Written by: Jennifer Kathleen Gibbons

Warning: If you’ve never watched the TV show St. Elsewhere, skip this essay.

Better yet, try to see if you can find any old episodes of the show online.

Trust me.

Because this essay won’t make sense if you haven’t watched the show.

Okay! If you are still reading, congratulations–because it’s a big day for St. Elsewhere fans.

It’s the 30th anniversary of one of the most bizarre ends to a show in television history.

Never a rating hit, this show about a rundown hospital in Boston. Its real name was St. Eligius but it received the nickname “St. Elsewhere” because it had a background of being a dumping place for patients who were too poor, too sick, and too much for a “regular” hospital. Despite its nickname, it also had the best reputation for being a teaching hospital, where young residents emerged as good doctors. John Masius and Tom Fontana came up with the show’s inventive storylines. If those names sound familiar, they went on to have careers in television that proved to be quite varied: Masius created Touched by An Angel and Providence, while Fontana created Oz and Homicide: Life on the Streets.

St. Eligius had so many storylines weaving through its halls, it’s hard to know where to begin: We had doctors sleeping with each other, doctors bickering with each other, and doctors dying not able to be saved. There were even serial rapists in the second and third seasons, way before #metoo was a thing. In the third season, we had Florence Hufnagel (Florence Halop), one of the most obnoxious characters ever to grace television screens, bickering with each resident and being rude to everyone, only to find herself a victim of inconsistent medical care. And don’t get me started on poor Dr. Morrison, who in three years went through hell: his wife died, leaving him behind with their baby boy, he was almost cut from the program when it turned out he went to a bad medical school in Mexico, and he had an unfortunate time volunteering at a prison.

Denzel Washington was a doctor at St. Elgius. So was Ed Begley Jr, Bruce Greenwood, Mark Harmon, Howie Mandel, David Morse, and countless others. Jane Kaczmarek was a nurse there as well. Helen Hunt dated Morrison. But Patricia Wettig married him! Christopher Guest played a hospital administrator. Judith Light played a character that held a gun at the doctor who botched her husband’s vasectomy.

And then there were the patients! There was Kathy Bates, Jason Bateman, Ray Charles, Blythe Danner, Geraldine Fitzgerald, Eva La Galliene, Dorothy Maguire, Piper Laurie, Tracy Nelson, Tim Robbins and Doris Roberts.

Some lived.

Some didn’t.

But they all made their mark on the show.

The show became known for using names/television references. A patient thought he was Mary Tyler Moore, then was delighted when he ran into Betty White in the hallway. “Sue Ann!” he chirped. (She wasn’t.) One therapist talked to a Mrs. Stevens, who claimed her daughter in law was a witch. There was a patient who died named Mr. Belvedere. Dr. Craig once worked with a B.J. Hunnicutt in the Korean War.

St. Elsewhere was always on the bubble for cancelation, despite Emmy wins for acting, writing and directing. By the sixth season, it was time to turn out the lights. The episode was called simply “The Last One” with several doctors leaving. Dr. Auschlander (Norman Lloyd) who had been ill for years with liver cancer, died of a stroke. Dr. Westphall (Ed Flanders) came back with his autistic son Tommy (Chad Allen) then found out he had to take Dr. Auschalnder’s place as head of the hospital. After giving a touching speech to the staff, Dr. Westphall stared out at the rainy night, listening to Dr. Auschalnder’s opera records. Tommy ran into the room, and the two shared a rare tender moment.

It was a perfect ending to the show.

Well, not quite.

We saw the exterior of the hospital, then the screen became slightly tilted. When I first saw it, I thought something went wrong with my set. Then it switched to a completely different scene. We saw Tommy staring at a snowglobe, shaking it. A man was reading the newspaper. Dr. Westphall walked in, saying “Hi Pop.” The man put down his newspaper. It was Dr. Auschalnder! He was alive! Dr. Westphall looked different; he wore a hard hat and a blue shirt. What was going on?

The two men looked at Tommy, talking about autism. Tommy shook the globe again. Then he was told to put it away, and wash up for dinner. The camera zoomed into the globe. Inside was a small version of St. Eligius.

End credits.

I remember watching it and thinking, Um, yeah. What just happened here?

What I meant, was what happened to the heart rendering ending? What the hell was that? Was the show all in Tommy’s head?

I was gobsmacked.

Of course, this opened a post-modern rabbit hole. Several years before, the doctors made a visit to a bar where everyone knew their name. So was Cheers in Tommy’s head? And if Cheers was in his head, maybe Frazier was in his head as well? Plus St. Eligius was mentioned in the TV show Oz as well–dear Lord, we’re those people in Tommy’s head, too? Richard Belzer was on Homicide, then switched to Law and Order Special Victims Unit. Does that mean the whole Law and Order franchise was in Tommy’s head?

And let’s not forget Munch was in Arrested Development!

So, the Bluths were in Tommy’s head?

There are websites dedicated to the “Tommy Westphall Universe.” where it might take hours to see how each TV show is connected to Tommy.

Part of me would love to see a reboot of the show: How are the new doctors coping with health care reform? Is the hospital still having computer problems? Would the hospital have wifi? However, this is wishful thinking. Three of the actors have passed away (Ed Flanders, Stephen Furst, and Sagan Lewis) and many have simply moved on.

Besides, how can you top that ending?