Thank you Jenjoremy for beta'ing this for me and Gredelina1 for all your support. Thank you all for reading x

Chapter Eight

By the time Dean had calmed himself and was ready to go in to Sam, Doctor Platt was just finishing up with him. Alfie had given him some space, but he appeared just as the doctor exited the room and met Dean in the hall.

"How did it go?" Dean asked.

"It was very helpful," Doctor Platt said. "There are some things we need to discuss, but I think it's better now for you to have some time with Sam. He is a little distressed."

Dean glowered at him. "What did you say to him?"

"Nothing," he said calmly. "Sam saw Bobby again while we were talking, and it upset him. Despite that, I have been able to make a good assessment of his condition and I can now make a plan of action for treatment."

"Sure," Dean said distractedly. "That's fine." He just wanted to get to Sam.

"Doctor Maddox said they're moving him and will be removing the ICP catheter later. I will come to you when they have taken him for the procedure and we can talk then."

"I can't be with him while they do it?" Dean asked, looking to Alfie.

"You wouldn't want to be," Alfie said. "Sam will be under conscious sedation, so he will be fine, but it could be upsetting for you."

Like that was something new, Dean thought. This whole thing had been more than upsetting. It had been impossible. He wasn't sure he was able to deal with it anymore.

Doctor Platt held out his hand and Dean shook it automatically before he excused himself and reached for a gown so he could go into Sam.

"There's no need for that, Dean," Jean said, coming along the hall with an orderly Dean hadn't met yet. "Sam's new room is ready, so Stephen and I are moving him now."

Relieved, Dean opened the door and went in. Sam was staring out of the window again, his face pensive and sad. He didn't look around until Dean called his name and then he looked almost annoyed.

"Hey, Sammy, they're going to take you to your new room now," he said.

"Are you coming?" Sam asked.

"Of course. We'll get you settled right in. They're going to take one of the tubes out later, too, so you can get up and out of bed again."

"Not now?" he asked.

"No, not now, but soon."

Sam nodded but didn't looked happy at the thought of some more freedom.

Jean came into the room and introduced Stephen to Sam as she began to move and disconnect the equipment beside the bed. Sam watched her carefully and then eyed Stephen as he disengaged the brakes from the bed.

"Ready to go, Sam?" he asked.

"I guess."

Alfie opened the second side of the door and locked it in place so they could wheel the bed out. "Where are you taking him?" he asked.

"Room 315," Stephen said.

"I will retrieve your things from the locker room and meet you there, Dean," Alfie said.

"Thanks," Dean said and watched Sam carefully as he gripped the sidebars of the bed. They steered him away from the wall and to the door, and Dean noticed that Sam looked almost scared. As Dean had seen him face off with Lucifer himself and handle it, Dean felt a jolt at the obvious fear in his brother for something so simple.

He stayed at Sam's side as they rolled him down to the hall to the elevator. It was a squeeze in the car with the bed and three people, but Dean scrunched himself against the wall and smiled reassuringly at Sam. When the doors opened, he stepped out and walked with them to the new room where a nurse was waiting at the door.

"Megan, this is Sam Smith and his brother," Jean said, gesturing to them each in turn.

"Hello, Sam," she said with a sweet smile. "Welcome to the rehabilitation ward. I'm going to be your assigned nurse for my shifts, so you'll see a lot of me while you're here."

"Won't she stay?" he asked, gesturing at Jean.

Dean didn't think he had any affection for any of the staff he'd met so far, but Jean had been the one there when Sam had woken from his sedation and given him something to drink. That must have had an effect on him after all.

"I can't stay, Sam," Jean said. "I am going to be needed on the ICU. Megan is here though, and she will take good care of you."

Sam narrowed his eyes but nodded.

They wheeled him into the room, and Dean saw it was different to the one he had been in before. There was a comfortable looking chair beside the spot the bed would be parked, and the other chairs in the room were padded though still wipe-clean. There were blinds at the window and a vase of what looked like plastic flowers on the bedside locker. On the other side of the room to the bed was a door that Dean saw opened into a bathroom.

"It's nice," he said.

"It's different," Sam stated.

The locked his bed in place and reconnected his heart monitor and reattached the blood pressure cuff to his arm.

"There," Megan said. "Is that more comfortable?"

"It's different," he said again.

"I like it," Dean said. "The chairs look much more comfortable." He pulled one from by the wall up close to the bed and sat down. "Yep, much better."

Megan hung Sam's IV bag on a hook and said, "I'll give you two a little while to settle in, but I will come back soon. If there's anything you need, there's a call button here on the bed."

"Thanks," Dean said.

She smiled at him and then she and Stephen left the room.

"How are you doing, Sam?" Dean asked. "You okay?"

