Alex Karev

"Maybe we have to get a little messed up before we can step up."

- Alex Karev

Alexander Michael Karev, born Alexander Michael Evans, is a pediatric surgery fellow working at Grey Sloan Memorial Hospital. Alex is an eager and competitive surgeon, but he can also be self-absorbed and overconfident; he only wants to work on cases that he feels are interesting. His offensive behavior and poor attitude cause him to be extremely disliked by doctors and patients alike. However, it is slowly revealed that Alex does care for others and is very kind. He actively plays down his soft side, adopting a brash and cocky attitude to project to other people. Alex married Izzie Stevens, but eventually divorced after she abandoned him.

Early Life
Not much is known about Alex's childhood other than Alex's dislike for his father. His father never took him to a park as a child, and Alex referred to himself as literally being raised in a bar. As a teenager, Alex Karev became a wrestler. He did so because his father, a musician and drug addict, used to beat his mother. Alex beat his father and put him in a hospital. When discharged, Alex's father never went back home. After he left, Alex's mother sank into a depression and Alex took care of her.

After Alex's grandmother died, he had a dream where she told him not to play with his parts.

He was in 17 different foster homes in the course of 5 years. He also spent time in juvenile detention for stealing food for his family. He lost his virginity to the school nurse when he was 15.

At some point, Alex legally changed his last name to Karev, his mother's maiden name, to disassociate himself from his father, James Evans.

Rebecca Pope (Ava/Jane Doe)
Alex rescued Rebecca while she was pregnant during the ferry boat accident. He also helped her pick a "new face" for Dr. Sloan to constuct. Because of her new face and because she couldn't remember her real name, Alex nicknamed her Ava. Later on, Rebecca returned and they had a brief relationship during which she believed he got her pregant (which was investigated by Izzie and turned out to be false).

African Project
Alex and his fellow fourth year residents began the race for chief resident. Alex initially fell behind in the race because he didn't have any projects to work on while his peers were going off on their own. However, an idea was planted into his head when he joined Robbins in looking at scans of patient in need of surgery. When he asked if he could scrub in, Robbins informed him that the child was in Africa and wouldn't be getting the surgery because she needed to stay to care for her own sick child who was in the NICU at the time. It would cost too much to fly him out herself and she was at a loss as to getting someone who was willing to bring that kid, plus the dozen others, to the US for surgery.

Later, when prompted by the Owen about his plans for chief resident, Alex impulsively blurted out a plan to bring over a group of African kids for much needed surgeries. From that point, Alex committed himself to the Africa Project, despite a rocky start. He initially presented his plan to Dr. Stark, asking for the help and money he needed to get the project off the ground. Stark denied him, however, because despite all of Alex's good intentions, he wasn't good at organizing the logistic part of the project, coming off as disorganized and "half-assed", according to Stark.

Resorting to Plan B, Alex went to one of his rich patients, Gladys Pulcher, who was suffering from late stage lung cancer. Pulcher, dubbed "Dragon Lady" by Alex because of her constant cold and mean spirited remarks, refused and threatened to sue him and the hospital. Alex persisted, however, going as far as to show her pictures of the many sick kids before she sent him away. She asked for him later when Lexie was having trouble moving her without causing pain. He refused to help unless she agreed to give him money for his project. She agreed and Alex walked away victorious. His glee was short lived as Pulcher coded and died soon after.

Despite the financial setback, Alex proceeded with his plans, first charging his credit cards and then giving "I owe you" promises until the children were set to arrive. Frantic and crumbling under the pressure of owing so much money and living up to the expectations he had set up for these kids, Alex nearly had a meltdown. He attempted to run away from the problem, ignoring Lexie who was hounding him about the debt, and instead focusing on helping the kids. However, a check came in the mail just in time from the lawyer handling the estate of Gladys Pulcher, giving Alex two hundred thousand dollars and essentially funding the project.

The children arrived and the surgeons of Seattle Grace Mercy West were able to give them their surgeries successfully. The project put Alex as the front runner in the race for chief resident.

