The episode begins with Meredith Grey standing on Derek Shepards land.  All of her candles laid out in the house she built.  Soon all the candles burn out and the time presses on before she finds herself back at Seattle Grace.  Cristina Yang tells Meredith that Derek has been in a car accident.  He tried to swerve around a car to avoid the accident, but wrapped his car around a tree. Cristina holds her back as she keeps asking, "Where is he?  Where is Derek?" and Crisitina cautions that she's going to need to be strong.  She pushes past the doctors and stares at a bloody Derek lying on the gurney.  Miranda Bailey is trying to resuscitate him, but you see the line go flat and she mouths the word "time of death."  Meredith screams "Noooo!" then wakes up from this frightening dream.

Meredith meets up with Cristina on rounds and tells her that she keeps having that dream that Derek dies in a car accident.  She's worried it's a bad sign, but she's trying to "lean into the fear," and wants to ask Derek to move in with her.  Cristina keeps trying to change the subject as she is much more concerned about working at a second rate hospital (#12 in the nation) than the silly relationship issues of Meredith.  When the three women patients come into the E.R., Meredith is struck by how cute it is that these women still love their husbands after all these years.  Maybe fairy tale endings do come true. 

Meanwhile, Derek is noticing that Rose is giving him the brush off.  She drops something off at the nurses' station where Sloan and Shepard are chatting and very obviously ignores Derek, but remembers to talk to Mark Sloan.  She walks away and Derek comments that he's surprised to see her taking it so badly because she seemed to take it so well at the time.  Mark then explains that she's having a delayed anger to the situation.  He says that Derek has "broken up emotionally, but now needs to break up professionally."  Soon Derek finds himself in the O.R. during an operation with Rose handing him the tools as usual.  In an attempt to find out more about his teaching style, Erica Hahn asks him to explain why he switched from one size to another on his tools. Having no real good explanation he simply says, "I changed my mind."  To this, Rose has a rather loud laugh and makes a snide comment about "changing his mind" causing all in the room to whisper around about the two.  Derek was upset by this and confronts Rose after the surgery.  He tells her that what she did was unacceptable and perhaps she needs to consider working in a different department.  She tells him, "there's no easy way to tell you this, but I'm carrying your child. . ."  He asks if she is serious and she says, "No."   He is not impressed with the joke and again tells her they can't work together.  She tells him he should change.  He yells, "I am a neurosurgeon!" clearly establishing his importance.  She storms off and says she's not changing. 

Meeting up with Derek in the hallway, Meredith asks Derek to move in with her.  He says that he would love to, but she is obviously still a little nervous about the whole thing.  She goes back to see her "happily married" patients and as their husbands arrive, Meredith realizes that things are not as perfect as they seem.  One woman confesses that she's been having an affair with her best friend's husband for the last 8 months.  Meredith starts to reconsider her decision to move in with Derek.  She talks to him about it and Derek says he's willing to take baby steps if she needs to.  He doesn't want to rush her into it.  The two agree, though to try it out and Meredith is on board.  She follows Cristina outside to talk to her about it.  Cristina is so sick of hearing about it, she tells her to "shut up."  Cristina tells her that the two won't work and will never work.  She goes to storm back into the hospital and slips on some ice landing flat on her back.  Meredith stands over her telling Cristina that she deserves it when a huge icicle falls and punctures Cristina's side.  Meredith goes to help, but Major Hunt comes to her rescue. 

Back in the O.R. for another surgery, Derek again finds himself with Rose handing him all of the necessary tools.  With obvious tension between them, he asks for the scalpel.  Rose flips it over to put in his hand then realizes that she handed it to him blade first on "accident" cutting his open hand.  He goes to get another pair of gloves to perform his surgery and throws an angry look at her saying that she better be more careful.  Rose is in shock about what she has just done and goes quiet.  Later on, Rose approaches Derek to apologize for what happened and tells him that there is an opening in neo-natals and she has taken it.  She will no longer be working with him.

After all is said and done, Derek goes to get his hand stitched up by Meredith.  Mark Sloan offers to do it instead, but Derek says he'd rather have his girlfriend do it.  "She gives me sex," he tells him.  Meredith stitches him up and the two go home after a long day at work.  At Meredith's house she is discussing with Cristina her fears again.  Meredith needs to know if Cristina really meant what she said about she and Derek not being good together, that they won't make it together.  Cristina asks why Meredith even cares what she thinks.  Meredith explains that Cristina is her "person."  What Cristina thinks really matters and she really needs her to support them even if she doesn't think it is going to work.  Meredith asks her again if she thinks it will work and Cristina says that she'll support Meredith through anything.   The last thing you see is Meredith helping Derek tape up boxes getting ready to move in together.

more from this episode . . .