It’s been more than five years since Patrick Dempsey scrubbed out of Grey’s Anatomy, following 11 seasons as Dr. Derek “McDreamy” Shepherd. Yet until now, little has been known about what exactly led to his high-profile exit. That’s changing with the publication of How to Save a Life: The Inside Story of Grey’s Anatomy. According to an excerpt from the unauthorized book, published by The Hollywood Reporter on Thursday, Dempsey’s alleged infighting with both costar Ellen Pompeo and creator Shonda Rhimes led to his ouster.

“There were H.R. issues,” former executive producer James D. Parriott told the book’s author, Entertainment Weekly editor at large Lynette Rice. “It wasn’t sexual in any way. He sort of was terrorizing the set. Some cast members had all sorts of PTSD with him.” Parriott continued, “He had this hold on the set where he knew he could stop production and scare people. The network and studio came down and we had sessions with them. I think he was just done with the show. He didn’t like the inconvenience of coming in every day and working. He and Shonda were at each other’s throats.”

Former executive producer Jeannine Renshaw agreed that Dempsey’s off-screen dynamic with Pompeo had also soured. “There were times where Ellen was frustrated with Patrick and she would get angry that he wasn’t working as much,” Renshaw told Rice. “She was very big on having things be fair. She just didn’t like that Patrick would complain that ‘I’m here too late’ or ‘I’ve been here too long’ when she had twice as many scenes in the episode as he did.” The producer said that when she would remind Dempsey that everyone had a demanding schedule, “he would get it,” adding, “It’s just that actors tend to see things from their own perspective. He’s like a kid…. He’s the kid in class who wants to go to recess.”

During Dempsey’s own interview for the book, he admitted to resenting the Grey’s schedule. “It’s 10 months, 15 hours a day. You never know your schedule, so your kid asks you, ‘What are you doing on Monday?’ And you go, ‘I don’t know,’ because I don’t know my schedule,” he explained. “Doing that for 11 years is challenging. But you have to be grateful, because you’re well compensated, so you can’t really complain because you don’t really have a right.” 

Dempsey continued, “It [was] hard to say no to that kind of money. How do you say no to that? It’s remarkable to be a working actor, and then on top of that to be on a show that’s visible. And then on top of that to be on a phenomenal show that’s known around the world, and play a character who is beloved around the world. It’s very heady. It [was] a lot to process, and not wanting to let that go, because you never know whether you will work again and have success again.”

Things reached a boiling point, apparently, when Rhimes witnessed tension with Dempsey in person. “Shonda had to say to the network, ‘If he doesn’t go, I go,’” Renshaw said. “Nobody wanted him to leave, because he was the show. Him and Ellen. Patrick is a sweetheart. It messes you up, this business.” 

Parriott said that the show flirted with three different scenarios for Dempsey’s departure. One had McDreamy remaining on the show but relegated to a story line in Washington, D.C., separate from the rest of the cast. Another would see Derek live, “and we figure out what Derek’s relationship with Meredith would be.” Ultimately, the team “decided that just bringing him back was going to be too hard on the other actors,” Parriott recalled. “The studio just said it was going to be more trouble than it was worth and decided to move on.”

Dempsey shockingly exited the series in 2015 after his character died in a car accident. “I don’t think there was any way to exit him without him dying,” said former producer Stacy McKee. “He and Meredith were such an incredibly bonded couple at that point. It would be completely out of character if he left his kids.”

Until now, the Grey’s cast and crew have largely remained tight-lipped about any animosity with Dempsey. Back in 2018, Pompeo—who is not quoted in the excerpt—hinted at their strained relationship in a conversation with The Hollywood Reporter, referring to Dempsey’s exit as a “defining moment” for her. Pompeo also recalled her struggle to reach pay parity with Dempsey. “They could always use him as leverage against me—‘We don’t need you; we have Patrick’—which they did for years,” she said. “I don’t know if they also did that to him, because he and I never discussed our deals. There were many times where I reached out about joining together to negotiate, but he was never interested in that.”

Just last year Dempsey made an unexpected return to Grey’s during a series of COVID-induced dream sequences with Meredith. How to Save a Life: The Inside Story of Grey’s Anatomy is available on September 21, just nine days before season 18 premieres on ABC.

— Unhappy Little Trees: The Dark Legacy of Bob Ross
— The True Story of a Hollywood Partnership Built and Destroyed by Money, Sex, and Celebrity
— Ted Lasso’s Roy Kent on Why the Show Isn’t “Warm and Fuzzy”
— Caftans, Goyard, and Elvis: Inside The White Lotus’s Costumes
— The Chair Is Like an Academic Game of Thrones
— The Best Movies and Shows Streaming on Netflix This Month
— Rachael Leigh Cook on Reclaiming She’s All That
— Watch Kristen Stewart Channel Princess Di in Spencer’s Official Trailer
— From the Archive: Jeffrey Epstein and Hollywood’s Omnipresent Publicist
— Sign up for the “HWD Daily” newsletter for must-read industry and awards coverage—plus a special weekly edition of “Awards Insider.”