Grey’s Anatomy’s return amidst other 2025 TV premieres will mark 20 years since its March 2005 premiere. Loyal fans have seen many doctors come and go in that time, but arguably no exit was as jarring as Derek Shepherd’s — the result of Patrick Dempsey’s allegedly “terrorizing” behavior on set. I remember despising the kill-off episode — Season 11’s “How to Save a Life” — and the 10th anniversary of McDreamy’s death inspired a full rewatch to see if my feelings changed.
Sure enough, they did, but not in a good way. I still hated it, and I now have 3 big reasons why the installment was even more infuriating after years of hindsight.
Flash back to April 23, 2015. My then-job didn't require me to keep up with behind-the-scenes drama of shows like Grey’s Anatomy, but I recall knowing it was likely Patrick Dempsey’s swan song. I was curious how the show would continue without Derek, but wasn’t particularly upset to be losing him. Ultimately, though, I was in disbelief by such a vital character's death being handled so haphazardly, and I felt that again rewatching it for the first time in a decade, with three big takeaways.
Derek’s Collision With The Truck Looks Ridiculous
I found myself rolling my eyes pretty often at the cheesy dialogue in “How to Save a Life,” but the first time I watched Derek’s car get hit by that truck 10 years ago, I recall letting out a shocked laugh at how terrible the effects looked. My memory wasn’t playing tricks on me, either; it was that bad, especially when compared to the effects-driven wreck that came just minutes before, featuring multiple flipping vehicles from different camera angles. Maybe they blew their budget on that?
Of course I think it was stupid that Derek pulled his car onto the road, blocking both lanes while stopping to look for his buzzing cellphone. (The lack of cell service was also repeatedly established, so having his phone ring made no sense.) The whole thing felt very much like a commercial warning teens about the dangers of texting and driving. However, at least human fallacy is believable. My real problem is with the truck.
Honestly, where did the truck come from? Because it didn’t blow its big 18-wheeler air horn until it was on top of McDreamy’s car. Did it come around a blind curve? If so, how and why was it going fast enough to skewer Seattle’s top brain surgeon? Perhaps due to the mysterious lack of seemingly any other vehicles on that particular road.
Plus, just look at the photo above. Where is the back of the truck? I feel like there should be more truck that keeps us from seeing sky and trees out of the back window.
Derek’s Narration Of His Impending Death Doesn’t Make Sense
I really didn’t like listening to Patrick Dempsey as Derek Shepherd narrating everything the doctors were doing wrong. At first, though, it made sense. When he got to Dillard Medical Center and was conscious but couldn’t speak, I totally bought his internal monologue explaining what he would do — and therefore what those doctors should do — as they initially treated him. When it stopped making sense was when they took him to surgery and put him under anaesthesia. Why are you still talking to us, Derek?
I’m certain there are plenty of Grey’s Anatomy fans who found it soul-crushing to hear Derek Shepherd say his final words when the trauma surgeon finally got to the hospital — “It’s too late. You’re too late.” — or McDreamy’s decidedly more impactful quote from midway through the episode:
I'm going to die because these people aren't properly trained.
I get it; it is sad. However, being able to know Derek’s final thoughts made the death less impactful than the utter chaos of, say, George O’Malley’s equally sudden death. We don’t know what was going through his head, which made it all the more torturous when we looked into his desperate eyes as he wrote “007” on Meredith’s hand with his finger. That was the shocking Grey’s Anatomy death its male lead deserved. What Derek got was less impactful because he literally told us over and over it was coming.
The Fakeout That Derek Had Survived Was So Cheap
The writers did attempt to make it less predictable by allowing us to think for a minute that Derek had beaten the odds and survived the surgery. We see Meredith arrive at the hospital and chide her very awake, very alive husband for scaring her, before climbing into his hospital bed and curling up next to him with a sleepy smile. Then we snap back to reality and realize the scene was merely a fantasy, and Meredith is still at her house with the officers informing her of the accident.
I can appreciate the parallels to Izzie Stevens and Denny Duquette in the imagery, but I think this was a pretty cheap way to get people’s hopes up before bringing in Meredith to take him off life support.
Other Questions I Have About ‘How To Save A Life’
Those are my big issues with “How to Save a Life,” but they’re not the only ones I’m left with 10 years after McDreamy’s final episode as a series regular. (He would, of course, make a surprising return to Meredith in dream form in Season 17.) Here are a couple more questions:
- Does the timing work? It was established in the previous episode “One Flight Down” that Meredith would wait until 5 p.m. to panic over Derek’s whereabouts. When the clock hit 5, she picked up the phone, only to see police cars pulling up to inform her of the accident. In the next episode, she arrives at the hospital after Derek has been declared brain dead following a surgery that started — according to a clock on the OR wall — after 8:55 p.m. Dillard Medical Center was supposedly near Puget Sound, which is only 90ish minutes away from Seattle (per Google Maps), so why did it take over four hours for Meredith to get there?
- Who’s really to blame for Derek’s death? At first we’re meant to blame Penny Blake (Samantha Sloyan) and her colleague Paul Castello (Mike McColl) at Dillard for failing to order a head CT for Derek; however, we later learn that McDreamy might have lived if trauma surgeon Dr. Cohn hadn’t chosen to finish his dinner before going to the hospital, taking an hour and a half to get there, rather than the expected 20 minutes. Meredith says, “Perfect Penny killed my husband” in Season 12 before literally killing Paul with one of Grey’s Anatomy’s most epic “Shondalogues” in Season 16. Why is Dr. Cohn getting off scot-free?
Regardless of if you share my opinion of this episode or not, it’s inarguable that “How to Save a Life” was a turning point in Grey’s Anatomy’s history. It’s not often that a series kills off its male lead and probably even more rare that it would go on for 10 more seasons (and counting!) after doing so.
If you want to relive that episode or, conversely, some of Grey’s Anatomy’s best episodes, all 21 seasons so far can be streamed with a Hulu subscription, while the first 20 seasons are available with a Netflix subscription. Season 21 resumes at 10 p.m. ET Thursday, March 6, on ABC.
