Grey's Anatomy Universe Wiki
Grey's Anatomy Universe Wiki

The human life is made up of choices. Yes or no? In or out? Up or down? And then there are the choices that matter: to love or hate, to be a hero or to be a coward, to fight or to give in, to live or die... Live or die? That's the important choice, and it's not always in our hands. Yes or no? In or out? Up or down? Live or die? Hero or coward? Fight or give in? I'll say it again, to make sure you hear me: the human life is made up of choices. Live or die? That's the important choice… and it's not always in our hands.

Death and All His Friends is the second part of the season six finale and the 126th overall episode of Grey's Anatomy.

Short Summary[]

Cristina and Meredith's surgical skills are put to the ultimate test when Derek and Owen get shot.

Full Summary[]

Derek is still lying on the ground, bleeding. Cristina pulls back a horrified Meredith as Gary proceeds to point his gun at April. She starts telling facts about her life, like where and how she grew up and her family. She says she's barely lived and begs him not to shoot her. Gary starts shaking and tells her to run. Derek is panting and Gary points his gun at him again, but he then sees a SWAT team entering through the main entrance. He disappears.

Meredith and Cristina are in the supply closet. Meredith wants to go to Derek to help him, but Cristina blocks the door, not wanting to risk to get shot themselves. Meredith then throws Cristina into a shelf and runs out to Derek. Meanwhile, Teddy and Owen are tending to their gunshot victim. They are bringing him to the ICU after his surgery. Teddy says she thinks he loves both her and Cristina, which is why he tried to get Shepherd to fire her so that he wouldn't have to choose, but now their lives are in danger so she really wants him to choose. He says he chooses no one. They then come across a shot resident. Owen checks, but the resident is dead. He decides not to go to the ICU as they'll be sitting ducks. He wants to take the patient outside and calls 911.

Richard asks Marty, the police officer, why only visitors are being evacuated. The officer explains that they're cleared out room by room. The policy states that nonessential hospital personnel is removed after the visitors. Richard asks about the shooter, but they don't know anything. The police then gains access to the 911 calls from the hospital. Richard overhears many of his colleagues and friends in panic on the transmitter. There are messages about colleagues who got shot, a description of the shooter and the fact that he was looking specifically for Derek, who got shot.

Meredith is sitting by Derek's side. She begs him not to die as Derek tries to make her leave. A cautious Cristina comes over and says she called the police. They won't be there in time. Cristina knows Derek needs surgery and runs off as Meredith tells Derek he doesn't get to die. 

Cristina runs to get a wheelchair and sees a frightened April sitting against a wall. She says they're bringing Derek to the OR so that Teddy can operate on him. April says she saw on Oprah that if you tell facts about yourself, they're less likely to kill you. Cristina helps April to get up and tells her to follow.

In the conference room, Alex rambles to Mark that you stop yourself from doing a lot in your life. He thinks he's dying and tells Mark to eat more bacon and have more sex. Mark says he will, but Alex should hang in there because Lexie's gonna be back any minute.

Lexie is wheeling a cart with supplies back to the conference room to help Alex as Gary appears at the other end of the hallway. Gary says he didn't mean to kill all these people. He only planned to kill her, Derek Shepherd, and Richard Webber. He partly blames her as she unplugged his wife. He aims and shoots, but misses because a SWAT team member shoots him at the same time. Lexie, who dropped to the floor, gets up and rushes away with the supplies while Gary is still down. 

Lexie makes it back to the conference room where Alex is barely hanging on. She begs Alex not to die. She blames herself for what's happening. She tells Alex she loves him.

Back in pediatrics, Callie Torres and Arizona Robbins are tending to Ruby, a young girl with a ruptured appendix. As Arizona administers drugs with a syringe, the girl squeezes Callie's hand. Callie looks at Arizona, but then gets a scared look on her face. Arizona turns around and sees Gary Clark standing in the doorway. Arizona says there are only children here and covers Ruby with her body as she keeps repeating it. Gary says they shot him. Callie gives Gary bandages. She tells them to press them to wound, which will stop the bleeding. She hands them over. Gary thanks her and walks off. Callie closes the door. Ruby starts crying. She wants her mommy. Callie says that until then, she has the best doctor with her. Arizona is the best doctor in the world. She can make people feel better with her super magic smile. Arizona is touched by Callie's word. Callie says she's got to call the police to inform them. Arizona says she's good now.

