Still grieving heavily, he went on a shooting spree at Seattle Grace Mercy West. He also shot Alex Karev, Owen Hunt, and Derek Shepherd, along with four others who were injured, but not killed.

The stress of witnessing his shooting caused Meredith to miscarry.

Eventually, she did get put into the trial because of her rapidly progressing disease.

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Many bones were broken and there was significant nerve damage.

Callie was able to fix his hand, with the help of the donation of a nerve from the leg of Derek's sister Liz.

After Addison cheated on him with Mark, Derek left his private practice in New York and accepted Richard Webber's offer to come work for him at Seattle Grace Hospital with the possibility of becoming the Chief once Webber retired.

Derek became aware that Burke was in the running too, after he was hired.

Derek coped with the traumatic experience by speeding. Andrew Perkins that the shooting gave him the courage to step down and quit.

He was arrested multiple times for speeding, which led to Meredith leaving him in jail overnight. After getting arrested prior to Cristina and Owen's wedding, Meredith told him about her miscarriage and begged him to stop making her worry with his speeding.When Richard started to get worried about Adele's mental condition (he knew she had Alzheimer's), he asked Derek to have her put into the trial.She did not get into the trial because her Alzheimer's has not progressed far enough yet, which was shown by a testing. As a result he is especially cynical when treating criminals and feels that they do not deserve any compassion from him. This event forms a large part of Derek's moral compass and consequently may have inspired him to become a surgeon to help save lives.Derek came to Seattle with a reputation as a gifted surgeon who had a penchant for taking on "hopeless" cases and highly complex procedures that are often passed on by his peers.