20 Saddest Grey's Anatomy Episodes Ranked

Summary

• The main characters in Grey’s Anatomy undergo heartbreaking losses, allowing viewers to connect deeply with the emotional narrative.
• Episodes like “Cold as Ice” and “Leave a Light On” showcase tragedies that evoke strong emotional responses from both characters and viewers.
• Grey’s Anatomy’s saddest episodes explore profound themes of loss, grief, and difficult decisions, creating a cathartic viewing experience.

Content Warning: This article contains references to murder, death, human trafficking, shootings, and infant loss.

In ABC’s Grey’s Anatomy, shocking moments are almost the norm, but there’s also quite a bit of sadness for the characters among those story moments. Grey’s Anatomy has been on the air for 20 seasons, and the drama series has covered just about every medical complication imaginable. Not to mention, the show’s main characters have gone through a lot themselves. It’s enough to send both the characters and viewers into fits of tears. But often, the saddest Grey’s Anatomy episodes are the show’s best.

The saddest episodes of Grey’s Anatomy can also be some of the most poignant. They allow the audience to connect with the characters as they suffer heartbreaking losses or grieve the outcomes of difficult decisions. Sadness that transcends the television program and allows the audience to feel what the characters are feeling provides for a cathartic television viewing experience.

20 “Cold As Ice”

Season 14, Episode 23

The main focus of Grey’s Anatomy season 14. episode 23, “Cold as Ice” is April, who is at death’s door. April is planning Alex and Jo’s wedding and seems to be warming up to everyone. Later, a car accident victim is brought in, and when they see it is Matthew Taylor, he asks if April is okay as she was in the car with him. Since she wasn’t with Matthew, everyone freaks out, and Owen heads to the accident scene and finds April unconscious in a ravine below the road. She is hypothermic and unresponsive.

Luckily, April survives this experience. However, this is a very sad Grey’s Anatomy episode regardless because the entire episode plays out as a tribute to the character and shows everything she has been through, what she means to everyone, and how important she is to the hospital and TV show. The show also looks at other characters, such as Meredith, who remembers when she almost drowned, and the entire emotional weight overwhelms even her, making this a tough one to get through.

19 “Leave A Light On”

Season 16, Episode 16

The sad emotions in “Leave a Light On” are not because of a death or someone getting severely injured as many Grey’s Anatomy fans are used to. Instead, they’re the result of a decision that a beloved character makes when he chooses to break someone’s heart, which turns everyone against him. This is the episode where Alex Karvev leaves Grey’s Anatomy. It remains one of the most controversial moments in the series because Alex goes completely against his character development in doing so.

Alex abandons everyone in Seattle, including his wife Jo, and leaves to reunite with Izzie and his children in Kansas. This gives Alex a happy ending since he has always wanted to be with Izzie and is giving their relationship a second chance (after not seeing her for a decade). However, what makes this sad is that viewers are left watching his wife and friends read letters he wrote before leaving. It was a very emotional moment as Jo was left betrayed by the man she loved and left with only a letter.

18 “Drowning On Dry Land”

Season 3, Episode 16

The season 3 episode looked like it might do the unthinkable, as it seemed like the show would actually kill Meredith Grey, the person the entire series is named after. While Meredith has left the show as a full-time cast member now, at the time, she was the definitive protagonist. Of course, as a hospital drama series, Grey’s Anatomy had to put everyone’s lives in danger at some point, and this was the episode where it happened to Meredith herself, with the whole storyline proving quite emotional.

A panicked man accidentally knocks Meredith into freezing water, and no one sees it but a young girl who can’t speak. Nobody knows where Meredith is, and Derek realizes that she might be out there somewhere, and he finds her. The scene of him walking out of the water, holding her in his arms with her skin blue and her not breathing, is a moment most Grey’s fans will never forget. This episode ends with Meredith at death’s door, and it takes a week to learn her fate, but seeing Derek and Cristina respond to this is highly emotional.

17 “It’s The End Of The World” & “As We Know It”

Season 2, Episodes 16-17

Meredith Grey has had more than one near-death experience. While her scariest moment came when she had COVID-19 many years later, she also almost died in season 2 when she came across a man with a bomb inside his body. Things get especially intense when the paramedic (Christina Ricci) who is working hard to keep the bomb in place with her hand has to pull her hand out, and Meredith puts hers in and takes over.

As Meredith watches her hero walk away, suddenly, the bomb explodes and kills Dylan.

