Derek’s Devastating Death in ‘Grey’s Anatomy’, Explained

Derek’s Controversial Death

In “How to Save a Life,” Derek Shepherd is driving to resign from a Presidential project to help map parts of the brain. On his way, he spots a car crash, so he stops to help the injured people. He waits for paramedics to arrive, then gets back to his car. However, a semi-truck collides with him, as he’s getting back into his car, leaving him injured.

Paramedics take Derek to a nearby hospital, far away from the show’s usual hospital in Seattle, Washington. One of the residential doctors at the hospital suggests a CT scan for Derek, but the physician in charge rejects the idea. Derek, being a skilled neurosurgeon, assesses his injuries in a voiceover and says that he needs a CT scan, but he’s unable to communicate with the doctors due to his injuries.

The doctors eventually notice that Derek has a blown pupil, which signifies that Derek has brain damage. A neurosurgeon is unable to arrive in time to save Derek, and the doctors declare that he is brain-dead.

‘How to Save a Life’ Gives Derek an Emotional Farewell

Meredith Grey only arrives at the hospital after the doctors have recognized Derek is beyond saving. Because Derek is brain-dead, she’s unable to have a final conversation with him, and she questions the attending physicians’ judgment in choosing not to perform a CT scan.

Meredith has to make the decision to pull Derek off life support. Meredith and Derek got married in earlier seasons of the show and even had adopted kids together. Their relationship was becoming strained with Derek working in Washington D.C. throughout season 11, but he was about to quit, and she was pregnant with their third child, making it all that much harder for her to sign off on his death. The episode ends with a montage showcasing the highlights of Meredith and Derek’s relationship.

The episode also comes full circle as it was written by the series’ creator Shonda Rhimes. It was the first time since Season 8 that Rhimes wrote an episode, and it was only fitting for a send-off for one of the show’s most popular characters.

Derek’s Death Came from Behind-the-Scenes Problems

Season 11 was a rough season for Derek Shepherd. Patrick Dempsey had appeared in every episode of the show up to that point, but his position working in Washington D.C. for the brain mapping project kept him from appearing regularly in episodes.

In the book How to Save a Life: The Inside Story of Grey’s Anatomy, cast and crew members of Grey’s Anatomy revealed that Patrick Dempsey was having a difficult time continuing on the show. Dempsey didn’t particularly enjoy working on the show, and it was affecting the rest of the Grey’s Anatomy crew. An excerpt of the book published in The Hollywood Reporter includes quotes from executive producer James D. Parriott detailing Dempsey’s behavior.

“There were HR issues. 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 had this hold on the set where he knew he could stop production and scare people. The network and studio came down and we had sessions with them. I think he was just done with the show.”

In the excerpt, Patrick Dempsey also gave his own defense of why working on the show was upsetting him. “It’s ten months, fifteen hours a day,” Dempsey said. “You never know your schedule, so your kid asks you, ‘What are you doing on Monday?’ And you go, ‘I don’t know,’ because I don’t know my schedule. Doing that for 11 years is challenging.”

The time away from Grey’s Anatomy after Derek’s death opened the opportunity for Patrick Dempsey to come back in an emotional way in Season 17 of the show. In a multi-episode arc starting with “The Center Won’t Hold,” Meredith Grey gets COVID-19 and falls into a deep sleep. In her sleep, she has visions where she talks to Derek again, still played by Patrick Dempsey. It’s an emotional return for the character, especially because Derek convinces Meredith in a vision to leave her sleep and help the hospital.