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Things You Probably Didn't Know About Grey's Anatomy

"Grey's Anatomy" has been on the air for what feels like forever, but unless you're a superfan, there's probably a lot about the show that you don't know. The series premiered way back in March 2005 with a short nine-episode first season. The TV juggernaut has only gained momentum since then, becoming one of the most popular and influential dramas in modern television history. Despite continued rumors that the show may end sometime soon, nothing has been able to stop the train -– not even the departure of many of the original cast members. Even leading lady Ellen Pompeo has conceded that it's possible the show could go on even after she decides to leave, whenever that might be (per People).

"Grey's Anatomy" has given us hundreds of episodes of entertainment, launching many of its cast members to worldwide fame in the process. The show has also spawned multiple spin-offs, including "Private Practice" and "Station 19," and won tons of accolades, particularly in its early seasons. Additionally, "Grey's Anatomy" is one of the longest-running primetime television shows of all time, and the lengthiest medical series ever to exist. Here are some interesting things you may not know about the beloved series.

The show's title was almost different

It's hard to imagine a world where "Grey's Anatomy" is called something different because the title is such a key part of the show. Not only does the "Grey" in the title reference the main character, Meredith Grey, but the title is also a play on an iconic medical textbook, "Gray's Anatomy," which was first published in the mid-1800s. The title is smart and unique, but it almost wasn't, as a number of other potential names nearly took the place of "Grey's Anatomy."

In her online MasterClass writing course, show creator Shonda Rhimes notes that the original title of the series was simply going to be "Surgeons" (via Elle). In an interview with Variety, star Ellen Pompeo admitted that the network desperately wanted to change the name, even as the premiere approached. "Once we finally got an airdate, two weeks before that airdate they wanted to change the title of the show to 'Complications,'" Pompeo said. Actor Kate Walsh, who plays Dr. Addison Montgomery on the show, noted in a separate interview with Buzzfeed that a third name –- "Doctors" –- was also in contention at one point. Overall, it seems like a good thing that the team ended up going with a more distinct name.

The original pitch had some major differences

The city of Seattle is a pivotal part of "Grey's Anatomy," but it was not the original choice for the show's setting. As discussed by Shonda Rhimes in her MasterClass, the series was always going to be in a big city, but the East Coast was the initial area considered (via Elle). She contemplated Boston, New York City, and Philadelphia before nixing the plan for Seattle. The city wasn't the only thing that was different in Rhimes' initial pitch to networks. For instance, all of the doctors smoked in the original script, including Meredith.

In fact, nearly every major character was changed in some way, be it something small like a name or a key feature of their biography. Per Elle, the original plan was for Dr. Derek Shepherd (Patrick Dempsey) to have a teenage child, Dr. Preston Burke (Isaiah Washington) to be married, and Dr. Richard Webber (James Pickens Jr.) to be a cold-hearted jerk. Dr. Cristina Yang (Sandra Oh) was to have a rich donor father and was set to fall in love with a patient –- a storyline that longtime fans know actually happened with a different character, Dr. Izzie Stevens (Katherine Heigl). Perhaps most shocking, Dr. Alex Karev (Justin Chambers), who was on the show for 16 seasons, wasn't even in the original pilot.

Episodes are named after songs

It's not uncommon for TV series to have little gimmicks when it comes to episode titles. All of the "Friends" episodes start with "The one," "Mr. Robot" episodes are all named to appear like computer files, and nearly all "Community" episode titles are stylized like college courses. "Grey's Anatomy" has always been quirky, so it's not surprising that Shonda Rhimes decided to do something unique with her episode titles as well. Each episode of "Grey's Anatomy" is named after a song that connects to the episode.

We couldn't possibly detail all of the episode titles in the show, but some standouts include "Into You Like a Train," which features a train crash that impales two patients on a pole, "Drowning on Dry Land," which depicts the aftermath of Meredith Grey's plunge into Elliot Bay, and "How to Save a Life," which is the episode where Dr. Derek Shepherd (Patrick Dempsey) dies. Only one single episode has gone against the grain and avoided a song reference, and that's the ninth episode of Season 14, entitled "1-800-799-7233." The episode deals with the reemergence of a Dr. Jo Wilson's (Camilla Luddington) abusive ex, and the title is a reference to the phone number for the National Domestic Violence Hotline. According to a Tweet from showrunner Krista Vernoff, actor Giacomo Gianniotti was the one to have the idea.

