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When the World Screams

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"Basic first aid kit?"

"Check."

"Defibrillator?"

"Check."

Castiel reached over and briefly flipped on the siren, smiling when it caused his friend to jump and clap his hands over his ears. It was supposedly a fairly deafening sound from inside the vehicle, but it wasn’t as though it bothered Castiel.

"Siren. Check," he murmured, a small smile playing on his lips. He glanced up when he saw Balthazar gesturing angrily towards the back if the ambulance while his jaw moved furiously.

"I can't read the back of your head, Balthazar." He said, marking another item off of his checklist.

The blond heaved a huge sigh before turning and pointing to his lips dramatically.

"I said: The siren isn't on the rig check, you complete asshole."

Castiel studied the shapes his friend's lips made, nodding with a smile once he'd read the sentence off of them.

"Apologies. It must have said 'Syringe'."

Castiel most definitely did not miss the glare that was shot his way, despite having turned his attention back towards the checklist.

"Adrenaline shots?"

Balthazar leaned down to check and gave him a thumbs up.

"Oxygen tanks?"

Castiel looked over at the tanks and double checked their fill levels. Last time they'd had a shift, the EMT's before them had forgotten to refill their tanks and caused them to lose precious time doing it for them. Fortunately, all seemed well this time around.

"Check. And that looks like everything's accounted for."

Balthazar just grimaced and pointed to his ears. "Except my eardrums."

Castiel stared back at him with an unamused expression on his face, but Balthazar was already going for the deck of cards they kept next to the first aid kit.

“And Anna,” Castiel mentioned. “What time is she supposed to be here?”

Balthazar checked the time on his phone and scoffed. “Ten minutes ago. That probie’s gonna have some explaining to do.”

Castiel hummed as he set down his clipboard just as the ambulance doors flew open to reveal their very frazzled-looking new team addition.

“I’m sorry,” she said, a little breathless as she clambered into the vehicle. “I didn’t hear my alarm go off this morning.”

Balthazar clapped Anna on the back and gestured towards Castiel. “Neither did Cassie. Never does, as a matter of fact, and yet he’s always here on time.”

Castiel rolled his eyes as Anna flushed red with embarrassment.

“It’s alright, Anna.” he assured, remembering how nervous and anxious he’d been when he first started. “You won’t get docked this time, but it’s very vital that you’re here on time from now on, alright? You missed rig check.”

“Right. Of course. I’m sorry. Is there anything you want me to do?”

Balthazar grinned and held up a pack of cards with a wink.

Playing cards on their down time worked out well for both Castiel and Balthazar, and had become their favorite thing to do in their free time. Seeing as Balthazar loved kicking Castiel's ass and Castiel loved that it could easily be played in silence, it worked out for everyone. No sound was necessary and if Balthazar really wanted to trash-talk he'd make sure it was when Castiel was looking at his face.

Anna made sure that neither one cheated.

Castiel studied the hand he'd been dealt and spared a brief glance to his watch. They were currently at the beginning of a 24 hour shift and they really should have been attempting to get some sleep in shifts while they still could.

"Do you think we'll get any crazy calls tonight?" he asked curiously. Balthazar had been at this for longer than he had, and tended to be better at predicting these things.

Castiel caught the scoff and the shake of his head.

"On a Thursday night? Fuck-all happens on a Thursday night."

Castiel rolled his eyes and brought the cards back up to his face just to feel a light touch on his upper arm. Balthazar's voice filled his mind.

"So expect to be crushed tonight. Many times."

Castiel cocked his head to the side and raised an eyebrow.

"We will see," he thought back.

***

Three hours later and Balthazar was indeed crushing him. Castiel had only won a single game and he was ninety percent sure that it was a pity win. There had been much gloating from Balthazar and many crude sign language gestures from Castiel that Balthazar had gleefully announced he was memorizing for future use.

Anna had to slap Balthazar’s hand from slipping an ace up his sleeve, but it was a one-time event and Balthazar concluded that he didn’t really need to cheat to win anyway--but it was fun to see if he could get away with it.

About halfway through the thirteenth game, Castiel felt his pager vibrating and from the look on Balthazar's face, his own walkie-talkie was ringing.

"Here we go," Balthazar muttered before bring it up to his lips and talking rapidly enough that Castiel couldn't quite keep up. Anna was nodding nervously as she listened to the conversation.

Balthazar finally nodded and grabbed Castiel's wrist, knowing that it was a much faster way to communicate when they were being rushed.

