Word Count: 2,900
Summary: Dean's expertise at field surgery is put to the test.
A/N: Written for a prompt by madebyme_x who wrote this for the ohsam comment fic meme: Without a hospital nearby, Dean is forced to carry out some emergency surgery on Sam (ie a chest tube or something equally as serious). Maybe Dean calls someone for advice and they guide him through it step by step or maybe he has to do some super fast research and he's all on his own.
Gen with plenty of h/c, freaked out Dean and maybe even some supportive Sam telling Dean everything will be OK and that he trusts his brother.
Warning: this unbeta'd and most likely a crime against the English language. Also, I'm not a medical expert by any stretch of the imagination and most of the medical stuff in this is completely made up, so don't try this at home, kids.
Of Little Brothers and Pointy Things
Flying through the air after being tossed by a pissed off spirit was never the hard part. The hard part always came a split second after that when soft, tender flash met hard, unyielding earth.
This time really wasn’t any different.
Except that it was.
As soon as he landed and felt the searing, piercing pain in his chest, he knew he was in deep, deep shit and rolling over to find that he had landed on a large, sharp branch only confirmed it.
He turned onto his back just in time to see old man McGee burst into flames with a howling screech. At least Dean had managed to get the bones of the mountain hermit who thought any hikers venturing near his cabin in the Ozarks were fodder for his murdering spree set ablaze, but he really didn’t have the presence of mind to focus on that positive aspect of the hunt as his eyes settled on the inch wide, two feet of tree branch sticking out of the right side of his chest.
He laid there stunned, unmoving, watching the rough pole of wood rise and fall rapidly with his panting breath.
Oh shit oh shit oh shit … get it out get it out get it out!
Without really thinking, he did the only thing that made any sense – he pulled it out.
Belatedly he realized what a terribly stupid and painful mistake that was. His vision exploded into tiny sparks accompanied by a sickening sucking sound and a stabbing, crushing spike of agony worse than any gunshot wound or broken limb combined.
He cried out, his hand still clutching the natural spear he had just removed from his body, unmindful of the blood that coated it and slid down to drench his fingers.
“Sam!” He could barely hear the noise of his brother rushing towards him as his heart hammered away, furiously pumping blood out of the hole and soaking his shirt.
He turned wide eyes on Dean who had come to his knees beside him while black spots crowded his sight and blotted out the image of his brother’s freaked out face.
“Shit … Sammy … what did you do?” Dean asked, panic pouring from his voice as he grabbed the bloody branch from his hand and shook it.
He opened his mouth, but couldn’t answer … air was becoming harder and harder to suck in like breathing through a juice-box straw and he was suddenly taken over by a wave blast of chills racing through his shaking body.
His awareness came and went after that.
He didn’t even realize that he was still holding the goddamned stick until he saw the blood that decorated it dripping onto the dried leaves scattered on the ground below. Flinging it aside like it was made of molten metal, Dean swallowed hard, his emotions warring within.
First to hit him was anger, “Christ, Sam … why did you pull it out?” he asked of his injured brother, letting his uncontrolled rage and fear take over. Shit … how many times had their father drilled into them that if they ever got stuck like this to leave the damned thing in so they wouldn’t bleed to death?
Sam shook his head, hurt and shame etched into his pale and clammy face while his eyes drooped and struggled to remain open, “s –sorry … not thinkin’ …”
Dean’s anger fled as quickly as it had come on seeing his little brother in such pain – and the blood – it was everywhere -- there was so much of it – too much. It spread across Sam’s chest and grew – he wasn’t going to last long if something was done right the fuck now.
Sam was quickly bleeding to death, but here wasn’t any way on this Godforsaken planet Dean was going to let that happen.
His first aid training and instincts to save Sammy switched on like a light bulb. All at once he went from angry fear and helplessness to centering all of his energy and focus on stopping the crimson flow of blood escaping from his little brother’s body. Dean pulled at the collar of Sam’s flannel shirt, popping off the buttons in one swift motion before using his bare hands and fingernails to tear the t-shirt under it away.
Sam shivered as soon as the night air struck his exposed chest, cooling his blood soaked skin and he groaned deep in his throat the moment Dean took the tattered remains of the t- shirt and pressed down hard onto the gaping hole in Sam’s chest.
It soon became clear to Dean that pressure alone wasn’t going to stop his brother’s blood from draining out of the wound. It quickly saturated the t-shirt and even after Dean’s tore off his own shirt to aid in the effort, it too was soaked. There was just no stopping it and whenever he lifted the clothing off to check the flow, it hadn’t slowed down -- not even a little.
Sam faded in and out of consciousness as the minutes ticked by, but during one of his more lucid moments, he weakly grabbed the hand Dean had covering the wound, “D – don’ feel good.”
“I know, Sammy … just hang on.”
“N –nuh … too fast … ar - art--…” Sam drifted off once more, his head rolling to the side, and leaving his sentence unfinished.
