Summary: Tag to 9x17, "Mother's Little Helper" – Hurt Sam / Guilty, Protective Big Brother Dean – Dean shook his head in denial even as he continued to stare at the dark bruises that covered Sam's abdomen. His mind buzzing as it quickly cataloged the organs located on the left side of the body...and concluded without a doubt that Sam's spleen had ruptured.

Disclaimer: Not mine

Warnings: Spoilers for Season Nine and usual language

A/N: I love Dean. Y'all know I do. And I know he has his own issues right now and deserves to be a little self-absorbed. But it really annoyed me how he treated Sam in this episode. And it really concerned me how injured Sam seemed after being thrown by that demon. So, here we go...

...blood pours from within... ~ Suffocation

The silence didn't bother him.

Not at first.

In fact...if anything, he welcomed it.

Because Dean had shit to do, shit to research, and shit to figure out.

And all of that shit could be accomplished quicker if Sam kept his mouth shut and didn't ramble about the hunt he had just returned from...or try to engage Dean in a pointless heart-to-heart...or think out loud about why Abaddon was doing whatever the hell she was doing.

Because right now, none of that mattered.

The hunt didn't matter.

And Dean's issues with Sam didn't matter.

And it sure as hell didn't matter why the self-proclaimed Queen of Hell was creating a demon army from scratch.

No reason would change Dean's mission of killing the bitch.

She was still as good as dead.

But Dean couldn't kill her until he was reunited with the Blade...and he couldn't be reunited with the Blade until he found Crowley...and he would never find Crowley if he didn't focus.

But focusing on anything was next to impossible when all Dean could feel was the shakiness of his arms, the constant burn of the Mark, and the restless agitation of an itch he couldn't scratch – like an addict who had gone too long between hits.

Dean snorted as the comparison crossed his mind and then shoved away the ancient book he had been pretending to read. His concentration shot to hell over an hour ago as exhaustion and frustration had begun to set in. As this strange feeling had taken firmer root – this sensation of being high-strung and on the verge of snapping, of going fucking crazy in the silence if Sam didn't say something to ground him.

"Talk to me," Dean ordered, his voice suddenly echoing in the large expanse of the bunker.

Not caring how desperate he sounded and not even looking at Sam as he instead gripped the edge of the table, watching the tremors once again course through his arms – his body physically reacting to the prolonged absence of the Blade, craving contact with the hilt of that jagged jawbone.

Dean closed his eyes, imagining how damn good it would feel to hold it; how the Mark would ignite, how the rush of power and strength would surge through him.

It was the perfect high.

Dean's arms shook harder, slightly vibrating the table and fluttering the pages of open books, shifting the papers tucked inside the stacked folders.

He opened his eyes.

"Sam..." Dean called when his brother had said nothing. "If you're pouting or some shit, get over it."

He paused.

"I mean it, man. Talk to me."

Because in that moment, the only thing Dean needed as much as he needed the Blade was to hear Sam's voice.

Dean's little brother having already proven that he was the only one who could reach Dean when he was like this – consumed by an unnamed power, teetering on the edge between lethal rage and indifferent insanity.

That strange but appealing outlook best described as "Fuck It, Let's Kill Everything".

Oh, yes.

Let's...

Dean swallowed against the temptation, the Mark seeming to have its own effect on him these days even without the Blade's assistance...which was why Dean needed to hear his brother's voice.

Needed Sam to break the proverbial spell.

And he needed it now.

But Sam remained silent.

Dean clenched his jaw, feeling the burn of anger spread through him as he cut his eyes to the left and glared at Sam seated at the other table.

Sam didn't acknowledge him.

Dean's glare intensified, knowing his brother could sense him staring. "Hey!" he shouted, his voice rough, his tone harsh – pissed at being ignored. "You hear me or what?"

It was a simple question with a snarky intent.

But it was actually difficult to answer.

Because Sam didn't look like he could hear anything.

Was instead just sitting there, still offering no response as he stared straight ahead.

And that was...odd.

Dean narrowed his eyes, feeling his anger begin to fade as concern crept in to take its place.

