Summary:  A family tragedy during a hunt redirects the lives of the Winchester's in a way they could have never predicted.
Warning:  AU.  WARNING MAJOR CHARACTER DEATH(S) IN LATE CHAPTER(S).
A/N:  I hope you enjoy this newest story. This story may different than what you’re used to reading from me. It’s not laden with tons and tons of angst, although there is angst for a few chapters here and there, especially the beginning. I just had an idea I wanted to run with and get out of my system, so here it is. Also, I already have several new stories begging to be written and when I can I will write them.
Happy reading, I hope!
Disclaimer:  The characters of Supernatural were created by Eric Kripke and are owned by the CW Network. No profit is being made.
Note:  Sometimes I wonder if I should include a glossary of medical jargon, but for the most part you should understand. I will give you one word: Bullet is simply an ER term for all current medical vital stats. It is usually asked of incoming paramedics when arriving with a patient to the ER. The doctor wants to know current vitals, injury info, patient info, if any, and any meds given in route to hospital, etc. In short, it’s a brief, condensed medical report known as the bullet. And, cannulation in simplest terms is inserting tubing like a chest tube into the arteries for use in bypass procedures. I’m over simplifying, but you get the idea. You’ll read some other medical terminology during treatment scenes, but it shouldn’t be too bad for you.
Also, the distance and/or mileage (drive time) between various cities used within this entire story may or may not be accurate … I’ve taken creative license in these minor details. Thanks!

HCMC Pediatric Emergency Department

“Alright people listen up we’ve got an eleven year old boy headed down from the helipad on the roof. I want everyone in this room on full trauma alert for a severe hypothermic resuscitation. The chopper medic said CPR is in progress and they have started our IV access for us, so be prepared.” Dr. Andrew Kiragu commanded.

The elevator doors from the roof helipad slid open and the gurney carrying Sam’s lifeless body pushed forward with urgency. One medic ran alongside the rolling gurney ventilating Sam from an ambu bag attached to a tube inserted down his throat. Another medic continued one handed compressions as the gurney moved briskly through the hospital corridor to the Pediatric Resuscitation Trauma Room. Dr. Kiragu took command. “Okay, give me the bullet.”

“Eleven year-old male submerged in Mile Lacs Lake for forty-five minutes before rescue divers found him. He fell through the ice. We have started two bore IV’s, and he was intubated on site. CPR has been in progress since rescue. The ER via in air communication indicated no IV meds be given other than fluids,” the doctor nodded. “We’ve started him on a 5 percent dextrose and normal saline drip wide open as ordered by the ER. Patient is unresponsive to all stimuli. Pupils are fixed and dilated. We’ve had no palpable pulse and heart monitor has indicated asystole without change. No known allergies or previous health problems were indicated by the parent. Patients name is Sam Winchester. His father and brother are en route by car from the lake.” The doctor nodded and went to work.

“Okay, we need to transfer him,” Dr. Kiragu stated. “On three,” he looked at the medics and his staff as they prepared to transfer Sam from the helicopter gurney to a treatment gurney. “One, two,” and they lifted in unison. Sam’s head lulled ever so slightly, his eyes still partially open and unseeing. What small amount of clothing that remained was cut free, and they left him with nothing. They resumed compressions and ventilation.

“I need a core temp on this kid now,” the doctor commanded. “And, start running his fluids through the fluid warmer. I want warm fluids going in.”

“57.8,” Sherry replied, as she called out Sam’s core temperature in an urgent tone a few moments later.

“Okay, let’s get this kid ready for high-flow cardiopulmonary bypass. Sherry?” The doctor turned to the lead trauma nurse. “I want him on warm, humidified oxygen while he’s being bagged. And, remember people this kid isn’t dead until he’s warm and dead.” The staff flew into action and they ran like a well oiled machine in an effort to save Sam’s young life. “I need a cut down tray for femoral access. Dr. Clinton?” Andrew Kiragu spoke to his third year intern. “I want you to start an internal jugular venous line.” He saw the hesitation cross over his interns face. “I’ve seen you do it more times than I can count. You’ll be fine.” The doctor kept on task, but always managed to help an intern. Joe Clinton nodded to his mentor.

“We need to get this kid warmed up. He’s too cold to try cardioversion and cardiac drugs aren’t going to do squat right now. We gotta warm him first. Continue CPR and bagging him. I want all of our I’s dotted and T’s crossed on this kid’s case everyone,” the room nodded. The doctor looked down into Sam’s pale bluish purple face. He gently pulled back each partially open eyelid and shined a penlight into each eye, and as expected the pupils remained fixed and dilated to mere pin head points, and didn’t respond to any light. He closed each eyelid completely when he finished. He reached for the cut down tray as it moved into view. And within minutes Sam had both femoral veins in his thighs accessed with venous cannulation and they were beginning to send his blood through the bypass warmer to warm and oxygenate his blood and return it back into him.

“He’s officially on bypass,” a technician called out. The doctor nodded. The staff stopped ventilating Sam and doing compressions as the bypass machine took over the duty of his lungs and heart while it warmed and recirculated oxygenated blood back into his body. They covered Sam partially with a hypothermic warmer blanket that glowed red while it was turned on indicating heat was active to help warm him externally.

