Summary: Dean smelled the old grease they had used to make his fries, he saw the smoke left over from making his hamburger in the open kitchen, but he didn't hear his brother taking a breath.

Disclaimer: Whish I would own them …

A/N: This is a "first" in many ways. The first time I wrote on request with a specific theme. The first time I actually did research (I apologize for any incorrect use of medical treatment, I researched as much as I could and made up some of the stuff towards the end). The first time I wrote such a long text in English. The first time I used English words I have never heard before (because I have no further experience with medical jargon beyond the occasional hospital show). The first time I really wrote limp!Sam. … Yet some things stay the same. I still tend to write from Dean's perspective. I still can't write normal and need to find a special way to tell my story. Sorry if it irritates anyone, it's just my style.

This fanfiction was specifically written for Faye. It was her request in the course of the SFTCOL(AR)s Summer Fic Exchange: Round Two. I hope you enjoy reading it as much as I enjoyed writing it!

Thanks to my wonderful betas: Bayre, AnickaMarie and ScaredofPennies. Any mistakes left are my own.

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Out of breath, out of time

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"You really want to eat that?" Dean asked pointing incredulousy at the salad opposite to his own plate full of french fries and a big hamburger. They had successfully finished their hunt for an ugly poltergeist in Alabama and were now halfway through Kentucky heading to Illinois to kill a Piasa Bird. Sitting in a greasy, nearly empty diner was their form of a well-deserved rest in between.

"It's healthy, you know. You could try it, too." Sam's answer was accompied by several coughs.

"I'll pass," his brother grinned. "Look at you. Eating healthy, right-turning stuff all time and getting a cold all the time, too."

Sam raised questiongly an eyebrow. "Right-turning stuff?"

"Probiotic yogurt … do you ever watch ads?" Dean took a bite of his burger. "Now that you ask, I don't know if the right or the left-turning bacteria in yoghurt is good for your gut flora."

"Stop." Sam sighed. "Why did I even ask?"

"Because youcan always learn something from your big brother." Dean smiled, pleased with himself.

Doctor Hannah Sandström sighed and looked at the nurse to her right side. "Why is it that time of the year again so soon, Melinda? And why me every time?"

"Bcause they like you. You don't scare them off."

"My next New Year's resolution: Get meaner." She wiped a dark hair strand out of her face and secured it behind an ear.

Melinda laughed, then gave her a slight shove outside the nurse's room. "They won't buy it. Hurry off, they're waiting for you."

Hannah murmured something undistinguishable before switching to a smile and entering the waiting room of the small hospital in central Kentucky. Four new interns stood up quickly as she entered.

"Okay, guys – and girls. Ready for being shown around and the twenty-eight-questions to show me how much you learnerd in medical school?"

"So what do we know about that feathery thing?" Dean slurped his soda and leaned against the red leather of the booth. While his plate was already empty, his brother still attacked his meal with a fork like it was his enemy.

"It's a big bird. Its original name 'páyiihsa' apparently comes from some supernatural dwarves who are said to attack travelers and - "

"Supernatural Dwarves? Why can't we hunt them instead? Sounds like more fun," Dean interrupted. Sam just rolled his eyes.

"Anyway, three hikers vanished in the woods near Elsah, Illinois, and were discovered slashed to death some days later. Coroner's report says the wounds didn't look like claws but were more likely wounds made by a beak … as they didn't know what bird could kill people, they decided to announce the hikers were mauled by a cougar."

"So how do we kill it?"

"Poisoned arrows."

"Sounds like fun, after all." He looked at the still nearly untouched salad in front of his little brother. "If you want to lift the crossbow you have to eat something." Sam glared at him and lifted a fork full of cucumber to his mouth.

"And here is one of our treatment rooms. That's enough of a tour, now to find out if you still remember the basics from medical school. Let's see … what's the most common cause for choking?" She looked expectingly in the faces of her new followers.

The young woman with the short red hair raised her hand. "A foreign object is lodged in the airway."

Dean was pleased to see his little brother eating after all and since he know that his little geek didn't like to be watched while eating he busied himself with the printouts about the Piasa.

"That's right, but as we can't exactly see that happen, what signs of choking can we register?," Hannah asked while leading her students down the corridor.

Ray, if she remembered correctly, answered: "The person usually clutches his neck, is unable to speak and his breathing sounds wheezy. Also his attempts at coughing are silent."