Outside, the officer asks Richard if the name Gary Clark rings any bells. Richard remembers the case and asks why.

April, Cristina, and Meredith have put Derek on the OR table. April and Cristina leave to go find Teddy. Derek asks Meredith to kiss him, which she does. He says he won't die. Meredith says that's good, because that would be the worst breakup ever.

Bailey's packing of Charles Percy's gunshot wound isn't holding. She has limited supplies and she knows she needs to get him to an OR. It's his last chance of survival. Mary wonders how they're going to do that. Bailey comes up with a plan, using the sheet.

April and Cristina are on the OR floor, inching their way to the OR where they believe Teddy is. April believes Gary is on the floor and panics, but Cristina says that she is in charge while everyone else is a mess, and she's sure that Gary is not on this floor. At that moment, a door opens and they duck. It's Jackson, who tells them they're not supposed to be walking around. He informs them that Owen and Teddy left this floor. Cristina informs him that Derek needs surgery right away, but there's no attending on the floor. Jackson looks decisive and tells April to go tell the OR nurses in the OR behind him to set up for a cardiac procedure. Jackson looks at Cristina and says that they have a surgeon. Cristina affirms that she is going to operate.

Meredith enters the scrub room and asks Cristina if she can do this. Cristina says she's very good for a resident, but every GSW is different, so it's half instinct, half improv. Cristina says she can't operate while Meredith is in there, so she orders Meredith to stay in the scrub room. She orders April, who came in to tell her the OR is ready, to stay with Meredith and stop her if she does anything else than sitting on the floor. Cristina promises Meredith to do her very best work. Meredith sits down as Cristina starts scrubbing in.

Back in the conference room, Alex is continuously calling out for his ex-wife, Izzie Stevens. He says he's sorry and asks her not to go. Lexie tries to keep him calm and reassure him she's not going anywhere. Alex is happy to see she came back for him. He asks her not to leave him ever again. A member of the SWAT team then comes in and evacuates them.

Back outside, Richard is still demanding details from the police. The police officer says that clearing out the floors one by one with one SWAT team is how it works. The officer tells a colleague to get a DMV photo of Gary Clark and have Webber confirm. He also orders her to shut down the elevators to isolate him. When he turns around, Richard has disappeared.

Teddy and Owen arrive outside with their patient, who's taken to the paramedics as the police start a body search on them. This is a secure area, so they're going to move them to holding. Owen asks if they’ve gotten the shooter or gotten the doctors out yet. The officer says no. Teddy sees Owen is worried over Cristina, who's still in there, and says it's okay to choose. She body blocks the officer as Owen runs back inside.

Richard is walking down the tunnels.

Meredith tells April to stop crying. It took her a long time to find Derek and then it took her even longer to know that she wanted to have a life with him, and now that she realizes that, he's about to die. April doesn't get to cry about that. April confesses that found her best friend Reed Adamson dead today. They hold hands.

Back outside, Mark and Lexie have been evacuated and load Alex onto an ambulance for transport to Seattle Pres. Lexie asks if Teddy if he's going to be okay. Teddy doesn't reply and gets on the ambulance.

Cristina is operating with Jackson's assistance. She locates the bullet right next the aorta, which requires the most complicated procedures. There are two options and she doesn't know what Teddy would do. She asks herself pig or cow. She then decides for one option and regains some confidence as she proceeds. Jackson calls her badass.

Bailey and Mary are dragging Charles towards the elevator to get him to an OR. They arrive at the elevator, but Bailey figures out they aren't working as there is no humming after she pushes the buttons. Bailey completely breaks down and yells to turn them back on. Mary manages to calm her down as the shooter is still walking around. With Charles watching Bailey, Mary asks what they're going to do. Bailey distances herself and starts crying inaudibly. She gathers herself and returns. She sits down and lays Charles' head on her lap. He takes off the oxygen mask and asks if he's dying now. She says yes. She starts crying again and says that she and Mary are going to be with him the whole time. He won't die alone.