Dean patted Sam’s cool and sweaty face, just wanting him to stay with him and reassure him that he wasn’t going to slide into a coma, or worse. Sam wasn’t allowed to die like this – not on his watch – not when he can still save him, “C’mon, … stay awake for a sec … what do you mean ‘art’? … What does that mean? … c’mon, wake up … you gotta give me a little more than that.”
Sam made a little pained noise and open his eyes to slits, whispering, “Artery … Dean …”
Oh Crap …
The branch must have nicked an artery on either its way in or out and Dean could have kicked himself for needing his injured brother to point that out – just how stupid was he?
Dean tried to push his self-bashing aside and think – what did he have that could put a stop to this bleeding?
They always carried a little first-aid kit with them whenever they hunted, especially when they were going deep into uncivilized areas like the one they were at, but it was rather limited, and contained mostly just an assortment of bandages and antiseptics. But maybe there was a chance that Sam had packed something in there that Dean wouldn’t have thought to bring – he was always doing anal things like that and Sam had been the one to carry the kit in his backpack with them this time.
Dean tossed his head around, looking around to see where his little brother might have dropped it. He spotted it only a few feet away from the still smoldering and open grave they had dug up in the middle of the empty forest.
Letting go of the shirt he’d been pressing into the wound, Dean grabbed Sam’s hand.
“Hold this.” He ordered his brother, making him take up the applying pressure duties even though Sam’s hand was limp and he was barely hanging onto consciousness.
Sam nodded sluggishly before Dean ran, covering the twenty feet to the bag in a dead sprint, snatching it up and dashing back. He zipped the sack open and dumped the entire contents onto the ground, finding the first-aid kit under a rolled up pair of socks.
Dean pried the kit open and saw that Sam had indeed stocked the thing with a few extras. Inside were pressure bandages, gauze, a couple of suture kits, aspirin, alcohol, and a pair of scissors. But the one thing in there that he found and he could have kissed Sam and his damned OCD for was a shiny, stainless steel pair of hemostat clamps. Why Sam had decided to included them in the kit, he didn’t know, and he really didn’t care – he was just glad to see them.
Now … Dean had seen his fair share of injuries – had patched up and sewn up cuts, bullet wounds, and gashes – had watched Dr. Sexy faithfully (secretly) and he knew a good amount of first aid, but he was far from being a doctor and the thought of what he needed to do in order to stop his brother from hemorrhaging to death sent a shiver of fear down his spine.
He had never done this before, though he remembered a hunt back when he was sixteen. Dad had taken down a rugaru, but not before the damned thing had taken a good sized chunk out of his leg, causing great big spurts of blood to come gushing out.
Thank God Caleb had been along for the hunt that time around. He had served as a medic in the Army before becoming a hunter and Dean recalled being so relieved to have him nearby since Dean didn’t have a clue as to what he should do. Caleb had been so cool – running back to his truck and grabbing his well-stocked medical kit. Dean could only stand by and watch as his father’s friend deftly took out a pair of clamps, and dug into Dad’s leg.
“Faster and better than a tourniquet.” Caleb had explained while Dean tried his hardest to keep his lunch from making an encore appearance and his Dad stoically bore the pain.
It only took a few moments and when Caleb was done, he had Dean help him get his father to the car and to the nearest hospital. Caleb had made it all seem so easy, but Dean didn’t have the same confidence in himself that he could do this with anything close to the skill Caleb had shown.
Dean grabbed the clamps and the bottle of alcohol with nervous fingers, pouring a healthy measure of the sterilizing liquid over the instrument. It wasn’t necessarily sterile even with the antiseptic and he had no gloves, but he was more worried about performing the next step correctly without doing more damage than he was in hygiene.
Scooting closer, Dean carefully removed Sam’s lax hand from the shirt that was useless in staunching the blood. Sam was even paler than he had been only two minutes earlier, but his eyes were still open as he stubbornly tried to stay awake. On one hand, Dean was glad that his brother was still alert, but on the other, he dreaded the fact that Sam would be awake for what he had to do – there wasn’t going to be any painless way he could do it.
“Sam?” Dean asked, placing a hand on Sam’s forehead, feeling the slick, clammy skin, “I gotta clamp that artery ---“
“’kay.” Sam replied almost inaudibly, blinking slow – dying – Dean pushed that thought out of his mind as Sam looked up at him with complete trust -- trust that Dean hoped to God wasn't misplaced.
Dean grabbed the branch that was the cause of all of their troubles and broke it in half, offering the end that wasn’t coated in his brother’s blood to Sam, “Here … bite down on this.”
Sam’s eyes widened a little and he shook his head, clearly not friends with this particular stick.
“C’mon … it’ll help.”
Sam sighed, but relented and let Dean place the stick in his mouth. Even after losing so much blood and poised to knock on heaven’s door, he still could pull off the bitchiest of faces and Dean felt a sliver of hope worm its way into his chest.
