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The Binding of Names

Summary:

Pamela Barnes has seen patients lost in paperwork before, buried alive under diagnoses that weren’t theirs to carry. Fifteen years of practice have taught her what to fear and what to trust.

But when Dean brings Castiel into her office for the first time, she strips the case back to its raw bones — and finds something far older, darker, and more dangerous than a string of clinical errors.

There are symptoms. There are signs. There are things you can’t put in the notes.

And once a name is written, it can never be unwritten.

Notes:

Disclaimer:

I am not a psychiatrist or mental health professional. This story contains elements of psychological horror and intentionally leaves Castiel’s condition unnamed to explore themes of misdiagnosis, confirmation bias, and the weight of labels. It is not an accurate representation of any specific mental illness and should not be read as clinical advice.

Content may include: misdiagnosis, medication use/misuse, clinical settings, anxiety/panic, altered perception, and medical distress. Please proceed with caution and put your well-being first.

Chapter 1: A Dark Room

Chapter Text

Dean knew the sound before he was even awake — the faint hum of the fridge, the quiet whir of the heating system kicking on, the absence of anything else. It was the kind of silence that pressed in on you, like the house itself was holding its breath.

When they’d first moved in, mornings had been noisy. Coffee beans grinding, music spilling from the kitchen radio, Cas humming under his breath as he read headlines on his phone. Sometimes Dean would walk in to find him in mid-rant about some obscure medical ethics case he’d read at three a.m., waving a wooden spoon like it was a gavel.

Now the kitchen just smelled faintly of cold toast.

Dean pulled his phone off the counter while his eggs hissed in the pan. Three missed calls from Benny — probably trouble with the Singapore deal — and a string of urgent texts from Charlie about the beta release.

The clock on the wall ticked louder than it needed to.

He tried not to think about work this early, but his brain was already running the numbers. If they could lock down the venture capital meeting next week, they’d have enough runway to push into the next market. If they couldn’t… Well. He’d built Waypoint Software from his laptop in a grimy shared workspace at twenty-five. He wasn’t about to watch it stall now.

His laptop bag was already by the door. Tie draped over the back of a chair. He’d meant to put in a few extra hours this week, but “a few” had turned into “every.”

He flipped the eggs, thinking he might just leave a plate in the microwave for Cas — not that it would get eaten. Breakfast had been hit-or-miss lately. Sometimes Cas ate like he’d been starving. Sometimes he just stood in the kitchen before heading back upstairs without a word.

A floorboard creaked behind him.

Dean turned, spatula in hand.

Cas was in the doorway, hair flattened on one side, wearing one of Dean’s old MIT hoodies that had seen better days. The sleeves hung past his hands. Bare feet on cold tile. His eyes were bloodshot — not in the red-rimmed-from-sleep way, but in the deep, lingering way that made Dean wonder how much of the night Cas had actually spent lying down.

“You’re up early,” Dean said, keeping his voice light.

“It’s 7:03,” Cas answered after a pause. His voice was dry, gravelly. “Early for me, yes.”

Dean smiled — the kind you put on for business meetings, the one that said everything’s fine — and nodded toward the pan. “Want some eggs?”

Cas’s gaze flicked to the stove, then away again. “No. The fridge smells wrong.”

Dean opened his mouth to ask what that meant, but closed it again. Pushing for details usually ended with Cas retreating behind a wall Dean couldn’t reach through.

Instead, Dean turned back to the stove. The eggs were browning at the edges.

From the corner of his eye, he saw Cas drift toward the living room window and pinch the curtain between his fingers. He pulled it back just enough to peer outside. The movement was quick, furtive, like he didn’t want to be caught looking.

Dean didn’t have to guess — Cas would do it again in twenty minutes, and again after that. Check, retreat, check again. Sometimes muttering under his breath. Sometimes standing there so long Dean wondered what exactly he thought he might see.

Dean slid the eggs onto his plate. “I might be late tonight.”

Cas didn’t turn from the window. “What’s new?”

Dean let the words hang between them. He drank the rest of his coffee, the bitter edge catching at the back of his throat.

In the corner of the living room, a mug sat on the floor by the armchair. The coffee inside had gone cold days ago.

He set his cup in the sink, crossed the room, and pressed a brief kiss to the top of Cas’s head before picking up his briefcase.

The August sun was bright enough to sting his eyes as he stepped outside. He paused on the porch, glancing back through the window. The curtain swayed shut, hiding Cas from view.

By the time Dean reached his car, his phone was already buzzing again.

Dean left the curtains uneven again. Cas smoothed the fabric between his fingers until the folds lined up properly. There was no point in telling him — he’d only nod, distracted, as if he agreed, then leave them crooked the next day.

From here, he could see most of the street. Two cars sat opposite each other, front wheels both turned toward the kerb. People didn’t usually park like that here. He watched for a full minute, but neither car moved.

Dean’s car was still in the driveway. He sat in the driver’s seat for a while before starting the engine. Cas imagined him checking emails — Dean was always reading something now. Contracts. Investor decks. Messages from people whose names Cas didn’t recognise.

When they’d first met, Dean used to talk. Long, winding stories about MIT, his first botched job interviews, the summer he worked at a diner in Lebanon and swore never to make pancakes again. Lately, he came home quiet, or not at all until after midnight. Cas didn’t mind the quiet. It was just… different.

The fridge clicked on. Cas crossed to it and opened the door. The smell hit immediately — faint, metallic. He closed it without looking inside. It wasn’t the food. It was the air, thin and sharp in a way Dean never seemed to notice. Probably the compressor. He’d mention it later, though Dean might brush it off, the way he always did with things like this.

Cas pulled the blanket from the sofa and wrapped it around his shoulders, tucking his legs beneath him. On the arm of the chair sat a mug of coffee he’d made yesterday morning. He hadn’t finished it because Dean had started in again — not shouting, just that steady, grinding voice he used when he thought he was being reasonable.

“You can’t just—” he’d begun, before catching himself. And then it was the same as always: Dean talking about “rules” and “process” and “waiting until the time is right.”

Cas knew exactly when the time was right. It was now. He’d already been away from the hospital too long. If he let the gap widen, he’d have to start over, and that was absurd when he was still perfectly capable. He just needed to get back into his routine, catch up on the reading, review a few procedures. Easy.

He’d been going through his old notes at night, revising. The terminology came back to him quickly — muscle memory of the mind. Sometimes he wrote out practice case summaries just to see if he could still do it. He could. His handwriting was even neater now.

The book on the side table wasn’t for pleasure; it was one of his old physiology texts, the cover soft from use. He read a paragraph about cardiac conduction, then set it down again. The same silver hatchback passed the house twice in ten minutes. He didn’t recognise it. People didn’t usually cut down this street unless they lived here.

Cas made a note of the number plate in the margin of his notebook.

Outside, the sound of Dean’s car starting reached him through the glass. Cas let the curtain fall but kept a narrow gap to watch. Dean backed out slowly, checked his mirrors, and drove away without looking toward the house.

Cas stayed at the window until the street was empty again. Then he waited a few minutes more, just to be sure.