10. Written Instructions

I Wish I Was Your Brother

A/N: When I first started this series, I had ideas for less than five stories and now here we are at Chapter 10. I've enjoyed every minute of writing these fics and getting your feedback. Thanks to everyone who has read, reviewed and added the series to their favourites and alerts.

A/N: Inspiration doesn't necessarily strike in chronological order; you just have to go with the stories as the muse dictates. This is the prequel to "Love Letters" the very first story in this series.

A/N: None of the medical advice outlined below has any basis in fact nor is it prescriptive.

A/N: Chapter 10 is dedicated to my beta, Ericka Jane who always does the hair and make-up.

A/N: Sam Girls, it's been a while since he's gotten solo screen time in this series; this one's for you. Happy reading.

- TEN -

Written Instructions

When you serve as a doctor at a college like Stanford, the endless stream of students often makes it difficult to distinguish one patient from another; but I'll never forget Sam Winchester.

I did his medical during his first week of college and it immediately struck me that there was something different about this young man. He defied every stereotype that had come through my doors during the ten years I worked at the prestigious university.

He wasn't the spoiled child from a wealthy family who figured Stanford was just one stop on the way to predestined greatness. He wasn't the awkward gifted student who couldn't see beyond academic achievement. He definitely wasn't the star athlete, although his build said he probably could have been had he been so inclined. And he didn't come across like the poor scholarship student, socially out of his depth and desperate to fit in.

I knew he was different when he stepped into my office and wasn't fazed by me or my workspace. As a Native American, who is fiercely proud of my antecedents, my clothes, hair and even my choice of decor all reflect my heritage.

The first time a student came to see me; it usually took them a good half hour to get over my office and even longer to get over me.

Sam Winchester didn't even blink.

As soon as we had finished going through the rudiments of his medical he began questioning me about the paintings and artefacts that adorned my walls. To my complete surprise, he recognised quite a few of the pieces and knew the meanings of several of the symbols.

Sam asked about my background, my childhood and my family and I was only too eager to share. Interestingly, he listened, not with the fascination of someone being told an exotic tale, but almost like a student who was getting valuable information on a topic with which he was already familiar.

As we stood examining my ancestral portraits Sam's gaze fell on the loan full colour photograph on the wall.

"Is that you?" He asked, pointing to the picture.

"And my Grandfather," I said running my finger along the edge of the simple silver frame as if it would give me a connection. "Chief Rivermoore Shayne. That was taken the day I graduated from Medical School. My Grandfather practiced what would now be referred to as alternative medicine. I've kept my maiden name for my medical practice in honour of him. He was really the first medical practitioner in our family; I was just the first to get officially qualified."

"And who's been more effective?" He asked, perceptively.

"Ask me that out of office if you want an honest answer," I said with a wistful sigh. "I did medicine at Harvard and I still consider Grandpa my most impactful teacher. Of course if I used all the things he taught me I'd have a malpractice suit every day. But he always said that every illness starts in the heart, and that's something I've carried with me. In more than 20 years of practicing medicine, I always keep my prescription pad in my desk drawer to remind me that the first recourse shouldn't always be pharmaceuticals."

Sam had looked at me then, with a curious mix of respect and acceptance. Somehow, I got the sense that I had passed some secret test, and had now been granted unspoken permission to come just a little closer.

"Do you really believe that?" He asked.

"I do," I answered sincerely. "My Grandfather's approach was always to treat the emotions before dealing with the physical symptoms. Of course that doesn't necessarily hold true for Diabetes and Cancer, but I have found that a rather large percent of what ails us tends to be more psychological than physiological."

I am not sure where Sam stood on faith healing and alternative medicine but he seemed to view established medicine as a last resort. The next time I saw him he was being wracked by a merciless flu that had him coughing like an eighteenth century pauper, plagued by Tuberculosis. I chided him for not coming to see me until he was at the point of death and he weakly admitted he didn't believe in over utilizing doctors. I lectured him strongly on that one and told him if he ever allowed any illness to become this severe before coming to see me again, I would have him hospitalised just to teach him a lesson.

Chicken Pox brought him back to my office, probably sooner than he would have liked but illness notwithstanding, I was happy to see him. I plied him with topical creams and tablets, anxious to ensure that the eruption would not be too severe and wouldn't cause scarring. He came back when the episode had subsided to show me that he had emerged unscathed.

Whenever I had an appointment with Sam, I always made sure there was enough time scheduled for us to have our talks. He seemed to thoroughly enjoy conversation even if it was about topics that seemed random and obscure. I got the impression that he was used to being listened to and I genuinely enjoyed speaking with him. He was very focused on his academics so I was always checking up on his grades, tests, and assignments.

