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 an attending pediatric surgeon working at Grey Sloan Memorial Hospital. Alex is an eager and competitive surgeon, but he can also be self-absorbed and overconfident. In the early years of his internship he only wanted to work on cases that he felt were interesting. His offensive behavior and poor attitude caused him to be extremely disliked by doctors and patients alike; this changed after he started working in pediatrics. 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
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 "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.

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

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

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

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

Starting the 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 constuct. Because of her new face and because she couldn't remember her real name, Alex nicknamed her Ava. Later on, Rebecca returned and they had a brief relationship during which she believed he got her 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 got married after a tumor was removed from her brain, but a second 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 abandoned him, and they ultimately got divorced.

Shooting and Aftermath
Alex get shot in the 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 his 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 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.

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.

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

Daddy Issues
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 at the same night. Alex visited the bar a 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.

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.

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

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

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

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

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

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

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

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



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

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

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

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

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

Addison Forbes Montgomery
Addison discovered Alex’s better side and found herself attracted to him. To some degree, Alex was also attracted to Addison as they subsequently shared frequent meaningful looks. This culminated in an actual kiss in Joe’s bar. Later, during the 60-day trial with Mark Sloan, Addison sleeps with Alex, breaking the deal. However, he later told her that he only wants to work with her professionally, and is not interested in pursuing a romantic relationship with her. 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 (Ava)
During a ferry accident, Alex found a severely injured pregnant woman crushed under a pylon. He rescued her from the debris, and encouraged her to stay alive. The pregnant Jane Doe subsequently became hysterical after realizing she could not remember anything, and turned to Alex for support, thinking that he was her husband. Alex showed much concern for her and constantly checked on her progress, bonding with her in the process. He also helped her pick out a new face for reconstruction, as well as a new name "Ava". As Alex spent more time with Ava, he became increasingly attached to her, spending most of his time checking on her progress and doing research. This led Addison to accuse him of being too emotionally involved with a patient, but he countered saying that he was just being prepared. In the heat of the argument, Addison kissed him and pushed him into an on-call room, where the two had sex. However, Alex rebuffed Addison's subsequent advances, after learning she wanted a committed man to have kids with, something which he was not ready for.

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

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

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

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

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

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



After his dad returned to the hospital trying to get clean, Alex said goodbye for a final time. 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 naked and DeLuca on top of her in bed. He jumped to the wrong conclusion and began to punch him.

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 suppose 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.

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 of 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 anyways. Morgan decided to call the baby Tommy after her father. Alex was very attached to Tommy. Alex and Morgan got close, but Arizona scared Alex off of Morgan by telling Alex that Morgan was into him. Alex avoided her and Tommy for weeks. Alex tried to get back into the case later. He almost missed his flight to San Francisco to take his boards because he was taking care of Tommy. He then flew back to Seattle the night before his boards to take care of Tommy and helped Morgan when Tommy died.

Professional
During his intern year Alex notably had a reputation for getting on the bad side of his attendings and other staff. He was often rude and condescending to nurses 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.

Career
Alex Karev is a former wrestler at Iowa State University, 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 because plastic surgery patients “sign up for the pain they get”. He has unwittingly been drawn to obstetrics and gynecology and neonatal surgery, after having several bad experiences in plastics, under Mark Sloan. Alex seems to have some talent in OB/GYN after serving as Addison’s intern for a while.

Alex Karev secured a position in the surgical residency program at Seattle Grace after graduating from medical school. Although first he was an intern of Jeremy, Alex was reassigned to a new resident Dr. Miranda Bailey, to the disdain of the other interns under her. His frequent sexist remarks and overt come-ons made him even more disliked by the interns, who proceeded to dub him “evil spawn”. He became even more hated when he hijacked an open-heart surgery that rightfully belonged to the other interns. After which, he proceeded to taunt a furious Meredith, who attacked him in retaliation, calling him a “frat boy bitch”.

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

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

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

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

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

It was during Alex's third year of residency that he heavily considered pediatric surgery as a specialty. Given his time as Addison's intern, and with Bailey's recommendation, 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 fellow 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.

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, Cristina told Alex he could be her proxy. However, it's unknown if steps were taken to legally affirm this.
 * Alex took care of his siblings because his parents were unable to do so, as his dad was a junkie and his mom was mentally ill.
 * His favorite dessert is banana cream pie.
 * Alex stole a car when he was 12.
 * 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.
 * Izzie sent Alex divorce papers after she left and he 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 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.
 * Although Meredith is the only character who has appeared in every single episode of Grey's, Alex and Bailey are tied with her when it comes to total number of appearances because they made appearances on Private Practice, whereas Meredith never has. Alex didn't appear in How to Save a Life on Grey's Anatomy, but he did appear in Ex-Life on Private Practice.
 * 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.
 * Alex is the emergency contact for Meredith Grey.
 * 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: 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).

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

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: 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.

Appearances
Alex Karev Alex Karev Alex Karev