Today we are winding up our blog series, “Examining Some of Our Favorite Medical Shows.” Six years seems to be the magic number of seasons for many medical shows and it was no different for our series today: St. Elsewhere.

St. Elsewhere was created by Joshua Rand and John Falsey. It aired on NBC from 1982-88. It was produced by MTM Enterprises, Mary Tyler Moore’s company that also produced Hill Street Blues; both shows had large casts, realistic plots, and continuing storylines.

The show was talked about a lot, but I was surprised to learn that it never ranked higher than 47^th in the Nielsen ratings, and that was in the final season. The reason it stayed on the air so long despite lower ratings was that it did very well with the 18-49 year age group with the networks were trying to appeal to. It did win 13 Emmys for writing, acting, and directing. (Overall the show won 13 Emmys out of 62 nominations.)

St. Elsewhere was set in St. Eligius Hospital, a rundown Boston teaching hospital. Its elevators don’t work and they still use an ancient tube system to send messages from one floor to another. Apparently “St. Elsewhere” was a slang term that referred to not well-equipped hospitals that served patients who were turned away from more well-respected institutions. The building that served as the hospital façade was the Franklin House on East Newton Street in Boston, which was originally a hotel for women. Young working women lived there including Faye Dunaway after she graduated from Boston University.

The show intertwined the professional and private lives of the medical staff and patients. It dealt with many cutting-edge social issues including heart transplants, artificial hearts, AIDS, religious conflicts, suicide, and gender identities.

Surgeon Dr. Mark Craig (William Daniels) informs the staff that their hospital was considered a “dumping ground.” Craig helped train the interns along with Dr. Donald Westphall (Ed Flanders) and Dr. Auschlander (Norman Lloyd). Flanders was a popular character and the role was originally offered to Hal Linden who turned it down. Other members of the stellar cast included Ed Begley Jr. (playing Dr. Ehrlich), David Birney (playing Dr. Samuels), Mark Harmon (playing Dr. Caldwell), Ronnie Cox (playing Gideon), Helen Hunt (playing Clancy Williams), Howie Mandel (playing Dr. Fiscus), Christina Pickles (playing Nurse Rosenthal), and Denzel Washington (playing Dr. Chandler). This was a fitting role for Denzel who was a pre-med student in college.

Daniels was sent five scripts. He thought the writing was wonderful and having so many scripts displayed how the ensemble cast would be used. He might have a large part one week and then three weeks with small parts. He said Dr. Craig was like him in many ways. He ran the gamut from angry to nice in minutes. It fit his temperament and was wonderful to play him.

Daniels met a surgeon and followed him around the hospital, including in the operating room for an open-heart surgery procedure. He said he used some of the medical information, but he did not like the surgeon as a person and did not model Dr. Craig on him. He said using so much medical jargon was difficult and he had to learn about it before he went in to rehearse. He said that Dr. Craig had some funny lines in the show. He said he did not have any input with the writers on his character; in fact, they never really saw the writers.

Among the many guest stars were James Coco and Doris Roberts who both picked up Emmys as a mentally challenged boyfriend and a bag lady. It was an interesting storyline where two couples are followed through their medical care. One couple is upper middle class and the other has no money. Nothing is said; there are only observations of the action. The wealthier woman leaves the hospital with no cure but a high hospital bill for many tests. The bag lady, Cora, learns she needs to have both feet amputated because of gangrene, but she needs to take care of Arnie, her mentally challenged boyfriend, so she refused the surgery.

Roberts was asked about her role on the show in a Television Academy interview. She said Coco had received the script and called her to say she needed to audition for the role of his girlfriend. When Doris reached out, they declined, so she reached out to Bruce Paltrow, who was a producer and writer for the show, and she was hired. She did a lot of research watching homeless people. She realized that most people squatted because they did not want to lie down because they were worried about having things stolen. This is how her character got gangrene. When asked about what she thought happened to the character she said she thinks she died shortly after. Roberts got emotional discussing the role and said it still makes her cry. She said it was the best dramatic role she ever played.

