As a result, much of the other Grey's characters made only brief appearances this week, including Owen Hunt. Instead the focus was on Derek's connections to everyone on the show and what would follow after Meredith opened the door to the police who waited on her doorstep. As the episode began, Derek got Meredith's voicemail when he called her from his beloved ferry. (Which should have been our first clue as to the direction of the storyline.) He then called from the car on his way to the airport and got to banter with Amelia, April, and Miranda before narrowly avoiding a horrific car accident on a less-traveled airport shortcut. Derek easily slipped into surgeon mode, tending four patients involved in the accident while on his own with no cell phone coverage.
The patient anvils continued to rain down as his patients expressed their fears about dying in such a desolate location, prodding Derek to try to reassure them that he doesn't let people die. Acting as a combination surgeon and Boy Scout, Derek seemed to be on his way to a good result as an emergency crew arrived to take his patients to a nearby hospital for treatment. Until he got back in the car and began fishing for his cell phone, which put him in the path of a semi truck. The resulting accident segued into the next anvilicous montage of historic scenes of Meredith and Derek's life. Unfortunately, the patient that Owen and Amelia unloaded from an ambulance at Grey Sloan Memorial Hospital wasn't Derek, who was instead sent to a smaller, overburdened hospital which we learned quickly was not a trauma center.
As he received treatment we heard Derek's voice diagnosing himself without being able to communicate with the team treating him. Instead of receiving the CT scan Derek knew he needed, he was rushed to surgery to treat his other injuries. While the stressed surgeons continued to work, Derek's brain injury remained untreated until it grew too late and his injuries turned fatal. We then flashed back to the police knocking on Meredith's door and her hopeful imagining of the result instead of what stood before her. The next scene showed us Meredith struggling with her emotional reaction as she reviewed the chart and quickly assessed that the CT scan would have made all the difference before she then signed the papers to remove Derek's life support. We were given another montage of Meredith and Derek's beginning scenes together as a nurse removed the equipment that was keeping Derek's body alive while Meredith stood stoically by his side.