And then we catch up to the scene from earlier, where he runs into Callie's OR to tell her that Arizona has septic shock and is crashing. Callie's eyes turn to saucers and she asks him everything he did. She's so panicked that she starts suggesting the same fixes over and over, and it doesn't matter anyway because Alex has tried everything and he finally bluntly tells Callie that she's dying. This snaps Callie back into some clarity and she immediately says that it's the leg. Alex agrees. She closes her eyes, takes some deep breaths, the music swells, and then she tells Alex to cut it off.
So now the puzzle is coming together. Before he runs out the door Callie begs Alex to do a good job, and then he leaves. Meredith runs in and asks Callie if she needs anything and what she can do to help. Callie tells her she is fine; when she looks up the two share a long look and Callie repeats that she's truly fine and seems to mean it, at least with respect to being able to complete the surgery. Mere responds calmly that she knows, and then leaves so that they can get back to work. Callie takes a moment to gather herself, and then gets back to the delicate surgery.
Meanwhile, Richard is handling the sad task of helping Mark put together his advance medical directives. Mark realizes that this is likely the end and as Richard goes through everything, Mark doesn't take his eyes off of him, almost as if looking at Richard is giving Mark the strength to get through this last task. When Richard gets to the last section regarding withdrawal of care, Mark doesn't hesitate to say 30 days is the limit for his being kept on life support with no signs of recovery. He's so weak it's a struggle to keep his grip on the pen but he signs his name with purpose as Richard looks on with tears in his eyes.
As Mere watches Derek's surgery from the gallery she pulls out her phone and gives Cristina a call. She gets her voicemail and leaves her a long message which turns into this week's ending voiceover. I have to laugh at the tone of her voice when she starts by saying in a defensive drone that she hasn't called because Cristina hasn't called either -- I have a terrible habit of sounding exactly the same when I don't want to apologize but know I should. She tells Cristina that she was right about everything.
Richard is still sitting with Mark when his breathing becomes even more labored and then after one last heaving breath, his stats drop and his eyes close. Richard jumps up as the alarms ring and calls for a crash cart.