Since it was generally highly contagious diseases or near fatal influenza that brought Sam to my office, I was caught totally off guard the day he came to see me about his Insomnia.

"You're having trouble sleeping?" I asked.

"I'm practically not sleeping at all," Sam responded.

I looked him at him closely and saw some of the tell-tale signs. His skin was pale, his eyes were shadowed and he seemed listless.

"When you say, not sleeping at all, what exactly does that mean?"

"I haven't slept well since I moved into the dorms. It usually takes me a while to fall asleep and then I get up two or three times during the night. But now, I just can't fall asleep at all."

"So you're not getting any rest?"

"Probably about an hour or so every night," he gave an anxious sigh. He was wringing his hands and looking down at the table distractedly. "It's really starting to get to me now. I can't concentrate, I'm tired all the time, and I'm getting forgetful. I'm not a pill-popper but I gotta ask for something."

The prescription pad was in its usual resting place in my desk drawer and I saw no immediate need to take it out. Instead, I decided to probe.

"Is your dorm room conducive to sleep Sam?" I asked.

"It has a bed."

"But apart from that, do you study in your room or entertain friends there? Sometimes when we use our sleep areas for various activities it becomes harder for the mind to associate that particular location with rest."

"I pretty much go there just to crash. I do most of my studying at the library and so far, I haven't really been doing much entertaining. But the room is fine; at least, I don't see anything wrong with it."

"Do you miss home? A lot of people find it difficult to cope with the change in their living conditions when they come to college."

"Home is a bit of an abstract concept Dr. Shayne. My family moved around a lot."

"Were you used to having your own room?"

"No. I've never had my own room. I've always shared with my brother, Dean."

"O.K. So it's not so bad having a roommate now, is it?"

"To be honest Dr. Shayne, it's completely awkward. I'm used to having Dean in my space, that's like second nature to me. Living with a stranger is taking some getting used to but, it's not like it's gonna kill me."

"Do you have any special bedtime rituals?"

"Like what?"

"It could be anything, like night time meditation or maybe reading. Some people write in a journal to bring closure to the day. Is there anything that you do that tells your mind and body that you're winding down and preparing to sleep?"

"No, I pretty much just shower and lie down."

I considered and then tried a different line of questioning.

"Did you have a comfort object when you were little?"

"What exactly is that?"

"Like a favourite pillow or a stuffed toy that you couldn't do without."

"You mean a security blanket?"

"Exactly."

"No, not at all," Sam shrugged. "Like I said my family moved around for most of my life and we didn't take much with us. I never really got attached to anything like that."

"So when you were little, there wasn't anything that you felt you had to have with you before you could go to sleep?"

"No, nothing that I can recall. My brother was always the one who put me to bed. When I was little, I would just crawl onto his lap when I was ready to go to sleep. He'd tuck me in and lie down with me, or tell me a story and he'd always stay with me until I feel asleep. But it wasn't like I couldn't sleep because I didn't have my special pillow or anything like that."

"Your brother would lie down with you every night?"

"When I was a little? Sure." Sam said casually. "Whenever my Dad talks about my childhood he refers to Dean as my sedative."

I chuckled. "Nice big brother."

"The best," he said and I'm sure I heard a hint of sadness but his face didn't reflect anything untoward. "My whole life I've been a restless sleeper and I'd always had these really bad nightmares, so I was constantly climbing into Dean's bed to get away from the monsters."

He looked up expectantly like he was waiting for me to make a judgement.

"It's a proven fact that sibling bed sharing promotes security," I smiled reassuringly. "There's medical evidence to support it. Sleeping in close proximity to someone you love and trust fosters feelings of well-being. That's why kids always want to sleep with their parents. Besides," I grinned mischievously. "I bet the monsters didn't bother you when big brother was close by."

"They didn't dare," Sam smiled back.

"So did your brother finally kick you out when you got big enough to fight him for the covers?"

"No. I don't think he would have. Even if he had a problem with it, he wouldn't have made a big deal if he thought it was what I needed. But I didn't give him a chance; when I turned ten I stopped, I figured it was the manly thing to do."

"Had your sleeping patterns gotten better by then?"

"No, it's never really settled down totally."

"How did you handle it when you had nightmares?"

