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Sam Winchester was 9 years old when he found out about all the things that live in the dark. When he found out he wasn’t safe, that the world wasn’t safe. Dad was risking his life every day, and even though Dean didn’t say it Sam knew there was a chance Dad would accidentally bring something home with him. Something that could kill him, kill Dean. Even people that didn’t hunt monsters sometimes got killed by them; it was a risk that everyone faced just by living on Earth.
Sam had to learn to live with this – he had no choice. At first he told himself it would be easy; he had his dad to protect him, and Dad was going to teach him and Dean how to protect themselves too. But it wasn’t easy. Sam would get scared of the darkness in a closet and Dad would hand him a gun like he’d know what to do with it. Dad hadn’t even taught him how to use a gun – not yet at least.
Sam got older, and Dean started going on hunts too sometimes, leaving him alone. One day his Dad decided to take Sam along too. This was his destiny: to be a hunter just like his dad and brother. But Sam didn’t want to be a hunter. He wanted to live in the world he’d had when he was little, where things were safe and simple and one day he’d be a doctor or a lawyer or a vet taking care of cute puppies. Instead he was stuck with a reality where he’d grow up to kill or be killed, and in the privacy of his mind he kicked against it.
When Sam was 14 he started to get taller. When he was 15 muscle started to fill in, encouraged by hours of training at his dad’s order. Sam looked in the mirror and he could almost see the hunter he’d be one day, a strong, tough man just like his dad. He wasn’t there yet, still a long way off, but he could see that future and every part of it felt unsafe, threatening. Damning.
One day when Sam was 15 he started at a new school, some place in Nebraska he’d one day forget the name of, and he met someone. A girl named Abby. She was small, smaller than any of her classmates and there were rumors about why. People whispered that she didn’t eat, that she spent lunch reading instead. That she was an anorexic. Sam had never heard that word before.
He looked at her, and he realized that she didn’t look pretty. Not really. But she was small like a child, something about her habits keeping her short and petite, scrawny even. It made him think of when he was little and Dean teased him, called him scrawny. Sam would punch him in the stomach when he said that and laugh when Dean wheezed. Then his brother would punch back in retribution and they’d end up sprawled on the floor, wrestling unskillfully. It didn’t matter that 7 year old Sam could never beat an 11 year old – he lived in a world where being weak didn’t mean danger. Not yet.
So the next day, for reasons he didn’t fully understand, Sam read at the lunch table. And that’s when it all started to go downhill.
--
It was Sam’s second semester at Stanford. He’d effectively cut off his dad and brother; or really, more accurately they’d cut him off. He missed them both more than he would even admit to himself, but he was free. He didn’t need to train, to kill monsters, to prepare for a future where he’d be able to do that all on his own. He didn’t need to rely on an old coping mechanism to avoid a future that frightened and threatened him. It had never worked anyway – he wasn’t muscular, sure, but he was over 6 foot now and intimidating in a way he’d never been able to shake.
He was making perfect grades, and in his first semester he didn’t really notice there was a problem. Maybe he wasn’t in any clubs, wasn’t making any friends. Maybe the only person he ever really spent time around was his roommate, and that was situationally forced upon him. Maybe sometimes it was too hard, too stressful to walk to the grocery store or visit a cafeteria or fast food restaurant on campus. Maybe, on days without classes he didn’t leave his dorm room at all.
But he was making good grades, and that’s what really mattered. Final exams stressed him out; he forgot to take time to eat in the middle of long, grueling study sessions. But that was easy for him – he’d been forgetting to eat since he was 15, and often choosing not to whenever he did remember. Being hungry helped, anyway. It was familiar, and it provided a sensory distraction whenever his surroundings became too overstimulating. Whenever his brain got too loud and he needed to focus on something to quiet it.
Sam first realized there was an issue at the start of his second semester, when it occurred to him why he avoided people. It was because pretending to be normal was the hardest it had ever been. In grade school he’d faked it plenty, but he didn’t have to maintain any one image for long. Before he started to crack, they’d up and move to some other school anyway and he could start back at square one.
