Sam's hands shook wildly as He tried to calm his brother, "can' breathe …" Dean gasped breathlessly, "can' bre … athe …" The words came out in short stuttering bursts between panting, laboured breaths.
"Dean," Sam gasped, tightly gripping his brother's waist for want of knowing what else to do. "what's wrong man? … Oh God, what's wrong with you?"
Heart pounding, he tore open Dean's T shirt in a desperate effort to glean clues to his brother's sudden and terrifying deterioration.
Dean's free hand clawed frantically at Sam's shaking arms as he tugged the tattered T shirt over Dean's good shoulder, muttering frightened and unconvincing reassurances to his distressed brother.
Releasing Dean's sling, Sam carefully lowering his injured arm into his lap and ran a hand over the livid bruising which covered the front of Dean's shoulder, swallowing back a gag at the grotesque kink of his fractured collarbone.
He watched in horror as Dean's chest convulsed in his fight for air; what little breath he could drag into his lungs was taking every ounce of his effort, and his strength was waning fast.
It was then Sam noticed that the movement was almost all on the left side of Dean's chest; the injured side holding disturbingly still.
"S'mmy …" Dean croaked fearfully, glassy eyes impossibly wide; "Sammy; hur's …" he pleaded, his cold, shaking fingers twining nervously in Sam's overshirt; "hel'me … plea… ease …" He forced the words out between yawning gasps.
Sam gently pulled Dean forward, lifting the tattered remains of his T shirt to examine his back.
There were no obvious injuries, but the same horrible lop-side heaving was evident.
He glanced up as he felt hot breath over his crown, ruffling his hair. Sam looked up straight into Indiana's curious face. "Not now big dude," he muttered, reaching up and gently swatting Indiana's face away, as he laid Dean back to lean once again against the fallen log.
Something about Dean's condition flicked a switch in his mind. He couldn't remember if he had seen or read or heard something like this before; the lop-sided breathing, the pain was ringing all sorts of bells.
Curiously, he tapped the paralysed side of Dean's chest with his knuckle, like he was knocking on a door; the sound echoed back to him hollow, resounding like he was banging on a drum.
The pieces fell into place.
Never having personally experienced such a problem, Sam didn't know much about the condition except that it was life-threatening. He glanced back at Dean's clammy face, a blue tinge forming around his lips; and scraped a hand through his fringe. Why here? Why now? He fought the rising urge to panic; that would gain them nothing.
Taking a long slow breath, he reached round pulling the saddlebag towards him, and tipped it up, spilling the contents including the first aid kit over the dusty trail.
"Hang in there bro'," he called back over his shoulder above the increasingly desperate sound of Dean's rasping breaths; glancing back as he rummaged through the first aid kit, Sam could see Dean's head thrown back, the tendons in his neck standing out starkly, glistening with sweat under the strain of each hard-fought breath.
Sam tore the first aid box apart before he found what he was looking for, he grasped the tatty blue book to his chest in a moment's sweet relief when he eventually found it.
The book had previously belonged to his father, now it belonged to the boys. The dog-eared little book was over thirty years old and held together with sticky tape and, most importantly, it had earned it's place in amongst the boys' arsenal more than once, but never in a situation as dire as this.
'The US Marine Corps Handbook of Field Medicine.'
Sam gently gripped Dean's knee, just to remind him he was there; "gonna sort you out real soon, bro'." he reassured softly.
He flicked through the tattered pages until he found the chapter which covered chest trauma; in particular collapsed lungs, and began to rapidly scan the words.
The text confirmed Sam's diagnosis:
Often caused by a blunt trauma to the chest - check
Lop sided breathing - check
Extreme pain on breathing - check
The affected side sounds hollow - check
His heart sank and his stomach flip-flopped as he read on.
Trauma related collapsed lung is often life threatening and requires immediate emergency treatment.
He wiped tears from his eyes with a shaking hand as he read the rest of the page, fighting the urge to throw up.
He knelt beside Dean, and began to knead the back of his neck. He wiped his eyes so that Dean couldn't see his distress.
"I'm gonna help you dude," he swallowed hard as he continued, "you've got a collapsed lung and I've gotta release all the air from inside your chest so your lung isn't squashed any more."
He continued to squeeze the back of Dean's neck, which was corded in rock hard strain as his head arched backwards in his weakening fight for breath. His eyes flickered towards Sam, who knew that it was the only response he could give.
"But, I'm sorry dude, I'm afraid it's gonna hurt;" Sam stifled a gag, "I can't do this without hurting you."Dean's hand squeezed a fistful of Sam's shirt, and Sam knew that was his go ahead; confirmation that Dean knew what had to be done, and that any pain inflicted was already forgiven.
Knowing they had no syringes in their first aid kit, Sam had to think of other options. "C'mon Sam, think …" he scolded himself. He needed something that was man enough for the job of piercing Dean's chest wall without leaving a wound so big he would bleed to death instead of suffocate.
Then it came to him in flash of inspiration; a darning needle.
The brothers didn't have the funds to just replace the numerous items of clothing and underwear that got damaged and worn, so they did running repairs. That is to say, Sam did running repairs; Sewing was, as Dean had reminded him on several occasions, women's work and, therefore, right up his street.
