In the six years and 137 episodes that the 1980s hospital drama St. Elsewhere was on the air, it accrued an impressive 13 Emmy Awards, and a modest but loyal fanbase. Still, it’s safe to say that the show doesn’t come up in conversation too often in 2014. In fact, for all its success, most aspects of St. Elsewhere have dropped out of the cultural lexicon entirely—except for one. The show’s one truly lasting and iconic contribution to pop culture stems from its bizarre and totally unexpected ending, and the sprawling web of theories that ending implies. And it all starts with the imagination of an autistic boy named Tommy Westphall.
On St. Elsewhere, Tommy was a very minor character, the rarely seen son of medical director Donald Westphall, a series lead. He’s totally insignificant to the plot until the series finale, “The Last One.” At the very end of that episode, the camera pans out slowly on the show’s hospital St. Eligius, slowly revealing that it’s actually a tiny model inside a snow globe being held by Tommy Westphall. Donald Westphall enters, but it’s clear from his attire and the dialogue that he’s not a doctor, and more likely a construction worker. Donald Westphall’s conversation with his father reveals everything:
“I don’t understand this autism thing, Pop. He’s my son, I talk to him. I don’t even know if he can hear me. He sits there all day long, in his own world, staring at that toy. What’s he thinkin’ about?”
Let’s take a moment just to appreciate the enormity of that revelation simply in the context of St. Elsewhere. With only a couple lines of dialogue, they retconned the entirety of the series, making it all a creation of Tommy’s extremely active imagination. It may as well have been followed by one of the producers walking on screen to address the audience: “So, did you enjoy getting to know these characters through 137 hours of programming? Well guess what? All of the people you love were hallucinatory figments in the fever dreams of a catatonic child! Bet you didn’t see that coming! Good night, America!”
All on its own, the absurdity of that ending could have given the show a legacy and point of reference for decades, but it turns out, it goes so much deeper. Because other shows on NBC occasionally crossed over with St. Elsewhere, it begs the question of whether they too came from Tommy’s imagination. After all, when one of the doctor characters of St. Elsewhere appears on Hill Street Blues, doesn’t that imply that Hill Street Blues exists in the same universe? TV writer Dwayne McDuffie certainly thought so when he codified the crossovers in a 2002 web post entitled “Six Degrees of St. Elsewhere.” Soon, other readers were joining in and making their own connections, noting that through additional crossovers, the Tommy Westphall Universe potentially included dozens or even hundreds of shows. As St. Elsewhere writer Tom Fontana eventually said in 2003, “Someone did the math once, and something like 90 percent of all [American] television took place in Tommy Westphall’s mind. God love him.”
Obviously, this hypothesis is simply research for the sake of thought experimentation, but some have taken the pursuit of finding the edges of the Westphall Universe very seriously. There’s a well-curated blog dedicated to all of the connections, in addition to spirited rebuttals of the core principle. It’s fascinating to read both sides, but especially fun to track the connections themselves, as they begin with the plausible, and then tunnel downward into an endless rabbit hole of feverish insanity. Let’s take a look at one particular example of such a chain.
1. Doctors from St. Elsewhere once visited the bar on an episode of Cheers.
