It's a Beautiful Day to Share These Grey's Anatomy Secrets

Meredith Grey Was Always Ellen Pompeo

Shonda Rhimes pictured “a girl like the girl from Moonlight Mile” for the part of ambitious, endearing surgical intern Dr. Meredith Grey.

“Finally," Rhimes recalled to Entertainment Weekly, "somebody said, ‘I think that girl is Ellen Pompeo.'" And the actress, who played Jake Gyllenhaal's love interest in the 2002 film, already had a deal with ABC.

The only issue was, Pompeo found the subject matter anxiety-inducing—unlike Rhimes, a self-professed scripted-surgery addict.

"I don’t particularly like medical shows at all," Pompeo told Parade in 2013. "I never have. The show that was really big at the time for my generation—before I started Grey’s — was ER. That was on forever, but I’ve never seen one episode!” (Nor, as she told The Hollywood Reporter, did she want "to be stuck on a medical show for five years.")

But after meeting Rhimes, she told EW, "It was like, 'I want to do the show.'"

Rob Lowe Literally Could Have Been McDreamy

Before Patrick Dempsey defied his skeptics and ascended to the role of dreamy brain surgeon Dr. Derek Shepherd, ABC wanted Rob Lowe for the part.

"He had a choice of either doing our show or Dr. Vegas for CBS," Grey's executive producer Peter Horton said, according to Lynette Rice's 2021 book How to Save a Life: The Inside Story of Grey's Anatomy. "He chose Dr. Vegas."

Lowe quipped, "My picker was awesome!" But really, the West Wing alum explained, he "just had a better meeting with CBS" and he went with "vibe over the script."

But you can't argue with science, Pompeo saying, per Rice, that she read with five potential McDreamys and "it was quite obvious right off the bat that Patrick and I had the best chemistry."

There Were Complications Naming the Show

The show was briefly called Complications because then ABC Entertainment President Steve McPherson "hated" the title Grey's Anatomy, producer Harry Werksman told Rice. ABC even optioned Dr. Atul Gawande's book Complications: A Surgeon's Notes on an Imperfect Science, JIC.

Kate Burton, who played Meredith's Alzheimer's-stricken mother Dr. Ellis Grey, said the working title was Surgeons when her manager brought her the script, while writer Eric Buchman remembered someone pitching the title Miss Diagnosis, which Rhimes "just outright hated." Chandra Wilson, meanwhile, recalled "coming into this untitled Shonda Rhimes project" that she assumed was "never going to go anywhere."

Buchman said he couldn't remember "who made the call to go back to Grey's Anatomy."

Production Was Halted After One Episode

 The Truth About the Grey's Anatomy Theme Song

When you think of Grey's music you probably think of "How to Save a Life" by The Fray or Snow Patrol's "Chasing Cars," or perhaps The Postal Service's "Such Great Heights" delivers you to Seattle Grace every time. But the show's actual title theme for the first two seasons was "Cosy in the Rocket" by Psapp, which still plays instrumentally over the closing credits.

"We weren't even going to release it, because we weren't that into it," Psapp singer Galia Durant told The Guardian in 2007 of the song that put them on the map. "But a few months later our manager played it to the music supervisor at Grey's Anatomy and she went, 'I want that.' We said, 'Have it, we're not going to put it out.'"

Bandmate Carim Clasmann told Shondaland in 2024 that they had no inkling at the time of what it meant to have Grey's use their song, "because in our little bubble making music, we didn't quite appreciate what was going on all around."

The Real-Life Seattle Grace

An abandoned veterans hospital in Northridge, Calif., was used to shoot the pilot and, as remembered by former showrunner Stacy McKee, per Rice, "the writers' offices were literally hospital rooms. The windows were nailed shut because apparently it had been a psych ward or something."

The show is still filmed primarily in Los Angeles, but the exteriors of fictional Seattle Grace Hospital—inspired by the real Harborview Medical Center—are Seattle's KOMO Plaza.

Hair & Makeup & Scrubs

Every actor must wear just the right thing, but the real challenge for costume designer Mimi Melgaard was to ensure that the clothes never stole the show.

"Everything had to be subdued," she explained to Rice. "Even in surgery, you see the bottom of the scrub cap and their eyes. I didn't want anything to distract from their eyes."

And scrubs are "totally ill-fitting," Melgaard noted, so they had to be altered to look natural but not unflattering "within the reality of the show."

Makeup director Norman Leavitt also took an oath to "do no harm," he told Rice. Producer Horton "wanted everybody to look, like, rough and ready," he explained, " to try to keep them looking real," but Rhimes, ABC, et al. "wanted a little more glamour."

Shonda Rhimes Thought the Isaiah Washington Scandal Would Be Terminal

Rhimes worried that Grey's wouldn't survive the bad press after Isaiah Washington was fired in 2007 for using a homophobic slur during an argument with T.R. Knight on set in October 2006.

“I think the thorn was having the bubble of joy burst so early on Grey’s," Rhimes told The Hollywood Reporter in March 2025, “and not having anybody interested in helping us deal with it, because that really shaped a lot of how we looked at the world going forward."

She added, "Every Grey’s actor I talk to who was there during that time is still traumatized by that incident. People still talk about it."

At the time, after initially trying to explain he hadn't meant the word in an anti-gay way, Washington apologized. After uttering the word again backstage at the 2007 Golden Globes, he issued another statement saying, "I know a mere apology will not end this, and I intend to let my future actions prove my sincerity.”

But plot authenticity trumped any old bad blood. The erstwhile Dr. Preston Burke credited Sandra Oh for his reappearance on Grey's in 2014 ahead of Dr. Cristina Yang's exit, writing on X in April, "She refused to leave the show without my return and she won that battle."

