A custom image of Chyler Leigh crying as Lexie Grey in Grey’s Anatomy
Image by Jefferson Chacon
Now on its 20th season, Grey’s Anatomy is a genuine TV juggernaut.

TV has changed dramatically since the show premiered in early 2005,

but it continues to draw a solid viewership, even if it no longer reaches

the impressive peaks of the early seasons. A key part of Grey’s Anatomy’s

enduring appeal is its powerful, emotive storytelling. The series is a real tearjerker,

with a knack for bringing up all the feels with devastating storylines, solid acting,

and, of course, its signature use of sad pop songs.

At times, this recipe veers into melodrama, and Grey’s Anatomy can be quite soap opera-ish but, overall, the show continues to be impactful. The writers know what the viewers respond to, and they’re more than happy to deliver it. Indeed, it sometimes seems as if they take sadistic glee in putting the audience through the emotional ringer. These are the episodes that do it best; they’re bound to have the viewer reaching for the tissue box.

This article contains spoilers for the episodes discussed.

10 “Now or Never”
Season 5, Episode 24
Grey’s Anatomy’s George looking ahead.
Image via ABC
“Drink it in. ‘Cause this is it. It might all be gone tomorrow.” Season 5 was one of the show’s strongest, all the way up to this finale. Various subplots intersect, with the characters dealing with their own challenges and dramas. For instance, Arizona (Jessica Capshaw) offers Bailey (Chandra Wilson) a pediatric fellowship, but Bailey hesitates because her husband, Tucker (Cress Williams), threatens to leave if she accepts. Then, of course, George O’Malley (T.R. Knight) causes a stir by announcing that he’s joining the army.

The episode then pivots when a badly disfigured, unidentified man is brought into the hospital. He’s fighting for his life after throwing himself in front of a bus to save a woman. Meanwhile, Izzie’s (Katherine Heigl) heart suddenly stops after her surgery. The show reveals that the injured man was, in fact, George, before ending on a cruel cliffhanger. We don’t know whether George or Izzie has pulled through. The writers really go for the jugular with this one, cutting to black just when the stakes are at their absolute peak.

9 “Didn’t We Almost Have it All?”
Season 3, Episode 25
A couple looking at each other in Grey’s Anatomy
Image via ABC
“I do not stand here, on my wedding day, optimistic or full of hope.” This episode was one of the most bruising for fan favorite Cristina Yang (Sandra Oh). It’s her and heart surgeon Preston Burke’s (Isaiah Washington) wedding day, but it doesn’t end in a happy ever after. Instead, Burke realizes that he has forced Cristina to change, and that he doesn’t love her authentic self. He abruptly walks out and vanishes, leaving Cristina distraught, and just as caught off-guard as the viewer.

This was certainly a left-turn for the story, which came as a result of ABC deciding not to renew Washington’s contract. Consequently, it feels a little jarring and unnatural given Burke and Cristina’s story up til that point, but the show mostly makes this work. It’s certainly a sad hour of TV, especially during Cristina’s moments of panic, like when she freaks out about having “scrubbed off” her vows.

8 “Fight the Power”
Season 17, Episode 5
Fight the Power Grey’s Anatomy
Image via ABC
“Mom, if you’re ready to go, it’s OK.” “Fight the Power” was the show’s most intense portrait of the COVID pandemic and its toll. When a surge of COVID cases strikes an assisted living facility, Bailey’s mother (Bianca Taylor), who also battles Alzheimer’s, is brought to the hospital with an advanced infection. Bailey is rocked by the news that her mother’s chances of survival are slim. Seeking solace, she turns to Maggie (Kelly McCreary) and finds support from a bedridden Meredith (Ellen Pompeo) before bracing herself to bid farewell.

Bailey’s final moments with her mom are tender and heartbreaking, especially since they were relatable and far too common. The gut punch is the scene where Bailey sings “My Girl” to calm her agitated mother. Webber (James Pickens Jr.) provides emotional support, prodding Bailey to say goodbye before it’s too late. Restrained writing and wonderful performances add to the impact, making it one of the more authentic character deaths on the show.

7 “Death And All His Friends”
Season 6, Episode 24
Death And All His Friends Grey’s Anatomy
Image via ABC
“I don’t hurt anymore. The pain’s gone.” Season 6 culminated in a two-parter that, like “Flight” later, introduced the staff of Seattle Grace to an unprecedented crisis: a shooter infiltrates the premises, prompting a lockdown. The shooter, Gary Clark (Michael O’Neill), unleashes mayhem, killing Reed Adamson (Nora Zehetner) and severely injuring Alex (Justin Chambers). Lexie (Chyler Leigh) and Sloan (Eric Dane) work desperately to save him, while Owen (Kevin McKidd) and Teddy (Kim Raver) brave danger to transfer a patient to the ICU. Meanwhile, Bailey teams up with patient Mary (Mandy Moore) to save another victim of the shooting.

This kind of story is challenging to tell on TV, especially in the context of a long-running show like Grey’s Anatomy. It could easily have come off as fake, insensitive, or sensationalist. Instead, Rhimes and her team pull it off, making for a dramatic and thoughtful pair of episodes. The pacing is brilliantly tense, and the actors rise to the occasion, turning in some of their best work. Webber’s harrowing conversation with Clark may be the highlight.

