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Picking up where "Sanctuary" left off, Meredith tells Derek to stay awake as she tries to stop the bleeding. Lexie runs into Clark, but a sniper shoots him before he can shoot her.
She later tells Karev that she loves him and they have a delirious exchange - he thinks she's Izzie - as Sloan looks on in disbelief.
Mr. Clark, bleeding, comes across Torres as she works with a child. She gives him bandages and he goes away.
Cristina, who is only a resident, decides to do the surgery on Derek herself. She bars Meredith from the operating room.
Richard slips into the hospital. Owen goes back in to find Cristina. Bailey freaks out when the elevators don’t work.
Owen tells Meredith to stay down as he goes into the O.R. The shooter is in the O.R. with Cristina! Owen tries to diffuse it.
The shooter wants Cristina to stop her surgery and let Derek die.
Meredith tells the shooter to shoot her. Instead he shoots Owen. The doctors let Derek’s vitals seemingly slip away - and the shooter leaves. But the machine’s wires have been pulled.
Owen is fine, the bullet went through his shoulder. But Meredith, of course, is having a miscarriage. Such a sad moment.
Richard confronts Mr. Clark, who has just one bullet left. He tells him to make a choice about his life and the afterlife.
The SWAT team closes in. The shooter kills himself. Richard is seen shaking hands afterward, having saved the day.
Back in the O.R., Derek’s heart is beating again. He asks to see Meredith. She throws away the pregnancy test.