"Elevator Love Letter" is the nineteenth episode of the fifth season of the

American television Television is one of the Mass media in the United States, major mass media outlets in the United States. In 2011, 96.7% of households owned television sets; about 114,200,000 American households owned at least one television set each in August ...

medical drama A medical drama is a Television film, television movie or film in which events center upon a hospital, clinic, doctor's office, a paramedic, or any other medical topic or environment. Most recent medical drama (film and television), dramatic progra ...

Grey's Anatomy ''Grey's Anatomy'' is an American medical drama television series focusing on the personal and professional lives of surgical internship (medicine), interns, residency (medicine), residents, and attending physician, attendings at the fictional ...

'' and the show's 97th episode overall. Written by Stacy McKee and directed by Edward Ornelas, the episode aired on the

American Broadcasting Company The American Broadcasting Company (ABC) is an American Commercial broadcasting, commercial broadcast Television broadcaster, television and radio Radio network, network that serves as the flagship property of the Disney Entertainment division ...

(ABC) in the United States on March 26, 2009. The episode primarily focuses on

Derek Shepherd Derek Christopher Shepherd, often referred to as "McDreamy" for his "attractiveness", is a fictional surgeon from the ABC medical drama ''Grey's Anatomy'', portrayed by actor Patrick Dempsey. He made his first appearance in the series' pilot ep ...

(

Patrick Dempsey Patrick Galen Dempsey (born January 13, 1966) is an American actor and racing driver best known for playing neurosurgeon Derek Shepherd in ''Grey's Anatomy'' (2005–15; 2020–21). He is also known for his leading man romantic film roles, such ...

) proposing to

Meredith Grey Meredith Grey M.D., F.A.C.S., (born 1977 or 1978) is a fictional and titular character from the medical drama television series ''Grey's Anatomy'', which airs on the American Broadcasting Company (ABC) in the United States. The character was c ...

(

Ellen Pompeo Ellen Kathleen Pompeo (; born November 10, 1969) is an American actress. One of the world's highest-paid actors since 2017, she has made multiple appearances on ''Forbes'' year-end lists. Her accolades include a Screen Actors Guild Award and a ...

), while

Izzie Stevens Isobel Katherine Stevens, M.D. is a fictional character from the medical drama television series ''Grey's Anatomy'', which airs on the American Broadcasting Company (ABC) in the United States. The character was created by series producer Shonda R ...

(

Katherine Heigl Katherine Heigl ( ; born November 24, 1978) is an American actress and model. She portrayed Izzie Stevens, Dr. Izzie Stevens on the American Broadcasting Company, ABC television medical drama ''Grey's Anatomy'' from 2005 to 2010, a role that b ...

) undergoes surgery for her

cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

, with

Alex Karev Alexander Michael "Alex" Karev (né Evans), M.D., F.A.C.S. is a fictional character on the ABC television series ''Grey's Anatomy'', portrayed by actor Justin Chambers. Introduced as a surgical intern at the fictional Seattle Grace Hospital, Ka ...

(

Justin Chambers Justin Willman Chambers (born July 11, 1970) is an American actor and former model best known for his role as Dr. Alex Karev in ''Grey's Anatomy'' (2005-20). Born in Ohio, he went to Southeastern High School, South Charleston, and later studi ...

) struggling with guilt over her condition. Also explored is

Cristina Yang Cristina Yang, Doctor of Medicine, M.D., Doctor of Philosophy, Ph.D., F.A.C.S. is a fictional character from the medical drama television series ''Grey's Anatomy'', which has aired for 20 seasons on the American Broadcasting Company (ABC) in the ...

(

Sandra Oh Sandra Miju Oh (born July 20, 1971) is a Canadian and American actress. She is known for her starring roles as Rita Wu in ''Arliss (TV series), Arliss'' (1996–2002), Cristina Yang in ''Grey's Anatomy'' (2005–14), and Eve Polastri in ''Kill ...

) dealing with the

PTSD Post-traumatic stress disorder (PTSD) is a mental disorder that develops from experiencing a traumatic event, such as sexual assault, domestic violence, child abuse, warfare and its associated traumas, natural disaster, traffic collision, ...

of her boyfriend and fellow surgeon

Owen Hunt Major (Ret.) Owen Hunt, Doctor of Medicine, M.D., Fellow of the American College of Surgeons, F.A.C.S., is a fictional character from the medical drama television series ''Grey's Anatomy'', which airs on the American Broadcasting Company (ABC) i ...

(

Kevin McKidd Kevin McKidd (born 9 August 1973) is a Scottish actor and television director best known as Dr. Owen Hunt in ''Grey's Anatomy'' and Tommy Mackenzie in Danny Boyle's '' Trainspotting'' (1996). McKidd played Colin in the 2008 film Made of Hono ...

) as she navigates the emotional toll of their relationship. Although the episode was fictionally set in

Seattle Seattle ( ) is the most populous city in the U.S. state of Washington and in the Pacific Northwest region of North America. With a population of 780,995 in 2024, it is the 18th-most populous city in the United States. The city is the cou ...

