"Well," Karen sighed, her gloved hand gently skimming the incision exposed by removed gauze and blankets folded down to her patient's slim waist. "Looks like you're right."
Dean said nothing, standing behind her, arms crossed over his chest. He hadn't called her into his brother's room to hear her tell him that he was right; he knew he was right. Their dad might be a selfish, inconsiderate asshole, but the man knew his first aid, had taught his sons well. And Dean knew the signs of infection when he saw them.
"When did you notice this?" Karen asked, glancing at him.
"Just now."
Karen nodded, briefly wondering what made Dean check his brother's incision since she had done so herself less than an hour ago and had noted no problems. And then she remembered, smiling to herself at the sudden clarity of the answer – she was dealing with one of the most protective, vigilant older brothers she had ever encountered...and that was why Dean had checked. Keeping an eye on Sam was just what he did.
Karen's smile lingered as she wondered if these boys knew how special they were, how priceless their relationship was...and then she blinked, noticing Dean's scowl of impatience.
"He's definitely got a nice little infection going on here," she commented as she refocused and continued her examination. "The redness, the warmth of the incision, the swelling and slight hardening from the inflamed tissue underneath..." Karen shook her head, checking the drain tube. "No drainage, though."
And wasn't that strange? There had been excessive drainage an hour ago when she had checked, recorded, and changed the dressing...and now there was nothing?
"Because the damn thing's probably clogged," Dean snapped and knew Karen's sigh confirmed it.
"You're right," she said anyway and sighed again.
"Shit," Dean hissed.
"At least he's already on antibiotics," Karen reminded. "But since the tube is occluded and no longer beneficial, I'll remove it and then call Dr. Collins to see how he wants to proceed."
"It never should've been placed," Dean ranted. "I told him it was a bad idea, that something like this could happen."
"That's always a possibility," Karen agreed, turning to face him. "But it was necessary to drain fluid which may have accumulated and in itself become a focus of infection."
"Or get clogged and allow infection to accumulate anyway."
Karen paused, realizing she wasn't going to win this battle. "I know you're upset, and I know it's the last thing Sam needs right now, but at least we know this infection has only been building over the past hour. We've caught it early."
"Super."
"Dean – "
"Enough talking," Dean stated flatly. "Are you gonna remove it, or am I?"
Karen smiled and almost laughed until she realized he wasn't joking. If given the opportunity, Dean would remove the drain tube himself. She was probably lucky he hadn't already done so and just told her about it later.
Dean stared at her.
"Um...I will."
"Then do it before he wakes up."
"We have time," Karen assured. "His sedation has been decreased, but we still have at least an hour or so before he starts to stir."
"We have about 20 minutes," Dean corrected, having moved to stand beside Sam's bed.
Dean's eyes instinctively scanned his little brother, noticing the way the kid's fingers minutely twitched and how the muscles around his eyes tensed, which was about as close as they were going to get to a waking-up-Sammy face scrunch since the breathing tube was still in place.
Karen narrowed her eyes, glancing from Dean to Sam and back to Dean.
"Twenty minutes..." Dean repeated and then paused as Sam's leg moved. "Maybe less."
Karen continued to stare at him. Experience told her that timeframe was incorrect, but then again...no one knew Sam like Dean.
Dean nodded, seeming to read her thoughts. "Trust me."
Karen laughed lightly, amusement overriding her annoyance at being bossed around by her patient's big brother.
"Fine," she conceded, fingers grasping the cuffs of the gloves at her wrists and pulling, folding them inside each other and dropping them in the trashcan before washing her hands. "I'll go gather a few supplies and be right back," she said, drying her hands and exiting the room.
Dean nodded again, staring down at his little brother. "Nothing's ever simple with you, is it kiddo?" he asked softly, slipping his hand under Sam's bangs, feeling a drastically warmer forehead than he had felt two hours ago downstairs in recovery. "Ah, Sammy..."
"What?" Karen asked, reentering the room with a canary yellow basin filled with towels, a washcloth, gauze, tape, swabs, and a smaller tray along with Sam's chart tucked under her arm.
"His fever's up," Dean reported, turning to the sink to wash his hands and watching as she placed the items on the bedside table and then came to stand beside him, filling the basin with water.
"I'm not surprised," Karen commented, carefully setting the basin on the table, feeling the warmth of the water through its plastic sides. "It's time for me to check and record his vitals again, so as soon as I'm finished with this, I'll do that."
"I'll do this," Dean corrected, drying his hands and snagging the washcloth and towel from her grasp. "You do that."
"Do what?"
"His vitals."
"You sure?" Karen asked, more out of habit than necessity.
Dean didn't respond, already spreading the towel across Sam's lap.
