Dean skidded the car into the clinic's parking lot and slammed to a stop. Sam, minimally conscious, braced himself automatically against the dashboard as Amelia flew forward and struck the back of the front seat. Dean killed the engine and lunged from the car to help Sam stand, tugging and bracing him in a way that spoke of long practice and total disregard for whatever was going on in his own ribs. Amelia darted ahead of them in her wooly loafers and sleep shirt, lead them to the service door, and punched in her security code. She flicked on the lights of the laundry and storage room, braced the door open with a cardboard box, and dug a set of scrubs out of the dryer while she waited for Sam and Dean to arrive.
The harsh fluorescents and the scents of cat pee, kennel, blood, and bleach comforted and galvanized her. She woke up the computer and had googled the human dose of Rompun by the time Dean dragged Sam into the clinic.
He and Sam managed to stagger into the treatment area before Sam let out a gurgling squeak and Dean lowered him to the floor, propping him up against the stainless steel island. In the light, Sam looked even worse. White skin. Gray lips. Floppy. Weak. Depressed mentation. Rapid shallow breaths.
Good god. She had a goddamn dying human on the floor of her veterinary clinic. And it was Sam.
"Sam's in shock," Amelia announced, sticking with what she knew for sure. "I can get some fluids into him, tide him over so you can get him to a hospital -- and you will get him to a hospital, because I'm a little out of my depth here -- and if you tell anyone I so much as stuck a needle in a human, I will lose my license, I kid you not. Ten minutes, then we move."
In answer, Dean unzipped Sam's canvas jacket and bunched his shirts up to expose his stomach. "That look like something fluids'll help?"
It was a testament to how long Dr. Amelia Richardson had been doctoring dogs that her first thought was "GDV" and not "UFO pregnancy" or "advanced liver failure." Sam's abdomen was massively distended, the cranial -- upper? superior? -- half bulging up beyond his ribs. The skin looked tight and painful.
"What the hell happened, Dean?" Amelia's hands wandered, as her brain stumbled over the dichotomy: this was Sam, Sam who'd held her like he was the lonely one and polished off half her bourbon and sherry, and this was an abdomen with an acute obstructive lesion. She was planning surgical margins between Sam's ticklish spots.
"He ate something he didn't agree with," Dean said, unhelpfully figurative. His voice rose, and his eyes widened, and for a moment, Amelia saw a family resemblance. "Dogs do this all the time, right? They eat stupid crap, and the vet has to cut it out?"
"You said this was twenty minutes ago?"
"Thirty." Dean checked his watch. "Closing on forty. Doc, you gotta move."
Sam was barely able to get enough air into his lungs; he was doing that shoulders-back heaving-sternum move that humans did when they had to expand their ribcage. "Take his boots off," Amelia ordered. Dean produced a knife out of nowhere and cut through the laces, and Amelia ripped off Sam's sock. His toes were red with pooled blood, and the nails were purple.
"Do humans get GDV?" Amelia asked herself. She grabbed her stethoscope off its hook by the dry erase board and pressed the bell to the grotesque bulge in Sam's abdomen, then flicked him with a finger. There was a dull thud. Something solid, not air. Not GDV, that would be stupid, but something. She rested both hands and the stethoscope on Sam and listened, hearing the soft distant rasp of Sam's gasping, the faint flutter of his straining heart, the sinister silence of his digestive tract, and something . . . strange. Faint. A soft rapid whud-whud-whud-whud, and a soft glide. Something brushed against her palm from inside him.
Disturbed, she stepped away. "He needs surgery."
"So quit fartin' around and get started."
"This is not a discount hospital, you asshole!" Amelia exploded. "This is a vet clinic! I'm an animal doctor! I can try to stabilize him, but if you care about Sam half as much as I do, you'll get him to a human O.R., with a full surgical team that's seen the inside of a human abdomen, that has staplers and endoscopes -- two hours will be worth the drive!"
"No, it won't," said Dean, his voice frighteningly level. "In two hours, he'll be dead. We've seen it happen. He's got maybe half an hour, you're his only shot."
Sam flopped his hand at her, and she grabbed it automatically. He pressed her hand against his drum-tight stomach and squinted into her eyes, his chest still heaving with his desperate sips of air.
"Look me in the eye and tell me there's not something freaky inside there," Dean said.
Amelia swallowed. "I want an abdominal radiograph."
"Make it quick."
******
Amelia scrubbed her hands frantically over the instrument sink, as though she could erase what she'd seen on the radiograph -- what she was about to look at up close -- from her gibbering mind. She was going to cut a human, cut Sam. And use Dean for an assistant.
She was going to lose her license and go to prison. Or she would if Dean reported Sam's death; they seemed more the "bury him under the old oak tree" type. She was going to kill Sam, he was going to get peritonitis and die, because she was going to do an enterotomy solo.
On a human.
"Has it been five minutes?" Amelia hollered toward the operating room, still scrubbing, scrubbing.
"Five goddamn minutes," Dean hollered back. "Are you gonna cut this thing out of him, or what?"
"How's his breathing?" Sam was alone with two fluid bags pouring into his big, pretty veins, and for all she knew, she could be swamping his lungs and drowning him in Ringer's solution.
"Still terrible," Dean replied.
"Wipe the scrub off," she ordered. "Use a fresh gauze every time. Spiral outward."
"Got it."
Amelia flicked her fingers dry, toweled her hands off, wriggled into her sterile operating gown, and gloved up. "Get over here and tie me in. Now, Dean." Dean stomped out of the surgical suite, still slathered in blood and mud. "You can touch the inside of the gown," she snapped, seized by paranoia as she turned her back to him. "Not the neck. Not the edges. The ties, and the inside."