Owen enters the scrub room and Meredith informs him of the situation. She thinks Cristina might need help. Owen tells her to stay put and says he'll go see if she needs help. He'll first go assess and come back to scrub in if Cristina needs him. He tells Meredith to stay down and enters the OR as April tells Meredith that it's good that a real surgeon is here now.

As Owen enters the OR, Gary stops aiming at Cristina and points the gun at him. Cristina is crying and Gary points the gun back at her, telling her to stop fixing Derek. She can't do that. Owen steps closer, distracting Gary, while Jackson, Cristina, and BokHee proceed. Gary tells Owen to keep back as Cristina says she can't stop. Owen tells Gary that if he so much as touches Cristina, he'll kill him.

Gary says that Derek is the only person in this room he wants dead to get an eye for an eye, but if Owen interferes, he'll first shoot him, then Cristina, and then Derek. Gary points his gun at Cristina again as Meredith enters the OR, telling Gary to shoot her. She's his way to get justice. Lexie, who pulled the plug, is her sister. Richard, his wife's doctor, is the closest thing she has to a father. Derek is her husband, so if he wants to hurt all of them the way that he got hurt, he has to shoot her. Gary points his gun at her. Meredith tells Cristina to tell Derek that she loves him and that she's sorry, but Cristina reveals that Meredith is pregnant. She wonders if he'd shoot a pregnant woman. Owen then tries to jump Gary, but Gary shoots him and he falls to the floor. Jackson tells Cristina to trust him and tells her to raise her hands, convinced Gary is gonna shoot again if they don't stop operating. Jackson tells Gary that in a few moments, Derek's heart will stop. After a few moments, the monitor flatlines. Meredith starts sobbing hysterically. Gary lowers his gun as Cristina says it's over. Meredith falls to the floor and Gary leaves. Jackson then reconnects the monitor and they continue the surgery. Cristina asks Meredith if Owen's dead. Meredith crawls towards him and says no. Cristina orders her to take him and April across the hallway to the other OR and remove the bullet. Cristina then tells Jackson to remind her to thank him later.

Charles says he doesn't hurt anymore. That's a bad sign. Charles asks Bailey to find Reed when this over, because he doesn't think she knows that he's always had a crush on her. Mary says girls always know, but Charles wants them to tell her anyway. He wants them to tell her that he died brave. Bailey says he is brave, she was a coward by lying about being a doctor. Charles says that was smart. He wishes he was that smart. Bailey assures him she won't forget. Charles knows that Bailey didn't like him, but she was always his favorite doctor. He then succumbs to his injuries.

April and Meredith are having difficulties to keep Owen on the table. Meredith says it's a through and through in his shoulder, so he's going to be fine. As they plan a course of treatment, Meredith suddenly experiences pain. She claims she's fine, but April wants to check her out because she thinks Meredith may have gotten shot as well. Meredith repeats she's fine, but April says there's blood spreading down her thighs. Meredith says she's having a miscarriage. She then lists what they need.

Richard enters the ICU and sees a dead doctor on the floor. He finds Gary sitting by himself in an empty room. Gary says he's been looking for him. Richard tells him the same. Gary says that five days ago, he bought the gun at a super store. He bought a whole bunch of ammunition because it was on sale. Then this morning, he didn't have enough room in his pockets because he wanted to bring his flask. On Gary's request, Richard opens it for him while Gary still points the gun at him. Gary drinks and says he's not much of a drinker, but he figured he'd need some courage. He offers Richard to drink, but Richard declines. Gary starts laughing and says he didn't need a drink until now. The only reason he needs a drink is because he only has one bullet left. Gary says he was going to shoot Richard and watch him suffer and die. Then he was going to shoot himself, but now he only has one bullet left. Richard says he has a problem then. Gary says he does. Gary offers him a drink again. Richard sniffs. He recognizes it as vodka and pours it onto the floor. Richard asks him what's it gonna be. If Gary decides to shoot him, the SWAT's gonna get him. They're not going to shoot him. They're going to capture him, and take him to prison. If Gary shoots himself, he's done and he might get to see his wife again. He has to choose between a life in prison or an afterlife with his wife. Richard says he's really lived. He's been to hell and back and he's also known joy, and passion. He's had a great love. For him, death is not justice. It's the end of a beautiful journey. He's not afraid to die. He sits down in front of Gary and says the question is if Gary is afraid to die. Richard repeats the choice.

