It's a lot of worrying things at once, and Dean hardly gets a moment to mull over any of them - Kisuke coming closer, the whole naked comment, the sudden push. It's like when Rukia expelled him topside, his soul sliding out as neat and smooth as a glove...and then it's very much not.

Dean fights the heaviness weighing down on him, the sudden pressure in his lungs. Kisuke says breathe, and Dean does, but it isn't helping like it should. His gaze flicks up, stubbornness keeping him upright despite the nauseous discomfort. "And then?" he grinds out, gasping another breath.