Dean’s earlier promise to himself, that they would stop having sex once they left the hospital, was still in place. But while they weren’t in the hospital anymore, they weren’t at their destination yet either. They were somewhere in Illinois, on a train, in motion, no-man ‘s-land, and if Dean didn’t know where they were, which he didn’t, then they could be qualified as being nowhere. Besides, Sam needed this. He’d done it to Dean, so it was only fair. Just this one time, just this once.
Not only is Dean in denial, it's as though he never heard the word.
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Not only is Dean in denial, it's as though he never heard the word.