This little bit of exposition suggests Grey’s wants us to know Karev is in some sort of crisis. This response — rather than an off-screen fatal accident — gives the Grey’s writers some wiggle room to deal with the absence of Justin Chambers, which is a good thing for fans. Production could easily put Karev’s character in limbo by explaining he has decided to stay in the Midwest for an undetermined time. This way, Karev can deal with his mental health issues in the fresh air and outside of the bustle of a city like Seattle. That explanation for Karev’s exit would give Jo the option to wait for her husband to return to their home together or divorce him, mourn the relationship for a while, and eventually jump back on the rollercoaster that is Grey’s Anatomy dating.