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St. Elsewhere
Title card of season 1
Genre
Created by
Developed by
Starring
Theme music composerDave Grusin
Composers
Country of originUnited States
Original languageEnglish
No. of seasons6
No. of episodes137 (list of episodes)
Production
Executive producers
Producers
  • John Masius
  • Tom Fontana
Production locationsCBS Studio Center
Studio City, Los Angeles, California
Running time45–48 minutes
Production companyMTM Enterprises
Original release
NetworkNBC
ReleaseOctober 26, 1982 (1982-10-26) –
May 25, 1988 (1988-05-25)

St. Elsewhere is an American medical drama television series created by Joshua Brand and John Falsey that originally ran on NBC from October 26, 1982, to May 25, 1988. The series stars Ed Flanders, Norman Lloyd, and William Daniels as teaching doctors at an aging, run-down Boston hospital who give interns a promising future in making critical medical and life decisions. The series was produced by MTM Enterprises, which had success with a similar NBC series, the police drama Hill Street Blues, during that same time. The series were often compared to each other for their use of ensemble casts and overlapping serialized storylines (an original ad for St. Elsewhere quoted a critic that called the series "Hill Street Blues in a hospital").

Recognized for its gritty, realistic drama, St. Elsewhere gained a small yet loyal following (the series never ranked higher than 47th place in the yearly Nielsen ratings) over its six-season, 137-episode run; however, the series also found a strong audience in Nielsen's 18–49 age demographic, a demo later known as a young, affluent audience that TV advertisers were eager to reach.[1] The series also earned critical acclaim during its run, earning 13 Emmy Awards for its writing, acting, and directing and is widely regarded as one of the greatest television shows of all time.[2][3][4][5]

Overview

[edit]

St. Elsewhere was set at the fictional St. Eligius Hospital, a decaying urban teaching hospital in Boston's South End neighborhood. (The South End's Franklin Square House Apartments, formerly known as the St. James Hotel and located next to Franklin and Blackstone Squares, stood in for the hospital in establishing shots, including the series' opening sequence.)[6] The hospital's nickname, "St. Elsewhere", is a slang term used in the medical field to refer to lesser-equipped hospitals that serve patients turned away by more prestigious institutions; it is also used in medical academe to refer to teaching hospitals in general.[citation needed]

In the pilot episode, surgeon Dr. Mark Craig (William Daniels) informs his colleagues that the local Boston media had bestowed the derogatory nickname upon St. Eligius since they perceived the hospital as "a dumping ground, a place you wouldn't want to send your mother-in-law." In fact, the hospital was so poorly regarded that its shrine to Saint Eligius was commonly defiled by the hospital's visitors and staff. Despite the hospital's reputation, they employed some first-rate doctors—including Craig, a world-class heart surgeon. As well, their administrative staff was shown to care deeply about the hospital's mission, even as they dealt with a lack of up-to-date equipment, funding, and experienced personnel.

Just as in Hill Street Blues, St. Elsewhere employed a large ensemble cast, a gritty, "realistic" visual style, and a multitude of interlocking serialized stories, many of which continued over the course of multiple episodes or seasons. In the same way Hill Street was regarded as a groundbreaking police drama, St. Elsewhere also broke new ground in medical dramas, creating a template that influenced ER, Chicago Hope, and other later shows in the genre. St. Elsewhere portrayed the medical profession as an admirable but less-than-perfect endeavor; the St. Eligius staff, while mostly having good intentions in serving their patients, all had their own personal and professional problems, with the two often intertwining. The staff's problems, and those of their patients (some of whom did not survive), were often contemporary in nature, with storylines involving breast cancer, AIDS, and addiction. Though the series dealt with serious issues of life, death, the medical profession, and the human effects of all three, a substantial number of comedic moments, inside jokes, and references to television history were included, as well as tender moments of humanity.[7]

The producers for the series were Bruce Paltrow, Mark Tinker, John Masius, Tom Fontana, John Falsey and Abby Singer. Tinker, Masius, Fontana, and Paltrow wrote a number of episodes as well; other writers included John Tinker, John Ford Noonan, Charles H. Eglee, Eric Overmyer, Channing Gibson, and Aram Saroyan.

The cast of St. Elsewhere (season one)

The show's main and end title theme was composed by famed jazz musician and composer Dave Grusin. Noted film and TV composer J. A. C. Redford wrote the music for the series (except for the pilot, which was scored by Grusin). No soundtrack was ever released, but the theme was released in two different versions: the original TV mix and edit appeared on TVT Records' compilation Television's Greatest Hits, Vol. 3: 70s & 80s, and Grusin recorded a full-length version for inclusion on his Night Lines album, released in 1983.

Main cast

[edit]

Along with established actors Ed Flanders, Norman Lloyd and William Daniels, St. Elsewhere's ensemble cast included David Morse, Alfre Woodard, Bruce Greenwood, Christina Pickles, Kyle Secor, Ed Begley Jr., Stephen Furst, Howie Mandel, Mark Harmon, and Denzel Washington. Notable guest stars include Tim Robbins, whose first major role was in the series' first three episodes as domestic terrorist Andrew Reinhardt, and Doris Roberts and James Coco, who each earned Emmy Awards for their season-one appearance as a bag lady and her mentally challenged husband.

Actor Character Seasons
1 2 3 4 5 6
Starring
Ed Flanders Dr. Donald Westphall Main
David Birney Dr. Ben Samuels Main
Norman Lloyd Dr. Daniel Auschlander Recurring Main
Ronny Cox Dr. John Gideon Main
William Daniels Dr. Mark Craig Main
Also Starring
G.W. Bailey Dr. Hugh Beale Main
Ed Begley Jr. Dr. Victor Ehrlich Main
Terence Knox Dr. Peter White Main Guest
Howie Mandel Dr. Wayne Fiscus Main
David Morse Dr. Jack Morrison Main
Christina Pickles Nurse Helen Rosenthal Main
Kavi Raz Dr. Vijay Kochar Main Recurring Guest
Cynthia Sikes Dr. Annie Cavanero Main
Denzel Washington Dr. Phillip Chandler Main
Ellen Bry Nurse Shirley Daniels Recurring Main Guest
Mark Harmon Dr. Robert Caldwell Main
Eric Laneuville Luther Hawkins Recurring Main
Kim Miyori Dr. Wendy Armstrong Recurring Main
Nancy Stafford Joan Halloran Main Recurring Guest
Stephen Furst Dr. Elliot Axelrod Recurring Main
Bonnie Bartlett Ellen Craig Recurring Main
Bruce Greenwood Dr. Seth Griffin Main
Cindy Pickett Dr. Carol Novino Recurring Main
Sagan Lewis Dr. Jacqueline Wade Recurring Main
France Nuyen Dr. Paulette Kiem Recurring Main
Jennifer Savidge Nurse Lucy Papandreo Recurring Main
Recurring
Barbara Whinnery Dr. Cathy Martin Recurring Guest
Byron Stewart Warren Coolidge Guest Recurring
Alfre Woodard Dr. Roxanne Turner Recurring Guest

Episodes

[edit]
SeasonEpisodesOriginally released
First releasedLast released
122October 26, 1982 (1982-10-26)May 3, 1983 (1983-05-03)
222October 26, 1983 (1983-10-26)May 16, 1984 (1984-05-16)
324September 19, 1984 (1984-09-19)March 27, 1985 (1985-03-27)
424September 18, 1985 (1985-09-18)May 7, 1986 (1986-05-07)
523September 24, 1986 (1986-09-24)May 27, 1987 (1987-05-27)
622September 16, 1987 (1987-09-16)May 25, 1988 (1988-05-25)

St. Elsewhere ran for six seasons and 137 episodes; the first season (1982–83) aired Tuesdays at 10 p.m. (ET), with remaining seasons airing Wednesdays at 10 p.m.

