JENNA
Much to her surprise, the patient in the corner cubicle makes it through the night.
Yesterday after admission he was evaluated 18 at SOFA score, today he's 19.
She has never seen a case of sepsis this severe survive.
The patient's brother is with him all the time. He doesn't drink, eat, or go to the bathroom—not once. There's a heaviness to his posture, as though the weight of his worry has settled into his bones, dragging his shoulders down. His lips, dry and cracked, are pulled into a tight, unnatural line.
Jenna tries to convince him several times to take a break, go home, and sleep a bit, but he remains unaffected.
Finally, the doctors force him to leave and take a shower; he cannot stay in the unit in dirty clothes.
He doesn't go home, though. Jenna finds him sitting on the floor by the ward doors, waiting for visiting hours to start.
Something inside her breaks. She takes pity on the man and leads him to the employee locker room, where there are showers. She gives him a set of clean scrubs left there by a nurse who retired last month.
"Thank you," he says dully, taking the offered clothes and paper towels.
"You should probably drink and eat something too," she lectures him, despite knowing what his answer will be.
"I will," he declares.
Liar.
DEAN
It's been twelve hours. Sam is balancing on the verge of death.
The doctors' faces are grim every time they approach Sam's bed. Only one nurse—the one who let him take a shower in the locker room (Jenna?) — tries to smile at him reassuringly as she checks his vitals on the monitors.
Doctor Coleman gives him and Mary a litany of everything that's wrong with Sam so far. His liver. Kidneys. Lungs. First signs of heart failure. They've started dialysis and inserted a PEG tube.
So, no good news.
Sam is still fading. They change his antibiotics, then give him what seems like every antibiotic they have.
They're on their own. Gabe is dead, Cass is drained, and restoring his grace is going to take weeks. Rowena's magic isn't really made for healing.
Dean is sure he's going gray, and fast.
Another twelve hours and another SOFA score. Sam's increases to 19.
Doctor Coleman says that means an 80 percent mortality rate.
I should have never let him go. I should have chained him to a chair and locked him in the basement the moment I had a bad feeling about this mission.
He knows he's terribly possessive. Sam is an adult, capable of making his own decisions.
What was I supposed to do? I'm his big brother. I'm responsible for his safety. Great job, Dean.
„It's still a 20 percent chance, Dean," Mary tries to comfort him, seeing his guilt. „That's a lot. Even if they gave him one percent, he'd still take it, you know that."
He nods, staring at Sam's face, yellowed with jaundice from his failing liver.
Twenty-four hours later, Sam soils his bed, and it takes three nurses to clean it up and it's fuckin' terrifying.
Dean knew these things happen in the ICU, but seeing it happen to his brother is a whole different story.
The next time he's forced to leave, he returns to the bunker and drinks himself out cold.
Hours turn into days.
Sam is holding on, somehow. The doctor says the infection is clearing, but now they're fighting to get Sam's organs to function.
Days turn into weeks.
Sam is losing weight. He didn't have much fat to begin with, and now his muscles are atrophying at an alarming rate. Dean can count every bone in Sam's body, especially since he's naked under the sheets.
„Why is he wasting away so fast? You gave him that feeding thing, right?" Dean asks Dr. Coleman one day during a routine check on Sam.
„We're doing everything we can for your brother. He's being nourished both enterally and parenterally," the doctor explains patiently. „But the inertia and catabolic nature of sepsis are taking their toll. We can't overload Sam's body with too much nutrition. Digestion requires energy and enzymes, and Sam's resources are being used to 'clean' what the bacteria and sepsis have left behind in his system. There will be time to gain back the lost pounds during rehabilitation."
Dr. Coleman is as strict as always. In other circumstances, Dean might have liked the man.
„Don't worry, Sammy. You'll have an angelic rehabilitation soon," Dean whispers to his unconscious brother when they're alone in the cubicle again. „Cass is almost ready. You'll be as good as new."
He remembers when he said something similar the first time, back in Cold Oak. He lied then.
He isn't lying now. He isn't.
————————————
A whistle of wings. Cass materializes in Sam's cubicle three days later.
„Cass."
„Hello, Dean."
„You ready, man?"