Plus, the social pressure of college felt very different than the one he faced in high school. He lived on campus 24/7 – it was forever-school, with no break to go home to his brother and dad and settle back into the familiar pain of training and hunting. There were no times where he could really allow himself to be weird; he could only relax a little when he was alone in his dorm room. Because Sam Winchester wasn’t normal, and he understood that more with each day that passed.
When Sam suddenly started to feel dizzy he didn’t even think about it. He lived in a perpetual brain fog that clouded over every moment of his life. It had in high school, too, but it was worse now than it had ever been. That’s what happened when you didn’t eat – he knew that. It was familiar, and even though he no longer needed to not eat he didn’t really see any reason to change his behavior.
It was only when his vision started to tunnel, when his ears started to ring and he felt nauseous and sweaty, when his heart started to beat in double time like he was running a marathon, that Sam thought, “Oh no.” The dorm room floor rose up to meet him, and the last thing he heard was his roommate’s voice saying “Sam? Sam!”
--
Sam woke to the sound of insistent beeping and the burn of bright light against his eyelids. With great effort he blinked his eyes open, squinting in the cold white light of whatever cold white room he appeared to be in. It took him a minute to ground himself; longer than it should have. A hospital. Oh fuck.
A nurse, some matronly middle aged woman in navy blue scrubs, noticed him. “Hey, Sam. You’re awake,” she said gently. “I’m Nurse Sara. I’ll be right back with the doctor, okay?”
After a few minutes of waiting, during which Sam felt too tired to panic as much as the situation probably deserved, the nurse returned with someone else trailing behind her. A man in his 30’s, with short cropped dark hair and turquoise scrubs under a white coat. “Hi Sam, I’m Dr. Ratcliffe. How are you feeling?” the doctor asked, and Sam tried to clear his dry throat.
“…Not too good,” Sam finally choked out after a long pause.
The doctor chuckled. “Well, I wouldn’t think so. You had quite a bad time,” he replied.
“What happened?” Sam asked softly.
The doctor’s expression turned serious and sympathetic. “Well, the bad news is you had a cardiac event that nearly killed you. The good news is that your vitals are looking good now,” he said.
Fuck.
“Why?” Sam coughed out, too hoarse for more words and not really sure what else to say. The nurse conveniently appeared with a small cup of water, and he gulped it down eagerly.
“Well, I’ll be honest with you Sam. You’re critically underweight. We can do tests to figure out why, but I think maybe you already know.” The doctor didn’t sound judgmental, but Sam still cringed.
“I guess,” he mumbled in response.
The doctor nodded. “Well, we’re going to get a social worker in here soon. In the meantime, is there anyone you want us to contact? Family, friends? A girlfriend?”
Sam thought about it through the fog in his head. Dean probably hated him now, but he felt so alone and… you know what, fuck it.
“Dean. My brother,” he whispered. He gave them the number to Dean’s private cell, the one only family knew, hoping against hope that his brother hadn’t changed numbers.
--
Dean was just finishing up a solo hunt when he got the call. Dad was off doing his own thing, as he often was these days. It had been a werewolf, simple and easy to handle. He frowned when that phone rang – only Sam and Dad knew the emergency number, and Sam was gone and Dad rarely called. He fumbled in the glove box, still driving.
“What?” Dean answered.
“Is this Dean Winchester?” a woman’s voice asked.
“Who’s asking?” he replied gruffly.
“This is Zuckerberg San Francisco General Hospital,” the voice said. “We’re calling about your brother, Sam.”
Dean veered recklessly off to the side of the road, putting the Impala in park.
“Sammy?! Is he okay?!” he demanded, desperate. His heart was pounding a mile a minute and he felt dizzy with fear.
