Grey’s Anatomy Review: Out for Blood / You Are the Blood (Season 18 Episodes 19 and 20)

Even 400 episodes in, and Grey’s Anatomy is still full of surprises. On Grey’s Anatomy Season 18 Episodes 19 and 20, “Out for Blood,” and “You Are the Blood,” everything changes in a way that marks the end of an era. 

It also feels like the show is trying to figure out what it wants to be next, and it’s been doing that for a while. 

The hospital has faced challenges before, but it’s always found a way to overcome them. They’ve always been able to save what they needed to save and re-invent themselves. The name itself has even changed, going from Seattle Grace, to Seattle Grace Mercy West, to Grey-Sloan Memorial. 

But this time, what needed saving couldn’t be saved. Between Meredith’s plans to leave, Owen and Teddy getting ready to run (more on that in a minute!), and all the other drama that’s occurred between the doctors, they just couldn’t get to where they needed to be.

Add a blood shortage and a risky surgery that Meredith may or may not should have even attempted, and it’s a recipe for disaster.

Thematically, it all makes perfect sense, though. What Jamarah Blake says to Bailey is all too relatable when you think about the series itself: after working together for so many years, they’ve really all become more like a dysfunctional family.

And so many of the issues hinge on authority — from Richard not respecting Bailey’s authority to Meredith not respecting his. Those lines have all gotten so messy over the years.

Then there’s Jackson, who returns with April on this episode. He’s the one with the ability to offer Meredith more money and try to come up with additional solutions. And with Bailey throwing in the towel, Meredith is suddenly sitting in the seat we probably should have always guessed she’d wind up in.

But it’s not an exciting moment. She’s been asked to take over for Bailey and rebuild the program from the ground up, all when she was about to leave it behind. 

It’s the flashbacks, paired with some nostalgic Grey’s Anatomy music choices, that really play to her emotions throughout the episode.

Every memory, good and bad, floods back to her throughout the episode as she contemplates whether she’s really going to say goodbye. So when it’s suddenly on her to save it all, she’s burdened with taking that on.

She’s one of few key characters who hasn’t had that position over the years, and it’s only fitting that she does get that chance. I keep saying, over and over it seems, that this show feels like it’s working its way toward an ending.

If Meredith leaving the hospital for Minnesota isn’t it, then her taking on the role as chief of surgery certainly feels like it could be. 

It’s an interesting choice for her character, and having such a moment to allow her to reflect on the place where she essentially grew up is pretty powerful. 

She’s also sent Nick away, which adds an entirely different heartbreaking layer. I hope he’s not gone for good after that.

Of course, there’s plenty else going on during this two-part finale. Owen and Teddy’s lives are about to change as once again, Bailey is in this position of having to fire some doctors because they did something illegal. It does seem like something like this happens every few years on Grey’s Anatomy, doesn’t it?

But Owen stands by what he’s done, and Teddy stands by him, which makes it all the more emotional to watch. They’re banding together in a way that feels stronger than anything else they’ve ever been through. You also can’t fault Bailey here. She has to protect herself, too.

Meanwhile, Amelia spends much of her time heartbroken over Kai on these two episodes, noting that she felt seen by them in a way she never had before. Not only does that end up being resolved when Kai comes back for her, but she also gets some closure with Link that feels mature and endearing. 

I appreciate that she can have that, just as she sees Owen and Teddy leaving. 

The blood shortage at the hospital is a major factor in so much of what goes on during these two episodes. For Schmidt, it’s very personal, because he’s not able to donate blood because of his sexuality.

This is addressed so well. His blood is needed and he’s more than willing, but yet an outdated guideline keeps him from being able to help. It’s worth it for the information alone — an awareness that this is something that’s still happening even though it doesn’t make any logical sense.

Instead of breaking the guideline in any sort of way, however, Schmidt and the other residents rally their friends via social media to get more volunteers to donate. It’s such a hopeful moment, and it’s only more shattering that the residents become displaced shortly afterward.

The most emotional storyline, however, revolves around Link and Jo’s patients, who we first met on Grey’s Anatomy Season 18 Episode 17. Kristen and Simon’s story is so tragic, and all they want is for their baby to be born in time for Simon to meet him. 

In true Grey’s Anatomy fashion, it’s a close call. Too close for comfort. And the blood shortage plays a role in that.

Kristen’s own life ends up in danger during childbirth, and she needs blood. But so does Simon, and they share the same blood type. Simon, of course, insists it all goes to his wife. The blood he needs has only been about buying him a little extra time anyway.

The baby is born just in time for his father to see him and kiss him on the forehead, saying, “Hello forever.” It’s gutwrenching and heartwarming all at once.

Of course, I can’t not mention the two special guests who appear on the 400th episode. Jackson and April return in a seamless and effortless way in the finale.

When the two reunited as Jackson left the show, the door was left wide open for them to return at any time. After all, Jackson’s position now warrants a visit to Grey-Sloan every once in a while, and April would be by his side. Plus, Catherine’s cancer is back — though there’s some good news there too, thankfully. 

I’d have liked to see more interactions between April and other cast members, in particular, but we do get a few. And there’s maybe no funnier moment than Bailey not even taking a beat to be surprised to see April before sending her off to cover the pit, just like old times.

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What did you think of this episode of the Grey’s Anatomy season finale? Share your thoughts in the comments below!

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Grey’s Anatomy returns this Fall to ABC.

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