„My grace is fully restored, yes. I can heal Sam." Cass replies, immediately springing into action. He places two fingers on Sam's forehead and immerses himself in concentration.
Dean's heart is in his throat.
„I don't understand," Cass says, looking up at Dean. „Dean, I… I can't do anything."
„What?" This isn't real. It can't be. Sammy is going to be all right. „What do you mean you can't? Is it something to do with your grace?"
„It's not my grace," Cass says, his eyes full of sadness.
„Then what?"
„I think it has something to do with passing through the rift," Cass speculates. „It changed something on a subatomic level. Blocked something. Like… what was done there needs to be fixed there."
No. No, no, no…
„Cass, come on." Dean refuses to believe it. „Sam needs you. Come on."
„I'm sorry, Dean," Castiel says, looking devastated. „I really am."
„No." Dean snaps. „You're wrong. It's just a sickness. A normal, regular person's sickness. You're an angel. You can fix this."
„Dean, I really can't. I'm so sorry."
Dean's world crashes all over again.
MARY
Dean is completely detached after Castiel's failure to help Sam. He speaks only when asked and eats only when prompted, his actions clearly mechanical. He spends his days in the hospital with Sam, and when he returns to the bunker, he shuts himself in his room, leaving only to drive back to the hospital each morning.
Mary tries to talk to him, but it's no use. The only response she gets is his insistence that she find and scrutinize every healer she can locate.
Castiel is also searching for a way to cure Sam. Mary knows he feels guilty. But he shouldn't—he's not the one to blame here. The only guilty person is her. They went to the apocalypse world to save her.
Weeks go by with no real solution emerging.
Mary starts to wonder if maybe it's time to consider a different solution.
DEAN
They say that Sam is doing better. His color is improving, his fever is under control, and the infection that nearly killed him seems to be retreating. Dean tries to convince himself that these small changes are real, but all he can see is his brother wasting away, turning into a depleted shell. To Dean's dismay, Sam looks small, almost childlike in his frailty, all thin limbs, sharp bones, and papery skin. It makes his heart ache.
It's been nine weeks since Sam was admitted to the ICU.
Nine weeks since Dean's world had stopped in the depths of the Morehead tunnel.
He's still reliving that moment, the sequence of events replaying in his head like a time-lapse video: vampires surrounding Sam, tilting his head back, blood, Sam calling his name, Sam losing consciousness with Dean's name on his lips, Sam disappearing into the darkness.
"Dean," Dr. Coleman's voice breaks through, startling the pensive hunter and interrupting the flow of trauma replaying in his mind. Dean hadn't heard him enter. The doctor stands in the doorway, a figure of calm purpose in sterile, pale blue scrubs. His intelligent eyes scan the room, glancing between monitors with practiced intensity.
"Sam's infection is under control, and his vitals are stabilizing. We're considering weaning him off the ventilator soon," Dr. Coleman continues. "We need to see if he can breathe on his own. Staying on the ventilator isn't something we want to prolong any further than necessary."
Dean looks at Sam, watching the artificial rise and fall of his chest. The idea of taking Sam off the ventilator scares him. What if he can't handle it? What if he starts crashing again?
"Is he ready for that?" Dean asks, his voice hoarse from lack of sleep and too much worry.
"We hope so," Coleman replies, his eyes steady. "It's a gradual process. We won't just pull the tube out—we'll reduce the support in stages and monitor him closely. If he struggles, we'll step back. But it's time to start trying."
Dean swallows hard, then nods.
MARY
Waiting is the worst.
Today is the day they will try to extubate Sam, to see if he can breathe on his own.
Mary is back at the bunker—the doctors allowed only Dean to stay with Sam. She tried to research, to do something useful instead of just sitting and worrying, but it was pointless. She couldn't concentrate anyway. Now she's just numbly pacing back and forth through the empty corridors, checking her phone every ten seconds.
She's going to drive herself crazy.
Her phone chimes late in the afternoon, and she answers it on the first ring.
DEAN
Sam's first unassisted breath is shallow and shaky, but it's there. Sam is breathing on his own.
The relief that floods through Dean is overwhelming.
It's almost like he's been born again. Sam is breathing. Sam is alive.
