Alex Karev

"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."

- Alex Karev

Alex Karev is the former Head of Pediatric Surgery at Grey Sloan Memorial Hospital. Alex was married Izzie Stevens and is now married to Jo Karev.

Early Life
When Alex was seven, he had to start cleaning up his drunk and drug addict father. At that point, he became the adult of the family as his mother was schizophrenic. Alex described himself as being "raised in a bar" and that his father never took him to the park or camping.

After Alex's father left he took care of his mother and his siblings. Alex 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 also admitted his mother into a psychiatric facility at one point. When he was 12, he stole a car.

Alex lost his virginity to a school nurse when he was 15.

He missed his high school prom because his father came home and was drunk and started to break things at the house, so Alex stayed home with him. He had a prom date whom he liked and even got her a bracelet, but he never talked to her again because he felt that he stood her up and thought she wouldn't want to talk to him again.

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

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

He attended college at University of Iowa, where he wrestled.

Starting Internship at SGH
Alex started his internship at the same day Meredith, George, Cristina, and Izzie did. He was at first assigned to a different resident, named Jeremy, than the other four. On his first day, Meredith saved one of his patients from a post-op complication in front of the chief after Alex dismissed the nurse and Meredith several times. He joined Miranda Bailey's service later, after his first resident gave him up for unknown reasons. He didn't get along with his colleagues due to his work attitude. For example, he would only pick the good and interesting cases and steal them from his colleagues. After a few weeks, the other interns learned of his softer, more understanding side and they became friends. Izzie took a particular liking to him and was first to notice the other, nicer side of him.

In the beginning, he told everyone that his dream specialty was plastic surgery, but after he got to know the specialty closer, Alex discovered that it wasn't for him. He wanted to go into plastics because most of the time the patients there willingly chose their pain. After a longer stint with Addison Forbes Montgomery, Alex discovered that he liked to work with infants and began to develop a keen interest in neonatal surgery.

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 construct. 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 pregnant (which was investigated by Izzie and turned out to be false). A bit later, under pressure from Izzie, Ava revealed the truth to Alex. Before she came back to Seattle, Ava had developed a borderline personality disorder. A part of this disorder was that she had forgotten that she already had a baby. Alex took care of her during her second stint in Seattle, but he couldn't prevent Ava's suicide attempt. Alex found her in Meredith's kitchen and took her to the ER, where she was treated by Izzie. Izzie pressured Alex to get her admitted to the psych ward. At first, Alex wouldn't allow that and told Izzie that she was "only going through a bad patch", and that he could take care of her. After a long talk with Izzie, Alex admitted that Ava needed help and that he couldn't give it to her.

Relationship with Izzie
Alex and Izzie had a rocky start to their relationship. In the beginning, Izzie disliked him as he was arrogant and cocky. He even plastered her modeling photos around the hospital to humiliate her. Izzie eventually saw the softer side of him and they had an on and off relationship. Alex and Izzie got married after a tumor was removed from her brain, but a second one was found by Dr. Shepherd. Izzie made a treatment error that endangered the life of a patient, and she ended up getting fired from the Surgical Program. She believed that her getting fired was partially Alex's fault, so she wrote him a Dear John letter and left Seattle. Then, she returned and attempted to get back together with Alex, but he refused because of the fact that she had left him, and they ultimately got divorced.

Shooting and Aftermath
Alex got shot in the lower chest by Gary Clark upon discovering him standing over Reed's body. After Gary had walked off, Alex dragged himself onto an elevator and got discovered by Mark and Lexie. They took him to an empty conference room and put in a chest tube. Alex thought he was dying and advised Mark to have more sex and eat more bacon. Lexie professed her love for him as he received a blood transfusion, but Alex mistook her for Izzie. He told her he was happy that she came back for him and asked her not to leave him again. Soon after, they were evacuated by a SWAT member and transported to Seattle Pres, where Teddy operated on him.

African Project
Alex and his fellow fourth year residents began the race for the position of 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 a 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 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 Johns Hopkins.

Betraying Meredith
When Meredith was working on Derek's Alzheimer's trial, Alex spotted her walking down the hall with a trial packet under her lab coat. She convinced him not to rat her out for a while, saying "Nothing I did changes anything." However, the race for chief resident was on and when Meredith became a top contestant, Alex told Hunt what he saw her do while drinking at Joe's. Meredith retaliated by kicking Alex out of her house, despite his many apologies. When Richard found out that she switched the packets so Adele would receive the active ingredient, he decided to take the fall for her and Meredith was able to keep her job and she eventually forgave Alex.

Fellowship
When the residents first began applying for fellowships, Alex was concerned because the interviews Robbins lined up were all at second rate hospitals. However, he soon discovered that Robbins was only doing this to convince him to stay at Seattle Grace Mercy West, and began to get calls from the country's top hospitals. He verbally committed to staying at Seattle Grace Mercy West and being Arizona's fellow. However, after Johns Hopkins Hospital created a fellowship spot just for him, he decided to take that spot, angering Arizona and leading her to take his spot on the plane that ultimately crashed. His guilt over her replacing him led him to agree to stay in Seattle while she recovered, even amputating her leg himself when the time came. After delaying his move to Johns Hopkins for months, he eventually decided to stay in Seattle and take Arizona's fellowship.

