How to Save a Life (Grey's Anatomy)

"How to Save a Life" was originally broadcast on April 23, 2015 in the United States on the American Broadcasting Company (ABC).[14] The episode was watched by a total of 9.55 million,[15] up 23 percent from its last years telecast airing around the same time.[16] In the key 18-49 demographic, the episode scored a 2.8 in Nielsen ratings,[15] up 22 percent from last year, scoring the best ratings since the eleventh-season premiere.[16] It was the second best TV show in the 8.00 pm slot, beating Bones, The Vampire Diaries and a rerun on The Blacklist, but was beaten by The Big Bang Theory.[15]

The 9.55 million people tuned into the episode marked a 24 percent increase from the previous episode (7.60), in addition to the installment's 2.8 Nielsen rating in the target 18–49 demographic marked a 33 percent increase from the previous episode (2.1).[15][16] The Nielsen score additionally registered the show as the week's highest rated drama and third-highest rated scripted series in the 18–49 demographic, only behind CBS's The Big Bang Theory (3.6) and ABC's Modern Family (3.0).[17]

The episode received mixed reviews by critics who gave a polarised view on the writing and handling of Shepherd's death. Ashley Bissette Sumerel of TV Fanatic gave the episode the highest praise in a 5 out of 5 star review highlighting the "interesting possibilities" that the death would offer for the show. However, she stated, "I'm beyond heartbroken. [...] We've seen tragic deaths and lost beloved characters, but never quite like this. I don't think I'll ever get over it." She also acknowledged the show's emotional connect with its audience and its courage to attempt the "inconceivable".[18] Ariana Bacle of Entertainment Weekly took the opportunity to reminisce the early years of the show saying that it is the compelling characters that have made committing to Grey's "irresistible". She added that despite some "weak moments" that the series suffers from, characters like "Meredith or Derek or Webber will have a moment that reminds me why I keep watching, why I never stopped— so watching one of those characters die hurts. It really, really hurts."[19] In a mixed review for the episode, a Spoiler TV writer criticized the plot calling it a "self-indulgent episode", contrasted it with "well crafted departure of Mark Sloan, or by Lexie Grey". Also criticizing the absence of the series' major cast from the episode the review said, "The presence of so many inconsequential and uninteresting characters was continually in danger of swamping the dreaminess of Derek."[20] However, appreciative of Pompeo's character, the reviewer remarked, "the writing of Meredith was completely on point. She was clinical, as we would expect her to be."

Pompeo's performance was a major point of praise among critics.

Pompeo garnered widespread acclaim from television critics for her performance in the episode; Rick Porter of Zap2it was largely laudatory of Pompeo's performance which he thought "made all the difference in the episode". He wrote highly of her role in the arc saying, "Without Meredith, and without one of Pompeo's strongest performances in her long time on the show, "How to Save a Life" would have run the risk of coming across as a baldly manipulative death episode". He noted that although it might not be the "ideal Emmy-submission episode" for Pompeo, because of the amount of time that she spent on screen, it was among the best work she's ever done on the show."[21] Robert Bianco of USA Today thought of the episode as "a showcase for Pompeo", agreeing that although she didn't play a prominent part until the later half of the episode, but some memorable and well-played scenes: "from her angry response to the doctor who tries to tell her what her choices are, to her resignation when she realizes she has to comfort and motivate the young doctor whose mistakes cost Derek his life."[22] Alexandria Ingham Guardian Liberty Voice was also impressed with Pompeo’s "range of emotions", which she described similarly, as going through many stages, including anger, resignation compassion.[23]

Shepherd's death came as a shock to the audience and was a major topic of discussion among critics, who gave polarising views on the character's exit.[24][25] Janalen Samson, a contributing Writer for BuddyTV noted the episodes generation of shock in the times of the omnipresent media saying, "Genuine surprise is a rare occurrence in television viewing these days", and added, "Imagine my amazement, then, when I sat down to watch [...] "How to Save a Life"".[26] Calling the death a "lightning bolt" David Hinckley of New York Daily News wrote, "In one of the most stunning moments from a high-mortality television season, "Grey's Anatomy" [...] killed off Patrick Dempsey's Dr. Derek Shepherd".[27] Also talking about the shock value Shepherd's death in her New York Post review Lindsay Putnam wrote, "“Grey’s Anatomy” did the unthinkable, killing off one of the few remaining original cast members", additionally putting up the question of the future of the series asking, "with Derek out of the picture, what will become of the rest of the Grey Sloan Memorial Hospital family? Is there still a future for Grey’s Anatomy?"[28] The sentiment was echoed by Slate writer Aisha Harris who weighed heavily upon importance of the death and its impact saying that despite the show’s ensemble cast, "Meredith has always remained the central figure of Grey’s, so this death marks a very important turning point in the show". Optimistic of the prospects for the show, she added, "if anyone can come out of this tragedy as a tougher, better character than ever, it’s Meredith Grey."[29]