Sam considered a moment, and Dean thought he was going to give more of an answer than the curt sentences that he had so far, but he didn't. Instead, he asked, "Where did Bobby go?"

Dean sighed. "I don't know, Sammy. I guess he only had a minute to come by and see you before he had to get back to work. You know what he's like when he's on a hunt."

"Did you see him, too?"

"No. I was with the other doctor when he came."

"He wants you to see him. He told me."

"I will," Dean said.

Sam nodded, apparently satisfied, and then tensed as there was a knock on the door and Alfie peered inside.

"Can I come in?" he asked.

"Sure, Alfie" Dean said with a smile, wanting to make the meeting as easy on Sam as he could by presenting it as a positive.

Alfie came in carrying Dean's duffel. "Your locker was a mess, Dean," he said amiably. "I imagined you as a man that would have more military precision."

"Not me," Dean said. "Sam's more like that."

Alfie turned to Sam and smiled. "Hello, Sam. It's nice to be able to meet you properly at last. You have been busy since you woke up."

Sam frowned at him. "Dean says you're good. Are you?"

"I like to think so," Alfie said calmly. "I was certainly a good doctor if my patients were telling me the truth."

"They didn't die?" Sam asked bluntly.

"The ones that lived said I was good," Alfie said.

Sam looked thoughtful. "I guess that's okay then. You're taking care of Dean?"

"I am doing my best. I think it will be easier now that you're awake to share the load with me."

"I take care of him."

"I thought that would be the case," Alfie said agreeably. "Now we can work together to take care of both you and Dean."

Sam smiled slightly. It was the closest thing to happiness Dean had seen in him since he had woken and seen Bobby. "Yeah. We can do that."

Alfie set down the duffel and pulled up a chair beside Dean. "Do you have any tips for taking care of him that I should know?" he asked Sam.

Sam frowned, clearly thinking carefully before answering. "He drinks too much and eats bad food. He isn't careful sometimes, and he worries a lot."

It was more than Dean had heard him say for a while, and it was habits of Dean that Sam would have answered with before. He was relieved that these details were still there for him. He still recognized Dean, and he knew him, too.

"I think I have seen some of that worry myself," Alfie said. "We will try to make that easier by taking care of you. What do you think?"

"Yeah," Sam said, smiling again. "We can try."

Dean laughed. "I am sitting right here," he said. "How about you wait for me to leave the room before you discuss me."

"My apologies," Alfie said, his lips twitching. "We will remember to ask you to leave next time."

Dean looked with false despair at Sam and was pleased to see his eyes were bright with amusement.

Seeing his face, Sam began to laugh. It was a rich and infectious sound. Dean had always been helpless in face of Sam's laughter, unable to keep from joining in, and he did so now. It felt good, freeing, and the relief that Sam could still do this for him, lift him up like that, was heady. He really was Sam still. He was just struggling now.

His amusement quickly turned into something different at the thought of that struggle. His laughter took on a tinge of hysteria, and his eyes began to tear. He wiped at them and tried to calm himself, not wanting to upset Sam, but Sam saw it as he always had before.

"Are you okay, Dean?" he asked.

Dean nodded and wiped at his eyes. "Yeah, I'm fine, Sammy."

Sam clearly didn't believe him, but he didn't push. Dean was equally relieved and disappointed. Before, he would have pushed Dean until he snapped at him or was forced to feel his feels. Maybe it was Alfie's presence that stopped him. Or maybe this was just another change to live with.

Sam grew upset when they came to take him down to have the ICP catheter removed; he was scared, and he was not reassured when Dean and Alfie tried to talk him down from his fear. They had a whispered discussion with Doctor Maddox before deciding that the best approach was to give him the sedation they would use before he went down. They used a drug to induce conscious sedation and it worked quickly. Sam still seemed vaguely aware and answered Dean when he told him he would be right there when he woke up, but he wasn't upset anymore.

When they wheeled him out, Dean had a moment to rake a hand over his face and try to gather his thoughts before Doctor Platt came in. "Are you free to talk now, Dean?" he asked.

"Yeah, sure," Dean said.

Alfie stood. "I should get home now. Dean, there is some spaghetti and meatballs in the staff fridge waiting for you. I have already checked that it's okay for you to store your food there and use their facilities. You won't need to sleep in the family room anymore either, as the chair here can be extended to use as a sleeper chair. Someone will bring you blankets and a pillow later."

"Thanks, Alfie," Dean said gratefully.

Alfie picked up his jacket and waved as he left the room. Doctor Platt took his seat and turned it so he was facing Dean.

"Well, Dean, I know Sam won't be gone too long, so I think we should push on with what I have discovered and planned."