Beginning Relationship with Jo and Father Issues
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 introduces the non fraternization policy, 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.

Alex didn't have an easy relationship with his father, James Evans. James abused Alex, his mother, and his siblings when they were young. James struggled all his life with a drug and alcohol addiction. At age 15, Alex stood up to his father, beat him up, and threw him out of the house. Alex later admitted to a patient that he had gone too far.

Years later, Alex met his father again at Grey Sloan Memorial Hospital after James was admitted to the ER. James and two of his friends were in a car crash and they were obviously on some drugs. It is later confirmed that the drug of his choice is heroin. After Alex recognized his father, he couldn't find the courage to speak with him in the hospital. After James was discharged, Alex tracked him down in a bar, but still couldn't find the courage to talk to him. Alex visited the bar the night after his initial visit and after a few drinks, he got into a fight with his father once again. After that fight, James recognized Alex as his son. He said he recognized Alex because of his angry eyes, which were the same when Alex was 15. After that incident, Alex left James for good. A while later, James came back to the hospital after quitting the drugs cold turkey. He said to Jo that he wanted to get clean for his family. At first, Alex declined to help him. After a while and a little push from Jo, Alex made up his mind and at least tried to help and talk to his dad.

After Shane froze while operating on James's heart, Alex was angry at Shane and tried to make his dad happy. He even went so far to lie to James's second ex-wife to get her to visit James. When James died, Alex was relieved and sad at the same time. Shane tried to apologize to Alex, but he was still angry at him and Alex beat him up in front of Meredith, Cristina, and Jo. Alex only stopped because Meredith held him back.

Leaving GSM Temporarily
Alex left GSM temporarily to join a private practice with Oliver Lebackes for the purpose of making enough money to pay off his medical school debts. When Pierce accidentally revealed in the OR that Alex was looking for a spot on the board, Lebackes fired him on the spot. Even though he didn't get the spot, GSM hired him back as an attending peds surgeon.

Assault and Suspension
When surgical intern Andrew DeLuca was helping Jo get into bed after a night of drinking, Alex walked in and saw Andrew on top of her. Assuming that Andrew was sexually assaulting her, Alex violently physically assaulted Andrew, leading to the former temporarily injuring his hand and the latter sustaining several critical injuries. When Meredith figured out that Alex was the one who had caused the damage to Andrew, she promised not to tell anyone, even going to the extent to lie to her colleagues about Alex's guilt.

When Andrew decided to press charges, Alex and his attorney thought it was for a misdemeanor, but quickly learned that the state had upped the charge to felony assault. Alex pled not guilty, When Bailey found out that one of her attending pediatric surgeons was charged with a felony, she was forced to suspend him from the surgical staff and offered him a position in the Denny Duquette Memorial Clinic, which he accepted. While working in the clinic, he had to get surgical consults, as he did not have surgical privileges. This, as well as being supervised by a nurse, led to Alex being quite frustrated with his temporary assignment.

The day before the trial, Alex talked to Meredith and Maggie about how it was his "last day on earth," and how they needed to drink that evening, despite Meredith's assurance that the trial would go well. After learning that Jo was married, which she was worried about being discovered during the trial, Alex decided to take the plea deal, which involved him serving two years.

Alex went to the District Attorney's office to take the plea deal, but Andrew unexpectedly walked in and tried to drop all charges against Alex. When he was told that since the case belonged to the state, he could not do that, he threatened to sabotage the case, which the attorney said was "a slam dunk." Andrew walked out before Alex could understand why he decided to drop the charges. The two eventually had a conversation outside of the hospital in which Andrew says that he did it to protect Jo, and expressed frustration that Alex never apologized when he had the chance. After a meeting, Bailey offered to reinstate Alex with full surgical privileges once she received the papers showing that the charges had been dropped.

Finding Jo's Husband and Reconciliation
Alex tracked down Jo's husband, Paul Stadler, and spied on him at a medical conference. He told Meredith that he planned to confront Paul, but never actually spoke to him. He later revealed to Jo that he saw Paul but didn't act violently towards him like Jo thought he would. Alex and Jo then got back together after Jo realized that she could trust him. Soon after, she invited him to move back into the loft by holding up a sign reading "Homecoming?", a move inspired by a shared patient.

Jo found herself hesitant to be included in an article about Meredith's surgery, as it showcased how much control her husband still had over her. When presented with the opportunity to become Chief Resident, she decided she was done hiding and filed for divorce from Paul. On her first day as Chief Resident, Jo was shocked when Paul showed up at the hospital with the divorce papers. Meredith stepped in and told Alex to stay away from Paul as he wanted to beat the guy up, so she helped Jo handle the divorce. The next day, Paul was brought in after a hit-and-run, which Meredith incorrectly first suspected was Alex and Jo's doing. Alex stayed clear of Paul's room per Meredith's instructions, but he stood by Jo as she was left with the decision about what to do with Paul after he slipped in an act of aggression towards Jo and his new fiancée Jenny and was declared brain dead. She chose to donate his organs and was overwhelmed with relief to finally be free.