At first Dean didn't recognize the sound he heard as something abnormal. Sam had this cold for a week and his breathing had sounded a little funny since then. Only when the fork clattered to the smooth surface of the table did he raise his eyes from the papers.

Sam looked scared.

That was the first sign Dean noticed when he looked at his sibling.

He didn't understand it. They were sitting in a rundown diner in a town whose name he had forgotten ten seconds after arriving. They finished one hunt and hadn't started another one. There were no demons, no poltergeists, no spirits in sight. Sam hadn't a vision, he would be clutching his head – the realisation hit Dean like a brick wall. Sam wasn't clutching his head but his neck. In an instant Dean was around the table at his brother's side.

"Sam?" His brother didn't answer.

"Assume you're out on the streets, enjoying your spare leisure time and you see a person choking. You don't have any medical equipment at hand. When the person is still conscious, what do you do?," Hannah asked over her shoulder when she opened the door to one of the hospital labs.

"Get the victim to lean slighlty forward, then give up to five sharp blows between the shoulder blades with the heel of your hand." Ray gave the answer in one rush, he seemed to like that topic.

Dean acted on instinct and slapped his slumped brother on the back.

"Sammy?" His brother still gave that awful wheezing sound.

"What's happening?" Dean jerked at the sudden touch on his shoulder. "Oh my god, is he choking?" He distantly remembered the smell of the perfume. The hand on his shoulder belonged to the waitress he had talked to at the counter. She had sounded flirty and mischievious back then, now she just sounded scared. "I'll call an ambulance."

"And if that doesn't work you should use the Heimlich maneuver", now the other men in the round spoke, apparently he had had enough of Ray running the show alone. "You stand behind the victim, put both your arms around the upper part of his abdomen and lean the patient forward. Then you clench your fist and place it between the umbilicus and the bottom end of the sternum. After that you grasp this hand with your other hand and pull sharply inwards and upwards."

Dean's thoughts raced in so many directions at once he couldn't catch a single one. He could deal with ghosts throwing them around, he could cite half a dozen exorcisms in Latin by heart, yet his mind refused cooperation when his little brother was choking to death next to him.

Sam's lips were turning blue.

Dean stared. Sam's lips were turning blue. He had to do something. Suddenly words like 'breastbone' and 'pull' filtered through his hazy mind and he remembered the instructions their dad had given them such a long time ago like it was yesterday.

Sam didn't offer any resistance when Dean put his arms around him, linked his hands together and pulled sharply.

Dean smelled the old grease they had used to make his fries, he saw the smoke left over from making his hamburger in the open kitchen, but he didn't hear his brother taking a breath.

"Come on, Sammy. You were the one that chose to hunt that bird, and now I'm supposed to do it all alone?," he whisphered in the ear of his unresponsive little brother when he pulled for the third time. "Sammy, please."

They had finished their tour around the lab and were now heading back to the emergency room. As they waited for the elevator, Hannah directed one last question at her interns. "Now I'm mean. What do you do when the Heimlich manoveur doesn't work and the person becomes unconcsious?" She looked at Maria, the only person in their little group who hadn't uttered a single word till now.

"You … you start performing CPR, it should hopefully dislodge the item sufficiently for air to pass it and of course you call an ambulance."

Sam was unconscious and didn't breathe.

Dean nearly started to laugh. Sam couldn't not breathe because that meant he was dying and dying was not an option. Dean hadn't any soul left to trade to get Sam back. If Sam died now it meant he was gone for good and the feeling of being the only one left behind was something Dean refused to live through ever again.

"The ambulance is on its way. They will be here in a few minutes." He had all but forgotten that he wasn't alone with Sam. The waitress had called help. Only a few minutes now and then Sam would get the treatment he neeeded. Now Dean only needed to ensure that his little brother survived those minutes.

Carefully he lowered Sam to the ground and tried not to notice the palor of his skin or the way the blue of his lips had darkened or that his eyes were closed. He looked so much like the day he had died in his arms, Dean wanted to run and hide and never come back to look at him again. Instead he tilted Sam's head back and lifted his chin.

"Come on, Sammy." He waited a few seconds to see if the change in position had triggered any chest movement, but he had no such luck. He placed his hands in the center of Sam's chest and started to apply pressure. After several compressions he breathed in Sam's mouth to give him the much needed oxygen.

"All your answers were correct," Hannah looked pleased, "but remember, as clinically as you quoted your textbooks, for the person actually experiencing the choking and the person who has to perfom the rescue, it can be quite traumatic. Now let's see how many patients are waiting for us."

