How to Save a Life

"When I was 5, my mom lost me in a park. I don't remember much, except that one minute, I was riding the carousel, and the next, she was gone. I don't remember how I found her. I don't remember how I got home. All I remember is what happened next. She told me not to worry. She told me everything would be fine. Funny, isn't it? The way memory works? The things you can't quite remember, and the things you can never forget. The carousel never stops turning."

- Meredith Grey

 is the twenty-first episode of the eleventh season and the 241st overall episode of Grey's Anatomy.

Short Summary
Derek witnesses a horrible car accident and springs into action to save lives.

Full Summary
As Meredith's voiceover talks again about being lost in the park when she was five, Meredith clutches her phone as the lights from the police car flash. There's a flashback to Derek leaving.

Derek is on a ferry. He takes out his phone and calls Meredith.

Meredith's phone is ringing, but she's busy getting the kids out the door. Zola says that surgeons can never be late because people die.

Derek leaves Meredith a message.

Derek sits in traffic for a moment before changing lanes to go faster.

Derek is talking on the phone with Amelia as she operates with April and Bailey. Amelia says he's going to miss his flight because there's an accident and they're operating on one of the victims. Derek says he has a secret shortcut. Derek says he's going to lose them in a minute because the cell reception was bad. She doesn't hear that because the signal is lost.

The car behind Derek is speeding and swerving. The driver passes him and he remarks that he's going 10 miles over the speed limit. Derek watches the car continue to speed. The car attempts to pass an SUV in front of them, but the driver clips the front of the SUV instead, sending them both flying.

Derek stops his car and searches for his phone. He can't find it, so he gets out and runs to the SUV. He finds Sarah trapped inside. She's calling for Winnie. Derek climbs onto the top of the car to talk to Sarah. When she tells him about Winnie, he checks on her. She's not talking because she thinks she's dead. He checks her pulse at her wrist and tells her she's not dead. She tells her mom she's not dead. Derek asks Sarah for a cell phone. Her phone was shattered in the crash, but it doesn't matter because there's no cell signal out there. Derek says he's going to check on the people in the other car and see if they have a cell phone. Sarah doesn't want him to leave, but he has to.

Derek runs to the other car, but there's no one inside. He hears someone calling for help and finds Alana off the road lying on the ground. He says she probably got the wind knocked out of her when she hit the ground. When he asks here if it hurts, she freaks out and says she's not supposed to be there. She tries to use her phone, but it's not working. He tells her she needs to calm down because she might be in shock. She says she's supposed to be in school. He asks if that's why she was driving so fast. She says she wasn't driving. Charlie was. It's his dad's car. Derek looks around for Charlie and finds him wandering down the road. Derek goes after him and asks if he's okay. Charlie says he's fine, but he has a head injury and says he doesn't feel good. Charlie keeps asking Derek what happened and then he collapses to the ground.

Derek has moved Charlie out of the road. He tells Alana he's going to look for a first aid kit. Derek goes to his car and finds only a small first aid kit with very little in it.

He does back to Sarah and Winnie. Derek asks what kind of supplies she has in the back. She says there's a first aid kit. He goes to the back of the car. He tells Winnie to get back, but tells her the glass won't hurt her. He finds the first aid kit. Winnie asks if he'll leave her again. He says he won't and gets her to crawl out. He tells Sarah they'll be right back. He tries to send Winnie over to Alana and Charlie with bandages. Winnie deduces that her mom's going to be in a lot of pain and he doesn't want her to see that. He admits that that's true. She says she can deal with seeing stuff; her dad died right in front of her. They were fishing out on a lake when he had a heart attack and died. She asks him if he fishes. Derek says no one's going to die, but she tells him he's not God so he doesn't know. She agrees to go wait with Charlie and Alana.

Derek breaks the glass to get Sarah out. Sarah says she loves that car. It's the first new car they ever owned. And a rich guy in a mid-life crisis car hits them. Derek tells her it's a 17 year old kid. Sarah says she can't hate him then. Then she says his parents are probably awful. She says she's not in pain and she's not sure why. Derek says she probably dislocated her hip. He says he needs to get her out and pop it back in.

Charlie is still asking what happened. Alana clutches her stomach in pain. She says she might throw up. They hear Sarah scream.

Derek is preparing to reduce Sarah's hip dislocation. She doesn't want him to, but he says he has to because it cut off the circulation to her leg. He quickly reduces it while she's distracted. She tells him she hates him. Winnie runs up and tells him that Charlie's car's on fire. He yells at Alana to get away. He then half-carries Charlie to safety. They watch as the car explodes.