Marriage to Jo
Alex came home and Jo was waiting for him. Jo started to say that she never fit in anywhere and that's why she always ran. She continued to say that maybe she ran from anyone who ever loved her. Alex paused her and started to look for the ring. He couldn't find it because Jo was already wearing it. Jo knelt down in front of Alex and said she didn't want to go anywhere without him and he is her home. She asked if he wanted to marry her. He said yes.

After months of being engaged, Alex and Jo arrived at the big day. However, everything that could go wrong, did. While the wedding was delayed by people going to the wrong address and minister being late, Alex and Jo snuck off to have sex in a shed and got locked in. When they were finally saved by Meredith and Andrew, they returned to the wedding site to find their wedding planner having a serious allergic reaction. The final straw was when Levi Schmitt fainted at the sight of blood and knocked over the wedding cake. Alex and Jo decided to get married at sea on a ferryboat, with their ceremony being officiated by Meredith.

Interim Chief of Surgery
While on their honeymoon in Los Angeles, Jo talked about an article she had read on cancer cells. It felt new to her, while Boston didn't. Alex said he wouldn't mind for their kids to grow up in Boston. Jo then said she had a thought and ran off from the beach. Thinking he had talked about kids too fast, he found her at a beach bar and apologized. She told him at wasn't about the kids. She had an idea and she needed to focus, so she asked him to shut up while she was writing things down on a napkin. The bartender treated Alex to a beer on the house. Jo retreated back to their hotel room, while Alex spent the day enjoying himself outside. When he came back, Jo presented him with her idea to design cancer killer cells by introducing suicide genes in the cancer cell DNA. She feared he hated her for ruining her the honeymoon, but he was just delighted that she agreed to marry him and commented that their kids would be very smart.

They returned to Seattle the next day and they talked to Meredith about creating a surgical innovation fellowship just for Jo. Meredith took the idea to Bailey, who told her there was no room on the budget unless she did not re-hire Alex, as they had just spent a lot of money on the hyperbaric medicine lab. Meredith then told Jo to go to Boston and come back when they found the money, but Jo had already turned Boston down by that point. Both out of a job, they went to Joe's for day drinking. Jo revealed she had only applied for Boston because she could, but she did not really want to move there as it felt like going backwards. Jo then decided to go back to Bailey and explain why she was the future of medicine. The meeting was very productive for the couple. Bailey decided to fund the fellowship with her own money and appointed Alex interim Chief of Surgery, as she herself needed a sabbatical. Meredith was not happy about the move but Alex told her she still got him around this way and that it was time for Jo to move on to her own stuff. Alex was thrown in the deep end of the pool on his first day as Chief. He signed off on Link's project to 3-D print prosthetics for kids. Alex feared that Bailey only picked him because he would never live up to her, so that she would be welcomed back with open arms after her sabbatical, but she told him that she did trust him to do the job. However, he messed up the OR board, missed appointments with his peds patients, and later butted heads with Richard when he wouldn't stop berating a supposedly drunk patient. He found some comfort with Meredith, who told him that every Chief always feel like they're pissing people off and doing a poor job. At the end of the day, Alex fired Vik when he lost a patient due to not taking his nosebleed seriously and did not take responsibility for it. Bailey checked on his work and found that he had spent the entire quarter's budget in one day. Jo left them to talk so they could correct his mistake.

Alex hated the job because everyone kept asking for stuff, including his wife. He froze some funding he had approved earlier, including Link's project. Alex got himself a case of a young man with a pulmonary bleb, but the man refused surgery because his insurance wouldn't cover it. Alex paged Richard for advice, but he refused to do Alex's job for him. He only told him being Chief is finding creative ways to get out of corners you've been backed into. Alex wanted to quit, but Richard told him you only quit when you've tried something to the best of your abilities, otherwise it's just failing. Alex then get creative and made a small cut in the patient's chest so that the surgery would qualify as a trauma surgery. Richard yelled at him, but Alex told him about the time when he was 12 and he stole his neighbor's car to drive his sister, who was spiking a fever, to the hospital. Like Alex had hoped, the patient was happy to have his bleb removed and wouldn't report it. Alex was delighted to have found his groove as Chief. While heading home, Alex and Jo ran into Link, who apparently knew Jo from her past life as Brooke.

Alex found out that Link and Jo had worked together waiting tables and that he was like a brother to her, but Alex gave him the cold shoulder while they working together on Rafi Elshami. Link noticed his threatening and dismissive demeanor and assured him that he and Jo had not been involved romantically. Alex then revealed that his problem was that Link had not protected her from Paul like a good brother would have. Link said he tried to tell her that he did not like Paul, but then Paul grew jealous and made Jo back away. He thought he was being respectful in honoring the distance, but he would not have if he had known that Paul was abusing her. Alex then warmed up to him. While he was catching up on paperwork after the surgery, Jo came by and he told her that Link was a great guy. He and Jo then started doing honeymoon things in the office.

