Editor's note: The episode "Night Shift" deals in topics of self-harm and suicide that may be triggering for readers.
Long-running medical drama ER, with its 15 seasons and 331 episodes, certainly covered a good deal of storytelling ground. The revolving staff of doctors, nurses, and staff at Chicago's County General fought to do their best for their patients while navigating joy, heartbreak, and any number of very real experiences that kept the series grounded, particularly in its earlier seasons.
While the show was a procedural, with things more or less reset to zero by the end of the episode, the series was far from boring. ER had many shocking moments over the course of its decade and a half on the air, from the heartbreaking to the heartwarming, to the kind that made us point at our TVs and yell incomprehensibly.
11 "The Honeymoon Is Over" (Season 13, Episode 23)
While the series did gradually start focusing more and more on the lives of County General's staff outside the ER fairly early on, it's safe to say that was the primary focus of those latter years, with romance and drama taking up as much time as the medicine itself. Season 13 saw Dr. Neela Rasgotra (Parminder Nagra) caught in a love triangle between her fellow doctors Ray Barnett (Shane West) and Tony Gates (John Stamos).
Despite arguably having much better chemistry with Ray, Neela decided to give a relationship with Tony a go, causing the two men to fight in a bar before Ray storms off and stops answering Neela's calls. It's not until two episodes later that she finds out why. It's not just that he was angry. It's because Ray was hit by a truck leaving the bar, damaging his legs so severely that both had to be amputated.
10 "The Show Must Go On" (Season 11, Episode 22)
ER really had a thing for the dramatic season finales, and the Season 11 closer was no exception. The episode was bookended with jaw-dropping moments, kicking things off with the type of large-scale property damage that would be remarkable in any other city in the world, but is par for the course in ER's Chicago. Ray and fellow doctor Archie Morris (Scott Grimes) attend a party that comes to an abrupt end when the balcony they're on collapses, turning the ER docs into ER patients.
The emotional crux of the episode, however, and the moment that feels shocking purely because it happened at all, is when ER mainstay Dr. John Carter (Noah Wyle) finishes his last shift at the hospital and walks out quietly into the night. This wasn't the first time Carter had left the hospital, previously taking several long stints at clinics in Africa, but knowing he would no longer be around after serving as the audience POV for 11 seasons left us staring at our TVs in disbelief.
9 "The Human Shield" (Season 12, Episode 7)
Not all shocks are bad, of course. Some can be sweet, like when a long-dormant romance flares back to life. After a fling that burned fast and bright midway through the series, Dr. Abby Lockhart (Maura Tierney) and the ER's resident heartthrob Dr. Luka Kovač (Goran Visnjic) had both moved on to other people and seemed happy to just stay friends. The power of friendship, however, has nothing on the power of chemistry.
With four long seasons between their breakup and their reunion, things weren't looking good for those of us invested in Luka and Abby's relationship, particularly when those four seasons weren't exactly filled with pining or longing looks from across the admit desk. It, therefore, came as a huge shock when, as Abby was distressed about losing a very young patient to something they should have prevented, Luka consoles her with a sudden, long, passionate kiss.
8 "Night Shift" (Season 3, Episode 11)
Dr. Peter Benton (Eriq La Salle) was known for being a brilliant surgeon, but a very exacting teacher. This led him to clash often with Carter, who did his best to keep up with Benton's standards, which would go on to inform his own standard of care down the line while retaining his softer bedside manner.
The same could not be said for one of Carter's fellow interns, Dr. Dennis Gant (Omar Epps), who was on the receiving end of frequent, very harsh criticism from Benton. The consequences of that became evident towards the end of "Night Shift." As the surgery team rushes to save an unrecognizable man hit by the L Train, it's only when his beeper goes off that Benton and Carter realize the man on their operating table is Gant.
7 "Partly Cloudy, Chance of Rain" (Season 8, Episode 8)
While Dr. Benton might be a demanding surgeon with a brusque bedside manner, one thing that could absolutely be said in his favor is that he is a good father. After navigating joint custody with his ex Carla (Lisa Nicole Carson), things grew more complicated when she was killed in an accident, leaving custody of their son Reese (Matthew Watkins) split between Benton and Carla's husband Roger (Vondie Curtis Hall).