St. Elsewhere was noteworthy for featuring episodes with unusual aspects or significant changes to the series' status quo. Some of those episodes included:

"Qui Transtulit Sustinet"

[edit]

Original air date: November 16, 1983

Dr. Morrison learns of the death of his wife, Nina (with whom he had an argument midway through the previous episode, which was the last time he saw her alive), after slipping and hitting her head. Nina's heart is donated to a heart transplant patient—a patient of Dr. Craig. The poignant final scene of the episode finds Morrison entering the patient's room and, with a stethoscope, hearing the patient's new heart—Nina's heart—steadily beating.

"Cheers"

[edit]

Original air date: March 27, 1985

St. Elsewhere ended its 3rd season with this TV crossover that found Drs. Westphall, Auschlander, and Craig getting together at Cheers. The scene, which was filmed on the main Cheers soundstage (Stage 25 at the Paramount Studios lot), finds Cliff Clavin trying and failing to gain free medical advice from the doctors, Auschlander confronting his former accountant Norm Peterson, and barmaid Carla Tortelli voicing her displeasure with the doctors regarding her stay in St. Eligius two years earlier for the birth of her baby. The scene ends with Westphall announcing to his two colleagues that he has decided to leave St. Eligius and medicine, a short-lived departure, as he returned in the Season 4 premiere.

The merger of Cheers' and St. Elsewhere's universes created a discontinuity with the second season finale, "Hello, Goodbye", in which Dr. Morrison and his young son spend a day on the town and visit the real-world Bull and Finch Pub, the banners out front celebrating it as the inspiration for (and exterior view of) Cheers.

"Time Heals"

[edit]

Original air date: February 19 and 20, 1986

This two-part episode featured storylines that fleshed out the 50-year history of St. Eligius, each sequence taped in a different style (i.e. black-and-white for the 1930s setting, muted colors for the 1940s). The storylines included the hospital's 1936 founding by Fr. Joseph McCabe (played by Edward Herrmann), the arrivals of Dr. Auschlander and Nurse Rosenthal, the early struggles of Mark Craig and his relationship with his mentor (which mirrored Craig's later mentoring of Dr. Ehrlich), the death of Dr. Westphall's wife, and Dr. Morrison simultaneously dealing with an overdose patient, a knee injury, and the disappearance of his son. TV Guide ranked "Time Heals" No. 44 on its 1997 list of "100 Greatest Episodes of All Time", calling the episode "a masterwork of dramatic writing."[8]

"After Life"

[edit]

Original air date: November 26, 1986

This episode deals with the shooting of Dr. Wayne Fiscus, who is critically wounded after being shot by the vengeful wife of a patient he is treating in the ER. As the staff frantically try to save him, Fiscus ventures back-and-forth between Hell (where he meets a former colleague, rapist Peter White), Purgatory, and Heaven, where he has a conversation with God, who presents Himself as a spitting image of Fiscus. Just as Fiscus shakes hands with Lou Gehrig, his colleagues successfully revive him.

"Last Dance at the Wrecker's Ball"

[edit]

Original air date: May 27, 1987

In the season-five finale, all attempts to save St. Eligius from closing seem to have failed. As demolition begins, a frail Dr. Auschlander, accidentally left in the hospital after a relapse, attempts to escape.

"A Moon For the Misbegotten"

[edit]

Original air date: September 30, 1987

St. Eligius is saved (and any damage from the above-mentioned "Wrecker's Ball" repaired), but it falls under the new ownership of Ecumena Corporation, a national managed health care concern. (The use of "Ecumena" garnered some real-life controversy, as Humana thought the use of that name sounded too much like its own. The trademark-infringement lawsuit that ensued prompted NBC to begin airing post-episode disclaimers stating that Ecumena was indeed fictional,[9] and to change the corporate name mid-season to "Weigert".[10]) Ecumena's choice to head St. Eligius, Dr. John Gideon, did not get along well with the St. Eligius staff, especially Dr. Westphall, who, in the final scene of this episode (and Ed Flanders's last moment as a St. Elsewhere series regular), delivers his resignation "in terms you can understand"—by dropping his pants and exposing his bare buttocks to Gideon ("You can kiss my ass, pal"). This scene, which would normally be considered controversial, was preserved by NBC's censors as they did not consider Westphall's display to be erotic in nature.[11]

"Their Town"

[edit]

Original air date: April 20, 1988

In a somewhat change-of-pace episode, Drs. Craig and Novino, Ellen Craig, and Lizzie Westphall visit Donald and Tommy Westphall (Lizzie's father and brother, respectively), who appear to be enjoying the quiet life in small town New Hampshire. The episode features Dr. Westphall occasionally breaking the fourth wall and speaking directly to the viewer, a la the "Stage Manager" character in Our Town (the episode title and its location are nods to the Thornton Wilder play). The teleplay for "Their Town" was written by St. Elsewhere cast member Sagan Lewis (as "S.J. Lewis"), although her character of Dr. Wade does not appear.

"The Last One"

[edit]

Original air date: May 25, 1988

St. Elsewhere's series finale features momentous changes for several main characters, including the departures of Drs. Fiscus and Morrison and the death of Dr. Auschlander, as well as the return of Dr. Westphall to an active leadership role at St. Eligius after Weigert agrees to sell the hospital back to the Boston archdiocese, as Dr. Gideon is set to move on to another hospital in San Jose, California.

The finale is more known for its provocative final scene: Westphall and his son Tommy Westphall (played by Chad Allen), who has autism, are seen in Dr. Auschlander's office watching snow falling outside. The image cuts to an exterior shot of the hospital, shaking. At that moment, Tommy and Daniel Auschlander are seen in an apartment building, with Tommy sitting on the floor playing with a snow globe. A much younger-looking Donald arrives home from a day of work, and it is clear from the uniform he wears and the dialog in this scene that he works in construction. "Auschlander" is revealed to be Donald's father, and thus Tommy's grandfather. Donald laments to his father, "I don't understand this autism thing, Pop. Here's my son. I talk to him. I don't even know if he can hear me, because he sits there, all day long, in his own world, staring at that toy. What's he thinking about?" As Tommy shakes the snow globe, he is told by his father to come and wash his hands for dinner. Donald places the snow globe on the family's television set and walks into the kitchen with Tommy and Auschlander; as they leave the room, the camera closes in on the snow globe—which holds a replica of St. Eligius.[12]

The most common interpretation of this scene is that the entire series of events in the series St. Elsewhere has been a product of Tommy Westphall's imagination, with elements of the above scene used as its own evidence.[13][14] Author Cynthia Burkhead explains that with this final shot, "St. Elsewhere managed to take the idea of a dream and alter it just enough, putting it in the imagination of an autistic boy", and surmises that an ending constructed in this manner "reminds viewers that the fiction they have watched for six years is actually fiction within a fiction, occupying a second level of unreality, one level beyond the space of illusion filled by all narrative television."[15] A notable result of this ending has been the attempt by individuals to determine how many television shows are also products of Tommy Westphall's mind owing to its shared fictional characters (the "Tommy Westphall Universe").