One of the background stars is a real nurse

Many of the actors on "Grey's Anatomy" play doctors so convincingly that you may at times forget that they're not actually in the medical field. But, at the end of the day, we're pretty sure that Ellen Pompeo and Patrick Dempsey wouldn't know what they were in a real hospital. One background actor might, however, as she's a real-life nurse. "The nurse in that scene, Bokhee, is a real surgical nurse," star Sandra Oh shared in a Tweet in 2013. "She's been with us since the beginning. She's like my 2nd mom, she's the best." Nurse Bokhee is indeed played by Bokhee An, who's appeared in over 250 episodes of the show.

According to a Metro article, some cast members even observed An during real surgeries as a means of prepping for the surgical scenes on the show. While she rarely speaks, some fans have made it a point to look out for Nurse Bokhee spottings, almost like a game. In Season 18, An had an especially powerful scene in an episode dealing with anti-Asian violence. In the scene, Bokhee aids two Asian doctors (Dr. Nico Kim and Dr. Michelle Lin) operating on a victim of a hate crime, and in the process, the three reflect on their own experiences as Asian Americans. "We are American," Bokhee tells the doctors after they confess to feeling like outsiders in the United States. "Your faces are American."

If you or a loved one has experienced a hate crime, contact the VictimConnect Hotline by phone at 1-855-4-VICTIM or by chat for more information or assistance in locating services to help. If you or a loved one are in immediate danger, call 911.

Real organs are used for surgeries

There are a great many things about "Grey's Anatomy" that seem unrealistic. People keep their jobs despite committing major ethical and legal missteps, characters rarely seem to date anyone outside the medical field, and just about every natural or human-made disaster that could happen has happened. To really enjoy the show, you have to buy into the more absurd storylines while also recognizing their ridiculousness. It's all part of the "Grey's Anatomy" charm.

Though the medical cases are sometimes far-fetched, one thing "Grey's Anatomy" keeps looking realistic is the actual surgery depicted on the show. The medical language is generally quite accurate, and the visuals are eerily real -– from the tools to the blood and the body parts. "We work with Bovine organs, which is cow's organs," actor Sarah Drew revealed in a 2010 interview with the Miami Herald (via RTE). "The smell is repulsive and makes us all gag. And we use an actual soldering tool to solder the organs. It smells like burning flesh. There's also a lot of silicone and blood matter — red jello [jelly] mixed with blood and chicken fat. It's pretty gross."

Shonda Rhimes found inspiration in various places

"Grey's Anatomy" is the brainchild of Shonda Rhimes, who's since gone on to create series such as "Scandal," "Bridgerton," and "Inventing Anna." Prior to "Grey's," Rhimes had only a smattering of writing credits, having written screenplays for the Britney Spears movie "Crossroads" and the second "Princess Diaries" film, as well as the TV movie "Introducing Dorothy Dandridge." It was "Grey's Anatomy" that launched Rhimes to fame and helped her establish her production empire, Shondaland.

The idea for "Grey's Anatomy" came from multiple sources of inspiration. Firstly, Rhimes was a self-professed "obsessed" fan of surgery shows. "My sisters and I would call each other up and talk about operations we'd seen on the Discovery Channel," she said in an interview with Oprah Winfrey. "There's something fascinating about the medical world — you see things you'd never imagine, like the fact that doctors talk about their boyfriends or their day while they're cutting somebody open." This fascination led her to set a show in the operating room, but she found even more inspiration from a chance encounter with a doctor. Rhimes told Winfrey that "the idea for the series began when a doctor told me it was incredibly hard to shave her legs in the hospital shower," which got Rhimes thinking about the internal life of the hospital and the ways that doctors negotiate the grueling hours.

There was a purposeful focus on strong female characters

If you think back to classic medical television series -– from "ER" and "House" to "MASH" and "St. Elsewhere" –- it becomes evident that most of them put far more focus on male doctors than female ones. Even when women have been featured on medical television, they've frequently been sidelined by their relationship drama, relegated to the role of "nurse" or "assistant," or both. To her credit, Rhimes made it a point to craft female doctors who were the central heart of the story. She also refused to make them squeaky clean in order for them to be likable. "I kept asking myself, 'What kind of woman should the heroine be?'" Rhimes told Oprah Winfrey in 2006. "I thought she should be someone who had made some big mistakes."

