Voices whispered around Sam, the words buried beneath a fog of medication. The tones sounded distorted – sometimes clear and close, sometimes far and faded – but always with him, hovering in the distance, pressing ever closer to his consciousness until he could no longer ignore them.

The darkness lifted from within as sensation slowly returned. Sam forced his eyes open and felt a hand on his forehead, sweeping his hair from his eyes. He tried to focus on the blurry image above him.

"D'n..."

"Shhh..."

Sam blinked.

"It's alright, Sam."

"Jim?"

"Mm-hmm..."

"Dean..."

"He's coming," Jim soothed.

Sam seemed to consider that promise as he swallowed with difficulty and slowly became more aware. He felt the invading pressure of a Foley catheter, the pinch of an IV; the tubing of a nasal cannula wrapped around his ears, stretching across his cheeks and up his nose, and there was some kind of clip on his finger that didn't hurt but was uncomfortable. There were wires coming from his chest and attached to monitors beside the bed, and then there was that unmistakable smell...

Hospital, Sam thought as his eyes dipped closed.

He opened his eyes again and turned his head toward the window to his right. It was dark outside and dark in the room, and he knew it must be late. Was that why he was so tired – or was it the cadence of the beeps the monitors kept producing that was lulling him to sleep?

Sam turned his attention back to the Pastor as he tried to change positions in the bed. A sharp pain emanated from his chest and abdomen, causing him to catch his breath harshly.

Jim frowned. "Sam? What's wrong?"

"Hurts..." Sam managed through shallow breaths.

Jim scanned Sam's body with his eyes. "Where?"

Sam's arms began to protectively encircle his midsection, giving Jim his answer.

"Do you want me to call the nurse?"

Sam shook his head.

"Sam, if you're in pain, then we need to let the nurse know," Jim explained reasonably.

Sam shook his head again.

"Sam..."

Sam continued to shake his head.

"Okay..." Jim relented, sighing and feeling his nerves begin to fray. He wasn't used to dealing with this version of Sam, and he hated feeling this helpless. "What do you want then?"

Sam stared at him.

"Sam?" Jim prompted, not wanting to but yet feeling a little annoyed; stress would do that. "What do you want?"

Sam's eyes were suddenly rimmed with tears. "Dean."

Jim softened immediately at the whispered name, wondering if Dean knew just how much this kid loved him. "He's on his way."

Sam held the Pastor's gaze and then slowly turned over his hand as it rested beside him on the mattress. "Promise?"

Jim smiled tenderly, reminded by that simple, trusting gesture that for all of Sam's intelligence and training and maturity beyond his years, he was still just a child; a sick child who only wanted the one person that always made things better.

Jim grasped the kid's small hand and squeezed it lightly. "I promise, Sam. Dean is on his way."

"'Kay," Sam responded, sniffling as his breath hitched on a sigh. He returned the pressure to Jim's hand and closed his eyes.

A soft smile continued to linger on the Pastor's face as he sighed in the silence that settled between them.

"Sam, do you want me to – "

Sam squeezed his hand again, effectively interrupting him, and then opened his eyes.

"What, Sam?" Jim leaned closer. "What is it?"

Sam blinked, trying to focus. "Sick?"

Jim's eyes widened. "You're going to be sick?"

Sam shook his head weakly, pointing to himself.

Jim stared at Sam.

Sam stared back.

"Sick?" Sam asked again.

Jim shook his head, wishing Dean were there to translate. He always made this look so easy. "Sam, I don't – "

Sam inhaled deeply, noisily. "Am I..."

"What, Sam?" Jim interrupted, leaning even closer, anxious to know.

"...sick again?"

Jim sighed, feeling embarrassingly dense. Of course that's what Sam was asking...

"Yes," Jim answered simply. "You are, buddy."

"What's..." Sam swallowed and winced. "What's wrong?"

"We're, um..." Jim smoothed the blanket over Sam's chest and then patted the hand he still grasped. "We're not sure yet."

"Am I..." Sam hesitated, glancing down and then looking directly at Jim. "Am I gonna be okay?"

The Pastor's heart constricted at the simple question.

I don't know, he silently confessed. But I don't have a good feeling about it.

Jim forced a smile, realizing he had taken too long to answer and that Sam knew the implications.

Tears glistened in Sam's eyes as he sank back into the bank of soft pillows and averted his gaze.

"Sam..."

Sam closed his eyes at the sound of his name and felt warm tears slip through his lashes. "Where's Dean?"

Jim smiled affectionately, thumbing the moisture from Sam's cheeks where it dammed along the tubing of the nasal cannula. If he had a nickel for every time Sam had asked him that...

"He's coming, Sam."