The project was temporarily threatened when a new doctor, Dr. Mel Barnett, took over for Robbins while she recovered after the plane crash and her amputation. According to Barnett, the project didn't fit in his agenda for pediatrics and would have been shipped over to a different hospital. This, however, did not happen as Alex stayed in Seattle instead of going to Baltimore to do his fellowship at John Hopkins.

Relationship with Jo
Alex and Jo begin dating after them both denying their feelings for each other. Jo and Alex fight over his father, but Alex realizes Jo was doing it because she loved him. They both were in foster care growing up. Alex proposes although Jo does not realize that that's what he was doing until he introduces her as his fiancée. When the board introduce the no fratzination rule, they fake a break up. Meredith finds a solution in a love contract, which they both have to sign, which states that their relationship is consensual.

Personality
Despite the callous image he projects, Alex is particularly affected when he treats addicts and abused children because of his childhood background. He initially refused to install a central line for a Demerol addict because he did not want to feed his habit. He was also able to connect with a teenage boy whose abusive father hit his mother. ("Enough is Enough")

Izzie Stevens
Izzie realized that Alex was not as insensitive and cruel as he portrayed himself to be. She began a tentative friendship with him, to the shock of Meredith, Cristina, and George. Later, Meredith’s opinion of Alex changed for the better when he offered to listen to her problems with her mother, Ellis.

When Alex found out that Izzie Stevens was an ex-lingerie model, he obtained a copy of her advertisement and proceeded to paste copies all over Seattle Grace. Although he succeeded in humiliating her, she turned things on him by stripping to her underwear in front of him and several other interns, reminding him that her modeling is the reason why she is debt-free while he is “sitting on two hundred grand of student loans”.

Alex eventually asked Izzie out on a date. However on that very day, he found out from the Chief that he failed his medical board exams. This caused him to suffer from a crisis of confidence, leading him to treat her shabbily during their date. His confidence took another blow when he froze up during a makeshift emergency surgery in an elevator during a power outage, and George had to operate on the patient himself. Izzie, still furious from the horrendous date, refused to speak to him. Afterwards in Joe’s bar, he went up to her and kissed her passionately, rekindling their budding relationship. However, their sex life hit a bump when Alex had difficulties performing. Meanwhile, his confidence in his medical skills further deteriorated after he accidentally administered a wrong dosage saline solution, paralyzing the patient. In a moment of vulnerability, he slept with Olivia and was caught in the act by Izzie, effectively ending their relationship.

Izzie subsequently found out about it and blew up at her friends for helping Alex. She eventually forgave him, but ruled out getting back together with him. Alex passed his re-test and became a full-fledged doctor. During the code black, the dire situation of a bomb scare caused Izzie to realize that she should act on her feelings. She accosted Alex and the two proceeded to have sex in a linen closet. They continued to sleep together several times over the course of the day.

Izzie’s patient, Denny Duquette, was re-admitted after he suffered a heart failure. Alex was jealous of Izzie’s concern for Denny, and tried to get Denny to back off by telling him that he was with Izzie and there is a good chance that he would die from his failing heart anyway. She confronted him, and he told her that she cannot get involved with her patients. However, Izzie realized that she didn't have to settle for Alex. Offended when Alex referred to the still-living Denny as a "corpse", she dumped him saying, "Just so we’re clear, we’re over. On your very best day, that 'corpse' is twice the man you will ever be. You're not good enough for me, Alex. You're not good enough for anyone."

When Denny died from a stroke, Alex picked up a devastated Izzie and told her that the dead man was no longer Denny, the man she once loved. In Staring at the Sun, Alex realized that his feelings for Izzie had not diminished since she dumped him, and impulsively kissed her in the stairwell. Izzie had yet to get over Denny and told him she cannot commit in a relationship with him just yet, and he understood. However, Alex claimed his lack of interest in Izzie and has appeared to have gotten over her.

His feelings for Izzie eventually came back and when she gave him an ultimatum (to pick between the nice Alex and the jerk Alex) he chooses nice and they begin to go out again. He starts dating Izzie exclusively and after winning his solo-surgery he tells her he loves her.

Following the revelation of her cancer, Alex snooches in a cup as they harvest Izzie's eggs in case they ever want a child. When Izzie is discovered to have an inoperable tumor, Meredith and Derek gave their wedding to Alex and Izzie and the two marry.