Jo started helping Alex out a bit at work because the workload made him grumpy all the time. Jo and Bailey revived a liver with a perfusion system, but Alex ordered them to shut it down because it could risk their standing with UNOS. He later operated with Meredith on Flor Medina and they discussed Meredith's father's impending death from AML. He advised her to go see him, because he found it had been good for him to be able to say goodbye to his own father. After the surgery, he found out that Jo and Bailey had gone against his orders and were performing a transplant with the revived liver. While angry at first, the transplant worked, so he then took Jo into his office and admitted to being turned on by her genius. They closed the blinds in his office when they wer spotted kissing by nurse Frankie. That night, they invited Link to the loft so Jo could properly cut his hair and Meredith came over, too, when she found herself in need of company. She took over from Jo and Alex and Jo agreed that Meredith and Link looked good together.

When nurse Frankie got in distress, Alex found that the entire nursing staff was worried about her and assisted Richard in surgery. Alex delivered the baby and took care of him himself so as to provide the best possible care. Alex himself had to call time on death on Frankie as Richard wouldn't give up. Her baby survived and was watched closely by a group of nurses.

Alex and Jo overslept on the day that a wind storm hit Seattle. They jumped out of bed to leave for work, but found that the storm made it unsafe to leave their house. Alex then had Bailey cover him. He found out how understaffed the hospital was, making him feel like a crappy leader. To cheer him up, Jo decided they could have a second honeymoon while staying in. Alex struggled to get reception so he had a hard time staying up to date with business at the hospital. He and Jo discovered neither of them had mailed in their marriage license, meaning their marriage wasn't official yet. They then went through all their wedding gifts. April had registered for them so they ended up with a bunch of stuff they didn't need. They agreed to return most of it and buy a bigger television with the money they'd get back. They then resorted to drink beer out of fancy glasses and making out.

As soon as he heard the bridge had been re-opened, Alex left for work. He caught Levi and Nico getting dressed after sex in an ambulance and was ordered by Bailey to step in for her in harvesting Phoebe Moss' organs so she could go take care of the hospital. He later confronted her about the way she had spoken to him. Bailey admitted that she was in crisis back then and didn't trust herself to finish the surgery. She told him she still needed more time to work on herself and asked him not to quit. He agreed not to and help her out in any way she needed. He later called out Nico and Levi for what they did and directed them to rooms with doors that lock.

Alex settled in the Chief job and got the hang of it. When Teddy was looking for a job, Bailey referred her to Alex, who made her audition for Maggie. Jo had been treating Natasha Deon all day and thanked Alex for being alive and having married her. Alex heard about Andrew stepping up and performing a solo surgery when Owen was accidentally paralyzed in the OR and congratulated him on pulling it off. With the holidays approaching, Alex chose to gift everyone on staff a ham. He and Jo organized a navy blue scrubs only NYE party at their loft. The two of them handed out beers before the countdown and kissed at midnight. At work, Alex came up with an idea to give Natasha and Garrett Boland the wedding under the stars they had always wanted. Meredith officiated with all doctors holding up their phones with images of stars on display.

As Chief, Alex decided to initiate a weekly free breakfast for the interns in the cafeteria. At the same time, a gallery with pictures of all past and present Chiefs was installed there. Jo made him pose next to his photo and sent a picture to Helen Karev to show her how far her son had come. Bailey found herself bugged by Alex's picture on there and reminded him of the time he wanted to step down but she still needed time. Now, she felt ready to return. However, Alex told her he had gotten good at the job and that he wanted to keep the job till the end of the six-month contract they had agreed to. Begrudgingly, she told him she was proud of him for standing up for himself.

While Meredith was breaking her longest surgery record, Alex had to navigate a flood of overdose patients. He and Jo treated a woman who lost her kid in the chaos at the park where the overdoses originated, only to later discover that she had taken her kid to the park so she could score some drugs. Reminding him of the time his father left him in a parking lot when he was six, Alex had a strong reaction to the situation and told the kid's father to do whatever he needed to to protect his son, even if it meant keeping him away from his mother. Jo later brought Alex a cup of hot chocolate to comfort him and he told her he loved her. On the day of Catherine's party, Meredith told Alex about her and Andrew dating. After mocking her a bit, as a friend, he was happy for her, and as Chief, he told her to inform HR. He then got ready to leave. Taryn came in to tell him that "Mrs. Karev" wanted to see it. He thought she was talking about Jo and told her to tell Jo to meet him at the party. Alex was the first to arrive at the party and indulged in appetizers and ping-pong while mocking Jackson about his ridiculously huge and luxurious penthouse. Having ignored his phone, Alex was surprised when Jo showed up at the party with his mother, who claimed she just came by for a visit. While he and Jo discussed their suspicion of a psychotic break and planned to her back to their loft, Helen disappeared into the crowd. They eventually found her and Helen showed Alex a bag of scarfs she had knitted as a wedding present. He picked the green one as it was his favorite color as a child. He then tried to reach his mom's doctor, but he couldn't reach them. He hated that a mere visit could be a sign of a split from reality. Now that she was doing fine, he didn't know what the warning signs were anymore, unlike in his childhood. He and Jo watched Helen knit and decided to wait until tomorrow to find out what was going on. He later went to tell her that her visit threw him, but it meant a lot to him. Helen was the first to detect the smell of smoke. Alex thought it was another sign and tried to keep her calm while she urged everyone to get out, disturbing the celebratory toast. However, she turned out to be right and they evacuated the penthouse with the other characters. Out on the street, Alex introduced his mother to Meredith, who confirmed she and Alex were each other's best friend. Alex and Jo then took Helen home and helped her get settled on their couch. Despite her being right about the fire, they still were not convinced she was okay. Jo and Alex took Helen with them to the hospital to show her around. She had been knitting baby hats ever since Alex told her they wanted kids. Before heading into back-to-back meetings, he asked Bailey to cover the ER. She commented she was counting down the 22 days before she could stop taking orders from him. His first meeting was with Vincenzo DeLuca, Andrew, and Carina. Vincenzo wanted to start research about gestational sacks. Seeing potential, Alex asked for two days to consider, although he was inclined to say. However, Meredith warned him to dig into Vincenzo's past, though she kept his mental illness a secret so as to not break Andrew's trust.

