Written by Krista Vernoff and directed by Ed Ornelas, the episode aired on the American Broadcasting Company (ABC) in the United States on September 24, 2009.
In the episode, the doctors of Seattle Grace Hospital grapple with the shocking revelation that a dead John Doe is actually their beloved co-worker George O'Malley (T. R. Knight).
Meanwhile, Derek Shepherd (Patrick Dempsey) is offered the position of Chief of Surgery, a role currently held by Richard Webber (James Pickens, Jr.).
The doctors at Seattle Grace are dealing with the aftermath of George O'Malley (T. R. Knight) being declared brain dead following his injuries from being hit by a bus.
Stevens, still recovering from her near-death experience, remains unaware of George's death, and her husband, Alex Karev (Justin Chambers), decides not to tell her immediately, fearing it could negatively impact her recovery.
Meanwhile, a speedboat accident victim, Clara Ferguson (Zoe Boyle), is brought into the hospital with multiple amputations, and plastic surgeon Mark Sloan (Eric Dane) informs her that they may be able to reattach her severed limbs.
Hospital president Larry Jennings (Mitch Pileggi) approaches Derek Shepherd (Patrick Dempsey) with an offer to take over as Chief of Surgery, citing Webber’s recent shortcomings in the role.
As preparations for organ donation begin, Miranda Bailey (Chandra Wilson), George's former mentor, struggles to accept the loss but eventually comes to terms with it.
At George's funeral, the woman O'Malley saved, Amanda (Shannon Lucio) is shown hysterically crying, while Meredith, Cristina Yang (Sandra Oh), Karev, and Stevens, awkwardly laugh and joke, unable to process their true emotions.
Knight was released from his contract at the end of Season 5 due to disagreements with series creator Shonda Rhimes over the lack of screen time for O'Malley.
[2] In the episode, Derek Shepherd (Patrick Dempsey) is offered the role of Chief of Surgery but postpones his decision out of loyalty to his friend Richard Webber (James Pickens, Jr.).
[5] Despite this slight decrease, the episode ranked first in both its time-slot and across the entire night, surpassing CBS's juggernaut CSI: Crime Scene Investigation.
"[7] Kelly West of TV Blend was also critical, writing: "I don't think based on the first episode that we can say that Grey's is headed in a new direction, nor do I think the writers are making much of an effort to bring the series back to the greatness of its earlier seasons."
West added that despite these concerns, the season premiere still featured the usual drama, romance, and medical mysteries that kept the show engaging for its core audience.
[8] Glenn Diaz of BuddyTV noted that the two-part premiere foreshadowed a "very dark" season, highlighting the conversation between Louise O'Malley (Debra Monk), George's mother and Torres as one of the most heart-wrenching moments of an already emotionally charged episode.