Alex Karev

Lore & Background

Alex Karev had a troubled childhood shaped by his mother's mental illness and his father's frequent absences and violent behavior. Alex took up wrestling in high school as a way to defend himself and his mother, eventually confronting his father, leading to his father's permanent absence. Alex has two younger siblings, Aaron and Amber, and the three were placed in foster care for five years. While Aaron and Amber were placed with only a few families, Alex went through 17 foster families before reuniting with his siblings. Later, it is revealed that Aaron was diagnosed with schizophrenia and attempted to harm Amber, with Alex present when Aaron was committed to a psychiatric facility. After graduating from the University of Iowa, Alex secured a spot in the surgical residency program at Seattle Grace Hospital. Initially, he made a poor impression on his fellow interns, taunting Izzie after discovering she had worked as a lingerie model, but eventually the two formed a friendship. Alex confided in Izzie about his father's heroin addiction and abusive behavior, revealing his motivations for becoming a wrestler to protect his mother. At the end of the first season, George contracts syphilis from Alex through their mutual involvement with nurse Olivia Harper, leading to significant animosity between the two.

In Their Own Story

Alex's initial relationship with Izzie faced challenges. After a failed date, due to Alex being preoccupied with his failed medical board exams, Izzie rejected him. Later, Alex experienced erectile dysfunction with Izzie, leading him to sleep with Olivia. Izzie caught him, causing them to break up. However, after passing his retaken exams and a bomb scare in the hospital, Alex and Izzie briefly reunited. Their relationship ultimately ended when Izzie fell in love with a patient, Denny Duquette. Alex helps Izzie recover from Denny's death and attempts to rekindle their relationship, but Izzie pulls away, still grieving her loss. Despite the setback, they maintain their friendship. Alex spends time working with neonatal surgeon Dr. Addison Montgomery, and although he later shifts to working with plastic surgeon Dr. Mark Sloan, his interest returns to Addison's specialty. Addison develops feelings for Alex, and the two eventually share a kiss and later sleep together. Following a ferry accident, Alex rescues a pregnant woman with amnesia, later revealed to be Rebecca Pope. She initially hides the fact that her memory has returned, fearing her troubled marriage. Alex helps her rediscover her identity, but ultimately turns her down after realizing she is married, feeling unworthy of her. Rebecca returns, and she and Alex sleep together again before she goes back to her husband. Alex also has a brief relationship with intern Lexie Grey, but chooses Rebecca when she tells him she is pregnant. However, after Rebecca's suicide attempt, Izzie convinces Alex to seek psychiatric help for her, as she begins hallucinating about the pregnancy. Alex later breaks down in Izzie's arms, and they share a kiss.

