Jim had a sense of déjà vu as he entered the Intensive Care Unit, shoes softly squeaking on the waxed floor, plastic bag crinkling in his grip. The corridor was quiet and dimly lit, much like his upstairs hall had been Tuesday evening when he had checked on the boys before he had gone to bed.
Had it really only been four days since he had laughed at Dean's outrage over some Wheel of Fortune contestant not knowing the name of his favorite Zeppelin song? More amazing than that, had it really only been six hours since Sam had been admitted?
It felt like a lifetime.
In the buzz of medical terminology and the hum of monitoring equipment, in the midst of hard questions and even harder answers, their world had been reduced to one small room and one scrawny kid; time hadn't mattered as it passed by. And now, in another ten minutes, it would be a new day, and Jim was afraid of what it would bring.
Jim sighed as he stopped at the edge of Sam's door and peered through the thin window, feeling tears prick his eyes at the sight of Dean lying on the bed next to Sam, eyes closed and doing what he did best: taking care of his little brother.
"They've been that way for the past half hour," Karen reported, startling Jim as she joined him at the door's window. "I've passed by here at least a dozen times with the intention of telling Dean he's not allowed to sit on Sam's bed, but I – "
"Considered the benefits of self-preservation and changed your mind?"
Karen laughed lightly. "Something like that," she replied, knowing the Pastor wasn't joking; Dean was formidable when it came to his brother. "I just couldn't bring myself to do it. Sam seems soothed and peaceful, and Dean just seems – I don't know..."
"Content," Jim supplied, still looking through the window.
Karen nodded. "Yeah. I guess that's a good description, but it seems a little strange given the situation."
"I suppose," Jim agreed. "But if Sam's fine, Dean's fine. That's how it's always worked."
"But Sam's not fine," Karen gently reminded. "Not at all."
"The boys have learned to live in the moment." Jim smiled sadly, staring through the window. "So right now – in this minute – they're together, and they're fine, and that's enough to make it to the next minute and the next and the next..."
Karen's eyes glistened with moisture. She had never heard something so beautifully sweet. "Sorry," she said, waving her hand to ward off further tears as Jim glanced at her. "Patients don't usually affect me like this."
Jim nodded knowingly. The Sam-and-Dean combo had been wreaking havoc on his emotions for years.
Karen sniffled and glanced at the Pastor. "Did Dean tell you?"
Jim returned the glance. "About Sam coughing up blood? Yeah..."
"And the seizure?"
Jim blinked. "What?"
Karen nodded. "He had a grand mal almost immediately following the hemoptysis. Well..." She reconsidered her word choice. "I guess I can't call it that, since we're not sure that the blood was coming from his respiratory tract. We were going to do a chest x-ray, but the seizure changed our plans. So instead, we adjusted his meds and put him on an oxygen mask to hopefully increase his O2 sats. Our main concern has been trying to keep him stable until Dr. Collins arrived."
"Where is he?" Jim demanded, patience having thinned at "seizure" and completely vanished at "grand mal".
"He's here," Karen assured. "He just arrived. In fact, I was coming to tell Dean that Dr. Collins is on his way up."
"I'll tell him," Jim replied, his tone signaling the end of their conversation as he pushed through the door, immediately attracting Dean's attention.
Dean's eyes were instantly open and glaring, his expression a nonverbal warning to fuck off, while his arms tightened around his little brother.
"It's just me," Jim soothed, approaching Sam's bed and pulling Dean's shirt from the plastic bag he held as if it was a peace offering.
Dean nodded, glancing down at Sam before carefully extracting the amulet from the kid's grasp – large fingers gently sliding under smaller fingers, loosening one-by-one – and then easing out from under his little brother's weight. He paused, watching Sam as he shifted, and when his brother settled, Dean stood to his full height, lacing his hands together, stretching his arms over his head.
As the fabric of Dean's shirt shifted across his chest, Jim's eyes were drawn to the rust-colored stains streaked and then clustered as though someone had reached and then clung.
Jim swallowed against his dry throat, knowing it wasn't just someone's blood; it was Sam's.
And there was a lot of it.
Dean lowered his arms, closing his eyes as he leaned his neck to the left and then to the right. "He's okay right now," he assured as he stretched stiff muscles, feeling them burn as tension briefly released its grip but also feeling Jim's gaze, knowing the Pastor's thoughts.
