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Grey’s Anatomy Recap: Is Derek Dead or Alive After Terrible Car Crash? Find Out McDreamy’s Fate!

Patrick Dempsey
Dr. Derek Shepherd (Patrick Dempsey) had hearts racing on Grey's Anatomy as he rescued four people from a deadly car crash. The insanity didn't happen until after everyone was saved, though, because then suddenly he was the one who needed saving.

Is everyone breathing? On Thursday’s Grey’s Anatomy, Dr. Derek Shepherd (Patrick Dempsey) had hearts racing as he rescued four people from a deadly car crash. The insanity didn’t happen until after everyone was saved, though, because then suddenly he was the one who needed saving.

Related: PHOTOS: Grey's Anatomy's most memorable moments

That’s right — Derek was involved in another accident, and his life hung in the balance through the appropriately titled “How to Save a Life.” It turns out that he never made it to the airport and his “shortcut” drive changed his life forever.

But did McDreamy survive the episode? If you don’t want to know his fate, stop reading here. Major spoilers ahead!

It’s A Beautiful Day to Save Lives

The episode opened with Meredith looking out at police lights flashing in her driveway, remembering her last words with Derek: “Stay here, don’t move, wait for me. I’ll be back before you know it.” This was deja vu for her, because he said that to her before as he was leaving the house years ago.

Patrick Dempsey on Grey's Anatomy - How to Save a Life
News of Patrick Dempsey’s exit from Grey’s Anatomy leaked early thanks to a feature in issues of Entertainment Weekly that were delivered to subscribers before the episode aired.

It turned out that he called her to tell her he was on the ferry, but she missed it because her phone was lying in a drawer and she was rushing to get the kids out the door for school. His actual last contact with the hospital was on speakerphone with Amelia, April, and Bailey in surgery, and they told him to turn around because he’d miss his flight. He claimed he knew a shortcut, but his cell reception went out before he could say goodbye.

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A car was driving like a maniac behind him one minute, and the next, it crashed into another vehicle and both flipped down the road. Ever the hero, Derek rushed out to help the victims, and everything went surprisingly well when he got a mom named Sarah and her young daughter, Winnie (Parenthood’s Savannah Paige Rae), out of the car and to safety, even though he needed to pop Sarah’s leg back into her hip. Next, he rescued two high school students who were in the other car: Alanna and Charlie, both 17-year-olds who ditched class. At first, Alanna seemed fine, but it turned out she had a stomach injury that forced Derek to push her insides back in using MacGyver-like tactics with dry cleaning bags tied around her body.

Even when high schooler Charlie’s car exploded, it was a good thing — the smoke signals sent for help when none of them could get cell reception. “It’s a beautiful day to save lives,” he said before everyone was rescued and taken away in an ambulance. Phew, right? Not so fast.

The Shocking Farewell

After Derek got in his car, he started to drive and ended up straight across the middle of the road. Just as he reached to answer a call — likely from Meredith — a truck slammed into him and he was rushed to the hospital. From then on, Derek never spoke — we just heard his thoughts as the ill-prepared hospital tried to save him. They didn’t take a head CT, and by the time they found out it wasn’t his chest bleeding but his head trauma that was killing him, it was too late.

Ellen Pompeo on Grey's Anatomy - How to Save a Life
Meredith Grey’s husband, Derek Shepherd, tried to save victims in a car accident during the Grey’s Anatomy episode “How to Save a Life.”

A neuro surgeon couldn’t make it to the OR in time, so there was no way to save him — he was brain dead. “It’s too late; you’re too late” were the last words we heard him “speak.” The entire time he was being taken care of, we heard his thoughts and coaching to the doctors from his mind.

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After the police knocked on Meredith’s door to tell her the news, we saw her go to the hospital, where Derek was alive. “I’m not going anywhere,” he promised. “I’m right here.” But in true Shonda Rhimes fashion, it was just a dream. When Meredith actually got to the hospital — all the while having stressful flashbacks to her mother’s suicide attempt when she was a child — she found out the truth. Derek was brain dead.

The doctors told her how sorry they were for her loss, and she gave a real verbal beating to one who delivered the papers that would decide her husband’s true fate. After yelling about whether she should hope for “fairytales and magic” in his recovery or just “pull the plug,” she screamed, “You want to talk about killing my husband? Give me the papers!”

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The episode ended with a solemn version of “Chasing Cars” as Meredith thought back to her first night with Derek, his proposal, their time with their kids, the bathtub scene, and many more incredible memories from their 11 seasons together. Before the doctor pulled the plug, she cried and told Derek, “You go. We’ll be fine,” but their official goodbye was actually in the past — we flashed back to Meredith’s first giggly goodbye to him after what was supposed to be a one-night stand.

Tell Us: Were you shocked by Derek’s death? What will you miss most about McDreamy?

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