Kyle Chandler also appears in the episode as Dylan, a member of the bomb squad there to help Meredith. Meredith and Dylan bond as they work to get the bomb out of the man’s chest so he can save Meredith’s life. However, what really throws things off is after Dylan gets the bomb out of the body. As Meredith watches her hero walk away, suddenly, the bomb explodes and kills Dylan. It was shocking and a terrifying moment.

16 “The Sound Of Silence”

Season 12, Episode 9

In season 12, Meredith Grey experiences terrible trauma when she is working on a patient who suffered a seizure. The man starts to violently lash out in aggression and attacks Meredith. This leads to the team rescuing her, but she ends up injured quite badly, as she loses the ability to speak and most of the episode (directed masterfully by Denzel Washington) shows things from Meredith’s point of view.

Since the episode shows Meredith’s point of view, it puts the viewers in her position.

Meredith is in a cast, her jaw wired shut, and her kids refuse to come see her, leaving her feeling alone and abandoned. However, she can’t speak to anyone and can only hold her thoughts in her head. Since the episode shows Meredith’s point of view, it puts the viewers in her position, and it is almost suffocating to see her pain and suffering. When she suffers a panic attack, things get worse, and the rest of the episode shows her vulnerability. It is something that played out later in the COVID-19 episodes, but here it is just as powerful.

15 “Didn’t We Almost Have It All?”

Season 3, Episode 25

Among all the doctors on Grey’s Anatomy, Cristina was undoubtedly one of the most brilliant surgeons ever featured. Fans also may recall that she was incredibly competitive from day one, eager to scrub in on surgeries and gain as much experience in the OR as possible. Her drive and cutthroat approach to the job eventually caught the attention of a more experienced surgeon, Preston Burke (Isaiah Washington).

As time went by, Cristina and Preston started dating each other and, at one point, they even got engaged. However, in this episode, Preston decides to call off the wedding as Washington exited the show. While fans weren’t exactly disappointed to see Preston go, they were heartbroken for Cristina, who had been humiliated in front of their family and friends. She had deserved so much more than this terrible treatment. Her heart-wrenching request for help getting out of her wedding dress is one the audience will never forget.

14 “One Day Like This”

Season 14, Episode 17

Season 14 was a pivotal one for April in terms of her character arc, as fans saw her go through a crisis of faith. While it was a storyline that went on for several weeks, the writers did manage to find a way to reconcile her faith in one of the saddest Grey’s Anatomy episodes, “One Day Like This,” through Eli (a rabbi who had been admitted to the hospital with toxic epidermal necrolysis).

Eli might have only been a minor character, but his words of wisdom and brief interaction with April touched the hearts of many fans. This was not only because the viewers could feel the intensity and passion Sarah Drew and Saul Hersh Rubinek put behind the words, but also because the scene contained one of the saddest patient deaths Grey’s Anatomy fans had ever seen as Eli, unfortunately, passed away not long after, believing April to be his wife when he did.

13 “Things We Said Today”

Season 9, Episode 10

In this episode, it was discovered that Adele Webber needed surgery due to an undiagnosed abdominal aortic aneurysm. Determined to save her, Bailey made the decision to delay her own wedding ceremony, so she could personally operate on Richard’s wife. Unfortunately, Adele suffered a heart attack, and Richard only informed Meredith about Adele’s passing during Bailey’s wedding ceremony.

The sorrow on his face was enough to make anyone weep, especially since he had a flashback to his and Adele’s own wedding. This is something that Grey’s Anatomy does many times, by taking a happy moment and then adding in the tragedy to weigh it down. What should have been a joyous time for everyone was now cathartic and mournful at the same time. What was particularly heartbreaking about “Things We Said Today” is that it was the final episode that Loretta Devine appeared in.

12 “Helplessly Hoping”

Season 17, Episode 7

Season 17 was one of the show’s most heartbreaking as it involved a lot of death and serious storylines. However, no one ever expected that they would lose another fan-favorite character, who was on his way to becoming one of the most promising surgeons. After months of investigating a human trafficking case, Andrew DeLuca was sadly murdered in “Helplessly Hoping” while trying to bring the criminals to justice.

In the Station 19 crossover, he stopped the child trafficker but sadly died doing so. While it was a well-written story and all the actors involved, particularly Giacomo Gianniotti and Stefania Spampinato, delivered powerful performances, it was nevertheless heartbreaking that DeLuca’s character journey ended on such a tragic note in one of the saddest Grey’s Anatomy episodes. What made this really tragic was that few people believed Andrew’s claims before this, thanks to his bipolar disorder diagnosis.

