Dean knew that little Sammy position within an instant and it just hit home harder about how far things had gotten, how bad things were, and this was only one trial under Sam's belt. Another one could kill him, two might completely mangle him, and that thought was enough to knock Dean on his ass if he let it get to him.
Closing the door behind him, Dean headed over and sat on the edge of Sam's bed, giving his little brother a small pat on the knee as he sat down. "How you doing?" He wasn't sure whether Sam felt sick all the time or just had this coughing blood thing, or what. He didn't know how to fix him either, and that was worse.