It’s been 10 years since Grey’s Anatomy debuted as a midseason medical entry, joining one of ABC’s strongest seasons of television—Lost and Desperate Housewives had launched that fall. Now, 237 episodes and hundreds of medical cases later, EW looks back on the seeds that executive producer Shonda Rhimes planted in the pilot episode that went on to shape the plot of Grey’s and make it such a successful series.
1. After Meredith (Ellen Pompeo) and Derek (Patrick Dempsey) sleep together in the pilot, she becomes the “girl in the bar,” a descriptor Derek later uses to describe her half-sister, Lexie Grey (Chyler Leigh), when they cross paths at Joe’s before her first day at Seattle Grace at the end of season 3.
2. Meredith plans to sell her mother’s house in the pilot, but it goes on to become the home to all of the Fab Five at some point throughout the series. Alex (Justin Chambers), Arizona (Jessica Capshaw) and Jo (Camilla Luddington) still live in this house in season 11.
3. George (T.R. Knight) nearly kills a patient during his first appendectomy, leading to everyone calling him “007” because he has a license to kill. After George gets hit by a bus and is injured beyond recognition, he writes “007” on Meredith’s hand to identify himself.
4. George harbors a huge crush on Meredith. They do eventually sleep together in season 2, but it’s a huge, very awkward mistake.
5. After Meredith scrubs in for Derek’s surgery in the pilot, she notes that saving someone’s life is like a high—the exact same reaction Derek’s research fellow Renee (Scottie Thompson) has in season 11 when they achieve a breakthrough in her project, which leads to her kissing Derek.
6. Bailey (Chandra Wilson) gives Meredith, Izzie (Katherine Heigl), George, and Cristina (Sandra Oh) a speech that includes her five rules for the interns, which they all later give to disastrous results once they become residents with interns.
7. After Webber (James Pickens Jr.) calls out Alex for being lazy on a case, Meredith steps up to impress him, to which he replies, “I’d know you anywhere, you’re the spitting image of your mother,” foreshadowing that Webber and Ellis Grey (Kate Burton) had a prior relationship.
8. Webber welcomes the interns to the hospital with the famous speech that notes eight doctors will switch to an easier specialty, five will crack under the pressure, and two will be asked to leave. Albeit most of the interns are red shirts, but we do see several of these come to fruition, including Izzie cracking under the pressure after cutting Denny’s (Jeffrey Dean Morgan) LVAD and leaving the program—though she later returns.
9. At the end of the pilot, it’s revealed that Meredith’s voiceover is actually her telling Ellis the story of her first shift at the hospital. Twist: Mer’s famous surgeon mother that everyone had been praising throughout the episode appears to not even know who Meredith is, which eventually leads to the reveal that Ellis has Alzheimer’s.