"I got it," Dean growled, tying the gown closed roughly but deftly.
Amelia clasped her sterile gloves together. "Scratch my right ear."
Dean leaned down, peered at her bushy hair through the gauzy surgical cap, and did so.
"Now wash up. Borrow some scrubs from the laundry room, strip to your boxers, I don't care, but don't bring that filth into the operating room again. And use the blue soap."
"Yes, ma'am." A little of the tension had gone out of him, and Amelia wanted to keep things that way. She left Dean hard at work over the sink with the fingernail brush and side-stepped into the surgical suite.
Sam was sprawled out uncomfortably on the bare steel pediatric surgical table in his boxers, his legs almost touching the floor and his arms taped to the bottom to hang in a half-way natural position at his sides. Dean had rolled up one of the clinic's thread-bare beach towels to prop his head up. He was looking at her, his eyes a little clearer now, his mouth tight with pain.
"Is Dean right about the thirty minutes?" she asked softly. "I can stick him with a sedative, knock him out, and get an ambulance here. We don't have to do this."
"Ten," Sam hissed between paints. He flicked his eyes at the wall clock. "Ten now."
Amelia swallowed hard. "You're gonna be awake for this," she told him. His eyes widened, and she hurried to reassure him. "It's okay, they do this in cows all the time. I'll do a local. But you need to hold very -- very -- still, so you don't eviscerate yourself, okay?"
Sam nodded. Amelia uncovered her instrument table, dropped some sterile towels on one side of Sam's torso so she could lean over him, then loaded up a 12cc syringe with lidocaine and jammed on a massive spinal needle. "This is the local block," she said, threading the needle under his skin beside the incision site. As she drew it back out, trailing anaesthetic as it went, Sam flinched and hissed. She laid another line on his other side, then dropped more towels over his swollen stomach. It seemed to have gotten bigger in the past twenty minutes. That had to be just the way he was lying.
By the time Dean got done cleaning himself up, the local had kicked in enough that Sam didn't even react to the towel clamps stabbing into his skin. Amelia unfolded the old green laparotomy drape, which only reached from Sam's knees to his chin. Gowned, gloved, standing under the hot operating lamp, and facing a tiny rectangle of abdomen, just an abdomen in a blank green field, Amelia felt strong and steady, though it was closing on four a.m. and she'd been running short on sleep for the past week.
"Dean, put a mask on Sam so he doesn't sneeze on my incision," Amelia called. Dean barged in, still tense, but clean and sanitary in a too-small gray-green scrub top. "Get a bottle of saline out of the cupboard -- no, the bottom one -- the one on the right -- the clear stuff. That. Pour some into my bowl and don't touch anything."
"Aren't you gonna knock him out?" Dean demanded, clutching at Sam's shoulder under the drape.
"I need Sam to concentrate on breathing," she explained, and she lowered her blade and cut.
Skin parted, trailing blood and wisps of sparkling fat. Below, thick dark muscle joined gleaming white central tendon, so broad, she could hit that midline after five cups of coffee and a hangover. Thank god for Sam's health obsession. She grabbed her forceps and tugged at the tough white aponeurosis. Sam's abdominals twitched.
"Relax," she warned him. She lifted the abdominal wall up into a little corner, edged the scalpel up to it, and punctured in.
Her nose caught the tang of peritoneal fluid, just like any other abdomen. God, she loved that smell.
Sam's breath hitched. Amelia made the mistake of looking up from her incision and saw, again, Sam's face sticking out from under the too-small drape, forehead creased in pain, and Dean looming over him, staring at her with furious tension, his fingers twitching. "Sorry," she said. "The peritoneum, it's innervated. It doesn't block well."
Amelia lifted Sam's abdominal wall and slit it toward Sam's navel. Sam whimpered, and his stomach bulged up to meet her.
It looked generally stomach-like, with big, bright, healthy gastric arteries and shining pink serosa, situated in what she recalled to be a generally stomach-like position, from her high-school human anatomy class. But it was distended, round and unyielding to the touch. Sam took a sudden sharp breath and it seemed to leap upward, ready to slither out of his body like a rumen in one of James Herriot's barnyard war stories.
"Careful!" she yelped. But Sam took another deep breath, harsh heaving pants, and soon there was some abdominal press in his exhalations to confound the problem; she pressed a restraining hand against the surface of his stomach, but at the caudal -- inferior? -- margin of the incision, a bubble of blood-lace omentum and a few adventurous loops of small intestine squirmed out. "Sam!" She set her instruments on the drape and cupped both hands over his viscera. Sam was sobbing, that's what the abdominal press was; he had his face turned away and his eyes squeezed shut, breathing deep and sharp and hard. He was squeezing out his jejunum like toothpaste. "Calm down! Dean --"
Dean was crouching in front of Sam's face, gripping his hair in his fingers and stroking his temple with his thumb. "Come on, Sammy, it's almost over. Breathe with me. In, out. In, out."
It took a few fraught minutes, but Sam caught on, opening his eyes to meet Dean's. Sam's diaphragm settled into a rhythmic push, in time with Dean's exaggerated breaths; his intestines stopped fighting for escape, but the stomach still bubbled up, stretching the edges of the incision. As Amelia wet a pile of gauze sponges in the saline, Dean huffed out a series of sharp Lamaze breaths. Sam gave a pained laugh, and as she watched, a loop of intestines squeezed out of the incision again. "Dude, not funny," Sam croaked.