After the death of George O'Malley, and the merger between Seattle Grace Hospital and Mercy West Medical Center, Izzie was fired partly because Alex told the Chief Webber she couldn't handle the pressure of working because she was still recovering. He meant to protect her but Izzie didn't think so and she left Seattle, leaving Alex with unpaid medical bills and no ideas of where she was.

Alex remained worried for weeks trying to join her because she had to treat her cancer and she didn't show up to her round of chemo. When she finally got back, to get some help for an old teacher, they didn't managed to work their problems out and Izzie left once again.

Izzie eventually sent Alex divorce papers, and while Alex signed them and had committed to Lexie, Alex still loved her. He called out for Izzie while he was delirious after getting shot. Alex, thinking Lexie was Izzie, expressed his glee that she returned and begged her to stay with him.

Olivia Harper
George contracted syphilis from Alex through Olivia. It was revealed that Olivia was already dating Alex when George asked her out. Olivia subsequently broke up with Alex after realizing how much she liked George. Furious at the revelation that Alex was the cause of his syphilis, George punched Alex in the face. That night, Joe, the owner of Emerald City Bar was admitted to Seattle Grace Hospital, and in discussions with Joe it was revealed that Alex was a regular at Joe's bar every night and that he and Joe had become close friends. When George finds a way to pay for Joe's hospital bills, the animosity between George and Alex is dissolved after Alex gives George a hug.

A mixer was held for the new interns, and it was at this mixer that he met and presumably hit it off with Nurse Olivia Harper, as he is shown leaving the event with an arm around her.

Addison Forbes Montgomery
Addison discovered Alex’s better side and found herself attracted to him. To some degree, Alex was also attracted to Addison as they subsequently shared frequent meaningful looks. This culminated in an actual kiss in Joe’s bar. Later, during the 60-day trial with Mark Sloan, Addison sleeps with Alex, breaking the deal. However, he later told her that he only wants to work with her professionally, and is not interested in pursuing a romantic relationship with her.

Rebecca Pope
During a ferry accident, Alex found a severely injured pregnant woman crushed under a pylon. He rescued her from the debris, and encouraged her to stay alive. The pregnant Jane Doe subsequently became hysterical after realizing she could not remember anything, and turned to Alex for support, thinking that he was her husband. Alex showed much concern for her and constantly checked on her progress, bonding with her in the process. He also helped her pick out a new face for reconstruction, as well as a new name "Ava". As Alex spent more time with Ava, he became increasingly attached to her, spending most of his time checking on her progress and doing research. This led Addison to accuse him of being too emotionally involved with a patient, but he countered saying that he was just being prepared. In the heat of the argument, Addison kissed him and pushed him into an on-call room, where the two had sex. However, Alex rebuffed Addison's subsequent advances, after learning she wanted a committed man to have kids with, something which he was not ready for.

After Addison leaves, Ava returns a couple times and they slept together. The last time she comes, she tells him that she is pregnant which causes Alex to ask whether she is keeping it. After that, he becomes more sensitive and has her move in. After a couple days, Izzie confronts Alex and tells him that Ava is not really pregnant and never was. Alex refuses to believe it and so does Ava. Izzie shows him the charts though and he can't dispute that. So he tells Ava and she thinks she had a miscarriage even though he tells her there was no baby. She can't take care of herself and so he does everything for her insisting that she is fine. Finally she cuts herself and Izzie admits her and forces her to get a psych consult. Alex calls her husband who tells him that he left Ava and went with the child. He also says that she'd already been diagnosed with borderline personality disorder. She is taken to a psychiactric ward and Alex is forced to move on.

Lexie Grey
Alex decided to not wait for her and he slept with Lexie Grey just before Izzie came back home. She tried to convince him that they could start over but he had moved on and he decided to break up with Izzie. So Izzie left Seattle for apparently the last time, telling she couldn't stand it.

Later, she sent the divorce paper to Alex, with her name signed on it. Alex then signed his name, kissed Lexie and they walked out of the hospital, hand-in-hand.

