As one could see, it is very likely that Ash is trapped in his world. But like every dream, everything, there is a beginning and an end. What would happen if Ash could fully recover? What would happen if he never does? There are infinite branches of possibilities that spiral upwards and intertwine towards the top at a single point, both in his “world” and the real world. In his hospital room, we see Delia, obviously distraught talking to a doctor with a grim look in his eye. He's saying that their insurance is up, and the boy has had no change in brain activity for seven years. That a shock like this may awaken him. She tearfully agrees.
Professor Oak is there to comfort her as they take Ash off life support.
In Ash’s “world”.
Ash has finally defeated the elite four, and one by one the people around him start disappearing. eventually everything is black. Pikachu comes dashing towards him glowing brighter and brighter in the darkness. Eventually Pikachu reaches ash and the two embrace one last time.
Back in his room, as his life signs fade, Ash mutters his genuine, final words.
The image of his gaunt, tube-fed, ten-some-year bed ridden body on the bed. His head appears bulbous from atrophy. As he utters his last words, he barely opens his eyes, seeing a silhouette of the figure at the center of his turbulent emotions, his mother, her face obstructed by her hands wiping away tears. He makes contact with her eyes and lets out one last tear before losing all strength. She breaks down in hysterics.