It was the third time he had been Here. The first time was when he was sixteen years old and he had slit both his wrist vertically in order to escape reality, only to end up in a worse one, which consisted of a month spent in a psychiatric ward and a slight shift in the way his brother acted toward him from then on.
The second time he had been Here was when he was twenty years old and he had (accidentally) overdosed, but his brother insisted that it was a suicide attempt and given his previous record the doctors didn't hesitate to send him to the psychiatric ward. He had been taking drugs in order to numb the pain and escape reality, only to end up in a worse one which consisted of two months in a psychiatric ward and the horrific pain of withdrawal symptoms. And now, the third time, he had Lucifer in his head shouting at him and nagging him for attention, keeping him from sleeping and just generally making his life shit.
And by Here I mean several different psychiatric wards, as his job did tend to move him about a lot, but it didn't really matter that they were in different hospitals, they all seemed the same. The same whitewashed walls, the same creaky beds, the same sympathetic stares from the nurses who try so hard not to break you because they know you're already partially broken.
As Sam lay there, staring at the cobwebbed ceiling, ignoring Lucifer's constant torment, he thought back to the times he had been Here last. The first time he had been so angry when he woke up. He had slit his wrists in the bathroom of an old motel room, whilst Dean and his father were out on a hunt. He didn't do it because he was bullied or because his father beat him, nor was it because his mother had died because of him. It was because he had been reading his father's journal. It was because a demon had called him special and hunters were looking for him. It was because if he was anything special to a demon, he may as well beat the hunters to the chase, because he knew already it was his fault his mother had died and he didn't want the same fate for his brother and his father.
His brother was the one to find him. They had come home only moments after Sam had done it, because they'd forgotten something. If you ask either of them, they couldn't tell you what it was they had forgotten, that day is the day Sammy almost died and nothing else mattered. Dean kicked down the door when his brother hadn't answered him for the 5th time. Sam was partially passed out on the floor, blood pouring from his arms. He murmured no, stop, leave me, as his brother wrapped towels around his arms to stop the blood flow. His shook his head in protest as his father called an ambulance, as he screamed down the phone that his son had tried to kill himself. He didn't understand why his father didn't even once reach for the bottle. He didn't understand why his brother didn't once leave his side. He didn't understand why they couldn't see that what he was doing was the right thing.
The second time he had been so confused when he woke up. He had been in college at the time, and he had overdosed and collapsed on the floor of his apartment, whilst Jess and his friends were in class. He had been taking heroin for over a month now and he didn't know how to stop. It numbed the pain that he had been feeling his whole life and he knew he shouldn't do it, and he knew Jess would hate him if she found out, but he couldn't stop.
Jess had been the one that found him. He was passed out on the floor of their apartment, a needle on the floor next to him. Jess was so afraid that she'd lose him she didn't even stop to care that he had been doing drugs. She called an ambulance and then Sam's brother Dean, because, even though they hadn't talked in years, she knew that he would need family.
And now it was the third time and he had prevented the apocalypse and saved the world. And his brother walked through the door, with a look of concern plastered on his face and he asked him how he was doing, and Sam supposed he was pleased to see Dean, because he was always there for him, even though he had done so much wrong. And when Sam asked Dean why he even cared about him anymore, after all the harm he had caused, Dean replied, looking slightly disheartened by his little brother's self-hatred, that it was because he was his baby brother and he wasn't going to leave him with just the devil for company. And with that Lucifer retorted "Actually, if you are going to give me a nickname I'd prefer Satan, much classier, don't you think, Sam?"