The effects of the Mark lessening as big brother instincts suddenly kicked in and overrode everything else.

Dean continuing to stare at Sam as he replayed Sam's entrance from over an hour ago, remembering how Sam's movements had been slow and sluggish when he had returned to the bunker; how his little brother had been uncharacteristically quiet even then.

How Sam had kept his left arm tucked against his side and had carefully sat. Had eased himself into the chair the way people did when they were stiff and sore and injured.

And it was then that Dean realized.

Sam wasn't ignoring him.

Sam was hurt.

Dean sighed, feeling a stab of guilt as he also realized that he hadn't even asked Sam if he was okay when Sam had returned from the hunt.

Hadn't even told the kid to be safe when he had headed out by himself, hadn't even considered that maybe sending his little brother out alone wasn't a good idea.

Dean rubbed his hand over his face, feeling two days' worth of stubble and wishing he could get his shit together.

Because this wasn't like him – not checking on Sam, not being concerned about Sam wasn't how Dean typically operated.

And yet for the past couple of days, Dean had barely thought about Sam.

Had instead just been thankful his brother was gone, almost not answering his phone more than once when the kid had called...and then lying – and hanging up on him – when Sam had clearly wanted his big brother to join him on the hunt.

I could really use your help down here.

Dean could still hear Sam's tone – his little brother not wanting to ask outright but hoping Dean would read between the lines.

And Dean had.

Dean had known exactly what Sam had wanted...but that had been just too fucking bad.

Because Dean couldn't be bothered.

Not then...and not now.

Dean had left his brother to watch his own back and then had sat beside Sam for the past hour without realizing the kid was hurt, without realizing he wasn't the only one suffering in the silence that had settled between them since Sam's return to the bunker.

Dean shook his head, frustrated with himself now that his head was out of his ass.

"Sam..." he called, watching his brother blink as though Sam had just heard his voice and then slowly turn to look at him.

Sam just staring at him from where he sat at the other table, his expression alarmingly vacant – both dazed and detached like he didn't know what was going on...and wasn't with it enough to care.

Dean frowned, not liking the implications of this one fucking bit.

"What's up with you?" he asked, echoing Sam's question to him only a couple of days ago.

One of Sam's shoulders rose as if he was attempting a shrug...but just couldn't manage the movement.

"Don't know," he murmured and closed his eyes, wincing and tucking his arm firmer against his left side as a jolt of pain rolled through him.

Dean's frown deepened. "Sam..."

Sam swallowed and opened his eyes, blinking at Dean. "Maybe m'just tired," he concluded and then nodded as though that had to be the reason he felt like crap.

Dean wasn't so sure.

There was a beat of silence.

Sam sighed. "I think I'll turn in," he announced, still holding his left arm protectively against his side while using his right hand to grip the table and pull himself to his feet...and then promptly stumbling forward under a wave of dizziness.

"Whoa..." Dean blurted and was out of his own chair in the next second, standing beside his brother as Sam braced himself against the table. "Sammy..."

Sam said nothing, his head ducked; his breaths fast and shallow; his right hand splayed on the wooden surface while his left arm continued to guard his left side.

Dean felt a swell of panic. "Sammy..." the big brother tried again. "Hey. Talk to me. What's going on?"

Sam's eyes squeezed shut. "Hurts," he choked out over a moan as pain jabbed through his side.

"It hurts here?" Dean clarified, his hand now hovering over Sam's left arm.

Sam didn't answer but flinched at the anticipation of Dean touching him and causing more pain.

"Easy," Dean soothed, his mind racing as he stared at Sam.

Every instinct telling him to reach for his little brother...but experience – and Sam's reaction – warning against the potential of hurting Sam even more if Dean touched him before he knew what was wrong.

Dean nodded and scanned Sam instead, taking in every inch of his kid and then slightly crouching for a better look at Sam's face.

The big brother on high alert for any indication of what the hell was going on.

It didn't take long to figure it out.