Winnie says the explosion was huge. Derek points out the smoke and says someone will see it and someone will come. Alana says she shouldn't be there. She's a mathlete. She takes 5 AP classes. She plays in the band. She has perfect attendance. She's boring. Charlie is the prom king. He's in remedial math. But he asked her if she wanted to go on a ride. Something must be wrong because that happened. Derek goes over to Alana and has Winnie help him put her on the ground. He opens her shirt to look at her stomach, which is lacerated and severely bleeding. He applies pressure to the area. He tells her he can take care of it. They ask how and he thinks about it. She says she's going to die out there. He asks her not to say that because it's insulting. He's very good at his job and he doesn't let people die. He then says he's thinking. He remembers that Sarah has dry cleaning in her car. He has Winnie get it out and he uses that to pack Alana's wound. He distracts her as he does that by asking her about kissing Charlie. He asks if it was her first kiss. It was, except for a fellow band-mate who plays second chair cello, which doesn't count because it was practicing. Winnie asks if she should be practicing. Sarah tells her she shouldn't be and points out how much trouble Alana's going to be in when her parents find out what she's been up to. Alana says she's not a role model. Derek tells her that every kiss before the right kiss doesn't count anyway. He says he's kissed a lot of women. The first time he kissed his wife, who wasn't his wife at the time, it was like he'd never kissed any other woman before. Sarah asks him if he has a brother.

"It's a beautiful day to save lives," Derek says to himself. Winnie asks him what he means. He tells her it's just a thing he says. They start to hear sirens. Winnie says that they got their smoke signal and hugs Derek for excitement. A fire engine pulls up.

Alana is loaded into an ambulance and Charlie and Sarah into two others. Winnie hugs Derek, who says he'll come see them in the hospital first thing in the morning. He helps her into the ambulance. Sarah thanks him and the ambulance is closed. A firefighter comes up to Derek and tells him to go home and get himself a drink. He's earned it.

Derek gets back in his car and pulls out to turn around. Before he gets all the way there, his phone rings. He goes to pick it up and gets hit by a semi.

Meredith continues to go through her memories and talking about how memory is silly.

The paramedics bring Jerome Davis into the GSM ER. Owen and Amelia meet them at the door. He has blunt force trauma to his head. They take him inside.

Derek is taken to the Dillard Medical Center ER. Toby meets the ambulance and says they can't take another trauma. They already have the first crash victims. They don't have room. Paramedic Jamal says when it rains, it pours. He tells him to let it pour somewhere else because they're not a trauma center, but Jamal says they have to take him.

Derek is wheeled into the ER. He thinks about his injuries as the doctors assess him. He can't speak. He thinks that he needs a CT. As Edie makes orders, Derek notes that he likes her because she's smart. She apologizes to him as she puts in a chest tube, saying it'll hurt. She asks him again for his name, but he can't speak.

Winnie watches Alana get taken somewhere and sees Charlie getting staples put into his head. Then she sees Derek in his bed. She tells her mom she's going to the bathroom and goes to Derek.

Edie wants a head CT, but Paul says he needs to go right to the OR for his abdominal bleeding. Edie continues to fight and Derek roots for her. He says Paul is arrogant because Edie is younger than him and probably because she's a woman.

Winnie comes in and takes Derek's arm. He thinks that she shouldn't be in there. She says she knows he's not dead because she can feel his pulse. She tells him to stay not dead and tells him, "It's a beautiful day to save lives." Paul asks her where she's supposed to be. Edie says she'll deal with her.

Edie asks Winnie about Derek. She explains that he's a doctor and he helped all of them.

Derek is thinking about they need to check his head. Edie comes in and tells them he's a surgeon who saved all the car accident victims. They sedate him to secure his airway as he thinks that they need to wait. Edie takes his hand and tells him it'll be okay. He thinks again that they should have taken him for a CT.

As they run to the ER, Edie notes that he's holding steady and makes a final plea to get him a CT. Paul says they don't have time and they continue to take him to the OR. Derek thinks that he's going to die because they aren't properly trained.

In the OR, Derek continues to think as they sedate him. He has to have a bowel resection and has a splenic laceration. He becomes unstable. He has a hemothorax, so Paul opens his chest over Derek's thoughts that he needs to wait. Paul finds no reason. He's bradycardic and Paul has the anesthesiologist check his pupils. One is blown, so they page the neurosurgeon.

The neurosurgeon was at a dinner and he'll be there in 20 minutes.

Over an hour has passed and the neurosurgeon has still not arrived.

