Inside the ambulance, they all look nervous. Bailey instructs them to put their ID on the outside of their jackets and reviews triage once again -- each patient is tagged with either green, yellow, or red. It's pretty self-explanatory, the reds need help immediately, and the greens can wait. They need to assess and move on, get critical patients to ambulances, and stay out of the way of Search and Rescue. They still don't know what kind of scene is awaiting them...
... which makes it all the more dramatic when they get out at the accident scene. They all stare, kind of stunned and trying to process what they're seeing, Izzie offering, "Holy mother of... " There are helicopters, paramedics, and then we see a giant CGI ferry crushed on one end. There's lots of smoke and fire and chaos. We're treated to a lot of admiring crisis shots, and then a long individual shot of each intern, mouths gaping at the damage.
After a commercial break, there's the same admiring shot of the ferry. They're really working to get their money's worth on this establishing scene. Izzie asks Bailey where she needs them, and once they pull her out of her own shock, she tells them she can't hold their hands, and to just go find where they could be needed. Music plays as they all scatter and get lost in the crowd. Each runs to a different patient, and George asks a fireman/cop/important guy what happened. He explains, "There was a fog bank. Container ship clipped the ferry." As if to illustrate just how horribly serious this is, he looks to the side and sees sheets covering bodies on the ground.
Meredith is helping a woman when she hears crying, and she identifies it as coming from a young blonde girl in pigtails. She determines that she must be lost, but she only gathers this from head nods and blank stares, as the girl absolutely won't speak. She's wet her pants from fear and eventually grabs Meredith and hugs her. Meredith assures her it will be okay, even though she seems somewhat lost herself, and takes the girl by the hand. With the long blonde hair and the silence, she's a little Mini-Meredith.
Derek is back at the hospital, puzzling about how his beloved, trusty ferryboats could possibly get in an accident. "It doesn't make sense. Ferryboats don't get in accidents; they're safe. They're reliable. The moment you take one for granted, along comes a container ship, and boom." And yet, while he totally knows that he loves ferryboats because he loves Meredith, I feel like even he doesn't see that this might be a sign of a container ship in his own future. Burke just stares at him, so as a reminder, Derek adds. "I have a thing for ferryboats." He starts to walk away as Burke explains that he's postponing a valve replacement so the OR is available for victims. On first viewing, I thought he was talking about Ellis' surgery, but it's another one. However, I can only assume that hers will be postponed as well. Derek comes back to the desk and finally opens up without hiding behind the ferryboat metaphor, saying that something is wrong but that Meredith won't say what it is, and then caps that off by trying to drown herself in the tub. "It's like living with a ghost." Burke just looks confused as he observes that Derek is confiding in him, which Derek confirms. That's it, Burke goes for the gold and tells him he's engaged, and Derek very sincerely congratulates him. Burke explains that he wasn't supposed to say anything until Cristina told Meredith, and Derek just responds, as if teaching young grasshopper a lesson: "They're different than other women." Burke agrees, and Derek observes that they might never know them, but now Burke has some work to do since they're engaged. And of course, Mark waltzes up at that very moment and hears the news. He offers a very loud congratulations, but Burke decides to pretend it didn't happen and says the mass casualties will be pulling in soon. Derek adds to be prepared for burn victims. Burke... you're dead. Why does no one on television ever realize that telling one person means you actually tell everyone, to generally comic results, a fight, and then a sincere and touching make-up scene?