Grey's Anatomy Cast Spills New Secrets Behind the Show's Most Shocking Exits

In an exclusive excerpt of the book How to Save a Life: The Inside Story of Grey's Anatomy, author Lynette Rice spoke to cast members about their shocking exits.

By Mike Vulpo Sep 17, 2021 9:23 PMTags
Watch: Patrick Dempsey Allegedly "Terrorizing" on "Grey's Anatomy" Set?

Some deaths at Grey Sloan Memorial Hospital are truly unforgettable.

For longtime viewers of Grey's Anatomy, they've seen their fair share of doctors roll up their sleeves and say goodbye to the long-running ABC series. While some get a proper TV funeral, others disappear without a trace, leaving some fans wondering, 'What really happened to that cast member?' Fortunately, a new book may just hold the answers. 

Just in time for season 18, How to Save a Life: The Inside Story of Grey's Anatomy is set to be released on Sept. 21. Author Lynette Rice shares behind-the-scenes secrets about a show that became a pop culture staple.

And with new interviews from show creator Shonda Rhimes and various past and present cast members, fans can count on the truth as they read through page by page. 

Ahead of its release, E! News received an exclusive excerpt from a chapter viewers will be talking about in the days and weeks to come.

Grey's Anatomy's Departed Doctors: Where Are They Now?

Why was Dr. McSteamy's (Eric Dane) exit from the show so tough for the writers? And how did Dr. Teddy Altman (Kim Raver) manage to exit and come back to the show? Keep reading for all of the hospital secrets. 

St. Martin's Press

When a show lasts as long as Grey's Anatomy, it's natural to expect that most cast members—if not all of them—will want to hit the road someday. No matter how great the salary is, playing the same role year after year can take an emotional (and sometimes physical) toll. It's the same sentiment for the writers: How many grueling surgeries and bad relationships can one character endure before you run out of story? In television, everyone has an expiration date.

If you're lucky enough—or, more specifically, if your name is Sandra Oh—you get the perfect goodbye. After giving Shonda Rhimes plenty of notice about wanting to leave at the end of season ten, Oh just had one very important request for her final episode, which she told Entertainment Weekly in 2014: "Please! I would like my character to remain alive."

Ron Tom/ABC

Sandra Oh: As much of my life as I feel like I [gave that] character, she has saved me and helped me grow into the artist that I am. If [Shonda] didn't ask me to come back for the series finale, I would hurt her.

Shonda Rhimes: I thought it was interesting that Cristina got the happiest ending of any character that I can imagine.

She wasn't kidding. Many of the show's high-profile departures were either surprisingly abrupt or shrouded in mystery and/or controversy. Case in point: After Jerrika Hinton stopped playing Dr. Stephanie Edwards in 2017, rumors persisted that her relationship with Ellen Pompeo—specifically, how Hinton liked to take personal photos on set without asking Pompeo's permission—had hastened her departure from the show. Hinton declined to address the situation for this book, but her comments to EW's Natalie Abrams at the time seemed to suggest the situation was a bit more complicated than her just deciding to leave one day.


Norman Leavitt: Jerrika was always laughing, but maybe she was a little naive. She hadn't been around a lot, so maybe she didn't quite understand the power Ellen had. If she'd gone and said, "Is it okay if I take these Polaroids?" Ellen probably would've gone, "Okay." But by just doing it and not including her, you're setting yourself up for disaster.

Shonda Rhimes: Actors evolve differently, and when an actor like Jerrika comes to me and says she wants to try something new creatively, I like to honor that. Jerrika has shared so much of herself with Stephanie, and I am incredibly proud of the journey we've taken together. While I'm sad to see Stephanie leave Grey Sloan Memorial, I'm excited to see what's next for Jerrika.

As for other cast members, walking papers were issued in myriad ways, for myriad reasons.

Watch: Would Sandra Oh Ever Return to "Grey's Anatomy?"

Tessa Ferrer: Shonda and Betsy, whom I adore, were brilliant, and they were nothing but kind to me. They called and said, "We love you. We don't need your character anymore. That's it." That's just how it was.

