Alex Karev

"Today's the day my life begins. All my life I've been just me. Just a smart mouth kid. Today I become a man. Today I become a husband. Today I become accountable to someone other than myself."

- Alex Karev (to Izzie, on their wedding day)

Alexander Michael Karev 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' 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.

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 in 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 in Deny, Deny, Deny. 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. In “It’s the End of the World”, 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.wife is dead

In What Have I Done to Deserve This?, 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 in Scars and Souvenirs, 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.

Olivia Harper
In “Who's Zoomin' Who?”, 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 something. 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.

During the season six finale, Alex is shot in the hospital by a grieving deceased patient's husband, but survives with the help of Lexie and Mark. While undergoing treatment, he mistakes Lexie for Izzie, he apologizes to her and continues by telling her "[she] came back" and tearfully begging her never to leave him again; Lexie, declining to correct him, assures him that she never will. Following the shooting, Lexie has a mental breakdown in front of Alex. Mark asks Alex to help her but he refuses and walks away. He returns to being very promiscuous and refuses to have the bullet from his chest removed, saying that it's "his war wound." After insulting Lexie, she cuts him down to size, stating that he is not "badass" for living because she is 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 in Season 7 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 a equal enthusiasm for college basketball, she liked him slightly more. Eventually they began a romantic and sexual relationship. Arizona offers Alex the proposal to go to Africa to tend to and check up on the patients that visited and recieved medical attention at Seattle Grace. Lucy is disappointed because as Alex is considering this opportunity, he doesn't even think about Lucy. She shakes it off by saying it doesn't matter what she thinks. Arizona approaches Alex and asks him if he isn't taking the job because of Lucy, as she doesn't want him to do the same thing she did and run back to Lucy once in Africa. Alex tells Lucy he's not taking the job in Africa because she's "a factor." She tells him to stop and says he was right when he said career comes first. She tells him she took the job -- not at Baylor, but Alex's in Africa. She assures him it wasn't personal.

Season Nine Interns
In the beginning of season nine, Alex is known as a "player" amongst the new interns and also as the attending who sleeps around with all of the interns.

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.

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, 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 doctor 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.

Alex passed his Oral Boards and is now a board certified surgeon and Peds fellow at Seattle Grace Mercy West Hospital after turning down a fellowship at John Hopkins for fear of boarding an airplane.

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 that he hasn't seen since she was 10, Amber is now 17 and is about to graduate from High School.
 * 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.
 * 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.