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Pop culture obsessives writing for the pop culture obsessed.

St. Elsewhere

Illustration for article titled St. Elsewhere

For most of the history of television, the barrier to syndication—and to profitability—has been 100 episodes. The shows that have made it to that mark are an unusual group. Many were big hits. Some found small cult audiences. Still others just hung on as best they could and never posted numbers quite low enough to be canceled. In 100 Episodeswe examine the shows that made it to that number, considering both how they advanced and reflected the medium and what contributed to their popularity.

In the mid-’80s, NBC president Grant Tinker faced an awkward problem. Working with wunderkind executive Brandon Tartikoff, he had managed to turn the network around, thanks to populist hits like The A-Team and The Cosby Show, as well as critical favorites that managed to cross over to a wider audience, like Cheers and Hill Street Blues. Once a last-place network that cynically programmed—and swiftly cancelled—a purposefully bad sitcom about a talking orangutan because it assumed no one would ever go broke underestimating the American public, NBC became the guardian of quality TV for a new decade after CBS, the ’70s “Tiffany” network, had given up the mantle.

Yet no matter what Tinker tried, he couldn’t save what might have been the network’s best program, a struggling hospital drama named St. Elsewhere.


Tinker had reasons to preserve St. Elsewhere beyond his devotion to putting good shows on the air and letting them find their audience. For starters, it was produced by MTM Productions, the company Tinker had founded in 1970 as a production company for his then-wife’s new television show, The Mary Tyler Moore Show. In fact, Tinker took credit in his memoir for the idea of doing a gritty, realistic take on the hospital drama, an idea he shared with Bruce Paltrow, the showrunner of the MTM-produced inner-city high school drama, The White Shadow. Paltrow would also serve as showrunner for St. Elsewhere, taking a script by young writers Joshua Brand and John Falsey, then using their stories of young residents in crumbling hospitals to attract some of the top TV writing talent of the time.

Tinker had good reason to assume that if he left the show on the air long enough, it would find an audience. Both Hill Street and Cheers had woefully rated first seasons, then built buzz in their second seasons thanks to key wins at the Emmys. Though Elsewhere never won the Best Drama Series trophy, it was a mainstay at the awards, racking up wins for writing, direction, and acting. Furthermore, Tinker had found that Hill Street’s innovations—serialized storytelling, engagement with contemporary social issues, adult themes—took time to sink in with audiences. With its darker moments, love of TV history and in-jokes, and willingness to kill off beloved patients, St. Elsewhere was unlike any other hospital drama that had been produced to that point. Perhaps it would just take time to catch on.

St. Elsewhere never rose above 49th place in the year-end Nielsen ratings (in a time when there were still only three networks to rank), yet it managed a run of six seasons and 137 episodes, good enough to send it into syndication and have it pop up periodically on the cable rerun circuit, even today. Now, if St. Elsewhere is thought of at all, it’s as the place that launched the careers of such actors as David Morse, Denzel Washington, and Ed Begley, Jr. TV scholars will point to the show as the one that trained many of the best creative personnel for the greatest dramas of the ’90s. Falsey and Brand would go on to create Northern Exposure and I’ll Fly Away. Acclaimed St. Elsewhere scribe Tom Fontana would shepherd a book by reporter David Simon to the small screen, where it became Homicide: Life On The Street. Thus, it’s become a show known more for what it led to than for what it did. (And, yes, it’s a show known for its closing moments, which implied the entirety of its run—and much of TV history—were occurring in the mind of an autistic child.)

Yet St. Elsewhere deserves to be spoken of in the same breath as the great drama series that followed. If some of its story arcs could be preposterous, its finest moments and strongest episodes remain among the best television has ever produced. Even leaving quality aside, however, St. Elsewhere deserves to be remembered as the show that led to an idea that’s essentially taken over television: keeping a program on the air because it appeals to a younger demographic.


Tinker and his executives couldn’t make an argument to save the show based solely on ratings, because the ratings were terrible. They could, conceivably, keep the show on the air because the reviews were good, and network executives liked it, making it something of an NBC vanity project, a subsidized money pit kept on the air because it made the network look good. (For a modern example of this, look at how the Fox network has treated Fringe.) But Tinker also noticed something in the ratings data he thought he could turn into a winning pitch to advertisers. The show’s numbers were much stronger in the 18-to-49-year-old demographic than they were elsewhere. That probably shouldn’t have come as a surprise, since the show’s legion of television in-jokes seemed directly pitched at baby-boomers, who had been raised on the medium, and since younger demographics were quicker to warm to Hill Street Blues and Cheers.