Alex was shot in the hospital by a grieving deceased patient's husband, but survived with the help of Lexie and Mark. While undergoing treatment, he mistook Lexie for Izzie. He apologized to her and continued by telling her "[she] came back" and tearfully begging her never to leave him again; Lexie, declining to correct him, assured him that she never would. Following the shooting, Lexie had a mental breakdown in front of Alex. Mark asked Alex to help her but he refused and walks away. He returned to being very promiscuous and refused to have the bullet in his chest removed, saying that it was his "war wound." After insulting Lexie, she cut him down to size, stating that he was not "badass" for living because she was the reason that he survived and that while he was dying, he cried out for the wife who left him, that is, Izzie. Alex is left speechless.

Lucy Fields
Alex had a brief romantic relationship with the attending OB/GYN Lucy Fields. At first, Lucy strongly disliked Alex after he called her patient a turnip, but after discovering they shared an equal enthusiasm for college basketball, she liked him slightly more. Eventually they began a romantic and sexual relationship. Arizona offered Alex the proposal to go to Africa to tend to and check up on the patients who visited and received medical attention at Seattle Grace. Lucy was disappointed because as Alex was considering that opportunity, he didn't even think about Lucy. She shook it off by saying it didn't matter what she thought. Arizona approached Alex and asks him if he wasn't taking the job because of Lucy, as she didn't want him to do the same thing she did and run back to Lucy once in Africa. Alex told Lucy he was not taking the job in Africa because she was "a factor." She told him to stop and said he was right when he said career comes first. She told him she took the job -- not at Baylor, but Alex's proposed job in Africa. She assured him it wasn't personal. Not long after that, she walked into Joe's and said to Alex, "tell me not to go to Africa." He told her to go to hell.

Interns
While still planning to go to Johns Hopkins Hospital, Alex was known as a "player" amongst the new interns and also as the attending who sleeps around with all of the interns because he didn't plan to stay at Seattle Grace Mercy West Hospital.

Jo Wilson
One of the interns, Jo Wilson, has started up a close friendship with Alex. They bonded at Bailey's wedding as they talked about their hard upbringings. They see each other as just friends. However, after some time, Alex begins to see Jo in a different way. This is seen when he gets jealous of her going on a date with another intern. He admitted his love for her to Cristina not long after that.

During the super storm, he finally admits to Jo that he loves her and the couple shares a kiss.

After that, they began dating. They hit a bit of a rocky patch when Alex's dad came into the hospital from a car crash related to drugs. Alex asked Jo to do a paternity test and he said he didn't want to know at the same time she said, "he's your father." Alex then proceeded to stalk his father at bars where he was performing. When Alex didn't come home for 3 nights in a row, Jo got worried. He then told her what was happening and they worked it out.

After his dad returned to the hospital trying to get clean, Alex said goodbye for a final time. Then he arrived outside April and Mathew's wedding to meet up with Jo. He then told her that would be great parents and would not need anyone apart from themselves. They then shared an extensive kiss before attending the wedding.

Meredith Grey
Initially, Meredith disliked Alex. He was not nice to anyone, especially fellow intern and Meredith's close friend George O'Malley. Eventually Izzie Stevens befriended Alex and Meredith accepted him as well. They maintained a close friendship throughout the years and Alex even made Meredith his best man at his wedding to Izzie. When Izzie left the hospital after being fired, Meredith became a source of support for Alex. They maintained a very close friendship until Alex informed Owen Hunt in a drunken state of Meredith's tampering with the Alzheimer's trial. Meredith became furious with Alex, especially since this led to Zola being taken away. Alex worked hard for Meredith's forgiveness, however, and even went to the judge responsible for Zola's adoption case. With his help, Meredith and Derek got Zola back. Since this, Meredith and Alex have recovered and maintain a close friendship. Alex also bought Meredith's House from her after he chose to remain in Seattle.

There has never been any sexual attraction between Alex and Meredith. When they lived together, Meredith would often sit in the bathroom while Alex showered and vent to him.

Cristina Yang
Cristina and Alex have a love-hate relationship. They are from the intern class, so naturally, they are close as they have spent so many years together.

