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Title: We Are Pilots
Pairing: Dean/Sam (Unrelated)
Rating: R (rating may increase later)
Kinks: mental health, reality vs. fantasy, caretaking/caregiving, hurt/comfort, angst
Summary: Sam Wesson is one of the longest-standing residents of Lawrence Regional Mental Health Center. The lines between reality and fantasy are severely blurred in his head, and he thinks that Dean Smith is his older brother, who he fights monsters with. Really, Dean is a nurse on Sam’s floor who’s been at the inpatient facility for years and has a soft spot for the kid. No one’s really sure why Sam can’t untangle fantasy and reality—the best guess anyone has is that it stems from long-standing emotional and mental trauma. Can Dean show Sam that the real wold isn’t so bad and heal the young man?
[This story is part of the Intermittent Fill set, meaning that it is expected to be a longer work and has been assigned a day for updates each week. This story’s updates are slotted for Tuesdays.]
Chapter One: Supposedly Sam
Holding close my secrets
Naked broken pieces
From the madness in what you do
The fingers point right back at you
What about my problems?
The people try to solve them
I guess I'm under the weather
Since no one else belongs here, with me…
—Shiny Toy Guns, “We Are Pilots”
From Dean Smith’s Journal – 20 January 2012
Started at LRMHC today. Not sure if this is the job for me. I thought I'd seen some crazy shit in the Corps, but this place is like another world. There are six patients in my caseload—individuals, we're supposed to call them, cause they're physically stable—with diagnoses all over the board. Dr. Winchester says they’ll cycle out a lot as they get better and then get worse. “All except Samuel,” he said.
And hell, maybe Sammy’ll have more luck than I have, ‘cause I sure as hell haven’t been able to figure it out .
Dean Smith hadn't always planned on becoming a nurse. Far from it. Before the explosion, before the shrapnel, before the ripping and tearing of muscle and the steel plate in his shin and the medical discharge and the Purple Heart, the closest Dean had gotten to the civilian nursing profession was the nurse that he had wound up bending over the exam table at the VA when he went in for his annual physical.
He had been a 68W, a combat medic. Two tours in Iraq, one in Afghanistan. It had gotten to the point that, by the time he was twenty-three, he was more comfortable in a war zone—and had spent more accumulative time in war zones over the previous five years—than stateside. He sacrificed everything to his service. His girlfriend, Lisa Braedon, had left when he was twenty-one, after he returned from his second tour and couldn’t handle being touched, couldn’t look at their son without seeing a kid his age blown apart in the streets. He couldn’t blame her. She never liked the military life anyway; had only stuck it out because he joined right after they found out she was pregnant. They were still friends; he still saw Ben sometimes.
It was his third stint under the wire that brought everything crashing down. When the dust cleared after open fire, he had rushed out with the rest of his unit, starting transfusions and patching up wounds that were really too serious to be fixed with gauze and tape, ‘cause that’s what he was supposed to do. He held his brothers-in-arms hands as the light faded from their eyes. It was part of the job. He took down their names in the long list in his head; promised himself he would write their widows when he got back and try to help them find some sort of peace that would, honestly, probably never come.
Then the bomb went off. Dean still didn’t know if he tripped it, or if it was one of the other Marines winding their way through the mess of bodies and blood-soaked dirt. It didn’t really matter. The air went impossibly hotter and his vision flashed red and then white and he fell as shrapnel tore through his shin, metal and rock digging deep into bone that would never heal quite right, held together by a sheet of titanium that would send shocks through his nerves when the air grew too cold or wet.
Then they were patching him up; patching up his wound that was really too much to be held together by gauze and tape.
He was lucky not to lose the leg, they said. Dean didn’t feel too lucky. He signed his discharge papers a month later, began a life of recovery and physical rehab and painkillers.
The desk jockey in charge of finding job placement for wounded veterans had suggested nursing school—said it should mesh well with his MOS. Dean thought the guy was full of shit; wanted to tell him that taping together pieces of a body in the hopes that his brothers will be able to hold on just a minute more when it would probably be kinder to just go ahead and put a bullet through their skulls was nothing like being a pill-pushing RN. But he didn’t have any other options, and he needed to begin to assimilate to civilian life, so he enrolled in nursing school.
In January of 2012, Dean Smith found himself at twenty-seven years old, with a sheet of titanium holding his leg together, a Purple Heart tucked away in the back of his dresser that he never brought out, a shiny new degree that confirmed he was a Registered Nurse, and a new job at Lawrence Regional Mental Health Center. That was three years ago.
LRMHC was an in-patient facility with a under-capacity residential roster and an acronym that didn’t fit right on the tongue. Dean’s caseload fluctuated with demand, from one to six ‘individuals’ at a time. The one was always Sam.
No one was one hundred percent sure what was wrong with Sam Wesson. He had been with them since he was sixteen; ten long years now. The doctors had guesses. Dean had guesses. Everyone had guesses but no one could offer any certainty. Sam was too trapped in his head, too unable to separate the fantasy in his head from the reality playing out around him.