11 “Suddenly”

Season 8, Episode 10

There have been plenty of iconic romances on Grey’s Anatomy that had a profound effect on fans, but one of the most underrated was Henry and Teddy’s. Henry came to the hospital in need of surgery, but he didn’t have the money. Teddy married him so he could be on her insurance. It may have started as a marriage of convenience, but the couple genuinely fell in love as Teddy supported Henry with his operations and condition.

The operation was successful, and the two looked like they were building a life together. Sadly, this didn’t last for very long as Henry sadly died after discovering a tumor near his heart in the episode “Suddenly.” Not only were the fans devastated by the outcome, but several characters’ relationships, including Cristina and Owen’s, were affected in the long run, too, since Teddy felt Owen put the hospital before her husband by not telling her he died until after she finished an upcoming surgery. It was a heartbreaking moment.

10 “Be Still, My Soul”

Season 13, Episode 18

Although she arrived near the end of season 10, it took three years before the writers delved into Maggie’s personal life properly. Other than knowing she is one of the best cardiothoracic surgeons Grey’s Anatomy has ever had and that she was the long-lost daughter of Richard Webber, fans had yet to learn what her upbringing was like or meet any of her parents.

However, that all changed by season 13 when Maggie’s mother, Diane, visited. Straight away, it was clear that Maggie had adored her and hung onto her every word. Sadly, Diane wasn’t in the series for long as she sadly passed away from cancer in “Be Still, My Soul,” with Maggie at her bedside. It was certainly an emotional episode, since it was clear that Maggie was struggling under the weight of all the recent changes and no one knew how she would cope without her mother.

9 “Going, Going, Gone”

Season 9, Episode 1

The season 9 premiere delved into the aftermath of the plane crash that rocked Grey’s Anatomy. At this point, the doctors had already gone back to work. However, nothing was the same as many of them were physically and emotionally changed. Sadly, fans were also forced to say goodbye to another fan-favorite character, as Mark died as a result of the injuries he sustained in the plane crash.

Where season 8 had been quite comical and light-hearted, this episode showed fans that they would not be getting another breezy installment. With Mark, Lexie, and Teddy Altman having made their departures and a new bunch of interns introduced, it was the show was definitely changing (which some were a little sad about). They were also disheartened to see that Mark didn’t get his happy ending, since they knew how hard he had fought to get back to Callie and his daughter, Sofia.

8 “Flight”

Season 8, Episode 24

“Flight” is arguably even sadder of an episode than “Going, Going, Gone” because of how the events play out. In this episode, a medical team made up of Meredith, Cristina, Derek, Mark, Lexie, and Arizona gets involved in a plane crash. After regaining consciousness, the doctors struggled to treat each other and stay alive after help didn’t arrive right away.

Among them, the worst off was Lexie who ended up getting pinned under a part of the plane. And when it became evident that they couldn’t free her, Lexie herself realized that she was dying. In a bittersweet moment, she admitted to Mark that they were “meant to be” before taking her last breath. Lexie was such a bright light amid heavier storylines in the show that it hit the audience hard. It was certainly a death that fans carried in the years to come as Meredith became darkerand the storylines a lot more intense.

7 “Sanctuary”

Season 6, Episode 24

This Grey’s Anatomy season 6 episode opened with Meredith’s voiceover explaining that the hospital can be a scary place for many people. It’s an ominous message, considering that a shooter named Gary Clark would go on a killing spree inside the hospital a few moments later. The deaths in this episode were shocking, as he killed Dr. Reed Adamson and also shot Alex. What really pushes the episode to the limit is when the man shoots Derek in the chest in front of Meredith, and her horror makes this a moment no fan would forget.

Since the episode contained mature themes and graphic violence, many fans felt that the writers handled the hospital shooting responsibly. It’s a difficult topic to include in any form of entertainment, given the prevalence of gun violence in the United States. It was certainly one of the more heartbreaking Grey’s Anatomy episodes, too, since many of the main and recurring characters were badly injured or killed.

6 “All I Could Do Was Cry”

Season 11, Episode 11

April had been a deeply religious person throughout her time on the show. That said, fans may recall that her faith wavered slightly when she learned that the first baby that she was carrying had a fatal condition. In “All I Could Do Was Cry,” April and Jackson discover that their unborn child has type II osteogenesis imperfecta (where the baby’s bones are breaking in her uterus). April questioning her faith and God forces Jackson to have his doubts as well, and it remains a powerful episode.