When Alex buys Meredith's house, Cristina moves in.

Morgan Peterson
Morgan was a surgical intern at Seattle Grace Mercy West. She was Alex's intern and was helping him pass his boards when she passed out. She had heart complications and needed an emergency c-section. She had a boyfriend, Chris, who worked at the Cleveland Clinic. The baby was born at 24 weeks, and Chris left a little while after the baby was born because he thought the baby was going to die and that it was pointless because the pregnancy was accidental anyways. Morgan decided to call the baby Tommy after her father. Alex was very attached to Tommy. Alex and Morgan got close, but Arizona scared Alex off of Morgan by telling Alex that Morgan was into him. Alex avoided her and Tommy for weeks. Alex tried to get back into the case later. He almost missed his flight to San Francisco to take his boards because he was taking care of Tommy. He then flew back to Seattle the night before his boards to take care of Tommy and helped Morgan when Tommy died.

Arizona Robbins
Arizona is Alex's mentor and the two have maintained a close relationship because of that. Arizona is one of the only people who fully believes in Alex's surgical abilities. When Alex had decided to take the fellowship at John Hopkins, Arizona was hurt and upset. As a result of this, she decided to take Alex's spot on the plane that eventually crashed. As a result of this plane crash, Arizona lost her leg. At first Alex worried that she blamed him as he was supposed to be in her spot. But this was not the case and Arizona and Alex continued to work well together.

Career
Alex Karev is a former wrestler at the University of Iowa, and studied medicine on a wrestling scholarship.

Alex prides himself on his honesty, which often lacks tact and can verge on being crude, brutal, and insensitive. This contributes to his poor bedside manner. However, Alex does have a moral code and is the only doctor who tells the truth to patients who make bad decisions about their health, at the risk of offending patients and getting kicked out of surgical cases.

Alex is also the first intern to decide on his specialty – plastic surgery. While it seemed at first that he chose that specialty due to "frat-boy" superficiality, the real reason was because plastic surgery patients “sign up for the pain they get”.

He has unwittingly been drawn to obstetrics and gynecology and neonatal surgery, after having several bad experiences in plastics, under Mark Sloan. Alex seems to have some talent in OB/GYN after serving as Addison’s intern for a while. Alex Karev secured a position in the surgical residency program at Seattle Grace after graduating from medical school.Although first he was an intern of Jeremy, Alex was reassigned to a new resident Dr. Miranda Bailey, to the disdain of the other interns under her. His frequent sexist remarks and overt come-ons made him even more disliked by the interns, who proceeded to dub him “evil spawn”. He became even more hated when he hijacked an open-heart surgery that rightfully belonged to the other interns. After which, he proceeded to taunt a furious Meredith, who attacked him in retaliation, calling him a “frat boy bitch”.

Alex confided in Meredith about his failed medical boards and she decided to help him study, roping in Cristina and George to help as well.

Alex’s streak of brutal honesty caused Addison to be on the receiving end of legal action, when he persuaded a patient’s husband to sue the hospital for Addison’s “mistake” in “Blue’s for Sister Someone”. Furious, she informs a stunned Alex that he would be placed permanently under her service. Despite his lack of interest in obstetrics and gynecology, he has exhibited some flair for it as he managed to deliver a premature baby by himself.

When acclaimed plastic surgeon Dr. Mark Sloan took up a position at Seattle Grace, Alex leapt at the chance to pursue his interest in plastics. He wanted Addison to release him from her service, and she did, but not before telling him that he would miss her. It becomes clear that Mark is a poor teacher, only delegating menial tasks to Alex. Alex gradually developed distaste for plastics after serving as Mark’s intern, and found himself drawn back to Addison’s surgeries. Addison left Seattle Grace and Alex found himself without any preferences for any specialty.

When Rebecca Pope returned to Seattle Grace and revealed she was pregnant, Alex took up some shifts at the Emerald City Bar.

When Cristina was chosen to pick the first resident to perform a solo surgery, she chose Alex who performed a below the knee amputation.