There was silence.
Dean opened his eyes. "Jim?"
Belatedly, Jim nodded, cleared his throat, but said nothing. He had spent the majority of his life offering words of hope and comfort and yet now...he was speechless.
After a few moments, Dean returned the nod, seeming to understand. He sighed.
"Everything okay in the hall?" he asked as he accepted his clean shirt from Jim.
Jim was startled by the question and then smiled at himself. He should have known that just because Dean had appeared to be asleep moments before, just because the lights were dim and the door had been closed, was no reason why this hunter – or perhaps more importantly in this situation, this big brother – didn't know exactly what was going on around him.
Dean looked expectantly at Jim before pulling the bloodstained shirt over his head and replacing it with the one the Pastor had brought; the one he had left behind in the laundry on Wednesday when he left to join John; the one he had been wearing the day Sam had his tonsils removed.
"Hard to believe that was just four days ago," Dean commented and saw Jim nod as though the Pastor followed his train of thought. He shook his head. "So, what did Karen say?"
Jim took the soiled shirt from Dean, folding it inside out before stuffing it inside the bag and dropping it in the chair by the door. "She said Dr. Collins is on his way up."
Dean nodded, standing by the bed, staring at Sam. "Good."
Jim returned the nod as he approached the bed and stood opposite Dean, then paused.
Dean glanced at him. "What?"
Jim cleared his throat. "I have more good news."
Dean narrowed his eyes, suspicious but listening.
"Your dad called."
Dean arched an eyebrow. And?
"He's on his way."
Dean snorted. 'Bout fuckin' time...
"Dean..."
Dean pierced the Pastor with a glare. "Don't."
Jim was startled by the intensity of Dean's expression. "Don't what?"
"Defend him."
"I wasn't – "
"You were," Dean snapped and then nodded, affirming what they both knew was true. "He called and gave some lame excuse or sob story and now you feel sorry for him and were going to defend him and try to smooth things over with me before he gets here, but you know what? I don't care."
Jim sighed. Sometimes he hated always having to play the role of peacemaker. "Dean, his phone was – "
"Was what?" Dean interrupted. "Destroyed? Stolen? Lost?"
"It's at the bottom of a lake...or something." Jim shrugged, indicating he didn't know the entire story, but his tone implied he believed it.
Dean snorted. "It doesn't matter, Jim." He shook his head, hands gripping the bedrail, knuckles white as he battled to keep his anger in check, to keep his voice quiet. "This whole situation is so far beyond a stupid phone."
"Meaning?" Jim asked hesitantly, though he already knew.
"Meaning Dad's an ass!" Dean yelled. "A selfish ass who is so obsessed with revenge that he only thinks about the hunt and doesn't give a flying shit about the rest of us! And you know what? We let him! He gives excuses, and we buy into them – hell, sometimes even supply them ourselves – and I'm fuckin' sick of it!"
There was silence, filled with Dean's harsh breathing and the steady cadence of the monitors.
Jim sighed. "Dean, I know you're angry – and you have every right to be in this situation – but John's only doing what he thinks is right, what he thinks is best to keep you and Sam safe. He's doing the best he can."
"I used to believe that," Dean stated with the quiet intensity of one who had lost faith. "But not anymore."
"Dean..."
Dean averted his gaze, effectively withdrawing from the conversation, glancing at the monitors before focusing back on Sam.
Jim narrowed his eyes, uncomfortable with the sudden change in John's oldest.
Dean was eerily silent, his jaw clenched, his expression unreadable.
If Dean had been a parishioner, Jim would have expounded on the virtues of forgiveness, would have warned about the downfalls of a grudge-bearing heart.
But Dean wasn't a parishioner.
At this moment, in this situation, Dean wasn't even a fellow hunter or a friend's son; he was a big brother grappling with the fact that his father had committed the ultimate unforgivable sin – jeopardizing his little brother, his Sammy.
John had put the hunt above Sam three separate times – by not accompanying the boys to the clinic...by not returning for Sam's tonsillectomy...and perhaps the worst, by calling Dean away during Sam's recovery.
The combination of those transgressions, along with John's perceived indifference concerning Sam's rapidly deteriorating health over the past several hours, had culminated in this – an impasse.
