Why did Katherine Heigl really leave Grey’s Anatomy ? Did McDreamy’s McAttitude cost him his surgical privileges? When will this beloved show seal its scalpels away for good? Answers – well, speculation – to these questions lie in How to Save a Life: The Inside Story of Grey’s Anatomy , out now, by Entertainment Weekly editor-at-large Lynette Rice. Rice wrote an oral history of television’s longest-running medical drama (its 18th season premieres on September 30) with near-surgical precision, including a mix of extensive interviews with writers, actors, former crew members and executives, not to mention a compelling collage of archived interviews from over the years. But some stories will likely stay behind operating-room doors. “It’s the story of one of the greatest successes in television history, and the rise of an amazing creator, actors, all that stuff,” an unnamed source told Rice. “But to me, the real story is never going to be fully told, because people won’t talk – at least on the record, like me.” The series – created by then unknown Shonda Rhimes – premiered in 2005, starring Ellen Pompeo (Meredith Grey) and four fellow surgical interns ( Sandra Oh , Katherine Heigl, T.R. Knight and Justin Chambers) who navigated medicine and relationships. What became (and remains) a bona fide hit in front of the camera, however, saw more than its fair share of drama behind it. Patrick Dempsey may have played Derek “McDreamy” Shepherd for the first 11 seasons of Grey’s Anatomy , but working 15 hours a day for 10 months out of the year brought out the negative side of his personality. “There were HR issues,” James Parriott, executive producer and writer, said. “He sort of was terrorising the set. Some cast members had all sorts of PTSD with him … he and Shonda were at each other’s throats.” His character’s death (after getting hit by a truck) may have shocked fans, but death was the only way for the character to go. “He and Meredith were such an incredibly bonded couple at that point,” writer Stacy McKee said. “It would be completely out of character if he left his kids.” Dempsey went on to reprise his role during a series of Covid-19-induced dreams Meredith has in season 17 – giving both fans (and the actors) a chance at a reunion, which seemed more sweet than sour. Much has been said about the exit of Heigl’s character, Izzie , from the show, but Rice’s timeline suggests multiple factors were behind it. The most well-known controversy: when Heigl said publicly she didn’t submit herself for an Emmy less than a year after she won (for best supporting actress in a drama series in 2007) on account of the lacklustre (in her opinion) material given to her at the time. “I could have more gracefully said that without going into a private work matter,” she said. “It was between me and the writers. I ambushed them, and it wasn’t very nice or fair.” She also grumbled to talk-show host David Letterman about long work hours, specifically on behalf of the crew – though the fact she was speaking for them wasn’t clear at the time. Ultimately, Heigl left after adopting her first child with husband Josh Kelley. She said starting a family “changed everything” and she no longer craved full-time work. A former ABC Studios executive said they could’ve reached a happy medium but that Heigl was after a film career. Another “person familiar with the situation” said she and Rhimes had difficulty working together. Whatever the case, Heigl’s career never truly recovered after it all (though her new Netflix series Firefly Lane earned a second-season renewal). Imagine being called a gay slur by one of your colleagues behind your back. Then imagine said colleague denying it in front of the press at the 2007 Golden Globe Awards a few months later. That’s what happened to T.R. Knight when Isaiah Washington (Preston Burke on the show) used a homophobic slur during an on-set physical altercation with Dempsey. “You can’t talk to me the way you talk to that little [expletive] T.R.,” he said. Despite a public apology, Washington later insisted he never used the word and actually advocated for having Burke come out as gay. He was written out of the show at the end of season three, only reappearing to help orchestrate the departure of his character’s ex-fiancée, Cristina Yang, (Oh) from the show in season 10. Rhimes defended bringing him back into the fold. “I feel very strongly and fully believe in people’s ability to grow and change, learn from their mistakes, and when they know better, to do better,” she said. Pompeo’s tenure on the show has given her much clout, and she’s spoken about improving a previously toxic work culture. But she may have contributed to such a culture herself, too. One incident details the departure of Stephanie (Jerrika Hinton) at the end of season 13. Allegedly, Pompeo was unhappy Hinton took personal photos on set without asking her first. “[Jerrika] hadn’t been around a lot, so maybe she didn’t understand the power Ellen had,” according to make-up artist Norman Leavitt. “If she’d gone and said, ‘Is it OK if I take these Polaroids?’ Ellen probably would’ve gone, ‘OK’. But by just doing it and not including her, you’re setting yourself up for disaster.” Hinton didn’t talk to Rice about the incident for the book. Maybe this isn’t so shocking – but in a certain way, it remains astounding. Season 17 was written as if it could’ve been the last season . “The reason why you’re like, ‘Oh my gosh’ every episode is because we approached it with a certain reverence of ‘OK, if this is the last season and we’re doing Covid-19, what are we doing?” showrunner Krista Vernoff said. Rhimes is still pinching herself and said she’s written at least six different endings. “But we just don’t end,” she said.