Alex took Helen to a park for lunch. He hated that he didn't come up with Vincenzo's idea of his own. They talked about his childhood. As a 6-year-old, he once asked her what the inside of a doorknob looked like. She took one apart to show and he wouldn't let her put it back together until he one day did it himself. So, she thought he would be an engineer. He said he was more of a fixer than an innovator, but she disagreed. She had always been in awe of his brain. Alex then brought up the baby hats that freaked out Jo. Helen says she only meant to give Jo a little nudge. Carina eventually informed Alex about her father's mental illness. He didn't want to say no because of that given his experience with his mother, so he approved to provide funding for the research. Later, Jo told him she freaked out not because of him but because she didn't know anything about her genome and her biological parents' medical history, so she decided to have her genome examined.

While Alex was hopeful about the DeLuca research, Bailey thought he had stared a moral slippery slope that she would have to handle soon. When a lamb died in one of the sacks, Carina thought it best to remove her father, who downplayed the death, from the research as it as too important to let it be screwed up by him, but Andrew disagreed. After a talk with Helen, Bailey came to tell Alex that Helen had been sticking around longer than planned because she was too scared to go home by herself and she didn't dare to ask for help. Teddy then paged Alex to tell him Vincenzo had pitched his research to help out a pregnant couple at risk of losing their baby. Alex, Carina, and Teddy had to deliver the news to the hopeful parents that they could not approve that procedure on humans yet and instead had to deliver the baby while doing the hysterectomy so it could pass away in its father's arms. Alex then called the DeLucas into his office and told them Vincenzo's major breach of protocol and reckless behavior had convinced him to stop the research. Furious, Vincenzo took his research back to Italy. While attending a fish fry hosted by Richard on the roof, Alex asked Bailey to cover for him while he flew back to Iowa with his mother. He and Helen said goodbye to Jo and left for the airport.

Jo's Depression and Treating Gus Carter
Jo decided to seek out her biological family in Pittsburgh. Once she got there, she stopped answering his calls, worrying him. He spent the day working with Andrew, who was shutting Meredith out ever since the failed research project with his father. They were to perform a total pancreatectomy. Andrew thought Meredith had asked Alex to put him on the case to cheer him up and said he didn't need any favors. The patient, Nora Hillridge, was sabotaging her own surgery by drinking juice to increase her glycemia so that she could stay in the hospital and wouldn't have to go back to school. The doctors found out and Andrew went a bit overboard in his attempts to convince Nora's mother to make her daughter get the surgery. Alex then threw Andrew off the case, but Andrew went to talk to Nora behind his back and convinced her to consent to the surgery by talking about how he overcame being bullied. Alex then performed the surgery behind Andrew's back to punish him for not obeying his orders. Andrew later confronted him about that move and Alex told him that he was letting the stuff with his father interfere with his job and relationship. He told Andrew not to bite people's hand when they reach out because then they stop reaching out. Alex then went home and found Jo in bed. He told her he missed her and got ready for bed, not noticing in the dark that she was crying and only pretending to be asleep.

She didn't talk to him about what had happened and started to avoid him, leaving for work while he was in the shower. It was his last day of Chief and he confronted her about not telling him what happened, but she gave some vague answer about needing Bailey for a fellowship grant and left. At the end of the day, he asked her to go out to celebrate his no longer being Chief, but she wanted to crawl into bed after the rough day she had. He wanted to join, but she needed to be alone and told him to go celebrate with Meredith. He once again told her she could tell him anything as he wouldn't judge given his own family history. She firmly stated she did not want and could not talk about it. She then went home by herself.