The SWAT team enters the ICU. They hear a gunshot coming from the room where Richard and Gary are.

Cristina is about to finish the surgery. Meredith is holding Derek's head as a complication arises.

At Seattle Pres, Mark and Lexie arrive in the ICU. Teddy has finished the surgery and Alex is still alive. Lexie goes into his room and starts stroking his cheek.

Cristina defibrillates Derek's heart.

Mary leaves the hospital and finds her husband Bill. They hug each other and she assures him she's okay. Bailey watches them as a police officer comes over to ask which doctor she was looking for again.

Cristina shocks Derek's heart again.

Arizona and Callie watch the ambulance with Ruby take off. Arizona goes to see if there are kids who need help finding their parents, but Callie stops her. People died today and she doesn't want kids if it means she can't be with Arizona. Arizona says no and says they'll have kids. Callie will be an amazing mom and Arizona loves her so much. She can't live without her or their ten kids. They share a passionate kiss.

Derek's heartbeat returns to the normal sinus rhythm. Cristina exhales deeply as her colleagues are relieved as well.

Richard shakes hands with Marty on the bridge, where someone's taking photos of the blood stains.

In the resident's locker room, Meredith finds her pregnancy test in her locker. Cristina appears in the doorway and says Derek's asking for her. Meredith throws the pregnancy test into the trash can and follows Cristina outside.


Main Cast[]

Guest Stars[]


Medical Notes[]

Derek Shepherd[]

  • Diagnosis:
    • Gunshot wound
    • Hematoma
  • Treatment:
    • Surgery
    • Pericardial repair

Derek had been shot in the chest by Gary Clark. He was conscious after being shot despite his blood loss. Cristina, Meredith, and April were able to get him to an OR, but Teddy had left, so Cristina operated on him herself. The bullet was lodged by his aorta and he had a huge hematoma. She was still working on him when Gary Clark returned to kill him. With Jackson's help, she convinced Gary that he was dead, so he left and she was able to continue the surgery. After she was done, he was stable and awake.


  • Diagnosis:
    • Hypothermia
  • Treatment:
    • ICU care

Pete was being transported to the ICU, but when they determined they couldn't get there safely, Owen called out and arranged to have Pete taken out to be taken out of the hospital so he could be taken to another hospital.

Alex Karev[]

  • Diagnosis:
    • Gunshot wound
  • Treatment:
    • Blood transfusion
    • Lactated ringers
    • Surgery

Alex continued to lose blood and Mark did his best to treat him while they waited for Lexie to bring blood from the blood bank. He lost consciousness, but Lexie returned with the blood. They transfused him and then he was evacuated to another hospital, where Teddy operated on him. He was stable after his surgery.

Gary Clark[]

  • Diagnosis:
    • Gunshot wound
  • Treatment:
    • Bandaging

Gary was shot by the SWAT team in an attempt to stop him. He went up to peds, where Callie gave him bandages and told him to leave. He later shot himself to death.

Ruby Kendall[]

  • Diagnosis:
    • Appendicitis
    • Ruptured appendix
  • Treatment:
    • Epidural
    • Appendectomy

Ruby's appendix had burst and they weren't able to get her to an OR, so they gave her an epidural and operated to remove her appendix. Her surgery was successful and she was later taken to another hospital to continue recovering.

Charles Percy[]

  • Diagnosis:
    • Gunshot wound
  • Treatment:
    • Bandages
    • Supplemental oxygen

Charles started to bleed through his packing, so Bailey, with Mary's help, started to try to move him to an OR. She managed to get him to an elevator, but the elevators had been turned off in an attempt to isolate Gary Clark. Bailey continued her care, but eventually had to tell Charles that he was going to die. She and Mary sat with him as he took his last breaths.

Owen Hunt[]

  • Diagnosis:
    • Gunshot wound
  • Treatment:
    • Antibiotics
    • Irrigation

Owen was shot in the shoulder by Gary Clark. Meredith took him into an OR, where they irrigated the wound, which was a through and through.

Meredith Grey[]

  • Diagnosis:
    • Pregnancy
    • Miscarriage
  • Doctors:
  • Treatment:

Meredith had a miscarriage while working on Owen after he was shot.


