Grey's Anatomy Recap: Things Take a Tragic Turn for Meredith and Derek

Well, thanks to an ill-timed news leak ahead of tonight's episode of Grey's Anatomy, we all knew that "How to Save a Life" wasn't going to end well for Dr. Derek Shepherd (Patrick Dempsey). But just how bad did it get?

The answer: Pretty bad. Get your tissues ready and let's dive into this recap.

We begin with Meredith (Ellen Pompeo) flashing back, as she did earlier this season, to her mom losing her in the park, intercut with memories of saying goodbye to Derek - both on his recent trip to D.C. and earlier on in their relationship.

On the morning he left for D.C., as luck - or fate - would have it, Meredith misses a call from Derek because she's rushing off with the kids, but later in the morning, he chats via speakerphone with Amelia (Caterina Scorsone), April (Sarah Drew) and Bailey (Chandra Wilson) while driving to the airport, until the call cuts out.

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Moments later, a reckless driver zooms past Derek, loses control and crashes, causing another to do the same. Derek tends to the passengers - a woman and her young daughter (a.k.a. Sidney from Parenthood) in an SUV, and a young woman and her (severely-injured) boyfriend - the bad driver - in the sports car. And of course none of them have cell service.

Over the next few ... minutes? hours? it's hard to tell for sure ... Derek has basically a worse day than he's probably ever experienced back at Grey Sloan. He fixes the mother's dislocated leg, drags the couple away from their car seconds before it explodes, and uses dry cleaning bags to hold the young woman's intestines in place, all while (somewhat unconvincingly) reassuring everyone that he doesn't let people die.

"It's a beautiful day to save lives," Derek mumbles, before thankfully hearing sirens in the distance. All the patients get safely loaded into the ambulances and a fireman shakes Derek's hand, sending him on his merry way. (Side note: Wouldn't he have been taken in for questioning after having witnessed an accident? The rules are different in Shondaland, I suppose.)

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Whew! And everyone lived happily ever after. Oh wait ... it's only 8:30? Oh no.

As Derek's reaching over to the seat to grab his buzzing cell phone, a tractor-trailer comes flying around the curve and plows into Derek's car at a speed I don't even want to contemplate. He gets brought to an overcrowded hospital, but is awake and conscious at this point, even talking himself through his multitude of injuries - albeit just mentally, as he's lost the ability to speak.

Then Shonda Rhimes takes the heartbreak factor up a notch, having Derek mentally coach the doctors, recognizing the mistakes they're making and the extent of his injuries, and yet being unable to do anything about it. Of course, by this point, Sidney has noticed him lying on the gurney and is now repeating Derek's own words of comfort back to him in order to keep him alive.

But, as Derek futilely tries to will the doctors to give him a head CT, they instead rush him into an operating room and Derek realizes he's probably going to die - because "these people weren't trained properly." (If only he'd gone to Grey Sloan! Cruelest of ironies.) Sure enough, the neurosurgeon takes an hour and a half to get to the OR because he's at dinner, dismisses the only doctor who knows what she's talking about, and discovers that it's too late to save Derek at that point.

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Then we get another false sense of security when police show up at Meredith's house and, in the next scene, she's talking to a bandaged Derek in a hospital room. But alas, it's only a fantasy. Meredith's really still just back at the house, where the cops are telling her there's been an accident.

Shortly after arriving at the hospital with Bailey and Zola in tow, Meredith gets told by the lackluster surgeons that there was nothing they could have done to save Derek's life. False! Meredith points out that they should have gotten a head CT - and later witheringly corrects a doctor who calls her "Mrs. Shepherd." Dark and Twisty Meredith is back in full force, as she condescendingly reviews all of her options with said doctor, before demanding that he give her the papers so she can sign off on pulling the plug.

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As Meredith leaves the hospital, the one good doctor tearfully apologizes and gets a "you can't win 'em all" talk from Meredith -- who's being remarkably levelheaded and calm at this point, no? Meredith tells the doctor to get back on that surgical horse tomorrow, and then promptly throws up next to a tree.

When Meredith returns to the hospital room for a final goodbye to her husband, we get another knife-twisting montage of the sweetest MerDer moments from 11 seasons - all the glances, hugs, kisses, sex and witty banter that defined their roller coaster of a relationship, set to a piano version of Snow Patrol's "Chasing Cars."

"Ready?" the attendant says. "No, but go ahead," Meredith responds. Cue the sound of Derek's monitor flat-lining.

What did you think, Grey's fans? Are you shocked that Derek is dead? Where will Meredith go from here? And can Grey's Anatomy go on without MerDer? Sound off in the comments!