Johnny Angel Ch. 14

Disclaimer: See chapter one

Previously: "Don't worry Brian, you can count on me and Bobby to give Sammy all the support he needs," Dean declared vehemently. He'd always been there for his brother, and that wasn't about to change now. Come hell or high water, they were getting their Sammy back.

Brian was pleasantly surprised to find out that Dean had meant every word he had said upon returning to his patient's room the next morning. He had no sooner arrived to transport Sam down to the therapy room when he found both Dean and Bobby raring to go, both men eager to learn all they could to help with Sam's PT.

"So, is there anything important we need to know about the Range of Motion exercises before the PT starts?" Dean questioned Brian as he and Bobby helped push Sam's portable gurney down the sterilized hallway that smelled of strong antiseptic. They had chosen not to use a wheelchair for transportation until Sam was able to handle sitting up for a short length of time, much to the chagrin of the youngest Winchester.

"You bet. One of the first things you need to know is that the exercises need to be done slowly and gently. You never want to jerk or push any of Sam's joints pass the point of resistance, which is the point where you can't bend the joint any further, as it could cause overstretching and a great deal of pain for your brother as well as injury to the muscle. You'll know you're approaching that point if Sam starts to exhibit any signs of pain such as grimacing or hissing. Secondly, if possible, the ROM exercises need to be done as a part of Sam's daily routine once he gets used to them and done at the same time of day. For example, you can do the exercises while giving Sam a bath or while he is watching television. The exercises don't have to be done at one time and can be broken up into two or three sessions," Brian stated as the walked along at a leisurely pace.

"Whoa, hold it right there Florence Nightingale, nobody said anything about Dean or anyone else bathing me," Sam grumbled, a tinge of pink encompassing both cheeks. "I can damn well bathe my own self."

"I'm sure you will be fully capable of it at some point soon Sam. But until that time, you are going to require help and who better than your brother to give it. Believe me, I know how uncomfortable it can be to have a virtual stranger helping you with the most basic of needs." Brian retorted in a calm manner, not taking any offense at Sam's ranting.

"Brian's right Sam so you better listen to him, ya idjit," Bobby intoned with a hint of affection in his voice. He knew how strong willed the Winchesters were and would stubbornly refuse help to the point of it being detrimental to their own health. "You need the help right now whether you like it or not."

"Doesn't mean I have to like it," Sam sulked, wishing he had the strength to cross his arms in front of his chest. He felt like he had lost total control of his own life and he loathed having to be taken care of like an invalid.

"Never thought you would kid," Bobby rebutted before returning his attention back to Brian. ""Will there be some kind of sequence we'll need to follow when doing the PT with Sam?"

"Well, I guess the most basic thing you need to remember is to do the exercises in the same order to keep it simple and easy to remember. Start the exercises at Sam's head and then work down toward his toes. That way, you'll make sure that he is getting a full body workout. I know some of the exercises will seem insignificant and of no use, but I promise you, they will help Sam's mobility in the long run," the therapist answered as they arrived at the door to the therapy room where the exercises would be performed.

Waiting for the automatic door to swing open, the three men escorted the gurney and it's occupant into the room and over to the far wall where the tilt table had been awaiting use.

"Okay, first thing we need to do is to move Sam to the table gently so that his I.V. and catheter is not disturbed any more than necessary," Brian informed the two men with him. Standing near the top of the gurney, he grasped Sam under the arms while Dean grasped Sam's legs, with Bobby supporting Sam's torso .

"Okay, let's move him on the count of three. One. Two. Three." Brian counted aloud and the three men moved as one to position Sam comfortably on the tilting table.

Once Sam was in position, Brian secured him with the safety belts and then attached a blood pressure cuff to his arm so he could monitor Sam's blood pressure and pulse during the therapy session. As he activated the table, he watched Sam closely for signs of nausea and sweating as it could indicate that his patient was about to faint. As soon as the table reached a desired angle, Brian stopped the upwards tilting motion.

"Okay Sam, you ready to begin?" Brian questioned, noting the slight pallor to his patient's skin.

"Does it matter?" Sam retorted, grimacing from the vertigo that was assailing him with the slightly upright position.

"Tell ya what Champ, I'll give you a few moments to adjust to the position and once the dizziness subsides, we'll get started then," Brian informed his patient with a soft pat to the shoulder.

"How did…?"

"It happens to everybody the first time they experience the tilt table," Brian answered in explanation as he went about his work. "Don't worry, it will pass as soon as your body adjusts to the change in posture and then we can begin the PT."

"Ya hear that Sammy? It won't be long before we can get this show on the road," Dean stated happily. The sooner they got started, the quicker he would have his little brother back with him riding shotgun in the Impala…right where he belonged.

"Yeah," Sam voiced, trying to sound upbeat for his brother even though he really wanted to go back to his room and sleep the rest of the day away. He was already tired and they hadn't even begun the therapy yet.