Steven W. Bailey: I never found out. I was never officially written off or anything. It just became an issue of economics, like so many things in Hollywood. They just basically determined that I was not adding any value to the show, so they didn't want to pay me.

Sarah Utterback: I remember being at a table read and finding out. Literally being there, you read and you go, "Oh, this is it. This is it." And everyone's looking at you like, "This is it. This is goodbye for Olivia."

Nora Zehetner: I knew my character arc was wrapping up, but I didn't know I was going to die as opposed to just going off in the world to another hospital. I didn't have any control over it. If I had, I would have saved a baby or something before I died instead of sleeping with Mark Sloan.

ABC/Mike Rosenthal

Kim Raver had a rather abrupt exit in season eight as Dr. Teddy Altman, only to come back in season fourteen to stay indefinitely. Her first goodbye on the show was gut-wrenching because, while grieving over her dead husband, Henry (Scott Foley), she told her former lover Owen (Kevin McKidd) that she hated him.

Jeannine Renshaw: It was hard to find stories for Kim [at that time]. We wanted Owen to be with Sandra Oh, so it was like, Who is he going to pick? Cristina or Teddy? It was getting harder and harder to find a place for her in the stories. No fault of hers, but once Henry died, that was such a moving, gripping story, and it just felt like we hadn't given her a lot of other things that could then foment into a story.

Kim Raver: I called Shonda and said, "Isn't this a little too harsh?" She was like, "You've got to go for it." It had to come from such a place of pain that Teddy couldn't even express her grief and the only person she could do it with was her person. I was wrecked when Scott's character died, but it was so wonderfully complicated with Cristina and Owen. It was an incredible collage of complexity, which was a gift.


Brooke Smith was a huge fan favorite for her portrayal of Dr. Erica Hahn, a cardiothoracic surgeon who was dubbed "the new Burke." After sleeping with Callie for the first time in season five, Erica gave what was lovingly nicknamed the "leaves speech" for comparing their sexual experience to getting glasses as a child. Erica gazes at Callie with teary eyes and declares,"You are glasses. I am so gay." Shortly after shooting that episode, the decision was made to yank Smith off the show. Smith didn't see it coming.

Brooke Smith: I know Shonda was very happy with the leaves scene. The next thing I heard was a message from the assistant director saying she wanted to see me after I wrapped. I had my Prius key in my hand the whole time. I guess I remember that I was squeezing it. I was totally blindsided. When she told me that I was going to be let go or fired or whatever, I said, "When?" And she was like, "This is your last episode." We were already shooting it. I was like, "What's going to happen to me?" I know there was quite a bit of time between when I was told and when the episode aired... It definitely felt like the order came from above. It was clear Steve didn't like me. I mean, I do remember him coming to visit the set about two weeks before I got fired. I remember asking, "Who is that guy?" Someone replied, "What do you mean who is that guy? That's the head of ABC!" Well, surely, I was thinking to myself, he's going to introduce himself, right? He never did. 

Mark Wilding: Steve McPherson made his decision and then that was that. She was gone. It was one of those things where we were told he didn't like her, so get rid of her. Then we came up with a six-episode arc to ease her out of the show. But it was like, "No, you don't understand. Get rid of her now." We had to do it in the here and now.

Stephen McPherson: I don't even remember who [Brooke Smith] was. This is why I left and hate the entertainment biz. I pity people like her—delusional blame and hate directed toward others in attempts to make themselves feel better. I had nothing to do with anything regarding her, including even casting her. When you're in a position like I was, there is a daily onslaught of hate pointed at you, as people want to blame their own failures on someone.

Brooke Smith: I loved Hahn. I thought she was great. I feel bad that she didn't have a proper send-off. I remember at the time, like, "Oh my God, what a coup. How did I get here?" I'm still hurt by Shonda, because I never heard from her again after that day. I guess part of me thought maybe, just maybe, she just didn't like the character and fired me. I have no idea. But if it was some order from above or whatever, I just kind of hoped that she would fight for her characters a little more.