"The Last One"'s closing credits differ from those of the rest of the series. In all other episodes, the credits appear over a still image of an ongoing surgical operation, followed by the traditional MTM Productions black-backgrounded logo, featuring Mimsie the Cat in a cartoon surgical cap and mask. Here, the credits appear on a black background, flanked by an electrocardiogram and an IV bag, with Mimsie lying on her side at the top of the screen; at the end of the credits, the heart monitor flatlines, and Mimsie dies, thus ending St. Elsewhere for good. Coincidentally, Mimsie the Cat died in real life shortly after the airing of "The Last One" at the age of 20.[16]

"The Last One" brought in 22.5 million viewers, ranking 7th out of 68 programs that week and attracting a 17.0/29 rating/share, and ranking as the most watched episode of the series.[17] In 2011, the finale was ranked No. 12 on the TV Guide Network special TV's Most Unforgettable Finales.[18]

Broadcast history and Nielsen ratings

[edit]
Season Time slot (ET) Rank Rating
1982–83 Tuesdays 10 p.m. #87 N/A
1983–84 Wednesdays 10 p.m. #70 13.2
1984–85 #49 13.4
1985–86 #53 13.8
1986–87 #55 13.4
1987–88 #47 13.3

The ratings for St. Elsewhere's first season were so poor that NBC hesitated to renew the show and the crew understood it to be cancelled. After a ratings pop from the season finale, network CEO Grant Tinker (Mark's father and a co-founder of MTM) personally intervened to continue the show. However, it struggled for renewals throughout its run due to its below-average overall ratings/viewership.[19][20]

Allusions, crossovers, and homages

[edit]

St. Elsewhere was known for the insertion of several allusions both large and small to classic movies, pop culture, and television events (the latter especially) throughout its run, including other shows that were produced by MTM Enterprises.[1] Some of the more noteworthy allusions have included:

  • The St. Eligius public address loudspeakers periodically summoned characters from other television series, often going unnoticed by the show's characters.
  • The character of hospital orderly Warren Coolidge (played by Byron Stewart) was carried over from The White Shadow, where Coolidge had been a student at Carver High. (Before St. Elsewhere, Bruce Paltrow served as Shadow's showrunner.) Coolidge occasionally sported a Carver High T-shirt while working at St. Eligius. In third-season episode "Any Portrait in a Storm", Coolidge sees guest star Timothy Van Patten (another Shadow alumnus) in an elevator and calls out "Hey! Salami!," to which Van Patten, playing an unrelated character (named Dean, in a three episode story arc), replies "You got the wrong guy, pal," leaving Coolidge trying to plead his case with a confused "No – it's Warren," as the elevator doors close.
  • In the third season episode “Saving Face”, in which a character has the same condition as the main character in The Elephant Man, Dr. Westphall mentions that he has a meeting with Tony Clifton, “modifying the phone system and rewiring the whole hospital”. Tony Clifton was one of several characters created by Andy Kaufman in his stage act. Later in the same episode Dr. Axelrod brings a ham to Mrs. Hufnagel after her husband, a vaudeville comedian, dies from an aneurysm in front of him while telling him a joke in the previous episode “Bye, George”. Mrs. Hufnagel ends up in the emergency room after eating the ham as it was too much for her gallbladder. In vaudeville a ham was a bad comic or one could kill by “hamming it up”.
  • In the third season episode "Playing God, Part 2", the Craigs are in their bedroom and Mrs. Craig says she wants to see who is on The Merv Griffin Show. Dr. Craig says, "Probably some stupid comic." She turns on the TV and Howie Mandel, the actor/comedian who played Dr. Wayne Fiscus on the show, can be heard. Dr. Craig says, "What is he wearing, a hand?" (a reference to Mandel's routine that involved wearing a surgical glove on his head, or more likely his prop "handbag" which was shaped like a hand).
  • The third season episode "Sweet Dreams" features a recreation of the music video for the ZZ Top song "Legs". It features the Eliminator car, but the band was played by members of the cast.[21]
  • The fourth season episode "Close Encounters" has numerous crossovers.
    • In the psychiatric ward, patients watch various MTM-produced shows on television – MTM (headed by Mary Tyler Moore and Grant Tinker) was the company that produced St. Elsewhere.
      • The patients briefly watch MTM's The White Shadow, produced by St. Elsewhere showrunner Bruce Paltrow. It is seen here as fictional, even though orderly Warren Coolidge is a carryover from The White Shadow (see above). (In the previous season, the bar from Cheers is seen as both fictional and part of the St. Elsewhere universe.)
    • The amnesiac patient John Doe #6, a recurring character played by Oliver Clark, while watching an episode of The Mary Tyler Moore Show on a hospital TV, believes himself to be that series' lead character Mary Richards. He then mistakes guest star Betty White, who had already appeared on the show in a straight role as a naval officer, for Sue Anne (the character White had played on that same show). She responds, "I'm afraid you've mistaken me for someone else."
    • John Doe #6 is verbally disparaged by another patient in the psychiatric ward — Elliott Carlin, the resident neurotic from The Bob Newhart Show played by Jack Riley. Carlin's treatment of Doe mirrored his behavior toward Oliver Clark's Bob Newhart Show character, Mr. Herd. Mr. Carlin subsequently appeared on an episode of Newhart, still uncured from the damage caused by "some quack in Chicago."
  • In "Santa Claus Is Dead", Dr. Craig mentions serving in Korea with his drinking buddy, B. J. Hunnicutt, implying that Dr. Hunnicutt was reassigned to another unit in Korea following the July 1953 deactivation of the 4077th Mobile Army Surgical Hospital at the end of M*A*S*H's finale, "Goodbye, Farewell and Amen".
  • The crew filled the series finale, "The Last One", with an abundance of allusions and homages. The cold open has Dr. Fiscus saying to an ER patient "General Sarnoff..." (the man responsible for launching NBC, the first television network, in 1926) "... cut down the time you spend in front of the television". There is a direct reference to the 1967 series finale of The Fugitive, when orderly Coolidge catches a "One-Armed Man", on a water tower, for "Dr. Kimble". A patient appears to get his hair cut by (The Andy Griffith Show's) Floyd the Barber, including his first name, face and clothing. There is a call over the public address system for a Code Blue (someone has reached their "end") in Room 222. There is a direct reference to the 1977 series finale of The Mary Tyler Moore Show, including a group hug, a group shuffle to get tissues and a suggestion that they sing "It's a Long Way to Tipperary". The finale for the character Dr. Henry Blake in a 1975 episode of M*A*S*H is referred to when cadaver "4077" is autopsied after a "helicopter crash". There are numerous song references, including Dr. Fiscus saying "It's the end of the world as we know it, and I feel fine", and Dr. Auschlander exclaiming "Jumpin' Jack, what was that flash?"[22]

St. Elsewhere was also host to one crossover, served as the source material for two others, and has been paid homage to in several ways:

  • The third season's finale featured Drs. Westphall, Auschlander, and Craig visiting the eponymous pub of Cheers (also set in Boston) for a drink. During the second season of Cheers, barmaid Carla Tortelli (Rhea Perlman) gave birth to a child at St. Eligius, and here expresses her displeasure about her hospitalization there, even getting into a verbal altercation with Dr. Craig.
  • Two St. Elsewhere characters were carried over to the NBC series Homicide: Life on the Street, which was executive produced by St. Elsewhere alumnus Tom Fontana. In an episode in season six entitled "Mercy", Alfre Woodard reprises her role of Dr. Roxanne Turner, who is accused of illegally euthanizing a cancer patient. Woodard was nominated for an Emmy Award as Outstanding Guest Actress in a Drama Series for her performance. In other Homicide episodes, the character of Detective Tim Bayliss (played by Kyle Secor) develops a bad back and is treated by an offscreen "Dr. Ehrlich". In the Homicide: The Movie finale, Ed Begley Jr., makes an uncredited appearance as Dr. Victor Ehrlich.
  • Ed Begley Jr., William Daniels, Stephen Furst, and Eric Laneuville reunited to appear in a season-one episode of Scrubs where the actors, rather than reprising their St. Elsewhere roles, play a quartet of doctors that fall sick at a medical convention. The episode was part of a week-long series of events honoring NBC's 75th Anniversary.[23]
  • Episode 7 ("There Are No F**king Sides") of Season 1 of Showtime's series City on a Hill (based in early 1990s Boston) includes an establishing shot of the exterior of St. Eligius, along with hospital scenes in which Dr. Morrison is referenced by a character, and in which Drs. Axelrod, Wade, Westphall, and Fiscus and Nurse Papandreau are paged in the background on the hospital's PA system. In S01E08, St. Eligius was mentioned by name.
  • In Oz, the company Weigert (which played a major role in St. Elsewhere's final season) takes over the prison's medical ward after the company makes a deal with Governor Devlin in Season 3. During the final season, nurse and angel of mercy serial killer is mentioned as having been fired from numerous hospitals prior to joining Oz's medical staff, including St. Elsewhere.
  • In the 2023 Rock N Roll Biographies comic book on King Diamond from Ten Ton Press, the ending is a direct homage to the final episode which writer Spike Steffenhagen has called "The greatest ending to any television show." The final panel features a couple looking at their two black cats (who have appeared as giants throughout the story) staring into a snow globe with a haunted house in it.

