- Derek witnesses a horrible car crash and jumps in to save lives.
- Derek was headed to D.C. and tried to call Meredith, but she left her phone. Meanwhile, Derek is on the phone with his sister, who is telling him he's not going to make his flight because of a bad car accident on the freeway. He's taking a shortcut through some back roads when a car driving wildly passes him and, when it tries to pass the next car ahead both cars flip wildly out of control. Derek slams on his brakes and when he realizes he's OK, he goes to check on the people in the other cars. He finds a woman named Sarah and her young daughter in one car, and they seem to be basically OK, even though they're trapped in the car. The young girl, Winnie, tells Derek she thinks she's dead, but he shows her how to feel for her pulse and she is relieved to learn she's alive. From the other car, he finds a teenage girl, Alana, who is in shock and was propelled several feet out of the car. She says she wasn't driving. Charlie was. Derek finds Charlie walking aimlessly along the road and sees that he has a big head wound and passes out.
Derek helps the little girl out of her SUV and she tells him she's "seen stuff" because she watched her dad die in front of her on a fishing trip. He sends her off to give Charlie and the teenage girl some bandages while he tries to get her mom out of the SUV. He realizes the mother's hip is dislocated and he's going to have to pop it back in. We hear her scream in pain and he gets it done. That's when the girl calls out that the sports car is on fire and Derek runs over to get Charlie and Alana away from it. He does, and the car blows up.
Derek hopes the smoldering car will act as a smoke signal to get help. Alana is panicking and explains that Charlie is a cool kid and she's a really good student and was surprised when Chairlie invited her to go for a drive. She keeps repeating that she isn't supposed to be there. Alana is complaining about pain in her stomach. Derek takes a look and it's bad. Her intestines appear to be coming out of a big cut. Derek gets some dry cleaner bags from Sarah's car and wraps Alana's stomach with them. Derek tries to distract Alana by asking her about the kiss Charlie gave her, and this leads to him talking about his first kiss with Meredith and how that's the only one that mattered. A fire engine comes around the corner and all the crash victims are taken away in ambulances. Derek gets back into his car, starts to make a three-point turn on the highway and reaches down into the seat cushion for his cell phone. We see a flash of a mack truck and hear its horn, and it T-bones Derek's car at full speed.
Derek is brought to a hospital outside of town where the E.R. doctor is already worried they're overloaded with the people from the earlier crash. He doesn't seem confident about handling Derek.
Derek can't speak but we hear his thoughts as he's following the doctors' treatment of him. Through the open curtain, Winnie sees Derek laying on his gurney. Derek likes the woman doctor because she knows what she's doing, but he hears an older doctor, a man, arguing with her about whether they should do a CT scan on him, which Derek thinks they need because he might be bleeding in his brain. Winnie comes over and tells Derek he's not dead, because she can feel his pulse. Winnie tells the female doctor that Derek is a doctor who saved everyone from the car crash. The doctors keep going back and forth about whether to try to operate on Derek quickly or take the head CT. He is thinking they should do the CT scan, like the female doctor, but the older doctor is overruling her and Derek thinks he's going to die because the doctors aren't property trained.
Derek is knocked out for the surgery, but is still hearing the surgeons and following along with their moves. Most of them are right, but occasionally they're off. The neurosurgeon, who took an hour and a half to get to the hospital instead of the promised 20 minutes, comes in all cocky and insulting the other surgeons for not having gotten the CT scan done earlier. He scrubs in, but Derek thinks, "It's too late."
Meredith is dazed when some police officers come to her door and tell her there's been an accident involving Derek. She's stunned and wonders what to do with the kids.
We next see Meredith come into the hospital and pass by Winnie. She stands quietly next to Derek's bed while the neurosurgeon tells her he's sorry. He's realized who Derek is and says he's long admired his work. She looks at Derek's chart and tells the surgeon and the female doctor that not getting the head CT was the wrong call. The female doctor explains that they're not a trauma center or teaching hospital and Meredith says, "You did the best you could."
Another doctor comes to talk to Meredith to "explain how this all works." Meredith asks for the papers, saying she knows how this works. Now that Derek can be officially declared dead, there's the question of whether to move him into some long-term care and hope for a miracle or pull the plug. She's angry and asks if the doctor wants to talk about killing her husband while she sits there with her sleeping children. She yells at him to give her the papers, and rips them from his hands.
Outside the hospital, the female doctor is crying and she comes to Meredith to say she's sorry. She's sorry because it was her job to save Derek and she "failed" and he's going to die because she "was not a good enough doctor to keep him alive." Meredith tells her she's right, she did fail and wasn't good enough, but she tells her she needs to learn from the experience and better herself for the next time she has to save lives of others. Meredith tells the doctor that the hard ones always haunt you, but this one will make her work harder and be better.
Meredith comes into Derek's room with the papers and sits next to Derek as a nurse turns off the life-support machines. Just before the nurse takes out his breathing tube, Meredith asks her to stop. She thinks back through all their good memories, from the moment they met onward, then touches Derek's cheek and tells him it's OK and he can go. The nurse asks if Meredith is ready and she says, "No, but go ahead." The tube is removed and Derek flatlines.
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