Song Performer Scene
"In My Veins" Andrew Belle
  • Bailey breaks down after realizes the elevators have been turned off.
  • She admits to Charles that he's going to die.
"Unarmed" Mariah McManus
  • Cristina and Jackson operate on Derek.
  • Charles asks Bailey to tell Reed that he loved her, and then dies.
  • Meredith has a miscarriage as she works on Owen's shoulder with April.
"The Way It Ends" Landon Pigg
  • Richard asks Gary to make a choice.
  • Derek goes into V-fib.
  • Lexie gets to see Alex in post-op.
  • Mary finds her husband Bill outside the hospital.
  • Arizona agrees to have kids with Callie.
  • Derek stabilizes.

Notes and Trivia[]


Grey's Anatomy 6x23 6x24

  • This episode's title originated from the song Death and All His Friends, originally sung by Coldplay.
  • This episode scored 16.13 million viewers.

    Grey's Anatomy - SEASON FINALE - 6x23

  • The season six DVD boxset includes an extended cut of this episode which is an hour long. It features 18 minutes of extra scenes, including Callie singing to Ruby, Ruby being put in an ambulance with her parents, and Lexie getting thrown out of the ambulance and Mark staying with her.
  • The gun held by Gary Clark was a real gun, only modified to be safer.
  • Sarah Drew revealed on Twitter that this episode, along with Sanctuary, was her favorite season 6 episode to film.
  • Shonda Rhimes revealed in a blog post that she considered Jackson and April to be part of the tribe from this episode on.
  • Teddy Altman is the only surgeon who has not seen the shooter.


Episode Stills[]

Behind the Scenes[]


April: (when Mr. Clark is pointing the gun at her) My name is April Kepner. I'm 28 years old, and I was born on April 23rd in, in Ohio. I'm from C-Columbus. Columbus, Ohio. Um, my mom, my mom is a teacher, and m-my dad is a farmer. Corn. C-corn. He, he, he grows corn. Their, their names are Karen and Joe. (crying harder) I have three sisters! Libby's the oldest. I, I'm next, and then there's K-Kimmie and Alice. I, I, I haven't done anything yet. I haven't...I've barely lived! I, I'm not finished yet. No one's loved me yet. Please. Please. I'm someone's child! I'm a person! I'm a person!
Gary Clark: Run.
(April runs away)

Charles: (to Dr. Bailey before he dies) You were always my favorite doctor. I thought you should know.

Meredith: Hold on, okay? Hold on. I love you. Please don't die.
Derek: Get out of here, Meredith, before he shoots you, too.
Meredith: Don't die. Do you understand? I can't live without you. If you die, I die.
Cristina: I called the police.
Meredith: Okay, good, the police are coming. They're coming.
Cristina: Mer, Mer. They're not gonna get here. They're not coming for us. Not in time. Oh, God, Mer.
Meredith: I picked you. I choose you. You don't die on me!

Alex: You gotta eat more bacon, have more sex.

Lexie: (trembling) Oh, Mr. Clark...
Gary Clark: I didn't plan to shoot all those people.
Lexie: Of course, you didn't.... No, you were sad, you were... You were grieving.
Gary Clark: I only planned to shoot Dr. Shepherd. And Dr. Webber. ... And you. (points gun at her) You unplugged the machines. Your hands killed my Alison.

Ruby: (crying) I want my mommy!
Callie: All right, okay. I know. I know you do and she's gonna be back soon, but you know what, until she gets here, you have the best doctor in the whole world with you right now. (Ruby stops crying, Callie looks at Arizona who is still shaken and crying from seeing Mr. Clark.) Yeah. Dr. Robbins is the best doctor in this entire hospital. I think in the whole world. Yeah, people, feel so much better after she helps them, sometimes people feel better just after she walks in the room. 'Cause she has got this super magic smile. (Callie looks at Arizona.) Yeah, and when she smiles at you, (Arizona finally looks at Callie.) everything gets better. You don't know it 'cause you have your back to her right now, but she is giving you... Wow, she is giving you her best super magic smile. (Callie smiles.) Isn't that right, Dr. Robbins?
Arizona: Right. I am. I am.
Callie: I gotta call the police and tell them what happened, okay?
Arizona: I... I'm good. (Callie puts her hand on her cheek) I'm good.