“Poor thing,” Sherry commented quietly to a fellow co-worker who was drawing a base line blood gas on Sam. “His skin is like ice.” Her co-worker nodded solemnly.

“Joe,” Dr. Kiragu began. “What are the parameter rates for rewarming with bypass?” He quizzed his young intern.

“Bypass averages a 3.6 degree increase every 3 to 5 minutes in core body temp.”

“Good,” the doctor nodded his approval. “And, what’s the severe hypothermia resuscitation rule of thumb I said earlier?” He hedged to his young intern.

“Hypothermic patients aren’t dead until they are warm and dead.”

“You got it.” He leaned forward and looked at the internal jugular line the intern had inserted. “Nice work.” His intern smiled briefly and nodded. “Start the kid on another round of dextrose and saline. Infuse a 100 cc bag of lactated ringers.” The activity around Sam continued. All monitors attached to Sam indicated that there was no life in his young body. Sam Winchester for all intents and purposes was clinically dead.

Somewhere between Mile Lacs Lake and Minneapolis

The car ride had been silent and tense. Dean stared out the passenger window as his father drove toward Minneapolis. Dean’s mind never strayed from thoughts of his little brother. A shiver worked its way through him as he remembered Sam’s face. His young face had been blue and purple. And, he remembered his little brother’s lifeless eyes that stared into nothingness and remained unseeing. John saw Dean shiver out of the corner of his eye and turned up the heat. He didn’t realize that the chill came from deep within his son. “Dean?” John’s voice broke into the silence. He watched his oldest son turn and look at him, but remained silent. “You hanging in there kiddo?”

“Yeah Dad. How much longer?” John looked at his watch and let out a frustrated sigh.

“At least another hour son.” Dean gave his father a quick nod and went back to looking out the window. John took a moment as he drove to reach over and give his child a reassuring hand on his young shoulder. Dean nodded his thanks and went back to staring at the darkening sky as the sun began to drop behind the trees as sunset quickly approached in the Minnesota December sky. John’s eyes shifted from his son back to the road. His hands squeezed the steering wheel as he allowed his mind to wander what his baby boy was being subjected to this very moment at the hospital. He wanted desperately to be at his youngest child’s side and to chase away every bad, painful thing, and the fact he was still at least an hour away from his child filled him with rage. His knuckles popped as his grip tightened on the wheel. He pushed the thoughts of what Sam was going through and focused on getting to Minneapolis.

Pediatric Emergency Department, HCMC, Forty-five Minutes Later

“Core temp?” Dr. Kiragu called out.

“88.6,” a staff member called out.

“All right, let’s take him off bypass,” he commanded. A technician turned the bypass machine off as it finished its cycle.

“Off bypass.”

“Alright begin compressions again, and continue with the warmed humidified oxygen while bagging. Push a high dose Epi bolus. Dr. Clinton?” The doctor looked up at his intern.

“Yes?”

“What is the suggested borderline core body temp for cardioversion?”

“Typically 89.6.”

“Good.” Dr. Kiragu shifted his gaze over to the IV technician continue rapid infusion of warmed fluids. I want the drip wide open.” The tech nodded.

A handful of minutes passed. “Core temp?” the doctor asked as he surveyed Sam’s cardiac monitor and saw the unwavering flat line of asystole.

“89.2.”

“Last epi?”

“Eight minutes ago,” a voice answered promptly.

“Alright push a high dose Epi and Lidocaine bolus.” The doctor took over compressions on Sam’s small eleven year-old chest. He completed five sets of CPR and stopped.

“PEA,” the intern called out when he looked at the monitor. “Wait,” he replied sharply as he watched the PEA degenerate into a weak ventricular fibrillation. “He’s in VF.”

“Okay, people,” Dr. Kiragu replied. “Charge paddles to 160 jules. Clear!” Sam’s young body jerked as the electrical shock entered his silent chest.

“No response,” Dr. Clinton called out to his mentor.

“Come on kiddo,” Dr. Kiragu replied. “Charge to 160 again. Clear!”

John Winchester burst into the emergency room with Dean at his side. He went up to the main desk. “My son was brought in by helicopter almost two hours ago,” his eyes were panicked. “Sam Winchester.” The desk clerk looked up the name.

“Sir, you need to go to the desk in the emergency center through those doors. He’s in the Pediatric Emergency Room.” John nodded and left quickly.

“May I help you?” The cheery desk clerk smiled, but tensed slightly at John’s wild eyes.

“My son Sam Winchester was brought in by helicopter almost two hours ago. He fell through the ice.” The clerk knew the case, as news of it had spread through the department quickly. Severe hypothermic cases when they happened were always large trauma cases that the department remembered.

“Yes, Mr. Winchester, we’ve been expecting you. The police at Mile Lacs Lake told us you were driving in from the accident scene. The trauma team is still working on your son, but if you’d like to wait in a private family waiting room we’ve set aside for your personal use,” she smiled. “The doctor will be in to speak with you as soon as he is able.”