Although fans knew that it would be such an intense and emotionally raw episode, many give the writers credit for handling such a sensitive topic so well. Sarah Drew and Jesse Williams’ performances were also commended. The episode has a lot of flashbacks, which build to the couple deciding to name the baby and deliver him regardless, knowing that the baby will die almost immediately upon birth. Seeing April hold her son and have him squeeze her finger once before dying was heartbreaking.

5 “Into You Like A Train”

Season 2, Episode 6

One of the saddest Grey’s Anatomy episodes also included one of the most heartbreaking patient deaths. It’s usually the surgeon’s personal drama that ends up taking center stage in most episodes. However, in “Into You Like a Train”, it is the patients and their cases that prove to be the most memorable aspects as their heartbreaking circumstances had fans mourning for weeks. Two patients came into the hospital impaled on the same piece of metal after a train accident, and it was made clear that the survival of both was unlikely.

As all the top surgeons were pulled into Bonnie and Tom’s case, everyone knew that the procedure would be grueling and intense (especially since their injuries were so severe). However, what truly broke the fans’ hearts was the dilemma the doctors were in, as they could only save one of them. After learning both patients’ backstories and how kind they were, viewers were devastated when Bonnie sadly passed, with her final words aimed at her boyfriend, telling him that she would still be there if love was enough.

4 “Good Mourning”

Season 6, Episode 1

At the end of season 5, fans were shocked to learn that patient John Doe had been George all along. In the premiere episode of season 6, he died on the operating table. Heartbreak was evident all over the hospital as doctors started to cry when finding out his identity. Callie was especially inconsolable as she decided whether George’s organs should be donated.

When the season 6 premiere aired, fans had already been on tenterhooks as there had been two characters that were on the verge of dying. While Izzie ended up being fine, it shocked fans to hear that George had died as he was the first main character to be killed off the show. It also took fans a while to get over the death, since George had been one of the kindest and most considerate people in Grey’s Anatomy.

3 “Losing My Religion”

Season 2, Episode 27

The season 2 finale episode dealt with the events following Izzie’s decision to cut Denny Duquette’s LVAD wire. Following the incident, Denny received a new heart, and it seemed that he was going to be just fine. Meanwhile, as interns refused to come forward about what happened, they were asked to organize a prom for Richard’s niece, Camille.

While the mood around the hospital was initially quite celebratory, it soon changed when Denny unexpectedly died. Although Denny and Izzie were certainly not one of Grey’s Anatomy’s best couples, many fans felt their hearts break at the sight of Izzie crying over his body — especially since she had been so excited about showing him her dress. Katherine Heigl’s performance is what truly made “Losing My Religion” one of the saddest episodes in Grey’s Anatomy history.

2 “How To Save A Life”

Season 11, Episode 21

Over the years, fans saw the evolution of Meredith Grey and Derek Shepherd’s relationship, starting as a one-night stand and eventually leading to kids and a wedding. Everyone thought they would finally live happily ever after — but that’s not quite what happened.

In this episode, Derek found himself at the scene of a car crash treating victims, only to be involved in a crash himself. He received the worst possible medical treatment and sadly died not long after with Meredith by his side. While a lot of fans disliked the decision to kill him, what truly made this one of the saddest Grey’s Anatomy episodes was that it was told from Derek’s point of view. He told the story for the viewer, recognizing all the medical mistakes made, and narrating while being completely unable to communicate with other characters. It was heartbreaking.

1 “Fight The Power”

Season 17, Episode 5

The saddest episode of Grey’s Anatomy gave Miranda Bailey and her mother the spotlight. This season 17 episode was emotionally charged for many as it offered a realistic view of COVID-19 and the pain that it caused families as loved ones succumbed to the disease. In the story, Miranda Bailey learned that her mother, Elena, became infected when the assisted living center she resided in received a surge of cases. In the end, Elena sadly passed away.

While Bailey’s heartbreaking rendition of “My Girl” to try to help calm and comfort her mother is heartbreaking in her final moments, it was the context behind the storyline itself that resonated deeply with them (as it closely reflected reality and gave fans an idea of what was going on in the medical sector). Grey’s Anatomy was one of the few shows that tackled the pandemic head-on when it came to medical workers, and having a beloved character lose her mother was an emotionally charged moment.