We see Derek on the way to the airport, talking on speaker to Amelia, who insists he is going to miss his flight. As he drives, he sees a car speeding around him, then watches that car wreck as he tries to stop his own car.
He gets out and tries to help the passengers, all of whom are hurt in some way. No one has a phone that works, so Derek does the best he can to help them all.
Derek looks for a first aide kit, and gets the little girl out of the car.
As Derek works to help everyone, one of the cars catches fire and explodes. He manages to get them all away in time. Derek is able to help all of the patients, and they are finally rescued. As Derek tries to drive away, he stops in the middle of the road to search for his phone.
And then, he looks up just in time to see a large truck smash into him.
Derek is brought to another hospital, but he looks to still be alive. We watch as other doctors bring him in, even calling him "John Doe." He tells himself to hold still, and understands things that are happening to him. He tries to speak to the doctors, but he isn't able. We hear all of his thoughts as he tries to motivate himself, and also makes judgments about the doctors.
Winnie sees him and tells him he isn't dead, just like he told her before. She tells hi it's a beautiful day to save lives. Winnie tells the doctors Derek's first name, and that he is a surgeon. Derek knows the doctors are focusing on the wrong things.
Music plays from the pilot episode.
The police arrive to Meredith's home, and bring her to the hospital. He's in a coma, and she has to decide what to do. The doctor apologizes to Meredith for not being a good enough doctor. Meredith tells her to learn from this and she'll be better for the next patient.
Meredith sits with Derek as he is unhooked from the machines.