“Is there any word at all? Is he alive? What’s happening?” John’s voice was demanding and pleading all at once.

“I’m sorry Mr. Winchester, but there are no updates at this time. I promise you that Dr. Kiragu is doing everything within his power. He’s the Chief of Pediatric Emergency Medicine your son is in the best hands.” The desk clerk had an aide show John and Dean to a small private waiting room just for them. John and Dean both sat down heavily.

“Dad?” Dean’s voice sounded so young and broken. John looked at his eldest child with a parental surveying eye as he tried to gauge his son’s state of mind.

“Yes?”

“Why’d they put us in this room? Why aren’t we out there with other families waiting?”

“It’s just a room Dean,” John tried to assure. “Maybe, with bad accidents families are given these waiting areas rather than the big room out there. It’s okay.” Truth was John was worried about this room, as well. Were they going to come in here in a while and tell him that his baby boy couldn’t be saved and that he and Dean had lost Sammy? His throat constricted at the thought. “It’s okay,” John said again as he saw the doubt in Dean’s eyes. John reached over and patted Dean’s right knee.

Meanwhile, the Trauma Room

“Core temp?”

“90.3” a nurse called out a short moment later.

“Still no response to cardioversion and CPR.” Dr. Clinton remarked to his mentor. The doctor looked at the clock.

“Okay, we’re not giving up on this kid yet, as far as I’m concerned I’m not prepared to call it until his core temp is normalized. Inject Amiodarone 25 mg, and push an amp of atropine. And, continue compressions.”

“Monitor still showing a weak VF.”

“Charge to 170 Jules. Clear!”

“No response.”

“Let’s go again at 170,” Dr. Kiragu commanded. “Clear!”

“Ventricular tachycardia,” his intern called out. “Shit,” he hissed. “He’s back in VF.”

“175,” Dr. Kiragu shouted. “Clear!”

Sam’s body arched upward again as the shock entered his chest. “No response.” His intern answered quickly as he looked at the heart monitor.

“Core temp?”

“90.6”

“Okay,” he let out a frustrated sigh. “The active external warming isn’t bringing his temp up fast enough following the bypass. His cardiac rhythm isn’t converting.” He started compressions once again as he thought out loud. “Alright,” the doctor began. “Let’s put him back on bypass to raise his core temp higher.” The Cardiac Bypass Technician readied the machine once again.

“Ready for bypass.”

“Okay, start it,” the doctor ordered. The tech nodded.

“On bypass,” the Bypass Technician called out as the machine started back up. It resumed its work of warming and oxygenating Sam’s blood, as the machine once again became his heart and lungs. The doctor stood back and waited as he watched the clock. I don’t want him on for more than ten minutes.” The doctor knew the bypass was his young patient’s best chance, but with all bypass usage it came with its own set of problems and complications.

“Ten minutes,” his intern called out a short while later.

“Okay, let’s cycle down and get him off bypass. I need a core temp.”

“97.8,” Dr. Clinton answered his mentor. “He’s in a strong VF.”

“Charge to 170 again. Clear!”

Forty-minutes later, the Private Family Waiting Room

There was a brief knock as the door to the private waiting room opened. John and Dean were immediately on their feet. John looked into the physician’s eyes. His face looked young, but his salt and pepper hair betrayed his youthful face. John figured the man was in his mid to late fifties. “Mr. Winchester,” he began in a gentle tone. “I’m Dr. Kiragu, your son’s treating physician since his arrival here at HCMC.

“Yes,” John nodded quickly. “My son, how’s Sam?”

“Please, have a seat,” he encouraged John and Dean both to sit as he himself took a seat across from the couch John and Dean sat on. “And, you are?” He looked at Dean not willing to disregard the youth.

“Dean,” he answered in a voice that shook giving away his emotional state. “Sam’s big brother.” The doctor nodded and offered a small smile.

“Please, my son,” John begged.

“We were able to get his heart beating again,” he began. John’s face spread into a huge smile.

“My boy’s okay. He’s alive.”

“Mr. Winchester…”

“Call me John.” The doctor nodded.

“John,” his voice was tentative and it was that pause that made the bile crawl into the back of John’s throat.

“What? You said his heart’s beating … he has a pulse.”

“Yes his heart is beating, but your son is in extremely critical condition. His core body temperature on arrival was 57.8 degrees which was only slightly above our lowest case on record here at the hospital of 57.6. We had to put Sam on cardiopulmonary bypass to warm and oxygenate his blood. Now, the lake water I’m told was near 0 degrees which is a good thing. The colder the better in order to hopefully preserve brain function. We had trouble getting his heart back, but he is maintaining a heartbeat and has a palpable pulse.”

“I want to see him,” John spoke up.

“Once he’s settled in the PICU you’ll be able to stay with him except during exams and tests. Right, now we want to be very careful with jostling him more than necessary. He is susceptible to cardiac arrhythmias right now and subsequent cardiac arrests and I’m trying to avoid that. He’s young, and unfortunately it won’t do him any good with this problem. Cardiac arrests in children are harder to come back from than arrests in adults, so we want to avoid a cardiac disturbance.” John nodded and continued to listen to the doctor. Dean listened to every word.

