Alex Karev may not have been present in the show's earliest drafts, but his impact on Grey's Anatomy is undeniable. Played by Justin Chambers for a whopping 16 seasons, Alex was a mainstay on the ABC medical drama, growing as a character and changing the dynamic at Seattle Grace/Grey Sloan Memorial Hospital since his introduction. While Alex's departure from the show may have felt a bit abrupt, it is hard to think of how this long-running program would look if he hadn't been there from the very beginning.
As many fans of the long-running show know, Alex Karev almost wasn't originally a member of Meredith, Cristina, Izzie, and George's class of interns. "The character wasn't even created yet," Chambers reminisced at a Paley Convention in 2008. "They sent the pilot to New York, where I live, and I saw it and I loved it and I went out to LA to try to win the part and auditioned and got the role, so that's how Alex came about." In fact, it is only thanks to a combination of reshoots and CGI, that Alex was inserted into the Grey's Anatomy pilot. Show creator Shonda Rhimes (whose studio, Shondaland, is responsible for other hit shows like Bridgerton, Scandal, and How to Get Away With Murder) brought in the character last minute in order to bring a broodier and more caustic spice into the mix.
Alex mellowed and matured over the years, intersecting closely with many of the show's most beloved characters — and even becoming one of Meredith's most valued confidants in more recent storylines. More than almost any character on the show, Alex showed a capacity for positive change when embracing ones' found family, rejecting his past and carving out a new future for himself. Here's a breakdown of how Grey's Anatomy's original plan would have turned out differently without Dr. Alex Karev.
Every Major Alex Plot Explained (& How They Would Change)
Alex's "evil spawn" persona is fully on display in the series' early episodes, pitting him against his fellow interns with his misogynistic comments and put-downs. Yet, the show wisely gives him moments of failure, perhaps best demonstrated in a memorable scene where his fear kept him from operating in a hospital elevator (allowing for George O'Malley to step up and shine). Little by little, the chip on Alex's shoulder gets smaller and he eventually finds support with his new community — regardless of his poor attitude. His slow-burn romantic relationship with Izzie Stevens softens him gradually, as well.
The pairing also leads to eventual maturity for Alex, who proves to have attained new levels of confidence when Izzie Stevens leaves the show. "I deserve someone who will say," Alex tells her, not unkindly. "I want you to go and be happy." This is a big moment for the character, ultimately showcasing his selflessness — a quality that will follow him into new relationships, many of which he assumes something of a caretaker role (seen in his unhealthy relationship with Ava/Rebecca) and, later, with Jo. While Alex's marriage to Jo is cut short thanks to Justin Chamber's rapid departure from the show, their relationship — which ultimately comes to a place of mutual respect and an ability to prop each other up despite their trauma — is the healthiest of Alex's life so far.
In addition to his personal developments, Alex's career trajectory is worth tracking. Although he had ambitions of becoming a plastic surgeon under Mark Sloan's mentorship, he ultimately discovered it wasn't for him. Surprisingly, Alex finds that he excels in pediatric surgery, forging one of Grey's Anatomy's strongest friendships with Arizona Robbins. The peppy attending takes the cantankerous intern under her wing, teasing out Alex's kindness and protective nature, which proved a perfect combination when working with kids.
In the first few seasons, Alex Karev helped to facilitate some of Grey's Anatomy's drama, primarily by positioning him against his fellow interns. He stole surgeries, played dirty, and slung insults at them on multiple occasions. However, he showed a great capacity for change over the decade and a half on the show, touching the lives of many of the show's other major players: Izzie, Arizona (and by extension Callie), Cristina, Miranda, and, perhaps most importantly, Meredith.
How No Alex Would Affect Meredith Grey's Character Plan
Despite their many differences, Alex (the class' underdog) and Meredith (the daughter of legendary Ellis Grey) are both damaged people. As surprising kindred spirits, the two come to a mutual understanding and learn to respect one another in early seasons. In fact, Meredith often defends Alex, asking George, Cristina, and Izzie to help him when he is struggling, saying, "As far as family goes, this hospital, you guys are it. So, I know you're pissed at Alex but maybe you could try and help him anyway." The group's gradual warming to Alex ultimately proves Meredith's influence, as well as her empathy and capacity for forgiveness.
Alex and Meredith's relationship serves as one of the show's strongest anchors to earlier seasons, particularly after Cristina's departure at the end of Grey's Anatomy season 10. Assuming the role of her new "person," Alex proves to be a great friend, who is there more Meredith even at her darkest moments. After Derek's death and Meredith goes AWOL, Alex comes to find her after she gives birth to her daughter because she chose him to be her emergency contact person. Meredith often returned Alex's loyalty, coming to his aid as when he was arrested for beating DeLuca in a blind rage.
That is not to say that Alex and Meredith's relationship hasn't had its fair share of turbulent moments, even in the show's later seasons. When Meredith tampered with the Alzheimer trial to help Adele, Alex drunkenly betrayed her to Owen (who was chief), which led to her being fired for a time. Alex worked tirelessly to win back her trust, namely by helping to secure Meredith and Derek's adoption of Zola — a crucial event that paved the way for Meredith becoming a mother.
More than anything, Alex and Meredith inspire and push each other to be more understanding, grounded, and empathetic (in and out of the operating room). Refreshingly, they are never presented as having any real romantic attraction, which could have been a far more predictable and tired storytelling decision. Instead, their sibling-like dynamic makes for one of the most long-lasting and deepest friendships in Grey's Anatomy's history.
Why Grey's Anatomy Was Better With Alex Karev's Character
Ultimately, the last-minute inclusion of Alex Karev in the Grey's Anatomy pilot turned out to be one of the show's most impactful decisions. Considering the revolving door which often led to cast shake-ups, Alex helped to establish a sense of normalcy and consistency for sixteen seasons. Alex's baggage ultimately makes him relatable to both his colleagues and the audience, and the melting away of his gruff facade gives him the room to grow as the story progresses.
Grey's Anatomy highlights its female characters, all of whom are presented as strong, competent, and, in many instances, brilliant. While Alex is first used as something of a foil to many of the women in this world (often enlisting misogynistic tactics), it seems to be a deliberate writing choice to have Alex's career and personal life flourish once he embraces his own sensitivity and compassion towards others. Throughout his journey, audiences learn that this is the true Alex Karev. His toxic masculinity merely stands in the way of him reaching his truest potential and best self.
Now in its historic seventeenth season, Grey's Anatomy's future is in limbo, much like the show's title heroine, who was last seen reminiscing on a strange heaven-like beach while her body struggled to cope with a bout of COVID-19. Recent episodes of the show have seen the reentrance of fan favorites like Derek Shepherd and George O'Malley, causing many fans to wonder if the show will see more familiar faces before the show ends its run (a possibility of an eighteenth and final season is reportedly being discussed). While he may not have left the series all that long ago, it would be fitting if Alex Karav made one last visit to Grey Sloan Memorial Hospital.