8 Biggest What Ifs In Grey’s Anatomy That Would Have Changed Shonda Rhimes’ Iconic Medical Series

Throughout its long run, Grey’s Anatomy has had pretty shocking developments that changed the course of the medical drama, making it interesting to think about how life would be at Grey Sloan Memorial Hospital had things gone differently. With only two of its original cast members still part of the main cast in Grey’s Anatomy and its titular character occasionally reappearing on the show, the medical drama changed greatly since its series premiere. The stories of various Grey’s Anatomy characters took a sharp turn when their loved ones or themselves unexpectedly died, making some what ifs more impactful than others.

In the decades Grey’s Anatomy persisted, the medical drama often grasped audiences’ attention through its most shocking tragedies, which easily made possible Grey’s Anatomy’s saddest episodes. Its long run – ABC’s longest for a scripted American primetime show – and dramatic flair caused Grey’s Anatomy’s characters to be in danger multiple times. When they weren’t, their choices baffled audiences, leading to some of the most surprising exit storylines even when the Grey’s Anatomy main characters left without dying. This makes wondering where would Grey’s Anatomy’s characters be had some occurrences not happened amusing, as it’d mean great changes for the medical drama.

8. What If Derek Shepherd Didn’t Die

Derek Dying Changed The Course Of Meredith’s Life

Derek Shepherd dying can be counted among Grey’s Anatomy’s biggest shifts with him being the other half of the key couple in the show. Dying after ten years on the show and after he and Meredith went through thick and thin to be together destabilized Meredith and her family. It also shocked viewers for how it happened, with Derek away from his loved ones saving people before getting in a brutal accident and dying as a result of the surgeons’ mistakes. Grey’s Anatomy changed greatly after Derek’s death, especially in regard to Meredith’s story and how that shaped her.

Had Derek not died in Grey’s Anatomy season 11, it’s unlikely his and Meredith’s marriage would have survived. Derek and Meredith spent the best part of Grey’s Anatomy season 10 fighting because Derek had promised to put his career on pause so that Meredith’s could thrive before accepting the president’s brain-mapping initiative, essentially putting his and Meredith’s marriage in deep waters as he once again prioritized his wishes instead of Meredith’s. Grey’s Anatomy season 11 showed them trying to make the relationship work in Seattle and Boston before Derek’s death, but it could have never worked long-term, had Derek survived.

7. What If Cristina Yang Didn’t Leave

Cristina Staying In Seattle Could Have Helped Meredith In Key Moments

The third one from MAGIC to leave, Cristina’s departure for Switzerland was also momentous, happening in relatively similar circumstances to Derek’s in relation to Meredith. Indeed, while not dying, Cristina and Meredith spent the better part of Grey’s Anatomy season 10 fighting and not understanding where their friendship stood, with Cristina feeling isolated because Meredith prioritized her family and Meredith feeling left behind as her career couldn’t progress as far and fast as Cristina’s. While Meredith and Cristina thankfully patched things up before Cristina’s departure, it’s clear the twisted sisters had partly drifted apart.

Hadn’t Cristina left in Grey’s Anatomy season 10, she could have been there for Meredith when Derek died, and audiences could have witnessed her support Meredith through her grief instead of seeing Meredith whisk away her family for months before returning with a third child. Cristina remaining in Seattle for some more time could have given her and Meredith the chance to fully establish the solidity of their friendship again before Cristina eventually leaving for her career to progress, which wouldn’t have made sense to happen in Seattle, not having emotional links there besides Meredith.

6. What If Meredith Grey Had Never Committed Insurance Fraud

Meredith’s Choices With Gabby Rivera Influenced Her Grey’s Anatomy Season 16 Story & Beyond

Meredith has done plenty of extreme things in her career at Grey Sloan, but only one nearly cost her the license to practice medicine. When Meredith chose to do the surgery on Gabby Rivera under Ellis’s name she imperiled her career, but also heavily impacted Richard’s and Alex’s, as all three of them ended up being fired from the hospital. Meredith committing insurance fraud meant she was put to do community service and risked losing her license, making her biggest fight in Grey’s Anatomy season 16 the one to continue being a surgeon.

Committing insurance fraud deeply influenced Meredith’s life beyond almost losing her license. Indeed, it put her and Andrew de Luca in a much more difficult position, as he admitted he was in love with her when she helped Gabby Rivera and Meredith’s silence when he told her was louder than words. Moreover, if Grey’s Anatomy season 15 saw Meredith focused on work and even diagnosing Catherine’s cancer, season 16 effectively stopped Meredith from practicing medicine. Without the insurance fraud, Meredith could have continued building her career to reach even higher highs in Grey’s Anatomy season 16.

5. What If Denny Duquette Didn’t Die

Izzie Could Have Happily Been With Denny For A While

Denny Duquette’s death easily established itself among Grey’s Anatomy’s saddest patient deaths, which also greatly influenced Izzie’s life, making it interesting to wonder what would have happened had he not died. The circumstances of Denny’s death made it exceptionally heartbreaking. Izzie chose to cut his LVAD wire to make his condition worse so that he could get a heart and even involved all those in her intern year to help, endangering her career. Izzie’s choices got Denny his transplant, only for him to die from a stroke after a successful surgery.

