Medical dramas like Dr. Kildare, Medical Center, Chicago Hope, and ER have long been one of the most popular television show formats. Of the many programs that presented the issues surrounding major medical institutions, none was more unique, ambitious, and unpredictable than St. Elsewhere. The series, which ran on NBC from 1982 to 1988, focused on the lives of the doctors, nurses, and patients at St. Eligius, an inner city Boston teaching hospital. Each episode offered a realistic look at the fallibility of doctors, the stresses of being hospitalized, and the ethical dilemmas inherent in the practice of medicine. Mixed in with the often tragic storylines were oblique in-jokes, subtle bawdy humor, and countless intertextual references to other works of popular culture. Although the series often struggled with mediocre ratings, its strong appeal to the demographically important baby-boomer and upscale urban professional audiences allowed the idiosyncratic show to remain on the air. After its surreal final episode, St. Elsewhere was widely hailed as one of television's most literate and original programs.
The term "St. Elsewhere" is derived from medical school jargon for a hospital that serves as a dumping ground for patients not wanted by more prestigious medical facilities. Unlike its namesake, however, the series had a distinguished pedigree. Joshua Brand and John Falsey, staff writers on the basketball series The White Shadow, were encouraged to create the series after hearing of a friend's experiences as an intern at the Cleveland Clinic. They assembled a core group of young producers and writers, including Bruce Paltrow, Mark Tinker, John Masius, and Tom Fontana, who crafted a program distinctly different than previous medical dramas featuring noble and perfect physicians. Their stories presented flawed doctors trying, and often failing, to provide the best medical care in less than ideal circumstances. The show's narrative center was held by three veteran physicians: Daniel Auschlander (Norman Lloyd), a liver specialist faced with liver cancer; Donald Westphall (Ed Flanders), a widowed chief of staff raising an autistic son; and Mark Craig (William Daniels), a brilliant and heartless heart surgeon. Many young residents, who confronted their own problems, surrounded them. That the series was set in a large, decaying urban institution, featured a large and diverse cast, and continued plots over a number of episodes caused many to initially consider the series as little more than "Hill Street Blues in a hospital."
In 1986, executive producer Bruce Paltrow said of the series: "The original concept was to try to do an ensemble medical drama in a real way, with a kind of spontaneity and snap—and comedy." The intense realism of the series was evident in its willingness to frankly address such issues as breast cancer, rape, infertility, impotence, and addiction. A 1983 episode contained one of network television's first dramatic presentations of the AIDS (Acquired Immune Deficiency Syndrome) crisis. To heighten the sense of reality, the writers routinely placed their main characters in life-threatening situations from which they did not always survive. Over the years main characters left the show through such means as committing suicide, being murdered, going to prison, and contracting fatal diseases. Howie Mandel, who played a resident, reflected that the characters were as vulnerable as real people when he said: "I could get hit by a car and killed on my way to work and so could Fiscus (Mandel's character). You always felt they could've killed anybody off. It wasn't past what they would do on St. Elsewhere."
The harshly realistic tone of the series was tempered by the writers' willingness to experiment with the show's form and their frequent use of black humor and pop culture references. The obnoxious patient Mrs. Hufnagel entered St. Eligius for an entire season only to die in a freak accident when her bed folded up on her. Another recurring patient, the amnesiac John Doe number six, became convinced he was "Mary Richards" from the Mary Tyler Moore Show. For that episode the writers included dozens of references to the classic series and other MTM productions. A highlight was a scene in a psych ward featuring actor Jack Riley as "Mr. Carlin," his neurotic character from The Bob Newhart Show. Episodes that departed from the show's usual format included one doctor's journey to heaven where he met God and another structured like the play Our Town. Robert Thompson, director of the Center for the Study of Popular Television at Syracuse University, stated "More than any other series in the history of American television, St. Elsewhere rewarded the attentive viewer."
Careful viewers were aware of the writers' affinity for placing dirty, but subtle, jokes in many episodes. The most infamous was one of the first references to oral sex on network television. While dictating a novel Dr. Craig stated: "She came in from the garden, cheeks flushed, arms filled with flowers. I sat playing the Wurlitzer. She said 'Where would you like these?' I smiled. 'Put the roses on the piano and the tulips on the organ."' Such hidden gags were a bonus for active viewers. The series' final episode itself contained dozens of references to other programs throughout television history. In its final moments the writers offered devoted viewers a great surprise as it was revealed that the hospital was only a model within a snowglobe. The entire series had sprung from the imagination of Westphall's autistic son.
Few television programs can claim to be as thoroughly dramatic, humorous, and inventive as St. Elsewhere. The writers demonstrated respect for their audience's intelligence on a weekly basis and revealed that network television can provide a level of sophistication beyond mere mindless entertainment. Furthermore, the constant intertextual references demonstrated that television possesses a rich heritage that can be drawn from by capable artists. Although it may not have been high in the ratings, the series stands as a high point in television history that has rarely been matched by other series.
Bianculli, David. The Dictionary of Teleliteracy. New York, Continuum, 1996.
Okie, Susan. "Too Close to Real?" The Plain Dealer. February 17,1986, C1.
Thompson, Robert. Television's Second Golden Age. Syracuse, Syracuse University Press, 1996.