Shonda Rhimes: Sara Ramirez [was] an incredible comedic and dramatic actress and we wanted to be able to play up her magic. Unfortunately, we did not find that the magic and chemistry with Brooke's character would sustain in the long run. 

Randy Holmes/ABC

Bidding farewell to Eric Dane, aka McSteamy, was also particularly tough for the writers. Though he was a highly respected plastic surgeon, Mark Sloan's best attributes were how he brought levity—and a great set of abs—to the halls of Seattle Grace.

Shonda Rhimes: When Mark Sloan first appeared on Grey's Anatomy in season two, the original idea was to have him do one episode. But none of us planned on what would happen once we cast Eric Dane. His Mark Sloan wasn't just flirty and handsome—Eric's Mark Sloan was dirty and hot but also completely self-aware of what he was lacking in emotion and self control. Eric's Mark Sloan was smart enough to know he was a man-whore and sexy enough to make the audience believe in him anyway.

Dane and Chyler Leigh sizzled, despite a difference in their ages. But their love was not meant to be: Lexie died in the plane crash at the end of season eight because Leigh wanted off the show to pursue other projects, while Mark succumbed to his injuries from the same disaster the following year. In a statement at the time, Shonda Rhimes made it sound like a decision that she and Dane made together, if not Dane's alone: "It felt like the right time for him. I love Eric, and Eric and I have been working together for a long time, so it was bittersweet. I'm happy he's going to go on and do other things." But economics may have had a lot more to do with it.

Jeannine Renshaw: Everyone wanted to keep McSteamy alive. He was a wonderful character to write for, very funny. I don't think anybody wanted him to die. As I recall, it was a budget thing. We had to get rid of somebody. So I don't think anybody wanted to kill anybody. Chyler had asked to leave, so then we just felt like... yeah, it was time, story-wise. You have to lose people on that show.

Shonda Rhimes: I like to believe that Mark is with Lexie somewhere. That those two characters are spending eternity together, getting to have the relationship they were never able to have when they were alive.

Vivian Zink/ABC

If only George O'Malley had someone waiting for him on the other side. By the time the decision was made to kill off T. R. Knight's character in the season five finale, it ended a long and supposedly uncomfortable period between him and Rhimes. The tension seemed to start after he followed the Isaiah Washington incident by announcing he was gay.

T. R. Knight: I think she was concerned about having my statement come out so close to the [initial] event.

Shonda Rhimes: I said, "If you want to come out, that's awesome. We'll totally support you." And then he went away, thought about it, and came back and said, "I'm going to make this statement." I remember saying to Betsy Beers, "This is our proudest day here. T.R. got to come out, and I got to say to him that it wouldn't affect his character," because he was concerned that he was going to come out and George would suddenly be gay. I was like, "We aren't going to do that." The idea that a gay actor can't play a straight man is insulting.

But then Knight saw his screen time diminish in seasons four and five, so when it came time to discuss his character's future with Rhimes, Knight said he would rather leave instead.

T. R. Knight: There just comes a time when it's so clear that moving on is the best decision.

Shonda Rhimes: I wasn't done telling stories for him. We used to joke that George would be the last person wheeled out of the hospital as chief of surgery. I looked in his face and he was really sure.

Katherine Heigl: I didn't think it was the right decision. I felt like some of the problems could be worked through or looked at differently or tolerated, because it [was] a good job on so many levels.

Mark Wilding: I just think he wanted to go do something else, frankly. I don't know that he was happy on the show at that point. I don't really think it was a breakdown in communication so much as it was he just didn't want to do the show anymore.

T. R. Knight: My five-year experience proved to me that I could not trust any answer that was given [about George]... I never made any demands, like, "You do this, or else." I was always very respectful. In any sort of creative process, there are going to be disagreements.

We Ranked All the Grey's Anatomy Deaths By How Hard They Made Us Cry

The decision to literally throw George under a bus after saving a stranger was not an easy one for the writers.