Awards and nominations

[edit]

St. Elsewhere won 24 out of 106 award nominations. The series garnered 62 Primetime Emmy Award nominations, winning 13 of them. Out of the thirteen wins, Ed Flanders won once and William Daniels won twice for Outstanding Lead Actor in a Drama Series, Bonnie Bartlett and Doris Roberts each won for Outstanding Supporting Actress in a Drama Series, James Coco won for Outstanding Supporting Actor in a Drama Series, John Masius and Tom Fontana won two awards for Outstanding Writing for a Drama Series, and Mark Tinker won for Outstanding Directing for a Drama Series.[24] It received five Golden Globe Award nominations, with four of them for Best Television Series – Drama.[25] St. Elsewhere received seven TCA Award nominations, winning once for Outstanding Achievement in Drama.[26] The series also won three out of four Q Awards. Additional accolades include a Peabody Award[27] and People's Choice Award for Favorite New TV Dramatic Program.[28]

Film adaptation

[edit]

In May 2003, Walden Media announced a partnership with Roth Films to create a film adaptation of the television series.[citation needed] It was never made.

Syndication

[edit]

After its initial run, reruns of St. Elsewhere aired for a time in syndication, with later runs on Nick at Nite, TV Land, Bravo and AmericanLife TV Network.

Also a popular series in the United Kingdom, St. Elsewhere has been aired twice by two separate British broadcasters. Channel 4 aired the series between 1983 and 1989, with Sky One later airing repeats in a daily Midday timeslot during 1992–93. In 2009, Channel 4 began showing the series again, usually at around 03:30 AM, and have repeated the entire series several times since then. All 137 episodes are also available to view online at All 4.

Nick at Nite first added St. Elsewhere to its regular lineup on April 29, 1996, as part of an all-night sneak peek of sister network TV Land. After the sneak peek, Nick at Nite aired St. Elsewhere regularly from May 4 until July 6, 1996, every Saturday night as part of a short-lived programming block called Nick at Nite's TV Land Sampler. St. Elsewhere was one of many rotating shows airing Saturday nights as part of Nick at Nite's TV Land Sampler, which included (among other shows) Petticoat Junction, That Girl and The Sonny & Cher Comedy Hour along with past Nick at Nite Classics Mister Ed and Green Acres. Nick at Nite aired reruns of St. Elsewhere once again from June 30 until July 4, 1997, as part of the week-long event The 100 Greatest Episodes of All Time.[29]

Home media

[edit]

On November 28, 2006, 20th Century Fox Home Entertainment released the complete first season of St. Elsewhere on DVD in Region 1.[30]

In Region 2, Channel 4 DVD released the first season on DVD in the UK on April 2, 2007.[31] All episodes have been made available on Channel 4's UK on-demand internet stream All 4 in the UK and Ireland, though these episodes are edited versions for syndication and not as they were originally aired.

Beginning October 2018, all episodes were available for streaming on Hulu.[32] On November 1, 2023, several episodes were removed from the series. Though no official statement from Hulu was provided as to why they were removed, customers who have contacted their customer support have been told streaming rights issues are the reason.[citation needed] The following episodes were missing from Hulu:

  • Season 1, Episode 8 "Tweety and Ralph"
  • Season 1, Episode 15 "Monday, Tuesday, Sven's Day"
  • Season 1, Episode 22 "Addiction"
  • Season 2, Episode 3 "Newheart"
  • Season 2, Episode 6 "Under Pressure"
  • Season 2, Episode 13 "In Sickness and in Health"
  • Season 2, Episode 17 "Vanity"
  • Season 3, Episode 8 "Sweet Dreams"
  • Season 4, Episode 3 "Haunted"
  • Season 4, Episode 7 "Close Encounters"
  • Season 4, Episode 10 "Loss of Power"
  • Season 4, Episode 13 "To Tell the Truth"
  • Season 4, Episode 19 "Out on a Limb"
  • Season 5, Episode 6 "Not My Type"
  • Season 5, Episode 11 "Lost Weekend"
  • Season 5, Episode 16 "Jose, Can You See?"
  • Season 6, Episode 6 "The He-Man Woman Hater's Club"
  • Season 6, Episode 9 "Weigh In, Way Out"
  • Season 6, Episode 12 "Final Cut"
  • Season 6, Episode 20 "Split Decision"
  • Season 6, Episode 21 "The Abby Singer Show"

As of October 1, 2025, all episodes of St. Elsewhere have been removed from Hulu due to loss of streaming rights.[33]

References

[edit]

Further reading

[edit]
[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia
from Grokipedia
is an American medical drama television series created by Joshua Brand and John Falsey that aired on NBC for six seasons from October 26, 1982, to May 25, 1988. Set in the fictional St. Eligius Hospital, a dilapidated teaching facility in Boston's South End, the program chronicles the professional challenges and personal lives of its diverse ensemble of physicians, nurses, and administrators amid ethical dilemmas, patient crises, and institutional decay. Produced by MTM Enterprises, the series departed from sanitized portrayals of medicine by depicting flawed characters, realistic failures in treatment, and unflinching explorations of mortality, mental illness, and social issues, earning acclaim for its serialized storytelling and cinematic techniques unusual for network television at the time. Starring Ed Flanders as the introspective Dr. Donald Westphall, alongside Norman Lloyd and William Daniels as senior physicians, it featured recurring themes of bureaucratic inefficiency and human frailty, culminating in a controversial finale revealing the hospital's events as the autistic imagination of a patient within a snow globe. The show received 13 Emmy nominations, including wins for writing, and influenced subsequent medical dramas by prioritizing character depth over procedural formulas.

Premise and Setting

Fictional Hospital and Core Themes

St. Eligius Hospital serves as the primary setting for St. Elsewhere, portrayed as a deteriorating urban teaching hospital in Boston's South End neighborhood. The facility operates as an underfunded public institution amid the economic and systemic strains of 1980s American healthcare, characterized by chronic resource shortages, overcrowding, and administrative bottlenecks that exacerbate daily operations. Nicknamed "St. Elsewhere," a term derived from medical slang denoting lesser-equipped hospitals that primarily treat indigent and underserved populations, it functions as a catch-all for complex cases rejected elsewhere, underscoring the chaotic environment of inner-city medicine. Core themes revolve around the unvarnished human cost of medical practice, including the ethical dilemmas arising from triage decisions, limited funding, and institutional politics in an era of healthcare reform debates. The series emphasizes staff members' personal shortcomings—such as burnout, moral compromises, and relational strains—without idealizing their roles, instead revealing how these factors intersect with patient outcomes in a non-miraculous framework. Societal issues like urban poverty, substance addiction, and public health crises are integrated realistically, reflecting the hospital's role in managing disproportionate burdens on marginalized communities. The prioritizes empirical depictions of pressures over heroic narratives, authenticity from observed routines and procedural to convey the toll of sustained exposure to life-and-death scenarios. This approach highlights causal between systemic underinvestment and frontline inefficiencies, such as delayed interventions and improvised solutions, fostering a portrayal grounded in the rigors of urban healthcare delivery.

