A Tear-Jerking Season Finale For ‘Grey's Anatomy'

"Grey's Anatomy" handed Dr. Isobel Stevens a fateful choice on its fifth-season finale Thursday night.

Izzie had to decide if she should have risky brain surgery for the cancer that has plagued her on the ABC medical drama. She wrestled with the decision as her fellow doctors at Seattle Grace Hospital pulled her in opposite directions. Whatever she did, she seemed a goner.

In another development on Thursday's two-hour season-ender, Dr. Meredith Grey (Ellen Pompeo) and her beau, Dr. Derek Shepherd, were wed.

Well, sort of. Last week, they had given up their fancy ceremony, so that living-on-borrowed-time Izzie could marry her fiance, Dr. Alex Karev, instead. Eager to get on with their own nuptials, Meredith and "McDreamy" (Patrick Dempsey) stole a few moments from their hectic hospital duties to draw up, andsign, a marriage contract on a Post-It pad.

Among the items in the contract: "You'll love me, even when you hate me," and "Nobody walks out, no matter what happens." As a ceremony, it would do in a pinch, and they pronounced themselves husband and wife.

Since cast member T.R. Knight is widely believed to be leaving the series, his character, Dr. George O'Malley, seemed a cinch to be exiting the hospital. It was no surprise, then, that mild-mannered O'Malley announced he was enlisting in the U.S. Army as a trauma surgeon, headed for Iraq.

He never made it. In the episode's crowning twist, O'Malley was revealed to be the unrecognizably bloodied, injured John Doe who had pushed a woman out of the path of a bus and been struck by it himself. He died a hero in Seattle.

But O'Malley wasn't the only casualty among the major characters.

Izzie had appeared near death when Dr. Shepherd proposed high-stakes surgery to remove her brain tumor. The gamble: that doing it would rob her of her memory.

"The tumor is sitting right in the middle of everything that makes you you," Grey told her, arguing against the procedure.

Izzie had the surgery anyway. It seemed to be successful. But then she quickly appeared unable to remember anything.

Her high-strung new husband, Alex (Justin Chambers), was frightened and lashed out at her.

"I'm sorry if this is hard for you," Izzie shot back, "but you are not the one with the short-term memory of a carrot."

Then her memory returned, just long enough for her and Alex to embrace.

"You're back," said Alex joyfully.

Then, shockingly, she flat-lined.

But it wasn't really much of a shocker. Izzie is played by Katherine Heigl, who is widely expected to be leaving "Grey's Anatomy" to concentrate on movies.

"When something begins, you generally have no idea how it's going to end," said Dr. Grey at the start of the episode, in one of her cloying voiceovers.

Viewers of "Grey's Anatomy" might beg to differ.

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