"Sure," Dean said tiredly. "Go ahead." He wasn't disinterested, he was just worn down by the news he'd already received today and wasn't really ready to receive more.

The doctor had a file on his lap, but he didn't open it as he began speaking. "Sam was initially distrustful of me, and I had to work carefully to enable him to speak freely."

"Yeah, Sam's like that."

He nodded. "He did eventually open up to me though, and I was able to get a good view of his mental state. I have since spoken to Doctor Maddox and she told me about his cognitive impairment. I had some idea after speaking to him, but it is my belief that with this diagnosis an improvement in treatment will come." He opened the file. "Now, I don't believe Sam's impairment is related in full to the symptoms that are presenting for him mentally now. I think it's the cause rather than effect."

Dean leaned forward in his seat, willing the doctor to get on with it.

"Once he did start speaking, Sam was surprisingly honest with me. At least I assume it was honest, as what I heard was extraordinary."

Dean wondered what he had told him. Had he opened up about being in the Cage with Lucifer and what had led him to be there? If he had, they were going to be treating Sam all wrong, as that was the truth not another symptom.

"Sam told me that his trauma involved being kept in a cage and hurt by two people called Michael and… Lucifer?"

"Yeah, that's what Sam calls him anyway," Dean said carefully.

"I see. I thought it was an unusual name. As I said, he was kept in a cage at some point in his trauma, and he was hurt which I assume to mean he underwent torture of some kind."

"Definitely," Dean said.

He made a note on the file. "This trauma was obviously great, and it has had a profound effect on him. He said he has been 'seeing' Lucifer for a long time since the trauma. Is that correct?"

Dean nodded.

He made another note. "That hallucination is what concerns me and also drives me to my conclusion. I am confident with what Sam has told me to diagnose Post Traumatic Stress Disorder. This is a name that brings to mind all kinds of difficulties, I know, but the thing to do with a diagnosis like this is to accept and prepare to treat. Dwelling on the name of it will not help anyone, least of all Sam."

Dean leaned back, trying to wrap his mind around what he was hearing. If he'd thought of what happened to Sam in human terms, he would have thought the same thing, but for him it had been explained as Hell leaking through, and with Castiel's dire warning, it made perfect sense. It was trauma though, the worst possible imaginable, and Sam was still suffering from it, so that made it a kind of stress, though that word didn't seem like enough.

"Sam told me some of the things that happened to him and what they did, though I am sure it was more complex that the actions he described."

"What did they do?" Dean asked. Sam had never really opened up about what had happened to him. The word hell explained enough since they both had experienced it.

"I can't disclose the details," he said. "Despite Sam's current situation, he has the right to confidentiality, and he didn't wish for me to tell you. He didn't want to upset you, I believe."

This doctor knew more about Sam's time in hell than Dean did. It felt wrong, but he remembered how little he had wanted to tell Sam about his own Hell experience, so he understood. He was even pleased that Sam was aware enough to want privacy to protect Dean. He was still trying to shelter him.

"Now, treatment options," Doctor Platt said. "I would ordinarily treat Sam with a combination of therapies. I will start him on an antidepressant. Interestingly, the medication Doctor Maddox has prescribed for Sam's seizures also has an effect on mood disorders, so there's a chance it may aid him." He hesitated. "I would also like to start Sam on antipsychotics."

"He's not crazy!" Dean said angrily.

"No, he is not," the doctor agreed. "He has a mental health condition that needs to be treated. The word psychotic has become synonymous with insanity when that isn't the truth. All kinds of mental health conditions can cause someone to suffer psychosis. PTSD is just one of them. Sam's hallucinations are a form of it and that's what I hope the medication will treat. At the moment, he is at the mercy of these episodes, and I am sure you agree that he should be protected from them, especially given his other impairment."

"Okay, fine," Dean capitulated, not sure Sam needed the medication, but not having the energy to argue any further. "Give him what you think he needs."

He made a note and then looked up again. "I would also like Sam to engage in therapy. A successful treatment for PTSD is exposure therapy, though I don't think that is advisable in Sam's condition, as he may not be in a position to differentiate between what we are trying to do and what is real. What I am suggesting is talking therapy. I would like to meet with him regularly to explore his thoughts and beliefs and try to help him find a way to deal with them."

"I'm guessing no one's told you that we've got no insurance then," Dean said. "We're already going to be swamped with bills when we get out of here. We can't afford more." Not that there was any chance of them actually being able to pay those bills or even trying to. Sam and Dean Smith didn't really exist.

"That is not a problem," he said. "I would like to take on Sam's care pro bono. I am not going to lie; my intentions are not altogether altruistic. Sam's case, with his condition combined with his impairment, is unlike anything I've ever seen before. I would like to explore treatment for him and make it a case study for an article."

