That’s All, Folks: St. Elsewhere and the Everlasting Legacy of Its Strange Snow Globe Finale

Most scripted television shows end in cancellation, so there’s something special about the ones that get the chance to go out on their own terms. This year, Ken Lowe is revisiting some of the most influential TV shows that made it to an officially planned final episode. That’s All, Folks is a look back at television’s most unforgettable series finales.

Beginnings and endings are important in all forms of fiction, but I’d argue especially so in scripted television. The first episode of a show has to hook viewers in for the long haul in a way totally unlike, say, the first pages of a novel. The finale (if you’re lucky enough to ever have a planned one air) might be one of the most watched episodes in the whole run of the show and the impression that lingers in the minds of most viewers long after the show ends.

In the age of streaming in particular, I feel as if this is even more true than it’s been in the past. Television these days—or rather, television that jerks like me actually bother to write about—basically falls into two categories now: Heavily scripted and serialized “prestige TV” or reality show stuff that sounds like a made up show on 30 Rock. Syndication used to be the method by which we would see old scripted shows, and a show’s rep needed to be good enough for you to stop flipping channels if you happened to land on an episode (ooh! Quantum Leap is on!). But now, viewers are picking shows out to binge watch, and they want to know that their time investment is going to have some payoff.

So what happens when an ending goes completely off the rails? In a way that actually sucks most  of contemporary-set American scripted TV into the inside of a snow globe?

The Show
St. Elsewhere was a show that got by largely on the strength of its ensemble, running for six seasons from 1982-88. The show was a proving ground for actors you have seen in a million things before or since: Denzel Washington and Howie Mandel were easily the most recognizable, but there were also ringers like Mark Harmon, David Morse, Ed Begley Jr., Bruce Greenwood, Ronny Cox, and not only Mr. Feeny himself (William Daniels), but his wife (real and fictional) Bonnie Bartlett. Helen Hunt even appeared in a few episodes. It’s been observed that much of American primetime TV has been about cops and the sex lives of doctors. While that can sometimes describe St. Elsewhere, the magic was in the tone, as it was with another show by the same production company, Hill Street Blues.

Both shows took a grittier and more realistic approach to their drama. St. Elsewhere is not a great place to work or convalesce. It is underfunded, understaffed, crowded, and running on fumes. Much of the humor between characters is gallows humor. I spent a shift sitting bedside with my daughter in the emergency room during a three-day-long stay once, watching the same sainted nurse come and go as an endless tide of needy patients washed in. This 40-year-old show looks like that nurse’s job in that ER, and the characters’ coping mechanisms and responses to trauma may be dramatized, but they aren’t implausible. ER and Chicago Hope wouldn’t exist in the form they did without St. Elsewhere, and I venture to say stuff like House or Scrubs, or even Grey’s Anatomy would not look or feel the same without its influence and success.

St. Eligius is a teaching hospital in Boston’s South End (the building that appears in the title sequence is actually an apartment building there). Nicknamed “St. Elsewhere” by the residents and the surrounding community, the place has a reputation as a rathole. The whole circus is overseen by Dr. Donald Westphall (Ed Flanders), with Dr. Daniel Auschlander (Norman Lloyd) and Dr. Mark Craig (Daniels) rounding out the experienced older set of doctors helping the residents learn the ropes. Mandel, Morse, and Washington are among the core cast of younger doctors that stuck around for the entire show, wringing their hands over their critical patients, racing to respond to someone randomly coding in the hallway, or occasionally banging in the morgue. Through it all, time skips are marked off by a digital clock readout in the corner, and it’s the lightest touch that makes a world of difference in how the show goes over, marking the endless grind the characters face in tangible hours and minutes.

St. Elsewhere was never a huge ratings hit, but it had a loyal following, won awards, and remained well-regarded in the years following its final curtain call. If it were just a solid hospital show, it would be a popular back catalog binge watch, but it’s a part of TV history for two reasons: its novel approach to the hospital drama, and…

The Finale
“The Last One”

The show’s cast had seen ups and downs, additions and subtractions in its time, with Flanders’ character Westphall eventually stepping down as the hospital’s head to become a doctor there. The common thread running through the last season (besides a consistent plot about a special new artificial heart) is that St. Eligius is probably going to close, right around the same time the hospital’s residents (read: the younger main cast members) are all ending their residencies and about to head out into the depressing world of medicine.

Fiscus (Mandel), Morrison (Morse) and Ehrlich (Begley) are all dealing with their own issues around their impending exits. Mandel’s character, though, gets the easiest metaphor of the episode. As Dr. Fiscus struggles with the anxiety of leaving the hospital, his last patient at St. Eligius is the actress portraying a valkyrie in a Wagner opera who has, get this, laryngitis. Craig, always a prissy sort, is absolutely beside himself with the prospect that his wife Ellen is taking a job in (gasp) Ohio. Westphall, Auschlander, and Gideon (Cox) are stressing about how they can possibly keep the hospital open. Somehow, a literal airplane has crashed into the hospital.

It’s an episode of heartfelt goodbyes and dramatic exits. In the moments before he’s expected to announce the fate of the hospital, Auschlander suffers a catastrophic stroke off-screen and is discovered dead, with the cast gathering for a mournful goodbye. And in the end, Fiscus’ patient does finally sing.

But of course, none of that is what people really remember the last episode for. They remember it because of young Tommy Westphall (Chad Allen)—the autistic son of Dr. Westphall, who was a recurring character on the show. In the final scene of the series, the camera widens out from St. Eligius, until it becomes clear the hospital is a model inside a snow globe being shaken by Tommy as he plays on the floor of a small apartment. In the door comes Dr. Westphall, but he hangs up a construction worker’s hat. What world is Tommy imagining inside that snow globe, he wonders aloud.

That is the actual ending, a strange world-within-a-world. It seems to imply that the events of the show were all imagined by the mind of a non-verbal young boy. There’s a lot to unpack: is it simply making a statement on the show as a fictional world? Is it positing that the hopes and the fears and the suffering we endure in our lives are being watched by a deity who is interested and all-knowing but who can only gaze in at us and never interfere in our tribulations—where in all the world but an under-resourced hospital in the planet’s richest nation could the question of such a being’s love or cruelty be more pressing?

Nobody is too interested in that, though. They’re more interested in the colossal mind-fuck that is the Tommy Westphall Universe. For indeed, St. Elsewhere, like basically every television series that is set in “the present day,” had crossover episodes or cameos with other popular shows. At one point, St. Elsewhere characters got the business from Carla while drinking at Cheers, the bar from, uh, Cheers—and therefore, Frasier, a spinoff, must also exist somewhere in that snow globe. Through crossovers, spinoffs, cameos, or fictional brands or products appearing in more than one show, everything from Brooklyn Nine Nine and Law & Order to Everybody Hates Chris and Dr. Who were arguably all dreamed up by young Tommy.

Is all of American television the hallucination of an autistic child?? Are you and I??? This is more interesting than interrogating the deeper philosophical or metaphorical meaning behind the very last scene of a six-season show! It’s simultaneously a lot of what I find fun about the inside baseball or meta commentary on TV, and also most of what I hate about it.

St. Elsewhere was a solid drama that gave a boatload of great actors some steady work for a few years, but it will always be a peculiar show for that final detail.

Be sure to join us next time as we look back on an even more esoteric final episode of an even more esoteric show: The Prisoner!

Kenneth Lowe is a regular contributor to Paste TV. You can follow him on Twitter and read more at his blog.

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