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St. Elsewhere

April 28, 2010

A reader requested a post about St. Elsewhere. So here it goes. If you want me to analyze a show you’ve seen me mention email me: snarky at snarkysmachine dot org.

Tommy Westphall

This post includes possible spoilers for the following shows: The X-files, Arrested Development, Homicide: Life on the Street and, of course, St. Elsewhere.

St. Elsewhere is one of those shows from my childhood which still has cultural relevance and its influence can still be seen on a number of shows. Not only because its creators/producers have continued creating quality television, but also because others have continued to mimic the shows best elements.


    St. Eligius – nicknamed St. Elsewhere – is a rundown teaching hospital in Boston. So if you’re looking for shiny, fresh faced doctors using the latest geewhizatron machine, this show is not for you. In terms of style, tone and pacing the obligatory comparison is Hill Street Blues. They share a similar depressing lighting and color palette, which at times tended to veer dangerously close to cheesiness when coupled with a tedious “budget cuts” story arc – those made the rounds about once every five episodes.
    In many ways it’s your standard hospital drama. You got your group of crabby attending physicians, a bunch of arrogant upstarts, some unleashed Lotharios, “slutty”/disposable nurses, teen runaways who fall in hearts with the “cute” and/or sensitive doctor, and ignored/melodramatic put upon spouses. Seriously, this is like making a cake. It basically starts with the same ingredients and it’s the skill of the baker responsible for bringing those ingredients to life.

    The show focuses on the above group of characters trying to go a couple of days without killing anyone on purpose, while negotiating whatever “ripped from the headlines” issues presented by the writers.


    St. Elsewhere hopefully answers the musical question – “Why are Howie Mandel and Ed Begley Jr. famous?” so let’s skip over them for a moment. I don’t have much to say except they both tended to get on my nerves with their clown horn/rubber chicken medicine. And I don’t feel like dishing the hilarity that was framing them as the best of the best only to constantly show them fucking things up.

    Over the six seasons the cast was peppered with some pretty fantastic and familiar names: Denzel Washington, Alfre Woodard, William Daniels, Mark Harmon, David (Baxter) Birney, Christina Pickles, David Morse, Kyle Secor, Helen Hunt, Bruce Greenwood and Ed Flanders.


    St. Elsewhere did not skirt controversy. Given what I know about its creators (based on previous and subsequent projects), these were folks really trying to say BIG THINGS and honestly, more times than not they did okay. So before I rip/praise, let’s just get that out of the way. These creators really wanted to change TV and move the hospital drama into the 80s, similar to what M*A*S*H wanted to achieve, only St. Elsewhere opted to do it without sending folks off to a TV war lasting longer than the actual war it sought to explore.

I’ll start with the biggest controversy – the final episode

The final credits hadn’t finished rolling before TV wonks and academics were frantically spilling ink trying to process the finale and what it meant for our weekend. This is the spoiler part, so seriously, if you don’t want to know, skip down to the next controversy.

I’ll let you in on the secret of life. It’s not the Law of Attraction or the golden rule. It’s this simple truth. We are all living in the mind of ten year old boy named Tommy Westphall. All of us. All the time and twice on Sundays.

According to Tommy Westphall’s Mind:

St Elsewhere – which had a direct crossover with Homicide – had many connections to other TV shows. And cross-pollinating Homicide with Dick Wolf’s Law & Order franchise bred even more connections.

Tom Fontana has increased his own corner of the multiverse by adding sly references to his past series in his current work. It is his hope that one day all of TV will be part of Tommy’s mind. I’m not sure if he’s joking or not, but slowly but surely, Tom’s (and Tommy’s) dream is coming true.

This comprehensive site also includes an L Word like chart:

The Fontanaverse

The cross indicates St. Elsewhere and Homicide: Life on the Street. It’s a compelling and provocative argument, but not devoid of criticism.

Most notably – and rather convincingly, even to this disciple of the theory – Brian Weatherson of the site Six Objections to the Westphall Hypothesis most compelling argument states:

To make the point more vivid, note that the massive list of crossovers misses one very important crossover. Michael Bloomberg plays the Mayor of New York both in Law and Order and in the real world. So by the logic used here, the real world (taken to be either what we’re in or the MTV show of the same name) is part of the giant St Elsewhere fiction. This is clearly false. (Or at least it was last I checked.) Similarly it is possible that the same character can appear in two different fictional worlds. That doesn’t mean that every time a character appears on two different shows they are different fictional worlds. Cheers and Frasier clearly are part of the same world, as are Friends and Joey. But it doesn’t mean that interpretation is forced on us by the common appearance of a character. So the Westphall Hypothesis is not forced on us by the existence of crossovers. And since it is a crashingly bad interpretative hypothesis as applied to any show except St Elsewhere, we shouldn’t accept it.

Bottom line on this controversy: There are strong, well-reasoned arguments from both sides, which as a bonus are both fascinating reads. I still stay firmly planted in Team “We’re In Tommy’s Mind”, but mostly because it I’m afraid I might be a replicant and too much logical could cause my head to explode. And as a person who has had enough distance from the original finale’s airdate to reflect, I’m entirely convinced its plot twist has not hampered my ability to enjoy TV or go about my daily business.