Karen sighed, having her answer. She pulled two gloves from the box on the wall.
"Want some?" she asked, wiggling her fingers into their respective slots, stretching and adjusting the blue nitrile over her hands. "I know Sam's your brother, but universal precautions and all that..."
Dean snorted.
Karen stared at him unwaveringly.
"Dude...seriously?"
Karen held out a pair of the blue gloves. "Seriously."
Dean continued to stare at her.
Karen rolled her eyes. "Fine. If not for your safety, then do it for Sam's. We need to keep everything as sterile as possible."
After a few seconds, Dean sighed and took the gloves, even though he hated the damn things. They never fit his hands correctly and made him feel like he was all thumbs, but – and Karen probably knew this, the manipulative bitch – he would do anything for Sam.
"Happy?" Dean asked sarcastically, wanting to feel irritated but not quite managing. He couldn't fault anyone who put Sam above all else.
"Ecstatic," Karen replied, her tone blunt but her eyes shining.
Dean gave a hint of a smile, appreciating the moment of banter with a cute nurse, but then turned to Sam.
Break was over. He was back on duty.
Karen smiled, noticing the subtle change in Dean's demeanor but then felt it slip from her face when she noticed him preparing to remove the tube.
"Whoa!" Karen's hand immediately grasped Dean's wrist, and then she laughed nervously, not sure who was startled more by the action. "Sorry," she apologized, glancing up at Dean and releasing her grip at his pointed stare. "But let me at least do that part."
Dean arched an eyebrow. "Why?"
"Because administration would freak if they found out I let a patient's family member remove a drain tube." She shook her head, almost shuddering at the thought of how much shit would hit the fan if that happened.
Dean seemed amused at her reaction but didn't back away from his brother's side, forcing her to contort her body and lean in front of him at an awkward angle.
Karen sighed, setting the small tray in Sam's lap and wondering if Dean knew that his protective nature was becoming a pain in her ass.
"Don't hurt him," Dean warned as her maneuvering of the tube caused Sam to shift on the bed.
"I'll try not to," Karen promised, a little surprised that Sam was close enough to consciousness to feel her handling the drain. Maybe Dean was right when he said his little brother was close to waking. "There we go..." she said, slowly sliding the tube out, and then wrinkling her nose at the smell that came with it. "Well, that's not good," she commented as she placed the bloody milky-white tube on the tray.
"No shit," Dean stated bluntly, pushing her aside in order to inspect the incision himself, alarmed but not surprised at the thick, blood-tinged, yellowish-white pus that oozed from between the stitches. "Sonuvabitch."
"I've paged Dr. Collins," Karen assured, knowing it wasn't much but feeling the need to say something. She removed the tray and quickly swabbed the incision, bagging the sample to send off to the lab before removing her gloves.
Dean said nothing, dipping the washcloth into the basin's water, twisting it tight to wring out the excess, then even tighter to relieve some of his stress.
Karen sighed in the silence that settled between them and grabbed Sam's chart from the table, crossing to the other side of the bed as she flipped through the pages and began writing down information from the monitors.
Dean's brow creased with the intensity of his focus as he gently cleaned Sam's incision; dabbing gauze to collect the drainage; then wiping away the dried blood, the crusted pus, and the sticky yellow surgical disinfectant. His touch was light as his fingers skimmed the bluish-purple skin puckered by the dark stitches. His gaze tracked the red streaks of infection that webbed outward as his palm hovered over the incision, feeling the warmth.
Dean sighed harshly, worried and pissed that Sam had to endure yet another setback.
Karen glanced at him, feeling his frustration and thinking they both could use a distraction. "Where's your uncle?"
"Who?"
"Your uncle...the Pastor."
"Oh." Dean nodded to himself. Of course she was referring to Jim. "He went downstairs to get coffee."
Although Dean would bet money he also stopped by the hospital's chapel. It didn't take this long to get coffee.
"I see."
There was more silence, punctuated by the cadence of the monitors.
"And your dad?"
Dean dropped the washcloth into the basin and narrowed his eyes. "What about him?"
Karen flinched at his sharp tone, wondering if she should abandon this topic. But she had already started it, so...
"It's been about two hours since Sam was in recovery, since the phone call, so should he be close by now?"
Dean said nothing as he placed a large square of fresh gauze over Sam's incision.
"He should be here soon, right?" Karen rephrased, squatting down to check the amount of urine gathered from the Foley.
Dean remained quiet, securing the gauze with tape and glancing up as Sam shifted under his touch. "Sammy?" he whispered, snatching off his gloves and tossing them on the bedside table.