Character Ensemble and Narrative Style

The character ensemble of St. Elsewhere featured a broad spectrum of hospital staff at the underfunded St. Eligius, encompassing idealistic young residents confronting ethical quandaries, veteran physicians hardened by institutional decay, pragmatic nurses navigating resource shortages, and administrators prioritizing fiscal survival over patient care. These dynamics generated causal plot progression through realistic interpersonal frictions, where factors like chronic overwork, personal addictions, or ideological clashes precipitated tangible consequences such as diagnostic oversights or procedural lapses, diverging from formulaic portrayals of infallible expertise in prior medical series. Narrative structure emphasized ensemble interconnectivity via serialized, vignette-oriented arcs that sustained multi-episode tensions across personal and professional spheres, prioritizing collective character evolution over self-contained resolutions typical of 1970s procedural dramas. Overlapping subplots mirrored the chaotic causality of hospital operations, with individual motivations—rooted in verifiable stressors like staff attrition rates exceeding 20% in urban teaching facilities—influencing group outcomes without contrived interventions. From the October 26, 1982 pilot, the series innovated by integrating non-linear techniques, including dream sequences depicting subconscious professional anxieties and meta-elements that blurred narrative boundaries to evoke the disorientation of medical decision-making under duress. This approach challenged audience preconceptions of linear causality in television drama, fostering a realism grounded in psychological and systemic pressures rather than episodic heroism, as evidenced by the show's avoidance of improbable recoveries in favor of statistically aligned morbidity patterns.

Production History

Development and Creative Team

St. Elsewhere was created by television writers Joshua Brand and John Falsey, who conceived the series as a realistic portrayal of life in an underfunded urban hospital, with development beginning in 1982 for NBC broadcast. The duo, known for their collaborative approach honed on prior projects, aimed to move beyond sanitized depictions in earlier medical dramas by emphasizing the gritty, multifaceted challenges of public healthcare delivery. Influenced by the groundbreaking ensemble format and serialized narrative depth of Hill Street Blues, Brand and Falsey structured St. Elsewhere around interconnected character stories and institutional dysfunction rather than isolated procedural cases or star-centric heroics. This approach allowed for ongoing arcs that reflected real-world causal pressures, such as resource shortages and ethical dilemmas in triage, prioritizing systemic realism over episodic resolution. The creative team incorporated input from medical consultants to ground depictions of diagnostics, treatments, and hospital operations in verifiable practices, countering dramatic tropes with evidence-based portrayals of high-stakes decision-making under constraint. These consultations ensured that procedural elements, from emergency protocols to administrative bottlenecks, aligned with empirical hospital dynamics rather than fictional exaggeration. In the pilot episode, aired October 26, 1982, the vision crystallized around an ensemble exploring a rundown Boston facility's failures, setting a tone for narratives that interrogated public healthcare's structural inadequacies without relying on individual savior archetypes.

Filming Techniques and Realism

St. Elsewhere utilized handheld cameras under the direction of cinematographer John McPherson to produce fluid, on-the-move shots that evoked the perpetual motion and disarray of an under-resourced urban hospital. This single-camera setup fostered a documentary-style authenticity, immersing viewers in the unpolished routines of medical staff and patients, in contrast to the more composed, procedural aesthetics of contemporaneous dramas like Trapper John, M.D. Exterior sequences were shot on location in 's South End, including at Franklin Square House on East Newton Street, leveraging ambient urban conditions to underscore the hospital's gritty, decaying environment. Interior filming occurred at CBS Studio Center in Studio City, California, where practical sets replicated resource-limited facilities without reliance on elaborate staging. The production's approach extended to narrative integration of verifiable medical inaccuracies and dilemmas, such as misdiagnoses and triage failures, informed by consultations with practicing physicians to reflect empirical healthcare realities. Episodes often dissected causal chains leading to adverse outcomes, including institutional shortcomings and procedural lapses, as seen in storylines addressing ethical conflicts over patient autonomy and resource allocation drawn from documented cases. This emphasis on unflinching portrayals—eschewing heroic resolutions for consequential analyses—elevated the series' realism, prioritizing observable hospital dynamics over dramatized triumphs. Produced under MTM Enterprises' model of ensemble-driven storytelling, the show avoided high-production spectacle, allowing budgetary pragmatism to reinforce depictions of strained operations akin to real teaching hospitals.

Cast and Characters

Principal Actors and Roles

Ed Flanders starred as Dr. Donald Westphall, the principled yet beleaguered Director of Medicine at St. Eligius Hospital, whose personal life revolved around caring for his autistic son, Tommy, adding layers of vulnerability to an otherwise authoritative figure. Flanders, who had earned an Emmy for his role in the 1983 TV film The Day After, was selected for his ability to convey quiet intensity and moral complexity, aligning with the series' aim to depict physicians as fallible humans navigating ethical dilemmas rather than infallible saviors. Howie Mandel portrayed Dr. Wayne Fiscus, a quirky emergency room resident whose unconventional methods and germaphobic traits provided comic relief amid gritty realism, reflecting the archetype of the eccentric but capable intern. Mandel's prior stand-up comedy experience, including appearances on Make Me Laugh (1979), suited the role's blend of humor and pathos, contributing to the ensemble's avoidance of stereotypical heroic leads by humanizing medical staff through idiosyncrasies. Norman Lloyd played Dr. Daniel Auschlander, the hospital's wise administrator grappling with terminal liver disease, embodying the seasoned mentor flawed by his own mortality and administrative burdens. At age 68 upon casting in 1982, Lloyd's extensive theater background, including work with Orson Welles, lent authenticity to the character's gravitas and subtle authority, reinforcing the show's commitment to portraying elder physicians as resilient yet imperfect. William Daniels depicted Dr. Mark Craig, a brilliant but arrogant surgeon whose interpersonal failings highlighted the series' focus on professional hubris. Daniels, fresh from voicing KITT in Knight Rider (1982), brought a sharp, authoritative edge that balanced the ensemble without dominating it. Ed Begley Jr. assumed the role of Dr. Victor Ehrlich, an ambitious resident prone to ethical lapses and romantic entanglements, exemplifying the young doctor's archetype of ambition tempered by inexperience. Begley's prior guest spots on shows like MASH* informed his nuanced take on vulnerability. Denzel Washington appeared as Dr. Philip Chandler, a driven surgical resident, for the first three seasons (1982–1985), exiting as his burgeoning film career—bolstered by early roles like Carbon Copy (1981)—demanded focus on projects such as Power (1986). The casting emphasized a repertory approach, with actors like David Morse (Dr. Jack Morrison) and Christina Pickles (Nurse Helen Rosenthal) filling out a diverse ensemble of underdogs and mentors, prioritizing psychological depth over glamour to mirror real hospital hierarchies.