“He is now,” she said gently. “He had a life-threatening medical emergency, but we’ve managed to stabilize him. He’ll be okay, but he asked for you,” she explained.
Dean clenched a hand around the cell, almost hard enough to crack it. “Emergency? What the hell happened?!” he demanded.
“We can’t give details over the phone,” she said, and Dean slammed his free hand on the steering wheel.
“I don’t give a damn what you can do over the phone! Tell me what’s wrong with Sammy!” he yelled.
“I’m sorry. I’m sure you’re worried about your brother but it’s not my choice. There’s only so much I can tell you under HIPAA law. If you come visit the doctor can tell you what happened in detail,” the woman said calmly.
“Screw the damn law, and screw you!” Dean yelled, before ending the call. And then he drove like a bat out of hell. He was 12 hours out from Stanford, California. He made it in 10.
--
Sam sighed as the social worker finally left the room. For the first time in his life he’d tentatively admitted to having a problem, and the social worker had started talking about therapists and inpatient facilities. Sam didn’t want a therapist and he certainly didn’t want to be committed.
That said, something about almost dying had a way of changing one’s perspective. The doctor had told him his likelihood of survival had been about 50/50, until they’d gotten lucky and managed to stabilize him. Sam hadn’t paid attention to mirrors in a long time, but judging by the tone everyone here used when talking to him he had to assume that he looked pretty bad.
Dr. Ratcliffe came back into his room; he seemed like a decent guy, unusually attentive to patients, but Sam still wasn’t thrilled to see him. He had a way of… emphasizing the likelihood of Sam’s eminent death if he didn’t change his behavior. Frankly, he didn’t really want to hear it.
“Did the nurses let you know your brother is on his way?” the doctor asked, and Sam nodded.
“Yeah, he travels,” Sam said. “He was probably a ways off when they called, he’ll get here in a few hours.”
The doctor nodded. “I hope his support will help you. You need it to get better,” he said.
“Who says I want to get better,” Sam growled, pushed past mild annoyance and into acute irritation.
The doctor gave him a sympathetic look. “I think you still want to live, Sam. And if you do you don’t have a choice.”
--
Dean pulled into the hospital’s parking lot, the Impala screeching to a halt. It was a little angled in the parking space but he couldn’t bring himself to care. He slammed the door behind him and all but ran into the hospital. He didn’t know what to expect – what the hell could have happened to Sam? As far as he knew he was fine when he left, fine enough to drop everything and run out of their lives the first chance he got. How could things have changed so quickly?
The secretary gave him Sam’s room number, and Dean navigated the hospital quickly until he stood a few feet to the side of the door, not quite close enough to look in. Suddenly he wasn’t sure if he was relieved to be there or if he’d rather be literally anywhere else. He shook his head at himself. There was nothing, nothing more important than protecting his little brother. He was just scared of what he’d find when he entered the room.
He took the final few steps and looked in. Sam was sitting up in the hospital bed, reading a book. Typical Sam; he’d take any opportunity he could to read, the nerd, though Dean supposed there wasn’t much else to do in a hospital. He rapped on the doorway and his brother looked over at him.
Dean noticed some things very quickly. Sam looked… terrible. It wasn’t just his pale face, or the dark circles under his eyes – it was his pronounced cheekbones, a lack of any fat in his cheeks, sunken in and angles where curves should be. He looked like a prisoner of war.
“…Sammy?” Dean whispered, suddenly feeling like he couldn’t breathe.
Sam gave him a wan smile. “Dean,” he replied simply.
“What- what the. Sam, what the hell happened?” Dean demanded, feeling like the ground was suddenly unstable under his feet.
Sam looked down at his lap, shrugged. “I, uh. Collapsed,” he answered.
“That’s not what I meant,” Dean said firmly. “What the hell happened? Why do you… why do you look like that?”
Sam made an almost imperceptible flinch and continued to avoid his eyes. “I, uh. Heart failure,” he mumbled, and Dean ran a frustrated hand through his hair.
