As the medical drama reaches 300 episodes, EW looks back to where it all started

“Welcome to the game,” says the chief of surgery. “The worst part of the game,” says the brilliant surgeon, shaking his head at the corpse on the operating table like a quarterback mulling an interception. “They say a person either has what it takes to play, or they don’t,” says the young intern fresh out of med school. “Look around,” the chief of surgery tells all the young interns. “Say hello to your competition.” When one of their own goes to work at the operating table, the wannabe surgeons cluster in the observation room, taking bets like they’re watching the big fight, snarking commentary like they’re the robots from Mystery Science Theater 3000.

Anyone who has had any long-term interaction with the medical establishment will worry, at some point, that their doctor doesn’t really care about them. That to them we are merely a bag of dug-around bones, maybe if we’re lucky blessed with a unique enough illness to constitute an exciting challenge for bored god-complex egomaniacs. More likely we’re a slot on their calendar, something to be foisted onto someone further down the totem pole. The genius of the Grey’s Anatomy pilot, “A Hard Day’s Night” — which aired in 2005, 299 episodes ago — is how completely and thrillingly it confirms all those worst fears. The doctors are macho, braggadocious, their spiritual act of lifesaving recast as an athletic event: “This is your arena. How well will you play?” The patients are an annoyance at worst, an exciting problem at best. Dr. Bailey (Chandra Wilson) warns her interns about interrupting nap time. “The dying patient better not be dead when I get there,” she says. “Not only would you have killed someone, you would have woken me for no reason.”

There’s a blithe comedy to all this, which would be dark if the whole thing wasn’t so kinetic, if it didn’t draw you into the schadenfreudic thrill of seeing good people feel bad enough for our doctors to save them. When the first patient arrives by helicopter, mid-seizure, the song on the soundtrack is “Super Cool” by Bang Sugar Bang, the kind of tune Michael Bay might use to introduce a tough group of asteroid-punching beefcake misfits. When George (T.R. Knight) performs his first (faulty) surgery, the soundtrack is “Dance” by The O.A.O.T.’s, the kind of song someone will use in 15 years as background for a lacrosse montage in a hyper-specific homage to turn-of-the-millennium teen comedies. “Dance,” “Super Cool,” are you getting the vibe here? Are you sensing the goal is the opposite of serious?

Grey's Anatomy
Credit: ABC

When Grey’s Anatomy debuted, ER was in its 11th season and had reached the point where its own neophyte central character John Carter (Noah Wyle) was now an experienced veteran making way for the third or fourth generation of castmate doctors. Once a phenomenon, the show seems a little lost to history now, and it deserves a new reconsideration; even its later years were grounded in some sense of the everyday drudgery of saving lives on the edge.

Right off the bat, Grey’s was different, fancier the way all brilliant fantasies are, and almost decadent with frank elitism. Cristina (Sandra Oh) was “top of her class at Stanford” and insult-asks George, “Where did you go to medical school, Mexico???” And Meredith (Ellen Pompeo) wears her Dartmouth shirt, and Karev (Justin Chambers) hates nurses, and at the end of a long shift, Meredith and George ponder working-class roads not taken. “I wish I wanted to be a chef, or a ski instructor, or a kindergarten teacher,” says she. “I would’ve been a really good postal worker,” says he. Did they choose this field out of any sincere motivation to help people? Maybe, but we don’t see much of that. Allowed into her first surgery, Meredith emerges ecstatic and spent and says, “I don’t know why anybody does drugs.” For them, the action is the juice.

There’s a moment in the Grey’s Anatomy pilot that I always think is the some key big-bang moment for Shonda Rhimes as a TV auteur and a generational spokesperson. The interns have been running for nearly 24 hours, are lingering down in a corridor. Izzie (Katherine Heigl) is doing yoga. George is moaning about his first botched surgery, wondering if he should’ve gone into geriatrics. “Surgery’s hot,” says Cristina, Oh already playing the coolest doctor on television. “It’s the marines, it’s macho, it’s hostile, it’s hardcore. Geriatrics is for freaks who live with their mothers and never have sex.”

The whole pilot’s like that: People talk about their job like they’re in a Hollywood pitch session. There’s some recognizable influence from the HBO Renaissance here, the thrilling possibility that the heroes of a show can be barely moral snobs created so well that you have to love them. The doctors in the Grey’s Anatomy pilot remind you of the mobsters in The Sopranos or the cops on The Wire: so proud, so self-regarding, and so funny about it. You wouldn’t want to hang out with them, unless they were your friends, in which case you’d never want to hang out with anyone else. Rhimes’ most defining follow-up shows would pick up this thread: Olivia Pope (Kerry Washington) and her “gladiators” on Scandal, the uber-competitive law students who keep forgetting How to Get Away With Murder, protagonists whose whole profession depends on rewriting rules, shifting public narratives or twisting legal webs. Diet Shondaland wannabes can never quite thread the needle: If there’s no sense of humor, then the characters become unredeemable douchebags, and if there’s no dark ambition, then everyone’s just a boring ol’ Good Doctor.

But the Grey’s pilot captured some other strand in the culture. The doctors are fervently devoted to their work, but only because they treat it like a game, like some great ongoing challenge. This feels less like the typical medical show than an echo of start-up culture, the all-or-nothing world where you give up your life for something better. (A key early plot point is Izzie choosing work over romance; eventually, as in all TV shows and most start-ups, work will become the only available venue for romance.) This is workaholic pop-punk, a proto-Lean In by way of The Art of War. At one point, having just saved a life, Meredith runs outside to vomit and then gets back to work, just like Jamie Foxx’s rookie QB in Any Given Sunday.

Rhimes brilliantly layered the pilot with a couple big reveals: That random hot dude Meredith slept with is the new surgeon, and Meredith’s narration is a story she’s telling her Alzheimer’s-addled mom. Rhimes already had a great knack for banter that was self-aware about its bantering. (“We don’t have to do that thing where I say something, you say something, somebody cries, there’s, like, a moment,” Cristina tells Meredith.) She calls no attention to the fact that every authority figure is an African-American — Wilson’s Dr. Bailey, Isaiah Washington’s Dr. Burke, James Pickens Jr.’s Chief Webber — but Meredith and Cristina bond first over casual gender-disparity shop talk, noting “only six women out of 20” in the program.

There is recognizable medical-drama pathos in the pilot, a little halfhearted upon rewatch: George has to tell someone that her husband has died on the table. It’s an essential part of the Grey’s formula, maybe, those sincere moments — but you watch the pilot and you can almost see another version of the show, not better but funnier and maybe just more British, where those moments of seriousness are just part of the joke, where George races to the break room to complain about grieving widows, where this whole thing is just a gag until somebody really sick comes in for a really cool surgery.

Grey’s became a hit and then a phenomenon, had good years and bad, and now it reaches 300 episodes with no obvious signs of slowdown. It could trend sappier, less cutthroat, more melodramatic; there was that point when everyone seemed to have a parent or a love interest in the hospital as a patient, the sweeps-week-iest of plot points (though Grey’s is powerful enough to have practically outlived sweeps). But the nastiest and most comedic instincts would flare up, in the shooter killfest that claimed the lives of so many unloved characters, in the trending-topic deaths of long-running characters. Those deaths were sad, and they were part of the game.

Episode Recaps

Grey's Anatomy

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

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