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As the fourth season finale gets underway, Meredith Grey works with Dr. Wyatt to understand what her mother was trying to tell her when she attempted suicide so many years ago.
Dr. Wyatt refuses to give Meredith the answers, saying that she is a very talented woman who needs to figure them out for herself.
Meredith is angry. At herself, Ellis, Richard, you name it.
She must put her feelings aside, however, to work with Derek on their final two patients for their clinical trial - Beth and Jeremy, two teenagers with brain tumors, and who have already met and fell in love in a support group!
They are very sweet, and it is all the more tragic as everyone from their group has died except for them. Beth's parents, while nice people who are looking out for their daughter, are against the relationship. Derek and Meredith work secretly to let the pair see each other - even helping the pair have sex for the first time before their risky surgeries!
After going 0-11, the company in charge of the clinical trial wants to pull Derek and Meredith's grant at midnight unless they can boast a successful patient. So they have time for one more, but Meredith works it so the two teens can both undergo it. Unfortunately, Jeremy's surgery is first and, unfortunately, he doesn't make it out alive. Beth is devastated.
While this is going on, the rest of the doctors are working together when a boy, 19, was rushed in after becoming stuck in hardening cement. He laid in the cement to impress a girl he liked after being dared by schoolmates.
The kids who put him up to it didn't seem to care, but Callie suspects the girl involved cares more than she lets on. After Meredith gives Cristina sparkle pager to recapture her mojo, Yang is on the case with Dr. Bailey, Richard, Mark, Callie, and Erica - who continues to the be the object of sexual tension for both Callie and Mark.
It's a long ordeal, but Bailey and Cristina, in particular, help the boy survive. Yang stands up to Hahn and Richard backs her up, telling Erica later that she's not being a good enough teacher to her residents.
Alex is struggling to take care of Rebecca, who's unable to bathe or feed herself. In the kitchen, while making lunch, she grabs a knife and slits her wrists while he's on the phone with a concerned Izzie.
At Seattle Grace, Izzie - technically Ava's doctor as she admitted her - steps in and says that she will call the police if he tries to take her home, which he insists on doing. In a shocking confrontation, Alex calls Izzie a "stupid bitch" and tells her to stay out of his life.
George, the Chief's intern, lets Lexie know he could go into the chief's office anytime he wants, but doesn't have any real power. So she takes it upon herself to sneak in there and read through everyone's files!
Lexie learns that George failed his intern test by a single point. One! She relays this to him, along with info on all the other residents, but he is upset. George confronts Richard, asking for a second chance, and the Chief agrees, allowing O'Malley to take the test again.
Beth insists on going through with the surgery anyway despite the failure earlier in the day on her best friend and lover. They go through it and Meredith and Derek's final clinical trial is a success! She comes out of surgery pretty sedated, but her tumor is shrinking! Woo hoo!
Alex admits to Izzie - who stood up for herself and got Rebecca into the psychiatric care division at the hospital despite Alex's protests - that she did the right thing, even if he doesn't say so verbatim.
He tells Izzie that his mom suffered from mental illness and he had to take care of her. Alex says he wants Rebecca to get the help she needs and then totally breaks down, crying to Izzie in his time of need, kissing her and begging her to stay with him for one night.
Mark, turning over his new leaf, continues trying to help Callie find who she is, even though he's enjoyed hitting that. He knows she is consumed with thoughts of Erica, and doesn't want to stand in the way.
After their long day, Callie finally goes up and plants a kiss on Erica, at Mark's urging - and not in a dirty kind of Mark urging. Awesome scene.
Ecstatic that he's getting another shot, George runs in to their apartment, grabs Lexie and plants a kiss on her - one we get an impression means way more to Lexie than George as she's developing feelings for him.
Richard goes home to Adele and asks her to allow him to move back. She says it's about time and they embrace.
Derek returns to the land to find Meredith on the property, having laid out the plans for the house he wants to build in candles.
They share an unforgettable kiss but he stops, saying he must go end things with Rose to clear his conscience before he can come to her - and do A LOT MORE than just kiss her. Wow. He asks her to wait for him.
With that, he walks off, as Meredith stands in the house of candles, awash in light, hopefully having become the person she always wanted to be.
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