For a week, Jo pretended to be sick and did not go back to work. He knew she was lying, but she continued to completely shut him out and lie in bed all day. He went to work in a suit, something he had grown to like as Chief. Bailey paged him to ask about the compliance reports due tomorrow, but he had no idea what she was talking about. Alex took the case of Gus Carter, a kid with autism that the doctors had to communicate with through LEGO blocks. Alex then reached out to Link to find out if he knew anything, but Link didn't even know she had looked up her birth mother. Alex then asked him to go over to his loft and distract her. The doctors diagnosed Gus with a thymoma, which was compromising his immune system, but they couldn't operate until they had transfused him to cure his anemia. However, the transfusion went badly and they discovered he had the extremely rare Rh0 blood type, meaning he could only receive blood from the exact same type. That meant that they had to put off the surgery until they found a match. Alex then received a text from Link. He rushed to the loft and found Jo laughing hysterically at a cartoon. Alex thought she was doing better, but Link told her she was in a rough shape, unlike anything he'd ever seen before. He was sure she needed help, but he did not know how to do that.

Alex managed to get Jo to agree to come back to work. He urged all of his colleagues not to make a big deal out of it. Meredith found him and told him she tried with Cristina Yang and Marie Cerone if they could help out for Gus's blood, but to no avail. Alex then told her Jo still wasn't talking. He was afraid Jo had finally broken and would leave him, like all his previous lovers had done. Meredith assured him that she wouldn't. She just wasn't ready to talk yet. Later, he heard she came to work drunk and confronted her about it at home. Angrily, he told her he was done being told to leave her alone if he loved her and he threatened to go to Pittsburgh himself to find out what had happened. She told him she would talk when she was ready to and that she'd leave him if he threatened to go Pittsburgh ever again. They then made a deal that he would report her to Bailey if she came to work drunk again, so she promised she wouldn't.

Jo was assigned to monitor Gus while Alex and Meredith took on the case of Gabriella Rivera, a kid with an obstruction that required surgery. Gabriella's father was an immigrant cleaning offices for a living and he made too much money to qualify for state coverage for the surgery, which was too expensive for Luis to pay. Meredith then put Ellis's name down on the paperwork. Before they headed into surgery, Jo found Alex and told him she had found a donor for Gus. He called her a good luck charm and gave her instructions to prepare Gus for surgery. After Gabriella's surgery, during which they found cancer, Alex found Jo sobbing in Lori Carter's arms. Alex took Jo away and found out she had mistaken a phone call from someone calling to see if Gus could donate blood as someone responding to their needing a donor. Alex met with Bailey in her office and vented his despair over the situation, not knowing what to do with Jo.

Alex then made arrangements with Meredith so that she could stay at the loft to get through to Jo while he helped out Amelia and Maggie with her kids. They finally found a donor for Gus from London. Alex sent Levi to go pick up the donor, who was severely agoraphobic, at the airport. However, when her therapist was arrested by customs for a problem with his visa, Frances Pinfield fled back onto the plane and refused to leave. Alex then sent Owen to help Levi out. Gus's parents grew frustrated while waiting. In between, Alex checked in on Gabby, who was doing well and spending time Andrew. Soon after, Gus had a heart attack and they managed to pull him through, but the need for transfusion only increased. While in the room, Owen FaceTimed Alex so Frances could meet Gus and his parents to convince her to get off the plane. That worked, but the car got stuck on the highway due to fog covering the city. With Gus's number rapidly worsening to the point of impending organ failure, Alex decided to took Gus to the hyperbaric chamber to guarantee maximum oxygen. Meredith, having reached a breakthrough with Jo, joined him in the chamber so they could talk. Meredith told him that Jo was the product of rape and that she had been told she looked just like her father, which sent her into a depression. Meredith had convinced her to get a proper leave of absence so she could ge the help she needed. The news made Alex think about the day she left for Pittsburgh. He was worried about what she'd find, but she told him that the worst that could happen was that her mother did not want to see her and then she'd just come home to him and at least she'd know. He thought he should have stopped her, but Meredith told him he couldn't have. She also told him he had tried to help her as best as he could, but she needed professional help. While in there, they were informed that the insurance company had found out about Meredith's insurance freud and that Andrew was taking the fall for her. Meredith couldn't stop him since she was stuck in the chamber, where Gus started coding again. Alex started CPR and started to lose it, saying Jo had disappeared and now Meredith would be going to jail, leaving him all alone. Meredith told him he wasn't alone yet and took over. They pulled Gus through and Jo arrived with the blood right when the chamber was decompressed. While Meredith took Gus away, Jo finally told Alex that she was not okay. She knew how to rise when she had to, but she needed help. Alex promised her they would figure it out. Richard then came to get Alex for Meredith's problems. The two of them went to back her in the meeting with Bailey and Catherine, which led to all three of them being fired by Bailey. Afterwards, Alex went to make sure Gus was fine, and then took Jo to the in-patient psychiatry ward. He said goodbye to her with a kiss and watched her check herself in. Bailey stood by him and as they left, he asked if he was really fired. She said it hurt her more than it did him.

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.

He hides his pain behind a mask of aggression and bad attitude. For a while, he pushed everyone away, but since going into peds, he's showed more of who he really is. After Cristina left, he acted as Meredith's person, which shows a different side of his personality, which shows him as sweet, caring, and compassionate.

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 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, 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. 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 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 manage 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.

