This post contains spoilers from Thursday's season 19 premiere episode of Grey's Anatomy.
The premiere episode of season 19 of Grey's Anatomy, called "Everything Has Changed," was set six months after the events of the season 18 finale. Now settled into the role, interim Chief of Surgery Meredith Grey (Ellen Pompeo) welcomed a new class of interns to the hospital and her ex, Nick Marsh (Scott Speedman) returned to Seattle from Minnesota.
Meredith gave a speech to the group of new recruits, saying, "Congratulations. You all made it. You're here… We didn't hire you for your grades, we hired you for your fight. We are all getting our second chance here today." She was interrupted by Dr. Simone Griffin (Alexis Floyd), who was running late for her first day in the program and blamed her tardiness on "a family situation" caused by a tornado. She promised it "won't happen again."
However, Griffin later admitted to Richard Webber (James Pickens Jr.) that her mother died during her birth at Grey Sloan Memorial and her tardiness was due to a panic attack about returning to the hospital.
Simone is not the only new intern with a secret: Dr. Jules Millin (Adelaide Kane) literally collided with her former one-night stand Dr. Atticus "Link" Lincoln (Chris Carmack). However, their night together didn't stay between them after she revealed what happened to fellow new resident Dr. Mika Yasuda (Midori Francis), who immediately shared it with the other interns in the locker room.
When Link told Meredith that he had slept with Jules, Meredith responded, "I'm in no position to judge you on this. I do recommend you stay away from elevators for the foreseeable future," a clear reference to the early days of her relationship with Derek Shepherd (Patrick Dempsey).
But the new pair may not last the test of time as Jules later told Link, "You're a nice guy and we had fun but we don't have a relationship," after he asked her to sign HR paperwork.
The new interns encountered their first major trauma in the hospital after a bus blew off a cliff and flipped over during the tornado, leaving up to 14 people brain-dead. After learning that nine patients were organ donors, Mika announced it was an "organ-palooza."
"I can't state how inappropriate that is," Amelia Shepherd (Caterina Scorsone) responded, demanding that Mika should not talk for the rest of the day.
As they entered the E.R. and saw the patients in hospital beds, Simone said, "This just got super real."
The accident brought transplant surgeons from around the country, including Meredith's former love Nick Marsh (Scott Speedman), who returned from Minnesota for the first time in six months.
Once Maggie Pierce (Kelly McCreary) spotted him, she ran to inform Meredith, saying, "The man you love is here waiting for an organ in the surgical corridor." She then added that even Meredith's daughter Zola noticed her sadness over Nick being gone. Instead of addressing the status of their relationship, Meredith asked Nick to do her upcoming triple organ transplant.
As Meredith and Nick later waited to find out if the surgery would move forward, she admitted that she shouldn't have told him to go back to Minnesota. "I called after you. You didn't hear me," she said.
"Oh, I heard you," he replied. "I was hurt, I was. I wanted you to do more than call my name. I wanted you to put in some effort."
In another part of the hospital, Jules informed Maggie that there is a heart available for her patient Howard Jones and asked to join for the transplant surgery. However, they later discover they won't be able to use the heart after all.
Mika told her patient Marina's mother that "there is a chance she might live" after she showed signs of brain activity. When the mom admitted she was too afraid to hope, Mika said, "I will hope for Marina the way I would hope for my own sister."
Marina later opened her eyes and grabbed Mika's hand. When her mother saw her daughter awake after the accident, she told the doctor, "You did it. You hoped," as Amelia observed the conversation.
But it wasn't smooth sailing for all the new residents. Simone had to tell outspoken intern Lucas Adams (Niko Terho) that he informed the wrong patient's mother about their brain-dead status and fellow new intern Benson "Blue" Kwan (Harry Shum Jr.) responded, "Congratulations on your first day and also your last. Gotta be some sort of record, right?"
Amelia apologized for Lucas' error to the patient's mother and told her that her son was, in fact, declared brain dead. Lucas then informed her that the patient was Meredith's triple organ match after the mother requested that the tests be redone which would delay the organ transplant.
After informing Nick and Meredith of the mistake, Lucas threw up in a trashcan. When the patient's family doctor confirmed the results, Benson stepped in to tell his own story of losing his brother in an accident when he was only 16 and the power of donating his organs. The mother then agreed to the organ transplant. However, he later revealed that the story was a complete lie — and he wants in on the triple organ transplant for helping her.
Despite the mistake, Lucas was also able to scrub in on the surgery, and it was revealed that he, too, has a special connection to the hospital. Amelia casually referred to him as "Derek's favorite nephew" but told Meredith she worries if "has what it takes" to be the program. "He's a mess," she said. "He doesn't follow instructions. He has to do everything his own way. Did you hire him because he reminds you of Derek?"
"No, not Derek. He is a mess and he does need to do things his own way. He also has a stroke of the family genius and he's a bit of black sheep," Meredith responded. "You don't see it do you?" In other words, Lucas is just like Amelia.
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After the surgery was successfully completed, Meredith offered Nick the job of residency director. She said the new residents are "diamonds in the rough" and she was inspired to hire them because of Nick's own backstory.
She also suggested Levi Schmitt (Jake Borelli) as a good candidate for chief resident after the general surgery residency program was restarted.
Some familiar faces also made their return to Grey Sloan Memorial. Miranda Bailey (Chandra Wilson) came back to check on the new intern class after she quit her job at the end of last season. Bailey later told Richard that he made a residency class "from the bottom of the barrel, the rejects." She added, "That smacks of desperation. I will not cosign." But he defended the hiring decisions.
Owen Hunt (Kevin McKidd) and his wife Teddy Altman (Kim Raver) also returned to the hospital after he had his medical license suspended for illegally giving pills to veterans as a form of assisted suicide.
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Grey's Anatomy airs Thursdays at 9 p.m. ET on ABC.