It's George! The opening of the season finale, amid scenes and screams from the plane crash in which six doctors' lives are in peril, flashes back to the series premiere when then-chief Dr. Webber welcomes the interns to Seattle Grace. Cut back to Meredith looking half-conscious and staring up at the trees. Cristina pulls Meredith up and there's still a lot of screaming in the background. Meredith pulls a piece of shrapnel out of her leg. Cristina has lost a shoe. Meredith calls out for Derek, and Cristina says Derek was sucked out the side of the plane when it hit the trees. We see it's Arizona who's screaming and Cristina yells at her to shut up. Then there's a persistent banging sound. Sloan joins Cristina and Meredith looking for the sound and they see Lexie -- only her arm -- banging a seat belt against the metal side of the plane. Arizona rips her pant leg and sees a massive wound. The pilot is stuck in the cockpit. Arizona, in shock, laughs about the fact that she's married to an orthopedic surgeon and she's staring at her leg bone. The pilot tells her he can't feel his legs.
Sloan finds Lexie trapped under a piece of the plane. She's short of breath. Cristina's shoulder is separated and she asks Sloan to pop it back in. He does, and the sound seems to echo through the trees.
Meredith goes off shouting Derek's name and he hears her. But she can't hear his response. His arm is also stuck under a piece of the plane. He reaches for a big rock with his free hand and whacks at the trapped hand, letting out a scream.
Back at the hospital, Hunt wants to find Teddy. He tells his assistant to send all calls to voice mail unless someone's dying or it's Cristina. There's a big trauma coming in: A building collapsed on firefighter recruits on their last day of training. Webber tells Hunt about taking a group of the residents to dinner. Hunt's not interested. Webber says it's a great time and not to be missed, meanwhile April, Avery and Alex are wishing they didn't have to go. Alex says Cristina and Meredith "skipped town at the perfect time." Avery tells Alex he's still weighing his options while deciding whether or not to go to Tulane. April says she's going to work at a Tasty Freeze back home, but Avery tries to remind her she's "still a doctor."
Ben is trying to sell Bailey on a "commuter marriage." She's not into it. Callie hears about it and says the long-distance thing is not the worst thing in the world. Callie says Arizona's only been gone a day and she's missing her already.
Back at the crash scene, Sloan and Cristina are trying to lift the plane off Lexie. A shaken Lexie tells Cristina her legs and pelvis are crushed, she can't feel her other arm and isn't sure it's still there, and her chest feels like he's going to explode, "so it's probably a massive hemothorax." Sloan tells Cristina to go get a bunch of supplies and Cristina pauses. Lexie tells Sloan that Cristina "knows it won't help." He tells Lexie she's going to be fine. Cristina tearfully tells Lexie she'll be right back.
Hunt finds Teddy and asks her about a job she's apparently weighing. She tells Hunt she's not taking it.
At the crash scene, Cristina tapes the pilot's head to the back of his seat to stabilize his neck. He worries about whether he's paralyzed and won't be able to walk again. Cristina stabs his leg with a pen and when he doesn't react she tells him, "I'm sorry."
Meredith tells Cristina she can't find Derek. Cristina tells Meredith she should come help Lexie. Meanwhile, Lexie tells Sloan she's dying. She asks him to tell Meredith she loves her and "that she was a good sister." She asks Sloan to hold her hand. He refuses, insisting she's "not dying." He tries again in vain to lift the piece of the plane off of her. He tells her he loves her, and she says he doesn't have to say that. He starts to lay out their whole life together. They're going to get married and a couple of kids. She smiles at this and he tells her they're going to be so happy, so she can't die. He tells her they're "meant to be." She says it back and then she's gone.
Meredith is crying uncontrollably while Sloan and Cristina sit by in silence.
At the hospital, Alex complains to Callie about Arizona holding it against him that he's going to Hopkins. He decides to call Arizona, and Callie says no good will come out of it. There's no answer.
Hunt wants to know why Teddy turned down a job at Med-Comm (Army Medical Command). He questions her loyalty and why she isn't responding to the call to serve her country. She tells him she's love to leave Seattle Grace and never look back, given all the memories of Henry around the hospital, but she's not going to leave because Hunt is as shaken and broken as she's ever seen him. She says that after all the kindness and friendship he's shown her.
