It's not that hard to figure out.

He could hear everything but could neither speak nor move. Hence the tear.

i completely agree with you.

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"Common sense is not so common."
- Voltaire

Yeah i thought there was one of two possibilities - the first being what you said, he realized he was in a coma and remembered that conversation with his wife so jumped. The other way of looking at it was that he didn't know he was in a coma but he wanted to jump to get out of the horrible situation he is in - and the flashback was for the audiences benefit, a kind of 'look, it all fitted together all along'. We all know how much directors like to spell stuff out to the audience...
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Jamie Bell! :) <3
...That Is All.

You've actually over-analyzed it. He DOES hear much of what is said around him in the real world. His sexual tryst with the nurse is obvious evidence of this. When she shows up during the family's visit near the end of the film, everyone is comfortable seeing her there because they know she's been tending to his needs for several months while he's been in a coma. The comatose George knows this, which is why she manifests in his coma-world as his only ally. Nearly everyone else has given him what he believes to be reasons to mistrust or fear them (largely unfounded, of course), and thus they become his enemies in the coma world.

That's a very good synopsis of his situation, Naroon201, but I disagree on one point. I think he knew what they were saying. "Mandingo" (his subconscious conscience, if you will, while he is in the coma) tells him his family is debating whether or not to pull the plug - meaning at least his subconscious hears what is going on around him. The "butchery" that Mandingo performs on him toward the end is simply his subconscious telling him his condition is getting worse. (Notice he wasn't missing any thumbs or fingers afterward.)

In order to save his family the agony and grief of having to make the decision and then live with it, he decides to stop fighting death and commits "symbolic" suicide.

Those who think his surgery was anything more than a simple colonoscopy gone bad, and that the hospital performed the wrong operation on the wrong person, and then amputated his leg because of flesh-eating bacteria in a wound are missing the whole point. ALL of that happens to his "coma persona" and you'll notice that when his "real persona" is lying on his deathbed with his family around him, he has both legs intact.

Great synopsis. Having just seen this movie last night, I noted and additional something that no one has yet mentioned.

I felt the tear was because of the discussion of the "Living will". As the doctor/lawyer suggests he be removed from life support, Geroge feels that he may finally get peace by being allowed to die. The tear and sadness is because his wife and brother disagree and Geroge cries as he loses hope.

His wife who should be his support and be the one to look out for his interests is now looking out for hers. As the brother told Geroge at the fountain how she gave up her career to raise children, how the children are grown up and ready to leave, how she's an older woman in a young work place world with nothing to do or feel important about. However, this opportunity provides her with a purpose. She'll keep George alive for as long as she lives.

And finally, remember the Last Supper photo that was taken on his birthday? His wife was Judas. And as Judas she is betraying his final wishes. He sheds another tear.

Wished your first paragraph had a spoiler alert. Just started watching it on tv and now I know the ending.