"I wanna..." Sam seemed to choke on his tears. "I wanna...see him." He looked up at Jim. "I want him here."

"I know," Jim soothed, wondering if Sam knew he was breaking his heart. "He's on his way."

"Soon?"

Jim nodded, brushing his fingertips across Sam's forehead, sweeping the fringe of bangs from the kid's eyes. "Soon."

Sam returned the nod, sighing as he closed his eyes again, exhausted.

Soon. Dean will be here soon.

It was the last thought to cross Sam's mind before he allowed the heavy pull of sleep to take him.

Hands touched him, probing, examining, causing intense pain. In the gray fog that encased his mind, Sam heard the sound of disjointed voices, fragments of words floating beyond his awareness or his ability to understand, to react.

"...extremely pale...his blood pressure...oxygen levels...still too low...heart rate...still too high...adjust meds...watch him closely."

Jim leaned forward placing his hand on Sam's forehead, feeling the heat burning inside the youngest Winchester. "His fever is up."

"I know," Dr. Collins commented as he wrote in Sam's chart. "It seems he may have an infection on top of everything else. Were antibiotics prescribed after his tonsillectomy?"

Jim nodded. "Yes, but – "

"Let me guess," Dr. Collins interrupted. "He wasn't consistent in taking them."

Jim nodded again, knowing it would've been different if Dean had been around. Sam would've taken the pills, whether he liked it or not. Period.

"That's typical. Patients don't want to eat or drink, much less swallow pills, after their tonsils are removed. Especially children. I'm surprised he didn't get liquid antibiotics."

Beggars can't be choosers, Jim thought sadly as his hand rested on Sam's thin, bruised arm, remembering the brown paper bag of medicine samples.

"Let's see..." Dr. Collins flipped through the chart. "Okay. Looks like the ultrasound confirmed a small tear in Sam's spleen, which would be consistent with his fall on the stairs last night. And since the spleen is a highly vascular organ, any kind of blunt trauma to the left upper quadrant of the abdomen can result in hemorrhaging, especially when it's enlarged, as Sam's is and mostly likely has been for the past few days, if not weeks." He glanced up at Jim. "Were you aware his spleen was enlarged?"

Jim remained silent, shaking his head as he stared at Sam.

"Huh. We'll need to find out more about that..." Dr. Collins commented to himself, making more notes in the chart. "Anyway...in years past, we would be discussing an emergency splenectomy right now, but things have changed."

"How so?" Jim asked, hoping this would lead to good news.

Dr. Collins tucked the folder under his arm and crossed to the bed. "Medical science has learned that the spleen plays a key role in immunity, so the preferred treatment is allowing the spleen to heal on its own whenever possible to preserve it. That's why we're keeping Sam sedated and flat on his back. Sometimes in lying flat, the spleen will clot and heal itself – which means we would avoid another surgery." Dr. Collins folded back the blanket across Sam's lap before pulling aside his gown, eyes expertly scanning the kid's torso. "But..."

Jim narrowed his eyes. "But what?"

"Well, it's been a few hours and the bruising patterns indicate that his blood is still not clotting properly."

Jim shifted his gaze to the doctor, not liking his concerned tone. "So Sam's spleen isn't healing itself as it should?"

Dr. Collins shrugged. "Hard to say. We'll wait and see how he does overnight, but in some cases, surgical repair – referred to as splenorrhaphy – may be required and is typically adequate to stem bleeding and preserve the spleen, thus protecting the patient's ability to fight infection. Our primary concern right now, though, is keeping Sam stable. Given the approximate time of his fall last night, he's been bleeding internally for close to 24 hours."

Jim felt a stab of guilt. How could he not have noticed, not have known?

"Fortunately," Dr. Collins continued, "the hemorrhage wasn't massive, but he's still in a state of hypovolemic shock due to the blood loss he's gradually sustained. Monitoring his vitals is crucial at this point. His breathing is shallow and rapid because he's not getting enough oxygen in his blood and that is causing his heart rate to be erratic. Plus, his heart was already having difficulty in pumping blood to his body due to inadequate blood volume, which could result in multiple organ failure if we don't get a handle on this situation."

"Organ failure?" Jim repeated, unsure if he was going to scream, cry, or throw up.

"It's a possibility," Dr. Collins confirmed. "But Sam seems like a strong kid, a fighter, so I'm not counting him out just yet." He smiled encouragingly. "Has he been awake?"

"About an hour ago, but only for a few minutes."

"That's typical, given his level of sedation."

Jim nodded, still trying to comprehend all the information. "He said he was in pain. Shouldn't the drugs take care of that?"

