She follows him up the stairs and the camera pans directly over all the baby gear just in case we forgot that they are Sad and Empty people without their daughter there. He tries to throw in her face that she once again didn't listen to him in the OR (unsaid: when he was certain he knew best) (but I was certain that he just wanted to disagree with her for the sake of it) but she argues that she didn't listen to him because she knew what she was doing and that it was right. She has a point there. Look, her decision making has been totally awful and nearly inexcusable but she did have a reason for doing all of these stupid things, which is Love. (Awwwwwwwwww.) [Insert Peter Cetera song here.] I don't expect everyone to just let her off the hook but I do wish that people would at least think about how complicated some of these situations were for her. And wow, I just spent a lot of page space defending Meredith. I don't think I'm ever going to get over how weird that feels. She tells Derek she has to trust him and he blows up that she set back his and Richard's careers, so he has no reason to trust her. Finally, she asks the million-dollar question: If he can't trust her, why on earth is he with her? He angrily points to their framed Post-It and screams at her that he meant what he wrote there. He promised to love her and that includes even times that he hates her too. He says that he is trying, but she makes it so hard. She refrains from telling him, "Likewise, buddy."
She understands but tells him she doesn't want him to keep his promise if he doesn't want to and if he can't trust her with Zola. He snaps back that that isn't what he said. He tells her that he knows she did all these crazy things to protect the ones she loved, and reminds her that she offered to take a bullet for him, which is exactly what he both loves and hates about her. He lies down on the bed and throws his hand over his eyes as if he has the weight of the world on his shoulders and no one has known this stress ever, before, to the level that Derek Shepherd is experiencing it now. Meredith finally realizes what he's driving at, which is that he can't trust her at work. She points out that there is an easy solution to this -- she is now off his service. She gets a consequence (which is actually a rather real one since she wants to be a neurosurgeon and we're reminded every week that he is the very best) and they have a fighting chance to make their personal life work and to get Zola back. She VO's something about stepping up and becoming a leader, which feels to me a little farfetched as a comparison. She kind of stepped up but I wouldn't call her a leader.