'This can't be happening.' As Dean stared at Sam's unmoving chest he wondered if some ancient dust-covered textbook contained a soution. An answer to how one could trade a life for a soul one didn't own anymore or how he could go back in time and toss this cursed salad in the trash before Sam could even glance at it. He couldn't loose Sam. They still had nearly a year together, they still hadn't seen the Grand Canyon, they still had too much to do and to say to each other. Sam wasn't supposed to go before him. They had done that and that wasn't an option for repeated performance. Yet looking at the unmoving chest of his kid brother Dean couldn't help but feeling as if his soul had been taken from him way too early.

"What do you have for us, Melinda?," Hannah asked.

"Paramedics should arrive with a case of airway obstruction in a few minutes."

Sudden movements disturbed Dean's thoughts and he lost the contact to the still body. He sat on the floor next to his brother, suddenly surrounded by too many people for a diner which minutes ago had been nearly deserted.

One of the paramedics moved into Dean's view. "Sir? Can you tell me the name of this man?"

Dean blinked a few times before he could bring himself to answer. "It's Sam, Sam Winchester. I'm his brother, Dean."

"Okay, Dean. We're taking Sam to the hospital in town. We don't have any space for you in the ambulance, so you will have to follow us. That's okay?" Dean could only nod.

"Male, white, mid twenties, name Sam Winchester, choked on salad. Attempts at Heimlich manoveur and CPR by his brother were unsuccessfull. We did a laryngoscopy and successfully removed the obstruction. He started breathing on his own during the drive, but is still unconscious," one of the paramedics reported to Doctor Sandström as they wheeled Sam on a gurney into the emergency admission.

Hannah turned to her interns. "Next thing to do?"

"Check for injuries caused by the pressure to the chest. Rip fractures are common and also the rupture of the spleen and the liver," Ray stated.

"Get me his stats and then take an ultrasound and x-rays," Hannah ordered.

Dean stood in the entrance to the emergency unit, having broken a dozen speed limits on his way. He was relieved to hear that Sam breathed on his own and shocked to hear that he could have harmed his little brother with his rescue attempts.

He managed to make it to one of the chairs in the entrace area before his trembling limbs made it impossible for him to stand any longer. His face buried in his hands he tried to block the images of lifeless Sam out, but failed miserably. Biting his lips till he was sure he drew blood was the only thing keeping him from screaming out loud at seeing Sam choking mingled with Sam being stabbed to death.

"Dean Winchester?" A soft voice reminded him of a world outside his dark thoughts. He spotted the doctor who ordered the tests on Sam in front of him. She smiled at him. "I'm Hannah Sandström. Sam's attending doctor."

In one single move Dean stood up. "How is he?"

"His oxygen levels were low, but that was to be expected, so we have him on an oxygen mask for now. His ultrasound and x-rays came back negative, nothing internally bleeding or broken. Though his ribs are a little bit bruised so he will be sore for a few weeks and sporting some quite colorfull streaks on his abdomen. But don't worry, that may be painful, but it's nothing serious. You can go sit with him now. He's awake and groggy, but he has already asked for you."

"Thanks."

"No problem, that's my job. His room is down the corridor, second door to the right."

Dean followed her directions and found Sam trying to get up.

"Hey, hey! What are you trying to do there, Sammy?" He put a hand on Sam's shoulder and stilled his movement. Sam pushed the mask from his face.

"What does it look like?" Sam coughed a few times and Dean thought it looked like a really dumb idea. "I'm getting out of here," he rasped and had already slid one leg from under the convers.

"Sammy, you sound like an old woman who hasn't used her voice in a century. No way I'm letting you leave the hospital so soon. Now put your leg where it belongs – and that mask is supposed to cover your mouth."

Apparently Sam hadn't heard him or he had just decided to ignore him – wouldn't be the first or the last time.

"They called me Sam Winchester. You gave them our real names, Dean!" That was a fact Dean had actually forgotten in the whole 'my brother is choking to death'-scenario. "We don't even have an insurance card with our real names." The last words were already mumbled as Dean gently lowered his brother back on the bed.

"Don't worry about it. I'll use my charm to keep the nurses from asking about insurance for a few hours while you rest. Then we leave. Okay? He put the mask back in place and sat down in a chair next to Sam's bed. His little brother made a sound that sounded remarkably like a chuckle and nodded while his eyes drifted shut.

"Oh, and Sammy?"

"Mhhm."

"You're so not getting healthy stuff ever again."

- fin