To Meredith, Alex begins his letter by explaining that he go to see her because she would convince him to stay. "You were always the one to set me straight," his letter reads as clips highlight the journey their relationship has taken since they first met. The bits of footage showcase their start as residents — when Karev was a machismo jerk hitting on anyone that could still breathe — to their later years as their friends' paths took them away from Grey Sloan and left them as each other's "person." Karev admits that he doesn't want Meredith to convince him to come back because the one good thing in life isn't at Grey Sloan anymore. It's back in the arms of Izzie.
He goes on to explain that the two got back in contact after he reached out for help when Meredith was in danger of losing her licence and needed references. As flashbacks of Karev and Izzie's past fill the screen, the former Chief of Grey Sloan Memorial discloses that while speaking with Izzie, he learned that not only was she now a mother of twins, but she was the mother of his twins. Five-year-old twins named Alexis and Eli who want to be doctors as Izzie saves lives working as a surgical oncologist. Karev explains that Izzie used their frozen embryos from seasons ago to have the twins and meeting them spurred Karev to leave everyone in Seattle behind to live on a farm with his twins and his former love.
"You always said Christina was your person, then I was your person," Karev tells Meredith. "But you were your own damn person — a force of freaking nature. You never needed anyone but you." He tells her that, though he loves Jo, he hopes Meredith never tries to get him to go back to Grey Sloan because he's "exactly where I'm meant to be."