“Right now we are keeping an eye on his potassium levels in his blood as they can become dangerously high after a hypothermic cardiac arrest and resuscitation. And, we’re watching him for a condition called rewarming shock. Your son was without a pulse for some time. As cold as the water was I suspect his heart had stopped within five to eight minutes of exposure to the cold water. Now,” the doctor took a breath and John tensed. He knew something bad was coming.

“The first stage of drowning we are looking at a condition of hypoxia which basically means there was a reduced oxygen supply to the brain and ideally a person would be receiving resuscitation efforts before five minutes. However, the cold water slowed your son’s metabolism down which buys the brain some more time, especially in the young. Sam was in the water over forty-five minutes before he was found and by that time he had entered into a state of anoxia which means there had been a lengthy lack of oxygen to the brain. But, as I said because of the cold water immersion the brain was given some extra time. We have him on an EEG machine right now, and as expected right now he is showing no signs of brain activity,” the doctor trailed off as he saw the look of devastation cross over John and Dean’s face.

“Are you telling me my son is brain dead?” John felt hot tears begin to sting his eyes, but they refused to fall.

“No, not yet John. Sam’s brain and entire body for that matter have been in a form of suspended animation for almost two hours. Sam was clinically dead for an hour and thirty-two minutes before we got a spontaneous heartbeat back. His brain and body need a chance to regroup. If Sam were a computer, his main board of circuits has cycled down right now and are offline, so to speak … make sense?”

“You’re saying he’s going to come back.”

“I’m not going to give false hope John. There is a chance that Sam may never wake up, but we can’t determine that until we’ve given him some time. If there are no signs of brain activity within forty-eight hours following resuscitation he’ll likely be declared brain dead after a series of neurological tests to reconfirm. Although, I have seen some cases take almost seventy-two hours, however, forty-eight seems to be the litmus test for brain activity. His pupils are fixed and dilated right now and aren’t reacting to the light, but it to can change as his body regroups. He’s obviously not breathing on his own and we have put him on a ventilator with mildly humidified and heated oxygen. It isn’t uncommon for the body temp to drop a little or for a patient to develop a fever after resuscitation following a hypothermic state, and we’re keeping an eye on that.

“So, he’s in a coma,” Dean asked suddenly as he added himself to the conversation after finding his voice. Both men looked at him.

“In a sense ‘yes’,” the doctor responded. “He is unresponsive to all stimuli including deep pain. This state of unconsciousness is profound.”

“But, he can wake up. You said we’d know in forty-eight hours,” John replied quickly.

“We should see some sign of brain activity and pupil response, but even if that returns there’s a …”

“A what?” John barked. “A chance my son may never open his eyes again?”

“I’m sorry,” the doctor replied earnestly. “Yes, it’s a possibility and if he does get a minimal brain activity response we can run tests to see if he has higher brain functions, and if they aren’t present … you may have to decide…”

“Decide what?” John hissed. “I’m not killing my son.” Dean tensed beside John and he reached out a put a comforting hand on his child’s arm.

“It wouldn’t be killing him John. You’d be letting him go. But, we’re not at that bridge yet, so let’s see how things go. There isn’t a quick fix to this. We have other things to factor in and worry about.”

“Like?”

“Right now Sam’s kidneys aren’t producing any urine, and that has me concerned. I’ve started him on an IV course of med’s to help his kidneys rebound, but if they don’t we’re looking at having to start him on dialysis, but I’m hoping he’ll start producing urine within the next three to four hours. Right now, his entire organ system is out of sync and needs a lot of support with medicine and machines. We are doing everything within our power.”

“Brain damage,” John began and stopped. “You said the cold water helps to preserve brain function.”

“Yes, it does, but only to a certain extent. I have seen children bounce back completely, and others have been profoundly affected. We won’t know Sam’s true state until he regains consciousness, but in the interim when he is more stable I can order an MRI and PET scan of his brain to look at possible damage. Right now, we’re concentrated on supporting him medically until he stabilizes.” John gave a tight nod.

Two Hours Later, PICU

John was the first to walk into Sam’s private PICU cubicle. The room was medium sized and there were a lot of machines and IV poles surrounding his son. They had prepared him with what to expect and he had truly thought he was prepared, but that notion couldn’t be farther from the truth. His reaction at the sight of his baby boy was a violent intake of air. Dean stepped next to his father when he heard his father gasp quietly and looking at his little brother he knew why. Sam was deathly pale beneath tubes, wires and machines. He was dressed in a pale blue hospital gown adorned with smiling teddy bears riding tricycles. Those smiling bears made the moment almost surreal to Dean, almost.

Sam was no longer the hideous bluish purple he had been when pulled from the lake, now his skin appeared bloodless and gray. His lips weren’t their usual pink, but appeared to be almost translucent they were so pale. Sam’s chest rose and fell with the click and whoosh of the ventilator. Dean studied the tube rising out of his brother’s mouth held in place by a blue plastic mouth piece. “Sammy?” he whispered as he stepped forward. Dean’s voice drew John out of his paralyzed stupor. He was amazed at how quickly his first born slipped right into big brother mode and adjusted to the horrific scene in front of him. The heart monitor beeped reassuring John that his little boy had life inside his body, but his mind, his beautiful, brilliant young mind, he only hoped the son he knew and loved with all his heart was still inside and simply sleeping as his body mended.