Now that Dean wasn't self-absorbed and was actually paying attention, he could see that Sam was pale with a fine sheen of sweat glistening across his cheeks and dampening his bangs.

And that was never a good sign.

"Hey. Look at me..." Dean ordered, his voice quiet and his touch gentle as he nudged Sam's chin, urging his brother to look up.

Sam did so, carefully raising his head and blinking at Dean with eyes still squinted in pain.

Dean instantly reached for his brother, palming Sam's forehead and frowning at how cool and clammy the kid felt; then focused on Sam's chest, noting the quick, shallow breaths.

Dean felt his stomach twist with increasing worry as his hand slipped from under the wet strands of Sam's bangs and slid down the kid's temple and jawline. The big brother pressing his fingers against Sam's neck and narrowing his eyes at the weak but rapid pulse.

Dean stared at Sam as Sam blinked back at him.

"I think you're getting a little shocky on me, Sammy," Dean commented as though it wasn't a big deal.

As though Sam wasn't a lot shocky and had likely been that way for longer than just the few minutes it had taken for Dean to get a clue.

Sam said nothing as he continued to blink at his big brother in that detached way that was becoming too familiar.

Dean sighed, also saying nothing as he grasped Sam's shoulders and maneuvered the kid until Sam was no longer leaning over the table but was instead sitting on its edge and facing Dean.

"Let me see," Dean urged, carefully pushing away Sam's left arm and lifting the edge of his jacket along with the hem of his button-up shirt.

Sam grunted and then hissed in pain as Dean froze, staring in stunned silence at the left side of his little brother's torso.

Because this was bad.

This had the potential to be really fucking bad.

No wonder Sam's body was in shock.

No wonder Sam had been quiet.

It was hard to speak when you were bleeding out.

Dean shook his head in denial even as he continued to stare at the dark bruises that covered Sam's abdomen. His brother's entire left side stained by shades of blue on black with hints of purple and red where the blood had seeped internally and had pooled beneath the skin.

Dean's mind buzzed as it quickly cataloged the organs located on the left side of the body...and concluded without a doubt that Sam's spleen had ruptured.

There was no other explanation.

And there was no time to lose.

But Dean just stood there, swallowing against the rising panic as his gaze tracked the multicolored path that marred Sam's skin, visually following the edges of the bruises as they stretched outward. The internal bleeding eager to lay claim on all of Sam's organs, aggressively forging its path and marking its territory...marking Sam.

Every bruise declaring its victory as it leached away Dean's little brother.

Every faint discoloration promising to snatch even more.

Every spiny tendril of blood reaching and chanting mine, mine, mine.

Sam's body slowly and quietly being taken over by its own injury.

Dean shook his head again, refusing to allow anything to take his little brother from him.

Because Sam was his and he wasn't losing the kid like this.

Dean wasn't losing his kid.

Maybe he had been too preoccupied earlier to do his fucking job and watch out for his little brother...and maybe he needed his ass kicked for that.

But Dean's shitty attitude and equally shitty choices shouldn't cost him Sam.

Nothing would cost him Sam, and Dean could feel the Mark of Cain begin to burn at the perceived threat to his little brother; could feel the added strength and power only intensifying his already fierce protectiveness.

Dean released a measured breath, trying to remain calm even as his heart hammered in his chest. "Sammy..."

Sam blinked at him expectantly.

Dean hesitated, wanting to ask what had happened, wanting to ask everything he should've asked over an hour ago when Sam had first returned to the bunker...but knowing there would be time for that later.

Right now...

"We need to get you to the hospital," Dean announced, fisting Sam's shirt and carefully pulling the kid off the table and toward him.

Sam frowned in confusion and then winced in pain. "Why?"

Dean snorted even though he had expected that question from his out-of-it little brother.

"Because you're hurt," Dean replied, keeping his answer simple and his touch gentle as he wrapped his arm around Sam, holding him steady as they began to walk together.

"You can't fix it?" Sam asked about his injury, leaning heavily against Dean and sounding even more confused.

Dean smiled softly, touched that after all these years...after everything that had happened between them...Sam still believed his big brother could fix anything.