"Car accident up on Maricopa Highway. Some idiot thought he could take one of those shallow cliff side turns going sixty and tumbled off the side."

Castiel raised his eyebrows.

"He's still alive as of two minutes ago but he's badly hurt and trapped in the car. We've got to move fast. I'll drive."

“What about the medics? This sounds like it’s a job for someone higher up.”

Balthazar nodded grimly.“They’re on their way, but they’re about forty-five minutes out. This one’s on us.”

Castiel nodded in agreement and broke their connection by jerking his arm back and getting to work. He needed to mentally take stock of which medical supplies they would probably need. With any luck, the fire department would get there just as fast as they did, seeing as the guy would probably need to be cut out of his vehicle.

They sped along the highway and Castiel assumed that Balthazar had turned on the siren because he could see the hues of red and blue flashing through the front window.

"How long until we get there?" he shouted, hoping he'd spoken loud enough to be heard over the siren.

Without looking away from the road, Balthazar held up five fingers.

Castiel looked back over to Anna. “I’m going to need you to write down my assessment for me when we get to the scene, alright? I’ll be busy helping the victim and it will be an easy way for you to learn.”

Anna nodded and Castiel clasped his hands together as he tried to get into the right headspace for what he had to do.

This was definitely going to be a tricky one. He could feel it. Nothing less than the top of his game was going to be acceptable.

He couldn’t think of a worse feeling than losing someone that he was trying to save. There had been countless nights that he’d spent awake in his bed, replaying what he could have done differently over and over again in the name of improving himself for the next time.

Balthazar had finally had to intervene, when Castiel kept coming to work with dark circles under his eyes.

Luckily for his state of mind, Castiel had yet to lose someone in a way that could have been prevented if he was person with hearing. With how much he was trying to prove to himself and those who doubted his proficiency, that at least was a weight off his shoulders.

The moment the vehicle was no longer in motion, Castiel opened the back doors and jumped out, tossing Balthazar a flashlight and meeting him out at the edge of the shallow cliff.

“Alright,” Castiel murmured, “I’ll climb down and see if I can stabilize him and let you know what equipment we need before you climb down.”

Balthazar raised a questioning eyebrow.

“I’ll be fine.” he said in exasperation. “I’ll probably have to communicate with him through touch anyway. And Anna will be there just in case.”

Castiel jumped over the busted railing, gestured for Anna to follow, and started down the incline just as a police car came into view. The rocky incline wasn’t incredibly steep, but he still couldn't go as fast as he wanted for fear of tripping and stumbling down to the bottom to join the crushed car.

The car looked like it was an older vehicle, a big black muscle car that had been more or less thoroughly smashed from its roll down the hill. It had been propped up on its side between a large boulder and a huge brush, making it so the driver’s side door was against the ground.

Castiel hadn’t seen many people survive an accident this severe.

He shone the flashlight into the--now nonexistent--windshield around the front of the vehicle, running forward when he caught sight of the driver.

The man’s jaw was clenching in what Castiel could only assume was pain. Blood was dripping down into his eyes from a deep cut on his hairline, causing him to keep his eyes shut or rapidly blink the blood away.

“Sir,” Castiel called out as he jogged forward, kneeling next to the injured man. “I need you to tell me what hurts. If you can.”

Yes, it was a stupid question, but necessary nonetheless. Between the two of them, the victim was going to be able to tell him what was broken the best.

Castiel watched him closely, already forming a mental checklist of what medical devices they’d need once the fire department arrived and cut him out of the car.

The man was breathing heavily, gritting his teeth a he struggled to speak.

This was wasting time.

Castiel reached out and placed a gentle hand against the bare skin of the man’s arm, expecting a grateful response for not having to expend energy by talking. Most victims of trauma preferred it when he could easily assess what was wrong with them by a simple touch.

“DON’T TOUCH ME DON’T TOUCH ME LET GO GET OUT OF MY HEAD--”

Castiel jerked his hand back in surprise at the shouting and violent emotions that had filled his mind the moment they’d touched.

Maybe the man’s mind hadn’t really processed what had happened yet, and thought he was some sort of threat. Situations like that did happen every once in awhile, but not usually in such a defensive manner.

Castiel frowned and reached through where the glass on the windshield once was to touch him on the arm again.

“Sir, I’m trying to help--”

“GET OUT OF MY HEAD STOP TOUCHING ME”

“I’m trying to help you!”