That was almost a full sentence. Amelia checked his cheeks and lips, and while he was still pale, he looked significantly less dead. His knees, where the stuck out from the other side of the drape, looked less purplish and congested. Venous return was better just from the abdominal incision, diaphragmatic excursion, too. "How's the, how's the pain?" Amelia asked.
Sam's eyebrows furrowed and contorted over his blue face mask. "Finite," he grunted after a moment.
"Tell me when you need more lidocaine," she said, eying his escaping stomach.
"Sure."
Amelia chewed on her lip and looked at Dean. This part was really a two-person job. "Dig out some gloves from the shelf -- on your right -- not that far -- second from the top. That bin. What's the largest size in there? Eleven?"
Dean held up a sterile pack of size-eleven gloves.
"Unfold that and put them on without touching the outsides. I need you to hold something."
She checked over her stack of open sutures on the instrument table while Dean figured out how to approach the gloves, then tucked laparotomy sponges between Sam's stomach and the rest of his abdomen. Sam winced as the damp cotton rubbed against his peritoneum, and when he saw her watching him, gave her a shaky smile. Good god, what was she doing, she should have dug out the morphine and to hell with the side-effects.
Dean held up his gloved hands, and Amelia waved him over to stand at Sam's opposite side. With a few quick jabs, Amelia anchored two long thick sutures into Sam's stomach, clamped hemostats over the ends for handles, and passed them over to Dean.
Dean got the concept and stretched the sutures out, lifting and immobilizing the stomach from two sides. He looked far, far too cool to be assisting at his first enterotomy. "Don't spill?" he guessed.
The stomach was completely taut, not just from the stay sutures, but from the thing inside it, the thing with the linear and cylindrical mineral radiographic silhouette, and the skull and the teeth and the tiny soft whup-whup-whup-whup. "I'm going to take the -- the object out now," she announced. "Do you know if it's, um . . . "
"Don't worry about it," Dean said, watching the stomach with fury in his eyes. "It's not big enough to bother us. Just take it out and sew Sammy back up."
Amelia laid her scalpel against the serosa. "Cutting."
Blood welled, and the tense muscular wall parted to let the back side of the mucosa bulge out behind it. Sam made a soft noise and tensed his abdomen again; hopefully the sponges were keeping everything in place. She dabbed some blood away with a square of gauze, trying to get a good look at the layers, when the mucosa bulged out violently under her hand. She clutched the scalpel.
"Just back off!" Dean ordered, but Amelia was frozen, watching the soft red mucosa puff and recoil, seeing the imprint of sharp things pressing behind it, claws, yes, jaws, teeth, an organism, a live animal. One of those clawed limbs punched up through the incision and tore its way out, perfect young hooked mammalian claws on a long, muscular foreleg, a ferret-sharp head, another foreleg, and then a slender thorax, all covered in fine black fur, damp and slick with Sam's stomach juices. It's newborn eyes were open, and they looked up at her with steady, puzzled appraisal -- blue eyes, blue puppy eyes. This animal had just crawled out of Sam's stomach, and it would have shredded its way out if she hadn't cut down herself.
It licked its nose with a long pointed tongue with a phallic-looking hole on its rounded tip.
In a spasm of revulsion, she gripped the newborn by the back of the neck and jabbed the scalpel through its chest. Greenish liquid that should not be blood spilled out, and she jerked the thing out of Sam to keep from contaminating his incision even further. The animal kicked and clawed as she dangled it over the floor, its angular jaws snapping at the air, but its movements were clumsy and weak. The weight of its body pushed it further and further onto the scalpel until the blade broke the skin under its neck. It's flailing legs stilled slowly.
"Not quite what I meant by 'take it out,'" Dean remarked, still holding Sam's wide-open stomach safely above the level of the sponges. The corners of his eyes looked like he might be smiling.
Amelia dropped the animal with a splat, not bothering to fish the scalpel back out of its chest. It lay curled and still, a long otter tail tucked between its legs to its nose: in all, two and a half feet long and around ten kilograms, the size of a large cat. "I need to re-glove," she announced, dazed. "Sam, are you . . . hanging in there?"
"It's a girl," Sam said, and snickered.
Amelia unfolded a new pair of gloves. "Closing, at three-fifty-five AM. Since this is the boring part, how about one of you tell me what the hell that thing was supposed to be."
Closing was uneventful, but nerve-wracking. Amelia sewed up Sam's stomach, took Dean off stay suture duty so he could pour five liters of saline into his brother, changed gloves a second time, took a quick feel around Sam's abdominal cavity to make sure she hadn't missed anything that might be important -- "Like what?" Sam had demanded, shivering and staring with huge eyes at her arm buried past the wrist in his guts -- whip-stitched his abdominal tendon back together, and, after a quick spray of the last of the lidocaine, the skin. It wasn't one of her worse skin closures, but she was pretty sure human hospitals didn't send people home with green monofilament in their skin. The linoleum was a morass of blood and salt-water, like usual after a laparotomy on a big dog.
Almost as bad as the waking nightmares of suture failure and massive fulminant peritonitis was Sam's and Dean's explanation of the little black penis-tongued ferret-puppy on the floor. They weren't sure what it was, but they did know that it wasn't unique; there was more than just mountain lions and grizzly bears out there eating people, and most of it didn't follow any kind of natural law.
Amelia could see that. The ferret-puppy didn't even have a placenta.
What was worst was the revelation that Sam and Dean were Sam and Dean Winchester, wanted felons and murderers, and that whether or not they were actually guilty, whether or not they were publically dead, they would always, always be running.
