How to Save a Life (Grey's Anatomy)

Plot

The episode opens with a flashback of a five year old Meredith Grey (Ellen Pompeo) lost in a park. The Chief of Neurosurgery at Grey-Sloan Memorial, Dr. Derek Shepherd (Patrick Dempsey), leaves Grey and their two children to go to Washington to resign from the President's brain mapping project. While she is at Grey-Sloan, Grey returns a call from Shepherd as he drives to the airport, and the two speak briefly until his phone loses its signal. Shortly thereafter, Shepherd witnesses a road accident and stops to help the victims. He rescues a young girl named Winnie (Savannah Paige Rae), and helps her mother who has a dislocated leg. With assistance from Winnie, he rescues another couple from their car right before it explodes, and offers them emergency medical care.

Paramedics arrive at the scene and transport the victims to a nearby medical health facility at Dillard. Shepherd returns to his car and stops briefly in the middle of the road to answer his cell phone. While doing so, his car is hit by a semi-trailer truck. Shepherd is transported to the same hospital at Dillard, with multiple fractures, internal injuries, and loss of speech. His thoughts are verbalized through narration. Shepherd realizes that he needs a CT scan for his head injury, but cannot tell the ER staff. Instead, they transport him to the operating room to address his abdominal injuries. By the time of the surgery, Shepherd is certain that he will die as his hemorrhage will not be discovered in time. One of his doctors, Dr. Penelope Blake (Samantha Sloyan), wants to perform a CT, but is dismissed by an ignorant senior. The hospital's neurosurgeon takes over an hour to arrive, and by the time he arrives Shepherd is already brain dead. He dismisses Blake, who was the only doctor on Shepherd's case to have devised the right treatment plan.

Shortly after arriving at the hospital with Bailey and Zola, Grey is informed by the surgeons that they tried everything to save her husband's life. Grey points out that they should have ordered a head CT, much to Blake's dismay. She condescendingly reviews all of her options with the doctor in-charge of Shepherd's case, before signing the papers to authorize the removal of his life support. Blake tearfully apologizes to a forbearing Grey, who then returns to his hospital room to say a final goodbye to Shepherd. This is accompanied by a montage of the happy moments from their relationship.

Production

The episode was written by showrunner Shonda Rhimes and directed by Rob Hardy. It was the first episode Rhimes has written since the season eight finale "Flight". Samantha Sloyan, Larry Cedar, Mike McColl, Allie Grant, and Savannah Paige Rae make guest appearances in the episode; Sloyan reprised her role in the show's 250th episode "Guess Who's Coming to Dinner". "How to Save a Life" featured the songs including covers recorded by Sleeping at Last of previously used tracks "Today Has Been OK" originally by Emilíana Torrini, and "Chasing Cars" originally by Snow Patrol, and the originals "Sedona" by Houndmouth, "Gulls" by David Gray, "Into the Fire" by Erin McCarley. Filming for the episode took place both at the studio and on location over a span of three weeks.

Speculation about Dempsey's exit from Grey's Anatomy began in November, when during an interview, Dempsey casually mentioned that he might be leaving the series very soon. Despite signing on for two more years at the end of the tenth season of the show, he disclosed that the eleventh season would be his last. The announcement was made public on April 23, 2015, just a few hours before the airing of How to Save a Life. In an interview with Entertainment Weekly, Dempsey explained how the bold move could have been made when he had just re-upped his contract as he asserted on the natural developments leading up to his exit from the long-running series. He said, "It really was something that was kind of surprising that unfolded, and it just naturally came to be. Which was pretty good. I like the way it has all played out." He went on to share further details on his character being written out of the show, as he said, "Things happened very quickly, where we were like, Oh this is where it’s going to go. It just sort of unfolded in a very organic way." The developments leading up to the eventual exit which he deemed "natural", began in February-March 2016.

Amidst speculation of rifts between Dempsey and Pompeo, and even show runner Rhimes the former maintained his stance of leaving in a "very good" place with his co-star of ten years. On his relationships with Pompeo in particular, he said "it’s beautiful. We’re like a married couple. It’s 10 years, and it was magic from the beginning. Chemistry right away.” He thanked his fans on Twitter and wrote, "I want to thank all the fans, what an incredible 11 yrs, I love you all." Rhimes asserted on the importance of Dempsey's character in the statement she released at his departure: “Derek Shepherd is and will always be an incredibly important character—for Meredith, for me and for the fans. I absolutely never imagined saying goodbye to our ‘McDreamy.’ As Ellis Grey would say: the carousel never stops turning.” Pompeo too took to Twitter to react to the death of Shepherd and wrote, “I am honored and excited to tell the story of how Meredith goes on in the face of what feels like the impossible. I hope you will all join me on her journey”.” It was the first time she spoke out publicly about Dempsey's publicised exit.

