As the doctors are all waiting around in the ER, reality seems to have set it for everyone but April, who is still thinking of things she can prepare for the potential onslaught of patients. Mark is the one to finally say out loud that if no one has been brought in thus far, it means no one survived the crash. It looks like April is the only one who hadn't realized this already, and she's crushed.
We managed to have so much of this season be blissfully free of Derek's self-righteousness, but he's got his holier-than-thou pants hiked up and secured tight with his superiority belt; he demands to know what Richard is going to do about it the situation. When Richard sighs and admits he doesn't know, Derek sneers that the protocol for this is clear. Mere asks, aghast, if Derek is actually encouraging Richard to fire her. I guess these two should really have just stuck with the post-it considering how things are going now that they have actual legal marriage paperwork. Richard admits his own role in the whole mess and says that he basically pressured Mere into doing what she did, so they'd have to both be fired. It's not the answer Derek wanted, so he storms out in a huff. Richard tells Meredith that he has to suspend her so that it doesn't look so bad, and then sighs that he'll hand the whole thing over to the FDA to figure out. There's a knock at the door and Owen nods, which sends a silent message that seems to say that everyone is dead and Richard is needed for the next phase of notifying everyone. But before Richard leaves the room, he says to Meredith with a voice a bit husky with emotion, "I don't know how to..." Mere doesn't make him finish the sentence but just tells him that she knows. Despite all the crap that has just hit the fan, she still seems totally at peace with what she did.