For this idea, I wanted to try to make “he was in a coma the whole time!” into an actually fun premise that you use to tell an interesting tale. Instead of it being the twist at the end of your story, it’s something characters uncover early on and have to face.
The story starts with our main character waking up in a gasp. They’re feeling groggy and out of it, unsure how they came to the hotel they woke up in. The people in the hotel act weird and it’s vaguely unsettling as they wander the halls. Trying to leave or find exits leads to doors being locked or people swarming routes that block off the character. The lead eventually meets some people from work and they're more like themselves but everything still feels off. From the hangers on doors to signs in the lobby to newspapers in front of rooms, there are repeated references to sleeping or waking up.
Eventually, our main character forces their way out of the hotel and into the small town below, not fitting this previously giant hotel they were just in. Everything still feels hazy and off. The lead eventually sees a billboard explicitly addressing them and telling them to wake up. The main character talks to some people and they conclude that protagonist is in a coma dream world and we’ve hit our “twist”. However, everything kind of turns around and the main feels freed from this. They can go out and do things they’ve always wanted. Rather than feeling trapped in this world, it now means that everything is open to them and they can explore and create. It’s their coma dream world and they can reshape it as they see fit. And there are no consequences because the world isn't even real!
After an unspecified but implied to be ages long time, our main character eventually wants to leave. Having god-like power is fun and all but you will eventually run out of excitement and knowing the whole thing is fake does put a bit of a damper on things. Is their body out in the real world just rotting away? What’s the time compression of coma world vs reality?
As they try to force themselves awake, our lead is now faced with figuring out how to actually do that. They have the power to shape the world, but how to actually end it and boot themselves out. The lead eventually finds a way to leave, but the world just keeps reforming itself around them or sucking them back in. Every time they think they’ve left, it's just a new part of the dream world. The first few times, the dream disguises itself to make it seem like our lead left and woke up. Once the protagonist catches on, the dream stops disguising the escape attempts and makes the lead face that they’re stuck.
The dream world itself becomes a character of its own. The lead still has complete control over the world and can fight it, but the dream doesn’t mind. The more time the lead spends waging war, the more time the lead spends sustaining the world. The dream world is the most golden of golden cages. You can have everything you want and can do anything, but once you’re aware of it, you can’t leave. The dream has no negative feelings towards the lead and actually acts the opposite way. It will gladly play the villain if the lead wants that, but the dream wants nothing more than to stay together, obsessively so.
The only way out is to destroy the world, the places in it, and the people you’ve come to love and bond with over the ages the protagonist has spent here. Any time the lead tries to cut that short and just disassemble the dream, it forms back around them. It’s not enough to want to wake up from the dream, you have to sever all ties to really leave. You have to face every person and creature and world you’ve created here and destroy them to really announce that you’re done here, have accepted the end, and that you’re serious about leaving.