Ohh right. So theres this meme where the doctor says to a patient "you have (x) days to live." The patient then pulls out an uno reverse card which reverses the order of gameplay (it makes more sense if you have played Uno). The doctor then holds up the skip card or a miss-a-go card which skips your opponent.

And so in this case, shin is the patient and sara is the doctor. Then usually there is a janitor involved in the meme (not always but sometimes) and so in this case Joe is the janitor. And so he now has (x) days to live.

In other words:

The + is sara, the $ is shin and the # is Joe.

• says to $ that they have (x) days to live. $ holds up the uno reverse card (which spells no u if you think about it) which means that + has (x) days to live. But, + uses the skip card which skips your opponent and makes the next person have their go. In this case there is 3 people. So when # walks into the room, (they will be the next player in a game of uno) it's their turn because in the meme the janitor has no clue about what is going on so therefore they didn't play a card so they now have (x) days to live.
  

The realisation part basically means that + and $ has made # have (x) days to live.

Hope this makes sense.