“But why?” he demanded, feeling in that moment like his entire world was falling apart.
Sam hesitated long enough that Dean started to think he wasn’t going to answer at all. But eventually he said softly, “I… wasn’t eating enough.”
“No kidding,” Dean said, more harshly than he meant to, and Sam flinched more noticeably this time.
“How could this happen?” he demanded. “Did you- did you do this to yourself on purpose?!” What the hell was Dean going to do if Sam said yes? How could they even begin to move on from this?
Sam was silent, hiccuped quietly, and it took Dean a moment to realize his brother was crying. Dammit. He was really screwing this up.
“Sammy,” Dean said gently, taking a few steps toward Sam’s bed. “It’s gonna be okay. It’ll be alright, I promise. Okay?”
Sam just cried harder, louder, and when Dean reached the bed he ran a hand through his little brother’s hair. That gesture had made Sam feel better for as long as Dean could really remember. “C’mere,” he said, opening his arms, and Sam leaned into his hold. He just cried and cried, and Dean squeezed him tightly.
--
“Your brother’s heart failed,” the doctor told Dean seriously as they stood in the hallway, just out of Sam's earshot. His brother had barely spoken a word to him since he stopped crying, no matter how much Dean tried to comfort him, cheer him up or prompt him into speaking. Sam’s doctor was the only way he was going to get any answers.
“His prognosis was pretty grave, but we managed to save him. But if he’s going to survive the next few months he has to recover. He’ll need you to get there,” the doctor said.
“Recover? Recover from what?” Dean asked, even though he had the feeling that deep down, he already knew.
The doctor sighed. “Your brother won’t put it into these words, but… we’re certain he has an eating disorder. It’s life threatening at this point, and he’s going to need a lot of support. He may even need to go to a treatment center,” he said.
“My brother is not getting committed,” Dean said emphatically. Then he sagged, feeling exhausted and just lost. “Why… why would he do this to himself? I just… I don’t understand it. He won’t explain it to me, he’s barely speaking at all. I just… what do I do?” he asked desperately.
The doctor gave him a sympathetic look. “He’ll open up when he feels comfortable. In the meantime you have to be his biggest supporter. Don’t push, don’t judge or fight him on it. Just be there, and listen when he needs you to.”
Dean nodded slowly, “I, uh- okay. Okay,” he replied.
“I’ll leave you with your brother,” the doctor said gently. “Just… sit with him. I’ll be back if anything comes up.”
Dean nodded, and the doctor walked away. Taking a moment to steel himself, Dean stepped back into the room.
“Hey, kiddo,” he said gently, sitting down in the chair he’d placed at Sam’s bedside.
“Mm,” Sam mumbled.
And then they just… sat for an hour. Sam eventually picked his book back up and Dean stared at his lap, trying to figure out where it had all gone wrong. Had Sam been doing this before, under their roof? He’d always been so damn skinny, but Dean had assumed he’d fill out as he aged. He just needed a bit more muscle on his bones, and hunting would give him that. Before he knew it, Sam was gone and it was a little too late for that.
Then Sam started speaking out of nowhere, startling Dean a little.
“I just… I hated hunting,” Sam said. Dean waited for him to continue; he’d already known very well how his brother felt about hunting.
“When I was little things were easy. Safe. And then I found out, about everything, and… I don’t know. I guess I just didn’t want things to be the way they were,” Sam said.
He stopped speaking, for a while, and eventually Dean said, “…This has something to do with… you know?” He couldn’t exactly bring himself to say “your eating disorder”.
“I- I guess. Really I just… I didn’t like growing up. I was going through puberty and starting to look like Dad and… I didn’t want to. I wanted to stay small,” he said. “I didn’t want to be a hunter,” he repeated.
Dean’s heart ached. “You couldn’t avoid hunting like that. That’s just… wrong, and it never would have helped. You know that, right?”
