He awoke in spells and all he could feel was the burning in his eyes and the pounding of his heart as it raced in his chest. Every moment a nightmare and the view of the ceiling burned into his eyelids. He could hear Sammy as he talked of salvation and Crowley laugh at the idea of it all. Not one time did they mention the name he longed to hear and so he went back into the madness of his mind. The nightmares drove him to insanity, within that insanity he prayed; but they were never answered, and all he could utter in his comatose state was "where are you?" to which Sammy replied, "We are right here". Crowley laughed at Sam's utter idiocy. Crowley knew he meant Cas and he knew he was far beyond his reach. Dazed and confused Dean sat up; sweat beating off his forehead, the fever rushed until he could feel it burning in all of his veins.
He looked upon the faces of his visitors. Inside he felt a rage building; a rage filling the throbbing void of his missing soul. Dean looked at Crowley and felt a connection and he wondered if this was unity; a brotherhood of the damned. In a painful gasp, he requested for the location of the salvation missing in his nightmares; his angel; Cas. Crowley laughed but quickly retracted when he saw the rage building on the face of his new brother. He responded with all the emotion he had left from his human blood addiction and said "Heaven, a place you will never be able to go". Sam walked out of the room; knowing Dean would need a minute to process what he has become.
Although Sam knew, he would have to realize he had lost his brother to hell once again and this time there was no bringing him back. Crowley disappeared and Dean was left with his thoughts. They ate away at his morality and all he could think about was how Cas would see him; he was ugly now; a demon; a knight of hell. Everything from the moment Cas was brought into existence, to hate, he had now become.