The fluorescent lights were flickering again.
Adrian Thorne didn't look up from the chest cavity splayed open before him. His gloved hands, steady despite thirty-six hours without sleep, were working through the subclavian artery with practiced precision. Blood pooled in the surgical field faster than the suction could clear it, painting his blue scrubs a dark purple that would never wash clean.
"Clamp," he said.
The surgical nurse hesitated. Her hands were trembling—had been for the last ten minutes. Adrian noticed everything, even when he appeared focused solely on keeping someone alive.
"Clamp. Now."
She pressed the instrument into his palm. The metal felt cold even through the latex. He secured the bleeder with mechanical efficiency, then glanced at the monitors. Heart rate climbing. Blood pressure dropping. The patient—a thirty-two-year-old construction worker who'd been impaled by rebar—was dying despite Adrian's best efforts.
They always die, Adrian thought, the cynicism that had calcified around his heart over twelve years of emergency medicine tightening another notch. We just delay it.
"Doctor Thorne." The nurse's voice cracked. "The walls—"
"I can see them."
The operating room walls were rippling. Not shaking from an earthquake, though Seattle sat on fault lines that could wake any moment. Rippling, like the surface of disturbed water, the tiles and paint distorting in ways that violated every law of physics Adrian had learned in medical school and subsequently stopped believing meant anything.
He'd noticed it five minutes ago. Ignored it. The patient mattered more than hallucinations brought on by exhaustion.
Except the anesthesiologist was staring too. And the scrub tech. And through the observation window, Adrian could see other staff members pointing, mouths open in shock or fear.
Not a hallucination then.
"Suction," Adrian said, because if the world was ending, he'd at least finish this surgery properly. Professional to the last. It was all he had left.
The walls weren't just rippling anymore. They were tearing. Reality itself seemed to be coming apart at the seams, dark fissures spreading across the surgical suite like cracks in ice. Through the fractures, Adrian glimpsed something that made his rational mind stumble—colors that shouldn't exist, geometries that hurt to perceive, vast spaces that couldn't possibly fit inside a hospital.
A sound filled the room. Not loud but penetrating, bypassing his ears entirely and resonating in his bones, his teeth, the base of his skull. It felt like the universe was screaming.
"Everyone out!" someone shouted. Probably the anesthesiologist. Adrian didn't turn to check.
His hands kept working. Tie off the artery. Check for additional bleeders. The patient's vitals were crashing, but that was the blood loss, not—
The floor buckled.
Adrian stumbled, catching himself against the operating table. The nurse fell. Equipment crashed. And through the widening tears in reality, something was emerging.
It looked like a man, if a man could be sculpted from shadow and fury and have eyes that burned with red light. It moved with inhuman grace, crossing the space between worlds as easily as stepping through a doorway. Behind it, Adrian glimpsed a landscape of twisted spires and crimson sky.
The creature's gaze swept the room, and Adrian felt the weight of that attention like a physical force. Ancient. Hungry. Alien in ways that transcended mere appearance.
Then it lunged toward the fleeing anesthesiologist.
Adrian's hands moved before his mind caught up. He grabbed the nearest instrument—a scalpel—and threw himself between the creature and his colleague. Not heroism. Just reflex. Twelve years of emergency medicine had conditioned him to step toward danger when others fled.
The creature's clawed hand swept toward him. Adrian raised his arm instinctively, knowing it was futile, knowing those claws would tear through flesh and bone like tissue paper—
The impact never came.
The creature staggered backward, hissing, smoke rising from where it had touched Adrian's skin. For a moment, they stared at each other, equally shocked. Then the thing snarled something in a language that sounded like breaking glass and lunged again.
This time Adrian was ready. He sidestepped—his body remembering the boxing lessons from college—and slashed with the scalpel. The blade bit into the creature's arm, drawing blood that looked black in the flickering lights.
The creature screamed. But so did Adrian, because the moment its blood touched his skin, something invaded him.
Power. Foreign and violent and overwhelming. It crashed through his nervous system like lightning through copper wire, rewriting something fundamental in his cells. Adrian felt his body changing, felt something awakening that had always been dormant, felt—
I can regenerate. I can heal. I can feel everything within ten feet of me, every heartbeat, every breath, every dying cell.
