Being the landmark 400th episode, “You Are the Blood” also featured a number of callbacks to earlier episodes, reminding viewers of just how far we’ve come over the course of 18 seasons. And of course, as is frequently the case with Grey’s Anatomy two-parters, both episodes were also chock full of major twists, shocks, and things that made us go, “Seriously?” Here are the seven most jaw-dropping moments from the 2-hour Season 18 finale of Grey’s Anatomy.
What happened in the season 18 finale of Grey’s Anatomy
Owen and Teddy go on the run from the law
When a man named John comes to Owen (Kevin McKidd) seeking his help in enabling his wife, a veteran named Rosie, to die with dignity, he threatens to reveal that Owen has assisted other veterans end their lives if he refuses. However, Teddy (Kim Raver) insists that Owen can’t give John what he’s asking for, and together, they turn him down. True to his word, John goes straight to the authorities… who in this case is Chief Miranda Bailey (Chandra Wilson). Livid, she goes to confront Owen and Teddy—right as they’re in the middle of packing their bags to run. After giving both of them a thorough piece of their mind, Miranda tells them she is obligated to call the police… but first she has to deal with an administrative crisis, which could take a few hours. She wishes them both luck, and the two of them prepare to collect their kids and go on the lam. After asking Amelia (Caterina Scorsone) to bring their kids to Joe’s Bar, they bid her a hasty goodbye, and they’re off to worlds unknown. Does that mean Owen and Teddy are gone for good? We don’t know, and there have been official confirmations one way or the other. Their closing shot—sitting on a plane with their two kids – definitely feels like a cliffhanger, and this storyline is uncharted territory for Grey’s Anatomy (a rare occurrence 18 seasons in), so we wouldn’t be surprised if the show finds a way to bring them back after leaving their fates up in the air for a little while.
The blood goes bad
In the midst of a major blood shortage, the hospital is canceling all elective surgeries and asking everyone to donate blood (a problem unnecessarily exacerbated by the fact that an archaic law prohibits sexually active gay men from donating blood—which prompts Levi (Jake Borelli) and several of the hospital’s other queer residents to organize a blood drive of their non-sexually active friends on social media). But when a risky surgery Meredith (Ellen Pompeo) is performing goes south, blood suddenly becomes of the utmost importance—only for Ben (Jason George) to call Miranda to tell her that the blood transport got in an accident, and the blood is now spilled in a puddle all over the road. The shortage leads to all sorts of hard decisions, chiefly when pregnant patient Kristen (Bianca Santos) suffers a placental abruption, and her terminal husband Simon (Cedric Sanders)—who just happens to have the same blood type—chooses to forego the blood required to continue his ECMO treatment so that his wife and child will have a better chance. In doing so, Simon realizes he may be forfeiting his chance to meet his son, but Winston (strong>Anthony Hill) heads into his wife’s operating room to retrieve the baby, and runs to bring him to Simon as quickly as he can. As Simon fades, Winston and Link (Chris Carmack) put his son on his chest, where Simon is able to kiss him and tell him “hello forever” before he dies.
Jackson and April return
After heading off to Boston together (although not together-together… yet) toward the end of Season 17, former series regulars Jackson Avery (Jesse Williams) and April Kepner (Sarah Drew) return to Seattle in “You Are the Blood” so that Jackson, as head of the Fox Foundation, can meet with the residency assessor (and give his mother a premature—and ultimately unnecessary—eulogy). April and Harriet tag along, seemingly mostly for moral support, but April has barely set foot in the hospital before she is immediately put in charge of the pit after Miranda learns what Owen has done. April and Jackson don’t have a lot to do in the show’s milestone episode, but they fit right back into the ensemble cast, with April having a brief heart-to-heart with Amelia, and Jackson handing Meredith some tough love as only someone who went through a residency with her can do. The biggest jaw-dropping moment, though, came at the end of the episode, when the pair boards an elevator to leave the hospital… and kiss as the doors close, confirming that the pair did indeed get back together while in Boston. Spinoff, anyone?