As the custody battle between the two men is drawn out, Roger wins points for having more flexibility to care for Reese, while Benton's advantage comes from being Reese's biological father. The revelation that Reese is actually not Benton's biological son pulls the rug out from underneath the surly surgeon and forces him to truly weigh what matters to him in order for him to remain a part of his son's life.
6 "Chaos Theory" (Season 9, Episode 1)
In this day and age, what's truly shocking about Season 9 opener "Chaos Theory" is how terms like "quarantine," "PPE" and "N95" have entered our daily vocabulary. What's equally shocking is that even a TV episode from 2002 couldn't envision a population listening to medical advice while living on the cusp of a public health crisis. But that's not the shocking moment this episode is remembered for.
As the hospital is being evacuated, Surgery Chief Dr. Robert Romano escorts a patient up to the roof to be airlifted away. As he is arguing with Drs. Kovač and Lewis (Sherry Stringfield), he bends down to pick up a fallen chart, and stands back up directly in the path of one of the medical chopper's blades, severing his arm above the elbow.
5 "Rampage" (Season 7, Episode 22)
For 8 seasons, Dr. Mark Greene (Anthony Edwards) was the moral center of County General. No matter who came through their doors, he expected that his ER doctors and nurses would give everyone the same standard of care, no matter what their personal feelings might be. That changes when Derek Fossen (Ted Marcoux) is brought in for treatment after going on a shooting rampage, killing nine people.
Fossen, an abusive father, seeks revenge for the role Mark played in getting his son taken away from him. Despite this, Mark is still prepared to do his job and escort Fossen up for surgery. The two wind up alone in an elevator together when Fossen goes into cardiac arrest. It looks like Mark is about to use the defibrillator to save his life, but instead makes the split-second decision to let Fossen die instead.
4 "Life After Death" (Season 15, Episode 1)
It is widely acknowledged that of all the main character deaths on ER, the slow passing of Dr. Greene is the saddest, and we are not here to dispute that. But the death of Dr. Greg Pratt (Mekhi Phifer) comes in at a very close second, made all the worse by how abrupt and shocking it is.
Season 14 left off with an ambulance explosion, and it took until the Season 15 premiere for the characters and audiences to realize Pratt was inside. The team springs to action to save the life of their colleague, and for most of the episode it looks like they're going to succeed — Pratt is even lucid enough to give them pointers — until a tear in one of his arteries makes recovery impossible. With the full range of emotions playing on his face, Pratt dies quietly with his friends at his side.
3 "Love's Labor Lost" (Season 1, Episode 19)
From the very beginning, ER made it clear that the series was going to take a grittier, more realistic look at emergency medicine. Not everything would be tied off neatly with a bow in 45 minutes. Not every problem had a happy ending. Season 1's "Love's Labor Lost," pushed that line of thinking to its absolute limit.
What starts as a routine visit from a pregnant woman (Colleen Flynn) very quickly escalates into a hellish day for her and her husband (Bradley Whitford) when Mark misdiagnoses her and is forced to try and deliver their baby in the ER. With very little assistance, things end in tragic results when she ultimately dies on the table, in possibly the most brutal case ER had done before or since.
2 "Be Still My Heart" (Season 6, Episode 13)
Often cited as another one of the saddest ER episodes, along with the subsequent episode "All In The Family," the Valentine's Day-themed "Be Still My Heart" unfolds mostly like a typical episode, with each ER doctor running in a different direction to see to their patients.
Medical student Lucy Knight (Kellie Martin) is tasked with looking after Paul Sobriki (David Krumholtz), who she suspects is in need of psychiatric care. Her suspicion is proven correct when Carter goes looking for her and is stabbed by Sobriki. He falls to the floor, and it is only then that he suddenly spies Lucy barely conscious and covered in blood.
1 "Freefall" (Season 10, Episode 8)
Dr. Romano wasn't exactly a popular guy — abrasive, rude, sexist, homophobic, with just enough tiny moments of humanity shining through that saved him from being a Saturday morning cartoon villain. Interesting then, that his demise would come about in such a cartoonish way.
Still traumatized from losing his arm to a helicopter, Romano heads into the ambulance bay for a breather after dropping off a patient to be airlifted away. The helicopter on the hospital roof, however, gets caught in a cross-draft and tries to make an emergency landing. Instead, it tilts and slides off the roof and explodes, with the fiery debris landing in the ambulance bay — directly on top of Romano.