The knowledge simply was, installed in his mind like software. He understood, with absolute certainty, that he'd just absorbed something from the creature. Not just its blood. Its capability. Its essence.
The creature was backing away now, cradling its wounded arm, fear replacing hunger in those burning eyes. It spoke again—still incomprehensible—then turned and fled back through the tear in reality.
Adrian stood frozen, scalpel dripping black ichor, while around him the world finished tearing itself apart.
The rifts were spreading. Through them poured more creatures—some humanoid, others definitively not. He glimpsed things with too many limbs, beings made of living flame, entities that seemed to exist in more dimensions than his eyes could process.
And through it all, reality was folding. Seattle General Hospital was occupying the same space as a dozen other locations simultaneously. Adrian could see the emergency room overlapping with what looked like a medieval castle. The parking lot merged with a crystalline forest. Dimensions were colliding, merging, becoming one catastrophic impossible space.
His patient flatlined. The monitors screamed their single, endless note.
Adrian looked down at the man on his table—a stranger whose name he'd never learned, whose family was probably in the waiting room hoping for good news—and felt nothing. The power still burning through his veins had pushed everything else aside. He was changing. Becoming something other than human.
He pressed two fingers to the man's neck, checking for a pulse out of habit, and felt the new senses activate. The worker's cells were dying, oxygen-starved, but the damage wasn't total yet. Not irreversible. Not if—
Adrian's hands moved without conscious thought. He placed one palm on the man's chest, and the power flowed. He felt it leaving him, pouring into the dying body, knitting torn vessels, restarting the heart, flooding damaged tissue with vitality that shouldn't exist.
The monitor beeped. Once. Twice. A rhythm establishing itself.
Impossible.
The ceiling collapsed.
Adrian grabbed the operating table and pulled, using strength he shouldn't possess, dragging it and the unconscious patient toward the door. Around them, Seattle General was folding in on itself, the building's geometry becoming meaningless as multiple realities occupied the same coordinates.
He could see staff members fleeing, patients being evacuated, the organized chaos of a hospital disaster protocol. Except this wasn't a fire or an earthquake. This was the end of everything they'd known.
Adrian hauled the table through the doorway and into a corridor that shouldn't lead where it did. One end opened onto the hospital's main lobby. The other end opened onto a cityscape that definitely wasn't Seattle—all dark stone and perpetual twilight.
"Help!" A voice, young and terrified. "Someone help!"
Adrian turned and saw her pinned beneath debris—a surgical resident he vaguely recognized. Blood was spreading from her trapped leg. Behind her, through another tear in space, something massive was emerging. Something with scales and wings and hunger in its reptilian eyes.
Leave her. Save yourself. You can't save everyone.
The thoughts were automatic, born from twelve years of triage and impossible choices and learning that sometimes people died no matter what you did.
But Adrian was already moving, his new senses mapping the debris pattern, calculating how to shift the weight without causing a secondary collapse. He lifted a chunk of concrete that should have required three men, tossed it aside like cardboard, and pulled the resident free.
Her leg was mangled. Compound fracture, arterial damage. She'd bleed out in minutes.
Adrian pressed his hand to the wound and let the power flow again. He felt her cells responding, bone knitting, vessels repairing. It was easier this time, more controlled. He was learning.
The dragon-thing behind them roared.
"Run," Adrian told the resident, and she did, limping but alive, while he turned to face whatever came next.
The hospital was dying around him. Through the chaos, Adrian could see the city beyond—Seattle transformed into something from a nightmare or a fever dream. Buildings merged with structures from other worlds. The sky was fractured like broken glass, showing different colors and different suns through each fragment.
People were screaming. Dying. The world was ending.
And Adrian Thorne, who'd spent twelve years learning that he couldn't save everyone, felt the power in his veins and wondered if perhaps, in this new impossible reality, he might actually be able to try.
The dragon-thing lunged. Adrian didn't run. Instead, he raised his hands—still stained with his patient's blood and the black ichor of that first creature—and prepared to learn just what else he could do.
The world shattered, and in the ruins of everything he'd known, something new began.