Longtime ‘Grey’s Anatomy’ Writer Zoanne Clack on Penning Her Literally Explosive Episode

For Zoanne Clack, writing an episode of Grey’s Anatomy is “all about the theme.” For the fifth episode of this season, titled “You Make My Heart Explode,” the focus was “fake it till you make it,” and since it’s a tale as old as time, we got to see our favorite doctors fumble, succeed, and witness some wild medical marvels.

Clack, who’s been a Grey’s Anatomy writer essentially since the beginning and has also served as an executive story editor and producer for the show, tells Shondaland, “You try your best and do what you can, and even if you don’t know how, you push through. It’s all linked within that theme, and it determines how each scene is going to move you forward. We also usually try to do something either funny or sad or heartbreaking or ‘Wow!’ to make sure there’s something in each scene that can really get to a person. And then, you weave them together.”

The tension-filled episode was quite literally explosive, with a patient’s heart erupting blood post-surgery. It also saw Levi and Lucas put into extreme peril after going to pick up a young patient in a helicopter, leading to an impromptu save midair. There was more bickering between Teddy and Owen and an argument between Jo and Link, both of which were eventually resolved. Ben and Winston found themselves at odds over a patient, while Blue stood up for Zayne, the hospital’s janitor, who was suffering from symptoms of sickle cell disease. And meanwhile, Simone just wanted everyone to vote.

“This is the last episode before the election,” Clack explains. “We wanted to make sure people had voting in their minds and would get out there and do it.”

Here, Clack, who is herself a doctor and was the showrunner for the final season of Station 19, discusses what went into penning “You Make My Heart Explode.”


EMILY ZEMLER: How do you find the right starting point when writing an episode?

ZOANNE CLACK: The initial inspiration always comes from the characters. Where are we trying to get them? Where are we moving them to? What just transpired in the last episode? That said, in this particular episode I did have some ideas about the medical aspects I wanted to pursue. I wanted to try to fit them with what the characters were doing. And the sickle cell story was important. We’ve been trying to do a sickle cell story for a number of years, and they kept falling out. We finally got an opportunity to showcase that because the FDA just approved the gene therapy for it. I thought that was an important point to try to get out into the world.

EZ: With the sickle cell storyline, why did you decide to spotlight a hospital employee who is not one of the medical professionals?

ZC: It’s the idea of “He’s working right under our nose and couldn’t get the kind of care he needed, even though he’s basically one of us, being in the hospital himself.” And he was working through the pain. He’s one of the worker bees who is seen and not heard. I always think it’s amazing to spotlight those people. We were going to spotlight someone like him during Covid, and then so many other things happened, so we never got to do it, but it always stuck with me. I always love to be able to highlight them as having a voice, and having needs, and having lives outside of the hospital. What they are doing makes our lives easier. I was able to mix two things together because Ofelia [the name of the little girl in the helicopter] is named after our actual housekeeper here at Grey’s.

EZ: Will we see more of Mr. Johnson in future episodes?

ZC: I would have liked to have seen more, but I don’t think we’re going have time during the season. I would have liked to have seen him coming in and figuring out how to get the treatment and living without sickle cell. What does that look like? Maybe next season.

EZ: How did the exploding-heart storyline come about?

ZC: I literally saw it when I was doing research for the show. I saw a nurse who had posted that this happened, and then I ran it by our cardiothoracic surgeon to see if it was hyperbole. And he was like, “No, it could absolutely happen.” And I was like, “I have to do that.” Originally, in my mind, it was going to be a Ben story. He’s usually the one who, without thinking, will just open people up. But since he’s on trial as a resident, he would be a little hesitant to open him up, and that’s when the big explosion happened. But character-wise, it felt like it worked better for what Teddy and Owen were going through: tension, tension, tension, explode, fun, now everything’s okay. So, it worked in a dual way.

EZ: What sort of details did you need to know to write that scene?

