Over some tense guitar music, there's a montage of the ambulance crash and Meredith and Cristina's dancing while Mere revisits the theme she started last week: "At the end of the day, the experience of practicing medicine bears little resemblance to the dream." Alex is down to his tank top, making out with Ava. Because her priorities are clearly out of whack, she keeps stopping their making out to ask him if he's okay, and does not seem to be grasping the "even if I'm not, I don't want to talk about it with you" that he's conveying by brushing her off and kissing her again. Instead she reminds him about how intense and awful the day was, and asks, "How can you be okay after a day like that?" But he doesn't answer, so we're left to wonder just how awful it was as Meredith reminds us, "We go into medicine to save lives."

Cristina and Lexie are in an empty exam room, each wearing scrubs, and Cristina tells Lexie sincerely that she did a good job today. "What you did was not easy, it was brave." But it seems to not be comforting Lexie, who stares silently down at the bed as if she's numb.

Mere's voice continues, "We go into medicine because we want to do good." Mark is sitting silently, somewhat like Lexie, and as the camera pans, we see Callie sitting nearby on the couch, sighing, she takes off her scrub cap. They both illustrate everything but what Meredith mentions: "We go into medicine for the rush. For the high. For the ride." Mark starts rubbing his forehead as Meredith finishes, "But what we remember most days are the losses."

"What we lay awake at night replaying is the pain we caused." Izzie's lying on her bed, looking sad, and George leans over her, resting his chin on her arm, watching her.

"The ills we couldn't cure." And in a miraculous moment four seasons in the making, Meredith walks up to Derek and without a stutter or a flinch tells him, "I don't want you to date other people. It may not be enough for you, but I'm trying here." He turns around and regards her seriously as she lightens up a bit and adds, "I don't want you to date anybody but me!" He gives her a tiny half smile but he seems sad, and oh boy howdy will we see why later.

"The lives we ruined, or failed to save." The Chief is in the bay, looking stricken as the cleanup from the accident finishes up and a tow truck takes one of the mangled ambulances ("ambulance"?) away. "At the end of the day the reality is nothing like we hope. The reality is that the end of the day, more often than not, turned inside out and upside down." As the camera pans around the Chief, the scene changes back to one of disarray, right where we left off with Meredith inside trying to help Ray. She cuts his shirt off while, in his room inside, blood continues to squirt comically out of Nick's neck. The situation itself isn't funny at all, but the squirt-gun-like spurts of blood are just so ludicrous, even if in real life that's what would happen. Fortunately, I don't have any experience in such matters, so I stick by my "funny" opinion.