"Sam thinking you were dead, that was another one of your 'unnatural' incidents?" she asked as she cut up the radiograph of Sam's cranial -- superior - abdomen with scissors. Sam and Dean shared a weighted look, Sam sitting propped up against one of the cupboards in the treatment area, coccooned in towels and blankets, and Dean leaning against the wall nearby, toying with a mop. She held up one of the slices of film to the ceiling light to look at Sam's ribs; there was a weird geometric pattern that showed up over the bones. She wondered how she'd missed that artifact, and resolved to check the developer fluid for precipitate debris.
"I got sucked into a dimension of eternal combat for a year," Dean explained after a pause, as Sam watched him warily. "It made perfect sense that I was dead."
"But you weren't," Amelia concluded, dropping the scraps of illicit radiograph into a plastic bag.
"Not so much."
Amelia looked at Sam, who was still pale, clutching his stomach, and had a bag of Ringer's, his third liter of the night, running into his left arm. "Sam, you have just adopted a two-hundred-pound mastiff named Tock," she announced, sinking into the computer chair and entering a new patient. "Tock ate a bottle of foaming wood glue and needed an emergency gastrotomy. Tock now needs morphine and tramadol for post-operative pain control." She knelt at the cupboard underneath the pharmacy area and opened the clinic's small safe, pulling out a glass vial, a bottle of tablets, and a log book.
"No, Dean," said Sam wearily from behind her. When she turned around, Dean was gazing at the controlled drug safe like a man in the desert spotting a freshwater spring.
"Are we going to have a problem?" she asked.
Dean grinned, looking shockingly handsome for an instant, now that he wasn't terrified, covered in blood, or endangering her boyfriend. "Nah, I'll just knock over some other vet's office."
Amelia pressed her palms into her eyes. "Okay," she sighed. She counted pills, drew up a syringe of morphine, and handed Dean the sliced-up radiograph and the pill bottles. "Here's your evidence. Here's Tock's pain pills. Here's his antibiotics. Here's his ulcer meds. Sam, don't get sick. Don't rip your stitches. Don't require medical attention. This is legally indefensible, understand? I would lose my license, I would lose my livelihood. Have you ever had a livelihood, Sam?"
"Hey!" Dean interrupted her, stepping in front of his shivering brother and pointing a scraped-up finger at her chest.
"How about you, Dean, have you had a livelihood?"
He glared at her for a moment, then nodded faintly.
"It's what I have, and it's all I have," Amelia admitted. "Take care of each-other."
"Here's Tock's morphine," Amelia changed the subject, holding up a loaded syringe. Dean stepped aside so she could peel some of Sam's blankets off and push the drug slowly into his injection port. Sam watched warily as it flared through his veins, and, too late, Amelia thought to ask, "You don't have a problem with narcotics--"
"No," Sam said. A minute passed, and he sighed and relaxed against the cupboard, eyes rolling shut.
She clamped off his fluid line, pulled the needle, and reinforced the IV catheter's white cloth anchoring tape with most of a dwindling roll. She caught herself reaching for the candy-colored cling wrap before she stopped himself. “Don't let him chew that out,” she told Dean, and handed him the half-run fluid bag and two more liters of Ringer's. Dean strung them all on his left pinkie.
“Ten drops a second, right?” He turned to Sam. "Okay, kiddo, let's get you back on your feet," Dean ordered, tugging at his arm, and Sam tucked his feet up under himself, wincing, and stood slowly. They'd managed to wrestle a fresh pair of boxers and pants from the car onto him before easing him off the operating table, but not his tee-shirt, and his button-down and jacket were only half-on, leaving the forearm with the IV catheter exposed. He seemed steadier now on a fresh dose of morphine and with a fresh celiotomy incision than he had when Dean had dragged him in. They lurched back out toward the car. Amelia watched them go from the front window for a moment, before recalling that she was wearing a sleep shirt under her scrubs and moccasins on her feet and rushing off after them.
“Want a lift?” Dean offered. He and Sam were engaged in some complex gymnastic maneuver to settle Sam in the back seat without straining his sewn-together abs, their arms locked together, moving as one. At the end of it, Sam was on his side on the back bench, legs half-dangling into the footwell.
“It's almost not worth it now, but my purse is at home,” Amelia said dryly. She slid into the passenger seat and leaned back to watch Sam breathe. Dean started the car and pulled out at a senior citizen's pace.
“Don't be such a stranger, Sam,” she said. “Riot misses you.”
“Oh, Riot misses me,” Sam muttered back, slurring a little. That was probably the morphine. “I should come see Riot, then. When I can stand up.”
Amelia looked from Sam, to Dean, and back again, and made a decision. “You should stay at the house. Both of you. Sam, at least until you get back on your feet, don't you want an actual bed? A kitchen? Your coffee press?”
Dean shifted in his seat. Amelia wouldn't have noticed the movement if she hadn't seen Sam's eyes flick to his brother's back. “We've got some travel ahead of us,” Sam said. “But this was fun. Maybe next time you can stick your arm in my chest.”
“How about no,” Amelia replied.
“Quiet, love-birds,” Dean grumbled, easing the car down the still-dark streets.
Amelia sunk low against the collapsed springs and sun-worn vinyl where Sam, according to his drunken ramblings, had spent most of his life - right here, in this seat, with this man. “How about Thanksgiving?” she suggested. “History Channel marathon, bottle of port, Don's mom's jalapeno cranberry sauce? Let me check on my handiwork?”
Sam was silent for a long moment, and Amelia, despite herself, felt a hated stab of disappointment and need well up. She heard Sam open his mouth and take a breath to speak, but it was Dean who said, “Sure, sounds like a party.”
Amelia twisted in her seat and caught the tail end of Sam's adorable slack-jawed gaping, this time directed at his brother's back.
