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Things You Never Noticed In The First Grey's Anatomy Episode

In 2005, ABC debuted a new medical drama as a mid-season replacement. At the time, they probably had no idea that this little series — which also marked showrunner Shonda Rhimes' debut — would grow to become the longest-running medical series in primetime television history. Named for a real medical textbook, Grey's Anatomy follows Dr. Meredith Grey (Ellen Pompeo), who begins her surgical residency at Seattle Grace Hospital alongside several other would-be surgeons. Together, the group — Dr. Isobel "Izzie" Stevens (Katherine Heigl), Dr. Cristina Yang (Sandra Oh), Dr. George O'Malley (T.R. Knight), and Dr. Alex Karev (Justin Chambers) — navigate their new lives as interns, relegated to grunt work and tooth-and-nail competition to be let into the operating room.

Grey's Anatomy set a record as the longest-running primetime medical drama, surpassing 350 episodes. It also turned Rhimes into one of the most sought-after creators in the industry. The show's success isn't all that surprising when you consider the strong outing the series made in its pilot. Right from the jump, Grey's Anatomy featured expertly drawn characters, sharp writing, convincing performances, and a strong story. Whether you're just beginning your Grey's Anatomy journey or rewatching the pilot for the millionth time, here are some of the little things you might have missed in the very first episode of Grey's Anatomy. Warning: Light spoilers ahead. 

The pilot's title starts a major Grey's Anatomy trend

Grey's Anatomy is known for its excellent soundtrack. Classic indie hits like Rilo Kiley's "Portions for Foxes" accompany Meredith's first day, but the first episode also sets an important standard when it comes to the episode titles. Entitled "A Hard Day's Night," the pilot is, of course, named after one of The Beatles' first big hits, a trend that continued throughout the series.

Nearly every episode through Grey's Anatomy's television tenure is named for a song; other Beatles titles like "Let It Be" and "Yesterday" were used early in the series, as well as classics like Method Man's "Bring the Pain," Stevie Wonder's "Superstition," and R.E.M.'s "Losing My Religion." Ultimately, only a few episodes bucked the trend, including season one's "The Self-Destruct Button" and season 14's "1-800-799-7233" — the latter of which is the phone number for the Domestic Violence Hotline, as the episode focused on a character's previous experiences with domestic assault.

Meredith's medical instincts kick in right away

Beginning a surgical residency is an insanely difficult task, as Meredith discovers while treating her very first patient, teenager Katie Bryce (Skyler Shaye), who keeps having seizures for reasons nobody can figure out. Overworked and looking for assistance, the hospital's new chief of neurosurgery, Dr. Derek Shepherd (Patrick Dempsey) asks every available intern for help solving this medical mystery.

Despite exhaustion, stress, and overwhelming pressure, Meredith ultimately solves the problem. Katie does teen beauty pageants and tripped during a recent rhythmic gymnastics practice, which ended up bursting a tiny aneurysm in her brain. Meredith might be new to the job, but by listening to her patient and keeping an open mind, she solves the problem and saves the girl's life — even though Derek initially describes her diagnosis as being a "one in a million" chance. In later seasons, Katie returns twice; both times, she remembers that Meredith was her savior.

Two speeches define the show

Rhimes is one of television's strongest writers, and her unique voice always shines through in her dialogue, which makes two moments in the pilot completely unforgettable. As the interns start their first day, Dr. Richard Webber (James Pickens Jr.), the chief of surgery, walks them through one of the hospital's spacious operating rooms and doesn't mince his words about how difficult their journey will be. "A month ago, you were in med school being taught by doctors," Dr. Webber says. "Today, you are the doctors. The seven years you spend here as a surgical resident will be the best and worst of your life. You will be pushed to the breaking point." He also tells them that, due to the competitive nature of the program, not everyone in the room will make it — a fate that does befall some of the interns. Later in the series, we find out that Webber gives this speech to every group of interns.

Meanwhile, Dr. Miranda Bailey (Chandra Wilson), whose nickname is "The Nazi," shows zero mercy to her interns, telling them she has "five rules" for them to memorize, including edicts like "Don't bother sucking up. I already hate you. That's not gonna change," and not to wake her while she's napping unless a patient is actively dying. When the original group of interns gets their own interns as residents, they try and reenact Bailey's speech — with varying results.

Meredith's meet-cute takes a turn

As the pilot episode opens, Meredith, who's about to start her very first day as a surgeon after moving back to her hometown of Seattle, realizes she's off to a pretty awkward start: after a night out, she wakes up on her first morning of work only to discover a naked stranger on her floor. After telling him in no uncertain terms to leave right away, Meredith writes the entire thing off as a one-night stand — until she gets to work and discovers that her fling is actually Dr. Derek Shepherd, the new head of neurosurgery and her new boss.

At first, Meredith resists her boss's romantic advances, but the two get together in a real way during the first season, which then results in the devastating discovery that Derek is married and running away from his dysfunctional marriage. Apparently, ABC executives weren't thrilled about this storyline and even encouraged Rhimes and her creative team to cut Meredith and Derek's first encounter, saying that it made Meredith less sympathetic — but Rhimes stood her ground, establishing one of primetime television's most iconic couples in the process.