"No," Dean admitted, pausing and shifting to accept more of Sam's weight as they approached the stairs that led to the garage. "I can't fix it, Sammy. I need some help this time."

Because Dean was good at first aid and was the best at taking care of his little brother...but he still hadn't mastered the art of stopping internal bleeding.

"I can help you," Sam offered, breathless and increasingly disoriented from the blood loss; not realizing they weren't talking about fixing Dean's problem. "I can help you, Dean, if you'll let me."

Dean felt something twist in his chest at Sam's words but said nothing, too concentrated on navigating the steps with a weak, injured little brother to risk distraction by speaking.

Sam moaned as the repeated up-down motion caused pain to flare in his left side.

"I know," Dean soothed about his brother's discomfort. "Just two more steps, Sammy..."

Sam swallowed another moan of pain and nodded, his head now lolling on Dean's shoulder as any lingering reserve of strength had been zapped by the exertion.

"One...two..." Dean counted the steps and then paused again to shift Sam's weight against him as they prepared to cross to the Impala.

Years of experience allowing Dean to practically carry his little brother the distance, then prop Sam on his hip while single-handedly opening the passenger side door and gently maneuvering the kid inside; situating Sam on the seat before folding those long legs and tucking them in the floorboard.

Dean stood there for a moment, staring at as brother – Sam's head leaned back on the seat, his eyes closed, his features pinched with pain, his left arm held against his side as he continued to breathe fast and shallow.

Dean swallowed, refusing to be overwhelmed by the seriousness of Sam's injury...or by the flood of guilt he felt for leaving his brother unprotected on a hunt.

Because now wasn't the time for self-loathing bullshit.

Now was the time to haul ass to the hospital.

Dean nodded in agreement, closing the passenger door and then crossing to the driver's side. Sliding in behind the steering wheel and turning to reach in the backseat, grabbing the blanket they always kept there for easy access.

Without a word, Dean shook the fabric and spread it wide, covering his brother.

Sam turned toward Dean's touch but didn't open his eyes.

Dean's hand lingered in the middle of Sam's chest, rubbing a comforting circle before reaching for the keys still hanging from the Impala's ignition where Sam had left them earlier.

Dean cranked the muscle car, her engine roaring to life and then idling patiently as they waited for the garage door to go up thanks to a lift kit Dean had installed several months ago.

Seconds later, the Impala was out of the bunker and on the road.

Dean glanced in the rearview – double-checking that the garage door closed behind them – and then glanced at his brother.

"Sammy. You with me?"

Sam shivered beneath the blanket, confused and consumed with pain but his mind still focusing on the one person who always made everything right – Dean.

Sam didn't realize that he had actually spoken his brother's name until he felt a familiar hand affectionately brush back his damp bangs and then rest on his head.

"Dean..." Sam repeated.

"Right here," Dean assured, rubbing his thumb over Sam's forehead to help anchor his brother. "I'm right here, man."

Sam sighed, instantly soothed.

Dean lowered his hand, his gaze flickering between the road and his brother as he drove.

"Look at me," he ordered - needing to see Sam's eyes - and then waited for his disoriented kid to process his words.

After a few seconds, Sam did as he was instructed; his eyes narrowed with pain and exhaustion as he stared at Dean from across the bench seat.

Dean tried to smile. "That's better," he praised, wishing the knot of worry in his stomach would unravel.

But that was unlikely to happen.

Because Sam looked horrible – his skin so pale he looked grey, his sweaty bangs plastered to his forehead, his eyes barely open as he clung to consciousness for Dean.

"You're doing good," Dean assured. "Like fucking Superman," he added with a wink, knowing how much it took for Sam to stay with him, to resist the effects of blood loss.

After all, Sam's spleen had fucking ruptured and was flooding the kid's abdomen with blood.

Sam had every right to be blissfully passed out...but there he was, slumped in the passenger seat and blinking at Dean.

Dean tried to smile once more. "Talk to me," he told his little brother, eager to keep Sam awake. "Tell me what happened."

