9:01 pm EDT, April 23, 2015

‘Grey’s Anatomy’ season 11, episode 21 recap: Everything ends

Are you breathing? Do you need someone to talk to? Tonight’s Grey’s Anatomy season 11, episode 21 sent all fans lunging for the tissues!

The notes of “How to Save a Life” are enough to send a Grey’s Anatomy fans into an emotional state. It is no wonder that tonight’s episode by the same title left viewers with a deep emotional wound.

If you were one of the lucky fans who did not catch the news that leaked 15 minutes before the episode was set to air, then Derek’s heroic act on the barren backroads of Seattle built with the proper amount of drama to pay off in the episode’s climax. But we’re getting ahead of ourselves. Let’s go back to the start.

Grey's Anatomy season 11 episode 21 Amelia OR

The first sign of trouble, the flashing lights that arrived in Meredith’s drive last week, remain as she runs through a cycle of memories. Her mother losing her in the park, Derek asking her two different times to wait for him. Some moments are crystal clear, while others become fuzzy on the edges.

As Derek heads to the airport and Meredith off to the hospital, she tells Zola to remind her why a surgeon can never be late. Zola happily chimes in, “because then people will die.” While Meredith is not late, Derek is for his flight and a short cut leads him off route just in time to catch a speeding car cutting off another driver and sending both cars flying.

Derek switches into superhero mode, first checking the flipped vehicle to find a mother and her daughter grateful they invested in the SUV that saved their lives. While they hang tight, Derek finds two displaced teens from the vehicle responsible for the crash, one with seemingly superficial injuries and the other with a severe head trauma that resulted in short term memory loss.

Breaking through the glass of the SUV, Derek gets Winnie the young girl out and turns his attention to her mother. He advises her to go stand across the road so she will not see anything she would not want to remember. But for a young girl whose father died right before her eyes, Winnie thinks she can take it. As Derek looks at the young girl, it is as if he is looking at his fearless sister Amelia many years ago. Sarah, her mother, suffers from a dislocated leg that Derek must put back in place to restore the blood flow to her lower body.

As he finishes up on one side of the road, the other car is about to explode. Derek pulls Charlie, the driver to safety and gets Alana across the road to the grass.

Grey's Anatomy season 11 episode 21 car fire

The good girl with the mathlete credentials and the AP grades to boot took a chance on the boy with the charm and his dad’s car. Derek keeps her focus on their first kiss because what is happening below her belt requires stabilization and most likely extensive surgery.

He and Winnie secure the wound with dry cleaning bags and he takes a step back to examine the morning no one was planning on having. Through the smoke Derek still admits it is a beautiful day to save lives. That smoke got the attention of the local emergency units and within minutes everyone is carted off the hospital.

Derek goes to answer his phone and turn around, but a truck comes around the bend.

Each moment in this episode took on greater importance as viewers take a second to remember seeing Derek partake in his favorite activity, riding the ferry boat, joking around with Amelia and Bailey on the phone, and spending the morning with his kids and the love of his life.

But his final surgery, which as it turns out is the one on his own body, becomes the last memory he will have and it doesn’t take place in the comfort of his ferry scrub cap or with the doctors he loves and respects. In the ER, Derek lies there, a John Doe, with substantial injuries to his chest, abdomen, and head. The bleeding in his head has caused his verbal skills to cease, but Winnie is able to identify him.

The doctors work over his body and the teacher and trauma surgeon still alive in his head corrects their mistakes in his mind. Frustrated that these doctors are not properly trained nor set up for a trauma situation, he lies still as he goes from chest tubes to the OR. All the while Derek tries to fight his way to convince them that his head is what needs attention. Under the knife his body is fighting to die, but the final piece of the puzzle, the thing they missed, is what ends up killing him.

Even Derek admits as the neurosurgeon eventually shows up, “You’re too late.” When surgeons are late, people die.

Grey's Anatomy season 11 Derek fate feature

Meredith finally answers the door and imagines showing up at the hospital, teasing Derek about always doing the right thing. But she snaps back to reality as she arrives outside of Derek’s hospital room door with the doctors greeting her with condolences. His pulse still beats, but there is nothing left. Meredith goes through the procedure of signing his death papers and taking him off life support.

As the tubes are removed the story of a girl in a bar meeting just another guy in a bar plays out as she waits for him to pull through with one final miracle. But their story was never the typical fairy tale. A happy ending is not in the cards.

Watch Grey’s Anatomy season 11, episode 22, “She’s Leaving Home,” Thursday, April 30 at 8:00 p.m. ET on ABC.

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