Over time, he started dating other girls and his love for Izzie faded. A couple of years after Izzie's departure, Alex entered a committed relationship with Jo Wilson. When a patient showed up that reminded Alex of Izzie, Jo told him to call Izzie to find out how she was doing. He stated he didn't need to, as he had made up a new life for lzzie in his head, in which she was married and working as a surgeon. He preferred not to call her and instead held onto that imagined life for her, in which she's always smiling as she's as happy with her husband as Alex is with Jo.

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. It was his work with her that led Alex to no longer pursue plastic surgery as a specialty but spark an interest in pediatric surgery.

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 psychiatric 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.

Callie Torres
Alex and Callie slept together after a big surgery involving reconstruction of a man's legs was successful. No one knew at the time, but the relationship was later revealed when Callie gave her speech on Lecture Day.

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 Karev
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 an OB/GYN resident, Jason Myers. Jo and Alex began to separate as she and Jason became a couple and Alex tried to avoid his feelings for her. After Alex told Jason about Jo's past, Jo yelled at Alex and told him that she shouldn't have trusted him. Alex admitted his love for her to Cristina not long after that.

The two avoided each other almost entirely after their fight. One night, Alex witnesses Jo and Jason fighting. Not long after, she shows up at his doorstep and he begins to argue with her for being unavoidable. She turns her face toward him and it's clear that she has been hit by Jason. Alex takes her up to his bed and tucks her in.

During the superstorm, 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. At April's wedding, Alex proposed to Jo, without actually saying that he wanted to marry her. When Jo realized that he proposed to her, she declined. However, they stayed together. Although Jo didn't accept Alex's proposal, he still knows that he will eventually marry her.

Alex proposed to Jo for the second time two years later. At the same time, Jo was trying to dump Alex for spending too much time with Meredith. Alex asked Meredith to keep Jo's ring until the day he would propose to her. Jo unfortunately didn't know that Meredith was only trying to pass Jo's ring to Alex without her seeing.

After Jo not answering the proposal, they broke up and after spending some time apart, they got back together. The unanswered proposal caused some strain on their relationship. She eventually told Alex that she didn't want the ring yet, but she also didn't want it gone and that he should keep in in the drawer.

After a few months, Alex asked Jo if they would ever get married. He said it didn't have to be today or tomorrow but he wanted to know that it would happen. She said she couldn't, but Alex was adamant that she could. She said no.

They fought. She said she loved him and that they should make a baby, but he wanted to get married. He wanted to know why and as she went to tell him, he cut her off and stormed out. Later, she told Andrew the reason why she couldn't marry Alex was because she was already married to an abusive man and feared if she filed for divorce, he would find her. Alex didn't know this because she worried about him going after her abusive ex. Alex walked into the loft and found Jo giggling while half-naked and DeLuca on top of her in bed. He jumped to the wrong conclusion and began to punch him.

After Alex told Jo that he'd found her husband and gone to see him, Jo locked the door and started kissing him, surprised that he'd seen her husband without killing him, which proved to her that Alex wasn't a violent guy. They got back together and eventually got engaged. Their wedding ceremony was held on a ferryboat and was officiated by Meredith.

Meredith Grey
Initially, Meredith disliked Alex. Meredith thought that Alex was a bad person, who just had sex with everyone in the hospital. 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. He apologized to Meredith lots of times but she refused to forgive him at first. When Cristina Yang got Alex to get up and help Meredith to keep Zola, after yelling at him, he replied with, "I don't have anyone! You guys are all I have! You're supposed to have my back! You have to forgive me!" 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.

Meredith even went so far to help Alex come up with a lie to tell the police since his hand was bruised from attacking Andrew DeLuca, and she helped him calm down.

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 as they have a brother/sister relationship.

With Cristina's departure, Alex has become Meredith's new "person".

Cristina Yang
Cristina and Alex have a love-hate relationship as they often make fun of each other but no matter what Alex, Cristina, and Meredith are there for each other. They are from the same intern class, so naturally, they are close as they have spent so many years together.

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

Cristina told Alex on her last day in Seattle that she was surprised by how good he became as a surgeon. This was one of the very few compliments Alex has ever gotten from her. She also told Meredith that Alex needs to be mocked at least once a day or he'll be insufferable.

After Cristina left Seattle for Zürich, Alex found an envelope in his bed that informed him that Cristina had left her shares of the hospital to him.

Morgan Peterson
Morgan was a surgical intern at Seattle Grace Mercy West. She was Alex's intern and was helping him study to 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 anyway. 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.

Professional
During his intern year, Alex notably had a reputation for getting on the bad side of his attendings and other staff. and laissez-faire in dealing with patients, earning him the reprimand of Chief Webber. Dr. Shepherd once kicked him out of the O.R. for asking if their critically ill patient who had to be taken back for surgery could count as his second surgery and Dr. Hunt called him out several times for his lack of bedside manners.

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 Johns 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.

Arizona also supported his decision to work for Oliver Lebackes and helped him after he ran into problems there.

Mark Sloan
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. 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.

During the shooting, Mark, along with the help of Lexie, saved Alex’s life after he was shot.

