Every frequent Greys Anatomy viewer remembers the first time the show made them cry. For legacy fans of 20 iconic seasons, including yours truly, the above image alone is quite triggering (RIP, MAGIC. If you know, you know).

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Ive lost track of how many times Greys has left me weeping; an early season two episode featuring a train crash, a hospital shooting, numerous character deaths, and more recently, a season 20 installment in which two doctors treat a prisoner with cancer all come to mind. Its safe to say the whole team are experts at dialing up the misery by now, and its rarely by accident. Current series showrunner Meg Marinis confirms the writers have a specific approach to ensure the long-running ABC show maintains its emotional high after all this time.

The A.V. Club conducted a roundtable interview with Marinis and four cast membersJames Pickens Jr., Kevin McKidd, Kim Raver, and Camilla Luddingtonearlier this month at SeriesFest, an annual TV festival in Denver that celebrated its 10th anniversary in 2024. During the chat, I asked Marinis how Greys still manages to induce plenty of tears when you least expect it. The showrunner, who started as a writers PA in 2006 and has climbed the ladder since season two, immediately and proudly nodded. She says they have a three-step approach to their formula in the writers room. (Do you really? Luddington, who plays Jo Wilson, is shocked to hear it.)

Weve always said the perfect Greys Anatomy scene has medicine, obviously, it brings laughs, and theres a huge emotional component to it, Marinis says. When drafts are turned in, were all looking at them, and often, someone says that we need to keep twisting the knife somewhere because Im not crying yet.

That explains season 20's sixth episode (which aired on May 2) in which cardiac surgeon Dr. Teddy Altman (Raver) and intern Dr. Mika Yasuda (Midori Francis) get attached to a patient whose cancer diagnosis was delayed because he was behind bars. At this stage, they cant do anything for him, which is sad enough. Then, as hes being taken back to jail, Yasuda runs up to him and offers him a piece of cake from his high school cafeteria. Its the last thing he remembers eating and enjoying before he was sent away the last time. Cue the tears.

The arc is also reminiscent of the season five episode, Sympathy For The Devil, which aired all the way back in January 2009. In it, Meredith Grey (Ellen Pompeo) shows compassion for a serial killer on death row. Marinis agrees nostalgia is a handy Greys Anatomy tool, and the show keeps wielding it to make longtime fans cry on demand.

Im so glad were back to in-person table reads, too, because you cant capture the feeling on Zoom of two actors being able to turn in this emotional performance, she adds. I look around the room at the cast, the PAs, and others who are watching and notice if their mouths turn up or if theyre shocked and teary. The directors and actors elevate what we put in our script. We give them a blueprint, but they take it 10 steps ahead. And then, editorial and post-production work dials it up, too. McKidd, who has been playing Dr. Owen Hunt since season five and has directed 40 episodes, chimes in to add they do their part as best they can, but if it isnt on the page, it wont be on the stage.

Marinis also teases the upcoming finale, airing on May 30. I watched it last night in my hotel room and started weeping. And then I remember thinking, Oh, I never thought this is the scene that would cause this. So we have the formula but it also sneaks up on us, she says. Brace yourselves, Greys viewers; even in its whopping 20th (!) season, the show is ready to cause a breakdown.

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Of course, Grey's Anatomy has the perfect formula to make viewers cry - The A.V. Club