The residents calling Derek, McDreary is a refernce to him being called McDreamy by the residents in early seasons.
Meredith: So, how about tonight you're not McDreary? You're just... You're just a guy in a bar.
Derek: And you're just a girl in a bar?
A refernce to when Meredith and Derek first meet in the bar. Derek is also wearing the same red shirt he wore when they first meet.
Charles: Oh, god. Just shoot me now.
Refernce to the season sixepisodesSantuary &Death and All of His Friends. Charles gets shot in Santuary by the gunman and later dies in Death and All of His Friends.
Alex: ...and O'Malley. 007. He, uh, failed his intern exam was never seen again.
Refernce to everyone calling George 007 when he screwed up an appy on his first day as an intern in the first episode A Hard Day's Night. George then failed his intern test in the season 3 finale Didn't We Almost Have it All?
Alex: I always say, never mess with the crazy chicks
Inside joke reference to Alex always dating chicks who go crazy. Alex dated Ava/Rebecca in season 4. And then Izzie when she kept seeing Denny in season 5.
Meredith (about Izzie): She was a girl in our class who was sleeping with a patient. And then she stole a transplant heart for him.
Refernce to season 2 when Izzie fell in love with Denny and then cut his L.V.A.D wires so he would move up on the transplant list and get a heart.
Jackson (about Cristina): Her and Preston Burke? Really?
Meredith: And apparently it was so scary for him, he actually had to leave the state.
This is a refernce to the first three seasons of the show in which Cristina dated Burke. Mer's comment about Burke leaving the state is a reference to the season 3 finale Didn't We Almost Have it All? where Burke leaves Cristina at the alter on their wedding day.
Bailey being a nervous push over is a nod to when we saw her as an intern (when she was a pushover) in the season 6 episode The Time Warp.
Also, Alex calling Bailey, Mandy is a refernce to when she was called that as a nervous intern.
This episode is named like Nirvana's song, "Heart-Shaped Box"
A woman in New England was really saved by having a heart transplant in which the organ, in fact, was preserved in a box.
Patrick Dempsey, who plays Derek Shepherd is wearing a Bowdoin College sweatshirt at the game at beginning of episode: Bowdoin is a small college in Maine where Patrick is from
Chyler Leigh (Lexie) does not appear in this episode.
Derek is blacklisted from ever doing a clinical trial again.
Mark says about making a patient looking like Frankenstein but Frankenstein is not the name of the monster that he was alluding to. Frankenstein is instead the name of the scientist who created the monster.
This episode spans the time of three months.
Callie and Mark's baby's name is: Sofia Robbin Sloan Torres.
Goof: Richard, Bailey, Cristina and a med student are in a room looking at a pheochromocytoma on an abdominal MRI scan. The medical student points to the transverse colon asking if that is the tumor. Cristina tells him it's the gallbladder. The gallbladder isn't even in the image they are pointing to. Also, Cristina later points out the kidney, "adrenal gland" and tumor, even though neither of the adrenal glands is actually present in that particular slice. However, the right kidney does demonstrate a round soft tissue lesion.
This episode originally aired just two days prior to the Tuscon Shooting.
If you look closely at the choir singing outside the hospital, you'll notice that it is the same group of 20 to 30 people digitally multiplied to create the illusion of a mass crowd.
In many television episodes with documentary story lines, most of the episode consists of showing the crew walking around and filming, with little attention paid to the final product. In this episode, however, the camera crew is rarely shown and the whole episode is the final documentary on the show Seattle Medical- Road to Recovery.