Dean felt a hint of a smile when his brother's hand brushed against his as the kid's arm moved restlessly by his side, a delayed attempt to push Dean's hand away from the incision, undoubtedly trying to stop the pain.
Dean's smile widened as he pulled the blankets higher and smoothed them over Sam's bare chest. He then gently restrained Sam's weakly flailing arm and laced his fingers with his brother's smaller ones, feeling an answering pressure as Sam squeezed his hand, responding to the familiar calming touch.
Dean felt ridiculously excited. He didn't want to rush Sam, but he was eager to see those hazel eyes.
"Dean?" Karen prompted, still crouched by the bed, squinting at the catheter drainage bag, trying to get an accurate reading. "I know it's not really any of my business, and I don't mean to pry but – "
"Shut up, Karen," Dean interrupted, his tone neutral yet demanding.
Karen blinked at the unexpected response. "I'm...um..." She paused and then stood. "I'm sorry. I just thought – "
Dean held up his hand to silence her, then glared for emphasis, and it was then that she realized why he wanted her to stop rambling.
Sam's eyes were open.
Not that he was looking at her.
Sam blinked drowsily at Dean, the corner of his mouth twitching as though he wanted to smile at the sight of his big brother...but he couldn't because of the tube that filled his mouth and was shoved down his throat. His eyes widened at the sudden realization as his other hand – the one not intertwined with Dean's – immediately reached toward his face.
"Whoa, dude." Dean instantly grasped his little brother's right hand, placing it back on the mattress, and then lowered his face closer to Sam's. "Look at me, Sam."
Sam's eyes slowly refocused on his brother after being almost crossed from staring at the tube protruding from his mouth. He made a strangled sound – maybe that's what Dean's name sounded like when it was choked out around a tube – as tears suddenly welled in his eyes.
"I know," Dean soothed. "Just calm down."
Sam blinked at him.
"Sam..."
Sam's only response was to once again reach for the breathing tube with his right hand.
And Dean once again intercepted.
"Don't touch," he said, feeling as though he was reprimanding a toddler Sammy.
Sam made another strangled sound, but this time it sounded more pissed than upset, and Dean sighed, suddenly realizing this wasn't going to be as easy as the first time, two hours ago down in recovery.
"They're gonna take it out soon," Dean promised. "But right now you need to leave it alone, okay?"
Sam seemed to consider that option – leaving it alone – and then shook his head violently, legs moving beneath the sheets, right hand squirming in Dean's grasp.
Dean tightened his hold, hating this. "Sam. Stop."
Sam didn't seem to like that idea either, continuing to fight Dean's grip.
Karen watched the struggle, knowing Dean wouldn't want her to physically intervene but feeling as though she should do something. "Do you want me to – "
"No," Dean responded, not even making eye contact with her and further confirming what she already knew – this was between him and his little brother.
In the next instant, Sam's hand broke free from Dean's grasp, and he grabbed the tube going down his throat.
"Damnit, Sam!" Dean yelled, lunging across his brother's chest to recapture the kid's right hand and realizing too late that in doing so, he had collided with Sam's incision on his left side, was leaning up against it.
Sam made a different sound – something between a scream and a sob – as his eyes squeezed shut.
Dean felt his little brother shudder at the intensity of pain that ran through him and then the kid went limp, all resistance instantly gone.
Dean closed his eyes briefly, feeling his heart drop as time stood still.
Fuck.
Dean sighed, opening his eyes as he lowered Sam's hand from the tube, resting it on the mattress and then releasing it. He slowly straightened to his full height and sighed again. He could hear the monitors' increased tempo; could see Karen in his peripheral; could sense her speechless gaze as he focused on Sam.
Dean lightly squeezed his brother's left hand, the hand he was still holding.
Sam didn't squeeze back.
Dean swallowed, simultaneously wanting to cry and scream. "Sammy?"
Sam's eyes were still closed, but at the sound of his name, tears slipped through his lashes, silently sliding down flushed cheeks.
Dean felt something twist inside his chest. "Hey. It's okay," he soothed, fingertips gently brushing his little brother's cheeks, then his forehead. "I'm sorry, Sammy. You know I would never hurt you."
For several seconds, Sam didn't respond; then he nodded weakly, his eyes still closed, pain still pinching his features.
Karen moved closer to check one of the monitors, drawing Dean's attention, and he sighed as she did when he noticed Sam's heart rate was returning to normal.
"He's okay," she assured quietly. "Just a wave of shock from the pain, but he's leveling out."
Dean nodded as his thumb rubbed the frown between his brother's eyes, waiting for the kid to look at him, feeling inexplicably desperate and helpless. Dean knew it was ridiculous, but Sam's continued denial of eye contact made him feel rejected by his little brother – and that was one of the few things Dean couldn't bear.