A big goal for Rhimes was to craft female characters who seemed like real, everyday folks. As she told Winfrey, "Most of the women I saw on TV didn't seem like people I actually knew. They felt like ideas of what women are. They never got to be nasty or competitive or hungry or angry. They were often just the loving wife or the nice friend." The network reportedly took some umbrage with Rhimes' take on female empowerment. Showrunner Krista Vernoff told Variety that the network president at the time did not like the idea of "ambitious women having sex unapologetically," as Dr. Meredith Grey (Ellen Pompeo), Dr. Cristina Yang (Sandra Oh), and Dr. Izzie Stevens (Katherine Heigl) all do in Season 1. That former president, Steve McPherson, later resigned from ABC after an internal sexual harassment investigation (per The Hollywood Reporter). 

A familiar face almost played Derek Shepherd

The love story between Dr. Meredith Grey (Ellen Pompeo) and Dr. Derek Shepherd (Patrick Dempsey) was a central storyline for over a decade of "Grey's Anatomy," up until Derek's death in Season 11. Dempsey was amazing in the role, but few people know that he only got it after Rob Lowe passed on the project. "Me in that part isn't as interesting as Patrick in that part," Lowe said in a 2021 interview with Variety. "If it'd been me (the fans) wouldn't have called me 'McDreamy,' they would have called me Rob Lowe."

While we'll never know for sure if Lowe's right about the interesting part, he was on point with the "McDreamy" nickname. It turns out that Patrick Dempsey inspired that nickname by just being himself, which prompted the writers to use it on the show. "When we were shooting the pilot, Patrick was seriously the most adorable man we'd ever seen on camera," Shonda Rhimes told Oprah Winfrey in 2006. "We'd watch the monitor and think, 'Look at his dreamy eyes!' So we started calling him Patrick McDreamy, and it stuck." Once the show had coined "McDreamy," a number of other Mcnicknames followed, including McSteamy (for Eric Dane's Dr. Mark Sloan) and McVet (for Chris O'Donnell's Dr. Finn Dandridge). The writers love a nickname and have experimented beyond the Mc-men with everything from "Dr. Model" to "Evil spawn."

Characters generally aren't written with physical descriptions

"Grey's Anatomy" has been celebrated for its diverse casting, and that's entirely by design. Shonda Rhimes has discussed her approach to character creation in the past, which includes crafting gender parity and being racially open when casting roles. "Take half the characters that you made men and make them women. Take one character you were gonna cast one color, cast them differently," she says in her writing MasterClass (via Elle). "I think it's important for people to rethink because what people see on television changes what people think about themselves."

One way that Rhimes goes about keeping casting more open is by avoiding physical descriptions when writing her characters. Though the "Grey's Anatomy" writers give characters specific personality traits, they attempt to leave their physical characteristics out of the picture. "The script was written with no character descriptions, no clue as to what anyone should look like," Rhimes told Oprah Winfrey in 2006. "We read every color actor for every single part. My goal was simply to cast the best actors. I was lucky because the network said, 'Go for it.' If they had hesitated, I don't know if I would have wanted to do the show."

Dr. Bailey was partially modeled after Rhimes' mother

Dr. Miranda Bailey (Chandra Wilson) was the sole "Grey's Anatomy" character written with a physical description before casting. Because Dr. Bailey is such a tough, no-nonsense person, Shonda Rhimes thought it would be interesting to have her appearance seemingly contradict her personality. She told Oprah Winfrey in 2006 that the character was originally meant to be a petite white woman with blonde curly hair. It was only because of the show's race-blind casting strategy that Chandra Wilson read for the role, at which point she completely changed Rhimes' view of the character.

Dr. Bailey's physical traits may have changed from her conception, but her strong personality and ambitious persona remained intact. In the same Oprah interview, Rhimes revealed that the character was based in part on her own mother. "She's very no-nonsense," Rhimes said. "Dr. Bailey says stuff like 'These people are nasty — all they think about is sex while we're trying to save lives here.' My mother is definitely that kind of realist." Actor Chandra Wilson said that people used to be scared to even talk to her when they saw her out in public during the early years of the show (per Variety). In the years since, Dr. Bailey has somewhat softened, thanks in part to her second husband and children, as well as her struggle with anxiety and her more empathetic mentorship moments.

Some real locations are used in shooting

Like with most network television shows, much of what's filmed for "Grey's Anatomy" takes place on a soundstage. All of the internal areas of the hospital are sets. The external views of the hospital actually feature a real location, but it's nowhere near Seattle. The facility used to portray Grey Sloan Memorial Hospital (as it is now named) is the Veterans Administration Sepulveda Ambulatory Care Center, located in North Hills, California (per Los Angeles Magazine). The bar that stood in for Joe's is also in the Los Angeles area, according to the same article.

