Clark is about to shoot Derek again when he sees the SWAT team descending, so he flees. Derek needs surgery immediately, and since she can't find Teddy or Owen, Cristina realizes she's the only one who can operate. She orders a distraught Meredith to wait outside the OR.
Alex needs a transfusion, so Lexie goes to get some blood packs. We gasp as she runs into Clark. "I only planned to shoot Dr. Shepherd. And Dr. Weber," he tells her. "And you," since she was the one who unplugged his wife's life support system. Just as Clark is about to shoot, a SWAT bullet wings him. Lexie returns to Alex's side with the blood he needs. "Please don't die," she begs. "I love you," she whispers as Mark looks on.
A wounded Clark wanders into the peds ward, where a terrified Callie hands him some bandages and tells him to take them and go.
Miranda has got to get Charles to an OR if he's going to live. She drags him to the elevators, but they've all been shut down. Miranda loses it, then collects herself to be there for him until the end. She tells Charles he's dying but says, "You are not alone. I'll be here the whole time." He asks Miranda to find Reed: "Can you tell her I loved her?"
Our heart breaks for both Alex and Lexie as Alex confusedly calls Lexie "Izzie" and begs her not to go. Lexie sobs, "I won't ever leave you. We're going to be together always." A SWAT member arrives and tells them that this floor is clear.
Teddy and Owen get their patient outside but are taken into custody as potential suspects. "She's still in there. Go. It's okay to choose," Teddy tells Owen and he runs back inside. Richard also manages to sneak in, despite the lockdown. Alex is whisked away to another hospital and Teddy doesn't answer when Lexie asks if he's going to be okay.
Owen finds Meredith and she tells him Cristina is operating on Derek. He goes in to the OR but we're shocked to find Clark standing there with a gun to Cristina's head: "Stop fixing him," Clark orders. "Just let him lie there and die."
Cristina keeps operating anyway. Owen tells Clark, "She is the woman that I love. You shoot her and I will kill you."
"I came here for justice. An eye for eye. The only person I want in this room is Shepherd."
Meredith appears and says, "Shoot me. I'm his wife. I'm your eye for an eye." He turns the gun on her, but Cristina blurts out that Meredith is pregnant. Clark hesitates and when Owen tries to get the gun, Clark shoots him instead. Jackson tricks Clark into thinking that Derek has flatlined, so he'll leave, but Cristina manages to save Derek after all. Owen's wound is a through-and-through but as Meredith goes to help him, April asks her if she's been shot too, as she's bleeding. We see Meredith wince, but she says, "I'm okay. I'm having a miscarriage."
Richard finds Clark sitting in the room his wife died in. Clark laughs, "I was going to kill you. And then I was going to shoot myself. But I only have one bullet left." "What's it gonna be Mr. Clark, me or you?" Richard asks. He tells him that if he shoots himself, he's free, but if he shoots Richard, he'll go to jail. We hear a shot just as the SWAT team closes in. Clark's taken his own life.
After their ordeal, Arizona tells Callie, "I can't live without you," and that they''ll have "10 kids."
After the surgery, Cristina tells Meredith that Derek's asking for her. Meredith takes the pregnancy test from her locker and throws it away.