“Sammy?” Dean spoke again as he reached a tentative hand out to touch his brother. His fingers ghosted above Sam’s limp hand that lied next to his blanket covered body. Dean reached out and touched his fingers and pulled away quickly with scared eyes. A nurse walking in to check Sam’s vitals had witnessed the reaction.

“Sweetie, it’s okay,” she encouraged. “Your little brother’s fingers and toes may be cold for a bit longer. His extremities will take longer to warm up. It’s okay to touch him just watch for the IV needles and tubing.” Dean nodded.

“Thanks,” he replied quietly as his eyes settled back on his little brother and he gently stroked Sam’s forearm.

“Sure thing, I’m Brenda,” she smiled. “I’m Sam’s primary care nurse.” Dean nodded. She turned her eyes toward John. “Mr. Winchester if you have any questions or need anything, please let me know, okay?”

“Call me John, and thanks. It was Brenda, right?”

“Yes. I’ll be out of here shortly. I just needed to make some notes and adjust some drips. You should expect a lot of activity in here, but you can stay unless he’s being examined or having some kind of procedure.” John nodded.

Two Hours Later, PICU

The emotional onslaught of the day had finally caught up with Dean as he had finally succumbed to sleep. John had requested a sleeping chair for Dean to rest in. John looked over at Dean who slept in the corner curled on his side. John shifted his eyes back to Sam and went back to stroking his son’s unruly bangs. “Listen Sammy,” he spoke softly as he leaned close to his little boy’s ear. “I know you’re mad at your old Dad for making you stay out of the hunt earlier, but this is no way to go about getting me to reconsider the next hunt,” he smiled softly. He watched Sam for any sign of life that wasn’t artificial. There wasn’t any. “And, anyway you don’t want to miss Christmas at Uncle Jim’s do you?” John had been taking his boy’s to Jim’s house for so many years it did seem he was their Uncle, and as far as John was concerned his trusted friend was family.

“Sammy, please kiddo, don’t do this, okay?” John’s voice caught in his throat. “You come back to us,” he urged as he continued to stroke his son’s chestnut hair. John leaned back in his chair for a moment to stretch his back out when he looked at Sam’s catheter bag. He bent over quickly and leaned in close. He rose quietly, but quickly and caught the eye of Brenda, Sam’s nurse and motioned for her to come to the room. She cast a glance at Dean’s sleeping form as she entered and kept her voice low.

“Is there a problem John?” She whispered.

“No,” John answered with a smile. “Look.” He pointed to Sam’s catheter bag which clearly had urine in it and for John that meant his little boy’s kidneys were beginning to work. Brenda went over and lifted the bag from its hanger.

“80 cc’s,” she replied. “Well, it’s a start. I’ll page Dr. Kiragu, he’s still Sam’s primary physician despite this not being his regular unit. He wanted paged for any changes.” John nodded.

“Brenda?”

“Yes?”

“It’s a good sign, right?” She smiled softly.

“Yes, it’s definitely a small step forward for him clinically. And, all steps forward no matter how big or small are a good thing.” She returned the bag to the hanger. She started to make a note on Sam’s chart.

“What are you writing?” John asked in his parental tone.

“Oh, just making a note that he’s produced 80cc’s of urine since his bag was last checked an hour and a half ago. I’ll go page Dr. Kiragu now.”

“Thanks.” She smiled and left. John sat back down and gently stroked Sam’s forehead with a broad thumb. “That’s my boy,” John cooed. “Sammy?” His voice soft and gentle. “I’m here kiddo. Dad’s here and Dean’s here. We’re waiting for you sport.” John leaned forward and smelled his little boy’s hair. Despite the antiseptic and medical smell that seemed to permeate his son’s hair he could still smell his baby boy. Sam’s scent had since birth always reminded him of vanilla when he smelled his hair and even now he closed his eyes as the scent of vanilla filled his senses and he smiled. “Love you Sammy,” he whispered. “I don’t say it enough, but I do,” his words were private, a moment between a father and his youngest child.

Four Hours Later, PICU

John stood outside his child’s room that currently housed both his son’s. One was in a coma and the other sleeping from emotional and physical exhaustion. “So, his kidneys are coming back?” John hedged rooting around for a straight answer.

“Well,” Dr. Kiragu began. “Sam has produced over 140 cc in the last four hours, so things are looking up. His neurological status remains unchanged, and his cardiac status is showing improvements. He isn’t having as many episodes of irregularity or short run PVC’s which are all good signs for his heart.”

“But, you said his neurological status is unchanged?”

“John, your son’s resuscitation from the hypothermia and long term cardiac arrest was only a few hours ago. I’m not expecting any changes yet.”

“I know about the forty-eight hour rebound, but ideally when would you hope to see some activity?” The doctor knew he was dealing with a parent first and fore most, but he recognized that John was also an intelligent man that deserved straight answers if he was prepared to hear them.