Dr. Cohn finally arrives and they're upset that he took so long. He gets in a spat with Edie over his response time and kicks her out. He scrubs in for the craniotomy. Derek thinks that it's too late.

Meredith continues to watch the police lights. When there's a knock at the door, she does to answer it.

Derek is awake in his bed. Meredith asks him what he did. He says what he always does, but he almost killed himself doing it. She tells him not to joke because she was scared. Meredith climbs into bed with him.

A police officer startles Meredith out of her day dream. He asks if this is the home of Derek Shepherd. She says it is. He says there's been an accident and she needs to come with them. She says she can't and asks what she's supposed to do with her kids.

Meredith pushes Bailey's stellar and holds Zola's hand as they ender Dillard. Meredith sees Winnie waiting. She sees blood on the floor and remembers her mother telling her it's just blood. A social worker gives Zola a balloon and takes both kids so Meredith can go to Derek.

In the elevator, Meredith remembers her calling 911 when her mother tried to kill herself.

In Derek's ICU room, Dr. Cohn apologizes and says he admired Derek's techniques. Meredith takes the chart from Edie and looks through it. She says the call not to get a head CT was a bad call. Edie says they're not a trauma center or a teaching hospital and Meredith says they did the best they could. She turns back toward Derek.

Meredith is sitting on a bench with Zola sleeping in her lap and Bailey in his stroller. Paul comes up to her and says he needs to explain how this works. She asks for the papers. He tries again to explain. She says she's a doctor. She knows how it works. They've waited long enough to declare him dead. Normally, they'd ask about organ donation, but from the looks of it, there's not much left that works to donate. So the ICU needs a bed. She lists off her options and then demands that he give her the papers. "Give me the papers." Meredith says. "Ma'am" Paul says as he tries to talk. "Give me the papers!" Meredith snaps.

Outside the hospital, Edie is crying when Meredith exits. Edie comes up and apologizes to Meredith. She says Derek saved all those people and it was her job to save him and she failed and now he's going to die because she was not good enough to keep him alive. Meredith says she's right. But tomorrow's Friday. There's more patients coming. And Derek was her one. The patient whose face she'll see every time she treats a patient and remember that he died on her watch. He'll haunt her because the hard ones always do. But it'll make her better. Or she'll quit. And she doesn't get to spend what would have been the rest of her husband's life being a quitter. She tells Edie to get back inside because she's not saving any lives outside. Edie tries to apologies again, Meredith brushes her off. Edie goes back inside. Meredith walks over to a bush and vomits.

Meredith looks around the ER and then walks into Derek's room. She tells a nurse that a social worker has her kids. The nurse says they'll care care of the kids even if it takes a while. She hands the nurse the papers so she can start to turn off the machines. Meredith sits by his side as the nurse turns off the machines. When she goes to remove his breathing tube, Meredith stops her. She says Derek's name a few times.

Flashbacks to important points in Meredith and Derek's relationship, including their first meeting.

Meredith says Derek's name again and brushes his cheek before telling him it's okay to go. They'll be fine. She stands and the nurse asks if she's ready. She says she's not, but tells the nurse to go ahead anyway. The nurse turns off the machine and removes his breathing tube. His heart stops. The nurse leaves Meredith alone with Derek.

Main Cast

 * Ellen Pompeo as Dr. Meredith Grey
 * Justin Chambers as Dr. Alex Karev (credit only)
 * Chandra Wilson as Dr. Miranda Bailey
 * James Pickens, Jr. as Dr. Richard Webber (credit only)
 * Sara Ramírez as Dr. Callie Torres (credit only)
 * Kevin McKidd as Dr. Owen Hunt
 * Jessica Capshaw as Dr. Arizona Robbins (credit only)
 * Sarah Drew as Dr. April Kepner
 * Jesse Williams as Dr. Jackson Avery (credit only)
 * Caterina Scorsone as Dr. Amelia Shepherd
 * Camilla Luddington as Dr. Jo Wilson (credit only)
 * Jerrika Hinton as Dr. Stephanie Edwards (credit only)
 * Kelly McCreary as Dr. Maggie Pierce (credit only)
 * Patrick Dempsey as Dr. Derek Shepherd

Guest Stars

 * Larry Cedar as Dr. Cohn
 * Mike McColl as Paul
 * Samantha Sloyan as Edie
 * Allie Grant as Alana
 * Savannah Paige Rae as Winnie
 * Che Landon as Sarah

