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As Part III of this three-episode story line commences, we can only hope that a hypothermic Meredith is somehow brought back to life. That would be some kind of miracle, indeed.
The doctors continue to work feverishly over a still-blue Dr. Grey, in an attempt to warm up her organs and eventually start her heart. But she still registers no heartbeat. A stoic Addison tells Mer's fellow interns that the situation doesn't look good and that they should prepare themselves.
Meanwhile, Meredith finds herself in the empty room with Denny and Dylan, who argue about the best way to break it to her that she's dead. If you thought this was weird, you haven't seen anything yet. They're joined by Doc (Meredith's old dog), a nurse that used to work for Ellis, and the teenage girl who was impaled on the metal pole - all memorable patients whose impact Meredith felt deeply.
Addison goes to check on Jane Doe, the pregnant patient whom Alex rescued from under a concrete pylon. She's awake, but has no memory of who she is and mistakenly thinks Alex is her husband. Alex quizzes Jane Doe on her family's medical history and she can't remember a single thing.
Upon hearing that Meredith's condition is dire, Cristina announces that she can't do this and leaves the hospital. She goes on a random shopping spree at the Dollar Store, then to Joe's, where she proceeds to get drunk and talk the big guy's ear off. When Joe asks if they need her at Seattle Grace, Dr. Yang retorts, "I'm coping."
Back in the afterlife (or whatever you'd call it), the patients all give Meredith the same message as she wanders the hall of the faux hospital - "there's no time." Bonnie, the girl who died from injuries on the pole, starts to bleed. Meredith begs Dylan for help, but he vanishes, as does Bonnie and everyone else but Denny.
He tells her it's time to talk.
As a dark mood extends over the room, Miranda says it's been over an hour that they've been working on Meredith and maybe it's too late. Richard insists that she's young and her body temperature is going up, albeit slowly, and that her heart might start again.
Miranda puts Callie in charge of George and Izzie, ordering them all back to work NOW. When Mrs. O'Malley expresses her sympathy, Izzie abrasively takes her to task for calling herself one of Meredith's friends. Callie says she's here - George wants her to be here - and Izzie can either get accustomed to it or she can become that person George USED to know.
Meredith keeps yelling at Denny and Bonnie to back off. She drowned. End of story. What's the big deal? But Bonnie is annoyed that Meredith seems to be happy to be dead, and have so little respect for life.
A devastated, weary Derek goes to Ellis' room, and tells her that she broke Meredith because nothing Meredith ever did was good enough for her. Addison drags him out of there, saying there's no point in yelling at Ellis now.
Derek confesses to his ex-wife that he thinks Meredith may not have wanted to live, that she's a good swimmer and didn't put up a fight. He starts to cry and Addison tells him he's not allowed to break down. Not while there's still a chance Meredith's life could be saved.
Meredith swears to Denny that she fought to survive in the water. He knows better. Izzie's fiance tells her that she can't stay here. It will break her friends. Moreover, it will devastate Derek - after the miracle of him even existing, being the incredible person he is, and Mer being together with him.
Back in the real Seattle Grace, Richard is upset Meredith's temperature has now dropped back from 89 to 86 degrees. Bailey suggests a cardiopulmonary bypass. They page Preston, who has gone to rescue Cristina at Joe's. Yang tells him she's not proud of it, but she just can't go back there and face Meredith dying.
Burke gets the page and tells her that she has to go back. No excuses. If Meredith dies, and she's sitting in a bar when that happens, she'll never come back from that. He tells her to come say goodbye to her friend.
Finally, Meredith gives in to Denny and admits that, just for a second, she wondered what the point of surviving would be, and let herself sink into the abyss. Now she wants to go back, but the ghosts tell her she might be too late. Back in the real world, a faint pulse shows up on the monitor.
The surgeons shock her and she flatlines again. Miranda pleads - begs - the still blue, comatose Meredith that she can't give up, not after everything they've been through. She checks for a pulse, but there isn't one. Just when it looks like all is lost, Cristina walks into the room and orders them to try again. A defiant Dr. Yang is not about to let "her person" slip away without a fight.
George finally confronts Izzie about Callie. She says she can't lie about how she feels, that's not who she is. He replies that yes, people lie all the time. And sometimes it's a good thing, because if she's wrong, she's going to feel stupid and if she's right, and he made a mistake, he's going to need her and she's taking that away from him.
Derek is still outside Ellis' room, distraught, when she goes into cardiac arrest. He goes right to work trying to revive Ellis when he hears that Dr. Burke is now doing a cardio bypass on Meredith. Ellis crashes a second time as Derek does everything he can to save her.
Literally stuck halfway between life and death, and with increasing clarity as to where she belongs, Meredith looks up to see Ellis walking by outside her room. They meet. Ellis tells Meredith she doesn't belong in this world. The elder Dr. Grey then hugs her and tells her she's anything but ordinary. Meredith runs back towards the light.
Right on cue, Burke declares that there's a heartbeat and Meredith is even breathing on her own. Addison comes in and asks if they've paged Derek, but Miranda says she wants to give Cristina time with Meredith first. Everyone leaves the room but Cristina. Meredith starts to mumble something, at which point Cristina orders her to talk. Say something. Anything.
"Ouch," Meredith groans.
As tears of joy run down Cristina's face, she exclaims that she and Preston are getting married, and Meredith was the one person she needed to tell to make it real. The other interns run to see it for themselves when they hear that Meredith is okay.
Derek is standing in the doorway when Meredith awakes. Having remembered - however vaguely - her brush with the afterlife, Meredith asks Derek if her mother is dead. But she already knows. Because the thing is, as sad as it is for Meredith to lose Ellis, it was time. She's at peace with it now. Derek climbs into bed with Meredith as she rests.
Watching Meredith and Derek gaze lovingly at one another, Addison tells Mark that Derek never felt that way about her. Mark says he did. Addison brushes him off. She says if he could go 60 days with no sex - including with her - maybe she'll believe him. He's game, so long as Dr. Montgomery doesn't sleep with anyone either.
In the touching concluding moments, Richard says his goodbyes to Ellis at her bedside, even though she's already gone from this world to the next. When Izzie leaves the hospital, she stops for a moment and we see Denny standing next to her. Both of them close their eyes and smile.
Denny walks down the hall and disappears.