Reader's Guide

As Izzie and Alex's relationship grows, Izzie begins experiencing hallucinations of Denny, eventually revealing she has Stage 4 metastatic melanoma with an estimated 5% chance of survival. It is discovered that her hallucinations of Denny are caused by her brain tumor. Despite being devastated by the news, Alex stands by her. Izzie plans Meredith and Derek's wedding, but when Derek discovers another inoperable tumor in Izzie's brain, the couple gives their wedding to Izzie and Alex. They marry in front of all their friends, and Alex, though fearful, supports her decision to undergo a risky surgery. After Izzie flatlines, Alex desperately performs CPR in an attempt to save her life. Izzie returns to work at Seattle Grace but is soon fired after making a treatment error that endangered a patient's life. She leaves a Dear John letter for Alex, providing no clue to her whereabouts. She later returns to the hospital to reconcile after learning that Alex wasn't the reason for her firing. Izzie reveals that her cancer is in remission, and though Alex expresses happiness for her, he tells her that he deserves someone who will stay. Izzie leaves Seattle once again, this time for good, and later sends Alex divorce papers. Following Izzie's departure, Alex rekindles his relationship with Lexie. At this point in his career, Alex realizes that his true calling is in pediatrics rather than plastics, which he had previously pursued. His ability to work well with children draws the attention of Dr. Arizona Robbins, who offers to mentor him in pediatric surgery. When Alex's brother Aaron comes to Seattle Grace for surgery, painful memories from their difficult childhood resurface, and it is revealed that Alex and his siblings spent five years in foster care due to their mother's inability to care for them. During a hospital shooting, Alex is gravely injured but survives with the help of Lexie and Mark. While undergoing treatment, Alex asks for Izzie, expressing his lingering feelings for her. However, after Lexie experiences a mental breakdown, Alex distances himself. Dr. Miranda Bailey insists Alex cannot return to surgery until the bullet from the shooting is removed, which Alex finally allows her to do. After recovering, Alex focuses on his pediatric career and begins treating children, showcasing his talent in handling young patients. He clashes with new pediatric attending Dr. Robert Stark while Arizona is on leave but is thrilled when she returns from Africa. Alex starts a relationship with Dr. Lucy Fields, an OB-GYN attending, after she kisses him. However, their relationship is short-lived as Alex's ambition leads him to sabotage Meredith's Alzheimer's clinical trial in an attempt to secure the position of Chief Resident. This action results in Meredith losing the chance to adopt Zola. Alex later apologizes to Meredith, and she forgives him. As the end of residency approaches, Alex prepares for his board exams, although he is late for his exam due to treating a patient. He passes the boards, and Dr. Webber informs him that Johns Hopkins Hospital, the top program in the country, has been impressed with him and created a position for him in pediatric surgery, which Alex accepts. However, when Arizona yells at him and takes his place on a plane that later crashes, Alex decides to stay at Seattle Grace, realizing his loyalty to his colleagues. After the crash, Arizona's health deteriorates, leading to the amputation of her leg. Alex extends his stay at Seattle Grace until a replacement for Arizona is found. When he learns that the replacement would send the exchange program to UCLA, Alex decides to remain at Seattle Grace permanently. He buys Meredith's old house, where he lives with Cristina. Alex eventually forms a close friendship with intern Jo Wilson, which develops into romantic feelings. He admits his love for Jo, and they become a couple. Alex's estranged father, Jimmy, reappears in Alex's life when he is admitted to the ER as a patient. Unaware that Alex is his son, Jimmy confides in him about the family he abandoned years ago. This angers Alex, leading him to punch Jimmy at a bar. Later, Jimmy returns to the hospital, suffering from withdrawal symptoms and hallucinations, which reveal more about Alex's difficult childhood. Eventually, Jimmy recognizes Alex as his son, and the two argue. Jimmy goes into cardiac arrest and is brought into surgery, where Dr. Shane Ross, still haunted by Dr. Brooks' death, makes a critical mistake that damages Jimmy's heart. This leads to Jimmy's death, but before he passes, Alex lies to him, saying that his estranged family knows he loves them and are on their way to see him. Jimmy dies peacefully, believing Alex's comforting words. That same night, Alex kisses Jo at April's wedding, expressing his desire to start a family, but is deeply upset by his father's death due to Ross' error. Alex later confronts Ross, punching him, and is comforted by Meredith. After completing his fellowship in Pediatric Surgery, Alex is offered a job at Dr. Oliver Lebackes' private practice. In the fifteenth-season premiere, Alex is appointed as interim Chief of Surgery after Bailey takes a sabbatical. In season 16, Alex leaves Grey Sloan Memorial Hospital to reunite with Izzie and their children, with his final appearance occurring in the episode titled "Leave a Light On".

Did You Know?

• Alex went through 17 foster families before reuniting with his siblings.
• He was appointed as Interim Chief of Surgery for six months while Miranda Bailey was on a stress sabbatical.
• Alex's final appearance on the show was in the episode titled 'Leave a Light On'.
• He passed his board exams despite being late due to treating a patient.
• Alex lied to his dying father Jimmy, telling him his estranged family knew he loved them and were on their way to see him.