His official diagnosis was typed out in neat, sterile font on the first page of his case file, the words flicking through Dean’s field of vision every time he opened it to review any changes to Sam’s meds or therapy plans.
297.1 (F22): Delusional Disorder; mixed type – grandiose and persecutory types evident – with bizarre content. Continuous course. Delusions 4; Negative symptoms 2 (alogia).
It was a fancy textbook way of saying that Sam was stuck in his own little world, pulling in everything around him and bending it to fit inside his accepted reality. When conflicts between reality and his fantasy world became too much, his verbal skills would decay and he would speak very little. It was part of the schizophrenia spectrum, with no hallucinations to support a diagnosis of schizophrenia.
Dr. Winchester’s best guess was that Sam had some sort of chemical imbalance that could be fixed with the right cocktail of drugs and intensive therapy. Dean’s best guess was that Dr. Winchester was full of shit.
Something had locked Sammy up tight in his head. The damage to the barrier between fantasy and reality in his head was a scar left from something that had happened to the kid. But Sam was considered an unreliable source for such information. And anyway, he wasn’t offering it. If you pushed too hard at that crack, if you hit the wrong nerve, Sam crawled back into the fantasy, tucking himself in tight, and didn’t poke his head back out for days.
So Dr. Winchester kept trying drugs and Dean kept caring for Sam through the onslaught of the side effects of various chemicals coursing through his system. Everyone at LRMHC liked Sam, and they’d talk about the day when they’d finally get to see him leave, finally go home, once Dr. Winchester found that magic bullet that would make his brain fire right and bring him back to solid ground. But Dean had seen that haunted, avoiding look in a lot of men’s eyes and he knew that there was only one magic bullet for that, and it wasn’t sitting in the bottom of a prescription bottle.
Dean arrived for his shift at eight in the morning each day, just in time to pass meds and watch the residents filter to their group therapy sessions. Group therapy was followed by individual therapy and medication monitoring until noon, which was lunch.
He set Sam’s salad on the counter and waited for him to come pick it up. The kid was in an alogia episode, which means his verbal interactions would be limited, so Dean didn’t bother trying to talk to him much, didn’t call him over. It was harder on those days; like talking to a brick wall. He was never sure how much of what he said landed, or what it became deep in Sam’s mind.
“How you doing, Sammy?” he asked, not looking up from the chart in his hands when the younger man came to get the salad. There was no answer before Sam was heading back to his table. Dean hadn’t really expected one.
Meg cleared her throat. “You know you’re not supposed to bring them outside food.”
Dean sighed, shutting the chart and setting it on the desk. “I don’t bring them outside food; just Sammy.”
“Their diets are an important part of their treatment.”
Dean balked at her. It wasn’t her fault, really. Meg hadn’t been there long, so she didn’t really know the drill. Still, Dean sometimes got the distinct impression that she was just trying to stir up shit.
“That food—“ Dean nodded to the nearest table, at the cafeteria-style Salisbury steak and glue-like mashed potatoes. “That food is an important part of their treatment?” He rolled his eyes. “Besides, I brought him a goddamned salad, not a bacon cheeseburger. The kid likes salad; leave him alone.”
“You know Dr. Winchester would say that you’re encouraging his delusions with stuff like that.”
“And what would the good doctor think about your blatant favoritism towards Cas?” Dean knew he had trumped her. The facility actually had a pretty nursing staff, and no residents got neglected or mistreated as far as Dean knew, but they all had their favorites. Meg’s was a young man named Castiel Novak; a schizophrenic who believed that he was an angel occupying a human ‘vessel’ on Earth as a soldier of God.
Meg smiled wryly, her eyes landing on the man in question where he was eating his lunch. “What can I say. He’s a sweetheart. A little honey for his morning toast isn’t going to hurt him.”
“I thought their diets were a very important part of their treatment?” Dean grinned at her.
She rolled her eyes and walked away. Dean turned his attention back to Sam.
Brandon set a plate down in front of Sam, confirming Bobby’s fears that the angry little man would be their waiter for the evening. “Sidewinder soup and salad combo goes to Big Bird.”
Sam furrowed his brow, opening his mouth to speak, but before he could think of anything to say the man went on. He set a plate of—horrible, really—food in front of Dean. “TDK Slammer to Ken Doll.” The last plate he set in front of Bobby. “And a little heart-smart for Creepy Uncle.”
Dean had had enough of the waiter’s attitude. “What is your problem?”
“You are my problem!” The waiter’s eyes bulged as he screamed, causing all three hunters to flinch. He stalked away without another word.
Bobby watched him go, looking amazed that anyone, even someone in the service industry, could function with such anger boiling that close to the surface. “Oh, Brandon’s got his flare up in a bunch.”
“Yeah, there goes his eighteen percent.” He poked at his salad with a wry grin.
Dean turned his attention back to the case. “Anyway, chief ranger—I don’t think he believes in the Jersey Devil.”
“Oh, oh, by the way, Did he seem a little uh…” Sam searched for a polite way to say it and then gave up, “Stoned to you?”
Dean laughed. “Ranger Rick? Yeah. Definitely growing his own on the back forty and smoking all the profits.”