The man’s eyes snapped open, anger clearly prevalent.

“STOP FUCKING TOUCHING ME”

Castiel quickly pulled his hand back when a very impressive mental wall came crashing down in front of him, effectively blocking him from getting any more thoughts out of the guy.

“Alright. I won’t touch you anymore. But I’m getting in the car so that I can make sure your spine isn’t damaged and to take stock of your injuries.”

He didn’t wait for any sort of confirmation before he stood back up and looked over to Anna who was gripping the clipboard tightly.

“Heavy blood loss, most likely broken bones.”

Anna stayed frozen, staring at the upturned car.

“Anna!”

She jerked her head and held a thumbs up, furiously copying down what Castiel had said.

Castiel ran around the car and stood facing the underside, hoping it would be stable enough for him to climb inside. He lifted himself carefully up onto the side of the car, muscles straining, and breathed out a sigh of relief at the surprising stability.

He pushed any remnants of shattered glass out of the way and shimmied through the window, dropping himself inside the small space directly behind the trapped man.

This was definitely going to be a bit tricky to maneuver.  Since both the car and the driver were on their sides, Castiel was going to have to sit on the very damaged seat directly behind him, and lie on his side in order to fit in the space.

“I’m going to reach around and check to make sure that your spine isn’t damaged.”

The driver immediately started squirming, causing him to jerk in what was probably pain.

“I’m not going to touch you. It’ll be over your clothing.”

The squirming stopped.

Castiel reached over the seat and gently felt the shoulder alignment. Nothing out of place so far. He slowly moved his hands inward and trailed them lightly down the spinal cord, concentrating on any possible abnormalities.

He let out a relieved breath and removed his hand. It would have been about ten times harder to get him out of the care if he’d had a broken spine or shoulder. That being said, it was still going to be difficult.

The man’s jaw started moving and Castiel grit his teeth in frustration. Even if he had been facing him in full view of his mouth, Castiel doubted he’d have been able to read the slurred speech on the man’s lips.

“I’m sorry,” he said aloud, hating that he had to resort to this. “I can’t hear you.”

His mouth kept moving and Castiel still couldn’t understand.

Castiel pushed himself up and crouched over the driver. The man’s right arm looked thoroughly banged up, probably broken in at least three places from the looks of it, and he had severe gashes on his legs and arms. They’d need to patch those up quickly.

Once he was satisfied with his quick lookover, he and lifted himself back up through the window, relieved to see that Balthazar was already almost to the car with the fire engine pulling up behind him on the street.

The moment Balthazar was in reach, Castiel grabbed his arm.

“Shattered right arm, lots of lacerations that he’ll need bandaged, possible broken ribs. Spine is fine, but you’re going to have to go in and patch him up. He’s trying to tell me something and I… can’t hear him.”

Balthazar tilted his head in confusion.

“Why didn’t you just touch--”

Don’t touch him. Or at least try not to touch him, as much as you possibly can. He’s… you’ll see. Are the paramedics almost here?”

“They're not going to make it in time.”

Castiel nodded, let go of his arm and got to work with the supplies, handing Balthazar the gauze before he crawled into the car.

He repeated his assessment to Anna, making sure that she wrote it down as well.

He waited, on edge, as three firefighters made their way down the steep hill, dragging the large shears they called “The Jaws of Life,” able to slice through car metal with ease.

Balthazar climbed out just as they reached the bottom and his hands looked like they had a good amount of blood on them from wrapping up the wounds.

One of the responders gestured at Balthazar wildly as he held up his hands in a surrendering look. It was too dark to read lips from that far away, but he could easily bet that they were being chastised for going into and near the car before it had been stabilized with struts. They had both known it was a risk, but the car seemed pretty well propped up.

Balthazar was wiping his hands on his pants as Castiel reached out to touch him on the arm for more information.

“Is he--”

“I wrapped him up best I could. We’ll have to do more when they get him out of there.” Balthazar shook his head. “If this guy makes it… holy shit, I hope he goes into some sort of mental therapy. I’ve never seen anyone reject a touch connection that strongly before.”

“Me neither.”

“His name’s Dean Winchester. Twenty-six years old. No prior medical conditions, but I’ll bet anything he’s had some mental trauma in his past. Maybe military. Alert and Oriented times two.”

Which meant he’d gotten one of the assessment questions wrong.

“Most likely. He threw a military grade mental wall at me. That’s something they teach in the marines.”

“Shit.”

