Grey’s Anatomy closed its season 14 premiere with a surprising twist: Amelia Shepherd has a large tumor in her brain.

The medical malady isn’t just ironic in terms of a neurosurgeon discovering she has a brain tumor, but it’s also all the more heartbreaking because it’ll make Amelia question every decision she’s made over the last few years. Could her brain tumor be to blame for some of her impulsive decisions on Private Practice? Was her Runaway Bride moment ahead of the wedding to Owen (Kevin McKidd) a side effect? Who is Amelia, really? That’s the big question going into season 14 as Amelia comes to realize the brain tumor has had quite the effect on her personality.

“It serves as the Monday morning quarterback moment where you’re like, ‘Oh, that makes so much sense,” Jessica Capshaw says. “This is a time when everyone is understanding, in a context of her having a brain tumor, everything that’s happened in the past few years. It’s a reckoning, if you will, but it’s also an explanation. Some of the people who are closest to her, I think it’s definitely a revelation and also scary.”

Credit: Mitch Haaseth/ABC

However, Amelia will be desperate to keep her brain tumor a secret for the time being, much to her new mentee DeLuca’s (Giacomo Gianniotti) dismay. “It’s a secret and she doesn’t want to tell Owen, she doesn’t want to tell her sisters until everything’s for sure certain,” Gianniotti says. “It’s tough. There’s this HIPAA thing, which is you’re not allowed to disclose patient information, and she’s a superior, so he cannot share the secret. She’s still trying to practice medicine, and I’m trying to stop her from doing that, so it’s a back and forth. I can’t really speak, so I’m trying to find creative ways for other people to discover it.”

That’s where the comedy that Grey’s is striving to return to comes into play during this rather dark story line. “There’s a comical scene I have with Maggie, Dr. Pierce, where I try to bring her into a room full of scans and I try to get her to look at them by talking about how our relationship ended and she’s just not getting it,” Gianniotti says with a chuckle.

“It’s a big deal because everyone’s been calling Amelia crazy for a long time and I think that’s a sad reality that she’s going to have to come to terms with,” Gianniotti continues. “‘Am I crazy? Was I crazy? Do I have to question every medical and personal decision I’ve made in the past year or two years, three years, however long this tumor’s been growing inside of my brain?’ That’s something that we’re going to be playing in the next couple episodes, her questioning everything that she’s done medically.”

Sure, there’s worry that removing this brain tumor could lead to a very different person in the aftermath, but the question remains whether Amelia will survive considering it would take a very invasive surgery to heal her. “I don’t think I should say anything about that,” McKidd says coyly. “I don’t want to torture anyone, but that’s part of the fun of the show. I hate to be that person, but a brain surgery is a very, very serious surgery, and with a tumor this developed, it’s not an easy procedure, by any means.”

This new twist is doubly hard on Owen considering his sister was only just found alive, having gone through a major surgery of her own in the premiere in a bid to then go back to Iraq for her adopted son. But McKidd says Megan (Abigail Spencer) won’t be leaving immediately. “Nothing is simple, especially on Grey’s,” McKidd says. “There are some medical developments for Megan that mean that she can’t rush off straight away.”

Grey’s Anatomy airs Thursdays at 8 p.m. ET on ABC.

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Grey's Anatomy

Meredith. Alex. Bailey. The doctors are definitely in on Shonda Rhimes' hospital melodrama.

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