“You make Thanksgiving pie?” Dean continued, with a note of challenge.
“Sure, I can make a pie. Can you keep a date?”
Dean's mouth twitched and he shrugged. “If we can make it, we'll be here. How's that sound?”
“Sounds like that's as good as we're gonna get,” Amelia replied, as they pulled up to the little house that Sam had helped make a home, whose door Dean had busted in. That one would be fun to explain to the neighbors. She stumbled out and stood in the driveway, bone-tired now that the excitement was over, and listened to Riot yelp from where he'd been locked in the bedroom as she watched the old black car slip away into the night.
She was going to lose her license and go to prison. Or she would if Dean reported Sam's death; they seemed more the "bury him under the old oak tree" type. She was going to kill Sam, he was going to get peritonitis and die, because she was going to do an enterotomy solo.
Even with this one paragraph, you made her more likable than cannon. Why can't we have *this* Amelia?
Maybe that could be a new genre: character modification. Does it count as OOC if it's how the character *ought* to be have?
That's the thing, I don't see her as being unlikeable. Maybe a personal and professional liability, with the pride and the self-pity and the drinking, but I largely enjoyed her scenes.
(Probably because OMGOMG SAM'S LOVE INTEREST IS A CROTCHETY VETERINARIAN!!!!!1)
I guess that's what fandom is about, taking something you enjoy and sharing what you enjoy about it.
The harsh fluorescents and the scents of cat pee, kennel, blood, and bleach comforted and galvanized her. She woke up the computer and had googled the human dose of Rompun by the time Dean dragged Sam into the clinic.
He and Sam managed to stagger into the treatment area before Sam let out a gurgling squeak and Dean lowered him to the floor, propping him up against the stainless steel island. In the light, Sam looked even worse. White skin. Gray lips. Floppy. Weak. Depressed mentation. Rapid shallow breaths.
Good god. She had a goddamn dying human on the floor of her veterinary clinic. And it was Sam.
"Sam's in shock," Amelia announced, sticking with what she knew for sure. "I can get some fluids into him, tide him over so you can get him to a hospital -- and you will get him to a hospital, because I'm a little out of my depth here -- and if you tell anyone I so much as stuck a needle in a human, I will lose my license, I kid you not. Ten minutes, then we move."
In answer, Dean unzipped Sam's canvas jacket and bunched his shirts up to expose his stomach. "That look like something fluids'll help?"
It was a testament to how long Dr. Amelia Richardson had been doctoring dogs that her first thought was "GDV" and not "UFO pregnancy" or "advanced liver failure." Sam's abdomen was massively distended, the cranial -- upper? superior? -- half bulging up beyond his ribs. The skin looked tight and painful.
"What the hell happened, Dean?" Amelia's hands wandered, as her brain stumbled over the dichotomy: this was Sam, Sam who'd held her like he was the lonely one and polished off half her bourbon and sherry, and this was an abdomen with an acute obstructive lesion. She was planning surgical margins between Sam's ticklish spots.
"He ate something he didn't agree with," Dean said, unhelpfully figurative. His voice rose, and his eyes widened, and for a moment, Amelia saw a family resemblance. "Dogs do this all the time, right? They eat stupid crap, and the vet has to cut it out?"
"You said this was twenty minutes ago?"
"Thirty." Dean checked his watch. "Closing on forty. Doc, you gotta move."
Sam was barely able to get enough air into his lungs; he was doing that shoulders-back heaving-sternum move that humans did when they had to expand their ribcage. "Take his boots off," Amelia ordered. Dean produced a knife out of nowhere and cut through the laces, and Amelia ripped off Sam's sock. His toes were red with pooled blood, and the nails were purple.
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Disturbed, she stepped away. "He needs surgery."
"So quit fartin' around and get started."
"This is not a discount hospital, you asshole!" Amelia exploded. "This is a vet clinic! I'm an animal doctor! I can try to stabilize him, but if you care about Sam half as much as I do, you'll get him to a human O.R., with a full surgical team that's seen the inside of a human abdomen, that has staplers and endoscopes -- two hours will be worth the drive!"
"No, it won't," said Dean, his voice frighteningly level. "In two hours, he'll be dead. We've seen it happen. He's got maybe half an hour, you're his only shot."
Sam flopped his hand at her, and she grabbed it automatically. He pressed her hand against his drum-tight stomach and squinted into her eyes, his chest still heaving with his desperate sips of air.
"Look me in the eye and tell me there's not something freaky inside there," Dean said.
Amelia swallowed. "I want an abdominal radiograph."
"Make it quick."
******
Amelia scrubbed her hands frantically over the instrument sink, as though she could erase what she'd seen on the radiograph -- what she was about to look at up close -- from her gibbering mind. She was going to cut a human, cut Sam. And use Dean for an assistant.
She was going to lose her license and go to prison. Or she would if Dean reported Sam's death; they seemed more the "bury him under the old oak tree" type. She was going to kill Sam, he was going to get peritonitis and die, because she was going to do an enterotomy solo.
On a human.
"Has it been five minutes?" Amelia hollered toward the operating room, still scrubbing, scrubbing.
"Five goddamn minutes," Dean hollered back. "Are you gonna cut this thing out of him, or what?"
"How's his breathing?" Sam was alone with two fluid bags pouring into his big, pretty veins, and for all she knew, she could be swamping his lungs and drowning him in Ringer's solution.
"Still terrible," Dean replied.
"Wipe the scrub off," she ordered. "Use a fresh gauze every time. Spiral outward."
"Got it."