Castiel dropped his hand to break their connection as he watched the firemen get to work on cutting the entire roof off the car, and Balthazar no doubt relayed any important medical history he’d been able to get out of the driver to Anna.

The driver had already lost a lot of blood and he doubted he could wait much longer. The moment that those firemen pulled him out of the car, he and Balthazar would have to move fast and get him on the backboard as fast as possible. They were probably going to need a few of the firemen to help get him up that hill as well. It was going to be difficult.

And it was already taking too long.

Castiel bounced on the balls of his feet as he waited, ready to spring into action the moment they brought Dean out of the car.

Beside him, Balthazar winced and stepped forward.

“What? What is it?” Castiel asked, craning his neck to look towards the car before looking back at his friend for an answer.

“He just screamed.”

Castiel wasted no time running forward to the section of the car where the roof had been cut and pulled back. Idiots. They should have made sure to tell them to be careful.

He reached out and tapped one of the firemen on the shoulder forcefully.

“Thank you, we’ll take it from here.” he said curtly, stepping in front of him to block the way between him and the driver. “Balthazar!”

Bending down and gingerly avoiding Dean’s broken arm, he firmly gripped the other shoulder and his waist.

“Don’t try and help,” he told Dean, “Let us do the work.”

Balthazar was right beside him, supporting the man’s lower half as they began to extract him from the car and set him on the rack.

The scary thing was, Dean had been fairly lucid while they’d been talking to him. The pain had probably been a big distraction, but he’d been awake and able to talk back to Balthazar. The moment they got him out from the car, Dean’s eyes began to glaze over, his entire body became limp, and if Castiel was reading his lips correctly, he was slurring everything.

Internal bleeding. It had to be.

While Dean was in the car, the way he was positioned must have been putting pressure on the wound, but when they’d taken him out, whatever had been keeping him alive was gone, and they didn’t have time to sit around and talk anymore.

“Dean, I need you to stay with me.” Castiel said, fighting off the mild panic that he thought he’d long since trained himself out of. If he was exhibiting a sign of internal bleeding, then they needed to get him to the hospital as fast as they possibly could. He quickly put the cervical collar around Dean’s neck to stabilize it just in case of any spine injury that he’d missed.  

Despite Dean’s previously violent protests, Castiel pressed two fingers against Dean’s wrist, trying to find a pulse as Balthazar strapped him to the backboard and waved some of the firefighters over to help them lift him up the hill.

“… don’t deserve to be saved anyway…”

Castiel pulled his hand back, looking up at Balthazar and the two other volunteers. “We need to get him into the ambulance now. On the count of three, we all lift. One, two, three.”

They all lifted at the same time, and got him up the hill in record time. Moving as fast as they could, they loaded him into the back of the ambulance and Castiel could see Balthazar radio in the report as he ran around to the front of the vehicle.

Castiel closed the doors just after Anna jumped into the ambulance behind him and secured the backboard.

Dean was staring up at the ceiling with glazed eyes half open.

“Stay with me, Dean.” Castiel said again, as he felt the engine roar to life. “You’ve got to stay awake, alright? Do you have family? Any brothers or sisters? A wife, maybe? You’ve got to stay awake for them.”

Shit. He was quickly slipping into an unresponsive state.

Castiel pressed two fingers to his wrist again, hoping for some kind of pulse but he wasn’t even picking up thoughts from him anymore. He switched to to the artery on his neck as the ambulance started moving forward. Nothing.

Castiel could feel his own heart throbbing hard against his ribs. The whining of the machines around him and the growl of the ambulance seemed far away, almost movie-like… and if this had been a movie, Castiel would have been able to save Dean right now, easily.

But that just wasn’t how it worked in the real world.

No amount of wailing and pounding on a chest was going to make a dead person gasp and sit up like heaven itself had touched them.

For example: When you do CPR, you become the heartbeat of an unwilling heart, forcing it to work until it can decide for itself whether or not it truly wants to give up.

A person can only do so much.

Castiel ceased the compressions and leaned down, plugging the man’s nose and and sealing their lips together to give him what would hopefully be the breath of life.

The chest rose and fell, and Castiel started up the compressions again after the third fall.

“Anna please grab me the defibrillator, I think he’s in V-fib.”

Another myth that movies always tried to state as fact: If the patient had no heartbeat, and they flatlined, a good shock with a defibrillator would restart their heart.

Wrong.

Wrong.

Wrong.