Character Arcs and Departures

Dr. Jack Morrison, portrayed by , exemplified the series' portrayal of yielding to cynicism through successive personal crises; initially a soft-spoken, compassionate resident known as "Boomer" for his , Morrison endured the of his , a during a volunteer shift, and near expulsion from the program, culminating in emotional exhaustion and his resignation from St. Eligius in the May 25, 1988, series finale. These events drove his arc toward pragmatic detachment, reflecting plot necessities to explore trauma's toll on medical professionals rather than sustained optimism. Dr. Robert Caldwell, played by Mark Harmon, underwent a transformative arc tied to the emerging AIDS epidemic; introduced in season 2 as a skilled plastic surgeon, Caldwell contracted HIV via a contaminated blood transfusion in 1986, facing workplace stigma and ethical conflicts over disclosure, which isolated him professionally and personally before his departure from the hospital in a February 12, 1986, episode. His off-screen death from the disease was revealed in the season 6 episode "Heaven's Skate" aired February 10, 1988, underscoring causal realism in depicting untreated progression amid 1980s medical limitations. Harmon's exit aligned with his pursuit of a miniseries role, prioritizing actor availability over prolonged storyline. Dr. Donald Westphall's integrated for his Tommy's autism, depicted through lenses as a profound developmental impairment requiring constant and institutional support, with Tommy exhibiting minimal speech and fixation on toys like a snow globe that symbolized escapist . This familial burden strained Westphall's administrative duties, evolving his character from detached to vulnerable without imposing later diagnostic expansions or affirmative reinterpretations, grounded in era-specific clinical views emphasizing dependency over . Later additions like Dr. Seth Griffin, enacted by Bruce Greenwood from seasons 5 to 6, entered as a cocky resident clashing with superiors such as Dr. Rosenthal, fostering conflicts that served episodic tension but revealed narrative conveniences in his rapid shifts from arrogance to competence, concluding with the ensemble's dispersal in the finale. Departures broadly stemmed from story logic—such as illness or burnout—or contractual realities, avoiding contrived resolutions while illustrating attrition patterns akin to real-world resident turnover driven by stress and opportunity.

Episode Structure

Seasonal Breakdown and Episode Count

St. Elsewhere consisted of six seasons totaling 137 hour-long episodes, broadcast on NBC from October 26, 1982, to May 25, 1988. The first season aired Tuesdays at 10:00 p.m. ET, with subsequent seasons moving to Wednesdays at the same time slot. Season 1 (1982–1983) included 22 episodes focused on introducing the ensemble cast and depicting the gritty, under-resourced environment of St. Eligius Hospital through largely standalone patient cases and procedural elements. Subsequent seasons—Season 2 (1983–1984, 22 episodes), Season 3 (1984–1985, 24 episodes), Season 4 (1985–1986, 24 episodes), Season 5 (1986–1987, 23 episodes), and Season 6 (1987–1988, 22 episodes)—gradually shifted toward serialized storytelling, featuring multi-episode arcs that intertwined personal character developments with broader medical and social challenges. This evolution paralleled real-world events, such as the AIDS epidemic, with initial U.S. cases reported by the CDC in 1981 and the series addressing it through ongoing narratives starting in late 1983. The format maintained consistency in runtime and dramatic structure, allowing for progressive deepening of themes from isolated emergencies to sustained explorations of ethical dilemmas and institutional strains, building toward the 1988 conclusion.
SeasonAir YearsEpisode Count
11982–198322
21983–198422
31984–198524
41985–198624
51986–198723
61987–198822
Total137

Notable Episodes and Storytelling Innovations

The episode "Cheers" from season 4, episode 9, aired on , 1985, incorporated a rare crossover with the Cheers, as St. Eligius administrators Donald Westphall and Daniel Auschlander visited the Boston bar amid a dispute, blending with comedic elements to highlight interpersonal tensions outside the hospital. This risk underscored the series' willingness to engage external universes for character-driven humor and relief from procedural intensity. Similarly, "Time Heals: Part 1" ( 4, 18, aired March 5, 1986) earned a Primetime Emmy for Outstanding Writing by chronicling interconnected patient and staff stories spanning five decades, converging on St. Eligius's 50th anniversary to explore long-term causal impacts of medical decisions without relying on linear chronology. Storytelling innovations in St. Elsewhere emphasized serialized arcs and ensemble vignettes that simulated the chaotic, overlapping demands of urban hospital operations, favoring unresolved interpersonal conflicts and cascading consequences over self-contained resolutions typical of 1980s procedurals. Time jumps, as demonstrated in "Time Heals," disrupted conventional timelines to reveal retrospective causal chains, such as how past ethical lapses influenced present crises, enhancing realism by mirroring how historical patient outcomes inform ongoing care protocols. These techniques prioritized empirical depictions of systemic pressures, including early portrayals of AIDS transmission risks in season 3 episodes like "AIDS and Comfort" (aired February 13, 1985), which integrated factual medical data on contagion vectors without didactic overlays, reflecting 1980s epidemiological realities drawn from contemporaneous CDC reports. Such approaches fostered narrative depth, with multi-threaded plots tracking character decisions' ripple effects across shifts, as seen in vignettes juxtaposing emergency responses to elective surgeries.

Broadcast and Commercial Performance

Airing Schedule and Nielsen Ratings

St. Elsewhere premiered on NBC on October 26, 1982, and aired for six seasons, concluding with its series finale on May 25, 1988. The series maintained a primary Tuesday night slot at 10:00 p.m. Eastern Time throughout its run, starting with the 1982–1983 season and continuing into 1988, though episodes occasionally faced preemptions due to special programming or scheduling shifts. In its debut season, the show averaged an 11.6 household Nielsen rating, translating to roughly 15 million viewers per episode amid a national TV household base of approximately 83 million. This placed it 86th out of 98 prime-time programs, with 13 episodes ranking in the bottom 10 for their respective weeks. Viewership grew modestly in later seasons, but the series never exceeded 47th in annual Nielsen rankings, reflecting consistent but subpar mass appeal compared to blockbusters like NBC's Miami Vice or CBS's Dallas. NBC renewed the program annually despite these figures, attributing survival to a dedicated audience demographic—upscale urban viewers appealing to advertisers—rather than raw numbers, alongside positive critical reception that built word-of-mouth momentum. The Tuesday slot pitted it against CBS's dominant lineup, including procedurals like Simon & Simon and soaps such as Falcon Crest, which often drew higher shares from broader family audiences, yet NBC prioritized long-term loyalty over immediate ratings dominance. By season six, cumulative viewer retention and network investment in quality programming sustained the show until its planned conclusion.

Initial Viewer Challenges

The first season of St. Elsewhere, which premiered on NBC on October 26, 1982, struggled with low Nielsen ratings, averaging in the low teens and failing to crack the top 50 programs, prompting the network to nearly cancel the series despite critical praise for its innovative approach. This underwhelming performance stemmed from the show's deliberate embrace of graphic realism, including unflinching portrayals of patient suffering, surgical failures, and institutional dysfunction without the redemptive uplift common in contemporaneous medical dramas like Trapper John, M.D. or Marcus Welby, M.D., which prioritized heroic resolutions and familial reassurance. Audience resistance was exacerbated by the series' moral ambiguity, where physicians grappled with ethical compromises and personal flaws amid everyday medical drudgery, alienating viewers seeking escapist or affirming depictions of healthcare heroism. While the program drew a niche following among urban, educated demographics appreciative of its documentary-style cinematography and serialized depth—evident in advocacy from groups like Viewers for Quality Television, which lobbied NBC to renew it despite the numbers—it repelled broader family audiences expecting sanitized, optimistic narratives that reinforced trust in the medical system. These market pressures manifested in subtle network nudges toward incorporating more interpersonal drama and lighter ensemble dynamics by mid-season one, as producers balanced artistic integrity against the need to broaden appeal, though the core gritty tone persisted and ratings remained modest. This tension highlighted a causal disconnect between the show's first-principles commitment to causal realism in depicting hospital life and the commercial imperatives favoring formulaic accessibility.

