No one announced it when Sam opened his eyes. Dean had no awareness of it. He was distracted by the doctor, and the phone in his hand buzzing as Amy continued to message him. And then Sam was wheeled out of sight, into an OR where Dean wasn't allowed to go. He'd seen enough TV to know if he busted in anyway, he'd cause more problems, and delay Sam's surgery.
He stopped himself from throwing his phone and instead punched the nearest wall. He kicked it too, for good measure, and he had just enough self control to keep from hitting the nurse who came over and dared to speak to him. He dropped into a chair and dropped his head between his knees.
He couldn't get the image out of his mind. Sam, trotting up the steps of the courthouse. He had long legs, he could easily take two and three steps at a time. His name, someone called out his name. The rest seemed to happen in slow motion. The man approached, Dean never saw the gun. Sam went down and the world seemed to stop. Dean beat on the side of his head, trying to beat the image of Sam getting gunned down out of his head.