Jackson: (to Cristina after seeing her bloody scrubs) Is that your blood? Are you okay?
Cristina: No. No... I'm fine. I'll go get Altman.
Jackson: Altman's not down here.
Cristina: Go get Hunt then.
Jackson: They left.
Cristina: What, they left?! Okay, you know what? Someone just shot Derek. He's got a GSW to the chest and he needs surgery right now. Tell me there is an attending on this floor.
Jackson: April, in the OR behind, there are two OR nurses and an anesthesiologist. Get them. Tell them to set up for a cardiac procedure
April: What? What, why? If we don't have a surgeon, what are we going to do?
Jackson: (looking at Cristina) We have a surgeon.
April: W..What? Who's going to operate on Dr. Shepherd?
Cristina: I am.

Cristina: (while operating on Derek, trying to find the bullet) It's right by the aorta.
Jackson: You can do this.
Cristina: I know that! I just wanted it to be easy. Not the hardest freakin' repair in the history of the world.

Gary Clark: (while Cristina is operating on Derek) You stop or I will shoot you. (pointing a gun at Cristina's head)
Owen: Hey! Hey! That is the woman I love. If you shoot her, touch her, I will kill you!
Gary Clark: (turns the gun on Owen) And I said stay back. Maybe I'll shoot you first. I shoot you then I shoot her and I shoot Shepherd. Is that what you want? (Owen shakes his head) I didn't come here for this. My wife is dead. He's responsible. I came here for justice, an eye for an eye. The only person I want in this room is Shepherd. Now back off! You step away from that table. (turns his gun back to Cristina)
Cristina: (crying) Please.
Meredith: (walks in) Shoot me.
Cristina: Meredith.
Meredith: You want justice, right? Your wife died. I know what happened. Derek told me the story. Lexie Grey is the one who pulled the plug on your wife. She's my sister. Dr. Webber, he was your wife's doctor. I'm the closest thing he has to a daughter. And the man on the table, I'm his wife. If you want to hurt them the way that you hurt, shoot me. I'm your eye for an eye.
Cristina: Meredith.
(Mr. Clark points the gun at Meredith and walks toward her.)
Meredith: Tell Derek that I love him and that I'm sorry.
Cristina: Meredith... Wait, wait, wait, wait. She's pregnant. You wouldn't shoot a woman who's pregnant? Please.
(Owen tries to tackle Mr. Clark; Mr. Clark shoots Owen)

Jackson: Raise your hands. Trust me, raise you hands. He's going to shoot again, raise your hands!
Cristina: I'm stopping, I'm stopping!
Meredith: No!
Cristina: See? See? I've stopped.
Jackson: Listen to me. In a few seconds his heart is gonna pump all the blood into his chest and stop beating. You'll see it on the monitor, just wait. Wait for it. Watch the monitor and wait for it.
Meredith: (sobbing) Please, don't stop!
Jackson: (to Meredith) Shut up!
Meredith: (sobbing) No, no. (Derek flatlines) No, Derek! No, no, no. (sobs harder)
Cristina: See? It's over. It's over. He's dead. (Meredith wails as Mr. Clark leaves the OR)

Cristina: Mer, is Owen dead? Dr. Grey, is Owen dead?
Meredith: (checks on Owen) He's, he's alive, he's unconscious but he's alive.
Cristina: Take Owen to the OR across the way and take that bullet out, and get April to help you.
Meredith: Cristina!
Cristina: I can't talk right now I'm trying to save your guy. Now please go try save mine. (Meredith leaves) Remind me to thank you later.
Jackson: I will.

Arizona: I'm gonna go see if kids need help finding their parents.
Callie: People died. People are dead. I, I don't want to have kids if it means I can't be with you.
Arizona: No. No. We'll have kids. We'll have all kinds of kids, and I always thought I wasn't cut out to be a mom, but you'll be a great mom. You'll be an amazing mom, and I love you so much, and I can't live without you and our ten kids...
(Callie interrupts her with a passionate kiss.)

See Also[]

A complete overview of this episode's crew can be found here.

The Grey Matter blog post on this episode can be found here.