Because he was eager to hear that, too – eager to hear how much he had let Sam down so he would know how much guilt to drown in later.

Sam's eyes dipped closed before blinking open with more effort than usual.

Dean frowned at the sign of his brother beginning to lose the battle. "Sam..."

Sam sighed, his face twisting in response to the shudder of pain that passed through him with the simple exhalation.

"Easy..." Dean murmured and reached for his brother, carefully grasping Sam's knee and squeezing to remind his kid that he was there.

To his surprise, Sam reached back; slowly worming his arm from under the blanket and curling his hand around Dean's.

Dean glanced at the rearview, at the road...and then back to Sam before lacing their fingers and feeling a strange sense of peace wash over him. Contact with Sam somehow calming the constant burn in Dean's right arm and quieting the equally constant hum of rage – the two most persistent effects of the Mark instantly soothed by his little brother's touch.

Dean smiled his relief at the realization and sighed as Sam's fingers twitched within his grip.

There was a pause.

The Impala's engine rumbling, her tires roaring on the asphalt as miles passed beneath them.

"What happened?" Dean asked again, wondering if Sam would even remember, would even know what he was referring to.

But the information was crucial – what had happened on the hunt? What had caused Sam's injury? Or more importantly...who?

Because whoever had hurt Dean's little brother would be dead whenever Dean found them.

Dean nodded in agreement; the anticipation of violence causing a fresh flare of heat as the Mark burned hot on his arm...and then faded almost as quickly as Sam's hand squeezed Dean's, seeking reassurance.

"I'm right here," Dean promised his injured little brother and rubbed his thumb over Sam's knuckles, keeping his attention divided between the road and his kid. "Sammy. What happened?" he repeated, his tone reflecting the urgency of their situation.

Because Sam was on the edge of consciousness...and Dean needed to know what had happened to his brother before the kid could no longer tell him.

Sam sighed. "Nun."

Dean frowned. "None? None what?"

What did that mean?

"No. A nun," Sam attempted to correct and shifted in the seat, restless and uncomfortable.

Dean's thumb continued to rub over his brother's hand. "Okay..." he allowed, trying to process Sam's words and wondering if the kid even knew what he was saying. "What about a nun?"

Sam swallowed. "A demon nun," he added, knowing that detail was important. "She was working for Ab-Abaddon. Harvesting the souls..."

Dean nodded at the reminder of what Abaddon was doing to innocent people.

But that wasn't his problem right now.

Sam was Dean's only focus.

"This demon nun...she's the one who did this?" Dean asked, his gaze settling on Sam's left side where the kid's blood was continuing to pool beneath his skin and layers of clothing, an unseen threat.

Sam nodded. "She c-caught me holding one of the bottles with the s-souls and then she...she threw me across the room."

He paused.

"I never saw her coming, Dean. She was just...there."

Dean clenched his jaw, staring out the windshield and feeling a fresh twinge of guilt.

Because if he had been there watching Sam's back, then he could've warned his brother, could've prevented that demon bitch from ever touching his kid.

But no...

Dean's grip tightened around the steering wheel while his other hand remained relaxed, gently rubbing Sam's knuckles, back and forth.

"Then what?" he prompted when Sam fell silent. "After she threw you, is that when you got hurt?"

Because that would make sense.

If Sam had been thrown hard enough and had landed at the wrong angle...

"I think so," Sam replied, sounding uncertain. "I mean...it hurt. But it hurt worse after the second time."

"The second time?" Dean echoed, feeling his anger return. "How many fucking times did she throw you?"

Sam seemed to consider the question. "Twice. Then she started to choke me, so I – "

" – choke you?" Dean interrupted, his anger and guilt warring within...because he should've been there.

Sam shouldn't have faced that attack alone.

But he did.

And now Sam was hurt – severely hurt – because Dean had let him down.

Dean sighed, trying to keep hold of his temper. "She choked you?" he repeated, glancing at Sam's neck and noticing finger-shaped bruises that he hadn't seen before.

Sam nodded.

Dean waited for more.