Co-Starring

 * Robby Rasmussen as Charlie Abbott
 * Scott Allen Rinker as Toby
 * Ashlee Brian as Paramedic Jamal
 * John Eddins as Firefighter
 * Thomas Owen as Police Officer
 * Terrence Edwards as Paramedic Calvin
 * Jennifer Aquino as Anesthesiologist
 * Irene Park as Paramedic #1
 * Joe Raffa as OR Nurse
 * Cassidy Brown as Nurse
 * Jael Moore as Zola

Amelia's Patient

 * Diagnosis:
 * Abdominal trauma
 * Head injury


 * Doctors:
 * Amelia Shepherd (neurosurgeon)
 * Miranda Bailey (general surgeon)
 * April Kepner (trauma surgeon)


 * Treatment:
 * Surgery

Amelia, Bailey, and April operated on an accident victim with abdominal and head trauma.

Sarah

 * Diagnosis:
 * Dislocated hip


 * Doctors:
 * Derek Shepherd (neurosurgeon)


 * Treatment:
 * Closed reduction

Sarah was injured in a car accident. She a dislocated hip, which Derek reduced in the field. She was then taken to the hospital.

Alana

 * Diagnosis:
 * Abdominal trauma
 * Scalp laceration


 * Doctors:
 * Derek Shepherd (neurosurgeon)


 * Treatment:
 * Wound packing

Alana was thrown from a car in a car accident. She sustained trauma to her abdomen. When Derek looked at her belly and saw that it was bleeding severely. He used a bag from Sarah's dry cleaning to pack the wound and stop the bleeding. She was then transported to the hospital.

Charlie Abbott

 * Diagnosis:
 * Head injury


 * Doctors:
 * Derek Shepherd (neurosurgeon)
 * Toby (ER Doctor)


 * Treatment:
 * Staples

Charlie was injured in a car accident. He had a head wound and had some memory loss and confusion as a result. He was taken to the hospital. In the ER, Toby stapled his head.

Jerome Davis

 * Diagnosis:
 * Blunt force trauma
 * Open skull fracture


 * Doctors:
 * Owen Hunt (trauma surgeon)
 * Amelia Shepherd (neurosurgeon)


 * Treatment:

Jerome came into the GSM ER with head trauma.

Derek Shepherd

 * Diagnosis:
 * Abdominal trauma
 * Head trauma
 * Chest trauma
 * Scalp laceration
 * Flail chest
 * Grade II splenic laceration
 * Hemothorax


 * Doctors:
 * Toby (ER doctor)
 * Edie
 * Paul
 * Dr. Cohn (neurosurgeon)


 * Treatment:
 * Chest tube
 * Exploratory laparotomy
 * Bowel resection
 * Colostomy
 * Thoracotomy
 * Craniotomy

After being hit by a truck, Derek was taken to Dillard Medical Center. They put in a chest tube to drain the blood. Edie suggested that they take him for a head CT, but Paul insisted that they didn't have time because of the abdominal bleeding. He became unstable in the ER and was rushed into surgery without the head CT. In the OR, they had to resect a part of his bowel and create a temporary colostomy. He also had a splenic laceration, which they just watched. He had a hemothorax, so they opened his chest, but that didn't solve the problem. They then remembered that he had a head laceration. His pupil was blown, so they paged the neurosurgeon. The neurosurgeon took a while to get there and by the time he arrived, it was too late. Despite their efforts, Derek was pronounced brain dead. Meredith then made the decision to take him off life support.

Notes and Trivia

 * This episode's title originated from the song , originally sung by The Fray. The song was featured on the episode Superstition and was also sung by Kevin McKidd, Ellen Pompeo, Kim Raver, Eric Dane, Jessica Capshaw, Chandra Wilson, Chyler Leigh, Sarah Drew, Justin Chambers, and Sara Ramírez during the musical episode Song Beneath the Song.
 * This episode scored 9.55 million viewers which is up 24.31% from its last episode "One Flight Down", and came second overall with ratings for its time slot.
 * Filming for this episode was scheduled from March 20 to March 31, 2015, but the filming continued for an extra day, thus ending on April 1, 2015.
 * This episode will feature action scenes which were filmed in Griffith Park.
 * This is the first episode in which only half of the current main cast appears.
 * It's also the first episode ever not to feature Alex Karev.
 * This is the first episode with Shonda Rhimes as the credited writer since Flight, the season eight finale.
 * The song Today Has Been Okay played in this episode and was previously featured in Into You Like a Train and Goodbye. Into the Fire was previously featured in A Hard Day's Night. Chasing Cars was previously featured in Losing My Religion and a version sang by the cast (Sara Ramírez, Kevin McKidd, and Chandra Wilson) was featured in the episode Song Beneath the Song.
 * Derek's death in a car accident is Meredith's nightmare come true as we can see on the episode Dream a Little Dream of Me, Part 1. There we can here Meredith's voiceover about, "It's the nightmares that always seem to become reality." This is in line with the previous episode, where he told Meredith to wait for him with the exact words he used at the end of Freedom, Part 2, which is the episode previous to Dream a Little Dream of Me, Part 1.
 * Both Mark Sloan and Derek Shepherd, who were best friends, died by turning of the life support machines.
 * Goof: The time and date shown in Derek's car is the same when he gets out of the car to help the crash victims as it is when he gets back in the car before being hit by the semi. The date reads March 26, 2015.
 * The version of this episode that aired on Australian TV used You Were Supposed to be Different by Aron Wright in place of Chasing Cars.