Mark Wilding: He was our first major character to actually get killed off. You're always faced with the dilemma of having him go to another hospital or dying in a heroic manner. Here's the thing about the show: we wanted to go for hard laughs, but we also wanted to go for really emotional moments, for people to get really caught up in and moved.

Jeannine Renshaw: You have to lose people on that show. That's what's so great about Shonda. Shonda was willing to lose people and to have people die, which felt sort of new and fresh. And then Game of Thrones started doing it and everyone was talking about how Game of Thrones was so willing to kill people. I was like, "Shonda's been doing that forever on Grey's Anatomy."

Jenna Bans: That was really hard to figure out what to do. You realize as a writer that so many people love and live with the characters; that it's kind of a huge responsibility to figure out how to give them a great send-off that will at least, if not make the fans happy, be satisfying story-wise. George leaves to join the military toward the end of that season and he gets in a horrible accident. Meredith is taking care of this disfigured, injured patient. And at the very end, he writes what they all call him from season one, 007, on her palm with his finger. That's the moment she realizes it's him. I think when Shonda pitched that, we all got chills in the room.

Mark Saul: I just remember my jaw dropping when I read that the first time. It was so clever and heartbreaking. It came out of nowhere for me, so I was really impressed with the writers' ability to do that.

Watch: T.R. Knight Sounds Off on "Grey's" Inclusive Nature

In fact, Knight didn't have to show up for those final episodes. Any extra could have worn the disfiguring prosthetic on his face. But Knight was determined to work until the very end.

Norman Leavitt: It was just weird, the whole thing. It was really uncomfortable and T.R. didn't need to be there. He chose to do it. He was real Method.

Tom Burman: He wanted off the show, so they literally threw him under the bus. He never complained once, and when we had his whole head covered, he never complained once. They punished him for wanting to get off the show. Petty, huh?

Jenna Bans: Although it was completely tragic, he died in service to other people. We felt like that was a really important part of his character. And not only was he leaving to join the military, he got hit by a bus because he was pushing someone else out of the way. We felt like he definitely died a hero. That was something collectively as the writers' room we wanted to give that character.

Nicole Rubio: It was so sad for many reasons. Obviously it was something he felt compelled to do. When someone is moving on to try different things, you wish them well. But man, I loved that George. I loved working with T.R. It's like you start losing the foundation. The foundation starts to shift a bit. And then can you hold that foundation together with the rest of the bricks that you have?

T. R. Knight: There were so many wonderful experiences. [After] doing so much theater, to be able to spend five years with some really remarkable people, and also get to constantly explore acting in front of a camera for that time, there's so much I learned from [Grey's] as a person, and also just as an actor, that it informs everything, but in a way that I'm really grateful that it informs everything. It leaves me with a very grateful and thankful heart.

Rhimes tried to convince Knight to return in flashbacks for the first episodes of season six, but to no avail. Still, fans did get one last look at their beloved George, and it was breathtaking: he's quietly standing in uniform while looking at Izzie standing in the elevator, wearing her pink prom dress.

T. R. Knight: To me it was so powerful. I thought it was the best way to leave it.


Ten years is a long time to be on a show—just ask Sandra Oh—so it wasn't too much of a surprise that Sara Ramirez was ready to throw in the towel at the end of season twelve. But the way that she did it was very unexpected, both for fans and for Shonda Rhimes. First, the actress tweeted, "That's a wrap for Doctor #CallieTorres @Season 13 #Grey's Anatomy. Thank you all for an enriching & unforgettable #rollercoaster ride!" Then she released a statement saying, "I'm deeply grateful to have spent the last 10 years with my family at Grey's Anatomy and ABC, but for now I'm taking some welcome time off." Later, Rhimes revealed at the Vulture Festival in New York that she'd learned of Ramirez's decision to depart only three days before the actress made her decision public.

Rhimes never wanted her actresses, including Ramirez, to feel uncomfortable during sex scenes. If they didn't want to show a lot of skin, it was always their choice to remain hidden under the covers. But Rhimes also wouldn't let Ramirez sabotage her own intimate scenes by wallowing in self-doubt.