ZC: First of all, we had to know how big it could be realistically. And then go up 10 percent from there. Then we had to get the details of how the explosion could happen, even though he was stitched up. Did he have to be stitched up? What was the configuration of that? What kind of surgery would he have had to have had to build up like that? Those were the main things we asked the cardiothoracic surgeon. Originally, he was just going to be there for a bypass surgery, but I think the surgeon told us there was some kind of trauma that needed to have happened to get him to where we wanted him. So, that’s why he was involved in a motor vehicle accident instead. In terms of the amount of blood, I wrote, “It was like in Alien when it explodes from the guy’s chest.” We also talked about people looking like they were in Carrie after it happened.

EZ: Fans know that Jake Borelli is leaving the show this season. What did you want to showcase about his character Levi in this episode?

ZC: We really just wanted to showcase him just as being kind of a badass. We needed to see his skill and also lead him on the trajectory of his exit. In this episode, we wanted him to have a trajectory of victory and not failure or death.

EZ: The helicopter scenes were very stressful. How did you know how much tension to create?

ZC: There were so many different levels. First, it takes maybe 30 minutes to get from there to there, right? So, we had to build in some tension as to why he would have to do this surgery in the helicopter versus just waiting to get to the hospital. So, of course, rainstorm, which is easy because it’s Seattle. Then we had to get around the rainstorm, so that was going to take extra time. Then she had the seizure because of the organophosphate poisoning, which was the thing that really elevated it, because just having the tourniquet on will cause a person to lose their leg if it’s on for too long. So, the tourniquet by itself was going to be a problem when we were rerouted. We always like to put things on a clock.

EZ: There was never an intention to crash the helicopter, though, right?

ZC: No. Initially, we hadn’t really thought about it, but as we were breaking the episode, we were like, “Oh, my God, people are going to know that he’s leaving, and this is going to be another Grey’s situation.” Which is perfectly great. And part of the way we pushed that thought was not seeing him for a while and having the people at the hospital fretting about him, and it’s very stressful, and then a sigh of relief when you see them going to get them from the helicopter.

EZ: Do you typically write the voice-over narration as you go along or after you’ve finalized the episode?

ZC: You could do either. This one was written after. I changed the voice-over a bunch of times. It always highlights the theme. So, we try something that’s highlighting the medical side of it all in the beginning and then give it more of a personal feel at the end.

EZ: Is there a character you look forward to writing for the most?

ZC: It seems so obvious but Chandra Wilson as Miranda Bailey. I’ve been here since the beginning; she’s been here since the beginning. I do a lot of work for Black doctor organizations, and there are a lot of Black women who have been inspired by Bailey throughout the 20 years. It warms my heart, and she’s just a very dear person.

chandra wilson

Anne Marie Fox

Chandra Wilson

EZ: Toward the end of the episode, there’s a big focus on the inequalities in the American health care industry. Why was it important to include that?

ZC: It’s so important to me in general. Covid brought out so many of those inequities and so many of the social determinants of health. There’s more than just what you have. Why do you have it? What is your social situation? Where do you live? What’s your environment? What are your stressors like? It’s really important to bring those kinds of things to light. I think it’s lovely to highlight that there’s more to health than just what we see in the hospital.

I used to say that I validated my existence because of this thing called entertainment education. It’s the ability to have people learn about different social issues and health issues and public health issues all through entertainment, where they’re learning without knowing they’re learning. We’re not going to be a documentary. We’re not going to tell you all the facts, but it gives you a springboard to go and look up something. Or maybe “Oh, my God, I’ve had those symptoms.” I’m tooting my own horn here, but we’ve saved some lives.

EZ: Do people come and let you know when that happens?

ZC: Yeah. With the breast cancer story with Maggie’s mom, there was a lady who went back to her doctor and said, “No, I have this rash. I need you to look further.” And because she did that, they found the breast cancer early. And there was a heart thing where a woman saw Grey’s and got her baby the surgery he needed because she saw it on the show. There’s been a lot of things like that. It’s really important to me that not only health information gets out, but accurate health information gets out. It’s funny to me because being a doctor, the writers have no boundaries. They just pitch things. So, for the first few years, I was like, “No, no, no,” and I had to learn to say yes, and merge my left and right brain. Since I do have boundaries, the reality can actually add to the story sometimes — things that they haven’t thought of — but then also the imagination can add to it, and we can get there in a really interesting way. It’s been this fascinating process throughout the years of opening that up and learning all of these intricacies and being able to tell important stories.

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