Cristina and Meredith are still looking for Derek with no luck. Cristina says that if they make it through this she's "leaving Seattle Grace Mercy Death and never looking back." Cristina tries to calm Meredith down. Meredith tells Cristina, "You're still my person, even if I'm not yours." Meredith starts to cry and Derek stumbles out from behind a tree, holding his left wrist. He breathlessly says, "I heard your voice, I thought I was dreaming." Then he collapses.
Cristina finds her shoe. Meredith is treating a massive wound on Derek's left arm. He asks where Lexie is, and Meredith's silent response says everything. Derek walks Meredith through the process of closing the wound. She's going to weave the pin through the flesh and Derek asks for a T-shirt to put in his mouth because he's going to scream a lot and probably pass out. Meredith starts, Derek screams and she begs him to pass out.
At the hospital, Webber is "jazzed" about the dinner and asks Avery, Alex and April if they're excited. They all go through the motions of telling him they are. After he leaves, Alex offers anyone $10 to stab him in the face.
Hunt talks to Teddy and tells her he realizes that if Cristina were staying, Teddy would probably take the job. He tries to convince Teddy he'll be fine, but she says he won't. He says she's not even gone and he misses her already.
Sloan is frozen, still holding Lexie's hand, and Cristina is insisting that he get up and help. He's not moving, and Cristina goes over to him and finds he's actually unconscious. She checks for a pulse, rips open Sloan's shirt and is stunned by what she finds.
At the hospital, Teddy and Hunt are checking a patient who appears to have a cardiac tamponade -- a compression of the heart that's a result of blood or build building up between the heart muscle and the pericardium. At the scene of the crash, Cristina thinks Sloan has the same thing. She's only about 70 percent sure, it's the best she can do without an ultrasound. With the scenes alternating between Teddy working on the patient with all the necessary tools in the hospital and Cristina, Meredith and Derek doing it with random implements in the woods, they both work. The only difference is that afterward, Teddy asks Hunt if he wants to grab lunch. Cristina and the others are still trying to survive.
Callie finds Alex, Avery and April eating junk food and asks about their "sense of occasion" and why they don't want to go to the chief's dinner. She mocks April for being sad about failing her boards, and tells them about all the terrible things that have happened to her. Now, she says, she's pretty darn happy. And, she says, the duck is freakin' amazing.
In the woods, the group gathers back around Arizona and she asks where Lexie is. Sloan tells her Lexie's dead. They suggest starting a fire. Jerry, the pilot, hears a helicopter and they all try unsuccessfully to shoot the flare gun into the air, but it doesn't work.
Getting ready for dinner, Avery tells April he chose Tulane. She says that's good for him, but he says he feels sick to leave Seattle and leave April. She goes off about how she's not happy and doesn't know who she is anymore. She says she's going to try -- for one night -- to be happy. He tells her she looks really nice and they leave together.
Alex calls Arizona and leaves a message, saying that the only reason Hopkins wants him is because she made him something. "I guess I'm saying thanks, or whatever," he says.
Night falls in the woods and Jerry worries that they won't be found anytime soon. Sloan tells Arizona that he should have told Lexie earlier that he loved her. Sloan seems to be fading and Arizona tells him to hang on. He says Lexie's waiting for him.
Hunt calls Teddy in for a meeting and she insists she's going to stay. He tells her she's fired, effective immediately. He tells her she has other opportunities and should take them. He tells her he doesn't want her there anymore. He says she's been insubordinate in front of staff and students. She says they're "passed all that," and he says they are because she's fired. He tells her pack her stuff. She storms out of the room calling him a "son of a bitch." Seconds later, she comes back in crying and they hug. Teddy tells him to fight for Cristina. He tells her to go and "be great."
Bailey finds Ben and gives him a lecture about making decisions together and not making decisions on his own. He tells her he is "not a free agent anymore." He asks if this means they're still getting married. She says she thinks she's made it clear. They kiss.
Hunt is finally checking his messages. There are several messages from the hospital in Boise, wondering when the Seattle Grace doctors were supposed to arrive there.
At the chief's dinner, they're about to toast and Webber is ready to give his big speech, but decides to wait until Meredith and Cristina show up.
Hunt hears one last message from Boise, with the doctor there saying she's starting to get worried. Hunt looks concerned.
In the woods, Cristina and Meredith are hungry and everyone else is sleeping despite Cristina's pleas that everyone stay conscious. Meredith goes to light the last match they have and it goes out immediately.