But Sam didn't continue, his eyes dipping closed instead.

Dean shook his head. "No, Sammy. C'mon, man. Stay with me. Finish the story. What happened after she started to choke you?"

Sam sighed, feeling Dean's thumb rub more vigorously across his knuckles before gently shaking his hand to further rouse him.

"Sam..."

Sam sighed once more and opened his eyes. "I tried to do the exorcism…but I…I couldn't get the words out."

...which wouldn't have been a problem if Dean had been there to say them...or if he had been there to distract the bitch while Sam had said them.

"But I...I had recorded it on my phone..."

Dean smiled, proud of his smart kid.

"...so I played it...and...well...long story short..." Sam abruptly summarized, because he was quickly running out of breath and energy. "I stabbed her in the back."

Dean arched an eyebrow, wondering how an exorcism had ended with having to use the demon knife...but figuring those details didn't matter.

"Ding dong the bitch is dead."

Sam twitched a smile. "Yeah."

Dean nodded, further absorbing the story and feeling his chest tighten with renewed guilt.

Several minutes passed, Sam's eyes once again closing but his grip remaining strong around Dean's hand – both brothers anchoring each other.

"I'm sorry."

Sam's eyes opened to thin slits at the sound of his brother's apology.

Dean stared out the windshield. "I'm sorry I wasn't there for you, Sam," he continued. "You asked me to come, and I just – "

" – you lied," Sam finished, his tone not accusatory...but just stating the facts he already knew.

Dean blinked.

Sam twitched another smile, amused by Dean's surprise. "I'm not stupid," he whispered, his voice hoarse and breathy. "I knew you weren't at home."

Dean glanced at his brother across the bench seat.

"I could hear the music," Sam continued, explaining how he knew Dean wasn't researching at the bunker that last time he had called. "I could...could hear the music and the people in the background. And I knew...knew you were that bar..."

That bar down the street from the bunker.

Dean said nothing...because what was there to say?

"S'okay," Sam mumbled, his eyes dipping closed. "I know y'got a lot on you right now. And I know y'just wanna be alone. But..."

He swallowed.

"I just miss you," Sam confessed to his big brother, his walls completely gone as the blood loss dissolved any inhibitions. "I really miss you."

He paused to inhale a shaky breath.

"And I really hate the lying, D'n. Always lying..."

And again, Sam wasn't trying to start an argument, wasn't placing blame or accusing Dean of anything.

He didn't have the strength or the clarity of thinking for any of the games they typically played.

This was just Sam stating how he felt without his usual filter.

Dean's jaw ached, not quite sure what to say in return as he resisted the surge of emotions clogging his throat.

The big brother suddenly reminded that despite what had happened between them, despite what had been said between them over the past few months...his little brother did still love him, did still need him, did still want him in his life and by his side.

I really miss you.

Dean nodded – because he had missed his brother, too – and then frowned as he realized Sam was quietly listing towards him.

And that was fine.

Sam could rest against Dean.

But Sam could not lose consciousness.

Not yet.

"Sammy..." Dean called and squeezed his brother's hand. "Open your eyes. We're almost there."

And they were, the hospital's sign appearing on the horizon.

Sam grunted but opened his eyes, bleary and barely awake.

Dean smiled. "Good. Good, Sam. Just stay with me..."

Sam blinked long and slow, continuing to stare at his brother.

Less than a minute later, Dean was parking the Impala and crossing around the front of the car, opening the passenger door and reaching for Sam.

Seconds after that, Dean was barging through the automatic doors of the ER, supporting most of Sam's weight and demanding help for his injured little brother.

The receptionist stared up at them, unimpressed. "What's wrong with him?"

Dean glared, not having time or patience to play a round of 20 questions with this woman.

"I think his spleen is ruptured," Dean reported about Sam, the kid only on his feet because Dean was holding him up.

The receptionist pulled a face, looking doubtful at Dean's diagnosis and on the verge of telling them to have a seat in the waiting room with all the other patients who had already been there for hours.

But Sam didn't have hours.

Sam needed help right fucking now.