“John,” he took a breath. “Alright, I’m going to give it to you without sugar. Are you sure you’re ready to hear it?” John felt his throat constrict as he nodded. “Fine,” the doctor began. “Ideally, I’d like to see some sort of pupil response come back within the next eight to ten hours. The best case scenario in another four to six, and subsequently I’d like to start seeing what we call Delta waves even if transient at first on his EEG for brain activity. Right now Sam’s base line is flat, it shows no higher brain function or activity, but that could very well change soon. I’m hoping it will since it appears his kidneys are showing real signs of rebounding and his heart, as well.

“But, even if he has the improvements you’re talking about that doesn’t mean he’s going to wake up, right?”

“The coma is deep, very deep, but that can change over hours and days.”

“That’s not answering my question.” The doctor offered a tight smile. John was right.

“Yes, there is a chance that even if Sam shows signs of neurological improvements on the basic level it is not an indicator that he’s going to open his eyes. The coma could be irreversible.”

“Do you think he’ll wake up?”

“Every resuscitation is different John. Two years ago, we revived a child a year older than Sam and with a core temp slightly higher and he woke up after a month in a coma and is a healthy child today. But, there is always the other side of the coin. A year ago we had a child who fell into a local pond and was under for only twenty minutes before being pulled out, but her brain function didn’t return and the family terminated life support. It’s a toss up. I hate to make Sam’s recovery sound like a crap shoot, but he’s a critically ill little boy right now, and there are no guarantees. But, I assure everything that can be done is being done.”

“Thank you,” John’s voice was tight, but he felt the genuine quality to the doctor’s approach. “I’m going to go back to my son’s now.”

“Sure, if you need anything, please have me paged,” the doctor replied. “And, John,” he said as John started to go back into Sam’s room.

“Yes?”

“Try to get some sleep,” the doctor encouraged. “Your boys need their Dad at a 100 percent.” John offered a slight smile and nodded.

Dean was pulled from his sleep by the click and whoosh of Sam’s ventilator. He looked over at their father and noticed that John had fallen asleep leaning against Sam’s bed with a hand resting on Sammy’s arm. He got up quietly. “Dad?” he was careful to keep his voice soft.

“Hmm?” John replied before his brain reminded him where he was. His head shot up and he scanned Sam’s silent features quickly and his eyes traveled to all of the monitors scanning for a problem. “Is it Sammy?”

“No, Dad,” Dean offered quietly. “Why don’t you lie down on that sleeping chair? I can sit with Sammy. I want to anyway.” John rubbed a hand across his tired eyes.

“No, I’m good, but here,” he stood up and offered Dean the chair. “I need to call Jim and tell him what happened. It’s late, but I should call. You stay with Sammy, and if there is any change I’m just outside the PICU at the phones, okay?”

“Sure Dad,” Dean replied. John smiled and reached out and cupped the back of Dean’s neck. He was so proud of the way his first born was handling everything.

“You doin’ okay kiddo?”

“Yeah, Dad,” Dean’s eyes dropped from his father’s. “I’ll be better when Sammy wakes up.”

“Me too,” John replied. “I think I’ll get us some grub from the cafeteria after I talk to Jim and bring it back, okay? I want you to eat something.” Dean nodded. John was glad he didn’t have to command his son to eat and take care of himself. Dean always put Sammy first, and neglected his own health, and John was going to make sure that didn’t happen.

Blue Earth, Minnesota, Pastor Jim Murphy’s House, 11:30 PM

Jim Murphy was pulled from his sleep by the incessant ringing of the phone beside his bed. He reached over groggily as he looked at the green lit digital clock. “Hello?” he cleared his throat trying to shake the effects of sleep from it.

“Jim?” at the sound of John Winchester’s voice on the phone at this hour woke Jim Murphy up completely.

“John, is that you?”

“Yeah,” he replied.

“I’ve been wondering when you and the boys would be showing up. You still on that Water Wraith hunt at Mile Lacs?”

“No,” John’s voice cracked and Jim knew instantly that something had happened to one or god forbid both boys.

“John what happened? The boys?” Jim clutched the phone tightly. “John?”

“Sammy,” John’s voice hitched and cracked as he tried to reign in his emotions that had been just under the surface ever since Sam disappeared beneath the ice. Jim closed his eyes and sent a silent prayer up before he asked his next question.

“How bad John?”

John relayed to Jim everything that had happened and that Sam was in the PICU clinging to life in critical condition. “They say the coma could be irreversible Jim, and that there are no guarantees.”

“Hell’s bell’s John. This is Sammy we’re talking about,” Jim chided. “He’ll wake up. He has to,” he affirmed. “It’s as simple as that. What hospital are you at? I’m coming to you.”

“You don’t have to,” John admonished. Although, privately he wanted nothing more than to have his long time friends comforting presence nearby for himself and his family. And, some part of himself he wasn’t willing to acknowledge wanted the religious man here should Sam slip away from them forever.

“John you and those boys are family. I’m coming.”

“We’re at Hennepin County Medical Center.”

“Minneapolis, right?”

“Yeah.”