Amelia flicked her fingers dry, toweled her hands off, wriggled into her sterile operating gown, and gloved up. "Get over here and tie me in. Now, Dean." Dean stomped out of the surgical suite, still slathered in blood and mud. "You can touch the inside of the gown," she snapped, seized by paranoia as she turned her back to him. "Not the neck. Not the edges. The ties, and the inside."
"I got it," Dean growled, tying the gown closed roughly but deftly.
Amelia clasped her sterile gloves together. "Scratch my right ear."
Dean leaned down, peered at her bushy hair through the gauzy surgical cap, and did so.
"Now wash up. Borrow some scrubs from the laundry room, strip to your boxers, I don't care, but don't bring that filth into the operating room again. And use the blue soap."
"Yes, ma'am." A little of the tension had gone out of him, and Amelia wanted to keep things that way. She left Dean hard at work over the sink with the fingernail brush and side-stepped into the surgical suite.
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"Is Dean right about the thirty minutes?" she asked softly. "I can stick him with a sedative, knock him out, and get an ambulance here. We don't have to do this."
"Ten," Sam hissed between paints. He flicked his eyes at the wall clock. "Ten now."
Amelia swallowed hard. "You're gonna be awake for this," she told him. His eyes widened, and she hurried to reassure him. "It's okay, they do this in cows all the time. I'll do a local. But you need to hold very -- very -- still, so you don't eviscerate yourself, okay?"
Sam nodded. Amelia uncovered her instrument table, dropped some sterile towels on one side of Sam's torso so she could lean over him, then loaded up a 12cc syringe with lidocaine and jammed on a massive spinal needle. "This is the local block," she said, threading the needle under his skin beside the incision site. As she drew it back out, trailing anaesthetic as it went, Sam flinched and hissed. She laid another line on his other side, then dropped more towels over his swollen stomach. It seemed to have gotten bigger in the past twenty minutes. That had to be just the way he was lying.
By the time Dean got done cleaning himself up, the local had kicked in enough that Sam didn't even react to the towel clamps stabbing into his skin. Amelia unfolded the old green laparotomy drape, which only reached from Sam's knees to his chin. Gowned, gloved, standing under the hot operating lamp, and facing a tiny rectangle of abdomen, just an abdomen in a blank green field, Amelia felt strong and steady, though it was closing on four a.m. and she'd been running short on sleep for the past week.
"Dean, put a mask on Sam so he doesn't sneeze on my incision," Amelia called. Dean barged in, still tense, but clean and sanitary in a too-small gray-green scrub top. "Get a bottle of saline out of the cupboard -- no, the bottom one -- the one on the right -- the clear stuff. That. Pour some into my bowl and don't touch anything."
"Aren't you gonna knock him out?" Dean demanded, clutching at Sam's shoulder under the drape.
"I need Sam to concentrate on breathing," she explained, and she lowered her blade and cut.
Skin parted, trailing blood and wisps of sparkling fat. Below, thick dark muscle joined gleaming white central tendon, so broad, she could hit that midline after five cups of coffee and a hangover. Thank god for Sam's health obsession. She grabbed her forceps and tugged at the tough white aponeurosis. Sam's abdominals twitched.
"Relax," she warned him. She lifted the abdominal wall up into a little corner, edged the scalpel up to it, and punctured in.
Her nose caught the tang of peritoneal fluid, just like any other abdomen. God, she loved that smell.
Sam's breath hitched. Amelia made the mistake of looking up from her incision and saw, again, Sam's face sticking out from under the too-small drape, forehead creased in pain, and Dean looming over him, staring at her with furious tension, his fingers twitching. "Sorry," she said. "The peritoneum, it's innervated. It doesn't block well."
"Just keep working," Dean growled.
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It looked generally stomach-like, with big, bright, healthy gastric arteries and shining pink serosa, situated in what she recalled to be a generally stomach-like position, from her high-school human anatomy class. But it was distended, round and unyielding to the touch. Sam took a sudden sharp breath and it seemed to leap upward, ready to slither out of his body like a rumen in one of James Herriot's barnyard war stories.
"Careful!" she yelped. But Sam took another deep breath, harsh heaving pants, and soon there was some abdominal press in his exhalations to confound the problem; she pressed a restraining hand against the surface of his stomach, but at the caudal -- inferior? -- margin of the incision, a bubble of blood-lace omentum and a few adventurous loops of small intestine squirmed out. "Sam!" She set her instruments on the drape and cupped both hands over his viscera. Sam was sobbing, that's what the abdominal press was; he had his face turned away and his eyes squeezed shut, breathing deep and sharp and hard. He was squeezing out his jejunum like toothpaste. "Calm down! Dean --"
Dean was crouching in front of Sam's face, gripping his hair in his fingers and stroking his temple with his thumb. "Come on, Sammy, it's almost over. Breathe with me. In, out. In, out."
It took a few fraught minutes, but Sam caught on, opening his eyes to meet Dean's. Sam's diaphragm settled into a rhythmic push, in time with Dean's exaggerated breaths; his intestines stopped fighting for escape, but the stomach still bubbled up, stretching the edges of the incision. As Amelia wet a pile of gauze sponges in the saline, Dean huffed out a series of sharp Lamaze breaths. Sam gave a pained laugh, and as she watched, a loop of intestines squeezed out of the incision again. "Dude, not funny," Sam croaked.
That was almost a full sentence. Amelia checked his cheeks and lips, and while he was still pale, he looked significantly less dead. His knees, where the stuck out from the other side of the drape, looked less purplish and congested. Venous return was better just from the abdominal incision, diaphragmatic excursion, too. "How's the, how's the pain?" Amelia asked.