Dean swallowed and then sighed. "Sammy..."
Sam made a sound – so soft it was barely audible – but Dean heard it and knew the meaning behind it, took it as the reassurance it was intended to be. Sam wasn't shutting him out; he was just pulling himself together.
Dean nodded – relieved more than he would admit – and continued to wait, providing comfort and love as his thumb still gently swept across Sam's forehead, as his hand still firmly clasped his brother's small hand.
A few seconds later, he was rewarded when Sam opened his eyes, still glistening with unshed tears, and weakly squeezed Dean's hand, complete absolution given with the twitch of small fingers.
Dean smiled, wondering if his little brother knew just how much he loved him.
"You gonna be still now?" Dean teased.
Sam glared weakly, jarring loose a few remaining tears.
Dean laughed, lightly thumbing away the moisture. "You okay now?"
Sam nodded, looking exhausted as he blinked up at Dean.
Karen cleared her throat, not wanting to interrupt – secretly cherishing this tender moment between the two brothers – but needing to know. "How's his incision?"
Dean glanced at Karen as she came to stand behind him and then once again folded down the blankets to Sam's waist, exposing the dressing covering his brother's left side. Dean sighed, not surprised by the red stain that had blossomed there or by the fresh wave of guilt that swept over him. He peeled back the layers of gauze to reveal one busted stitch at the corner of the incision allowing more blood to flow with the steadily oozing pus.
"Shit," Dean hissed, shaking his head. "I'm sorry, Sam."
Sam squeezed his hand in response. It's okay.
Karen seemed to agree. "It could be worse," she said, grabbing a fresh pair of gloves and then passing clean gauze to Dean. "At least it's already starting to clot. Good thing he had the FFP and transfusions..."
Dean nodded as he dabbed away the last remnants of blood, feeling Sam flinch and then hearing him grunt. "Almost done, Sammy," he soothed, inspecting the incision more closely.
"Even though one of the stitches busted, I think it'll be fine for now," Karen stated. "At least until Dr. Collins gets here..."
Dean nodded in agreement, covering the incision with several layers of fresh gauze. "What do you think he'll do to treat this?"
"To treat the infection?" Karen shrugged. "Hard to say. He might just want to monitor for the next few hours and increase Sam's dosage of antibiotics or change antibiotics altogether or put Sam on a combination of antibiotics. Or he might want to reopen the incision and clean it out. Or..." She shrugged again. "I don't know. Guess we'll see."
There was silence as Dean pulled the blankets over Sam, noticing his little brother's eyes were closed but knowing the kid wasn't asleep...at least not yet.
"Hey, Sam..."
Both brothers looked at Karen as she moved to stand at the foot of the bed. She flinched at Dean's unexpected scowl of disapproval – probably for disturbing his brother's rest – but she continued anyway.
"Now that you're awake, how 'bout we start weaning you off the vent?"
Sam stared at her as though she was speaking a foreign language.
Karen narrowed her eyes. Was he okay?
"Sam?"
Sam blinked at her.
Karen shifted. "Um..."
"It's okay," Dean assured, smiling softly at his brother, recognizing the signs. "He gets this way when he's tired." He winked at Sam. "Don't 'cha, Sammy?"
Sam looked at him, his eyes dipping closed as his hand slackened in Dean's grasp.
"Well, he certainly has the right to be tired," Karen conceded, feeling a little more at ease after that explanation.
"Yeah, he does," Dean agreed, staring at his brother, affection in his tone.
"Maybe we should wait until later..."
"And have a repeat of what just happened?" Dean shook his head. "Hell no."
Karen laughed lightly. "Good point, but..."
Dean shook his head again as he gently nudged Sam's arm. "Hey."
Sam opened his eyes.
Dean smiled. "Getting you off this vent sounds pretty good, huh?"
Sam made a sound – how an enthusiastic "yes" comes out when choked through a hallow tube – and squeezed Dean's hand for emphasis.
"Awesome. But you need to stay awake, okay?" He gently rubbed his brother's chest, trying to help rouse him. "After we get you off this thing, then you can sleep. Deal?"
Sam squeezed his hand again and made a visible effort to open his eyes wider.
"That's my boy," Dean praised softly, ruffling Sam's hair.
Karen felt her heart swell as she watched the brothers interact, thinking it was probably unhealthy how attached she had become to these two in such a short time.
"Alright," Dean said, looking at her. "Let's do this."
TBC
I'm amazed at how this story just keeps growing, one thing truly leading to another. This chapter was almost 30 pages long, so I decided to cut it in half. Anyway…expect John's arrival and Sam's weaning to be in the next chapter, along with more drama and yet another complication.