"Yes, but we may need to increase his dosage. The pain is coming from the ruptured spleen and the bleeding that's beginning to seep into his joints. Immobility is the best thing to prevent any further bleeding and lessen the pain; unfortunately, immobility is detrimental to his low circulation. Because he doesn't have the proper blood quantity, his circulation is poor, which advocates blood pooling. One thing leads to another, and it becomes a vicious cycle. I'm going to order physical therapy twice a day to help keep the blood circulating."

Jim watched as the doctor began to write in the chart again. "Physical therapy?"

"Yes," Dr. Collins said, closing the chart and giving it to the nurse who had been dutifully standing nearby. The door closed softly behind her as she left the room and the doctor continued. "They won't get him out of bed, of course, but they'll do light massages and different exercises to keep his blood circulating."

Jim nodded.

"Also, he's not producing red blood cells at a satisfactory rate, and we need to find out why he's so severely anemic. The blood loss is, of course, a contributor, but I suspect something else. It could be as simple as a vitamin deficiency, given Sam hasn't been eating properly, but it could also be..." His voice trailed off and he paused. "Pastor Murphy, as Sam's uncle, do you know if there is a family history of cancer?"

"No," Jim answered, uneasy at the sudden change of topic and at the mention of that word. "Why?"

Dr. Collins chewed on the inside corner of his mouth, hesitant to share his thoughts. Relaying suspected diagnoses to patients and their families based solely on a gut feeling was frowned upon; such information needed to be backed by test results, by scientific evidence.

Jim sensed the doctor's unease and felt his own heart rate increase. "Why?" he asked again, worry and fear making his tone harsh.

"Well," Dr. Collins sighed, "we won't know for sure until the test results come back, but his symptoms are indicative of ALL – acute lymphocytic leukemia."

"Leu..."Jim's voice faltered.

"Yes, leukemia," Dr. Collins nodded. "This particular type is most common in children, and progresses quickly if it is not treated."

Jim shook his head, refusing to believe. "But he's been fine..."

"Sometimes this condition can present with little to no warning." Dr. Collins paused, trying to remember without retrieving the chart. "He has a brother, correct?"

Jim nodded.

"Good. If this turns out to be ALL – and if we need to perform a bone marrow transplant – his brother would be the best source for a match. He would be willing, yes?"

Jim cut his eyes to the doctor, offended that he would question Dean's love, his commitment to his brother. "Dean would do anything for Sam."

"That's good to hear." Dr. Collins held Jim's stare, sensing he had unintentionally caused an affront. "But we're getting ahead of ourselves. Before we start thinking about treatment, we'll need to run more tests to confirm an actual diagnosis. I've ordered a peripheral blood smear and a cytogenetic analysis, and those results should be back in a few hours."

"And then what?"

"Well, depending on those results, we may need to do a bone marrow aspiration and biopsy tomorrow to confirm and officially diagnose. But all of his symptoms – weakness, fever, bruising, shortness of breath, pain below the ribs and in his joints, even the enlarged lymph nodes in his neck that may have been misdiagnosed and resulted in the tonsillectomy, along with the enlarged spleen that ruptured – everything points to ALL."

Jim glanced at Sam, then back at the doctor, speechless.

"I know it's a lot to absorb." The doctor smiled sympathetically. "I'll be back later with the results, and in the morning, we'll begin running our other tests. Hopefully we'll know for sure what we're dealing with in the next 24 hours. In the meantime, try to get some rest. This could be a long road."

"Okay," Jim said simply, not knowing what else to say. It was all so overwhelming.

Dr. Collins nodded, understanding Jim's loss for words, and left the room, allowing the door to close quietly behind him.

As the minutes clicked by, as the silence began to impose its own brand of solitude, Jim stood beside Sam's bed, lost in his thoughts. He gazed down at John's youngest son, mentally reviewing all the information he had just received and slowly shook his head. Hope was sometimes so delicate, and it was amazing how quickly panic and despair could set in; it was more amazing still how quickly both could lead to grief.

Jim eased down into the chair beside the bed as he closed his eyes and bowed his head, sighing. Remembrance, like a candle, burned brightest at night – and he remembered this feeling, had felt it and shared it with friends and parishioners throughout the years: a devastating combination of concern and anger, hopelessness and sorrow, denial and regret.

Jim lifted his head and continued to stare at Sam.

He doesn't deserve this.

Jim felt tears sting his eyes then slip silently down his cheeks as he realized the irony. People tended to live under the impression that they always got what they deserved – and life didn't work like that. Experience was often a cruel but accurate teacher, and every hunter had learned the lesson well. Life had a well-founded urgency. Time slipped; days passed; years faded; and life ended. Time was all you had – and then one day you realized you had less than you thought.

