Grey’s Anatomy Season 18 Ending Explained: Makeups, Breakups, And Someone’s On The Lam

Ellen Pompeo as Meredith Grey
(Image credit: ABC)

Spoiler alert! We're about to get into details about the Grey's Anatomy Season 18 finale. 

Grey’s Anatomy delivered a packed Season 18 ending that saw multiple changes in relationship status, the return of Jackson Avery and April Kepner (much to fans’ delight), Owen’s decisions coming back to haunt him, and does anybody even still work at Grey Sloan anymore? Some questions got answered — like, what’s going to happen to the residency program? — but a lot more questions were introduced, and the stage was set for a really interesting Season 19 when the medical drama returns to ABC this fall. Let’s unpack the makeups, breakups and why the hospital lost so many doctors in the season finale.

Owen Hunt and Teddy Altman.

(Image credit: ABC)

Owen And Teddy Forced To Flee After ‘Death With Dignity’ Scandal Exposed

Owen and Teddy had their worst fears realized in the Grey’s Anatomy season finale, when the husband of a veteran showed up asking for Owen to help his wife die with dignity. Teddy put her foot down and said they weren’t breaking any more laws, prompting the husband to inform Bailey that Owen had stolen drugs from the hospital to help other terminally ill veterans end their lives.

Bailey was understandably livid, and while Owen stood by his decision, the chief told him she had to report them to the police — it was a legal issue, not a moral one. However, she accepted their resignations and said she’d give them a few hours before she contacted the authorities. The couple collected their kids from a very worried Amelia and boarded a plane to an unknown destination. 

Is that the last we’ll see of Kevin McKidd and Kim Raver? It’s unlikely, as ahead of Season 17, the actors (along with Camilla Luddington) reportedly signed three-year contracts that should keep them on the show through Season 19, but we’ll just have to wait and see. 

Richard Webber and Catherine Fox.

(Image credit: ABC)

Catherine’s Cancer Treatment Was Successful, So She And Richard Went On Sabbatical

Catherine Fox had reason to celebrate, and it wasn’t just the fact that she got to see her granddaughter Harriet. Amelia delivered the good news that the treatment was working, and she was again merely living with cancer, not dying from it. She and Richard decided to celebrate the news by taking a sabbatical to see the Great Pyramids — interesting timing, as the hospital faced its biggest challenge yet with the shutdown of its residency program.

Miranda Bailey

(Image credit: ABC)

Bailey Quit With No Notice After The Residency Program Was Shut Down

Jamarah Blake told Bailey the working relationship between her, Richard and Meredith had become dysfunctional, after Meredith went against Richard’s orders to not perform a risky operation and Richard, in turn, refused to respect Bailey’s authority as chief. Blake tasked the chief with starting from scratch to rebuild the residency program, revoking the hospital's accreditation in the meantime. Yes, that means Levi Schmitt, Taryn Helm, Mabel Tsang, Zander Perez and the rest of the residents no longer work at Grey Sloan.

Bailey — who nearly suffered another heart attack from the events of this season and whose priorities shifted with her and Ben’s adoption of Pru Miller (RIP Dean) — said enough is enough and decided to put her own well-being first. She quit the hospital with no notice, handing Meredith the keys to her office on the way out and telling her, “You broke it, you bought it.” But wait, wasn’t Meredith moving to Minnesota?

Meredith Grey

(Image credit: ABC)

Meredith Ascends To Chief Of Surgery: Her Birthright, Or Is She Stuck In Seattle?

With Richard and Bailey gone — and pressure from Jackson not to go to Minnesota — Meredith was left as Chief of Surgery. It practically seems like her birthright, with her family’s history there, but she really wanted to leave. Her visions of her mother’s abusive words and trying to save Derek the day he got shot indicated that her trauma will always keep her bound to Grey Sloan Memorial. 

As she sat in Bailey’s office — correction, her office — telling Nick to leave because his life was in Minnesota and her life was in Seattle, Meredith seemed to give in to the futility of it all. But in the final moments of the episode, she might have changed her mind, trying to yell for Nick to come back. Did the risk of losing him force her to push past her demons?

Todd and Jo Wilson.

(Image credit: ABC)

Relationship Roundup: Finale Makeups And Breakups

  • Meredith and Nick’s status is unclear, after she tried to send him back to Minnesota following a fight over her rogue surgery. Nick suggested she may have made the wrong decisions based on her complicated feelings about leaving Seattle, and Meredith did not take kindly to that. 
  • Things were looking so good for Jo and Todd, but everything changed after they slept together and he told her he loved her. Apparently she found it hard to overlook his singing after sex (it’s Skylar Astin, what do you expect?), which can’t be worse than him bringing a giant teddy bear (“It’s a sex bear.”) to her at the hospital the next day. So that’s over, but at least things are getting back to normal with Link. Will they go back to BFFs, or is there something more there?
  • Amelia was reeling the whole episode over her breakup with Kai, and it turns out Kai was reeling as well. They showed up at the hospital, telling Amelia they couldn’t sleep, and the two shared a kiss. I’m interested to see where Season 19 takes this couple, because they are my favorite, but I don’t want Kai to sacrifice the life they’ve chosen.
  • Last but not least, Jesse Williams and Sarah Drew did return for the Season 18 finale, and fans had to wait until the very end to see Jackson and April walk away hand-in-hand, kissing once they got in the elevator. Breathe easy, Japril fans, they are back on in Boston!

That was a whole lot of change to absorb. In the span of two hours, Grey Sloan went from being understaffed to straight-up hemorrhaging doctors, losing Owen, Teddy, Richard and Bailey, as well as all the residents. Will Meredith be forced to stay, sacrificing love? Could she even bring herself to leave if that were an option? 

We don’t know how many more seasons of Grey’s Anatomy we’ll get — or if the show will eventually continue without Meredith — but we do know that the drama will continue this fall for Season 19 on ABC! Check out our 2022 TV Schedule to see what premieres are coming up in the meantime.

Heidi Venable
Content Producer

Mom of two and hard-core '90s kid. Unprovoked, will quote Friends in any situation. Thrives on New Orleans Saints football, The West Wing and taco trucks.