When Meredith chose to donate part of her liver to Thatcher, Derek demanded to be allowed in the OR, stating, "that's my wife you're cutting into. Addison had also brought divorce papers but made it clear that if Derek was willing to give her a second chance, she wanted to give their marriage another try. With nobody to talk to, Derek started to talk to Mark again, and they slowly began to rebuild their friendship and soon enough became best friends again. In the third season, Alan Sepinwall of The Star-Ledger wrote that "the attempt to give the moral high ground back to McDreamy was bad. The job required more paperwork and less surgery than he thought, and after being in the shooting he was very cautious and didn't want that responsibility, which led to his resignation.

With the show concluding its second season, Robert Bianco of USA Today said that Emmy voters could consider him because of the "seemingly effortless way he humanizes Derek's 'dreamy' appeal with ego and vanity". However, after talking with the true Meredith for only a short while, she told Derek that she was the "good one" and gave him the ring his father wanted him to have for the "one.

Shortly before Cristina left, Amelia came once again to see her brother in Seattle, announcing she was now engaged to James. The image is printed directly onto the case and wrapped around the edges for a beautiful presentation. He comes to terms with the fact that his career as a surgeon may be over and is grateful that he is alive.

The Material is made from strong hard plastic or silicone rubber cases that may protect the back, sides and corners of phone from crash and scratches. Following Nancy's advice, Derek asked Meredith for time to take some space for himself and then embarked on a very brief camping trip, which only cemented his desire for Meredith. She told him not to say anything yet, so he was unable to tell Meredith that he had just kissed Rose, a nurse who he'd been getting to know and flirting with over the last few days. Throughout the day, a personal assistant of the President's came back to Seattle to offer him the job again, but he refused again.His youngest sister Amelia ( Caterina Scorsone) takes over his position at Grey Sloan as Head of Neurosurgery. He pressured Meredith to make the most of her career to make up for the sacrifice he made, which she soon grew tired off. Before he actually left, they fought a lot in the OR, both not dealing well with the reversed situation of her being his boss.

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In the season one finale, his past eventually catches up with him when his estranged wife Addison moves to Seattle and is offered a position by Dr. Meredith and Derek intended to get married at city hall but found they had no time due to Izzie's surgery and the John Doe patient. While Derek appeared to be happy in his relationship with Rose, it was clear to those close to him, namely Mark and Addison, that he wasn't.

She would later learn that the woman was Derek’s sister, Nancy, but the explanation of the misunderstanding did not make Meredith any more appealing to Nancy, who continuously referred to Meredith as the "slutty intern.