When we tuned into the “How to Save a Life” episode of Grey’s Anatomy on April 23, 2015, we had no idea what we were in for, no clue that original cast member Patrick Dempsey was going to be killed off as Dr. Derek Shepherd after 11 seasons. (The actor still had a year left to go on his contract.) But even if we had been forewarned, we still wouldn’t have been adequately forearmed against the emotional roller-coaster ride that the hour held in store.
One minute, it appeared that McDreamy was going be fine, just fine. Maybe rumors of his imminent death had been greatly exaggerated, we wishfully thought. Maybe it was all but a classic Grey’s Anatomy misdirect. But then the next minute, the neurosurgeon’s car had been rammed into by an 18-wheeler, and Meredith Grey’s beloved husband had been rushed to a subpar hospital where he’d subsequently perish.
We, along with Mer and everyone who adored Derek, were gutted. Behind the scenes, however, it wasn’t necessarily such a sad occasion. In Lynette Rice’s How to Save a Life: The Inside Story of Grey’s Anatomy, former executive producer James D. Parriott said that “there were HR issues” with Dempsey. “It wasn’t sexual in any way. He sort of was terrorizing the set.
“Some cast members had all sorts of PTSD with him,” he added. “He had this hold on the set where he knew he could stop production and scare people.”
Perhaps the actor’s departure was the silver lining to the dark cloud that was the demise of his popular character. (Dempsey reprised his role in Season 17 when a comatose Mer encountered her late spouse on what fans dubbed her “COVID beach.”) On the anniversary of Derek’s passing, scroll through the below ranking of the long-running drama’s most impactful deaths.
25. Jessica Smithson
We still get a lump in our throats just thinking about the little girl whose father was desperate to get her to Mexico for an experimental treatment to save her life. When Bailey finally forced him to hold his daughter as she slipped away, we damn near died along with her.
24. Bonnie Crasnoff
When the pole connecting this Season 2 patient to fellow train-crash victim Tom Maynard was removed, making the hospital her last stop, we were the real wrecks. And don’t even get us started on the bittersweet message that she had Derek deliver to her fianc… Too late. Sniffle.
23. Mary Portman
Though the patient that This Is Us’ Mandy Moore played made it through Gary Clark’s Season 6 shooting spree unscathed, she stunned her husband, Bailey and us along with them when she simply didn’t wake up after routine colostomy bag reversal surgery the following season.
22. Reed Adamson
Speaking of Gary Clark’s reign of terror, this Mercy West transplant had no sooner made the mistake of telling him that she was a surgeon, not a tour guide, than he’d put a bullet in her head and left her body behind to be found by bestie April.
21. Olive Warner
Richard’s Alcoholics Anonymous sponsor had accepted her imminent demise and was ready to go in Season 14. Trouble was, Richard wasn’t ready to let go of his dear friend, played by Mary Kay Place — and neither were we, it turned out.
20. Chloe Yasuda
Mika’s beloved kid sister had just endured her first round of chemo in Season 21 when a car accident with her drowsy sib left her with injuries from which she wouldn’t recover. And as sad as that was, Mika’s reaction upon learning that Chloe hadn’t pulled through — see above — was even sadder.
19. Kyle Diaz
“Faster, Jo! Faster!” we cried. But alas, she didn’t get to the gallery in time to keep Stephanie from seeing as her musician boyfriend, played during Season 12 by Wilmer Valderrama, passed away on the operating table and was pronounced dead by Amelia.
18. Susan Grey
Sure, we felt bad for Thatcher when he lost his second wife during Season 3 of what started as just a case of chronic hiccups. But we felt a hell of a lot worse for Meredith when she told him that Mare Winningham’s sweet character had passed, and in response, he slapped his daughter.
17. Heather Brooks
We still wish that Tina Majorino’s Season 10 exit hadn’t been so “shocking”: If the erstwhile “Mousey” hadn’t been electrocuted following a superstorm, by now the actress might have returned to slip into the lab coat that had accidentally been made for Heather despite the fact that she never got to complete her internship.