Jim sighed and opened his mouth to speak but stopped when a brief knock on the door heralded the arrival of the doctor, followed by Karen.
"Okay," Dr. Collins began, wasting no time on pleasantries. "The OR's on standby. We're prepping Sam for surgery."
Dean exchanged glances with Jim, their conversation momentarily forgotten, the anger instantly disappearing as he felt a rise of hope – at least they were finally doing something – then a spike of panic. "Is he stable enough for surgery?"
"At this point, it doesn't matter," Dr. Collins replied bluntly. "It's likely Sam will never be stable enough for surgery, and we can't keep waiting. His spleen is showing no signs of clotting itself, and Sam's organs are beginning to shut down." He paused. "I'm sorry..."
Dean felt his heart slam in his chest, not knowing much about the procedure Sam was about to endure but knowing a doctor's apology before surgery wasn't a good sign.
Dean glanced again at Jim and then sighed loudly, turning back to Sam just as the monitors started to blare their warning, just as his little brother made a strangled sound and then went rigid.
Dean felt the color drain from his face in realization, instinctively grabbing his brother's flailing arms. "Oh God...not again. Not again, Sam! No!"
"What's happening?" Jim asked anxiously.
"He's seizing!" Dr. Collins yelled, rushing to his patient, as the room immediately erupted in frantic chaos.
Dean and Jim were unceremoniously pushed back from the bed as two more nurses rushed into the room.
"Sats are 80 and dropping," Karen reported, eyes scanning the monitors for other information.
"He's hypoxic..." Dr. Collins said to himself.
"ARDS?" Karen asked.
"Most likely," Dr. Collins agreed and then directed his attention to the other two nurses. "Nicole, get me an intubation tray now, and Claudette, push 4mg of Ativan into this kid. We've got to get this seizure under control." He glanced across the bed. "Karen, page respiratory and tell them to meet us downstairs, then call the OR and tell them we're coming as soon as this tube is placed."
Karen nodded, her eyes locking with Dean's – I'm sorry – as she left the room.
Dean watched in horror as the scene played out in front of him, so focused on his brother that he didn't feel Jim standing beside him, didn't feel the Pastor's hand on his shoulder.
"Sammy, I'm here," Dean called, feeling helpless and useless and so fucking scared.
With the help of the medication administered through his IV line, Sam's seizure slowly began to abate, and Dean shared a sigh with Jim and exchanged glances.
"Where the hell is that intubation tray?" Dr. Collins barked.
"Right here," Nicole responded, tearing open the tray and passing the materials to the doctor.
Dr. Collins arched Sam's head back as he slid the metal tongue blade of the laryngoscope into his patient's mouth, preparing to intubate. The laryngoscope descended Sam's throat, then the tip of the endotracheal tube advanced down into his trachea.
"I'm in," Dr. Collins reported as Nicole taped the tube to the corner of Sam's mouth and Claudette attached the ventilator. He pressed his stethoscope to Sam's chest, listening intently. "Good breath sounds bilaterally. What are his sats?"
"Ninety and climbing," Nicole instantly responded.
"Good." Dr. Collins wrapped the stethoscope around his neck as the nurses unplugged the monitors, preparing for transport. "Let's move."
Dean and Jim separated, standing on either side of the door as Sam's bed was pushed over the threshold, then fell in line beside him as he was wheeled down the hall toward the elevators.
Dean grabbed Sam's hand as he kept pace and glanced at Karen as she joined them.
"OR's ready," she reported, breathless in her rush.
Dr. Collins nodded tightly and pushed the down arrow button.
Dean felt his heart climb into this throat. He knew he wouldn't be allowed to board the elevator, wouldn't be allowed in the OR.
This was it.
Dean leaned down, pressing his forehead to Sam's temple. "Remember what we talked about, Sammy," he whispered over the whoosh of the ventilator, hoping his brother could hear him. "You keep fighting..."
The elevator arrived in a series of dings and sliding doors.
Dean squeezed Sam's hand for good measure and felt his brother's fingers twitch against his palm before he was wheeled away.
Despite the seriousness of the situation, Dean smiled, taking that slight movement for the answer he knew it was – Sam had heard him; he remembered; and he would fight because his big brother had asked.
"That's my boy," Dean murmured as the elevator doors slid shut.
TBC...probably on Monday
ARDS = Acute Respiratory Distress Syndrome