Broadcast

"How to Save a Life" was originally broadcast on April 23, 2015 in the United States on the American Broadcasting Company (ABC). The episode was watched by a total of 9.55 million, up 23 percent from its last years telecast airing around the same time. In the key 18-49 demographic, the episode scored a 2.8 in Nielsen ratings, up 22 percent from last year, scoring the best ratings since the eleventh season premiere. It was the second best TV show in the 8.00 pm slot, beating Bones, The Vampire Diaries and a rerun on The Blacklist, but was beaten by The Big Bang Theory.

The 9.55 million people tuned into the episode marked a 24 percent increase from the previous episode (7.60), in addition to the installment's 2.8 Nielsen rating in the target 18–49 demographic marked a 33 percent increase from the previous episode (2.1). The Nielsen score additionally registered the show as the week's highest rated drama and third-highest rated scripted series in the 18–49 demographic, only behind CBS's The Big Bang Theory (3.6) and ABC's Modern Family (3.0).

Critical reception

The episode received mixed reviews by critics who gave a polarised view on the writing and handling of Shepherd's death. Ashley Bissette Sumerel of TV Fanatic gave the episode the highest praise in a 5 out of 5 star review highlighting the "interesting possibilities" that the death would offer for the show. However, she stated, "I'm beyond heartbroken. [...] We've seen tragic deaths and lost beloved characters, but never quite like this. I don't think I'll ever get over it." She also acknowledged the show's emotional connect with its audience and it's courage to attempt the "inconceivable". Ariana Bacle of Entertainment Weekly took the opportunity to reminisce the early years of the show saying that it's the compelling characters that have made committing to Grey's "irresistible". She added that despite some "weak moments" that the series suffers from, characters like "Meredith or Derek or Webber will have a moment that reminds me why I keep watching, why I never stopped— so watching one of those characters die hurts. It really, really hurts." In a mixed for the episode a Spoiler TV writer criticized the plot calling it a "self-indulgent episode", contrasted it with "well crafted departure of Mark Sloan, or by Lexie Grey". Also criticizing the absence of the series' major cast from the episode the review said, "The presence of so many inconsequential and uninteresting characters was continually in danger of swamping the dreaminess of Derek." However, appreciative of Pompeo's character the reviewer remarked, "the writing of Meredith was completely on point. She was clinical, as we would expect her to be."

Pompeo garnered widespread acclaim from television critics for her performance in the episode; Rick Porter of Zap2it was largely laudatory of Pompeo's performance which he thought "made all the difference in the episode". He wrote highly of her role in the arc saying, "Without Meredith, and without one of Pompeo's strongest performances in her long time on the show, "How to Save a Life" would have run the risk of coming across as a baldly manipulative death episode". However, he noted that the episode, "may not be the ideal Emmy-submission episode for Ellen Pompeo, considering Meredith is off screen for more than half of it. But it's among the best work she's ever done on the show." Robert Bianco of USA Today thought that the episode "was even more of a showcase for Pompeo", noting that although she didn't play a prominent part until the later half od the episode, "but she had some of the more memorable and well-played scenes, from her angry response to the doctor who tries to tell her what her choices are, to her resignation when she realizes she has to comfort and motivate the young doctor whose mistakes cost Derek his life." Alexandria Ingham Guardian Liberty Voice was particularly impressed with Pompeo’s "range of emotions", which she described as as going through many stages: "the anger, the resignation when she realized there was nothing she could do, and the compassion she had for the young doctor who had failed to save her husband."

Shepherd's death came as a shock to the audience and was a major topic of discussion among critics, who gave polarising views on the character's exit. Janalen Samson, a contributing Writer for BuddyTV noted the episodes generation of shock in the times of the omnipresent media saying, "Genuine surprise is a rare occurrence in television viewing these days", and added, "Imagine my amazement, then, when I sat down to watch [...] "How to Save a Life"". Calling the death a "lightning bolt" David Hinckley of New York Daily News wrote, "In one of the most stunning moments from a high-mortality television season, "Grey's Anatomy" [...] killed off Patrick Dempsey's Dr. Derek Shepherd". Also talking about the shock value Shepherd's death in her New York Post review Lindsay Putnam wrote, "“Grey’s Anatomy” did the unthinkable, killing off one of the few remaining original cast members", additionally putting up the question of the future of the series asking, "with Derek out of the picture, what will become of the rest of the Grey Sloan Memorial Hospital family? Is there still a future for “Grey’s Anatomy”?" The sentiment was echoed by Slate writer Aisha Harris who weighed heavily upon importance of the death and its impact saying that despite the show’s ensemble cast, "Meredith has always remained the central figure of Grey’s, so this death marks a very important turning point in the show". Optimistic of the prospects for the show she added, "if anyone can come out of this tragedy as a tougher, better character than ever, it’s Meredith Grey."