"At first I thought I'd had to just tough it out but I'm a pretty noisy dreamer, so I'd usually wake Dean up. He'd talk to me until I went back to sleep. He kinda had a system, if my nightmare wasn't too bad he'd just stay on his bed talk, but if he thought I was really scared he'd come and sit on my bed. Of course he'd sit up against the headboard so it wasn't like he was sleeping with me or anything, but he wouldn't leave until I was out for the count. Sometimes he ended up falling asleep right beside me."

"So this is the first time you two have been apart for an extended period?"

"First time in our lives," Sam confirmed.

"Well, that explains a lot."

"A lot like what?"

"Well Sam, most children, when they're babies they get a comfort object. It's something parents give them or they latch on to that makes them feel secure, especially when their parents aren't around. It's usually a blanket or a pillow or sometimes it's a teddy bear. Children come to equate their comfort object with security and constancy, hence the term 'security blanket'. And, these things become particularly important at night because when we get tired and sleepy, that's when we tend to feel most vulnerable and that's when we really want to be close to whatever makes us feel secure.

"As a child gets older their parents usually have to wean them from the comfort object. They have to get them to see that one pillow is just as good as another or there's nothing really magic about that tattered old blanket. Usually by then the child has formed other attachments to friends, family members or maybe even pets, so eventually they let go. Sam, I'd say, in your case, your brother was your comfort object."

"What?"

"Well from what you said, he's the first thing you got attached to. He was who you always saw just before you went to bed at night and probably the first person you saw when you woke up in the morning. When you were little – and way beyond that, from what you told me – he was what you clung to when you felt most vulnerable. He's what's always made you feel comforted and safe, and so you've come to associate his presence with your own sense of well-being."

When he didn't respond, but only looked down at his hands again, I went on.

"It sounds to me like the weaning never really did take place. So whereas most children have some kind of cut-off point for their dependence, yours just evolved."

"I'm eighteen years old Dr. Shayne," his tone was measured but his annoyance was audible. "I'm not dependent on anybody."

"Sam," I gentled my tone knowing we were in uncomfortable territory. "I can only go by what you've said, and it sounds to me like you never stopped equating your big brother with safety and he never stopped being your protector. So even when you felt like you got too old to crawl into bed with him if you were scared, you two just replaced cuddling with talking. The connection was still there although it may not have manifested itself in physical affection. Sure, masculine pride would make you think that there was a big difference between him lying on your bed and talking to you, as opposed to hugging you until you fell asleep, but it was his presence, in whatever form, that made the difference to you."

Sam wouldn't look at me, but I could see the blush creeping across his face.

"It's nothing to be embarrassed about," I said encouragingly. "I grew up in a very close family and I wouldn't change that for anything. You're lucky to have such a close relationship with your brother. Which is more to my point; you've never really slept alone, and you're used to always having a comforting and protective presence. So college must be a huge adjustment for you. Strange environment, different living conditions, unfamiliar sleeping arrangements, your psyche is probably reacting to your new circumstances and that's why you're not sleeping."

"I don't see what the big deal is," Sam was starting to sound defensive. "Like I said, I moved around a lot. One bed or one room is just the same as another."

"Sure." I deliberately kept my tone even to defuse him. "But going by what you said, your brother was always with you, so even if the room changed and the bed changed, he didn't. He was the constant."

"Yeah," he said softly. "He always was."

"So here's my recommendation, I want you to try talking to your brother at night. Give him a call before you go to sleep and that might help you to relax. Try that for about a week and see if it helps you to rest better."

"That's not possible."

"Why?" I asked suddenly concerned that something had happened to the much esteemed Dean. That would certainly explain Sam's extreme sleep disturbance.

"It just isn't possible right now."

"Is he alive?"

"Yeah," Sam nodded tiredly.

"So what's to prevent you from calling him?"

A pregnant silence ensued before Sam finally said, "We're not really talking right now."

"Oh. How come?"

"It's a long story."

"It usually is with families," I said understandingly. "And I don't expect you to recount the details of the Winchester saga for my benefit, but if you and your brother aren't on speaking terms, the healthy thing to do is to patch things up. Give him a call."

"I don't know if he'll even talk to me," Sam muttered looking down at the desk. "We had a huge fight before I left to come to school, and we didn't exactly part on a speaking terms."

"So not only is your sense of security one thousand miles away, you're not even communicating with him, which means you're operating with seriously impaired emotional faculties. No wonder you can't sleep."

Sam looked up suddenly; ready to go back on the defensive. "Dr. Shayne, I really don't think that has anything to do with what's happening to me. I can't sleep because I'm working part time and carrying an excessive course load. I probably took on too much and it's catching up with me."