Dean lowered himself to lean forward over the counter, eye level with the receptionist and holding her gaze as he spoke in an eerily calm, quiet voice.

"Believe me when I tell you that you don't want to fuck with me."

Because Dean could feel the Mark once again beginning to burn at the threat of Sam's condition worsening because the bitch behind the receptionist desk was denying the kid immediate access to a doctor.

"D'n..." Sam called, the word slurred but his intent clear as he squeezed Dean's arm, trying to curb his brother's rage even as he suddenly slumped against him, unconscious.

The receptionist's eyes widened. "Oh my god..." she gasped, seeming to realize that Dean wasn't bluffing about his brother's condition.

But Dean ignored her, readjusting his hold on Sam and then glancing at a man in scrubs approaching from the right.

"What's going on?"

"Ruptured spleen," Dean reported as he continued to support this limp little brother, not having time to elaborate but thankful for the doctor's immediate response.

Because within seconds, Sam was on a stretcher and being wheeled back to one of the curtained cubicles.

A flurry of activity surrounding Dean's kid as nurses came and went, asking questions – what happened...what's his name...what's his blood type...does he have any allergies – all while stripping Sam's clothes, taking his vitals, and hooking up IV lines...then attaching other monitoring equipment before acknowledging additional orders and filling syringes.

"Wait. What's that?" Dean asked, placing his hand over the port that offered a straight shot into Sam's bloodstream.

The nurse smiled, understanding a protective big brother standing guard and wanting to know what was being pumped into his little brother.

Especially since that little brother hadn't regained consciousness.

"This is for pain," the nurse told Dean, gesturing to one of the syringes. "And this is something to help bring up his blood pressure," she explained about the other, not naming the medication since she knew it would mean nothing to Dean. "Sam's lost a lot of blood, so his pressure is dangerously low...which could further stress his systems and damage his organs."

Dean swallowed – appreciating her honesty even if it felt like a blow to the gut – and then nodded, removing his hand and allowing the nurse to inject the medications.

Sam remained motionless, unaware of a nasal cannula being placed over his ears and under his nose to help him breathe. Not noticing the bag of blood being brought in to join the bag of saline as the ER staff fought to restore the balance disrupted by the hypovolemic shock caused by the prolonged internal bleeding.

Dean remained by his brother's side, standing next to the bed and once again holding Sam's hand as he watched the nurses tend to his kid.

Minutes passed before the doctor from earlier reappeared, pushing a machine on a cart.

"Portable ultrasound," the doctor commented, washing his hands and gloving up, then crossing to Sam as one of the nurses lowered the sheet and lifted their patient's gown.

The doctor let out a low whistle at the sight of Sam's bruised skin; the kid's entire left side a huge blot of blue and black and purple.

"Oh, yeah..." the doctor agreed about Dean's diagnosis of a ruptured spleen. "I think you're right. But let's see just exactly what we're dealing with..." he cautioned, accepting the gel and the wand from the nurse and setting about his task.

Dean continued to hold Sam's hand, staring at the screen showing the inside of his brother and displaying Sam's organs in shades of grey and black.

The doctor pointed. "Right there..." he identified and nodded. "Yep. Right there."

Dean leaned closer and arched an eyebrow, not exactly sure what was right there except a darker shade of black.

"That's the blood seeping out of Sam's spleen," the doctor explained. "All of this..." he clarified, waving his hand around a relatively large section of black on the screen. "All of this is blood going where it doesn't belong...where it's not supposed to go."

Dean frowned.

Because he wasn't a doctor...but that looked like a shitload of blood that was out of place inside his little brother.

The doctor nodded. "You're right," he agreed, seeming to read Dean's thoughts. "But you already knew that your brother had lost a great deal of blood."

Dean returned the nod.

"And although it looks bad, it's certainly not as bad as it could be. Sam's already beginning to respond to treatment, which is an excellent sign. His prognosis for recovery is good."

The doctor paused.

"How did this happen?"

Dean didn't hesitate, not needing a cover story to explain this injury.

"He was in a fight."

