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As with so many flashbulb memories, fans of the medical drama “Grey’s Anatomy” likely remember where they were when Derek “McDreamy” Shepherd took his final breath.

In episode 21 of season 11, Patrick Dempsey, the show’s leading man and idealized love interest, was killed off in a car accident, much to the shock and dismay of the episode’s 8.83 million viewers.

But amid all of the drama, another story was playing out behind the scenes, according to a new book by author and entertainment reporter Lynette Rice.

In her forthcoming oral history, “How to Save a Life: The Inside Story of Grey’s Anatomy,” Rice recounts new details behind some of the show’s biggest moments and departures — including issues swirling around Dempsey’s exit, according to the Hollywood Reporter, which published an excerpt of the book Thursday.

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In more than 80 interviews with former and current cast members, Rice reveals exclusives about the show’s culture, as well as how some cast and crew members viewed Dempsey’s behavior on set, according to the Hollywood Reporter.

“There were HR issues. It wasn’t sexual in any way. He sort of was terrorizing the set. Some cast members had all sorts of PTSD with him,” James D. Parriott, a “Grey’s Anatomy” executive producer during Dempsey’s final season, tells Rice in the excerpt.

A publicist for Dempsey did not immediately return a request for comment about statements made in the new book, set to be released Sept. 21.

Things didn’t begin that way on the show, according to Rice. Hailing from Lewiston, Maine, Dempsey became a global heartthrob over the course of his run on “Grey’s.” His relationship with Meredith Grey, played by actress Ellen Pompeo, an Everett, Mass. native, was widely considered one of television’s most coveted and unbreakable bonds.

Leading up to season 11, cast and crew members describe an idyllic Dempsey, whose personality and charm mirrored that of his character. The show’s creator, Shonda Rhimes, was reportedly “protective” of McDreamy, insisting on framing him as the perfect man, and that persona translated off-camera to his fellow actors, crew members, and anyone who would come visit the set, Rice reported.

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But by his final season, fans might have noticed Dempsey’s absence while his character was “relocated” to a hospital in Washington, D.C. It was the first time in 250 episodes that McDreamy didn’t appear on-screen.

“There was a critical reason for Derek’s strange absence,” Rice writes, according to the Hollywood Reporter. “Behind the scenes, there was talk of Dempsey’s diva-like fits and tension between him and Pompeo.”

Pompeo reportedly grew frustrated with Dempsey and would “get angry when he wasn’t working as much. She was very big on having things be fair,” producer Jeannine Renshaw says in the book, according to the excerpt.

Publicists for Pompeo and “Grey’s Anatomy” creator Shonda Rhimes did not immediately return requests for comment.

Renshaw describes Dempsey as “the kid in class who wants to go to recess.” He’d often say, “I’ve been here too long,” or “What’s happening next?” Renshaw said she’d point out that other cast and crew members had been there just as long.

“He would go, ‘Oh, yeah.’ He would get it,” Renshaw told Rice. “It’s just that actors tend to see things from their own perspective.”

The show’s network — ABC — reportedly had sessions with Dempsey, according to the book. “I think he was just done with the show,” Parriott said, according to the excerpt. “He didn’t like the inconvenience of coming in every day and working. He and Shonda were at each other’s throats.”

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Dempsey seems to recall things differently. In an interview with Rice for the book, Dempsey talked about how his schedule was becoming a challenge: “But you have to be grateful, because you’re well compensated, so you can’t really complain because you don’t have a right. You don’t have control over your schedule. So, you have to just be flexible.”

Renshaw recounted that Dempsey’s complaining became the final straw for Rhimes: “Shonda had to say to the network, ‘If he doesn’t go, I go,’” according to the book.

Despite negotiations and several drafted storylines that kept McDreamy around, it was decided that bringing him back would be difficult on the other actors, Parriott said, according to the excerpt.

“I don’t think there was any way to exit him without him dying,” producer Stacy McKee told Rice. “He and Meredith were such an incredibly bonded couple at that point ... There was no exit that would honor that character other than if he were to die.”

Production tried to keep the details of Dempsey’s final episode a secret, and even shot in an abandoned hospital in California, according to Rice. Some actors had to sign non-disclosure agreements before production would give them the script.

“There was no goodbye party, no goodbye cake,” Rice wrote, according to the excerpt. “Maybe that’s because some cast members were left out of the loop.”

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Despite production’s extensive efforts to keep Dempsey’s fate a secret, an exclusive exit interview written by Rice in Entertainment Weekly leaked on the morning of Dempsey’s final episode.

Many cast and crew members described a “cooperative and good” Dempsey during filming of the death episode.

“I remember him being incredibly kind. They had his neck in a brace, and he’s strapped down to the board, so there wasn’t a ton of chatting. I remember him being really kind, but it was clearly intense for him,” actor Samantha Sloyan told Rice.

“I very quietly left,” Dempsey reflected in the excerpt. “It was beautiful. It was raining, which was really touching. I got in my [Porsche] Panamera, got in rush-hour traffic, and two hours later I was home.”

Whatever drama was swirling behind the scenes back in 2015, Dempsey made an emotional return to “Grey’s” for it’s 17th season during the COVID-19 pandemic. A romantic dream sequence reunited McDreamy with Meredith — and fans were riveted.

“I thought it was a beautiful way to close it,” Dempsey told Variety about the reunion in April. “The intention was to really give people some hope because they are such an iconic couple. We’ve lost so many people this year, the thought that we’d have angels hovering around us taking care of us is a good message to send out in such a bleak world that we’re living in.”

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Brittany Bowker can be reached at brittany.bowker@globe.com. Follow her on Twitter @brittbowker.