How Denny and Izzie connected while he was a patient at Seattle Grace heavily influenced their relationship. Had Denny not died, it would have been unlikely Izzie and his relationship would have survived for long, as the two wouldn’t have met if not for Denny’s congestive heart failure. Denny’s death also partially derailed Izzie’s career. While Izzie would have still received punishment because she cut Denny’s LVAD, had he not died, Izzie would have had the strength to fight for her job, making Denny not dying a watershed moment that would have simultaneously hindered their relationship but helped Izzie’s career.

4. What If George O’Malley Didn’t Sacrifice Himself For A Stranger

George Was Set To Leave Seattle Even Before Dying

George’s death in Grey’s Anatomy season 6 was the first time a main character exited the series so brutally, opening the door for many other characters leaving the series by being killed off, often ruthlessly. George deciding to sign up to serve as an emergency doctor in the military made his death unnecessary, as he was already headed away. Sharing the John Doe his friends and coworkers worked hard to save was George at the end made his exit storyline shocking for characters and audiences alike, making it easy to wonder what would have happened had George not sacrificed himself.

George’s death had a massive impact on all members of MAGIC and beyond. Had his death not happened, George would have still been far from Seattle after shipping overseas, but Izzie, Meredith and the rest of his coworkers wouldn’t have had to mourn George. Instead, their lives could have moved on easily, little by little forgetting he was an integral part of their group as he chose a different path. George’s death instead cemented his importance at Seattle Grace, as they all had to deal with their grief following George’s brutal death.

3. What If Bailey Never Became Grey Sloan’s Chief Of Surgery

Bailey Becoming Chief Of Surgery Greatly Influenced All At Grey Sloan Memorial

Miranda Bailey became Grey Sloan Memorial Hospital’s Chief of Surgery in Grey’s Anatomy season 12, with the medical drama finally paying its dues as Bailey had been the rock on which the hospital relied for so long that she should have received an acknowledgment of her importance before. Bailey remained Grey Sloan Memorial’s chief till Grey’s Anatomy season 18, making her changes to it so impactful that Grey Sloan Memorial would have been a different hospital without her mark.

Becoming chief of surgery also impacted Bailey’s life negatively. While Bailey loved her job, her anxiety became more difficult to manage between being Grey Sloan’s chief and dealing with her husband Ben becoming a firefighter. If Bailey had never become Grey Sloan Memorial’s chief of surgery, she would have never had the feud that caused her to fire Meredith, Alex and Richard in Grey’s Anatomy season 16. Bailey wouldn’t have overseen the pandemic and the residency program being shut down, thus making Grey’s Anatomy an entirely different show had Bailey not been in charge.

2. What If Richard Never Lied To Protect Meredith

Richard & Meredith’s Relationship Would Have Greatly Differed For The Better

Richard and Meredith’s relationship has been complicated throughout Grey’s Anatomy. Without Richard’s meddling, Meredith would have never ended up as an intern at Seattle Grace, and while at first, they didn’t have a bond, their relationship eventually became strong enough that Richard and Meredith both bailed each other out repeatedly, whether from arrest, by messing with research so that their loved ones could have a chance or by lying to protect each other. Richard perjuring himself to protect Meredith nonetheless directly influenced Meredith’s dilemma in Grey’s Anatomy season 21, making that choice one whose ramifications would be interesting to explore.

Richard lying during Meredith’s medical license hearing guaranteed she would have still had a job as a surgeon, but it also influenced Richard’s opinion that Meredith somehow owed him – despite Meredith already doing suspicious things for him in the past, like getting Adele the experimental drug despite having been assigned the placebo, thus messing with Derek’s research. Had Richard not lied to protect Meredith, Meredith wouldn’t have had a job as a doctor, but she also wouldn’t have been accused of unfairness by Richard only because she didn’t tell him straight away about Catherine’s biopsy in season 21.

1. What If Alex Never Chose To Go To Kansas

Alex Would Have Likely Had Kids With Jo

Meredith’s license hearing united multiple key events in Grey’s Anatomy season 16. Indeed, Alex only heard about Izzie having his biological children because he contacted Izzie to ask her to support Meredith at her hearing. Their reconnection and learning about his children led Alex to leave Seattle and Jo in the worst way possible, first by lying about his whereabouts, before sending three letters to explain what had happened to Meredith, Jo and Bailey, letting audiences know the last time they had seen Alex Karev had already passed.

Alex’s decision to leave without a word destroyed Jo for some time, as he had always supported her before and helped her with her rehab, proving how stable they were, only for Alex to disappear without a word and move to Kansas. Had Alex not moved with Izzie and their children, Jo would be having Alex’s children instead of Link’s in Grey’s Anatomy, as they were on the same page. Similarly, Meredith would have still had her person in Seattle, making it more difficult for her to leave in Grey’s Anatomy season 19.