Doris said one funny moment came at the Emmy Awards. When they called her name, she did not know what to do with her purse, so she handed it to Jimmy Coco. The next name called was his so he came on stage with the purse and mentioned he didn’t use one often but it came from Doris. Then a few nights later he was on the Tonight Show, and when he came on stage he had her purse and in it was a cigar, a half-eaten sandwich, and a few other items.

The show was classified as a drama, but it included comedy, as well as inspiring moments of interaction and care. One of these scenes is when Jack, a resident, has to deal with his wife’s death. She is an organ donor, and her heart is given to a female patient. Jack sneaks into the patient’s room when she is sleeping so he can listen to his wife’s heart.

Jazz musician Dave Grusin composed the theme. Grusin won twelve Grammys. He won an Academy Award for his score of The Milagro Beanfield War in 1988. He also scored some popular films including The Graduate, On Golden Pond, The Fabulous Baker Boys, and Tootsie. Before writing the theme for St. Elsewhere, he cowrote the themes for Good Times and Baretta.

One of the most interesting things about the writing on St. Elsewhere was the number of allusions to other television shows and movies and several cross-overs. There are many of these but some of the most fun ones for me included (1) the public loudspeakers often page characters from other television shows, (2) one of the characters on The White Shadow, Warren Coolidge, becomes an orderly and sometimes wears Carver high school shirts, (3) a psychiatric patient who watches The Mary Tyler Moore Show believes that he is Mary Richards and has an encounter with Betty White, and she says she is not Sue Anne Nivens, (4) Dr. Craig once mentions serving in Korea with B.J. Hunnicutt, and (5) the teaching doctors are seen at the bar at Cheers in one episode.

The hour-long show started on Tuesday nights. The show was canceled after the first year. Then Grant Tinker changed his mind and they were back on the air. For the second season, it was moved to Wednesdays where it remained until it was canceled.

The finale of this show gets talked about almost as much as Newhart. However, while fans loved the Newhart ending, there was a lot of controversy over the ending of St. Elsewhere.

Warning: This is a spoiler alert if you haven’t seen the show and want to watch it. After wrapping up several storylines, the final scene is a much younger Dr. Westphal and his son Tommy (Chad Allen) who has autism. Westphal is obviously a construction worker. Dr. Auschlander appears to be Westphal’s father. Tommy is playing with a snow globe and the two “doctors” discuss the fact that Tommy spends much of his day staring at the snow globe. They set the globe down and when the camera goes in close, we see St. Eligius inside.

We are left to assume that the entire series had been Tommy’s imagination. In other words, the show was fiction but the fiction was also fiction inside someone’s mind. Viewers understandably were confused and upset.

Later the cast did a special on Entertainment Weekly and was asked to share their thoughts about the finale. Here are a few of the comments. Chad Allen said, “From the mind of a young person whose fantasies were coming to life before him, it was neat.” William Daniels said he was “shocked, actually. I had no idea of their plans to do that. . . it was a provocative ending. A surprise to everybody.” Ed Begley Jr. felt that “it was quite fitting for what they had done the previous six years. They always tried to be out there, beyond the limits of what was being done before. They tried to think outside the box. . . . It was bold and shocking and upset some people.  . . . It was highly unpredictable, just like every episode.” Howie Mandel knew it would offend half the viewers and appeal to the other half, but he described it as “ahead of its time, pretty ingenious, and creative and not like anything else.” Mark Harmon had been killed off earlier in the series, but said, “It made me smile when I heard about what they did because it was so them. They made a choice. and the choice is interesting.” Noman Lloyd said he “never bought it. I said at the time we were shooting, ‘This is a cheat.’ For me, it was a cheat.”

I will admit this was not a show I regularly watched. I find the entire philosophy of the ending fascinating. Many felt they had been cheated by getting pulled into the lives of characters for six years that never existed. However, if they are on a television series, did they ever exist? It shows how real characters become to us when we invest in a show and invite these people into our homes every week.

If you didn’t watch the show in the eighties, you can find it on Hulu and make your own decision about the finale. I do admit that I never look at snow globes the same way anymore.