“It’ll probably take me a good three and half maybe four hours to get to you, but I’ll head out as soon as I call a friend to stop by and take care of Duncan.” John smiled slightly at the sound of the old Golden Retriever that Sammy loved to play with so much when they visited Jim.

“Thanks Jim.”

“What else is family for John? I’ll see you soon.” Jim hung up the phone and allowed the positive attitude he kept up for John’s sake evaporate from him as tears welled up thinking back on all the details John had relayed to him about Sammy’s condition. He felt his throat tighten at the thought the little boy had been clinically dead for almost two hours before they were able to get his tiny young heart beating again. There were so many what if’s and possibilities that he himself felt overwhelmed at the mere scope of them. He had no idea how John was even keeping sane. “Oh, Sammy,” he whispered. Duncan trotted into the bedroom and nuzzled Jim’s hand. The older man smiled and patted the dog’s head. “Hey, boy,” he spoke softly as he stood up to pack for the trip and call a friend to care for Duncan.

Three Weeks Later, PICU Family Conference Room, 6:00 PM

“The coma is lighter, but what does that mean?” John ran a hand through his thick dark hair. “What about his brain activity? I’ve watched the monitor and I know he’s having activity…” John wanted to continue, but the doctor stopped him.

“John, I know this has to be frustrating, and that you want him to open his eyes. Sam is showing movements, or what we call purposeful movements. He has also been triggering the vent, so we’ve begun to wean him off over the past few days, and I expect we’ll be able to remove the breathing tube in another day or two. And, yes, there have been signs of delta wave brain activity, but John,” Dr. Kiragu started and stopped. The MRI and PET scan they had completed on Sam the day before had finally been evaluated by the Chief of Neurology and the results would not be what John wanted to hear, no parent would, and Dr. Kiragu hated this part of his job.

“But what?” John asked when the doctor paused.

“I want to show you Sam’s brain scans from yesterday. They have been evaluated by the Chief of Neurology and he relayed his finding to me.” Dr. Kiragu stood up from the private conference room table and pulled out the scans and put them on a light display to show John. John stood and walked over to the scans.

“This is his MRI and Dr. Hawthorn has noted these areas as the ones most heavily affected by the anoxia Sam suffered. But, his PET scan is conclusive with its results.”

“Wait,” John stopped the man. “The MRI, these dark areas you say are the ones affected by the lack of oxygen, right?”

“Yes.”

“But, what does that mean? These dark areas?”

“It’s areas of damage John. This area here,” the doctor pointed with his finger is his speech center, and this part of the brain allows him complex cognitive thinking and problem solving. And, this area deals with motor functions. Perhaps, if I show you the PET scan this will all begin to make more sense.” He pointed to the red areas on the PET scan. “These are active areas and have a good blood flow, but the dark areas with only little to no red are the damaged areas I showed you on the MRI scans. John, these areas won’t come back. This is essentially dead tissue, and unfortunately brain cells that are lost due to oxygen deprivation or other trauma do not reproduce or mend themselves. Once a brain cell dies it is lost forever.”

“What are you saying?” John forced the question past the tense muscles of his throat. He was so glad that he had told Dean to stay with Sam and Jim rather than come to this meeting.

“We’ve been monitoring Sam’s brain activity and he does show delta waves, and that is good, at least there is hope that some form of rehab will help your son to learn to speak and walk again, and perhaps even learn self care, eventually. But, there are clear issues that I’m afraid will never resolve themselves. John, I’m so sorry, but the results are conclusive and have been reviewed by not only the Chief of Neurology, but a panel here at the hospital, and…”

“Don’t you fucking say it,” John hissed. “My boy isn’t … Sammy isn’t…” John Winchester finally lost the battle with his emotions that he had kept under a tight lock for three weeks, and tears welled up and spilled down his cheeks. “He’s a smart boy,” he choked. “Sammy was always bright. He is bright,” John corrected himself. “He’ll be okay,” he looked at the doctor with pleading eyes. “Right? There is hope.” It was a plea more so than a question.

“John, I wish nothing more than the ability to undo all of this and not have to say what I need to say to you, but,” he began with a solemn face. “Sam has suffered irreparable brain damage from the near drowning. Now, a scan can tell you that there is damage, but the brain is a complex thing and we’ll know more once Sam comes out of the coma completely, but John the son that existed before that day at the lake is gone forever, however, that doesn’t mean you’ve lost your boy. He’s young and his brain is still capable of making new connections. I don’t mean to imply the damage will repair, it won’t, but I’ve seen cases where the brain rewired itself in a young trauma victim over months and years and they were able to access functions that they had previously been denied because of damage. It’s the same principle about young epileptics who have half their brain removed to stop constant seizures. They can lead a perfectly normal life with half a brain, of course they go through extensive therapy, but they relearn things.”

“His damage,” John began brokenly. “How bad … I mean … his IQ … what are we looking at?” John couldn’t seem to form his thoughts.

“John, it’s hard to say until he is awake and can actually be tested. But, it’s going to be rough for a while. He’ll probably require round the clock care for some time, perhaps forever depending on whether or not he is an acceptable candidate for rehab. But, I suspect he’ll be able to attend rehab at a twenty-four hour care facility. It’s going to be a long road John.”

