Miranda Bailey is introduced to the interns as "The Nazi" in the first season premiere because of her blunt attitude and demanding of respect. When she was still a resident, Webber once pointed out that she disliked nearly every attending she worked under and, indeed, the attendings take her seriously due to her formidable reputation. Off the bat she tells her interns to 'not bother sucking up cause I already hate you and that's not going to change' however Miranda's more motherly and protective side is exhibited as she increasingly cares about not only her patients but also her colleagues. She is protective of her interns, as shown when she warns Derek to stay away from Meredith. Miranda also stays beside Cristina's side as she recovers from surgery. It is later found out that she has been married for ten years and is expecting a baby. Her son was born during a bomb scare at Seattle Grace while her husband was in surgery with Dr. Derek Shepherd, having crashed his car on the way to the hospital. George O'Malley helped her through labor, and she thanked him by naming her son William George Bailey (though he is nicknamed "Tuck").
Bailey adjusts to becoming a parent and reconciling this with her desire to continue her career as a surgeon. Her professional confidence was shaken and questioned by other surgeons when Izzie Stevens cut Denny Duquette's LVAD wire and Denny subsequently died and Burke's secret was kept by Cristina; Bailey felt that she wasn't in control of her interns, and that the incidents were ultimately her fault. Dr. Richard Webber, Chief of Surgery, comforts her saying 'You raised them like babies, and some of them turn out just like you'. Disillusioned by how little she can help patients as a surgeon, Bailey decided to open a free clinic at Seattle Grace; The Denny Duquette Memorial Clinic has since opened, paid for using part of the $8.7 million bequeathed to Izzie by Denny Duquette. She competed for the post of Chief Resident but lost to Callie Torres.
After losing the Chief Resident position Miranda decided to be Callie's "number two," as Torres was lacking competence. The Chief saw Bailey pick up the slack and told Bailey that he made a mistake in not giving her the job in the first place. Miranda helped save the life of a white supremacist paramedic despite his racist treatment of her. When closing his stomach after the surgery, she comments to George that the incision will need to be aligned better, thus ruining the patient's large swastika tattoo on his stomach. Following severe injuries to her son and several arguments over the state of their marriage, Doctor Bailey and her husband separated because her husband believed that she placed her job at the hospital before her family and that it led to Tucker's injuries. Miranda realizes that if she wants to continue with her surgical career, she will not be able to remain in control of the clinic, and so hands over the reins to Izzie Stevens, telling her she has earned it.
After watching the residents fight after the chance to do a solo surgery Bailey realizes that she has become somewhat bored with General Surgery and may need a change of specialty. She became drawn to Pediatric surgery after working on a number of pediatric case and working closely with, (and having many arguments with, Arizona Robbins, a Pediatric surgeon. Chief Webber is unhappy with Bailey's decision to leave General Surgery, and discouraged her at every opportunity, giving her an uninspiring letter of recommendation and purchasing a surgical robot to lure her back to General Surgery. Ultimately, Bailey decided to continue to pursue her career in General Surgery because she had a fight with her husband who said that if she accepted a position as a Peds fellow, he would divorce her. She decides to go through with the divorce and states there will be no time to start a new specialty as a single-mom. Additionally, Bailey supports Izzie through her rounds of chemo and cancer treatments.
After declining a fellowship in Pediatrics Bailey starts as an Attending in General Surgery. Bailey is deeply hurt by the news of George's death and Izzie's near-death that she realizes that she is caring about them like her own children. She begins a relationship with the anesthesiologist from Mercy West, Ben Warren. After witnessing Charles Percy being shot Bailey is caught at gunpoint when Gary Clark comes back to the hospital. She grows close with a patient, Mary Portman who was to get her colostomy bag removed that day, when she fights to save Charles' life. She is unsuccessful in getting him down to the OR and Charles dies in Miranda's lap. As Miranda comforts him Charles' last words were "You [Bailey] were always my favorite, I thought you should know".
Left devastated, Bailey goes to visit her parents with her son and upon coming back breaks up with Ben trying to hold it together. Mary Portman comes back to get her surgery however ends up in a coma after the surgery and dies, with no known cause. Miranda starts on a quest to cure fistulas and encounters a nurse, Eli, who she starts dating.
Dr. Bailey takes Meredith's deceit in the Alzheimer's trial personally, and she takes her anger out on Meredith throughout the first when Richard resigns as head of surgery and takes the fall for Meredith's mistake. Dr. Bailey resumes control of Ellis Grey's Diabetes trial and Richard consistently pushes Dr. Bailey to forgive Meredith and put her on the trial. Bailey forgives Meredith admitting that her anger stemmed from her frustration at seeing her interns stand up for principles at the detriment of their careers (Meredith) and lives (George). Bailey breaks off her relationship with Eli, recognizing that she was not interested in pursuing the relationship further, and renews her relationships with Ben the anesthesiologist. Though she eventually moves in with him and Ben asks her to marry him on a crossword puzzle. However, at the moment she is about to say yes, he tells her he landed a surgical internship in California.
They become engaged and her newfound happiness leads to her being dubbed as BCB ("Booty Call Bailey") by new interns because whenever Ben is in town she is giddy and has sex with him as much as possible. On the way to her wedding, Bailey is pulled in to perform surgery on Richard's wife, Adele. After saving Adele she returns to the venue and gets married to Ben. She launches a genome mapping program and Meredith is the first one to test it. An investigation on Bailey takes place after three of her patients contracted an infection and died. It concludes that she initially had the infection but that it spread via permeable gloves, which are a new brand the hospital had been recently using. Following that incident, Bailey shuts everyone out for some time, because she feels that she is dirty and contaminated. She blamed Dr. Webber the most for abandoning her and avoids him altogether. Eventually, her husband, Ben, flies to Seattle to get her out of the genome lab. In the first part of the season finale, Bailey returns to work but does not go into the surgical OR. Eventually, with Dr. Webber's stern push, she decides to be on the OR rotation for the upcoming storm along with her intern, Shane Ross.
After feeling responsible for the electrocution of Richard Webber, Bailey takes him on as a patient. Bailey's husband Ben returns for Halloween and states that he has dropped out of residency to spend more time with her and Tuck. Bailey is not impressed by this decision and starts exhibiting some odd behaviors. Ben suggests that Bailey might have developed OCD after what happened with the CDC investigation.
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