It was during Alex's third year of residency that he heavily considered pediatric surgery as a specialty. Given his time as Addison's intern, and with Bailey's recommendation, Chief of Pediatric Surgery Dr. Arizona Robbins mentored Alex for the remainder of his residency; he officially declared his specialty during his fifth year, paving the way for his fellowships after his residency.

Alex was Owen's original choice for chief resident but after he sold out Meredith when she tampered with the Alzheimer's trial, Owen chose April Kepner instead.

Alex passed his oral boards and is now a board certified surgeon in general surgery and a pediatric surgical fellow at Grey Sloan Memorial Hospital after turning down a fellowship at Johns Hopkins.

Notes and Trivia

 * Alex Karev was not in the original pilot script. He wasn't added until after the pilot was shot, therefore scenes with him were either reshoots or digitally altered.
 * Alex's younger brother Aaron was introduced in late season 6. Aaron needs surgery for abdominal hernia. While in the hospital, we learn more about Alex's childhood. Alex was in foster care and bumped around to 17 different homes before he left the system.
 * Alex also has a younger sister called Amber.
 * Alex took care of his siblings because his parents were unable to do so, as his dad was a junkie and his mom was mentally ill.
 * His favorite cake is banana cream pie.
 * He drives a black and white Chevrolet Camaro SS as seen in Goodbye.
 * Izzie sent Alex divorce papers after she left and Alex signed them and sent them back.
 * Alex spent time in juvenile detention at age 11 for theft. He had been stealing food to feed himself and his siblings.
 * He spent time in 17 different foster homes before his stint in juvenile detention.
 * Alex is the only one of the 5 original interns to have never quit or been fired. Izzie was fired, George resigned to join the army, Meredith was fired in the Season 8 premiere and quit later in Hard Bargain and Cristina quit (not officially) in the aftermath of the shooting and later (officially) in Hard Bargain.
 * Alex mentioned he gives blood every two months in I Saw What I Saw.
 * He used to laugh in his sleep.

Notable Episodes
These episodes are Alex-centric or are otherwise very informative about his life.
 * Enough is Enough (No More Tears)
 * What a Difference a Day Makes
 * Elevator Love Letter
 * Invest in Love
 * Sympathy for the Parents
 * The Face of Change
 * Map of You
 * Man on the Moon
 * Get Up, Stand Up

Memorable Quotes

 * Alex: Let's say you were drafted to a team that wasn't your first pick. You know, you don't like the players. You hate the way they play the game. You even think the quarterback is full of crap. The quarterback's a pain in the ass you don't owe a damned thing to. But, it's your team. You don't quit. You don't talk to the press. You don't bitch to the coach. You just, you just go out there every Sunday and you make the blocks and you take the hits and you, you play to win. You show up and you suit up and you play, because it's your freaking team. -  Losing My Religion
 * Alex: Surgeons are all messed up. We’re butchers, messed up knife happy butchers. We cut people up, we move on. Patients die on our watch, we move on. We cause trauma, we suffer trauma. We don’t have time to worry about all the blood and death and crap it really makes us feel. Doesn’t matter how tough we are, trauma always leaves a scar. It follows us home, it changes our lives, trauma messes everybody up, but maybe that’s the point. All the pain and the fear and the crap. Maybe going through all of that is what keeps us moving forward. It’s what pushes us. Maybe we have to get a little messed up, before we can step up. - Elevator Love Letter
 * Alex: I'm not big into change. In oncology, when a normal cell changes into something malignant, it's called cellular transformation. The damn cells turn toxic right in front of your eyes. So as far as I'm concerned transformation sucks. Change is a funny thing, and not everyone can handle it. It can sneak up on you. Things aren’t what they used to be. Your whole world has transformed. You realize the ground beneath you has shifted. Things are uncertain and there’s no turning back. The world around you is different now. Unrecognizable. And there’s nothing you can do about it. You’re stuck. Your future is staring you in the face and you’re not sure you like what you see. Like I said… I’m not big into change. - The Face of Change
 * Alex (to Jo): We're the only family we need, right? And we'll be together forever, right? You and me. And if we have kids, we'll be great. I'll be a great dad, and you'll be great, and we'll be just us. We won't need anybody else, right? - Get Up, Stand Up