Twenty-Minutes Later, PICU, Sam’s Room

John walked back into his little boy’s room and tried to put on his best face for Dean’s sake. “Dad?” Dean asked as he stood when his father walked in. “What did the doc say?”

“You know doctors Dean. A lot of technical talk. How’s Sammy?” He looked at his young son lying motionless in the same bed he’d been in for three weeks.

“He moved his hand,” Dean answered excitedly. John looked at Jim for confirmation.

“It’s true John. His right hand moved and he lifted two fingers.” John stepped forward with a soft, painful smile on his face. He stood over his baby son and brushed back his bangs gently.

“Hey Sammy,” he whispered. “That’s a good boy.”

“So,” Jim began. “What did the doctor say? Any good news?” Jim knew John was covering something, but he hoped there might be some sliver of good news.

“Dr. Kiragu said they think Sammy will be able to have the breathing tube removed in a day or two.”

“Really?” Dean smiled. “Here that Sammy,” he patted his brother’s leg. “You’re going to get that friggin’ tube pulled soon.”

“Dean, would you stay with Sammy? I think I’m going to stretch my legs.” John looked at his eldest son. “I know you’re probably going stir crazy, but…”

“No, Dad. I’m right where I want to be, and anyway Pastor Jim…” Jim cleared his throat reminding Dean that in the PICU he had to be family. Dean smiled. “I mean Uncle Jim,” he corrected. “I went and got him a coffee while you were gone and he stayed with Sammy.”

“Oh,” John cast a look at Jim. “Jim you could probably stand to stretch your legs, too.” Jim nodded knowing full well his old friend wanted to talk out of Dean’s ear shot.

“Sure Johnny,” he answered quickly.

Thirty-Minutes Later, a Quiet Corner in the Hospital Chapel

Jim had scoped the place out earlier and noted that it didn’t seem occupied very often and he thought this was a better place for John to talk to him than the cafeteria. And, he couldn’t have been more right. His mind was still reeling over the definitive prognosis for Sam. His heart ached for what the Winchester family had lost and he ached for Sam’s lost potential, but felt some comfort in the fact that Sam could hopefully have some kind of future, a different future, but a future nonetheless. Jim cast a concerned sideways glance at his old friend who had been silent since finishing his talk about his little boy. “John?” He prompted gently.

“How do I tell Dean?” John finally spoke. “I don’t know if I can.” Jim reached over and dropped a comforting hand on John’s forearm.

“Dean can handle this John. It won’t be easy, but he’ll cope, and so will you. Sam’s alive John and that’s what counts. You have to take hope in the fact the doctor thinks Sammy will have some kind of future with rehab. There’s hope.”

“Hope? My little boy is brain damaged,” John’s tone was angry. “Future? What future? The doctor doesn’t even know how bad Sammy is yet … he said we have to wait until he comes out of the coma fully to have him assessed. Dammit Jim,” John hissed. “They won’t even know if he’ll be a candidate for rehab until he wakes up. I told you the doctor said Sammy will need round the clock care for a long time … what if he can’t take care of himself … wash himself, go to the bathroom on his own …” John’s voice tapered off and John could see the anguish. “I should have never taken him on that hunt. I could have stopped by your place and dropped him off, but I …”

“Stop right there Johnny,” Jim chastised his friend gently. “This wasn’t your fault. You’ve taken those boys on plenty of hunts with you whether they’ve played an active role or not … it just happened, okay?”

“He’s eleven years old Jim, eleven,” John’s eyes were blood shot and agonized. “He’s still just a baby … my baby.”

“It isn’t fair John, but we’re going to have to work with what we’ve got right now. Look, there is a bright side, the doctor did say they’re going to take him off of the ventilator in a day or two, and Sam is beginning to come out of the coma, something is better than nothing. It’s going to be baby steps for a while, but you’ll get through this and your boys, too, one way or the other you will.” John nodded at his friend.

“Yeah,” his reply was gruff. “I should go talk to Dean.” He stood up. “Jim, do you think you could sit with Sammy while I take Dean for a walk?”

“Of course.” John offered his friend a genuine smile.

“Jim?”

“Yes?”

“You’ve put your life on hold and your commitments to the rectory and I just wanted you to know …” Jim put his hand up.

“Don’t Johnny. You and the boys are family. And, the church has a substitute and Duncan is being cared for by a friend.”

“Thanks anyway,” John replied quietly. “You think you could take Dean with you back to our hotel room tonight? He really needs a good nights sleep.”

“We’re going to play hell getting him to leave Sammy.”

“I know, but we’ve got those two rooms for showering and naps, and the boy needs sleep and a real meal. I just need to know he’s taken care of Jim while I spend some one on one time with Sammy. I just need…”

“I know John.” Jim comforted. “After you talk to Dean I’ll take him back to the hotel.” John nodded a thank you. Both men headed toward Sam’s unit.

John walked toward the PICU with a heavy heart. He had to tell Dean the horrible truth about their Sammy, and he just hoped that he’d be able to find all the pieces of his first born son’s heart when it shattered.