Sam's eyebrows furrowed and contorted over his blue face mask. "Finite," he grunted after a moment.
"Tell me when you need more lidocaine," she said, eying his escaping stomach.
"Sure."
Amelia chewed on her lip and looked at Dean. This part was really a two-person job. "Dig out some gloves from the shelf -- on your right -- not that far -- second from the top. That bin. What's the largest size in there? Eleven?"
Dean held up a sterile pack of size-eleven gloves.
"Unfold that and put them on without touching the outsides. I need you to hold something."
She checked over her stack of open sutures on the instrument table while Dean figured out how to approach the gloves, then tucked laparotomy sponges between Sam's stomach and the rest of his abdomen. Sam winced as the damp cotton rubbed against his peritoneum, and when he saw her watching him, gave her a shaky smile. Good god, what was she doing, she should have dug out the morphine and to hell with the side-effects.
Dean held up his gloved hands, and Amelia waved him over to stand at Sam's opposite side. With a few quick jabs, Amelia anchored two long thick sutures into Sam's stomach, clamped hemostats over the ends for handles, and passed them over to Dean.
Dean got the concept and stretched the sutures out, lifting and immobilizing the stomach from two sides. He looked far, far too cool to be assisting at his first enterotomy. "Don't spill?" he guessed.
"Try your best," Amelia replied.
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"Don't worry about it," Dean said, watching the stomach with fury in his eyes. "It's not big enough to bother us. Just take it out and sew Sammy back up."
Amelia laid her scalpel against the serosa. "Cutting."
Blood welled, and the tense muscular wall parted to let the back side of the mucosa bulge out behind it. Sam made a soft noise and tensed his abdomen again; hopefully the sponges were keeping everything in place. She dabbed some blood away with a square of gauze, trying to get a good look at the layers, when the mucosa bulged out violently under her hand. She clutched the scalpel.
"Just back off!" Dean ordered, but Amelia was frozen, watching the soft red mucosa puff and recoil, seeing the imprint of sharp things pressing behind it, claws, yes, jaws, teeth, an organism, a live animal. One of those clawed limbs punched up through the incision and tore its way out, perfect young hooked mammalian claws on a long, muscular foreleg, a ferret-sharp head, another foreleg, and then a slender thorax, all covered in fine black fur, damp and slick with Sam's stomach juices. It's newborn eyes were open, and they looked up at her with steady, puzzled appraisal -- blue eyes, blue puppy eyes. This animal had just crawled out of Sam's stomach, and it would have shredded its way out if she hadn't cut down herself.
It licked its nose with a long pointed tongue with a phallic-looking hole on its rounded tip.
In a spasm of revulsion, she gripped the newborn by the back of the neck and jabbed the scalpel through its chest. Greenish liquid that should not be blood spilled out, and she jerked the thing out of Sam to keep from contaminating his incision even further. The animal kicked and clawed as she dangled it over the floor, its angular jaws snapping at the air, but its movements were clumsy and weak. The weight of its body pushed it further and further onto the scalpel until the blade broke the skin under its neck. It's flailing legs stilled slowly.
"Not quite what I meant by 'take it out,'" Dean remarked, still holding Sam's wide-open stomach safely above the level of the sponges. The corners of his eyes looked like he might be smiling.
Amelia dropped the animal with a splat, not bothering to fish the scalpel back out of its chest. It lay curled and still, a long otter tail tucked between its legs to its nose: in all, two and a half feet long and around ten kilograms, the size of a large cat. "I need to re-glove," she announced, dazed. "Sam, are you . . . hanging in there?"
"It's a girl," Sam said, and snickered.
Amelia unfolded a new pair of gloves. "Closing, at three-fifty-five AM. Since this is the boring part, how about one of you tell me what the hell that thing was supposed to be."
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Almost as bad as the waking nightmares of suture failure and massive fulminant peritonitis was Sam's and Dean's explanation of the little black penis-tongued ferret-puppy on the floor. They weren't sure what it was, but they did know that it wasn't unique; there was more than just mountain lions and grizzly bears out there eating people, and most of it didn't follow any kind of natural law.
Amelia could see that. The ferret-puppy didn't even have a placenta.
What was worst was the revelation that Sam and Dean were Sam and Dean Winchester, wanted felons and murderers, and that whether or not they were actually guilty, whether or not they were publically dead, they would always, always be running.
"Sam thinking you were dead, that was another one of your 'unnatural' incidents?" she asked as she cut up the radiograph of Sam's cranial -- superior - abdomen with scissors. Sam and Dean shared a weighted look, Sam sitting propped up against one of the cupboards in the treatment area, coccooned in towels and blankets, and Dean leaning against the wall nearby, toying with a mop. She held up one of the slices of film to the ceiling light to look at Sam's ribs; there was a weird geometric pattern that showed up over the bones. She wondered how she'd missed that artifact, and resolved to check the developer fluid for precipitate debris.
"I got sucked into a dimension of eternal combat for a year," Dean explained after a pause, as Sam watched him warily. "It made perfect sense that I was dead."
"But you weren't," Amelia concluded, dropping the scraps of illicit radiograph into a plastic bag.
"Not so much."
Amelia looked at Sam, who was still pale, clutching his stomach, and had a bag of Ringer's, his third liter of the night, running into his left arm. "Sam, you have just adopted a two-hundred-pound mastiff named Tock," she announced, sinking into the computer chair and entering a new patient. "Tock ate a bottle of foaming wood glue and needed an emergency gastrotomy. Tock now needs morphine and tramadol for post-operative pain control." She knelt at the cupboard underneath the pharmacy area and opened the clinic's small safe, pulling out a glass vial, a bottle of tablets, and a log book.