16. Elena Bailey
We’ll never listen to “My Girl” the same way again — not after hearing the tear-stained rendition of The Temptations’ classic that Bailey sang to her beloved mother in Season 17 as she lay dying of COVID.
15. Dylan Young
It was with red eyes and heavy hearts that we watched in horror as Kyle Chandler’s Bomb Squad Guy was blown to bits during Season 2 after calming down Meredith enough to remove an explosive device from a patient.
14. Craig Thomas
Though Cristina argued endlessly with her old-fashioned Mayo Clinic mentor, played by William Daniels, she came to care deeply for him. So when he suffered a heart attack while performing an operation during Season 9, we were as gutted as she was.
13. Diane Pierce
We knew that Maggie’s adoptive mother was dying. Yet that did nada to lessen the blow when she stopped doling out life lessons (“Be a little slutty”) and quietly slipped away during Season 13 as her daughter was painting her nails.
12. Adele Webber
Richard’s first wife died off screen during Season 9. However, Grey’s still made sure that we felt the full impact of his loss when the new widower pictured himself and his missus dancing to “My Funny Valentine” as he watched Bailey and Ben on the floor at their wedding.
11. Thatcher Grey
Before Mer’s estranged father died in hospice in Season 15, he made peace with her as best he could by thanking her for the gift of time that she’d given him along with part of her liver. “I just wish,” he added ruefully, “you and I could have shared it.”
10. Ellis Grey
After Meredith died in Season 3, she bumped into her mother in sort of a dimension between life and the afterlife. “You are anything but ordinary,” the elder Grey said before sending her daughter on a journey back to the other side — a journey she herself would never make.
09. Andrew DeLuca
Meredith spoke for us all in Season 17’s midseason premiere when she told her onetime significant other that she’d miss him if he stayed on the other side. But stay, he did. After being stabbed by a sex trafficker, he succumbed to his injuries and reunited in the afterlife with his beloved mother.
08. Doc
We were already in tears when Mer and Derek made the heartrending decision to put down their (and Addison’s) ailing dog in Season 2. But then Mer refused to let Finn dispose of him like garbage — instead, she and Derek would bury Doc near the trailer — and we completely lost it.
07. Samuel Norbert Avery
Lives don’t come much shorter or more painful than that of Jackson and April’s son. Owing to osteogenesis imperfecta, the baby’s bones began breaking in the womb during Season 11, so labor was induced at just 24 weeks. When the newborn died soon after, a part of his parents went with him.
06. Henry Burton
Teddy never meant to fall in love with Scott Foley’s patient; she only married him to get him on her insurance. But by the time he expired during a Season 8 tumor resection, not only was she crazy about him, so were we.
05. Denny Duquette Jr.
By the hardest, Jeffrey Dean Morgan’s charmer had gotten — and survived — his Season 2 heart transplant. He even had warm hands afterwards! But he’d no sooner gotten Izzie to say yes to his marriage proposal than he’d thrown a blood clot and given their romance the unhappiest of endings.
04. Lexie Grey
But… but… Lexie and Mark were supposed to get married and have kids. They were meant to be. She’d agreed with him on that. “Meant to be” was even the last thing she said… before succumbing to injuries sustained in the plane crash with which Season 8 ended.
03. Mark Sloan
Not cool, Grey’s. Not cool. The show let us think that McSteamy was gonna be OK after the plane crash, only to let him slip into a coma during Season 9 before being taken off life-support and leaving behind a crazy-hot corpse.
02. George O’Malley
We never saw it coming. In Season 5, George was on his way to become a trauma surgeon in the army when he leapt in front of a bus to save a woman. Afterwards, he was so unrecognizable that he might’ve died a John Doe, had he not traced a telltale 007 in the palm of Mer’s hand.
01. Derek Shepherd
After McDreamy spent a beautiful day saving lives during Season 11, his car was rammed by a semi, and Dillard Medical Center botched his treatment. “It’s OK,” Mer told her husband after he was taken off life-support. “You go. I’ll be fine.” And she was. But at the time, we weren’t sure we ever would be again.