Next controversy – AIDS.

    I have written extensively on AIDS narratives in pop culture, but I have always shied away from the way in which it was explored on St. Elsewhere. For one thing, I was incredibly young – 13 or 14 – while this story arc played out and I was lucky to have accurate information regarding the disease from my mom, which I believe frames my viewing in way that might not be as powerful or useful as someone who did not have access to similar knowledge. I will say that they dropped the ball in a big way with this story arc. It seems more like retconning to lay claim to being the first TV show tackling AIDS without added qualifiers such as, “First network show with sizable audience” or “First show with a protagonist with AIDS that folks might actually care about”. Someone was talking and producing media tackling this issue so I take issue with how this arc was framed. Anyway, that said, they did ditch the prevailing narrative at the time, choosing to create a heterosexual character (Dr. Bobby Caldwell, played by Mark Harmon) to contract the disease through heterosexual contact – a fact they made clear several times and in ways just short of having the character wear an electric sign on his chest. Here’s where I had the problem. Character contracts onscreen and is sent to die off screen and his passing is mentioned in an “oh by the way” manner which I STILL REMEMBER TO THIS DAY. Thanks for letting us use this as a learning opportunity, but now we have to wish you away to the cornfield. So yeah, writing about the treatment of AIDS on this show requires more thought, time and nuance than I can do here. Long story short, D-.


    Class – Remember the budget cut chow chow I mentioned way up-post? Well, in my opinion this is pretty much the extent of the class analysis on the show. Budget cuts and the rundown hospital motif were supposed to circumvent examining class, health disparities and the audience was I guess supposed to infer all the issues of class from the drumbeat of those two talking points. I would say that was as useful as a chicken in cha cha heels.
    Race – There were lots of black guys on the show who were NOT DENZEL, – leaving race analysis aside for a second – and that’s NOT FUCKING COOL. Not nearly as much Denzel as my 13 year old self needed or wanted. Okay, with that out of the way, well I haven’t gotten confirmation but it did look as though every blacktor within a 200 mile radius with a SAG card walked the halls of St. Eligius. Most of them were NOT DENZEL. If you aren’t familiar with the Fontanaverse (Tom Fontana) be prepared to see lots of brown people in all kinds of roles portrayed in non-monolithic ways and not all eating at the same table in the lunch room. Even for me it was hard to get used to when I first started watching H:LOTS because much of the racial diversity is executed with limited commentary, and at times can feel a bit heavy handed and too self aware. I have the same issue with The Wire (another star in the Fontanaverse) When I say “brown people” I mean all kinds of brown people
    Gender – Not so good here. Fontana generally has mixed results with this. For every Dr. Roxanne Turner (Alfre Woodard) or Det. Kay Howard (Melissa Leo) there are at least THREE Det. Ballards. It’s like what Golden Hawn’s character said in First Wives Club: Babe, District Attorney and Driving Miss Daisy. Rinse, lather and repeat. Still, this was the tail end of female nurses getting respectful and complex treatment on TV, and oddly enough the entrance of more female doctors characters seemed to exacerbate this! There was still a “slutting” of younger female nurses and othering of female doctors. Like I don’t recall seeing more than one female doctor actually IN THE OR, in the first season and my memory is fresh. I am nervous of my decision to include Trans issues here because it might seems like a dodge or cookie seeking, but as a cis identified person I’m just going assume there is nothing but TRANSFAIL and my failure to notice specific moments say nothing about their absence and everything about my privilege. I own it. But considering this is a medical drama, I’m not inclined to expect any nuance or respectful treatment in this regard, if the subject is broached at all.
    Disabilities – PWD are featured – albeit in tokenizing and othering ways – on the show. Again, as a medical show, this isn’t going to be the best place to find support of agency. The hospital’s legal wonk uses walking assistance and it was handled in a D- fashion. It would have been a D if not for the desire for the writers to make tedious use of what I term (in the context of bodies of folks with disabilities) “the superhero origin” trope. I don’t like it. The character was NOT there to talk about his own body, but there to keep DENZEL’s body out of the slammer for KILLING A PATIENT. Autism is featured in the show, but again, do not look for nuance here. I neglected to mention it is the Tommy Westphall character who navigates Autism and I’m not sure if I know what is trying to be said about it in this case. I worry that missing something big, considering we all live in his mind, and I am not seeking to make light of the use of Austism as an element of the show. I just don’t know what was the point since the writers never provided commentary or framed it in a larger context, so I’m inclined to think it’s 88% problematic. But I generally feel this way whenever -isms are trotted out with limited commentary or framing. Moreover I am very uncomfortable with the idea of Autism as a trope, particularly when used in service of a bigger bang than say your run of the mill “it was all a dream…” trope. In addition, I don’t support Autism = psychosis. There are folks on the spectrum who may express psychosis but psychosis isn’t an EXPRESSION of Autism. So even being on Team Tommyverse, I am completely aware of how that can be framed as problematic and take ownership of that.
    Fat – Long story short – too late – body size is stratified by class in most cases. The fatter characters, not that there are many – are usually of color, female and are usually engaged in what’s termed by the medical industry as “allied health” careers.