"No, Dean," said Sam wearily from behind her. When she turned around, Dean was gazing at the controlled drug safe like a man in the desert spotting a freshwater spring.
"Are we going to have a problem?" she asked.
Dean grinned, looking shockingly handsome for an instant, now that he wasn't terrified, covered in blood, or endangering her boyfriend. "Nah, I'll just knock over some other vet's office."
Amelia pressed her palms into her eyes. "Okay," she sighed. She counted pills, drew up a syringe of morphine, and handed Dean the sliced-up radiograph and the pill bottles. "Here's your evidence. Here's Tock's pain pills. Here's his antibiotics. Here's his ulcer meds. Sam, don't get sick. Don't rip your stitches. Don't require medical attention. This is legally indefensible, understand? I would lose my license, I would lose my livelihood. Have you ever had a livelihood, Sam?"
"Hey!" Dean interrupted her, stepping in front of his shivering brother and pointing a scraped-up finger at her chest.
"How about you, Dean, have you had a livelihood?"
He glared at her for a moment, then nodded faintly.
"It's what I have, and it's all I have," Amelia admitted. "Take care of each-other."
"Always," Dean replied, like a credo.
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"No," Sam said. A minute passed, and he sighed and relaxed against the cupboard, eyes rolling shut.
She clamped off his fluid line, pulled the needle, and reinforced the IV catheter's white cloth anchoring tape with most of a dwindling roll. She caught herself reaching for the candy-colored cling wrap before she stopped himself. “Don't let him chew that out,” she told Dean, and handed him the half-run fluid bag and two more liters of Ringer's. Dean strung them all on his left pinkie.
“Ten drops a second, right?” He turned to Sam. "Okay, kiddo, let's get you back on your feet," Dean ordered, tugging at his arm, and Sam tucked his feet up under himself, wincing, and stood slowly. They'd managed to wrestle a fresh pair of boxers and pants from the car onto him before easing him off the operating table, but not his tee-shirt, and his button-down and jacket were only half-on, leaving the forearm with the IV catheter exposed. He seemed steadier now on a fresh dose of morphine and with a fresh celiotomy incision than he had when Dean had dragged him in. They lurched back out toward the car. Amelia watched them go from the front window for a moment, before recalling that she was wearing a sleep shirt under her scrubs and moccasins on her feet and rushing off after them.
“Want a lift?” Dean offered. He and Sam were engaged in some complex gymnastic maneuver to settle Sam in the back seat without straining his sewn-together abs, their arms locked together, moving as one. At the end of it, Sam was on his side on the back bench, legs half-dangling into the footwell.
“It's almost not worth it now, but my purse is at home,” Amelia said dryly. She slid into the passenger seat and leaned back to watch Sam breathe. Dean started the car and pulled out at a senior citizen's pace.
“Don't be such a stranger, Sam,” she said. “Riot misses you.”
“Oh, Riot misses me,” Sam muttered back, slurring a little. That was probably the morphine. “I should come see Riot, then. When I can stand up.”
Amelia looked from Sam, to Dean, and back again, and made a decision. “You should stay at the house. Both of you. Sam, at least until you get back on your feet, don't you want an actual bed? A kitchen? Your coffee press?”
Dean shifted in his seat. Amelia wouldn't have noticed the movement if she hadn't seen Sam's eyes flick to his brother's back. “We've got some travel ahead of us,” Sam said. “But this was fun. Maybe next time you can stick your arm in my chest.”
“How about no,” Amelia replied.
“Quiet, love-birds,” Dean grumbled, easing the car down the still-dark streets.
Amelia sunk low against the collapsed springs and sun-worn vinyl where Sam, according to his drunken ramblings, had spent most of his life - right here, in this seat, with this man. “How about Thanksgiving?” she suggested. “History Channel marathon, bottle of port, Don's mom's jalapeno cranberry sauce? Let me check on my handiwork?”
Sam was silent for a long moment, and Amelia, despite herself, felt a hated stab of disappointment and need well up. She heard Sam open his mouth and take a breath to speak, but it was Dean who said, “Sure, sounds like a party.”
Amelia twisted in her seat and caught the tail end of Sam's adorable slack-jawed gaping, this time directed at his brother's back.
“You make Thanksgiving pie?” Dean continued, with a note of challenge.
“Sure, I can make a pie. Can you keep a date?”
Dean's mouth twitched and he shrugged. “If we can make it, we'll be here. How's that sound?”
“Sounds like that's as good as we're gonna get,” Amelia replied, as they pulled up to the little house that Sam had helped make a home, whose door Dean had busted in. That one would be fun to explain to the neighbors. She stumbled out and stood in the driveway, bone-tired now that the excitement was over, and listened to Riot yelp from where he'd been locked in the bedroom as she watched the old black car slip away into the night.
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And laughing at the green monofilament stitches and the bottle of foaming wood glue.
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Thanks so much!
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You did such a great job with this prompt!
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Thanks!
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She was going to lose her license and go to prison. Or she would if Dean reported Sam's death; they seemed more the "bury him under the old oak tree" type. She was going to kill Sam, he was going to get peritonitis and die, because she was going to do an enterotomy solo.
Even with this one paragraph, you made her more likable than cannon. Why can't we have *this* Amelia?
Maybe that could be a new genre: character modification. Does it count as OOC if it's how the character *ought* to be have?
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(Probably because OMGOMG SAM'S LOVE INTEREST IS A CROTCHETY VETERINARIAN!!!!!1)
I guess that's what fandom is about, taking something you enjoy and sharing what you enjoy about it.
I'm glad you liked this interpretation.
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