Career
Alex Karev is a former wrestler at University of Iowa, and attended college 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 that 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, Head 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 a board certified surgeon in general surgery and completed a pediatric surgical fellowship at Grey Sloan Memorial Hospital after turning down a fellowship at Johns Hopkins. He then joined Lebackes Pediatric Surgery Clinic, a private practice, as a new partner under practice director Dr. Oliver Lebackes.

When Cristina transferred her hospital shares to Alex, he considered sitting on the board of Grey Sloan Memorial Hospital. Unfortunately, the board unanimously voted for Bailey to take Cristina's seat, but hired Alex as an attending pediatric surgeon, especially as Arizona needed to focus on her new fellowship in fetal surgery.

Sometime after Robbins was promoted to the head of fetal surgery and Bailey was promoted to Chief of Surgery, Alex was promoted to Robbins' old position as department head of pediatric surgery. Alex was then temporarily demoted to staff physician at the Denny Duquette Memorial Clinic when he was suspended. When his charges were dropped sometime later, Bailey reinstated Alex back to the surgical staff as the pediatric surgery head.

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 to include him.
 * His uncle is a rodeo clown.
 * When discussing medical proxies, Alex told Cristina she could be his proxy. However, it's unknown if steps were taken to legally affirm this.
 * Alex is the emergency contact for Meredith Grey.
 * His favorite dessert is banana cream pie.
 * He believes the marshmallows are the best part of Lucky Charms.
 * Alex doesn't have any visible tattoos, as Justin Chambers' tattoos are concealed in shirtless scenes or hidden by clothing otherwise.
 * He drives a black and white Chevrolet Camaro SS as seen in Goodbye.
 * Alex is the only one of the 5 original interns and remaining residents of his class to have gone into private practice, albeit briefly, after their training was complete.
 * Alex gives blood every two months.
 * He used to laugh in his sleep.
 * He used to braid Amber's hair when she was younger.
 * Alex wrote an essay explaining that he got bad grades in medical school due to testicular cancer. He even claimed he lost a testicle which turned out to be false.
 * Alex wears a personalized scrub cap that is a mix of silver and brown seemingly stylized in a marble-wood fashion.
 * Alex has had sex with doctors in all stages of education: a medical student (Laurel Pinson), several interns (such as Leah Murphy and Heather Brooks), several residents (such as Izzie Stevens and Jo Wilson), a fellow (Lucy Fields), and an attending (Addison Montgomery).
 * Alex was promoted off-screen to the head of pediatric surgery sometime after Walking Tall as he does not mention himself as a department head when Amelia, Maggie, Callie, Arizona, and Owen were pointed out as heads of their respective departments.
 * Alex was confirmed as the department head of pediatric surgery in the show's dialogue only after he was suspended and pending conviction. During Jukebox Hero, Minnick told Robbins and Murphy, "Apparently we need to hire a new peds surgery chief, since ours went up the river."
 * He hates ties.
 * His favorite type of donut is powdered sugar.

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
 * It's a Long Way Back
 * The Face of Change
 * Map of You
 * Man on the Moon
 * Get Up, Stand Up
 * I Choose You
 * Undo
 * Catastrophe and the Cure
 * Old Scars, Future Hearts
 * Fight For Your Mind
 * All of Me

Memorable Quotes

 * Izzie: I don't know what you're so mad about, and I don't know what you're scared of because you won't talk to me. But I'm scared too, Alex and I-I can't... If you won't... If we're gonna have any chance at a life together, then I need you to... please.
 * Alex: You died in my arms. You died in my arms. You freakin' died and then you left instructions that I wasn't allowed to save your life. You want to know what I'm scared of? I'm scared of everything! I'm scared to move! I'm scared to breathe! I'm scared to touch you! I can't lose you, I won't survive. And that's your fault. You made me love you, you made me let you in, and then you freakin' die in my arms!


 * 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.


 * 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.


 * 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.


 * 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?


 * Alex (to Mark): You gotta eat more bacon, have more sex.


 * Alex: You just don't give up. It's lame. You're not a quitter. That's not who you are.


 * Jo: I never fit in anywhere and I kept trying, I kept wanting to belong but nothing ever worked out so I had to keep moving. Or maybe I was running from my circumstances, running from myself, running from anyone who dared to love me...
 * Alex: Just wait a minute, just one second.
 * Jo: Wait, Alex.
 * Alex: It's right here, I put it right here.
 * Jo: No, Alex I'm still talking
 * Alex: Dammit! It was just right here!
 * Jo: Alex! I'm not done yet!
 * Alex: Where the freak is my ring!
 * Jo: Alex! I'm wearing it! I always thought there was something wrong with me and I always wanted to run, until I met you. You're so screwed up that you make me make sense. You and me; we just fit, and I don't wanna leave you Alex. I wanna great, big, giant career but I never wanna go anywhere without you. [they kiss] You are my home [they kiss] and you are my heart. Alex Karev will you marry me? [they kiss] Wait so that's a...
 * Alex: It's a yes, it's a hell yes!

Appearances
Alex Karev Alex Karev Alex Karev