Just as Meredith and Derek begin to rekindle their relationship, Derek is suddenly killed in a car accident while en route to the airport to catch a flight for one final meeting in DC. He was taken to an understaffed hospital, which reluctantly took him in despite not being a trauma center. The doctors failed to recognize his head injury in time. Derek is declared brain dead, and Meredith must go to the medical center to consent to remove him from life support. She tells Penny, the intern who was assigned to Derek, that every doctor has "that one" patient who dies on their watch and haunts them forever and "that one will make you work harder, and they make you better."