Critical and Public Reception

Positive Assessments of Innovation

St. Elsewhere received praise for pioneering serialized storytelling in medical dramas by emphasizing ongoing character arcs and subplots amid procedural elements, departing from episodic formats dominant in prior shows like Marcus Welby, M.D.. Critics noted its emulation of Hill Street Blues' ensemble approach, crowding the screen with interconnected narratives that reflected the chaotic realism of hospital life, thereby influencing subsequent series such as ER. This innovation elevated the genre from formulaic case-of-the-week structures to more layered, continuity-driven plots. The series' procedural accuracy and ensemble depth were endorsed by medical professionals, with actor Ed Begley Jr., who played Dr. Victor Ehrlich, stating it was the first show to accurately depict medical procedures and physicians' lifestyles. Actual doctors have commended its gritty portrayal of hospital operations, including ethical dilemmas and resource constraints at an underfunded urban facility like St. Eligius. This authenticity stemmed from consultations with experts, fostering believable depictions of diagnostics, surgeries, and interpersonal dynamics among staff. Retrospectives in the 2020s have affirmed St. Elsewhere's role in normalizing complex, flawed protagonists in procedurals, portraying doctors as multifaceted individuals grappling with personal failings, addictions, and moral ambiguities rather than infallible heroes. Outlets described it as the biggest leap forward in medical drama evolution, modernizing the genre through bold narratives and character-driven innovation that paved the way for shows like House M.D. by prioritizing psychological depth over sanitized heroism.

Criticisms of Tone and Pacing

Critics frequently highlighted the series' persistently bleak and depressing tone, which emphasized the grim underbelly of inner-city medicine through frequent depictions of patient suffering, ethical dilemmas, and staff burnout, often at the expense of uplifting resolutions. A 1988 Los Angeles Times analysis described the vision as deliberately "bleak," reflecting creator Joshua Brand's intent to portray unvarnished hospital realities, yet this approach drew complaints for fostering a morbid atmosphere that deterred mainstream viewers accustomed to more escapist programming. Similarly, contemporary reviews labeled episodes as emotionally exhausting, with unresolved tragedies amplifying a sense of hopelessness rather than dramatic tension. The show's reliance on multiple vignettes per episode, emulating the chaotic ensemble dynamics of Hill Street Blues, contributed to pacing inconsistencies, as rapid shifts between subplots often left arcs dangling or underdeveloped, prioritizing stylistic experimentation over narrative cohesion. A 2018 Rolling Stone retrospective noted this made St. Elsewhere "more uneven than many of its peers," with the fragmented structure sometimes feeling indulgent and alienating audiences seeking streamlined storytelling. Critics like John J. O'Connor in a 1986 New York Times piece critiqued the evolution into "a middling example of nighttime soap opera," arguing that overloaded emotional beats and slow-building interpersonal conflicts exaggerated melodrama while slowing momentum, turning potential innovations into viewer fatigue. These tonal and structural choices manifested in commercial underperformance, as St. Elsewhere struggled to cultivate broad appeal despite a dedicated cult following; it never exceeded 49th place in annual Nielsen rankings across its run from 1982 to 1988, with first-season averages hovering at 11.6 and multiple episodes bottoming out in weekly tallies. A 1986 Washington Post report echoed viewer sentiments by attributing such metrics to the series' perceived overemphasis on raw pathos over resolution, positioning it as critically acclaimed but commercially niche, where shock value and vignette density overshadowed sustained engagement.

Major Controversies

Series Finale and "Snow Globe" Twist

The series finale of St. Elsewhere, titled "The Last One," aired on NBC on May 25, 1988, concluding the program's six-season run. In its closing sequence, the narrative shifts to Dr. Donald Westphall's apartment, where he interacts with his autistic son, Tommy Westphall, who has been a recurring minor character fixated on a snow globe. As Donald places the snow globe on a television set, the camera zooms into it, revealing a miniature model of St. Eligius Hospital—the central setting of the series—implying that all prior events depicted across 137 episodes were products of Tommy's imagination. This revelation retroactively frames the hospital's staff, patients, deaths, and dramatic arcs as fictional constructs within the boy's mind, rather than objective occurrences. Screenwriters Tom Fontana and John Masius intended the twist as a meta-commentary on the artificiality of television storytelling, drawing from the show's history of experimental elements like dream sequences and fourth-wall breaks to underscore subjective perception and the blurred line between reality and fiction. Fontana later described it as a deliberate push against conventional finales, anticipating that regular viewers familiar with the series' quirks would appreciate the humanism in portraying an autistic child's inner world as a valid narrative space. Proponents argue it elevates the series by inviting reflection on how personal imagination shapes perceived truths, aligning with themes of mental health and empathy explored throughout the show, without negating emotional investments in character journeys. Critics, however, contend the ending constitutes a narrative cop-out akin to the overused "it was all a dream" trope, invalidating six years of causal events—such as character deaths, ethical dilemmas, and interpersonal developments—without empirical or logical justification within the established diegesis. This undermines the series' realism, as the twist imposes a retroactive unreality on verifiable plot progressions (e.g., surgical outcomes and policy changes at St. Eligius) that had been treated as consequential, lacking first-principles grounding in the autistic boy's limited real-world exposure to justify the breadth of imagined details. Fan responses remain divided, with Fontana estimating roughly 50% expressing extreme anger over perceived betrayal of invested time, while others embraced its provocative irony; no large-scale empirical polls exist, but retrospective analyses highlight persistent debate, with some outlets labeling it television's most notorious twist for alienating audiences. The ending inadvertently birthed the " Universe" , positing that crossovers with St. Elsewhere characters or settings extend the dream logic to affiliated shows, linking an estimated 441 television series (from to modern entries like The Flash) through degrees of separation via shared personnel or plot . Fontana rejected this expansive interpretation as unintended overreach, emphasizing the finale's focus on St. Elsewhere alone rather than a broader deconstruction of the medium. Despite criticisms of logical inconsistency, the twist's enduring discussion underscores its role in challenging viewers' assumptions about narrative permanence, though it prioritizes philosophical ambiguity over causal coherence.

Portrayals of Sensitive Topics

St. Elsewhere featured one of the earliest televised storylines on AIDS, beginning with the December 13, 1983, episode "AIDS & Comfort," which depicted a politician's diagnosis and hospital staff reactions amid the disease's initial U.S. emergence, drawing from contemporaneous epidemiological reports of cases beyond high-risk groups. Subsequent arcs, such as Dr. Robert Caldwell's 1985 contraction via heterosexual intercourse with an infected prostitute, aligned with verified transmission vectors documented by the CDC at the time, though the narrative's emphasis on rapid progression and institutional panic has been retrospectively critiqued for heightening public apprehension disproportionate to heterosexual risk statistics, which remained low (under 1% of U.S. cases by 1986). The series introduced autism through Tommy Westphall, the nonverbal son of administrator Dr. Donald Westphall, appearing in 15 episodes across its run and portrayed as withdrawn and fixated on objects like snow globes, reflecting 1980s clinical understandings of severe cases under DSM-III criteria emphasizing social deficits and repetitive behaviors. This depiction was pioneering for mainstream network television, predating broader awareness, yet modern analyses highlight its reliance on tropes of emotional isolation without nuanced communication or agency, potentially reinforcing outdated stereotypes over the spectrum's variability evidenced in later research. Episodes tackled 1980s taboos via medical framing, such as a season 1 storyline addressing adolescent nocturnal emissions through a doctor's explanation to a patient, contextualized as physiological education to navigate broadcast standards that prohibited explicit depictions outside therapeutic discussions. The show consistently portrayed medical ethics through flawed practitioners confronting dilemmas like resource allocation in an underfunded urban hospital, empirically mirroring real bureaucratic inefficiencies—such as delayed funding and overcrowding—that exacerbated care disparities, as corroborated by contemporaneous reports on public hospitals like Boston's. While praised for demystifying heroic physician myths and exposing systemic failures without romanticization, some reviewers faulted selective emotional intensification over procedural rigor, though this served to underscore causal links between administrative inertia and patient outcomes.