Sam gently laid Dean out flat on the ground with his folded hoodie under his head, laying the book out beside him and re-read the passage which explained in nauseating detail the process of 'aspiration' he was about to follow. He took a deep, stuttering breath and counted down two ribs below the collarbone; he swabbed the spot between them with an antiseptic wipe, using another to sterilise the thick 4-inch needle he held in his shaking hand.
Placing the needle point down on the bruised ridge between the two ribs just below the collarbone; he fought not to close his eyes. Under any 'normal' circumstances he would never even want to watch a procedure like this, never mind inflict it on his brother with his own two quivering, sweat-soaked hands.
"I'm sorry Dean," he whispered and pressed down the needle, piercing the skin easily, Dean jolted, his gasps hitching into a pained hiss, but as hard as Sam pressed, once the needle hit the dense muscle layer beneath the skin, Sam's sweaty fingers slipped down the shaft and it went nowhere.
Dean gasps rose to a breathless squeal as he arched against the pain. Sam cursed, gripping the needle again and pressing it hard, into the twitching, flickering skin, but to no avail as his sweaty fingers simply slipped down the thin metal shaft again. He cursed again; louder this time. He wanted to get this over quickly for Dean's sake.
He stared down at the thick needle embedded in his brother's stocky, muscular chest. "Jeez Dean" he snorted, pushing down on the needle again, "why can't you be some puny runt with no friggin' muscles?" He snorted, "why've you gotta have a chest like a friggin' brick wall?"
He was hurting Dean, that much was clear; and it tore Sam to pieces. He scraped a soaking hand across his face and, in desperation, he picked up the little book and slammed it down on the head of the needle, cringing as he heard Dean muster a hoarse screech. The needle's point drilled down through the thick muscle layer, and pierced the chest wall with a muffled pop. There was a hiss as a bubbling ring of foamy blood began to form around the shaft of the needle.
Sam, carefully pulled the needle out, keeping his hand pressed flat on Dean's chest to hold him down as he squirmed, teeth gritted against the pain.
As the point of the needle emerged with a quiet sucking sound, it was followed by a bubbling hiss as more watery scarlet foam flowed over the tiny puncture wound, spraying upwards in a fine red mist as the trapped air burst out under intense pressure. Sam continued to hold his hand flat against Dean's chest, gently rubbing small circles to reassure his brother as he still gasped for breath.
Eventually the hissing subsided, and Sam swabbed the lightly bleeding wound with their last antiseptic wipe, taping the little plastic bag which had previously held the wipes over it, leaving an opening so that the air could still trickle out.
Job done, he sat back, pinching the bridge of his nose and watched Dean intensely. He seemed a little calmer; his breathing, although still seriously strained was definitely easier. "How ya doin' bro?" he asked softly, lifting Dean back up into a sitting position against the log and leaning over him to fasten his sling again. Finally, he wrapped his hoodie around Dean's shivering shoulders. "I'm real sorry about all that, dude," he sighed.
Dean's eyes drooped closed, and he leaned closely into Sam's solid presence; "m'b-better, S'm … my, th-thanks."
It was getting dark, and Sam reluctantly accepted he wouldn't be able to go seeking help now. They were going to have to try to sit out the night, Sam knew he would have to find help in the morning; he was painfully aware that Dean wasn't out of the woods; far from it. All he had done was bought Dean some time.
He looked up to see Indiana's big muzzle filling his field of vision again and smiled, taking the time to ruffle the horse's velvet nose; "sorry I pushed you away earlier, big dude," he whispered, rubbing the horse's long, flat forehead.
Indiana cocked his head, and Sam gazed into his big, liquid chocolate eyes. "I'm gonna need you to help me stay awake dude," he smiled, "I can't go to sleep - not tonight."
He patted Indiana's neck, and glanced across to Dean, his eyes closed as he leaned heavier into Sam's shoulder; "Someone's gotta keep both your asses safe from the Chupacabra."
Indiana whittered softly and tossed his head. It could have been a nod.
Sam gathered up his rifle, and placed his a hand on his dozing brother's head as he watched Dean, on alert for changes in the pattern of his harsh breathing.
As the night progressed, and Dean had settled as much as he was going to be able to; Sam sat and listened out at the sounds around them; the warm breeze rustling through the trees, the scrabbling of small animals in the undergrowth, Indiana's restless shuffling and stamping. He closed his eyes briefly and pondered how, on this otherwise beautiful Summers' night they could be in such a dire straights. He gazed up at the stars and thought back, scarcely believing that it was only this morning that he was basking in the bliss of an idyllic Summer dawn. It seemed like a lifetime away.
The chirping of a million crickets and his brother's rhytmic wheezing began to have a soporific effect after the evening's dramas; Sam's eyes began to droop, and the fight not to doze off became more and more of a challenge. He clung to his brother, his fingers carding through Dean's spiky hair; taking his own comfort from the contact; comfort which added to his fatigue. Everything suddenly seemed so peaceful, so quiet … Sam began to succumb to the pull of rest.
A rest which was abruptly interrupted on hearing a heavy rustling crunch in the undergrowth behind them.