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‘St. Elsewhere’: Why You Should Revisit TV’s Groundbreaking Medical Drama

All six seasons of this Eighties stalwart are now streaming on Hulu — a binge-worthy watch that reveals a show far ahead of its time

The sprawling cast of 'St. Elsewhere' included, clockwise from top left, Ed Begley Jr., David Morse, Howie Mandel, Mark Harmon, Sagan Lewis, Stephen Furst and Denzel Washington.

The sprawling cast of 'St. Elsewhere' included, clockwise from top left, Ed Begley Jr., David Morse, Howie Mandel, Mark Harmon, Sagan Lewis, Stephen Furst and Denzel Washington.

NBC-TV/Kobal/Shutterstock

There’s a famous episode of South Park called “Simpsons Already Did It,” where Butters proposes various schemes that he then has to abandon upon being reminded that someone on The Simpsons had previously tried it. It was a reflection of the innovation and influence of Bart, Homer and friends, and of the long shadow they cast over so many shows that followed them. It’s damn hard for any animated comedy — including The Simpsons itself, which, like South Park, is still making new episodes 16 years after “Simpsons Already Did It” first aired — to try something that doesn’t in some way echo those classic early seasons in Springfield.

Eighties hospital drama St. Elsewhere didn’t have nearly as long a run, barely making it through six modestly-rated seasons. But those 137 episodes — all of which are now available on Hulu (which previously only had the first season) — featured so much experimentation, so many things that American TV had never tried before, that most of the great dramas of the last 30 years (as well as some of the comedies) could easily do a similar episode called “St. Elsewhere Already Did It.”

A morally complicated drama with a sprawling cast and intricate ongoing narrative? St. Elsewhere already did it.

Technically, Hill Street Blues (which Hulu has had for a while now) did that even before St. Elsewhere. The latter drama, created by Joshua Brand and John Falsey, transplanted the Hill Street formula to a hospital setting, for the same network and studio as Hill Street no less. But it went bigger — by the end of its first season the cast featured 16 regulars, a huge number for the time and even for most non-Game of Thrones series today — and often deeper. Story arcs played out over years(*), whether sensationalist material like a serial rapist (who turned out to be one of the doctors) terrorizing the staff or something more understated like the long fight against cancer by the avuncular Dr. Auschlander (Norman Lloyd, who is still acting at 103). At any given time, it had at least a half-dozen regulars the writers didn’t know what to do with. (Most striking in hindsight: Denzel Washington as confident resident Philip Chandler; his rise from half-forgotten TV supporting player to movie megastar might force Bradley Cooper and Melissa McCarthy’s career biographers to write, “Denzel already did it!”) But the size of the ensemble allowed the show to be unmistakably diverse — in gender, race, age and even style of performer (pairing veteran character actors like Lloyd and William Daniels with comedians like Howie Mandel and Ed Begley Jr.) — in a way that seemed effortless, especially in light of how many shows today still struggle with inclusive casting.

(*) The series figured out a clever workaround to the fact that most of the characters were residents in a three-year program at St. Eligius: Each season covered only six months. This led to oddities like Christmas episodes airing in May, but it also avoided the contortions necessary to keep everyone working at the hospital over a longer term. Some high school shows might do well to consider this before the inevitable moment where all the kids decide to attend college together.

Hot-button issues tackled with great thought and sensitivity? St. Elsewhere already did it.

The series was on the cutting edge of what medicine was dealing with at the time: heart transplants(*) and artificial hearts, gender transitions, AIDS (Mark Harmon’s womanizing plastic surgeon Bobby Caldwell became TV’s first significant character to contract, and then die of, the illness) and in vitro fertilization, among many others. And the hospital also proved a stage on which to present conflicts about religion, race, sexuality, family, suicide, war and much more. It was never shy about discussing current events, even at the risk of alienating viewers who might disagree with the stance one character or another took.

(*) The heart transplant arc led to the series’ most powerful moment and one of the great scenes in the medium’s history. The organ winds up coming from the young wife of luckless resident Jack Morrison (David Morse), the first of a long string of tragedies and humiliations visited upon him by the writers. Jack is understandably devastated, but he copes in part by sneaking into the recipient’s room while she sleeps so he can listen to his wife’s heart continue to beat. It was such a beautiful notion that countless other hospital shows (including a few from St. Elsewhere veterans) have copied it in the years since.

Wild experimentation with format, tone and genre? St. Elsewhere already did it.