Jim drew a shuddering breath and shook himself, suddenly standing.

I'm not going to do this, he thought as he wiped his eyes and straightened his shoulders, seeming to draw on determination he knew he would need.

"Don't worry, Sam." Jim approached the bed once more, stroking Sam's fever-damp hair. "I'm going to be strong for you," he whispered and then suddenly thought of Dean...and of John and Bobby. Jim smiled and continued to card his fingers through Sam's hair. "We are going to be strong for you."

A little over two hours had passed by the time he arrived.

"How is he?"

The uncharacteristically soft words drifted into the stillness of the room, startling Jim as he rose stiffly from the chair, his body fatigued from sitting in one position for so long.

The Pastor approached Bobby as he stood by the door but said nothing as he looked at his fellow hunter and then back to their friend's youngest son, motionless in the bed.

Although he knew that silence was an easy text to misread, Bobby couldn't help the unease that rose in his chest as he followed Jim's gaze to Sam.

I just saw him...and he was fine, he thought as he took in the IV lines, the wires, the monitors.

It had been the same thing he had said when Jim had called earlier that evening. He had answered his cell phone on the second ring, seeing the Pastor's name on the caller display.

"Make it quick, I'm busy," he had said gruffly, phone pressed to his ear by his shoulder and held in place by his chin as he hoisted an ammo crate into his truck bed.

"I need you to find John."

"Why? What's shit-for-brains done now?" Bobby had asked distractedly, pushing the crate back and slamming the tailgate. The answering silence had made him pause. "Jim?" he had prompted.

"Sam's sick," Jim had said, his voice tight. "He's in the Intensive Care Unit here at United."

"He's what?"

"Dean's on his way," Jim had continued as though Bobby hadn't spoken. "But we don't know where John is...and he needs to be here."

Bobby had felt his stomach drop at the implication of those words, at the determined desperation in that tone: this was serious – life or death serious.

"But I just saw Sam last night," Bobby had responded. "I just saw him, and he was fine."

He was fine, Bobby's mind repeated as his thoughts faded and his attention again rested on Sam, who was clearly not fine anymore. He swallowed with difficulty; a knot of emotion suddenly lodged in his throat.

"I didn't expect you to come by," Jim commented.

Bobby shrugged. "Just wanted," – needed – "to check on things..." – on him.

Jim nodded, understanding without further explanation. John's sons didn't just belong to John. The boys were their boys, too.

"So...how is he?" Bobby asked again, aware that his question had been dodged earlier, and was horrified to see tears spring to the Pastor's eyes.

Jim took a shuddering breath, determined to keep control.

"Jim – "

"They think he has leukemia," Jim blurted, the words spilling out in a rush as though saying them faster, as though sharing them, would ease the pain they caused.

"They..." Bobby began and then stopped abruptly as his voice wavered. "Ah, shit." He breathed deeply. "Are they sure?"

Jim shook his head. "Not yet," he responded, looking back at Sam. "We should know more later tonight."

Bobby once again followed Jim's gaze to Sam and then looked away. It was too much; he had seen a lot of messed up shit, but he couldn't bear to see the kid like that. It was strange and disconcerting for Sam not to be bouncing around, full of energy and questions and explanations that no one understood. He was so pale, so still. He looked like he was...

But he's not, you damned idjit, he chastised himself, closing his eyes briefly. Jesus. Pull it together, Singer.

He sighed. "Have you heard from Dean?"

Jim nodded. "He's been calling about every ten minutes."

"What's his 20?"

"He's about half an hour away."

There was silence.

"Does he know?"

More silence.

Jim slowly shook his head.

Bobby nodded, understanding Jim's decision to not relay such news over the phone and not envying the Pastor's task of telling Dean once he arrived.

"So..." he sighed. "Tell me about J.W."

Jim surprised himself with a smile and a chuckle. John hated it when Bobby called him that. "He was in Ida Grove until Thursday morning, when Dean said he left the motel, heading north. No one has heard from him since, and he's apparently not in the mood to return messages."

Bobby snorted but said nothing, absorbing the information as his skill and instinct began to map out a plan. He crossed to the bed, staring down at John's youngest as he slept, before grasping the kid's unnervingly cold hand and gently tousling his hair.

"If your daddy is still in one piece when I find him, I'm gonna kick his ass."

"And I might help," Jim added, also crossing to Sam's bedside and smiling when Bobby arched an eyebrow.

"I'd like to see that." Bobby chuckled. "Wouldn't you, Sam?"

"Better get moving then, before the offer expires," Jim advised, thankful for the momentary lightness.

A smile lingered on Bobby's lips as he nodded, squeezing Sam's hand and patting Jim's shoulder before turning towards the door.

TBC