This idea said that the television landscape was shifting. It was getting harder to reach younger viewers, who might tune out in the 10 p.m. hour to spend time with family or go to bed before work the next day. Older viewers had always been a reliable TV audience, at least since radio had finally ceased to be a competitor for TV, but they were also more likely to be set in their ways about brands, which made them less attractive to advertisers. Shows like St. Elsewhere, which pulled in a solid number of younger viewers—indeed, a larger number of younger viewers than some shows in the top 30—could be monetized in that fashion. Advertisers who wanted to reach younger viewers would advertise on St. Elsewhere. That was how the show would be kept alive.


It is impossible to know just how successful this gambit was in keeping the show profitable. Network economics are kept under lock and key, at least at the show-by-show level, and executives aren’t known for extreme truthfulness when explaining their motivations to the press or, later, in self-serving memoirs. Yet the idea exploded from there, and now networks increasingly only look at the 18-to-49-year-old demographic in the current TV landscape. Cult comedies with niche audiences stay on the air because of their viewers’ average age, and the sort of inventive, acclaimed network drama that might be called the St. Elsewhere of today, a show like The Good Wife, can be considered “on the bubble” because its audience skews too old (maybe even old enough to have kept St. Elsewhere on the air).

By the late ’80s, other networks were already applying this ratings logic to their struggling programs. ABC’s Thirtysomething was a flop with everybody but thirtysomethings, but man, that demographically desirable audience watched the shit out of the show. A comedy bloc aimed at a non-traditional audience, like ABC’s old TGIF bloc, could succeed just by convincing advertisers to pay premium to target that demographic. With the growth of cable and, later, other TV competitors like videogames and the Internet, the niche was programmed to. Broadcast networks started to evolve from offering mass-market entertainment to flattering cult audiences with desirable demographics. It continues to this day, an inadvertent revolution in how we watch TV that was first successfully realized by this strange little hospital drama.


That cult status can be irritating, and if there’s a problem with St. Elsewhere all these years later, it’s the way the show congratulates itself about being off-putting for many viewers in the ’80s. (The last season, in particular, is rife with meta-gags about how the hospital at the show’s center will have to sell out to perform better economically if it doesn’t want to shut down permanently.) On the other hand, the show’s greatest innovations—such as episodes in which patients died—have been thoroughly subsumed by other medical dramas.

But this is the curse of the innovative TV drama. What seems fresh at the time will often seem rusty and hackneyed to future generations. This often isn’t the case with sitcoms. Lucy and Ethel working at the candy conveyer belt or Ralph Kramden not being able to remember “Swanee River” remain as funny today as they were in the ’50s because most often, comedies only need to be funny. A TV drama, on the other hand, usually needs to be engaging, groundbreaking, and entertaining while engaging with the world from which the show emerges. It can’t be just entertaining; it has to be tuned in to the concerns of the time.


That quality will always keep a show like this at arm’s length for some viewers. Consider one of St. Elsewhere’s most famous plotlines: A man in a ski mask has either raped or attempted to rape several women in the hospital. He’s eventually revealed to be one of the show’s doctors—one of the series’ regulars, no less. (Hard to imagine many shows doing this nowadays.)  He’s acquitted at his trial, but one of the hospital’s nurses decides to avenge one of her friends and kills the doctor. She’s charged with the murder, and the others in the hospital close ranks against her when she comes in for treatment she can’t receive at the prison’s infirmary. It’s a little infuriating. The show insisted that its cult find its characters basically likable and empathetic, then turned on one of its own, essentially saying, “Sure, he was a rapist, but you’re the real awful person.” But it’s also fascinating and thought-provoking, doubling as a time capsule of ’80s gender politics (and one where the writers thoroughly knew every single button they were pushing). It’s also ridiculous and melodramatic. The rapist wears a ski mask? His true identity is hidden? If a show other than a goofy primetime soap like Revenge were to try this today, it would be derided, not considered one of the foremost dramas of its time.

And yet in programming directly to its niche audience, St. Elsewhere often transcended such problems. The show’s finest hours were a two-part episode aired in the fourth season called “Time Heals,” which took the audience on a journey through the 50-year history of St. Eligius, the rundown hospital at the show’s center, and through the back-stories of many of the show’s characters, but especially its two central figures: kind, avuncular Donald Westphall (Ed Flanders) and prickly, brilliant Mark Craig (William Daniels). Filled with callbacks and references to St. Elsewhere’s own mythology and burgeoning history, it’s the kind of episode that only a show programmed to a niche can do, and it’s the kind of episode that only a cult audience can truly appreciate. For all of the things that seemed innovative about the show at the time that now seem a little silly, what stands out about St. Elsewhere today is its basic understanding that the best possible audience for the show were the sorts of people who would really love a show like St. Elsewhere.

Next: I Love Lucy


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