Sara Ramirez: I was pretty much naked that season [when Callie dated George]. They put me in my underwear, for God's sake. I felt intimidated and fat. I said to [Shonda Rhimes], "Girl, there is so much cottage cheese up in this set." She smiled and said, "Work it." She would not entertain my insecurities. It's a beautiful thing.

Mimi Melgaard: I think everyone has moments of insecurity. It doesn't matter if you're famous or not famous. You still go, "Argh!" I was there to make sure that they looked good, and they did look good, trust me. We all had a really great working relationship.

Still, there were differences of opinion over whether the show was oversexualizing Callie. Though naturally beautiful, Ramirez still wore more makeup than the other actresses—something that was not lost on the network or Rhimes.

Norman Leavitt: We'd get notes that her hair was too much or too little or too... something. Her bright cheeks or her lips were weird. Sara was a great gal, just really wonderful, but I think she was insecure. Some of the other actresses are really attractive and have big egos. Actresses are funny, because without doing a lot, they can make another actress feel really insecure.

Jaicy Elliot (Dr. Taryn Helm): I think it is important to talk about it, because everyone's so beautiful in the cast and everyone is so slender. Everyone is just so incredibly flawless. Growing up, I definitely would have felt empowered by seeing a plus-size character on such an iconic show. I get a lot of feedback from people feeling represented. I think that that's really important, because we're in the time when images are changing and people are opening up to different realities. In real life, I'm a healthy person and I work out and eat healthy, but it's important for people to know that opportunities aren't restricted to people who are a certain type or fit in a certain box.

Grey's Anatomy's Most Shocking Moments

Callie, like Cristina, got a happy ending: she reconciled with Arizona and reunited with Penelope in New York.

Tony Phelan: I'm particularly proud that we put a relationship between a lesbian woman and a bisexual woman in America's living room. We had these two characters fall in love, get married, have children, and break up. And I think it was the relationship that a lot of people were deeply invested in, and I think it went a long way to making that kind of a relationship something that people in Middle America would now understand.

But even Ramirez seemed to indicate there was more story left in her alter ego. After Rhimes revealed that she'd tried to get Ramirez to return for Jessica Capshaw's send-off in season fourteen but was stymied by CBS, Ramirez's new network for Madam Secretary, the actress took the time to post this 2018 tweet: "For the record @CBS has been nothing but gracious and generous to me. They are open to Callie coming back! The ball is in @ABCNetwork's court." She added the hand/peace sign and some purple heart emojis.

Sara Ramirez: Shonda and I agreed to keep the conversations going, and she knows I'm open to keeping those conversations going.

Lesley Goldberg: Sara's exit came as a big surprise. Many industry observers, myself included, thought a cryptic tweet that she posted in April 2016 was an attempt to leverage her sizable and vocal fan base to bolster ongoing contract negotiations. A month later, she was gone, and the chapter on one of television's most important examples of LGBTQ+ visibility would be closed. Callie and Arizona were TV's first prime-time lesbian wedding.

Shonda Rhimes: She will always have a home at Shondaland.


If Ramirez's departure stung fans, then the news about Jessica Capshaw and Sarah Drew exiting in 2018 just about killed them. The timing was not ideal: Ellen Pompeo had just signed a $20 million–plus two-year deal that would keep her on the show through the sixteenth season. And thus a narrative emerged that Drew and Capshaw were dropped because "no producer likes to add more to the budget," one studio executive opined. Insiders insisted that one had nothing to do with the other.

Krista Vernoff: As writers, our job is to follow the stories where they want to go and sometimes that means saying goodbye to characters we love.

Sarah Drew: The answer that was given was, "We've put you through so much and I don't know what else to put you through," and it's a "creative decision, it's not a budgetary one." I feel like I'll never really know why. It is what it is. It's just that for someone who'd been on the show for nine years, it felt strange... I must have said "I'm so confused" like ten times in that meeting... When you're in the writers' room, you're trying to come up with what's going to shake things up and what's going to make things fresh and new and interesting.

