've been doing better, let's play it by ear," Dean said hopefully. "I don't hear that fat lady singing yet, so don't go walking into any white light little brother. We're not done fighting this yet, not yet…" Sam's fingers once again curled around Dean's for a moment and his eyes slowly blinked. "Hey, kiddo, close your eyes and get some rest. I'm here," he assured.

Two Hours Later

"Doc, I wanted to talk to you about Sam," Dean sat across from Dr. Finley in his office. "I need you to tell me where we're at … you've always been straight, so…"

"Dean, Sam is a fighter, I'll give him that but this isn't a fight he's going to win. This PSP case has been rare and aggressive from the start. This latest aspiration has been too much for him …"

"But, he's taking more breath's on his own. His fever is basically gone. The med's are working…"

"Yes, the med's are working Dean but to what end? His blood pressure is still requiring IV intervention to keep it up and stable and we will most likely be changing medications again soon. His lungs are severely compromised. He could come off the vent but he'll only last a few hours. Dean, you asked me to be straight with you and I will be," the doctor looked at Dean and could see the anguish in the young man's eyes. "It's time to honor Sam's directive." Dean wanted to bolt but he had to do this, he had to for Sam.

"Sam," Dean's started and stopped. He took a deep breath and continued. "He's willing to go home rather than a hospice. I talked with Valerie once and she said that home hospice care could happen for Sam…"

"Yes, but Dean, I can't discharge him without taking him off the vent and he'd pass away within hours…"

Dean's mind had been thinking hard on a way to keep Sam with him longer and keep him comfortable. "Isn't there something he can get set-up back at that house to help him breathe or something that isn't a vent. I'll ask him but I'm sure he'll agree to something that isn't a vent, something that is just helping but not doing all of the work." The doctor rubbed a hand across his eyes.

"Okay," he started. "There is something I could have delivered and set-up at the house. We use these machines in the ICU for patients that have been extubated but are in danger of respiratory failure and intubating again isn't an option. It's a BiPap machine, it's on a larger scale than those used by people with sleep apnea but it can help deliver oxygen to Sam and it forces positive air into him when he breaths. It will help him take deeper and more frequent breath's. But, he's still requiring blood pressure medications Dean and without them his pressure would bottom out and would likely trigger a cardiac arrest."

Dean felt his body trembling but he tried to hide it from the doctor. "Can't you send him home with whatever IV's he needs? Valerie and Margaret can handle them. They are certified in advanced care, right?"

"Yes, but…"

"He wants to be home doc. He had our uncle help him write a letter a few months ago when he could still talk and he doesn't want to … he doesn't want to …" Dean couldn't say the words. He turned pleading eyes toward the doctor.

"He doesn't want to die in a hospital," Dr. Finley offered quietly. Dean nodded tightly. His eyes burning and stinging but he refused to let the tears fall. "Fine, I'll make the needed arrangements and I can probably have him home in a day or so. But, Dean, you need to accept that he's not going to get better. I know this is hard, but he's being released to home hospice care and based on his directive, he'd be home under what we call 'comfort care'."

"Comfort care?"

"We keep him comfortable with IV fluids, meds for pain and anxiety, but comfort care means that we won't keep adjusting his blood pressure meds or his BiPap settings to compensate for drops. Here in the ICU we have been adjusting his blood pressure medication frequently to compensate for drops but with comfort care the settings he goes home on will remain the same. The BiPap machine will be on the setting that keeps him from struggling but once that setting is set it will not be adjusted. This is about helping Sam to let go, to pass away peacefully. This isn't about him getting better. Also, you need to know that should his pressures bottom out or he stop breathing even with the BiPap mask in place there won't be any heroic measures to resuscitate him. He'll be allowed to die."

Dean looked away for a moment. "I want him home." His voice was tight.

"I'll start making the arrangements and we'll wean him off the vent and with his approval we'll start trying the BiPap mask, but this is his call Dean. You should know that even if he agrees to the mask, if he changes his mind at home and wants it taken off it will be removed and like the vent removal he'll have a few hours at most."

"I get it," Dean couldn't keep the bitter sound out of his voice. He hated this and he hated the fact his father was still not picking up. Sam needed him here and so did he.

"I'll make the arrangements for the care to become advanced home hospice care. I'd like everything delivered and set-up before Sam is returned home in order to make his transition as stress free as possible. He'll be taken home via an ambulance." Dean nodded. "Once plans are arranged Dean, I'll need to talk to you about some other issues, too, alright, but for now go talk to Sam and I'll be in to get his approval for the vent removal and to start him on the BiPap."

Dean walked back to the ICU. His heart aching, his soul splintering …

To Be Continued