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This episode gives us perhaps the most defining moment of the entire MerDer romance. As they're searching for a shaman for their patient, Meredith and Derek find themselves at a crossroads in their relationship. Addison, Derek's estranged wife, is settling down at Seattle Grace, and Derek hasn't signed divorce papers yet, unsure if he should forgive her for her infidelity or move on with Meredith.
After they finish a surgery, Meredith gives Derek the infamous and disarmingly sweet "pick me, choose me, love me" speech and tells him to meet her at Joe's after work. Meredith gets terribly drunk by the end of the episode, and it looks like Derek's a no-show. Unfortunately, Meredith doesn't know there's a lot more heartache to come.