Shonda Rhimes: I will be forever grateful to both Jessica and Sarah for bringing these characters to life with such vibrant performances and for inspiring women around the globe. They will always be a part of our Shondaland family.

Sarah Drew: Honestly, to speculate is, for me, a waste of time. It doesn't help me in any way to try to understand. In the aftermath I've had so many people come up to me to say, "I'm so glad you're at least alive, like, I'm so glad that April didn't die." For the sake of the fans, then, yeah, I'm glad. She had a happy ending. She discovered her new calling and she got mar- ried and that made her really happy and feel really fulfilled. I think that felt good for a lot of the fans.

And it felt good for Drew, too.

Sarah Drew: There were so many beautiful things that happened because of how it went down. I wouldn't have experienced the kind of love that was thrown my way if I had just left when the show ended. I wouldn't have gotten letters from my cast mates and members of the crew. I wouldn't have had fans hire a plane to fly over the set saying, "We love Sarah Drew and Jessica Capshaw." It meant so much to me. So it's interesting how the things in life that feel really challenging can actually wind up being beautiful. I'm constantly being reminded of that in my life.


An actor who has appeared on a show since the very beginning should, at the very least, get his own sky sign. But there was no time to throw any sort of goodbye party for Justin Chambers, who released the shocking announcement in January 2020 that he was leaving the drama that made him a household name. There wasn't even a last chance to see him in scrubs, since his final episode had aired almost two months prior.

Justin Chambers: There's no good time to say goodbye to a show and character that's defined so much of my life for the past fifteen years. For some time now, however, I have hoped to diversify my acting roles and career choices. And, as I turn fifty and am blessed with my remarkable, supportive wife and five wonderful children, now is that time. As I move on from Grey's Anatomy, I want to thank the ABC family, Shonda Rhimes, original cast members Ellen Pompeo, Chandra Wilson, and James Pickens, and the rest of the amazing cast and crew, both past and present. And, of course, the fans, for an extraordinary ride.

In an episode that aired two months later, it was revealed through a handful of letters that were sent to Meredith that Karev left Seattle to reunite with Izzie and their twins.

Krista Vernoff: It's nearly impossible to say goodbye to Alex Karev. That is as true for me and for all of the writers at Grey's Anatomy as it is for the fans. We have loved writing Alex. And we have loved watching Justin Chambers's nuanced portrayal of him. For sixteen seasons, sixteen years, we have grown up alongside Alex Karev. We have been frustrated by his limitations and we have been inspired by his growth and we have come to love him deeply and to think of him as one of our very best friends. We will miss him terribly.

Justin Chambers: You're in a bubble [on the show]. You wear scrubs every day, you see pretty much the same people every day, in the same four walls, the same studios, you drive the same route to work. For me it [was] sort of a factory job for acting. You just clock in, clock out. Yeah, I guess it is sentimental, but it's sort of like,"Wow, I just can't believe how fast it's gone."

Raymond Liu/ABC/Kobal/Shutterstock

More than a year later, fans were caught off guard by the news that Giacomo Gianniotti's run as Dr. Andrew DeLuca had come to an end. His character was fatally stabbed in the March 11, 2021, episode—and boy did he bleed out in those final hospital scenes.

Giacomo Gianniotti: I don't think people were really told before, so it was sort of a surprise to everyone. We were all on Zoom, of course, and everyone was just kind of looking up with tears in their eyes and shocked and jaws on the floor and being like, "Are you kidding me?" Because as we find out, we don't know what happens until the very end. At that time in the script, to protect the integrity of the story line, it didn't say whether he died or not. So everyone was on the edge of their seats, wanting the answer. I think my last stuff, if I'm remembering correctly, was my stuff in the OR. Strangely enough, DeLuca's end was my end, too. It was emotional. I felt like, here I am on this table, I've got blood everywhere and bleeding out, and it just made it very real.

How to Save a LifeThe Inside Story of Grey's Anatomy by Lynette Rice. Copyright (c) 2021 by Lynette Rice and reprinted with permission of St. Martin's Press, a division of Macmillan Publishing Group, LLC.

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