Sam smirked, running through their interactions with the man in his head. “He did seem to think there was something—”
Dean cut him off with a low moan, his mouth full of food. “Oh, that is a good sandwich.”
“What the hell did you get?” Bobby asked, giving Dean’s lunch a look like it might haunt his dreams later.
Dean turned the placard at the center of the table around, slamming it down triumphantly for the other two to see. “New Pepperjack Turducken Slammer—limited time only.” The tone in his voice seemed to suggest that he had scored big by ordering it before it was discontinued.
Bobby grunted disapprovingly. “Bunch of birds shoved up inside each other. Shouldn’t play God like that.”
“Hey!” Dean looked offended. “Don’t look at me sideways from that…that Chinese chicken salad there, okay? This is awesome.” He gave the sandwich an almost worshiping look. “Like the perfect storm of your top three edible birds.”
Sam raised an eyebrow at him, astounded that anyone could stomach that horror of a sandwich. “All right… anyways, um…” He tried to remember what he had been saying before the conversation had devolved into an assessment of the merits of a chicken in a duck in a turkey. “The ranger did seem to think there was something out in Wharton Forest.”
Bobby shrugged, figuring it was their best lead. “Well, I’d say it’s safari time.”
At that point all three whipped their heads around as shouting broke out in the restaurant. “She’s big-boned!”
Brandon was sneering at a man who was steadily turning redder in the face with outrage. “Look at her! You’re telling me she’s not fat?”
“Hey,” another waiter broke in, trying to dissipate the rapidly-escalating situation.
“Up yours, Mike!” Brandon spat, whipping his apron off and slamming it down on the counter. “Shove it right up yours!”
Dean waited a beat after Brandon had stormed out before shrugging. “Well, anyway. Back to bigger and better things.”
“Sammy?” Dean asked, waiting for the man’s hazel eyes to rise to meet his. “You hear me?”
Sam nodded but didn’t answer. He pushed the empty salad container forward and Bobby, the head of custodial services, picked it up and tossed it into the trash can. Dean smiled at the older man, shrugging as he looked questioningly at Sam and then back at Dean.
Dean waited until the man moved on to the next table and then leaned in towards Sam, his voice low. “What’re we hunting, Sammy?”
He saw the flicker in Sam’s eyes as the words hit, as he assimilated them. “Don’t know. Jersey Devil, maybe…” He shifted and his eyes raised back up from the table to meet Dean’s, searching. “Rats don’t shake their ass, Dean.” He frowned. “It’s two shakes of a lamb’s tail.”
Dean laughed. “Sorry, Sammy. I’ll remember that.”
Dean thought that Sam was probably abused. There was no proof to back his theory; he had been brought in after being pulled from the streets, tagged as a runaway, and made a ward of the state back in 2005. He had been sixteen. The kid had been in a completely dissociated state at the time, ranting about his soul and Lucifer and God missing from the equation. In his initial seventy-two hour observation, he hadn't slept more than two minutes before he was lurching up again, eyes wide with fear. That had been seven years before Dean started at LRMHC. The nurse had actually been across the world, on his first tour in Iraq. But the details were all packed neatly into his case file.
Samuel Wesson might not even be his real name, Dean knew. He had been brought in as a John Doe, had told them his name two months after coming to LRMHC. Dean knew there was no record of birth that matched the name and the year. There was also no known match for his fingerprints in the system, and no response to the alerts of a found teen across the US. After a time they started to treat Sam like a corpse, had filtered through dental records for patients about his age for months without finding a match. Sam swore he had been born in Lawrence, and that his mother had died in a fire when he was an infant. For awhile the police had chased this lead. Then Sam revealed that it had been a demon that had set the fire after feeding him his blood to give him psychic abilities. At that point the police pretty much threw their hands up and Sam’s case went cold.
So Dean had no proof that Sam had been abused. But when he tried to think of what could cause such a vicious break with reality—especially when the fantasy world the man preferred was often so much more violent and hopeless than the real world—he always landed back at that conclusion. Something terrible had happened to Sam, and when he couldn't escape in the physical world he fled into fantasy, locking himself up tight in his mind where he could protect himself, could save the world.
Dean didn't know how to help Sam detangled the crossed wires, how to help him find the path back to reality or how to illuminate the sharp contrasting colors of the fantasy to show Sam how artificial they were. No one did. But Dean wanted to.
Sam thought that Dean was his brother. It was probably something in the way Dean looked out for him, the way he called him Sammy or stood up for him when Dr. Winchester was too harsh or when Crowley—a snarky English-born man with narcissistic personality disorder mixed with something unspecified on the schizophrenia spectrum and who called himself the King of the Crossroads—bullied him.
But whatever it was, Sam had assimilated Dean into his world as his older brother. And Dean had decided to operate within Sam’s parameters in his care, letting him think that. Dr. Winchester didn't like it; he said that Dean was encouraging Sam’s dissociation, legitimizing the delusions. But Dean didn't know any better way to help the kid.
Or at least, he didn't for a long time. Not until the day that Sam gashed his hand open.