Mere finds Richard who explains, somewhat sadly, that he got a call from the board that oversees clinical trials. Since she and Derek have had eleven deaths and no successes, they're allowing one more patient. They have until midnight that night, and if this patient (Jeremy) dies then the trial will be shut down. He asserts, "One last patient."
Cut to Dr. Amy telling Meredith that Richard is who she's mad at, but Meredith doesn't understand why. Dr. Amy somewhat desperately reminds her that she's ripped the wound that is her past right open again, and she's mad with Richard, her mom, and herself, but Meredith insists that she understands that Richard went back to his wife and her mom didn't want to live. They each did what they had to do. And when Dr. Amy suggests that she thinks Ellis didn't want to kill herself, Meredith insists she did and they each wonder why the other is so sure. Dr. Amy only tells her to think about it, since the answer is right in front of her.
Derek is quick to jump to the conclusion that he's a failure, and Mere has to be the cheerleader. She convinces him that they could move up Jeremy's surgery and fit in Beth afterwards to do them both before midnight. They're really close to what they feel is the right cocktail with the virus and maybe they could beat the deadline! Rah rah rah! He's sort of on board but then remembers that these are actual people's lives they're dealing with, and stops to ask if his ego is too big. She assures him it's just right, and after he thinks a moment and notes that this bends the rules without breaking them, decides he's in if Meredith will clear it with Richard.