Soft piano and a close-up shot of one of Mere's candles usher us into season 5, and she VO's, "We all remember the bedtime stories of our childhoods: the shoe fits Cinderella, the frog turns into a prince, Sleeping Beauty is awakened with a kiss. 'Once upon a time.' 'And then they lived happily ever after.' Fairy tales. The stuff of dreams. The problem is, fairy tales don't come true. It's the other stories. The ones that begin with dark and stormy nights that end in the unspeakable." As time passes, Mere stands alone in the house of candles and one by one they are blown out by the wind. "It's the nightmares that always seem to become reality."
Mere bursts into the ER where Cristina and the Chief have been watching worriedly through a window while the Long Beep of Death sounds. Mere demands to know what happened and Christina tells her that "he" tried to avoid an accident in front of him on the road but couldn't, and as Mere shrieks to know how he is, Cristina tells her she has to be strong. Mere runs to the window and begins screaming; behind the glass, a bloody Derek is lying on the table while Bailey and Sloane do their best to try and save him. Bailey heaves a sigh and we can read her lips as she gives the time of death. Meredith understandably freaks out, screaming his name and pounding on the window. However, this being the internet age where any big casting decision makes news -- and Patrick Dempsey leaving the show would certainly be big news -- it's not surprising that Meredith wakes up from a start from her nightmare and runs down the hallway back to work. Her VO concludes, "The person that invented the phrase 'happily ever after' should have his ass kicked so hard."
After a shot of the hospital from outside so that we can see it is snowing, Meredith runs up and joins the others gathered around Bailey at a computer. They're waiting for some sort of results and continue to pester her to "hit the refresh button." Mere and Der sweetly say hi to each other over Cristina's head while she rolls her eyes at them. They're guessing at what the results could show, and while we still don't know exactly what it is, they talk about Hopkins and Mayo both possibly ending up ranked ahead of them. Let's thank Hahn, who exposits that they're waiting to see where they rank as a teaching hospital, and they all assume they'll be somewhere in the top three. In one of the biggest nods to reality this show has ever made, it turns out that Seattle Grace is now ranked #12.