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When Krista Vernoff read the script of the “Grey’s Anatomy” pilot in 2004, she was coming off the “most difficult job” of her TV career, writing on “Wonderfalls.” In an interview for Variety’s cover story about “Grey’s Anatomy” for the magazine’s Power of Women issue, Vernoff said of the quirky Fox dramedy: “I just kept getting rewritten systematically. It was the only time in my career that happened, but it was humbling, and important for me to experience.”

But Vernoff knew she would be a perfect match for “Grey’s Anatomy.”

“I feel like I wrote this script in a fever dream,” she remembers telling her agent after she’d read Shonda Rhimes’ ABC pilot. “I get this voice. I need to meet this woman.”

Vernoff ended up becoming the show’s head writer for its first seven seasons. She returned for Season 14 as its showrunner, anointed by Rhimes and approved by star Ellen Pompeo to take over after a series of cast exits and sad storylines had darkened the tone of the saucy medical drama. As “Grey’s Anatomy” nears its Season 17 premiere on Nov. 12, filming under COVID-19 protocols in real life and tackling the coronavirus on screen, Vernoff reflected on the show in its infancy, writing out the character of Alex Karev and why the “Grey’s” characters feel like friends.

Can you talk about the writers’ room in the early days of the show? Were certain writers tasked with writing particular characters?

Everybody has to be able to write every character. The show had such a great, great energy, because we had a lot of theater people — a lot of passionate, funny, smart people. And we would jump up and argue as if we were the characters. I remember fighting like I’m Meredith, fighting like I’m Izzie — Tony [Phelan] would fight for Derek’s point of view. There were men in that room who were like, “The men have a point of view!”

How did the medical stories work back then?

We had Zoanne Clack in the writers’ room, who was still at the time a practicing ER physician. We had a medical researcher. And we had [surgical nurse] Linda Klein on the set. The medical researcher would send us every article in the world — any miraculous thing that had ever been pulled off by any surgeon, ever. Every kind of crazy accident that had ever caused terrible harm to any human ever, that was our homework at night.

The joke that was not really a joke is the pitch of: “Can’t they be decapitated at the scene, and have their heads sewn back on?” And Zoanne would just stare at us and yell at us and quietly brood at us and go, “No! It can’t happen!”

The rule in the beginning was it had to have happened at least once somewhere in the world in order for us to put it on the show. The medicine had to be accurate.

How did the tumult among the cast — which caused earlier-than-planned departures of Isaiah Washington, T.R. Knight and Katherine Heigl — affect the writers?

For sure, some of those things radically changed the story plans. When word comes down that an actor is leaving the show, and what you’ve got scripted is a wedding…

Katie’s departure changed the course of the Alex-Izzie love story quite abruptly. One of the things about working in television and being a TV writer is you have to be able to pivot. You don’t have to love pivoting, but you’d better be willing to throw everything out and work through the night on a completely different story at the 11th hour.

That’s the truth; that was the job. There was a lot of drama. There was a lot of drama on screen and drama off screen, and young people navigating intense stardom for the first time in their lives. I think that a lot of those actors, if they could go back in time and talk to their younger selves, it would be a different thing. Everybody’s grown and changed and evolved — but it was an intense time.

My job was to do my very best to make it look like good storytelling that was intentional.

Speaking of actors leaving abruptly, can you talk about Justin Chambers leaving?

It’s just not my story to tell.

But how did you come up with the delightfully batshit idea that he left his whole life — including his wife, Jo — for Izzie?

It evolved out of a conversation in the writers’ room of, “Look, what’s a satisfying way to say goodbye to this character?” What we knew is that we didn’t want to kill him. Jo had been through just a massive depression in the wake of “Silent All These Years.” She had just emerged.

She had just gotten through it.

She had just gotten through it! And the actress [Camilla Luddington] had had to play so much grief. And Ellen in her lifetime on the show, has had to play so much grief. Grief is really, really, really hard on actors. I get that it’s their job. But when you have to play sustained grief for episode after episode after episode — I’ve never met an actor who didn’t go into their own personal depression, because they have to run those chemicals through their system.

In addition to not wanting to put the actors through sustained grief, I didn’t want to put the characters through another sustained grief. And that was probably the more significant thing. I don’t want Meredith Grey to lose Alex Karev to death. I don’t want to see it! I can’t take it!

And I didn’t want the audience to go through it. That character was so sacred. He was so sacred. And the collective grief in this world and in this country right now is pretty f—ing intense.

And so how do you write this character off? Well, the fabric was all sewn in — they were a part of the story. Jo had found [out about the embryos] — it had been a big fear. And Izzie had disappeared when Alex was very much in love with her. And yes, he had said, “I deserve better than you,” but that was rooted in his pain. And it was something that we had to write pretty abruptly back in the day that hadn’t quite felt true. So it was, like, “Oh, wait a minute — there’s a way to bring all of this full circle.”

For us, what had driven Alex Karev as a character his whole life was a desire for an intact family. A desire for sanity was a desire for pancake breakfasts — like, he wanted a childhood that nothing in his life had ever given him. And yes, he had Jo now. And yes, that was a beautiful love story. And yes, for many years writing them, I had thought they were endgame. And so I understood why to some people this felt like a betrayal of that character development.

Yes.

But also if you look back at Episode 16.01, Alex almost didn’t go get Jo from the mental institution she had checked herself into. He almost didn’t go get her! Women with mental health crises have been the bane of his existence for his whole life. For him to go and discover that Izzie had these gorgeous, gorgeous children that were his, and that she was stable now, and here was this farm and these kids and this joy and this thing that he never ever, ever in his life imagined that he would have — that felt like a happy ending for that character, even though it caused him to cause Jo tremendous pain. Even though it caused this abrupt and shocking rupture.

And one of the things that I have known and believed and experienced in my life is that sometimes a person comes into your life to help you heal. And then once you’re healed, you two no longer resonate together. Alex and Jo carried each other through so much. She went and she got inpatient treatment, and she got coping skills that she’d never had before. They healed each other!

Then Alex went and discovered this other thing, and he couldn’t leave. And that felt true. And it felt fair. And it felt OK to our writers, who also grew up with these characters. These people are real to us, too. And that, that felt like the way we could say goodbye to Alex. And that is the biggest answer I’ve given on that, Kate!

Yes, what is the level of awareness of how — after watching “Grey’s Anatomy” for so many years — these characters are people in our lives?

I am very aware of that. I remember when “Friends” was in its final year, I was talking to one of my friends who didn’t watch the show about Phoebe and Rachel and Joey. And I was going on at some length. And my girlfriend looked at me and tilted her head and said, “You understand that these people are not actually your friends, right?” And I looked at her, and I was like, “No. Those were my friends. The ‘Friends’ were my friends.”

I think that this is true for people who grew up with characters they love on TV. I survived my childhood because of books. I mean that literally.

So yes, I am aware of the impact that these fictional characters have on the fans. And I don’t know that there’s ever been anything quite like these characters, who’ve been on the air now for coming up on 17 seasons. The other shows that have stayed on for this long are more procedure driven.

One of the things that makes these characters so significant to people is that we’ve watched their lives and their loves and their friendships. We’ve watched them get married and divorced and widowed and have children. It feels very real, and very powerful and profound. And I get that!

This interview has been edited and condensed. To read the Variety cover story about “Grey’s Anatomy,” click here. To watch the video of Pompeo, Debbie Allen, Chandra Wilson and Vernoff filmed for Power of Women Conversations, click here. To read an interview with Pompeo, click here. To read a story about how the show is filming this season during the coronavirus pandemic, click here.