As Meredith lay unconscious at Grey Sloan, she was transported once again to her COVID dream, where she saw a figure leaning over the side of the lifeguard's station on the beach. "Excuse me!" she yells toward the shadowed figure.
As the camera pans closer, it becomes clear it's George.
"Mer?" George asks, slightly confused. "What are you doing here?"
Meredith and George pick up right where they left off, as if no time had passed between them. "Derek said the sand isn't real," Meredith says, not believing it to be true.
"Yeah, nope...," George confirms. "It is nice though. I wouldn't want to leave either." The two friends catch up on all that's happened since his premature death, most notably Meredith's three kids.
"You didn't meet them," she mentions, prompting George to reply, "I check in sometimes...." Excuse us, that's just our hearts breaking into a billion little pieces.
After a beat, Meredith asks the proverbial question about the afterlife: "Do I choose? Do I get to decide?"
"I don't know. I didn't," George answers truthfully, referencing the brutal accident that left him unrecognizable. "I would've stayed if I could've. Different for everyone though."
In a cathartic conversation between the pair as they walk side by side near the water, Meredith and George discuss grief and how different people handle loss. They also talk about George's funeral, which saw the surviving class of interns laughing and smiling in an attempt to celebrate the life he led.
"I was devastated when you died," Meredith recalls.
"You were cracking up at my funeral!" George brings up, later adding, "That made me happy."
"I was devastated and then I was OK. Even with Derek, eventually, you go on. And the kids would go on," Meredith says.
Later, George asks Meredith if she still "dances it out," a favorite past time of Meredith and her "person," Cristina, when they're feeling stressed or down: "Do you still dance it out?"
"No, not so much anymore," Meredith replies, citing Cristina's absence as the primary reason why.
"She didn't die," George reminds her. "It's what I miss about being alive. Dancing 'til you drop, laughing 'til you cry, food... the crunch of cereal when you eat it out of the box... the feel of clean sheets at the end of a long day."
Moments later, Webber (James Pickens Jr.) appears alongside George and Meredith beachside, as Meredith goes in and out of her comatose state. "If you stay here, it might break him," George tells Meredith.
"I was so mad at you for choosing someone over yourself," Meredith tells George of his untimely death, when he jumped in front of a bus to save a woman's life. "Do you regret it?"
"Does it matter? You would've done the same thing," he says to his friend.
"You went all in for everybody... Think that didn't somehow affect me? You changed my life, George."
The episode ends with Meredith, George, Webber and Bailey (Chandra Wilson) sitting together on the rocks, as a time machine had transported back in time.
Knight played George for the first five seasons on Grey's before departing the series in 2009. The character was killed off in the season 6 premiere following a brutal accident in the fifth season finale, which remains one of the most stunning TV developments in Grey's history.
"Old friends are the BEST friends @t.r.knight... but like we aren’t old... we’ve just known each other for a very long time yes yes that’s it....," Pompeo captioned the smiley photo on Instagram back in March.
Knight also reshared the photo on his own Instagram, joking, "I’m just happy we met when we were fetuses."
Kevin McKidd, who directed the last episode, played coy when asked if McDreamy's appearance opened the door for more returns down the line, only saying that Dempsey's return is just the "tip of the iceberg."
"I say nothing. But you know, it's a great premise. What I love about this is that COVID -- many people who have had COVID report that in night time, they get these night visions and strange dreams and [it's] very hard to sleep and it's all lucid dreaming," he told ET. "So this opportunity to do what we're doing with the character of Meredith [through our storytelling] is truly [remarkable]."
"I know nothing," he quipped, pausing for a moment before hinting that he knows more than he's letting on. "Maybe..."
Grey's Anatomyairs Thursdays at 9 p.m. ET/PT on ABC. For more on McDreamy's return, watch the video below.