"Okay gentlemen, it's time to get started," Brian announced as he noticed Sam's vitals had stabilized and that his pallor of his skin had improved approximately twenty minutes later. Not wanting to startle his patient s he began, Brian said, "Sam, I am going to start with some head and neck exercises to help stretch and strengthen the muscles in your neck," before placing his right hand behind Sam's head to support it and his left hand on Sam's chin. Gently lifting Sam's head from the bed, he tipped it forward towards the hunter's chest. Once he felt resistance, he stopped and allowed Sam's head to lay back and rest on the table once again. Repeating the exercise, he tried to get a little further each time until Sam was nearly able to rest his chin on his chest.

"You're doing fantastic Sam," Brian encouraged as he moved on to the head tilts. Placing a hand on each side of Sam's face, he tilted it to the right, and then to the left, making sure to explain what he was doing to Dean and Bobby so that they could do the same exercises with Sam later in his room.

Giving Sam a moment to rest after finishing the head and neck exercises, Brian then moved onto the shoulder and elbow exercises, once again explaining everything as he went. Placing one hand under Sam's elbow, he used the other to hold Sam's wrist and then began to process of moving his shoulder up and down. Turning Sam's palm in towards his body, Brian lifted Sam's arm upward and over the hunter's head until the inner arm touched Sam's ear before lowering it back down to his side. Afterwards, he did the side to side movements where he raised Sam's arm out to the side and upwards as far as possible. He immediately stopped when he noticed the wince of pain upon Sam's face and allowed the arm to rest on the gurney once again. Giving the right arm a chance to rest, he repeated the process on Sam's left arm. Once he finished with the left shoulder therapy, he started working on the elbows, bending them up and down until Sam's fingertips were able to touch his shoulders.

"Okay, that's it. I've had enough," Sam panted as Brian finished the therapy with his arms. He was beginning to sweat from all the exertion the therapist was putting his body through and felt like he was nearing the limits of his endurance.

"Sorry Champ, but we've got a little ways to go yet," Brian apologized as he grasped Sam's right hand in his and began the wrist rotation exercises of bending his hand back towards the wrist until he felt resistance. Once that was accomplished, he rocked it sideways and then back and forth, before rotating it in gentle circles and then manipulating the fingers into various positions to help rebuild the dexterity in his hands.

"Brian, don't you think the boy's been through enough?" Bobby inquired as he tugged his fingers through Sam's sweat dampened hair as the younger hunter lay exhausted on the bed. He could tell the kid had been through the wringer and felt they needed to give him a break. Not only that, but he could also tell Dean was feeling some angst by the way the elder Winchester clenched his fists as he watched his baby brother go through the taxing experience of physical therapy.

"I know it seems like we're putting Sam through too much too soon, but I promise you it's nothing more than his body can handle. Sam's muscles have languished too long already and we can't afford to stop now," Brian intoned as he began the leg and hip exercises, beginning with the knee bends. Placing one hand under Sam's right ankle and the other under his knee, he slowly pressed Sam's knee up towards his chest until he felt the required resistance and lowered it towards the bed again. Repeating the exercise five times, he then moved to the other leg and started the process all over once again, taking extra care with the catheter line taped there. Next, he moved on to movements where he moved the right leg out to the right side as far as possible before moving it back towards the center and crossing it over the left leg. Once completed, he loosened the tape keeping the catheter tube in place and allowed it to relax on the gurney before he repeated the process with the left leg.

Finally after what seemed like hours later but was only approximately thirty minutes, he finished up with the ankle bends and rotations to strengthen the muscles there. Those muscles would be required to be in top physical shape once they attempted to get Sam on his feet and walking again.

By the time that the physical therapy finished, Sam was pushed past the point of exhaustion and fell into a deep slumber, not even waking as Brian re-taped the catheter tube into place and they transferred him from the tilt table to the gurney to be transported back to his room again.

Arriving back in Sam's room moments later, Brian pushed the portable hospital bed into its normal position and then locked it into position. "He'll probably sleep for a while which is quite normal with everything he's been through," Brian informed Dean and Bobby as he hooked Sam back up to the heart monitor in the room.

"How long should we wait before starting the exercises once again?" Dean questioned of Brian once the therapist had finished what he was doing. He didn't want to chance doing the exercises too soon, thereby causing Sam harm instead of good.

"If he feels up to it, you can do the exercises again later this afternoon. It will probably make him feel better if you did them in increments of time though since he's been through a full session this morning already," Brian answered.

"Okay, thanks man," Dean stated, watching the therapist leave as he stood by his baby brother's bed and carded his fingers through Sam's hair, he needed the contact with his brother right now to know that Sam was indeed okay and would eventually recover.

Smiling his thanks as Bobby pulled over a couple of chairs for the two of them, Dean sat down to watch over his baby brother, ready to jump at a moments notice if Sam needed him or became distressed.

TBC I hope you weren't bored by all the medical aspects of this chapter. More to come soon.