6 “All I Could Do Was Cry”
Season 11, Episode 11
All I Could Do Was Cry Grey’s Anatomy
Image via ABC
“You have lost somebody, and you are hurting, but you will get through this.” This one centers on April Kepner (Sarah Drew) and Jackson Avery (Jesse Williams), who learn that their unborn baby has Type II osteogenesis imperfecta, a condition that causes extremely brittle bones that break in utero. The news causes the devout April to have a crisis of faith and a reckoning with her Creator.

Seeing April like this causes Jackson to also confront God, leading to several intense scenes about belief and the problem of suffering. The show deserves credit for engaging smartly with these themes. There are several well-written scenes, like April’s conversation with a woman whose fiancé died in a car accident. She’s reminded that pain, even of the worst kind, is a universal experience. Most moving of all, the episode ends with the bereaved parents finding the resolve to move in the face of this loss. April continues to believe in miracles, despite everything.

5 “Into You Like A Train”
Season 2, Episode 6
Into You Like A Train Grey’s Anatomy
Image via ABC
“In the dark, there may be fear, but there is also hope.” In this one, a train accident floods the hospital with patients, including two passengers who are impaled on the same piece of metal. It becomes clear that saving both is impossible, confronting the passengers and the doctors with a terrible dilemma. Tom (Bruce A. Young), a man in his 50s, offers to be the one to die, since he’s older, but Bonnie (Monica Keena), a twenty-something set to be married, has the more serious injuries.

Meredith is outraged by what’s happening and intervenes passionately on Bonnie’s behalf, leading to some poignant moments. Tom’s and Bonnie’s is an extreme case, but it highlights the difficult choices that medical professionals and patients frequently have to make. The episode explores this issue well and remains one of the most highly-rated Grey’s episodes ever. Fans responded to the character of Bonnie especially positively, leading to her reappearance later in a dream sequence.

4 “Good Mourning”
Season 6, Episode 1
Good Mourning Grey’s Anatomy
Image via ABC
“We offer up our souls in exchange for just one more day.” After the tense Season 5 cliffhanger, Izzie survives but is confronted with the tragic reality of George’s death. The hospital staff mourns while Meredith and the other residents attempt to cope in their own ways. (Spoiler: They’re not very good at it.) George was the first major character to die on the show, making “Good Mourning” an important and hard-hitting installment.

In large part, George was killed off because actor T.R. Knight wanted to leave the show. He was unhappy with some of his storylines and felt the character had “expired”. Once again, this is an instance where the show transformed behind-the-scenes pressures into solid on-screen drama. The actors portray their shock and grief well, especially in their moments of crazed laughter. Many of these scenes and story patterns would grow a little repetitive and stale in later seasons, but here they still land.

3 “Flight”
Season 8, Episode 24
A doctor tends to a patient of a plane crash
Image via ABC
“Please tell Meredith I love her and that she is a good sister.” The Season 8 finale was intense to the point of being over-the-top, shocking the viewer with a plane crash that strands half the main cast in the mountains. Nevertheless, confident storytelling holds it together, making for one of the most pivotal Grey’s episodes ever.

“Flight” is incredibly cruel to the characters. Derek’s (Patrick Dempsey) hand is trapped under debris, throwing his career into jeopardy; Sloan has internal injuries; and Arizona’s leg is badly hurt. Lexie is in the worst shape of all, crushed under part of the wreckage. It’s shattering when Cristina and Sloan realize that she cannot be saved. Lexie dies as Sloan holds her hand, telling her about the life they should’ve had together. Leigh received rave reviews for her performance in this scene, and for good reason. It was a challenging moment to pull off, but she makes it believable – and heartbreaking.

2 “Losing My Religion”
Season 2, Episode 27
A woman comforts her boyfriend in a hospital bed
Image via ABC
“I get a choice now. I get to choose. I choose you, Izzie Stevens.” “Losing My Religion” is the conclusion of a three-part arc revolving around Izzie and her love interest Denny Duquette (Jeffrey Dean Morgan), a cardiothoracic patient. There was a controversial scene in the episode before where Izzie deliberately tampers with Denny’s LVAD wire to make his condition worse in order to move him up the donor list.

It’s an intriguing, ethically fraught moment, though unfortunately, the show doesn’t deal with the fallout from this incident very realistically. Nevertheless, the episode does blindside the viewer with Denny’s sudden death after a seemingly successful heart transplant. He dies soon after Izzie accepts his marriage proposal, making this one of the show’s quickest transitions from joy to sorrow. Heigl’s performance is top-notch, both urgent and realistic. If only the script dealt with this storyline better: Izzie receiving only a suspension felt inadequate and unbelievable.

1 “How To Save A Life”
Season 11, Episode 21
How To Save A Life Grey’s Anatomy
Image via ABC
“Don’t be scared. I’m not going anywhere.” “How To Save A Life” is a crucial episode because it sees the death of Derek Shepherd, Meredith’s soul mate and one of the show’s most beloved characters. While assisting the survivors of a car accident, Derek himself is hit by a truck, eventually dying in hospital after Meredith removes life support. The episode toys with the viewers throughout, ruthlessly using misdirection and imagined sequences to keep them guessing.

The episode is not especially well-written, relying on tropes the show has executed before, but it succeeds because fans know Derek and Meredith so well. Audiences had been watching them together for over a decade, seeing their relationship grow and change. As a result, Derek’s death felt like a real loss and a major change to the essence of the series. Fittingly, in something of a meta moment, the pivotal scenes play out to Snow Patrol’s “Chasing Cars”, which Grey’s Anatomy has used countless times before during its saddest scenes.

Grey’s Anatomy can be streamed on Hulu in the U.S.