Legacy and Cultural Impact

Influence on Medical Dramas

St. Elsewhere introduced a gritty realism to the medical drama genre by depicting the chaotic operations of an underfunded urban hospital, St. Eligius, where staff contended with resource shortages, ethical quandaries, and personal failings rather than prevailing as infallible saviors. This approach marked a departure from prior sentimental portrayals, prioritizing procedural accuracy and the high-pressure environment of inner-city medicine, as evidenced by its use of authentic medical consultations and avoidance of sanitized resolutions. The series aired from October 26, 1982, to May 25, 1988, establishing serialization techniques that wove ongoing character arcs and institutional dysfunctions across episodes, influencing a shift from standalone cases to narrative continuity in the genre. These elements directly shaped ER (1994–2009), which amplified St. Elsewhere's ensemble focus and raw procedural intensity—described by reviewers as "St. Elsewhere on methamphetamines"—while retaining the emphasis on systemic pressures like overcrowding and triage failures over heroic individualism. Grey's Anatomy (2005–present) extended this legacy by blending St. Elsewhere-inspired group dynamics and hospital flaws with interpersonal romances, fostering viewer investment in flawed professionals navigating bureaucratic inefficiencies and moral ambiguities. Industry analyses credit the series with catalyzing post-1980s trends toward less idealized doctors, as seen in subsequent shows' routine explorations of understaffing and administrative conflicts that mirrored real healthcare strains without romantic gloss. By foregrounding causal factors like fiscal constraints and human error in patient outcomes, St. Elsewhere prompted a genre-wide reevaluation of sentimentality, validated by its role in priming audiences for unvarnished depictions that persisted into the 1990s and beyond, as reflected in ER's procedural fidelity and the ensemble-driven realism of later entries. This influence endured, with 2023 retrospectives affirming its foundational impact on modern medical dramas' avoidance of glorification in favor of institutional critique.

Awards Recognition

St. Elsewhere received 62 nominations for the Primetime Emmy Awards between 1983 and 1988, securing 13 wins across categories such as outstanding lead actor, writing for a drama series, directing for a drama series, and supporting performances. Ed Flanders won Outstanding Lead Actor in a Drama Series in 1983 for his portrayal of Dr. Westphall, while additional victories included writing awards for episodes addressing complex medical and ethical dilemmas, and directing honors for innovative episode structures. These Emmy recognitions highlighted peer acclaim for the series' technical and narrative craftsmanship, even as its viewership lagged behind network competitors. Beyond the Emmys, the program earned a Peabody Award in 1984, awarded to NBC and MTM Enterprises for its distinctive approach to dramatizing urban healthcare challenges and social issues, marking it as the only regularly scheduled dramatic series to receive this honor that year. The Peabody citation praised the show's commitment to realistic portrayals of institutional decay and human frailty in medicine, underscoring its empirical depth over sensationalism. Such awards quantified elite validation from industry bodies, sustaining creative momentum despite inconsistent mass audience metrics.

Crossovers, Allusions, and Hypothetical Universe

In the episode "Cheers" aired on March 27, 1985, St. Elsewhere characters Dr. Donald Westphall (Ed Flanders), Dr. Daniel Auschlander (Norman Lloyd), and Dr. Peter White (Ed Begley Jr.) visit the Cheers bar in Boston, interacting with bartender Carla Tortelli (Rhea Perlman) and patrons Norm Peterson (George Wendt) and Cliff Clavin (John Ratzenberger), establishing a direct canonical crossover between the medical drama and the sitcom. This shared scene confirms both series occur within the same fictional reality, as the St. Elsewhere doctors reference their hospital work amid the bar's familiar setting. Another explicit crossover occurred post-series, with St. Elsewhere's Dr. Roxanne Turner (Alfre Woodard) reprising her role in the Homicide: Life on the Street episode "Mercy," aired January 15, 1993, where detectives Frank Pembleton (Andre Braugher) and Tim Bayliss (Kyle Secor) investigate her for a patient's mercy killing, linking the shows through character continuity. These interactions represent verifiable narrative ties, distinct from mere cameos, as they advance plots in both originating and guest series. The "Tommy Westphall Universe" hypothesis emerged from St. Elsewhere's series finale "The Last One," broadcast May 25, 1988, which reveals the hospital as a snow globe model within the autistic imagination of Tommy Westphall (Chad Allen), son of Dr. Westphall, framing the entire narrative as his fantasy. Fan theorists extended this meta-twist to encompass shows connected via crossovers, arguing that Cheers' linkage pulls in its universe (including Frasier through character migration), while Homicide's tie incorporates its crossovers with Law & Order and others, purportedly totaling 441 programs as of 2024. However, this remains speculative fan discourse without endorsement from creators Joshua Brand or John Falsey beyond the finale's intent for St. Elsewhere alone, as crossovers typically denote independent shared canon rather than subsuming all events into one character's hallucination. Self-referential allusions in St. Elsewhere occasionally nod to television conventions, such as episodes parodying soap opera excess or hospital drama clichés, but these do not extend to endorsing the broader universe theory, which critics view as an interpretive overreach that disregards shows' autonomous narratives and production realities. Empirical assessment limits the hypothesis to its originating twist's scope, with crossover evidence supporting only direct interconnections rather than a monolithic fictional collapse.

Distribution and Availability

Syndication History

Following the series' original NBC run from 1982 to 1988, St. Elsewhere saw sporadic syndication primarily on basic cable in the and early 2000s, including Bravo, , , and the AmericanLife Network. These limited reruns were constrained by the show's mature themes, such as graphic depictions of illness, ethical dilemmas, and social taboos, which proved challenging for advertisers and broadcasters seeking broad family audiences. The series finale's "snow globe" twist—revealing the hospital's events as the autistic imaginings of a child—exacerbated syndication hurdles by disrupting episodic standalone viability, as new viewers encountered a narrative invalidated by the meta-reveal, per retrospective analyses of its broadcast afterlife. This contributed to St. Elsewhere's evolution into a cult favorite rather than a syndicated staple, with no sustained mainstream revivals. Between 2023 and 2025, no significant syndication pushes materialized on cable or broadcast, underscoring the content's niche, era-specific intensity amid shifting viewer preferences for lighter procedurals.

Home Media Releases

The first season of St. Elsewhere was released on DVD in by as a four-disc set containing all 22 episodes from the 1982-1983 broadcast year. This release included supplemental materials such as an track for the episode "Cora and Arnie," which discusses production choices and the series' approach to realism, along with four featurettes on topics including and episode development. Subsequent seasons followed in phased DVD releases by MGM through 2009, enabling collectors to acquire the complete six-season run (137 episodes total) in physical format for archival purposes. These DVD editions preserved the original broadcast versions without network-mandated edits, providing unadulterated access to the series' content, including portrayals of medical procedures and interpersonal dynamics as originally aired. No official Blu-ray or high-definition upgrades have been issued, reflecting ongoing challenges with rights ownership among legacy studios like MGM/UA and MTM Enterprises. As of October 2025, digital home media options are limited to purchase and download rather than subscription streaming, with full episodes available on Amazon Video, Apple TV, and Fandango at Home. These platforms offer the complete series without free ad-supported access, stemming from expired licensing agreements that previously placed it on services like Hulu until early 2025. Physical and digital formats thus remain the primary means for comprehensive, ownership-based viewing, unaffected by transient streaming rotations.

References

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