So, I surprised even myself with getting this ready to post by today. It's short but sets up the next few chapters.

Happy Thanksgiving to all who celebrate it! Next post on Monday...for real, this time!

Sam woke a few hours later, shivering and plagued by multiple aches. Intense, fiery slivers of pain lanced under his ribs and dug deep into his stomach every few seconds, causing him to hold his breath as he waited for the next torturous stab.

With effort, Sam slowly turned his head to the side to look at his brother, asleep in the chair. He was opening his mouth to call Dean's name when another chill struck him, and he shivered as sweat trickled into his eyes, an absurdity considering he was freezing. Suddenly, pain flared in his stomach, and Sam gasped sharply. Dragging in an uneven breath, he squeezed his eyes shut and pressed his cheek deeper into the pillow, waiting for the pain to subside.

"Sam?"

Sam recognized Dean's voice as his brother touched his shoulder, and the contact – light as it was – sent hot pain spiraling down his arm. He moaned aloud, trying to pull away.

Dean snatched his hand away from his brother as panic seized his heart. "Sam, what's wrong?"

Sam thought about making his tongue move, but the effort of speech abandoned him. There was only sharp pain, hot and low in his stomach, coupled with the icy chill of rising fever. He coughed, tasting the bitter tang of copper in his mouth, and then wiped his lips.

Blood, Sam's mind screamed at the recognition of the taste and the stain on his hand.

"Holy shit."

Sam felt his heart drop at his brother's hissed curse, terrified of the fear he heard in Dean's voice.

"D'n..."

Sam gasped the word, the residual taint of blood still clinging to his tongue. Fear knifed through him as intense and crippling as the pain itself. He heard a click and then felt the mattress sink beside him and knew that Dean had lowered the bedrail and was now sitting on the bed with him, facing him.

The coughing came again, harder this time so that Sam attempted to rise on one elbow.

"Easy, Sammy," Dean murmured, lifting his brother and holding him upright as he pressed the blanket to Sam's mouth to collect the copious amounts of bright red blood.

When the spasm passed, Sam folded against his brother, slumping into Dean's chest. He couldn't stop shaking, his body spent and used from the excruciating hacking, his throat blistered and raw.

"I'm gonna get the nurse," Dean said, attempting to rise.

"No."

Sam gripped his brother's shirt. Even in the darkness of the dimly lit room he could see his hand was bloodstained, could still taste the appallingly metallic coating on his tongue. Sam knew he was breathing too fast and too shallow and tried to catch his breath.

"Don't." He swallowed painfully. "Please...don't...leave me."

"I've gotcha, Sam. It's alright; just take it easy, kiddo," Dean urged, a sense of dread growing as he recognized Sam's breathing pattern. "C'mon, Sam...you're gonna hyperventilate if you don't calm down."

Sam nodded but couldn't catch his breath. The tightness in his lungs made his chest feel like it was going to explode. Each breath came faster than the last, spurred by swiftly migrating pain and the icy clutch of fear.

Sam dug his fingers into Dean's shirt; saw his blood smeared on the fabric; felt sweat track down the side of his face. Each labored breath became critical, one painful inhalation after the next, his throat so raw he thought he would scream from the shredding pain.

Instead he hung his head and pressed harder into Dean's chest, desperate for strength – and yet, as his breath teased him with evasion, he was scared. His heart was drumming a dirge, and his mind instinctively responded with denial: Not me. Not now.

"I...c-can't...c-can't...can't breathe," Sam gasped, vaguely aware of the increasing tempo of the surrounding monitors.

"Hey. Less freaking, more breathing, huh?" Dean cupped his brother's chin and drew his head up. "Sam, listen to me. Slow breaths...one at a time...in and out." His hand dropped to Sam's chest, trying to slow his little brother's breathing, to adjust the mercurial flow of precious oxygen by the weight of his hand. "In and out...in and out...in – "

" – and...out," Sam wheezed.

Dean smiled softly, squeezing the back of his brother's neck. Exactly.

Several moments passed before Sam felt a lessening of pressure. Air flowed into his lungs, longer this time, expanding without as much pain. His pulse thrummed in his throat, his heart pounding. His bloodstained fingers were still hooked into Dean's shirt, bunched in a vise-like grip.

"That's it, Sammy," Dean soothed, keeping his voice calm and encouraging. "You're doing good, kiddo." He wiped his hand across his brother's forehead, mopping cold sweat. "Keep concentrating...in and out..."

Sam nodded, and slowly, his breathing returned to normal; exhausted, he leaned heavily against Dean.

Dean closed his eyes.

Fuck.

"What happened?"

Dean jerked his attention to Karen standing in the doorway. Her cheeks were flushed and she was slightly out of breath, as though she had rushed to his brother's room.

"Hell if I know," Dean said bluntly, the last few minutes a blur. "One minute he's sleeping...and the next he's coughing up blood."

An expression of alarm crossed Karen's face as her gaze dropped from the bloodstained blanket to the pink-tinged catheter drainage bag. "And voiding it." She turned abruptly. "Page Dr. Collins," she called down the hall as she left the room in a sprint.

His heart slamming in his chest, Dean rubbed his brother's neck with gentle, firm strokes that conveyed what words couldn't. "Sammy?"

The coughing fit, combined with nearly hyperventilating had sapped Sam's limited reserves. He felt drained, too weak to open his eyes. Only half awake, he was vaguely aware of Dean's fingers massaging the back of his neck. Knots of tension melted from his shoulders as he nestled closer to his brother's warm, solid chest. Dean was here, and that was all that ever mattered to Sam.

"I'm glad...you're here," Sam whispered, as he allowed sleep to claim him.

Dean smiled tenderly, continuing to hold his little brother as tears stung his eyes. He felt his heart constrict and his jaw tighten against the emotion that suddenly surged through him.

Only Sam could do this. Only Sam could say something – something so simple – that struck to the core of his heart and brought forth emotions even he was unaware of housing.

What was it about Sam that affected him so deeply? His little brother could make him so pissed, could be such a colossal pain in the ass – and yet he could also draw up the very emotions that Dean tried so hard to keep hidden.

Dean reached out and took Sam's hand, noticing that it was still smaller than his own and feeling fiercely protective.

Karen reappeared in the doorway, followed by two orderlies clad in blue scrubs.

"Dr. Collins is on his way," she reported as they approached the bed. "We need to find the source of the bleeding; just because he's coughing up blood doesn't mean the source is confined to the respiratory tract. Blood coming from elsewhere, like his stomach, can mimic coughing up blood, so it's important for us to determine the site of the bleeding."

"Maybe it's just his throat," Dean suggested desperately. "He had bleeding after the tonsillectomy when he threw up too many times. Maybe he just coughed too much and too hard."

"That's a possibility, but not likely. We're concerned he's now bleeding into his stomach and coughing it up." Karen paused, staring down at the bag of red-hued urine. "He's also not producing enough urine, and as for the blood from the Foley..." Her voiced trailed off, clearly disturbed by the implications.

Dean fought against the rising panic and held Sam closer. "Tell me."

Karen hesitated.

"Tell. Me."

Karen sighed. "Sam's showing signs of acute renal failure as well as acute respiratory distress syndrome. Dr. Collins gave verbal orders for a chest x-ray and a CT scan, so we're going to prep him to go downstairs." She was silent for a moment before gently adding, "While we're doing that, you might want to start gathering any family or friends..."

Her voice trailed off again, and it was just as well; Dean knew the implications and didn't need to be told what he could already feel – Sam was slipping away.

TBC