Quotes

 * Meredith: Derek... It's okay. You go. We'll be fine.
 * Nurse: Are you ready?
 * Meredith: No. But go ahead.


 * Derek: It's a beautiful day to save lives.
 * Winnie: What does that mean?
 * Derek: It's just a thing that I say.


 * Winnie: Derek?
 * Derek: (thinking) Winnie... You shouldn't be in here.
 * Winnie: I know you're not dead. Know how I know? 'Cause I can feel your pulse, which means your heart is beating. Your heart is beating, which means you're not dead, okay? Hey. Eyes on me. You stay not dead, okay? It's a beautiful day to save lives, right? So you stay not dead.


 * Meredith: The call to not get a head C.T. was a bad call.
 * Edie: We're not a trauma center. We're a teaching hospital.
 * Meredith: You did the best you could.


 * Paul: Ma'am? I thought that if this was a good time, I might take a moment to explain how this all works.
 * Meredith: Where are the papers?
 * Paul: Mrs. Shepherd, there's some things you need to know... some things we need to discuss. Difficult things.
 * Meredith: I'm a doctor. Dr. Grey. I'm a surgeon, just like my husband was. I know how this works. You've waited the requisite number of hours, and now you can officially declare him dead. Normally, you'd talk to me about organ donation. But by the looks of his chart, there's not much left that works to donate. So, the ICU needs a bed. Those must be the papers... the papers you want me to sign to decide what to do with my husband... Now that he's dead, but not really dead. Do we ship him off to a long-term-care facility and cross our fingers and hope for fairy tales and magic? Or do I pull the plug? And stop all curative intervention? Discontinue all routine monitoring, remove all the catheters, drains, and tubes, end any and all treatments that might provide comfort to the patient. Terminate all life-sustaining measures... and behave as any sane doctor would behave. Does that about cover it, doctor? Is that what you want to talk to me about... while I sit here with my sleeping children? You want to talk about killing my husband? Give me the papers.
 * Paul: Ma'am...
 * Meredith: Give me the papers!


 * Edie: I'm so sorry. I know that that's useless to you right now. But I am. He saved all those people. And it was my job... to save him. And I failed. And now... He's gonna die... Because I was not a good enough doctor... to keep him alive.
 * Meredith: Yeah, you're right. You did fail. You weren't good enough. But do you know what tomorrow is? It's Friday. There's gonna be more patients who come in who need you to save them... someone's mother, someone's kid, someone's husband. They need you to save them because they can't save themselves. So learn from this, better yourself, and you will be better for next time.
 * Edie: What if I'm not?
 * Meredith: You will be.
 * Edie: How can you know that?
 * Meredith: Because he was your one. Every patient you treat, you're going to see my husband's face and remember that he was the one that died on your watch. He will haunt you. The hard ones always do. And it only takes that one. But that one will make you work harder, and they make you better. Or they make you quit, and you don't get to waste what would have been the rest of my husband's life being a quitter. So get back inside because you're not saving any lives out here.
 * Edie: I really am so...
 * Meredith: Yeah, I know. I know.


 * Derek: I'm going to die because these people aren't properly trained.


 * Derek: Every kiss before the right kiss doesn't count anyway. I've kissed a lot of women. The first time I kissed my wife, well... I mean, she wasn't my wife then. She was just this girl in a bar. And when we kissed, it... it was like... I gotta tell you, it was like I never kissed any other woman before. It was like the first kiss. The right kiss.


 * Meredith: Okay, Zo-Zo, walk a little faster 'cause we are late. And who can never be late?
 * Zola: Surgeons.
 * Meredith: What happens if surgeons are late?
 * Zola: People die.
 * Meredith: Right on, sister.