Things you missed in the first episode of Grey’s Anatomy

Grey’s Anatomy first premiered in 2005 to rave reviews, quickly garnering a loyal fan base with each passing season. However, even if you’ve been watching the show from the beginning, there’s a lot about the pilot episode that you probably didn’t notice. 

Some details about the series premiere of Grey’s Anatomy are so tiny that they’re easy to gloss over. Others only become relevant later in the show’s run, which can be credited to the show’s talented team of writers and their ability to establish story lines, craft interesting characters –and, of course, teach viewers plenty of false things about medicine along the way.

Old and new fans alike will learn a lot from looking back at the first episode of this award winning series. After all, there are so many small details hidden throughout the hour-long pilot, and noticing them upon a rewatch makes the rest of the show that much better. From a significant cameo appearance to a hint at just how tangled Meredith Grey’s love life will become later in the show, here are some of the things that you likely missed in the first episode of Grey’s Anatomy. Warning: there are some major spoilers ahead.

The first episode of Grey's Anatomy isn't called 'Pilot'

Grey’s Anatomy has proven itself to be different than other TV shows, even with its very first episode.

While first episodes of television shows are often simply labeled “pilot,” this isn’t true in the case of the first episode of Grey’s Anatomy. Instead, the first episode of the show is called “A Hard Day’s Night,” borrowing its title from the classic song by The Beatles. The title of the episode references the first shift of Meredith Grey and the gang as interns at Seattle Grace Hospital, where they work — you guessed it — all day and all night.

The fact that the first episode of Grey’s Anatomy isn’t called “pilot” isn’t the only notable aspect of the title. It also kicked off a long-running tradition on the show to name episodes after song titles. In fact, all of the episodes of Grey’s Anatomy – with the exception of one — are named after a song. As noted by Glamour, a controversial episode from Season 14 that focused on domestic abuse was instead titled “1-800-799-7233,” the phone number for the National Domestic Violence Hotline.

Meredith Grey's commitment issues are clear from the first episode of Grey's Anatomy

Throughout Grey’s Anatomy, Meredith Grey exhibits classic signs of having commitment issues. 

As fans know, these issues are understandable, considering Meredith’s strained relationship with her mother, Ellis Grey. She also has a rocky relationship with her father, stemming from the fact that he abandoned her when she was a young girl. Meredith has a hard time letting people in, although when she does, she is a fierce and loyal friend.

Meredith’s commitment issues are explored in a major way throughout her relationship with Derek Shepherd, and we see them in the very first episode. When she wakes up next to him after a one night stand, she’s eager to kick him out of the house and doesn’t even remember his name. While this could be dismissed as normal hookup behavior, Meredith also turns him down when he asks her out. Granted, there are good reasons for doing so, like the fact that they work together, but it’s clear that Meredith’s main motivation for wanting to keep things professional with Derek is that she doesn’t want to get too close to him — or anyone else. 

Meredith Grey was supposed to sell her mom's house in the first episode of Grey's Anatomy

In Grey’s Anatomy, Meredith Grey’s house plays a pretty big role, serving as one of the show’s major settings. 

Over the years, many of the Grey’s Anatomy characters live in the home, including Meredith, George O’Malley, and Alex Karev. Early in the show’s first episode, Meredith reveals that the home was her mother’s and she’s planning on selling it.

At the end of the episode, though, Meredith tells her mom that she has changed her mind about selling the home and has decided to instead continue living in it and to get some roommates. This was one of the best things Meredith could have done, as it brings her closer to her fellow interns who later move in with her. Grey’s Anatomy would have been a very different show indeed if Meredith had followed through on her original plan and gotten an apartment instead of deciding to stay in her mom’s house — which served as the location for many heartbreaking moments throughout the series. 

Alex Karev isn't part of the gang in the first episode of Grey's Anatomy

Grey’s Anatomy wouldn’t be the same without its famous cast. However, while shooting first episode of the show, one important character wasn’t actually there.

The core group of interns that the early episodes of Grey’s Anatomy focuses on consists of Alex Karev, Cristina Yang, Meredith Grey, George O’Malley, and Izzie Stevens. While we see plenty of Cristina, Meredith, George, and Izzie in the first episode of Grey’s Anatomy, Alex only has a couple of lines and isn’t even assigned to the same resident as the other four. How could such an important person have been omitted from the first episode?

It turns out that Alex wasn’t even part of the initial shoot for Grey’s Anatomy‘s first episode. Justin Chambers, the actor who plays Alex, explained to TV Guide that the first episode of the show was filmed a year before it aired. In that time, producers decided that the show was missing something, so they digitally added him to the pre-existing pilot. “I guess they felt they needed a jerk, so they brought in this jerk,” Chambers joked. Added the actor, “It worked out.”