Does it hold up?

    I would say it does. It feels like an 80s show, but that’s just costuming. Unless of course we’ve solved all those pesky issues of -isms and found enough money to avoid budget cuts.

So there you have it

    Those are my thoughts, reflections and strong opinions on St. Elsewhere. It’s a very good show. It’s flawed and none of it can be attributed to the era in which it was produced. That’s the good news, I guess, given that folks who enjoy it CANNOT use that defense as a part of any well-reasoned argument.

Televisionary has another discussion of The Westphall Hypothesis.

Thanks to Dean/Penpusher for a great comment and as usual generous use of his vast wealth of pop culture knowledge.

a version of this entry previously appeared on Snarky’s Machine

6 Comments leave one →
  1. evmaroon permalink
    April 28, 2010 3:07 pm

    But wait a minute! If we were in Tommy’s mind, how would we know? Would it be like the Matrix? Or wouldn’t it be like when Moriarty got stuck in an endless loop program on Star Trek, TNG? He was just fooled forever. Though I guess he was just a hologram.

    Wait, wait, wait. Are we all HOLOGRAMS???

  2. April 28, 2010 3:12 pm

    I love the Moriarty ep of ST:TNG.

    I remember as a kid I watched St. Elsewhere and there was this one patient with some kind of rare terminal disease whose hair and eyebrows had turned white suddenly and he looked scary so I avoided watching it any more.

  3. evmaroon permalink
    April 28, 2010 5:24 pm

    Also, thanks for this great recap of a great series, Snarky! It is under-appreciated as the starting point for ER, Grey’s Anatomy, Chicago Hope, Providence, and others, and it hasn’t really lost its punch in the way that Quincy, M.E. has. Which is sad, because I like an angry Jack Klugman, but the plot lines are just way too simple and overheated for viewing today. So it’s nice to see that the character-driven story triumphs over time.

  4. April 29, 2010 8:06 am

    I believe St. E stands the test of time because despite being topical it wasn’t so enmeshed in the topics of the day in a way that quickly dates a show – Murphy Brown comes to mind – so that there are things about hospitals that rarely change (budget cuts, emerging public health issues). The topic d’ jour was not the driving force of the narrative, like it was with MB.
    The framework the producers pf St. E use to examine issues mimics the classic narrative structure while at the same subverting it by finding interesting lens from which to focus their examination.

  5. Tea-Man permalink
    May 1, 2010 6:54 pm

    I wanted to add that “St. Elsewhere” had one of the best TV flashback episodes I’ve ever seen (“Time Heals” from season 4)…excellent writing, acting and directing that filled in a lot of the details about the characters from the series.

    Also, I wanted to shed some light on the final scene of the series…I don’t think it was meant to be taken literally (the entire series being a figment of Tommy’s overactive imagination). I think it was the show creators, producers, writers and staff (creative) way of saying farewell to the series and its viewers. A key to this is the conversation Auschlander and Westphall have near the beginning of the scene. When Auschlander asks Westphall how his day went, he responds with something like, “We topped off the twenty-second story and I’m beat”. That final episode was the 22nd story of that season. Also, the actors in that scene are portrayed as being one family unit which may have been a reference to the Tinker family (Grant Tinker, who was the CEO of NBC during the run of “St. Elsewhere”, and his two sons, Mark and John, who directed and wrote for the series). Before the scene ends, the snow globe is placed on top of blank TV screen, which was likely their way of saying “that’s all there is folks and it’s time to move on!”

  6. July 4, 2010 11:54 pm

    I’m hauling my comment from your original post over here, because I can!

    When it came to AIDS, you forgot (or maybe never knew) that St. Elsewhere had another character who acquired the virus, Dr. Griffin (Bruce Greenwood). He apparently was “cured” of his affliction through the power of prayer! All in all, I’d say that drops St. Elsewhere’s treatment of the AIDS virus to a flat F.
    However, how you can overlook the hilariousness of the Daniels/Begley duo as one of the great comic pairings of this era is an oversight I cannot let stand! I tuned in just to see William Daniels glower at Ed Begley Jr’s dumb smirks in the scrub room or ridiculous commentary over some sad sap’s open chest during a cardio procedure. Compared to most of the sitcoms of the 80s (not that there were many), this show held its own in moments like that!
    I would also point out that the references the show would constantly drop in (it started with the pages over the PA system – “Paging Dr. Howard, Dr. Fine, Dr. Howard”) and eventually extended to direct dialogue by the players – “Move the gurnee, Hal!”) they continually slipped in tons of pop culture references throughout the series, which was sheer genius, though I suspect may be missed by any new viewers of the program now.
    Finally, two more articles to point to: one is an amazon review of the DVD box set here:
    It’s worth a read, through to the respond comments.

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