Great Expectations (Grey's Anatomy)

The episode opens with a voice-over narration from Meredith Grey (Ellen Pompeo) about the pressures and expectations that come with becoming a surgeon.

George O'Malley (T. R. Knight) is seen using sex as a way to cope with the recent death of his father, Harold O'Malley (George Dzundza), which frustrates his girlfriend, Callie Torres (Sara Ramirez). Seeking advice, Torres turns to Izzie Stevens (Katherine Heigl), O'Malley's best friend. Meanwhile, news of Chief of Surgery Richard Webber's (James Pickens Jr.) retirement sparks a competitive race among Derek Shepherd (Patrick Dempsey), Preston Burke (Isaiah Washington), Addison Montgomery (Kate Walsh), and Mark Sloan (Eric Dane) to fill the position. In the midst of this, Cristina Yang (Sandra Oh) and Burke, who are romantically involved, are avoiding each other due to unresolved tension.

Miranda Bailey (Chandra Wilson), proposes opening a free clinic adjacent to the hospital. However, her idea is met with rejection from Webber and the attending physicians, who view it as impractical. Meanwhile, Jillian Miller (Jessica Stroup), a young woman admitted to obstetrics and gynaecology, is diagnosed with advanced cervical cancer. Her best friend, Rachel Meyer (Rachel Boston), opposes contacting Jillian's parents, revealing that the two ran away from their Amish community years ago. Stevens becomes emotionally attached to the case and urges Jillian to reconcile with her family.

A runner in orthopedics receives the devastating news that he will never race again following his surgery. Meanwhile, Sloan reveals plans to return to New York City, only to change his mind upon hearing about Webber's impending retirement. His decision angers Derek, sparking a heated argument between him and Meredith, threatening their relationship. At the same time, Webber seeks forgiveness from his wife, Adele (Loretta Devine), but is heartbroken to learn she has been spending time with another man.

Bailey ultimately finds a partner for her free clinic dream in Izzie, who enthusiastically offers to use her $8 million inheritance to fund the project. The episode concludes with significant developments: Yang, after confiding in Burke, is surprised when he proposes to her, while O'Malley, finally acknowledging how deeply his father's death has affected him, proposes to Torres.

The episode was written by producer Eric Buchman and directed by Michael Grossman.^[2] Buchman explained that his main concept was to depict George O'Malley's grieving in a way that contrasted with how Izzie Stevens experienced her loss, yet would be emotionally challenging for both her and O'Malley's partner, Callie Torres.^[1] He elaborated, "We wanted Callie to feel some remorse. She finally got George, but not in the way she wanted. She's gotten his body, but the underlying relationship isn't there anymore."

Buchman initially planned for Cristina Yang and Preston Burke's cold relationship to be maintained by depicting silent sex between the two, but this idea was ultimately rejected as "boring, neither dramatic nor comedic" and not reflective of the characters' deeper emotions.^[1] The story arc involving the four attending physicians (Derek Shepherd, Burke, Addison Montgomery, and Mark Sloan) vying for the position of Chief of Surgery after Richard Webber's retirement was intended as comic relief, designed to highlight the more immature side of their personalities, a facet that had not been explored before. Additionally, Buchman described Webber's retirement as part of his attempt to reconcile with his estranged wife, Adele leading to his emotional devastation upon discovering that she had moved on with another man.^[1]

Buchman noted that the fight between Meredith and Derek was unique among the other storylines, as it involved "no more taboos". He explained, "Even though it was a minor fight, it's very revealing for Meredith. This is probably the longest relationship she's ever been in and the first with someone she feels a genuine connection with. We might know Derek will come back, but she doesn't." Their final scene together was considered "a milestone of sorts" for Meredith, as it forced her to confront the unfamiliar territory of a serious romantic relationship, contrasting with her previous years of excessive drinking and casual relationships with inappropriate men.^[1]

Regarding the aftermath of Alex Karev and Addison's kiss in the previous episode, Buchman commented, "What's most painful about that scene? Not that Alex effectively shut Addison down in such a cold and direct manner. But that it seems like such a waste of chemistry. When they went into that closet, the last thing we wanted to see them do was pour water on their fire." He noted that the scene was intentionally written to be "frustrating, shocking, and therefore unexpected."^[1]

"Great Expectations" originally aired on January 25, 2007, at 9:00 ET, averaging 21.50 million viewers and ranking third in weekly viewership with a 7.6 rating, according to Nielsen ratings.^[3] It was the sixteenth most-watched episode of the season, airing in the third week after the winter hiatus.^[4] Despite a strong viewership, the episode saw a slight decline in ratings, attracting approximately half a million fewer viewers than "Six Days (Part 2)", which received a 7.7 rating.^[5] "Great Expectations" remained the time slot leader, drawing one-fourth more viewers than CBS's juggernaut CSI: Crime Scene Investigation, which ranked fourth in weekly viewership with a 7.5 rating.^[3]