If Castiel was right, then you would use it for situations like now. When the heart was struggling, but not done. When it couldn’t quite figure out how to coordinate pumps with the rest of the muscles.

Then you delivered the shock, and you stopped the heart in hopes that it’d come back with a vengeance.

By the time he’d done twenty more chest compressions, Anna was back with the defibrillator and a pair of scissors. Castiel could almost have cried, glad that he hadn’t even had to specify that he’d needed some. Somewhere in the back of his mind, he hoped that Dean wasn’t too attached to this ACDC shirt, seeing as Castiel had already sliced directly down the logo.

He shoved the material aside and placed the pads on Dean’s bare chest, one pad just below an odd tattoo.

Castiel stepped back, finger on the switch.

“Clear.” he said, looking over at Anna to make sure that she’d heard him before flipping the switch and sending the shock wave.

This was where the heart made a decision.

Dean’s chest rose and fell, back arching in an enforced compulsion.

Castiel reached out to take the pulse.

No pulse, no breathing, no thoughts.

Castiel stepped back again. “Clear.” He flipped the switch.

No pulse, no breathing, no thoughts.

He glanced over at Anna, who was giving him a look he knew too well.

“Clear.” he murmured again, waiting just a moment before flipping the switch.

Rise.

Fall.

No pulse, no breathing, no thoughts.

“Clear.”

Castiel looked up when he felt a hand on his shoulder. Anna shook her head and ran her hand down his shoulder until she was touching the skin on his arm. “Castiel.”

Her face was filled with as much regret as Castiel felt.

With the victim still not responding, it was time to call it. Get the time of death and get the body back. Even as a very new EMT, Anna knew the procedure.

Castiel’s lips thinned as he jerked his shoulder away and began chest compressions once again, stubbornly refusing to give up.

One of the things he’d learned in his line of work was that the people who felt like they didn’t deserve to be saved were usually the ones that needed it most.

“Come on,” he thought as he pressed down on his chest over and over. Or at least he was pretty sure he thought it. It might have been out loud.

“Everyone deserves to be saved.”

That was his job. If an axe murderer had been impaled on his own axe and Castiel got there in time to attempt to save him, he would. He absolutely would.

Whatever had happened in this man’s life that made him believe he deserved this didn’t matter.

Castiel stepped back again and wiped at his forehead. “One more time. Just one more.” he murmured. “Clear.”

He flipped the switch.

Rise.

And--

This time, he felt a steady pulse.

“He’s still here!” he said excitedly, and glanced over at a very shocked-looking Anna. “How much longer until we’re there?”

She held up two fingers.

Two minutes. He could hold on for two minutes.

He continued the chest compressions as Anna relayed some information to Balthazar so he could radio in an update to the hospital. The doctors there were more than likely going to have to do something drastic when they arrived.

Castiel’s arms were already protesting a minute later, but he kept on doing compressions. Any second. Any second now and they’d make it to the hospital, but every second was beginning to feel like an eternity.

The ambulance finally came to a halt and the doors immediately flew open, doctors and nurses dragging the gurney that Dean had been set on out of the vehicle and down onto the ground. Castiel quickly jumped out, latched himself to the side and continued to do compressions as he stood on the edge of the stretcher’s undercarriage.

Unfortunately, this meant that one of his hands would have to be gripping the side of the stretcher as he did one-handed chest compressions. He’d only ever studied this technique, because he’d never had to help with a situation severe enough to warrant the use of it.

He put as much pressure as he could on one arm, continuing the rhythm that had originally been set to keep the heart pumping as they wheeled him into a trauma room. Doctors and nurses immediately congregated around him, taking over the stretcher.

Castiel finally stepped away, still breathing heavily, and turned to who he really hoped was the lead physician. “Twenty-six year old male from an MVA with rollover. Initially alert and oriented, some external bleeding. Shock developed en route and CPR initiated….ten minutes ago.”

The physician nodded and Castiel watched as they began to get to work on Dean. A nurse pulled Castiel aside and had him answer a few more questions on Dean’s condition.

“Is that an intra-osseous infusion?” Castiel asked in the middle of a question, peering over the nurse’s shoulder to get a look.

He nodded. “The patient has lost too much blood. We need to get fluids into him fast.”

Castiel’s heart sank as they injected him with the needle. It was a very last resort procedure that was used for people that didn’t have much hope.

Castiel watched and held out hope for as long as he could, until the nurse finally had to usher him out of the trauma room.

Everyone deserved to be saved.