Sam sighed, quiet. “Yeah, I know that now. But I was 15 and… I wasn’t exactly thinking rationally,” he admitted.
And that made Dean feel even worse. 15. That meant Sam had done this for three years under their roof, and no one had noticed. Not Dad, not even him. How could they have not noticed? How was that even possible? Shaking himself out of a self-hating spiral, Dean had another thought.
“But you left. You weren’t gonna be a hunter anyway. Couldn’t you have stopped?” he asked.
Sam shrugged. “Yeah, but… I guess it was too late then. And I was so stressed, being at school. I couldn’t pretend to be normal properly. Couldn’t make friends. And mid-terms were so stressful, and… I guess I just couldn’t handle it.”
Dean should have seen this coming. All of it. He’d assumed Sam, ever the nerd, would take to college like a duck to water. But college was different than high school, different than their nomadic hunting lifestyle. Of course the adjustment would be hard.
After a long silence, Dean said, “I’m gonna fix this. All of it.” His voice was firm, filled with conviction.
Sam sent him an open, despairing look. “How, Dean? I- I’m not sure there’s any fixing this.” His voice cracked mid-sentence and Dean’s heart broke.
“We gotta, Sammy. You don’t have a choice. The doctor says if we don’t you’ll die,” Dean said.
Sam suddenly looked irritated, and he muttered, “Yeah, he keeps telling me that.”
“And he’s probably right, Sam! You look like- like-“ Dean cut himself off abruptly. That wasn’t helpful at all.
But Sam’s gaze jolted up to him, eyes flashing. “Like what, Dean? I look like what? Whatever crap you’re thinking, at least own it.”
Dean shut down that initial thought: Like a prisoner of war. Instead he settled on, “Like you’re not okay.” And Sam broke.
He was crying again, and Dean was hugging him again and hell, he had no idea how they were going to fix all this but somehow, some way, he had to make it happen.
--
Dean got home from work, done for today with his job at the restaurant. It paid well enough for him to afford a small apartment that wasn’t completely shitty, and as soon as he’d paid the first month’s rent and security deposit Sam had moved in with him.
Dean still hunted, but it was very infrequent and only jobs within a few hours of Palo Alto. Dad was AWOL most of the time – Dean checked up on him regularly enough but the man had no idea about Sam’s health or Dean’s semi-retirement. He apparently didn’t have much time for his kids these days; he seemed to think he was on the demon’s trail, but all of his ramblings had started to sound a little unhinged and Dean had the feeling he wasn’t as close as he thought he was.
Sam had taken a year off of college; they’d decided he’d transfer his credits to the City College of San Francisco when he wanted to go back to school. Sam hadn’t seemed as disappointed about it as Dean would have expected - he had bigger things to worry about, perhaps. He saw a therapist twice a week and while he went on his own most times Dean had sat in on a session or two. The therapist seemed nice, helpful.
With the help of many visits to the local library and things said both in therapy and out of it, Dean had gotten a much better understanding of Sam’s condition. It was a coping method, something he fell deeper into in times of stress. The best thing they could do at the moment was keep his stress at a minimum until he’d gained enough new skills to be able to handle greater challenges.
Dean had no doubt Sam would get there – his little brother was the strongest person he’d ever known. He was putting on weight week by week, and while he was still visibly thin his face had filled out and he looked fairly normal, with his clothes on at least. He had regular doctor’s checkups, and the doctor seemed happy enough with Sam’s progress. With the help of medications his heart was doing a lot better, too, and that was a huge relief.
There were setbacks. Dean kept an eye on what Sam ate and prompted him at times. He tried to be non-confrontational about it, but there were times it spiraled into fights. There’d be a week here and there where Dean knew full well Sam was skipping breakfast and lunch. Dean had to gain patience he’d never had before, and emotional intelligence life as a hunter hadn’t really gifted him.
The most important thing was that Sam wanted to get better; the second most important thing was that Dean loved his brother. And those two things were getting them someplace better, slowly but surely.