Across the ER, where no one seems terribly concerned about the van resting inside their workplace, Janell isn't responding to the seizure medication. Derek explains to Randy that he wants to put her in a medically induced coma, which freaks him out, especially as she just turned 32, and the two of them hadn't ever discussed any medical decisions. Once Derek and Mere explain just how bad her situation is he agrees to it, and Derek calls to a nurse to get some Propofol or, as I will now always think of it, Michael Jackson's sleeping potion.
A tow truck pulls the van out of the ER and we see all of the bouquets left in its wake. April starts to pick them up but Owen angrily yells at her to throw them out and get back to work. Man, I'm tired of bitter, angry, martyr Owen. He made his bed, or he at least saw what the bed looked like before he decided to climb in. This Owen is no fun to watch in any way.
Richard and Lexie, waiting for an ambulance, see this exchange and when Owen is out of earshot, Richard acts horrified as he asks April if she's really going to throw those all out. He then tells her conspiratorially that Owen doesn't have to know, and April grins as she sprints off with some saved flowers. Richard then turns to Lexie and comments at how everyone is a cynic. On the one hand... yes. On the other hand, in this particular scenario he was at the worst first birthday party on earth and heard the outburst from Owen, so he shouldn't bother acting surprised that the guy isn't into this day of loooove. He tells Lexie that he takes this holiday seriously which is of course due to the fact that it is also his wedding anniversary. He's looking forward to leaving work early and spending the rest of the day with Adele. He asks Lexie if she's going to be hitting the town and before she can stop herself, she answers, "I'm not hitting much of anything these days." She's horrified as soon as it passes her lips but I think it takes a lot more than that to shock Richard after so many decades in this place. She apologizes profusely and then is saved by the arrival of an ambulance.
They can hear yelling coming from inside before the doors are even open, and then the paramedics wheel out a guy, Charlie, who ran directly into traffic and consequently has a whole laundry list of awful things wrong with him. His girlfriend is screaming like a banshee in his face and the gist of it is that he served her breakfast in bed but then gave her a cheap necklace when she was expecting a diamond ring and a proposal. She ran out of the house, he ran after her, and ran directly into a car. His would-be fiancée Sharon is so livid she's practically having a psychotic break and screeches that they are over.