Warning! SPOILERS about Grey’s Anatomy season 21, episode 17 ahead.

Amelia Shepherd went through her share of heartbreak and difficulties, but her sobriety was always something she protected fiercely – her main story arc in Derek in Grey’s Anatomy, only to lose him and gain two new sisters in Meredith and Maggie Pierce. The relationships she cultivated in Seattle helped Amelia preserve her sobriety, even if it was tested every now and then in Grey’s Anatomy.

Amelia’s life in Seattle also helped her confidence in her career. Growing as a neurosurgeon in Derek’s shadow, Amelia felt the pressure of the comparison with her brother. Becoming the Head of Neurosurgery let Amelia recognize her abilities in her own right, with her job generally being a source of joy. With her and Meredith’s Alzheimer’s research necessarily taking a step back in Grey’s Anatomy season 21, Amelia found herself drawn to take on impossible cases that other surgeons had deemed inoperable. Dylan’s case in Grey’s Anatomy season 21, episode 17 is the first to emphasize how those affect Amelia.

Amelia's Impossible Cases Put An Unbelievable Amount Of Pressure On Her

Dylan Getting Worse In Grey's Anatomy Season 21, Episode 17 Showed That

First introduced in Grey’s Anatomy season 21, episode 3 by Teddy offering Amelia something to work on, the impossible cases took over Amelia’s arc in season 21. Amelia’s step-by-step approach and willingness to study Rhiannon’s scans to see if operating on her without terminating her pregnancy was possible established Amelia as the neurosurgeon to go to after others said no, in addition to letting Amelia honor one of Derek’s best Grey’s Anatomy cases. With Rhiannon’s case, Amelia officially decided to take on the most difficult surgeries to give patients who had been told no another chance.

Amelia’s impossible cases let her follow in Derek’s footsteps, honoring the multiple impossible cases he took on in more than a decade on Grey’s Anatomy.

Dylan displaying signs of Locked-in Syndrome in Grey’s Anatomy season 21, episode 17 wasn’t the first time Amelia faced difficulties with an impossible case. Indeed, Grey’s Anatomy season 21, episode 8 almost had a young patient die in Amelia’s OR after she managed to clip all the aneurysms, only for her heart not to restart after Amelia and Winston warmed her up. Jackie’s heart eventually restarted, making her case only a close call and not a tragedy.

Dylan’s young age and health made everything more difficult, and her worsening condition in Grey’s Anatomy season 21, episode 17 proved Amelia was right to be worried.

Dylan’s case was different from the beginning in Grey’s Anatomy season 21, episode 16. While being confident in her abilities, Amelia struggled with the pressure of taking on that case before Dylan’s surgery, and it was evident in the way she “bit [Monica’s] head off.” Dylan’s young age and health made everything more difficult, and her worsening condition in Grey’s Anatomy season 21, episode 17 proved Amelia was right to be worried. Grey’s Anatomy season 21 finale’s promo showing Dylan’s mother taking Dylan’s doctors hostage in the OR reveals that the pressure isn’t going away, potentially setting up Amelia’s downfall.

The Pressure On Amelia Can Threaten Her Sobriety In Grey's Anatomy

Amelia's Impossible Cases Have A Bigger Chance Of Going Wrong Than Right

When Teddy gave her Rhiannon’s case, Amelia was hesitant to take it on, not being overconfident and instead repeating how it had never been done before. That success brought many more patients whose cases were deemed inoperable. With their peculiarity being their extreme difficulty, the chances that Amelia could fail and her patient could die were higher.

While that had always been a possibility for surgery and Amelia’s specialty in particular, the fact that most of the cases that got to her were impossible ones can potentially threaten Amelia’s sobriety. Although Grey’s Anatomy season 21 hasn’t hinted at that eventuality at all, it highlighted multiple times how much pressure Amelia was under because of Dylan’s case. Big stressors, and the aftermath of Derek’s death proved so, greatly tested Amelia’s sobriety in the past, although she didn’t relapse at that time.

Why Amelia Relapsing Again Would Be A Massive Mistake In Grey's Anatomy

Amelia Already Considered Taking Drugs After Derek's Death & Briefly Relapsed In Season 12

Amelia seemingly reacted as if everything was normal when she learned that Derek had died. However, after she finally let herself feel, Amelia scored some drugs with the intention to take them, stopping only thanks to Owen’s . Grey’s Anatomy not only already toyed with Amelia’s sobriety, but it also let her briefly relapse previously, after a fight with Owen in season 12, when she accepted a drink from Riggs, who didn’t know about her sobriety. These occurrences in Grey’s Anatomy, along with her greatly detailed relapse in Private Practice, explain why Amelia shouldn’t relapse again in Grey’s Anatomy.

After the removal of her tumor and the painful ending of her and Owen’s marriage, Amelia was happy and stable. Between her rewarding career and having Scout, Amelia finally had a prolonged period of time when she might have been tempted, but never came close to relapse. Amelia’s impossible cases would cost too much if they were tackled at the expense of Amelia’s well-being, especially after the things she already had to go through in both Grey’s Anatomy and Private Practice.

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Grey’s Anatomy season 21’s finale airs on Thursday, May 15, 2025, at 10pm EST on ABC.