Washington Washington most commonly refers to: * George Washington (1732–1799), the first president of the United States * Washington (state), a state in the Pacific Northwest of the United States * Washington, D.C., the capital of the United States ** A ...

, filming took place in

Los Angeles Los Angeles, often referred to by its initials L.A., is the List of municipalities in California, most populous city in the U.S. state of California, and the commercial, Financial District, Los Angeles, financial, and Culture of Los Angeles, ...

California California () is a U.S. state, state in the Western United States that lies on the West Coast of the United States, Pacific Coast. It borders Oregon to the north, Nevada and Arizona to the east, and shares Mexico–United States border, an ...

. It was viewed by 15.81 million Americans upon its original airing and garnered a 5.5/13 Nielsen rating/share in the 18–49 demographic. The episode received critical acclaim from television critics, with high praise for the storylines and performances of Dempsey, Pompeo, Heigl, Oh and McKidd. Oh received a nomination for the

Primetime Emmy Award for Outstanding Supporting Actress in a Drama Series The Primetime Emmy Award for Outstanding Supporting Actress in a Drama Series is an award presented by the Academy of Television Arts & Sciences (ATAS). In early Primetime Emmy Award ceremonies, the supporting categories were not always genre-, ...

for her performance in the episode. The storyline involving Izzie's embryos is picked up again in the

Season 12 A season is a division of the year based on changes in weather, ecology, and the number of daylight hours in a given region. On Earth, seasons are the result of the axial parallelism of Earth's tilted orbit around the Sun. In temperate and polar ...

episode, " I Choose You" and subsequently concludes on the

Season 16 A season is a division of the year based on changes in weather, ecology, and the number of daylight hours in a given region. On Earth, seasons are the result of the axial parallelism of Earth's tilted orbit around the Sun. In temperate and polar ...

episode, " Leave A Light On".

Plot

The episode opens with a

voice-over Voice-over (also known as off-camera or off-stage commentary) is a production technique used in radio, television, filmmaking, theatre, and other media in which a descriptive or expository voice that is not part of the narrative (i.e., non- ...

narration from

(

) reflecting on love and trauma.

(

) and

(

) are growing closer, spending nights together, watching surgical videos. One evening, as they settle down for the night, Owen falls asleep, but his

takes over, leading him to unknowingly choke Cristina in his sleep. Cristina struggles to free herself, and

Callie Torres Calliope Iphigenia "Callie" Torres, M.D. is a fictional character from the medical drama television series ''Grey's Anatomy'', which airs on the ABC in the United States. The character was created by series producer Shonda Rhimes and is portr ...

(

Sara Ramirez Sara Elena Ramírez Vargas (; born August 31, 1975) is an American actor. Born in Mazatlán, Mazatlán, Sinaloa, Ramírez moved from Mexico to the United States at eight years old, eventually graduating with a fine arts degree from the Juillia ...

) walks in just in time to stop Owen. The next day at the hospital, Cristina hides the bruises on her neck with a

turtleneck A polo neck, roll-neck (South Africa), turtleneck (United States, Canada), or skivvy is a garment—usually a sweater—with a close-fitting collar that folds over and covers the neck. It can also refer to the type of neckline, the sty ...

, but Meredith notices and urges her not to cover for Owen, emphasizing that both Owen and Cristina are not okay. Meanwhile,

George O'Malley George O'Malley, Doctor of Medicine, M.D., is a fictional character from the medical drama television series ''Grey's Anatomy'', which airs on American Broadcasting Company, ABC in the United States. The character was created by series producer S ...

(

T. R. Knight Theodore Raymond Knight (born March 26, 1973) is an American actor. He is best known for his role as Dr. George O'Malley on the ABC medical drama television series ''Grey's Anatomy'' (2005–2009, 2020), which earned him a nomination for the Pr ...

) feels betrayed by

(

) for not informing him about her

diagnosis. In an effort to distract himself, he requests to work with Callie for the day, avoiding his emotional turmoil. Izzie is preparing for her brain surgery and, in her hospital room, she reminds her friends that they have patients to care for and urges them to focus on saving lives.

Miranda Bailey Miranda Bailey, M.D., F.A.C.S. is a fictional character from the long-running medical drama ''Grey's Anatomy'', created by Shonda Rhimes and portrayed by Chandra Wilson since the series' debut in 2005. Bailey has appeared in 387 episodes across ...

(

Chandra Wilson Chandra Danette Wilson (born August 27, 1969) is an American actress and director best known for her role as Dr. Miranda Bailey in ''Grey's Anatomy'' since 2005, for which she has been nominated for the Primetime Emmy Award for Outstanding Su ...

) gathers the residents, reminding them that Izzie needs friends, not doctors, at this moment.

(

) approaches

(

), offering to answer any questions about Izzie's surgery, but Alex remains distant. Later,

Richard Webber Richard Webber, M.D., Ph.D., F.A.C.S., is a fictional character from the ABC medical drama television series ''Grey's Anatomy''. The character was created by Shonda Rhimes and is portrayed by actor James Pickens Jr. since the series' incepti ...