Meredith and Cristina strike up an immediate friendship

Derek and Meredith might be an amazing couple, but as the series progresses, one could argue that he's not the love of her life — that title belongs to Cristina Yang. When the two team up to solve Katie Bryce's medical mystery, the connection is there right from the start, even when Meredith ends up stealing a groundbreaking neurosurgical procedure out from under Cristina. Ultimately, Meredith and Cristina, who refer to one another as "my person," form the defining relationship of Grey's Anatomy. Even though they're constantly in competition with one another, they understand each other deeply and stick together no matter what.

Depictions of great female friendships are rare on primetime television, but Grey's Anatomy set a serious standard with Meredith and Cristina right in the pilot. 

A fellow intern is carrying a torch for Meredith

Throughout the first two seasons of Grey's Anatomy, Dr. George O'Malley often seems like the least capable of the original group of interns, fumbling surgeries and seemingly totally unsure of himself pretty much constantly. He's also unlucky in love, thanks to his unrequited crush on Meredith. In the pilot, George tells Meredith right away that he remembers her from the mixer; her black dress and strappy sandals evidently made an impression. Awkward and bumbling, George has made it abundantly clear that he has an enormous crush on Meredith, which continues for two full seasons.

George's infatuation ultimately ends in the most embarrassing way possible when he and Meredith have a disastrous late-night encounter, but the pilot sets up their dynamic immediately: George obsesses over a completely oblivious Meredith. 

The tunnels become the interns' hangout spot

Considering that the interns' first shift lasts for 72 full hours, it's a pretty grueling experience, which means that the group needs to find time to eat, sleep, and take breaks while patients' lives are on the line. In the end, Meredith, George, Cristina, Izzie, and Alex retreat to the recesses of Seattle Grace to commiserate and lick their wounds. Angry that they all went to years of school to simply fill out charts and do busywork, the interns bemoan their lack of surgical experience — or, as George puts it, "Who here feels like they have no idea what they're doing? I mean, are we supposed to be learning something? Because I don't feel like I'm learning anything."

In future seasons, the core gang continues to meet down in the tunnels whenever they need a moment, as do younger generations of interns (though older residents sometimes kick them out of the space out of spite). The tunnels represent a space to breathe and relax somewhat within the walls of Seattle Grace, and the pilot establishes this location perfectly.

Shepherd debuts his catchphrase

The pilot introduces Derek Shepherd as one of the most brilliant and innovative neurosurgeons in the country. As he vies for chief of surgery and runs away from his ailing marriage, he finds a place for himself at Seattle Grace. Derek is definitely Meredith's soulmate, but throughout the series, he's also her mentor at several points, teaching her the intricacies of neurosurgery. In the pilot episode, he debuts an unforgettable catchphrase that he repeats throughout the rest of the show.

As he prepares to operate on Katie Bryce, Derek looks around the operating room and says to his support staff, "It's a beautiful day to save lives. Let's have some fun." Derek says this frequently throughout the series, and in one of the show's most heartbreaking moments, he even says it during the show's 11th season, when he dies after a devastating car accident. Still, this catchphrase isn't just, well, catchy. It also establishes Derek as a confident, lighthearted surgeon who is perfectly capable of performing risky, life-saving operations.

Meredith has a complicated family legacy

Meredith isn't just any average surgical intern at Seattle Grace — as Cristina puts it, she's "surgical royalty." Behind Meredith's back, the other interns discuss the fact that Meredith's mother, Dr. Ellis Grey (Kate Burton), was a medical legend, winning multiple prestigious awards and even inventing a general surgery technique known as the "Grey method." Cristina even later accuses Meredith of only earning a spot in the program — especially because Ellis also did her residency at Seattle Grace — because of her famous mother, though there's no doubt that Meredith got in on her own talent. 

To make matters more complex, Meredith is keeping a secret about her mother that nobody else knows. Everyone knows Ellis is retired, but only Meredith knows the truth: Ellis has early onset Alzheimer's and lives in an assisted living facility. At the end of the pilot, Meredith visits her mother, who doesn't recognize her, providing a heartbreaking twist to close out the series' first episode and introducing a character who later provides fodder for lots of drama. 

One of the show's main characters was added after the fact

If you're a longtime fan of Grey's Anatomy, you probably can't believe that Alex Karev, one of the original interns, wasn't actually supposed to be on the series from the beginning. A difficult and cocky intern who spends his time bullying his colleagues, Alex runs the gamut from obstinate to outright cruel throughout the early seasons. Ultimately, he grows as a character, becoming one of Meredith's closest friends, marrying Izzie, and turning into the man that he was meant to be. A perfect example is his eventual choice of specialty: Originally interested in plastic surgery thanks to the high pay, Alex realizes that he's amazing with children, and even becomes the chief of pediatric surgery.

However, as it turns out, Alex Karev was — rather clumsily — added into the pilot as an afterthought, intended as a foil for meek, sweet George O'Malley. Though the show added two scenes with Chambers that were shot with Pompeo, for the rest of the pilot, Chambers is awkwardly edited into existing scenes. If you look carefully, you can definitely see that the CGI isn't perfect, and that one of the show's longest-running characters was edited into the show after the pilot had already been filmed.