Make sure you fully extract the ZIP before running it (right-click the ZIP > Extract All). Running the .exe directly from inside the ZIP without extracting won't work because it can't find the engine files it needs. If you already extracted and it still won't start, your antivirus might be blocking it. Try right-clicking ThePatientSea.exe > Properties > check "Unblock" at the bottom, then run it again. I just tested and it worked for me, using ThePatientSea.exe