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The 5 most shocking stories from the new, unauthorized 'Grey's Anatomy' oral history

Why did Katherine Heigl really leave "Grey's Anatomy?" Did McDreamy's McAttitude cost him his surgical privileges? When will this beloved show seal its scalpels away for good?

Answers – well, speculation – to these questions lie in "How to Save a Life: The Inside Story of Grey's Anatomy" (St. Martin's Press, 320 pp.), out now, by Entertainment Weekly editor-at-large Lynette Rice.

Rice wrote an oral history of television's longest-running medical drama (its 18th season premiered Sept. 30) with near-surgical precision, including a mix of extensive interviews with writers, actors, former crew members and executives, not to mention a compelling collage of archived interviews from over the years. But some stories will likely stay behind operating-room doors.

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Patrick Dempsey went on to reprise his role as Dr. Derek Shepherd during a series of COVID-induced dreams Meredith has in Season 17.
Patrick Dempsey went on to reprise his role as Dr. Derek Shepherd during a series of COVID-induced dreams Meredith has in Season 17.

Patrick Dempsey's alleged 'HR issues'

The series – created by then-unknown Shonda Rhimes – premiered in 2005, starring Ellen Pompeo (Meredith Grey) and four fellow surgical interns (Sandra Oh, Katherine Heigl, T.R. Knight and Justin Chambers) navigating medicine and relationships. What became (and remains) a bona fide hit in front of the camera, however, saw more than its fair share of drama behind it.

Patrick Dempsey may have played Dr. Derek "McDreamy" Shepherd for the first 11 seasons of "Grey's Anatomy," but his personality apparently became anything but after working 15 hours a day for 10 months out of the year.

"There were HR issues," said James D. Parriott, an executive producer and writer. "It wasn't sexual in any way. He sort of was terrorizing the set. Some cast members had all sorts of PTSD with him. He had this hold on the set where he knew he could stop production and scare people ... He and Shonda were at each other's throats."

His character's death (after getting hit by a truck) may have shocked fans, but death was the only way for the character to go.

"He and Meredith were such an incredibly bonded couple at that point," writer Stacy McKee said. "It would be completely out of character if he left his kids."

Dempsey went on to reprise his role during a series of COVID-19-induced dreams Meredith has in Season 17 – giving both fans (and the actors) a chance at a reunion, which seemed more sweet than sour.

Why exactly did Katherine Heigl leave?

Much has been discussed about Izzie's (Heigl) exit from the show, but Rice's timeline suggests myriad factors were behind the exit. The most well-known controversy: When Heigl said publicly she didn't submit herself for an Emmy less than a year after she won (for best supporting actress in a drama series in 2007) on account of the lackluster (in her opinion) material given to her at the time.

"I could have more gracefully said that without going into a private work matter," she said. "It was between me and the writers. I ambushed them, and it wasn't very nice or fair."

She also grumbled to David Letterman about long work hours, specifically on behalf of the crew – though the fact she was speaking for them wasn't clear at the time.

Ultimately, Heigl left after adopting her first child with husband Josh Kelley. She said starting a family "changed everything" and she no longer craved full-time work. A former ABC Studios executive said they could've reached a happy medium, but that Heigl was after a film career. Another "person familiar with the situation" said she and Rhimes had difficulty working together.

Whatever the case, Heigl's career never truly recovered after it all (though her new Netflix series "Firefly Lane" earned a second-season renewal).

Why did Isaiah Washington come back?

Imagine being called a gay slur by one of your colleagues behind your back. Then imagine said colleague denying it in front of the press at the 2007 Golden Globe Awards a few months later.

That's what happened to T.R. Knight when Isaiah Washington (Dr. Preston Burke on the show) used a homophobic slur during an on-set physical altercation with Dempsey.

"You can't talk to me the way you talk to that little (expletive) T.R.," he said.

Despite a public apology, Washington later insisted he never used the word and actually advocated for having Burke come out as gay. He was written out of the show at the end of Season 3, only reappearing to help orchestrate ex-fiancee Cristina Yang's (Oh) departure from the show in Season 10.

Rhimes defended bringing him back into the fold.

"I feel very strongly and fully believe in people's ability to grow and change learn from their mistakes, and when they know better, to do better," she said.

Sigh: Isaiah Washington reignites feud with former 'Grey's Anatomy' co-star Katherine Heigl

Ellen Pompeo improved a toxic culture – but did she contribute to it, too?

Pompeo's tenure on the show has given her much clout, and she's spoken about improving a previously toxic work culture. But she may have contributed to such a culture herself, too.

One incident details Stephanie's (Jerrika Hinton) departure at the end of Season 13. Allegedly, Pompeo was unhappy Hinton took personal photos on set without asking her first.

"(Jerrika) hadn't been around a lot, so maybe she didn't understand the power Ellen had," according to makeup artist Norman Leavitt. "If she'd gone and said, 'Is it OK if I take these Polaroids?' Ellen probably would've gone, 'OK.' But by just doing it and not including her, you're setting yourself up for disaster."

Hinton didn't talk to Rice about the incident for the book.

More on the COVID season: 'Grey's Anatomy' is 'not responsible for politicizing COVID,' Ellen Pompeo says of new pandemic season

'Grey's' could literally go on forever

Maybe this isn't so shocking – but in a certain way, it remains astounding. Season 17 was written as if it could've been the last season.

"The reason why you're like, 'Oh my gosh' every episode is because we approached it with a certain reverence of 'OK, if this is the last season and we're doing COVID, what are we doing?" showrunner Krista Vernoff said.

Rhimes is still pinching herself and said she's written at least six different endings.

"But we just don't end," she said.

For all our sakes, best to pull the LVAD wire soon before even more drama ensues.

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This article originally appeared on USA TODAY: 'Grey's Anatomy' oral history: Details on Patrick Dempsey's shock exit