This actor has a cameo in the first episode of Grey's Anatomy

Grey’s Anatomy has been the big break for many of its stars. However, it’s also kicked off the careers of some of its more minor characters. 

If you look closely, you might see a familiar face in the first episode of Grey’s Anatomy. Sendhil Ramamurthy played an unnamed intern at Seattle Grace Hospital. He only had a couple of lines so his character isn’t super memorable, but he got a big moment when he and the other interns gather to watch George perform his first surgery. Ramamurthy’s character bets against George successfully completing the surgery, only to be scolded by Meredith, who says that the interns should be sticking together.

It was a small role for Ramamurthy, but much bigger things were in his future. The year after the first episode of Grey’s Anatomy aired, he landed a starring role on Heroes playing Mohinder Suresh. Like Grey’s Anatomy, Heroes would go on to become one of the most memorable shows of the late aughts, so it’s pretty cool to see one of its stars featured in the first episode of Grey’s Anatomy.

Cristina Yang and Meredith Grey's friendship is off to a solid start in the first episode of Grey's Anatomy

Grey’s Anatomy features many iconic television relationships. However, perhaps the most important relationship of the show is the friendship between Meredith Grey and Cristina Yang.

As longtime fans of the ABC medical drama know, Meredith and Cristina share a friendship that often feels more like a sisterhood.  They’re each other’s “person,” and even in the first episode of Grey’s Anatomy, their special bond is evident. 

In Season 1, Episode 1 of Grey’s Anatomy, Meredith and Cristina team up together to diagnose a patient and, while they do have a brief spat, it’s clear that the two passionate, driven, and ambitious women are fated to be BFFs. Cristina and Meredith bring out the best in each other throughout following seasons, and are there to support each other through the highs and lows of both their careers and their personal lives.

Richard Webber's relationship with Meredith Grey's mom is hinted at in Grey's Anatomy's first episode

Longtime fans of Grey’s Anatomy know that Meredith’s mom, Ellis Grey, once had an affair with Richard Webber, who is the chief of surgery at Seattle Grace Hospital when Meredith starts her internship. 

While we don’t learn about this affair until later in the series, the groundwork for it is laid out in the very first episode when Webber tells Meredith that she is the spitting image of her mother. It’s a small comment that most viewers of the episode who aren’t familiar with the series would likely just take to mean that Weber knew Meredith’s mom in a professional capacity — they’re both doctors, after all. Knowing just how much the two meant to each other, though, gives that line a much deeper meaning.

Webber’s pride in Meredith and her abilities also foreshadows the relationship the two share later in the series. As the series progresses, the two form something of a father/daughter bond, as Webber becomes a mentor to Meredith. 

Derek Shepherd's behavior in the first episode of Grey's Anatomy is kind of problematic

The first episode of Grey’s Anatomy sheds new light on one of the show’s fan favorite characters.

We love Derek Shepherd (a.k.a. McDreamy) as much as the next person, but his behavior in the first episode of Grey’s Anatomy is not okay. Even after learning that the woman he met at a bar and subsequently hooked up with is Meredith Grey — a new intern at his job — he still asks her out. When she says no, he continues to pressure her. Making things even worse is the fact that — as Meredith is an intern and Derek is an attending — he is her boss. There’s a clear power dynamic in play here that makes his pursuit of Meredith not just unprofessional, but totally inappropriate.

Somehow, though, Derek’s actions are framed as romantic because he’s young, charming, and handsome. Even worse than the fact that this is a clear abuse of his privilege is the fact that Derek is married (albeit separated), and makes no mention of his wife as his relationship with Meredith unfolds in the first season of Grey’s Anatomy.

Derek Shepherd's catchphrase is introduced in the first episode of Grey's Anatomy

Any fan of Grey’s Anatomy knows Derek Shepherd’s catchphrase: “It’s a beautiful day to save lives.” It’s a phrase heard often throughout the show, as Derek says this before most of his surgeries — sometimes subbing in “night” for “day.” However, this seven-word sentence is more than just a mantra; instead, the catchphrase shows Derek’s optimism, as well as his passion for his profession. 

Fans of Grey’s Anatomy get used to hearing Derek say this over the course of the show; however, what many fans may not realize is that he actually said it in the very first episode. As he prepares to operate on a patient in Season 1, Episode 1 Derek smiles as he says, “It’s a beautiful night to save lives.”

That one line doesn’t just establish Derek’s signature catchphrase, it also shows what kind of a doctor — and what kind of person — he really is. 

