We’re 16 seasons in, and quite a few doctors have come and gone over the years. So, it wouldn’t be surprising if Alex’s exit plays out similarly to a previous one. He could die as the result of his injuries in a gruesome manner that leaves him unrecognizable (since Chambers isn’t in the episode) and the others realize too late — or with just enough time to say goodbye.
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He did rekindle an old flame
After learning her married patient reconnected with a high school ex, Jo worried her husband “ran into some old girlfriend from high school and one thing led to another.” Maybe there is some truth to that — but maybe she shouldn’t be thinking about an ex from his teen years. Sure, Alex and Izzie’s relationship was certainly (very) messy at times, but maybe this will be the best way to give him a clean break from Seattle, the hospital, his wife, and even (at least) some of his friends.
He didn’t want to burden Jo
Maybe he’s off dealing with something (and used his mother as an excuse to not invite questions) and didn’t want Jo to feel she had to drop everything to help him.
Maybe he claimed to be visiting his mother in Iowa as a bit of a clue. Maybe he’s worried that one day he, too, could be schizophrenic and need help from a family member. However, instead of burdening his wife, he decided to leave. It’s weak and not likely, but it would be one way to write the character out without ruining his development over the years.
Alex is off finding himself
This might be the best option to remain vague about his and Jo’s future for the time being and without erasing all his character development over 16 seasons. After all, he was fired from Grey Sloan and tried to turn around Pac-North earlier this year. And if he was struggling with where he is, especially professionally, celebrating Catherine buying Pac-North with emojis in a text would fit.
He is dealing with his family (eventually)
He may not be in Iowa yet, but perhaps he got delayed on his way and he will be staying with his mother to help her out (eventually).
He has a new job
Alex failed to steal Jo from Grey Sloan — back when Pac-North was a thing and he was recruiting doctors left and right — and lost the bidding war. Maybe rather than asking Jo to pack up her life and move with him (and perhaps not even really wanting her to, despite legally getting married earlier this season), he didn’t even offer her a choice about their future.
He was murdered on his way to Iowa
Though he claimed to be in Iowa dealing with family issues, that appears to be a lie. According to his mother, he’s not there and he never has been. What if he was killed on his way, and his murderer has been sending texts (and using previous ones as a guide) to keep up the ruse that he’s still alive? This is quite the stretch, but you never know.
Following news of Justin Chambers' exit in January, the ABC drama has given us bits and pieces about what his character has been up to off-screen. He was presumably off taking care of his mother, only for Meredith (Ellen Pompeo) and Jo (Camilla Luddington) to both reveal that wasn't the case in Episode 15.