“Try to hold still, okay?” Dean spoke, trying to sound more confident than he felt and offering his brother his most sincerely apologetic face, “You ready?”
Sam nodded, transmitting a supportive 'You can do it' with his eyes.
Dean gulped down the hard lump in his throat and got to work while Caleb’s voice from all of those years ago coached him along,
The first thing you need to do is find the artery – you may need to dig a little, but it should feel like a little worm in there.
Dean’s shaking finger entered the wound as he attempted to explore. Sam grunted and bit down hard on the stick, his legs sliding back and forth across the ground.
Sometimes the artery is deep and it’s hard to see.
Dammit … it was dark as fuck out and he couldn’t feel the artery – he needed light. He pulled out of the wound with a cruse and reached again for the pile of stuff from the backpack – surely Sam had taken a flashlight with him.
Sure enough, Dean found a small one that fit between his teeth so he could hold the light and still work.
“Please …” Sam cried, spitting the stick from his mouth as he pleaded, “Stop … please …” he panted heavily, sweat beading down his sallow face.
“I’m sorry, Sammy … I have to.” Dean hated that he had to go back in, but he didn’t have much of a choice – it was either cause his brother more pain or watch him exsanguinate. Sam could hate him for this later.
“No … no … Dean, don’t” Sam begged. Dean wanted nothing more than to stop the torture he was putting his brother through, but he couldn’t – he just couldn’t.
Dean steeled his resolved and entered the wound again. Sam let out a curse as he screamed, tears streaming from his eyes that tore at his older brother’s heart. Dean reached inside the wound, feeling around and a millennium seemed to pass before Dean felt the slick outer edges of the artery.
With his other hand he brought the hemostat up and pressed it into the hole. Sam cried out one last time just as Dean slipped the instrument in and a moment later, his eyes rolled up into his head and he passed blessedly out. For once, Dean was thankful that his brother was unconscious -- probing and stretching the wound so he could see what he was doing had to be pure agony, but with him out like that, Dean hoped he wasn't feeling anything.
Clamp it just above the damage … remember that arteries send blood away from the heart so you’re blocking any of that blood from escaping.
Dean angled the light and did his best to see, prying the wound open further with his fingers. He could just make out the artery and the part of it that was oozing blood with each of Sam’s heartbeats. He pushed in with the clamp and positioned it around the blood vessel, squeezing the scissors-like end until it clicked several times, creating a vice around it.
Now that he had it clamped, Dean quickly pulled out, finally allowing himself to breathe. The bleeding appeared to be stopped for the time being, but Sam lay motionless on the ground, his face slack and pale as death, and for a split instant Dean feared that his efforts had all been in vain and he panicked, “Sammy?” He called out, touching Sam’s carotid, praying for some kind of movement.
A fluttering met his fingers and he released the breath he had been holding, letting relief flood his system temporarily.
Shit … that had been close, but he still needed to get Sam out of there.
He reached into his back pocket and pulled out his phone, hoping beyond all hope that there might be at the very least, a bar or two of service so he could call for help.
God seemed to be on their side this time and Dean was able to get his call for help out to 911. All he could do after that was wait and hold Sam’s hand, willing him to keep breathing one breath after the other.
Waking up always sucked.
Whether it was an early morning rise so they could get on the road before traffic got insane or a pain addled, drug induced haze that refused to lift – it was always a struggle and a crappy way to start the day.
Sam lifted uncooperative eyelids, and stared up at a water-stained ceiling.
“S’bout time you got up. I was wondering if you were going to sleep through the next apocalypse.”
Sam turned his eyes, trying to get his fuzzy, narcotic soaked mind to focus on the face the voice came from.
He tried moving, “Gah ….”
That was a mistake.
“Hey … don't squirm – you’ve got more stitches in you than Betsy Ross’ flag.”
Sam took his brother’s advice and tried to remain as motionless as possible – that is until his nose started to itch.
He lifted a hand and attempted rub the offending spot on his nose, hitting the nasal cannula shoved up his nostrils and skewing it to the side. Dean grinned a little at him and reached out, straightening the tube gently. Immediately, Sam felt a wave of gratefulness wash over him. He remembered begging Dean to stop when he had only been trying to save his life, but he had done what Sam wasn’t sure he could do: hurt his brother in order to save him.
For that, he wasn’t sure what he should say.
Sam looked thoroughly into Dean’s face – he had dark bags under his eyes and a haggard appearance that spoke of too much caffeine and too little sleep.
“You okay?” Sam asked automatically.
“I’m not the one that got shish kabob'd.”
“Maybe not, but you look like shit.” Sam replied already feeling like he could go back to sleep for the next year or so.
“Right back at ya, bitch.”
“Thanks.” Sam told him simply, finding that he didn’t have any words that were a better fit for saving his life, except for this: “And get some sleep or I’ll kick your ass.”