While the show is filmed in Los Angeles, a variety of real Seattle locations have been used in shooting as well. Fans will note that the Seattle skyline has made many appearances, Space Needle and all, and the rooftop of the hospital (where the helipad lives) was filmed at KOMO Plaza in Seattle (per Seattle Refined). Various sources have also noted that Dr. Meredith Grey's house –- a central setting throughout every season of the show –- is a real home in the Seattle area. Per Los Angeles Magazine, the house is located in the city's Queen Anne neighborhood. Other Seattle locations where filming has occurred include Kerry Park, Poo Poo Point, and Bainbridge Island.

Medical professionals work on the show

In order to make things appear as accurate as possible, "Grey's Anatomy" has medical professionals who help writers and producers behind the scenes. Zoanne Clack is chief amongst these professionals, and the former emergency room doctor has worked on 357 episodes of "Grey's Anatomy," working her way up to executive producer. "What was interesting was that the writers don't have those boundaries because they don't know the rules, so they would come up with all of these scenarios, and my immediate thought was like, 'No way!'" Clack said in an interview with Variety. "Then I'd have to think about it and go, 'But could it?'"

While Clack was the only staff doctor for Season 1 of "Grey's Anatomy," production has employed many others throughout the years. In her book "Year of Yes," Shonda Rhimes notes that the writers don't even write medical jargon into the original script. "Meredith will say, 'I need a medical medical to medical,'" Rhimes writes (via Mental Floss). "And someone else will go, 'Well I have medical medical.'" In addition to filling in the blanks in the script, medical advisors also work with actors to ensure proper pronunciation of terms, and with production to ensure that the sets looked accurate (per Right as Rain by UW Medicine).

Many of the actors are not American

"Grey's Anatomy" takes places in Seattle, Washington, and the vast majority of the characters are believed to be American. In fact, only a couple of main or recurring characters have had foreign accents, and neither of them -– Dr. Cormac Hayes (Richard Flood) and Dr. Carina DeLuca (Stefania Spampinato) –- have been especially central to the show. But don't let the accents fool you, because a great number of the "Grey's Anatomy" characters are played by foreign actors. Dr. Callie Torres, for example, is portrayed by Mexican-born actor Sara Ramirez, who moved to the US at the age of eight.

"Grey's Anatomy" has also had many Canadians appear in major roles. These include Sandra Oh as Dr. Cristina Yang, Catarina Scorsone as Dr. Amelia Shepherd, Scott Speedman – born in London — as Dr. Nick Marsh, and Giacomo Gianniotti – born in Italy — as Dr. Andrew DeLuca. Three other cast members have also had to hide their accents for the show –- Camila Luddington (Dr. Jo Wilson) is British, Kevin McKidd (Dr. Owen Hunt) is Scottish, and Martin Henderson (Dr. Nathan Riggs) is from New Zealand. "'Grey's' was my first American accent role, and so, I still screw up like every single day," Luddington admitted on "Live with Kelly and Ryan" in May 2022. "Now it's been 10 years, so hopefully I'm a little bit better and, in real life, my accent is slowly becoming more American."

The cast is active behind the scenes

Nowadays, it's not uncommon to see actors directing episodes of their television series. Jason Bateman has done it on "Ozark," as have "This Is Us" stars Milo Ventimiglia, Jon Huertas, Mandy Moore, and Justin Hartley. The "Grey's Anatomy" actors have been similarly drawn to life behind the camera, and many of the show's stars have taken a turn in the director's chair. Kevin McKidd, who portrays Dr. Owen Hunt, is one of the show's most frequent directors, having helmed close to 40 episodes since 2011. Other cast members who've directed include Debbie Allen with over 30 episodes and Chandra Wilson with more than 20, as well as Jesse Williams, Ellen Pompeo, and Giacomo Gianniotti.

In addition to directing, a couple of cast members have taken on producing duties as well. Debbie Allen, who portrays Dr. Catherine Fox, has been in a production role since 2015 and has been credited with further increasing the diversity of the set. "It was a blessing and a great responsibility that Shonda Rhimes gave me to continue the relevance of the show, the inclusivity of the show," Allen said while guesting on "The Ellen Show." "I found women. I hired black men. I still hired some cute white boys –- I didn't leave them out." Ellen Pompeo has also taken on a producer role, which started with her deal for Season 15. She was upped to executive producer for the show's 19th season (per Deadline).