( James Pickens Jr.) awkwardly asks Alex about harvesting Izzie's eggs before her treatment, a request to which Alex immediately agrees. Mark Sloan (

Eric Dane Eric William Dane (born November 9, 1972) is an American actor. After multiple television roles in the 1990s and 2000s, which included his recurring role as Jason Dean in ''Charmed'', Dane was cast as Mark Sloan (Grey's Anatomy), Mark Sloan on ' ...

) faces a tough case with an elderly patient nearing death, but her family, impatient to catch flights, seems indifferent to staying by her side until she passes. Meanwhile, Owen and Derek attend to a trauma patient brought in by helicopter. The sound of the helicopter triggers Owen's PTSD, but Derek snaps him out of it, reminding him that PTSD is real and treatable. As Meredith heads toward an elevator, Richard steps in her way, blocking her path. When the next elevator opens, it reveals Derek, who has transformed the walls into a visual timeline of their surgical achievements together. He recounts their significant moments, including the surgeries that shaped their careers and relationship. In a heartfelt moment, he tells Meredith that her strength and resilience—her "dark and twisty" nature—are what make her capable of guiding others through hardship. Derek then professes his love and desire to spend his life with her. Meredith responds by kissing him, sealing their emotional connection.

Release

"Elevator Love Letter" was viewed by 15.81 million Americans upon its original airing and garnered a 5.5/13 Nielsen rating/share in the 18–49 demographic.

Reception

"Elevator Love Letter" received critical acclaim from television critics upon telecast, with high praise for the storylines and performances of

(

) and

(

). ''

PopSugar PopSugar Inc. is an American media and technology company that is the parent to the media property PopSugar (stylized POPSUGAR) and a monthly subscription business PopSugar Must Have. The company was founded in 2006 by married couple Brian and Lis ...

'' praised the episode as a quintessential ''

'' installment, highlighting moments such as the elderly woman who wouldn't pass away and memorable lines like, "People are better than no people". The site also appreciated the humor, noting

's (

) delivery of his sperm sample to the Chief

( James Pickens Jr.) during lunch, and commended Derek's proposal, calling it, "better than a room full of roses and candles". Additionally,

(

), received praise for her performance, with ''PopSugar'' noting, "Bailey rocks my world, especially with her new-new hairstyle."

Alan Sepinwall Alan Sepinwall (born October 19, 1973) is an American television reviewer and writer. He spent 14 years as a columnist with ''The Star-Ledger'' in Newark until leaving the newspaper in 2010 to work for the entertainment news website HitFix. He ...

from ''

The Star-Ledger ''The Star-Ledger'' was the largest circulation newspaper in New Jersey. It is based in Newark, New Jersey. The newspaper ceased print publication on February 2, 2025, but continues to publish a digital edition. In 2007, ''The Star-Ledger''s ...

'' lauded the episode, commenting that the series was on a "real roll" and acknowledging the improvement after some questionable storylines earlier in the season. He specifically praised Oh and McKidd for their nuanced portrayals of Cristina and Owen, remarking, "Oh and McKidd are killing it right now." Sepinwall also lauded Derek's proposal, describing it as "grown-up and sweet", noting that it marked a shift in the relationship away from typical "will-they-or-won't-they" drama. Dempsey's performance was highlighted, especially in the scene where Derek confronts the oncologist, with Sepinwall adding, "Dempsey has been doing some nice work." Chambers also received praise, with Sepinwall stating, "Every time I watch Chambers get a showcase episode like this, I think about how lucky he is — and we are — that he landed this more demanding, high-profile gig." ''

BuddyTV BuddyTV is an entertainment-based website, which generates content about television programs and sporting events. The website publishes information about celebrity and related entertainment news through a series of articles, entertainment profile ...

'' echoed the sentiment, calling the proposal scene "possibly the most perfect proposal ever," while ''CinemaBlend'' praised the emotional depth of the episode, noting that it could have served as a

season finale A season finale (British English: series finale; Australian English: season final) is the final episode of a season of a television program. This is often the final episode to be produced for a few months or longer, and, as such, will attempt to ...

due to its intensity. They particularly liked the progression of Derek and Meredith's relationship, with the proposal delivering a "great speech and proposal," culminating in Meredith finally accepting. ''Wired'' added the episode to its "must-watch" list, highlighting Derek and Meredith's evolving relationship and the dramatic storyline involving Owen's PTSD, noting, "If you did happen to endure the Meredith/McDreamy roller coaster of

Season 4 Season 4 may refer to: * "Season 4" (''30 Rock'' episode), an episode of ''30 Rock'' See also * * Season One (disambiguation) * Season 2 (disambiguation) Season 2 may refer to: * ''Season 2'' (Infinite album), 2014 * ''2econd Season'', an album ...

, this episode is your payoff."

Awards

earned a nomination for the

at the 2009 ceremony for her performance in the episode, though she ultimately lost to

Cherry Jones Cherry Jones (born November 21, 1956) is an American actress. She started her career in theater as a founding member of the American Repertory Theater in 1980 before transitioning into film and television. Celebrated for her dynamic roles on st ...

of ''24''.

References

External links

* {{Grey's Anatomy episodes Grey's Anatomy season 5 episodes 2009 American television episodes