The doctor cringed. "Must've been one hell of a fight," he commented about the brutality it would take to cause this level of splenic rupture...not to mention the other bruises that surrounded Sam's neck as if whoever had attacked him had also tried to choke him.

The doctor sighed, hating what people did to each other.

"Were you there?"

Dean clenched his jaw at the question, feeling a fresh stab of guilt and the burn of anger as he shook his head.

The doctor nodded, sensing Dean's barely contained rage. "I understand. I have a kid brother, too. And if somebody had done this to him..."

His voice trailed off.

"Anyway...you did the right thing bringing Sam in as quickly as you did. Another half hour and..."

The doctor's voice faded once again, the implication clear.

Another half hour and Sam would have likely been dead...or at least too far gone to bring back.

And while Dean was thankful he had gotten Sam the help he needed in time, Dean wished he had noticed sooner, had brought Sam in sooner.

He sighed, not wanting to think about it.

"So...now what?"

"Well..." the doctor began, handing the ultrasound wand back to the nurse and crossing again to the sink. "Years ago, we would be taking Sam to surgery," he replied, trashing his gloves and washing his hands. "But now we understand the importance of the spleen's role in immunity and aren't so quick to perform a splenectomy. Now we take a different approach."

"Okay..." Dean drawled, glancing at Sam as the nurse wiped the gel from his brother's skin before lowering Sam's gown and smoothing the blanket over his chest.

Dean glanced back at the doctor.

"So what's the plan?"

Because Dean needed to know how they were going to fix his little brother.

"Wait and see," the doctor answered, drying his hands and facing Dean. "We admit Sam for observation for 24 to 48 hours. We administer medications to help manage the effects of bleeding. We restore what has already been lost. And we hope like hell this situation will begin to resolve itself and surgery can be avoided."

Dean nodded. "But if not?"

Because they needed a Plan B since things rarely turned out well for them.

The doctor shrugged. "If not, then we'll do the splenectomy and take it from there."

He paused, accepting Sam's chart from the nurse and scanning the monitors before jotting notes.

"But like I said, Sam's already doing better than when he first arrived. And I'm confident his condition will continue to improve."

He paused, reading what he wrote before signing beneath it.

"I'll check back in a few hours once Sam is transferred from the ER and settled in a regular room upstairs," the doctor told Dean. "Until then, the nurses will keep check on everything. And you're staying with him, correct?"

Dean nodded.

Hell yes he was staying with Sam.

The doctor smiled, one big brother understanding another. "Good. If you need me, have a nurse page me. Otherwise, I'll see you both in a few hours."

And with that, he was gone – handing the chart back to the nurse and wheeling the portable ultrasound from the cubicle.

The nurse blinked at Dean. "Do you need anything?"

Dean snorted, because he needed so many things...none of which this woman could give him.

He needed his brother to wake up.

He needed this Mark of Cain off.

He needed Abaddon dead.

But none of that was happening tonight.

Dean sighed. "No," he told her and finally sat in the chair positioned beside the bed, rubbing both hands over his face.

The nurse nodded. "Okay. I'll be around if something changes...if he needs me," she added, gesturing at Sam and then leaving the room, pulling the curtain closed behind her.

Dean sat in the silence, listening to the monitors and staring at his brother, willing Sam to open his eyes.

But Sam didn't move, deeply unconscious from the trauma his body had sustained on a hunt gone wrong.

A hunt gone wrong because Dean hadn't been there to watch the kid's back.

Dean snorted his disgust with himself. "I'm sorry, Sammy..." he whispered.

The big brother silently vowing to never leave his little brother unprotected again; to never allow Sam to be blindsided by an attack; to never not be there when his kid needed him.

I really miss you.

Sam had said it...and Dean had known exactly how he felt.

Dean smiled sadly and sighed once more as he reached for Sam, not knowing what else to do in that moment but needing to touch his kid.

When the nurse peeped around the curtain an hour later to check on her patient, her heart warmed at the sight of Sam's brother holding his hand and softly humming some song she didn't recognize.

FIN