Someone is mopping up Nick's blood from the floor as Tyler wraps his body up in plastic. Lexie is sitting next to the bed, and asks if his parents are coming. Tyler tells her that they're on a plane, and asks if she's waiting. She says she is, and then stares morosely at the plastic.
Meredith rounds the corner and sees Derek at the nurses' station; after just a beat she walks right up to him and before he can turn around, she tells him that she doesn't want him to date other people, in the scene we saw at the beginning of the hour. Now we know why he looks a bit stricken. She adds that she's scared to want him, but she's here wanting him anyway, and she doesn't want to lose him, et cetera. He turns around and with a sad smile says her name, but she stops him. It seems like she knows he's about to stomp all over her emotional progress, and she tells him not to say anything; she'll leave, and he can say something tomorrow. She asks, "That's progress, right?" He smiles sadly as she turns and practically skips down the hall. That skip makes it seem like maybe she didn't actually guess that he's about to crush her, which will make it all the more wrenching when, yet again, any progress and growing on her part is squashed like a bug. Everyone on this show is allowed to change and grow but Meredith, it seems.
Now to Alex and Ava and the getting busy. She finally asks him, whining a bit, why he won't talk to her, and he angrily demands to know what he should talk about: a guy almost bleeding out on him, or his week's suspension? (I'm relieved we didn't have to see that scene, to be honest. We've seen enough reprimands for stupidity in the workplace already over the years.) He then delivers his biggest blow and calls her Rebecca. She protests that it's "Ava," but he angrily tells her that she's playing dress-up right now, and reminds her about her baby and her husband. He then adds classily about Lexie, "I'm screwing her," while pointing out that Lexie might be a wreck, but she's not married, won't get him suspended, and isn't trying to be someone she's not. Ava protests some more but he just interrupts to demand that she be honest about why she's there, because she'd probably see that it wasn't to talk. She's got tears in her eyes, but apparently he likes tears and whining and she likes cruel anger, because they start to go at it.