"And in the short time I've known you, you've taken all of that in stride. When was the last time you got a B Sam?"

"Still haven't."

"Exactly. From day one it was so clear that none of the things that freak first year students out even bothered you. From the day I met you I saw you had the air of a very old soul Sam. Now I'm not sure what you might have seen or done in your short lifetime young man, but it seems there's not much in college life that really fazes you. So in my opinion, you can't sleep because your mind is not allowing your body to shut down and that's because subconsciously you don't feel safe."

"Please don't psychoanalyze me, Doc."

There was a faint plea in his voice that I couldn't ignore. I was his physician, not his psychiatrist and this was going beyond the scope of our working contract. But at the same time he knew my style now, and he could not have expected me to just send him away with a prescription.

"The problem is psychological, Sam. You have insomnia because subconsciously, you're not at peace. Remember what I said; when we're tired is when we feel the most vulnerable, and that's when we want to reach for whatever or whoever makes us feel safe. Your body can't wind down because you don't have that sense that everything's O.K. And it's not O.K. because your brother isn't here, and your sense of well-being seems to be directly dependent on him being around. Every illness starts in the heart."

He sighed deeply and rubbed his hands over his face. I felt like I was watching the facade of a composed young man peeling away, gradually revealing a vulnerable little boy.

"Sam, I'd say your insomnia is a just a symptom of a deeper psycho-emotional issue. Now I can write a prescription for something that will treat the symptoms but I'm afraid that's only going to give you temporary relief at best. Personally, I would prefer to treat the underlying issue and I think that means sorting things out with your brother."

I got a challenging, defying look in response. "Dr. Shayne," Sam said politely. "I'm an adult. Don't reduce me to a scared little four year old who can't sleep if his big brother isn't there to tuck him in."

A boundary line had been drawn and I had no choice but to respect it.

I opened my top desk drawer, took out my prescription pad and picked up a pen.

"Prescription sleep aids can be habit forming," I said. "So I'm going to need to monitor you closely once you start taking them."

"I'm sure I won't need them for too long."

"I'll write the initial prescription for two weeks," I paused briefly with my pen just above the paper. "Then you need to come back and see me and we'll evaluate if the situation is improving."

He agreed, but just as I was about to start writing he spoke again.

"I don't know if he'll even listen to me."

"There's one way to find out," I quietly put the pen down. "Give him a call."

"The thing is, if he doesn't want to talk to me I think I'd rather not know."

"Sam from what you've told me it's highly unlikely that he doesn't want to talk to you. He may be really upset with you but that doesn't mean he won't listen to what you have to say."

"I don't even know what I want to say. I don't know that I trust myself to say anything. I'm afraid if I try to talk to him it'll just end with us shouting again. I don't know that I won't make it worse."

"Then maybe you shouldn't call him. Maybe you should just send him an email or better yet do it the old fashion way; write him a letter."

"Seriously?"

"Yeah, seriously," I said liking the idea the more I thought about. "Just write it all down and that way you don't have to worry about having an argument. You can get everything out and tell him your side of the story without dealing with any kind of retort. And that way, he'll at least know how you feel."

"Dean's gonna think that's so lame," Sam shook his head incredulously. "He's always accused me of being a girl. This will seal it."

"If this is the same big brother who managed to find an inventive way to indirectly keep cuddling you, even when you were a teenager, then I think his machismo can handle a letter."

Enough said; I started writing.

"You can't consume alcohol when you're taking this medication so no night time boozing, OK?"

"OK."

"Try to ensure you can get at least eight hours sleep for the first few nights, or you might feel drowsy in the mornings."

"Sure."

I quickly scribbled on two sheets of the prescription paper, which I tore from the pad, folded and handed to him.

"Thanks, Dr. Shayne."

"I hope you feel better, Sam. And I'm serious about monitoring you so please make your next appointment with my Assistant right now."

"Sure thing." He gave a shy, grateful smile before slipping out of my office.

Once he was gone I took a few moments to decompress, reminding myself that this was professional and not personal. Even though I felt strongly that Sam's condition was directly related to his acrimonious separation from his brother and the subsequent loss of his support system, I couldn't force him to see it that way.

He could view his condition as a psychological problem or a physiological one. The choice was his and his approach to treatment would directly depend on whatever he decided.

So, since my job was to ensure that he was adequately prepared for either eventuality I had given him two prescriptions. One said: "20mg Citroval. One tablet to be taken at night 20 minutes before bedtime." But, if every illness starts in the heart, then that's where the healing must begin. So, the other prescription said: "Write Your Brother!"

THE END

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