George O'Malley's feelings for Meredith Grey are evident in the first episode of Grey's Anatomy

Grey’s Anatomy is known for its onscreen romances — and the first episode of the series hinted at more than one love connection.

Derek Shepherd isn’t the only person who falls for Meredith Grey in the first episode of Grey’s Anatomy. George O’Malley also harbors a big crush for his fellow intern, although his crush isn’t immediately obvious to the rest of the interns. In fact, they seem to think he’s gay. As the show progresses, though, it’s clear that George has some serious feelings for Meredith, and the tension only grows more awkward when they end up as roommates.

While George and Meredith do hook up once (which she later regrets), George’s feelings for her are a big part of the show’s early seasons. For George, it feels like love at first sight — as he even remembers what Meredith was wearing the day he met her. More importantly, however, the first episode of Grey’s Anatomy shows that George is kind, compassionate, and a good friend. He’s definitely the sweetheart of the interns, and that is firmly established at the start of the show.

It's clear Meredith Grey and Derek Shepherd are soulmates in the first episode of Grey's Anatomy

Grey’s Anatomy is a fan favorite show to binge watch on a lazy weekend, largely due to the show’s steamy romances. And as Grey’s Anatomy fans know, the love story of Meredith Grey and Derek Shepherd is front and center throughout the series. 

At the beginning of the first episode of Grey’s Anatomy, it’s hard to tell if Derek is meant to be an important character, or if he’s simply present to create more conflict in the episode. By the end of the pilot, however, it’s clear that Derek is definitely there to serve as Meredith’s primary love interest. After sharing a moment following Meredith scrubbing in on her first surgery, the intern seems to realize she’s starting to have serious feelings for the neurosurgeon. 

Unfortunately, it takes a while for the couple to make it to their romantic Post-It Note wedding ceremony – and their love story eventually ends in tragedy. However, Derek and Meredith are absolutely fated for each other — and the first episode of Grey’s Anatomy makes that clear. 

We learn Meredith Grey's alma mater in Grey's Anatomy's first episode

Grey’s Anatomy teaches us a lot about its main character, Meredith Grey, in the first episode. However, there’s at least one subtle detail about the intern that goes unspoken: she’s a Dartmouth alum. 

Eagle-eyed fans will likely take notice of the Dartmouth t-shirt Meredith wears in the episode’s final scene when she’s visiting her mom, Ellis Grey. As Meredith is a doctor, it’s pretty much expected that she’s already at the top of her game — but the fact that she went to the Ivy League school proves just how hardworking and intelligent the Seattle Grace intern really is.

Meredith’s alma mater is more than just a hidden detail about the character, though. It’s also a nod to the alma mater of show’s creator, Shonda Rhimes, who — like Meredith — also went to Dartmouth. Rhimes graduated from the prestigious school in 1991, and even returned in 2014 to deliver a commencement speech.

Did George O'Malley foreshadow his own death in the first episode of Grey's Anatomy?

In the first episode of Grey’s Anatomy, George O’Malley nervously says, “We’re going to survive this, right?” He’s talking about being an intern, which is already proving to be grueling on the very first day. However, his words later take on a whole new meaning.

As fans of the show know, while George does survive his internship, he doesn’t survive his residency. Tragically, the fan favorite character dies at the end of Season 5 when he’s hit by a bus after pushing a woman out of its path. However, there’s another small detail about George revealed in the first episode of Grey’s Anatomy that becomes even more relevant during his final episode. 

In a dramatic turn of events, George is unrecognizable after being hit by the bus, and is only identified after he writes his nickname, “007,” on Meredith’s hand with his finger. George earns this nickname in the first episode of Grey’s Anatomy after botching his first surgery, which prompts the other interns to mockingly nickname him “007” — a reference to the fictional spy James Bond and his “license to kill.”

This is why Meredith Grey's first patient in Grey's Anatomy looks so familiar

The first episode of Grey’s Anatomy features a face familiar to fans who may have skipped out on the first few seasons.

Meredith Grey’s first patient as an intern is a nightmare, thanks to Katie Bryce — a teenage girl who makes Meredith’s very first shift at Seattle Grace extremely difficult. The teen is whiny and demanding, but later gives Meredith a chance to prove herself when the intern is able to diagnose her, which subsequently saves her life. 

The actress who plays Katie is Skyler Shaye, and she actually returned to reprise the role of Katie Bryce two more times (as of this writing), in 2016 and 2019. Grey’s Anatomy has a lot of guest stars, and most of the patients treated by our favorite TV doctors only appear in one episode — so the fact that Katie comes back to the hospital a decade later is pretty significant. Thankfully, by the time Katie returns later in the show, she’s not quite as difficult — although she still serves Meredith plenty of attitude.

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