Blasts from the past
Throughout “You Are the Blood,” we are treated to a host of flashbacks to earlier seasons. At first, as Meredith treats her patient, Cora, Ellis Grey (Kate Burton) is at the forefront of her memory, lecturing Meredith about not living up to her potential or Ellis’ expectations. Then as things begin to go wrong with Cora, Meredith’s memories drift to her husband Derek (Patrick Dempsey), recalling him reprimanding her in the O.R. Later, as Cora crashes, Meredith’s memories shift to when Derek was shot at the end of Season 6, and ultimately him dying in Season 11. But afterward, as Meredith thinks back on her own residency, we get to see a number of other familiar faces, with Meredith remembering her earliest days as an intern with Izzie (Katherine Heigl), Alex (Justin Chambers), Cristina (Sandra Oh), and George (T.R. Knight). And at the end of the episode, the floodgates open, with moments featuring pretty much every major character who has ever appeared on the show flashing by, reminding us of all that has happened in the halls of the hospital over the years. Throughout, “You Are the Blood” also featured some of Grey’s Anatomy’s most memorable songs, including “How to Save a Life,” “The Story,” and “Chasing Cars,” imbuing the whole episode with a lingering sense of nostalgia.
The Grey Sloan Memorial residency program gets shut down
It’s been building all season, and finally, it’s time for the representative from the residency program accreditation council (Dawnn Lewis) to render her verdict. At first, she appears nearly ready to sign off on allowing Grey Sloan to continue business as usual, but things then take a sharp turn. When Richard (James Pickens Jr.) shoots down Meredith’s idea for an ambitious surgery that would involve taking all of her patient’s organs out of her body and then putting them back in, Meredith disregards his call and schedules it anyway. Richard’s fear is that the procedure is too much of a risk while the residency program is still under such severe scrutiny, but Meredith believes it may be just the thing to save the program. Unfortunately, she’s wrong, and her patient dies following a surgery that blows through quite a bit of the hospital’s meager blood supply. Afterward, Richard tells Meredith just how frustrated he is with her decision, and Nick (Scott Speedman) agrees, telling Meredith that the surgery wasn’t necessary and used up too many valuable resources. After observing Meredith’s decision, as well as taking into account Richard’s decision to push ahead with the “Webber method” earlier in the season against Miranda’s wishes, the assessor concludes that the senior staff of Grey Sloan are too close, to the point where they don’t respect seniority anymore. She observes that they see each other as family, which can be an asset personally, but a liability to the hospital. The result, she believes, is an environment that is not conducive to teaching well, leaving her no choice but to shut down the residency program.
Kai changes their mind
While other doctors were running themselves ragged over blood, Amelia spent the season finale reeling from her abrupt breakup last week with Kai (E.R. Fightmaster), after Kai revealed that they didn’t want children. Since Amelia is already a mother, that seemed like an insurmountable hurdle, and the couple split. Finding herself on the receiving end of heartbreak caused by her partner not wanting the same things she did, Amelia then apologizes to Link for how she handled their breakup. She tells him that if she realized what this felt like, she would have done things differently. He accepts, telling her he loves her, just “not in the painful way” anymore. But no sooner has Amelia made her amends than Kai shows up in the parking lot! “I couldn’t sleep,” they tell her, and that’s all it takes for them to be in each other’s arms again. So I guess parenthood is back on the table?
Miranda Bailey quits
True to form, Grey’s Anatomy saves its biggest shocker of the night for the closing minutes of the episode. After being run ragged all season—and really, since her first day of residency at Seattle Grace—the residency program getting shut down on the same day in which two of her attendings quit to flee from the law proved to be Miranda Bailey’s final straw. In the closing minutes of the episode, she tenders her resignation from the hospital, effective immediately, handing the keys to her office to Meredith, who she appoints de facto Chief of Surgery (is anyone really going to argue?). Meredith doesn’t seem thrilled to have the job, but she also doesn’t think she has much of a choice (unless she does? The closing moments of the episode leave things a bit vague). Granted, we’ve known for a while that Miranda’s job was taking a significant toll on both Miranda’s mental health and her marriage, leading her to take a brief sabbatical earlier in the season, but we never dreamed it would lead to her just quitting on the spot. Miranda lives and breathes surgery—or at least, we thought she did. We can’t imagine what Grey Sloan will look like without Miranda Bailey, but it looks like in Season 19, we just may find out. When are your favorite doctors returning? Here’s everything we know about Grey’s Anatomy Season 19.