"You want him to be a guinea pig?" Dean asked, glowering at him.

"No, I want to use Sam's experience and situation to help other people in the future. If we can find a treatment for him that works, we can use it for others, too."

"I don't know," Dean said, some of his anger leeching from him. "I don't want Sam's name and story to be picked over by a bunch of shrinks."

He smiled at the term. "Sam will remain anonymous if I do write an article. All he would be known for is his diagnosis. I will even arrange appointments to be held at home. There will be no need for Sam to return to the hospital, as I know he isn't comfortable here."

"I'm not sure," Dean said. "This therapy thing might backfire."

"How could it?" he asked. "What are you afraid of, Dean?"

What he was scared of was that Sam might slip. If he started talking about the devil and the apocalypse he could get locked up. He and Sam had both managed to be checked into the institution after they'd spilled the truth of the world to that doctor in Oklahoma.

"I don't know," he said evasively.

"I think you do."

Dean sighed. "What if he says something you don't like. What if he says something you think really is crazy?"

"First of all, I would never use that word, and secondly, it's unlikely that Sam can say anything more shocking than what I have already heard in my career. If he was to say something… disturbing, I would explore it if I believe Sam is able to, and if not, I would revisit it at a later point."

"You won't lock him up?" Dean asked.

"No, Dean. The only reason Sam would need to be hospitalized for his condition is if I believed him to be a danger to himself or others. The time has long since passed in which we locked people up for psychosis. As long as he is cared for and safe, there is no need to bring him in again. Sam is showing no signs of being a danger, so I would be happy to recommend him to be discharged into your care. I sincerely hope you will allow me to treat him still though. I think I can really help him."

Dean nodded. He believed him, though it was hard to.

"I'll think about it," he said. "That's the best I can do."

"Very well. There is something else I wish to discuss, and I don't anticipate that we will have much longer before Sam returns."

"What?" Dean asked.

"Bobby. I don't believe that Sam's sightings of your friend are the same as his PTSD. That's something I would like to explore in further sessions. I don't believe his absences are seizures either. I am not disputing that Sam is epileptic," he said, breaking Dean's moment of hope. "But I think they are something different. He showed no other signs of a petit mal seizure when he had an episode in our meeting, and when he came out of it he told me it was Lucifer. I think they are psychological in nature rather than a physical manifestation of brain disturbance. I have a theory, and I would like to see what you think. Do you think Sam might be withdrawing to deal with the memories of what happened to him without causing you or others distress? Is that something Sam would do?"

Dean nodded at once. It was a total Sam move to do it like that. He would absolutely want to protect Dean from that. He hadn't wanted to tell him about Lucifer at all in the beginning. It was only when Death outed him that he had come clean. Sam was usually a talker. He wanted to discuss everything openly when it came to Dean, but when he was hurting, he was more reclusive. He was like a wounded animal sometimes—seeking solitude.

"Then we will work on that, too, if I am allowed the chance, of course. We will try to make Sam be open and therefore we'll be able to monitor him better."

Dean ran a hand through his hair and checked the time. Sam should be back soon.

"Do you have any questions for me, Dean?" he asked.

"Yeah. Doctor Maddox said I shouldn't correct Sam when he sees Bobby, and he's asking about Jess too now. I don't want to hurt him, but I want to do what's right for him."

He considered. "Did it hurt Sam very much when these people passed?"

"More than you can imagine," Dean said instantly, remembering Sam's grief for Bobby and his total devastation in the wake of Jessica's death.

"Then don't tell him. Guard him from it. You must have felt the same grief."

"Yeah. Losing Bobby was tough."

"In that case, protect him from feeling that grief again. There is no reason for him to experience those feelings even once more. Lie if you can, evade if you can't, but don't correct him unless forced."

There was movement at the door and they stood as Sam's bed was wheeled in. He looked drowsy, but the turban of bandages was gone and been replaced with a small white dressing on his temple.

"I will find you tomorrow, Dean, and see if you have come to a decision regarding my treatment plan."

"Yeah, thanks," Dean said distractedly.

Dean pulled back the chairs so they could situate Sam again as the doctor slipped out. Dean waited for Sam to be settled and then he sat down beside him again.

It was time to take care of Sam again.

So… I knew this story had to be dealing with Sam in human terms and the more I read about PTSD, the more sense it made that was what his Cage trauma was presenting as.

I have written PTSD before in Picking Up The Pieces, and my hope now is the same as it was then—to show respect and realism. I don't want to insult anyone with my portrayal. I have researched as much as I can, but if I make a mistake in my representation, I apologize.

Until next time…

Clowns or Midgets xxx