The show’s third season ended with the hospital’s three senior doctors stopping in for a drink at the bar from Cheers, with Carla, Norm and Cliff all wandering over to banter with them (sans laugh track). “Time Heals,” the series’ two-part masterpiece from Season Four, moves back and fourth over 50 years of the hospital’s history, with each period shot in the style of movies of that decade, filling in key details about the lives of the doctors and St. Eligius itself. Season Five’s “After Life” takes Mandel’s Dr. Fiscus through heaven (a sunny garden party), hell (a desolate lake without any fish to catch) and purgatory (a depressing vacation filled with people who didn’t fulfill their dreams, including, notably, NFL referees) before giving him a chance to speak directly with God. Other episodes dabbled in dream imagery, theatrical concepts (one hour is structured like Our Town, with Ed Flanders’ Dr. Westphall directly addressing the audience), superhero fantasies and various additional conceits that no one expected to find on a hospital drama.

Meta humor and self-awareness? St. Elsewhere already did it.

Long before Abed on Community became convinced he was a TV character, St. Elsewhere winked early and often at its own fictional nature and at the history of TV in general. One longstanding patient, the amnesiac John Doe #6 (Oliver Clark) became convinced he was Mary Richards from The Mary Tyler Moore Show, attended therapy sessions with Elliot Carlin from The Bob Newhart Show and, when confronted by Betty White in a non-MTM role, still addressed her as Sue Ann Nivens. As orderly Warren Coolidge, Byron Stewart was reprising a role he’d played for St. Elsewhere showrunner Bruce Paltrow on The White Shadow; his former co-star Tim Van Patten (Shadow guard Salami) appeared in a few Season Three episodes playing a different role, and when the two crossed paths by a hospital elevator, Coolidge was understandably confused. Dialogue was peppered with references both to other series and this one. (While treating a trauma during one premiere, Fiscus jokes, “First day of fall; what a way to start a new season, huh?”)

Divisive finale that makes viewers retroactively question their time spent watching the whole series? St. Elsewhere really already did it.

Its concluding scene revealed that the entire series had existed in the imagination of Dr. Westphall’s autistic son Tommy(*) as he stared at a snow globe of the hospital’s exterior all day. To underline the point — and to make the audience feel even more judged about their own commitment to this imaginary hospital and its imaginary doctors, Westphall places the globe on top of the TV set in the final shot. (Years later, St. Elsewhere writer Tom Fontana, who came up with the snow globe idea, would tell me of this century’s many controversial drama finales: “I was like, ‘Oh, thank God there’s other people in the room with me now! It’s so lonely in there being the guy who had somehow infuriated half of our audience.'”)

(*) The late comics writer Dwayne McDuffie once pointed out that because St. Elsewhere crossed over with so many other shows, all of those shows — not to mention the ones they crossed over with (one of the St. Eligius doctors was later a suspect on Homicide, which links the series to every one where Richard Belzer has played John Munch) — also must exist only in Tommy’s imagination. This has led to various attempts to catalog the entirety of the Tommy Westphall Universe, which now totals in the hundreds of shows.

All that crazy energy and inspiration made St. Elsewhere more uneven than many of its peers and creative descendants. The first season is largely skippable (save for the Emmy-winning “Cora and Arnie,” about an aging homeless couple), as it focuses too much on characters who got dropped after that year along with Brand and Falsey. The topical stories can play a bit didactic now, as complicated new ideas had to be spelled out in detail so audiences could understand each side of the debate. The production values look spotty even for the era. (Hill Street has its own aspects that have aged badly, but it looks and feels more contemporary all these years later.) Where a lot of the Eighties and Nineties classics in Hulu’s library like Hill Street or ER are still suited to marathoning straight through their best years, St. Elsewhere probably works better as a show where you bounce around the seasons(*), making sure to hit the highlights like “Time Heals” and the finale.

(*) But be warned that Hulu has at least a few episodes out of order. At the moment, “After Life” and the episode that follows it, “Once Upon a Mattress,” are labeled as one another.

That concluding hour (titled, simply, “The Last One”) was the show at its most self-aware even before Tommy shook the snow globe. There are recreations of the iconic endings to The Fugitive and The Mary Tyler Moore Show, plus references to M*A*S*H, The Andy Griffith Show and more. Fiscus begins the episode treating a patient with eye strain named General Sarnoff (after NBC’s founder), whom he advises to cut down on his TV viewing. (He then complains to a colleague that he doesn’t want his last St. Eligius patient to be “someone who spent their entire existence in front of the tube.”)

It’s not hard to imagine Fontana and the other writers feeling uneasy about St. Elsewhere‘s status as a television show, even an all-time classic one. St. Elsewhere was one of the shows that helped unlock TV’s full narrative potential and started to change its reputation as a haven only for big-tent, pre-chewed, lowest-common-denominator storytelling. But the medium still had that rep at the time, and there’s a degree of televisual self-loathing that you can still find decades later in shows like The Sopranos or 30 Rock or The Good Wife. Like everything else, when those shows poke fun at themselves for being shows, it’s easy to say that St. Elsewhere already… well, you know.

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