Dean knows he doesn't have to watch his brother's every breath—there's an oximeter on his finger for that—but he can't stop. He has to keep an eye on him; otherwise, something bad might happen.
Then Dean hears a gurgling sound bubbling up from Sam's throat, raw and congested, as if his airways were coated in thick, heavy syrup. A cough shakes his frame, hoarse and ragged, leaving him weak and struggling to clear the obstruction. Between coughs, faint wheezes slip through his parted lips, whistling and crackling like air forced through a narrow tunnel, trapped and restless.
"Help! Nurse!" Dean yells, panic rising as he presses the call button frantically. "Help, my brother is choking!"
The nurse appears in an instant, and it takes her only one inhale from Sam to understand what's happening.
"He's just a little congested," she says calmly, reaching for the suction device beside Sam's bed. "I'll clean his airways for him, and he'll be fine. Don't worry."
Gently tilting Sam's head back, she positions the suction catheter near his lips, guiding it past the corners of his mouth and carefully down his throat.
The suction activates with a soft hum, a steady and reassuring sound as the device begins drawing out the congestion from deep within his chest. A wet, gurgling noise fills the room, muted by the tubing, as mucus and phlegm move up through the catheter. The nurse watches Sam's face closely, monitoring for any signs of distress, but there is none. His breaths become clearer, his chest rising and falling with less struggle. With each pass of the catheter, the rasping sounds in his lungs soften, replaced by a faint, clear whistle of air beginning to pass more freely.
As she completes the final pass, the nurse retracts the suction catheter and gently dabs at Sam's lips, murmuring words of comfort.
"There, all better," she says, more for Dean's comfort than Sam's. "He can't cough properly yet, so he might need a little help from time to time. It's nothing unusual. You might need to learn how to do it for him someday."
"What?" Dean mumbles, confused. "What do you mean I might have to learn to do it?"
The nurse lifts her brows and gives him a slightly surprised look. "Dr. Coleman didn't talk to you about Sam's future care?"
"Future care?" Dean sounds dumb, just repeating the nurse's words, but it's all he can manage right now.
"Okay," the nurse says politely, trying to sidestep the conversation. "It would be best if you discussed this with Dr. Coleman tomorrow."
"No, no, talk to me now," Dean demands, already on high alert. Every detail about Sam's health is his priority—he needs answers, and he needs them now.
"I'm not really authorized to provide that kind of information. Please ask Dr. Coleman tomorrow."
"Listen, you can't drop a bomb like that and just walk away," Dean pleads. He would never do this for anyone but Sam. "I'll ask Dr. Coleman tomorrow, but I need something now. Please. He's my little brother; I have to be ready."
Dean might not have his brother's puppy-dog eyes, but it works.
"Alright," she sighs. "In my experience, people who have been this sick for this long often need at least partial care at home, sometimes complete assistance with daily living activities. It may be temporary, or in some cases, lifelong. That means help with feeding, bathing, toileting, and things like clearing his airways. That's why I mentioned that you might need to learn how to care for him."
Dean just stares at her, blankly.
What? Feeding Sam…? Bathing him, changing him? She doesn't know Sam. He's the smartest and most independent person I know.
"He went to Stanford, you know?" Dean says, almost to himself. "Pre-law. He's that clever."
"Of course he is," the nurse affirms. "I never meant that he isn't. But this isn't about intelligence or education. It's purely physical," she says, placing a supportive hand on his shoulder. "Everything will be fine."
She leaves quickly, before he can ask her more questions.
He should call Mary.
SAM
The nothingness around him is sweet, but a little frightening. No light, no sound, just a thick, heavy darkness pressing him down to the bottom of a deep, dark ocean.
He hears something—a steady, artificial beep from a machine nearby. It's really annoying, like a stubborn fly that keeps landing on your forehead.
He feels like he's floating. Something is pulling him, inch by inch, toward something brighter. He can hear muffled voices, fragments of sound drifting in and out like waves. They're soft, familiar somehow, but distorted, as though he's hearing them from underwater.
He knows he can't stay here, not forever. He has to come back—Dean is waiting for him, probably worried, like he always is. Stupid jerk. He's going to make himself sick if he keeps worrying so much about everyone.
But Sam is just so, so tired and lost.