St. Elsewhere (Review)
- 3 days ago
- 5 min read
In the early 1980s, American television underwent a seismic shift as NBC began transitioning from a struggling network to a "guardian of quality TV". At the heart of this revolution was St. Elsewhere, a medical drama that premiered on October 26, 1982. While it never achieved massive populist ratings, its impact on TV history is immeasurable. By eschewing the sanitized, heroic tropes of previous medical shows for a "gritty, realistic" atmosphere, the series paved the way for the complex serialized dramas we enjoy today.
Production Background: The MTM Legacy
Originating in the United States, St. Elsewhere aired for six seasons and 137 episodes on NBC, concluding its run on May 25, 1988. The series was produced by MTM Enterprises, the legendary production company co-founded by Grant Tinker, who served as NBC president during much of the show's run.
The show was created by the "wunderkind" duo Joshua Brand and John Falsey, with significant development by Mark Tinker and John Masius. Executive producers Bruce Paltrow and Mark Tinker shepherded a sophisticated writing staff—including Tom Fontana—who utilized the show to experiment with narrative structures that would later become industry standards.
Synopsis and Plot: Life at "St. Elsewhere"
The plot is set at St. Eligius, a fictional, decaying urban teaching hospital in Boston’s South End. The series earned its title from a derogatory nickname; because the facility was so run-down and underfunded, the local media referred to it as "St. Elsewhere"—a "dumping ground" for patients unwanted by more prestigious institutions.
The overarching synopsis follows the professional and personal lives of the teaching doctors and their interns. Unlike the infallible doctors of the 1970s, the staff at St. Eligius were portrayed as deeply flawed individuals dealing with exhaustion, addiction, and professional failure. The show was a pioneer in tackling contemporary social issues, including AIDS, breast cancer, and the ethics of euthanasia, often allowing beloved characters or patients to die to maintain its commitment to realism.
The Stellar Ensemble Cast and Main Characters
St. Elsewhere is perhaps best remembered for its massive, talented ensemble cast, which served as a launchpad for future Hollywood legends. Key stars and main characters included:
• Dr. Donald Westphall (Ed Flanders): The compassionate Chief of Services and the show's moral compass.
• Dr. Mark Craig (William Daniels): A "prickly, brilliant" world-class heart surgeon whose arrogance provided both drama and dark comedy.
• Dr. Daniel Auschlander (Norman Lloyd): The administrative head who managed the hospital's mission while battling liver cancer.
• Dr. Phillip Chandler (Denzel Washington): An ambitious and capable young doctor; this role famously helped launch Washington’s film career.
• Dr. Victor Ehrlich (Ed Begley Jr.): A socially awkward resident who often served as the comedic foil and protégé to Dr. Craig.
• Dr. Wayne Fiscus (Howie Mandel): An energetic ER doctor who brought a lighter touch to the show's heavy themes.
The cast also featured David Morse as Dr. Jack Morrison, Christina Pickles as Nurse Helen Rosenthal, and Mark Harmon as Dr. Robert Caldwell.
Critical Response and the Demographic Revolution
While St. Elsewhere struggled in the general Nielsen ratings—never rising above 47th place—it was a critical darling. Critics praised its "gritty realism," its "meta" sense of humor, and its willingness to be "off-putting" to casual viewers through inside jokes and complex allusions to TV history. On IMDb, the series maintains a strong 8.0/10 user rating.
The show is historically significant for changing how networks value audiences. Grant Tinker noticed that while total viewership was low, the show performed exceptionally well in the 18-to-49-year-old demographic. This affluent, younger audience was highly desirable to advertisers, allowing the show to survive despite its low overall rank. This "demographic gambit" essentially took over television, allowing niche, high-quality programs to find a home on broadcast networks.
Accolades and Recognition
The series was a powerhouse at award ceremonies, earning 62 Primetime Emmy nominations and 13 wins. Notable winners included William Daniels (two-time Lead Actor winner), Ed Flanders, and Bonnie Bartlett. Beyond the Emmys, the show received a Peabody Award, a TCA Award for Outstanding Achievement in Drama, and was named one of the "greatest television shows of all time" by various publications.
Crossovers, Spin-offs, and Adaptations
Though it didn't have a direct narrative spin-off, St. Elsewhere is famous for its crossovers. In the third-season finale, "Cheers," the doctors visited the eponymous bar from the sitcom Cheers. Furthermore, characters like Dr. Roxanne Turner (Alfre Woodard) and Dr. Victor Ehrlich (Ed Begley Jr.) later appeared on the drama Homicide: Life on the Street. In 2003, a film adaptation was announced by Walden Media, though it was never produced.
The show is perhaps most famous for its series finale, "The Last One," which revealed that the entire six-year run of the series existed only within the imagination of Tommy Westphall, an autistic boy staring into a snow globe. This ending created the "Tommy Westphall Universe" theory, suggesting that many other TV shows—due to their crossovers with St. Elsewhere—also exist only in Tommy’s mind.
Distribution and Modern Viewing
Following its NBC run, the series entered syndication on networks like TV Land, Nick at Nite, and Bravo. It was a popular import in the United Kingdom, airing on Channel 4 and Sky One. In recent years, it was available for streaming on Hulu, though the platform removed all episodes as of October 1, 2025, due to the expiration of streaming rights.
🔖 Key Takeaways
🗝️ Legacy: St. Elsewhere redefined the medical drama by introducing serialized, gritty realism and flawed protagonists.
🗝️ Demographics: It was the first major show kept on the air primarily due to its appeal to the 18-49 age demographic.
🗝️ Talent: It served as a vital training ground for stars like Denzel Washington and creators like Tom Fontana.
🗝️ Impact: The show earned 13 Emmys and is consistently ranked among the best series in TV history.
🗝️ The Finale: The famous snow globe ending remains one of the most discussed and controversial sign-offs in television history.
🌐 External sources
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St Elsewhere Review
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