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We usually open on grand, sweeping views of Seattle. A voice takes over, usually Meredith's, and it picks a very particular topic of discussion. Sometimes it's a big life theme, like "gratitude." Sometimes, she picks an idiom, like "the early bird gets the worm," as a jumping off point. Sometimes she uses doctor speak as an allegory, like a meditation on "scars" or "wounds."
It's not always Meredith. We've had Cristina, and Derek, and more. But it's pretty much always a voice-over.