Katherine Heigl's Dr. Izzie Stevens Was Almost Killed Off

Rhimes revealed she envisioned an off-camera demise for Izzie, who survived a brain tumor and disappeared in the middle of season six when Katherine Heigl was released from her contract, but thought that would be an unfair blow to Alex Karev, played by Justin Chambers.

And when Chambers left the show 10 seasons later, Alex and Izzie got their happy ending as together-again parents of twins.

"At the end of the day, there were three choices," showrunner Krista Vernoff told TVLine in 2020. "Kill Alex off camera, have Alex be alive and in Seattle—and still married to Jo [Camilla Luddington]— and we just never see him, or [he's] with Izzie."

Ultimately "this wasn't even a debate in the writers room," Vernoff said, giving Alex life and Jo a fresh start "was so clearly the right course."

Katherine Heigl Backlash Postmortem

Heigl, who won the Best Supporting Actress Emmy in 2007, was slapped with the difficult tag after calling Knocked Up "a little sexist" and, in a separate interview, revealing that she didn't submit herself for Emmy consideration in 2008 because she didn't feel that Izzie's storyline deserved it.

Heigl told Howard Stern in 2016 that she apologized to Rhimes for her Emmys comment, but the backlash she encountered from speaking her mind left her feeling "completely like the biggest piece of s--t on the bottom of your shoe. I was really struggling with it and how to not take it all personally and not to feel there was something deeply wrong with me."

Therapy helped because, Heigl explained, "I don't want to compromise who I am and what I have to say so much that I go to bed going, 'I've just become a robot, now I just do what they tell me to and say what they want me to say.'"

Hindsight Is 20/20

Heigl also raised some eyebrows when, on The Late Show With David Letterman in 2009, she called it "cruel and mean" to require the Grey's team to routinely work a "17-hour day."

Looking back, Pompeo said on an April 2022 episode of her podcast Tell Me With Ellen Pompeo that, had Heigl "said that today, she'd be a complete hero. But she [was] ahead of her time. She made a statement about our crazy hours and, of course, let's slam a woman and call her ungrateful. When the truth is, she's 100 percent honest and it's absolutely correct what she said, and she was f--king ballsy for saying it."

Pulling the Plug on McDreamy

After Rhimes cryptically admitted on the Nightly Show With  Larry Wilmore in 2015 that she had killed a character in the Shondaverse because she didn't like the actor, speculation swirled that the corpse was Dempsey's Derek, who had long since chosen to love Meredith when he was devastatingly killed off at the end of season 11.

Asked for his diagnosis, Dempsey told EW that Rhimes "loves being provocative and that's fine for who she is." Calling her "an amazing woman who's incredibly productive," he added, "I think she knows how to deal with the media and what she needs to say to get the response that she's looking for."

Per How to Save a Life, tensions were high between Dempsey, Rhimes and cast members who, according to former executive producer James D. Parriott, "had all sorts of PTSD with him." But by then, Parriott said, Dempsey "was just done with the show."

Pompeo "would get angry that he wasn't working as much," former executive producer Jeannine Renshaw said, per Rice's book. "She was very big on having things be fair."

Any alleged wounds were salved enough to welcome Dempsey back to be in comatose Meredith's dream in season 17.

Scrubbing In Again and Again

Though Pompeo stepped back from her every-episode presence in 2022, she, along with series regulars Wilson and James Pickens Jr.—Drs. Miranda Bailey and Richard Webber—are the only season 22-and-counting Grey's stars who've been there since day one.

Pompeo told El País in April 2025 that it "would make no sense, emotionally or financially," for her to leave the show.

"The show was streamed more than a billion times in 2024," she explained. "The companies that own the show and stream the show make a lot of money from our images and our voices and our faces. If I were to walk away completely, everybody gets to make money from my hard work for 20 years and I wouldn’t make any money…And emotionally, the show means a lot to people. I want to have an attitude of gratitude toward the show."

How Ellen Pompeo Earned Her Massive Paycheck

In 2017, Pompeo signed a deal worth more than $20 million a year: $575,000 per episode plus a seven-figure signing bonus and two backend equity points worth upward of $6 million, per The Hollywood Reporter. She also became a series producer with an office on the Disney lot in Burbank for her Calamity Jane production company.

Harkening back to when she asked for $5,000 more per episode than Dempsey was being paid, "just on principle," and was turned down, Pompeo explained in 2018 that his exit from the show was a "defining moment, deal-wise."

No longer having him on the show meant his popular character's presence couldn't be leveraged against hers. And with Rhimes' various mega-deals as inspiration, Pompeo aimed higher and went after what she felt she deserved.

"When your face and your voice have been part of something that’s generated $3 billion for one of the biggest corporations in the world," she told THR in 2018, "you start to feel like, 'OK, maybe I do deserve a piece of this.'"

Chandra Wilson Thought She'd Be One and Done

Wilson thought her IRL pregnancy during season one would precipitate her exit from the show.

"My first instinct was to get in touch with Shonda and say, 'Thank you so much for allowing me to to play Dr. Bailey for the first season, and I understand that I'll have to step away now,'" she said on Good Morning America in October 2025 ahead of the season 22 premiere. "She was like, 'I don't know what you're talking about. Don't be ridiculous.' And that was news to my ears."

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Hands-On Experience

So, do any of Grey's doctors feel as if they know how to save a life IRL? Or at least use a tourniquet?

Pompeo admitted she had become "definitely more interested" in medicine, but "wouldn't say you can learn things."

"Being a doctor is the hardest thing you can do," she told Parade. "Twelve years of school, the pharmaceutical knowledge, the body parts, the Latin terminology, the memory retention you have to have. Doctors are serious rock stars, so I wouldn’t pretend to know even a tenth of what they know."