How Grey’s Anatomy keeps upping drama: Sex, disasters and more than 140 tumors

During almost two decades on air, writers of hit TV show “Grey’s Anatomy," have had to weave a seemingly endless stream of medical cases into the complicated, sexy and often tragic lives of its characters.

The drama has been a darling of broadcast TV and the streaming eras, with roughly 300 hours of content. While bingeable comfort watches such as “Friends" and “Seinfeld" ended long ago, “Grey’s Anatomy" continues to air new episodes, entering its 21st season on Sept. 26.

“Insane medical cases and patients" have been the constant, said showrunner Meg Marinis, who joined the writing staff as an assistant in 2006. White boards line the walls of a Los Angeles bungalow where about a dozen writers, two writers’ assistants, a researcher and three doctors gather on a studio lot to map out how best to combine blood and scalpels with romantic encounters and friendship.

Grey’s Anatomy made its debut in 2005, chronicling the exploits of ultracompetitive surgical interns at a fictional Seattle hospital. The show opens after a one-night stand between Grey and a stranger she met at the bar who turns out to be a married brain surgeon at her new place of work.

Since then, writers have faced a constant challenge of how to subject characters to just the right amount of heartache, professional hurdles and loss.

Grey’s has appeared on ratings firm Nielsen’s weekly list of the 10 most-watched streaming shows 122 times since 2020, only one of four shows to hit triple digits.

“We’re going to have blood. We’re going to have scary talk about people dying and we’re ‘Grey’s Anatomy’ so there’s going to be sex," Marinis said.

Characters elope, lose friends, revive crashing patients, make snap judgments, hook up in supply closets and dance it out in break rooms. Patients bleed, seize, code and die—sometimes when they appear to be on the road to recovery.

‘You’re a monster’

When writers have an idea for a new twist for a character they “play the make it worse, make it sadder game," Marinis said.

“Sometimes we’re like, ‘why would you say that! That’s horrible! You’re a monster.’ We’re all trying to one up each other," she said.

More recently, writers have had to adapt to star Ellen Pompeo’s decision to reduce the number of episodes in which she appears.

Writers spend about a month writing each episode, followed by three weeks of production and two weeks of edits. A document called the “Grey’s Anatomy Bible" keeps track of all the plotlines, voice-overs, medical cases and themes covered.

They try to strike a balance in keeping the show dramatic without wreaking havoc for characters. A main character collapsed in the operating room at the end of the 19th season, for example, so the writers opted for emotional turmoil at the end of the next season.

Instant shock

“We try not to hurt or make our characters sick too much," Marinis said. “It’s an easy well to go to because that’s instant shock and drama when one character is at risk of dying, but we try not to do it too often."

Elizabeth Washington, 27, started bingeing the show in April after a breakup and watched the first 19 seasons of the show in five months. She watched the title character almost die repeatedly, surviving a plane crash, nearly drowning in icy Seattle water, and plugging a hole in a man’s body with her finger to stop a bomb from detonating.

“She has the most traumatic life ever," but is resilient, said Washington, who is from Grand Rapids, Mich.

Streaming platforms have ushered in a younger fan base, some of whom weren’t alive when the show first aired on ABC. Episodes debut on ABC and are available on Hulu in the U.S. the next day; past seasons are accessible on Netflix and Hulu.

Characters’ phrases, from “seriously" to “pick me, choose me, love me," and McDreamy, have been cemented into pop culture with memes of famous scenes getting new lives on social-media platforms.

Ashley Boren, 28, from Norman, Okla., started watching the show when it first premiered with her mom and has re-watched the first eight to 10 seasons multiple times.

“If you’re having a hard day and you want to turn your brain off or watch it for the funny parts, you can do that. Or if you want to cry, you can go to those episodes," she said.

Across all of Disney’s streaming services globally, “Grey’s Anatomy" has garnered 3.6 billion hours of viewing. Grey’s drew more viewing hours among U.S. Netflix subscribers than any other show on the platform between the first quarter of 2021 and the first three months of this year, according to analytics firm Digital I.

Some ideas for patient conditions—like one early on in which doctors save a teenager stuck in a block of cement—come directly from Shonda Rhimes, the show’s creator, known for other addictive fare such as “Bridgerton," “Scandal" and “How to Get Away With Murder."

To keep the medicine on the show fresh, the drama has run a fellowship for surgical residents since 2013. Residents from across the country can apply to work in the“Grey’s Anatomy" writing room and receive credit for their surgical residency by consulting on the show.

“People find new ways to injure themselves everyday," Marinis said.

Sarah Krouse contributed to this article.