Before the indie rock-drenched epiphanies of Grey’s Anatomy, before the adrenalized, crisis-a-minute pace of ER, there was St. Elsewhere, which invented the modern TV medical drama. Breaking with the monochromatic, one-protagonist / one-story formula of Ben Casey and Marcus Welby, M.D., St. Elsewhere was the second show (after Hill Street Blues, which NBC debuted the prior year) to bring soap opera techniques to bear on “serious” drama. It featured an expansive, ensemble cast (12 actors are billed in the opening credits of the first season, along with many recurring guest stars), multiple plotlines in each episode, and ongoing story arcs that frequently involved cliffhangers and the phrase “Previously on…” Rather than focusing on a central character, St. Elsewhere helped popularize the TV trend of making a community — frequently a workplace — the main character. Cast members came and went over the course of its run, but the focus was always on St. Eligius itself, a rundown, under-funded teaching hospital in South Boston.
In addition to modernizing narrative structure, St. Elsewhere also shook up the visual language of the TV drama, using long tracking shots and jittery hand-held camera work (now a TV cliché) to lend a sense of immediacy and continuity to the action. Frequently, the camera will track from one group of actors to another in a single shot, binding several disparate storylines into a larger context. Although primitive compared to the swirling cinematography of ER, the long takes are still impressively choreographed and acted, and helped give TV a visual life it had never had before.
Lastly, St. Elsewhere made possible the career of David E. Kelley by introducing quirky humor into the previously no-laughs zone of hour-long drama. Right from the pilot episode, which features an impromptu tryst in the hospital morgue, the show placed absurdist situations and off-center dialogue in the midst of trauma and distress. (Sample dialogue: one doctor to another in the morgue: “Can you give me a hand?” “Sure.” “It’s in the bag.”)
St. Eligius, referred to disparagingly by the press as “St. Elsewhere” (because it’s everyone’s second choice), is a bit of a joke. It’s so behind the times that the elevators never work and it still uses a tube system to exchange messages between floors. Although some brilliant doctors work there, including the obnoxious cardiologist Dr. Mark Craig (played by William Daniels, sadly known to my generation as Mr. Feeny on Boy Meets World), there’s a pervasive sense of disappointment and frustration that runs through the hospital’s somewhat dingy corridors. The series’ wide scope includes Dr. Craig; the hospital’s paternalistic chief, Dr. Donald Westphall (Ed Flanders); a variety of surgeons, nurses, and psychiatrists; and a group of over-worked young residents played by a number of major actors in their first big roles: Ed Begley, Jr. as the dorky, compulsive Dr. Victor Ehrlich, insufferable David Morse as white-savior Dr. Jack Morrison, Howie Mandel (with hair) as the jittery, wisecracking Dr. Wayne Fiscus, and Denzel Washington, who is barely utilized in the first season as Dr. Philip Chandler.
The show alternates seamlessly between medical cases and personal lives, between wrenchingly tragic storylines and bizarrely humorous ones. A baby-faced Tim Robbins, in his first professional role, shows up for a few episodes as an entitled anarchist whom the hospital is forced to treat. A mental patient who thinks he’s a bird roams the hospital (the first of many to escape from St. Eligius’ seemingly open-door psych ward) posing as “Dr. Bullfinch”, visiting patients and attending in surgeries. In the bluntly titled “Down’s Syndrome”, a couple struggles with whether or not to abort their possibly handicapped child; with a minimum of hysteria, the show smartly limns both sides of the argument before building to a toughly unsentimental conclusion.
The doctors struggle with cases, careers, family and romance. Dr. Craig berates and traumatizes the residents, especially the promising Ehrlich, who makes a continual embarrassment of himself. Fiscus, an emergency room doctor, is mugged by a patient and starts carrying a gun to work. The skeevy Dr. Ben Samuels (David Birney), a star surgeon at the hospital, saves lives and ravishes ladies. Dr. Morrison uses every case as a springboard for ruminations on the morality and ethics of medicine. Future semi-famous actors who turn up as guest stars include Ally Sheedy, Michael Madsen, Ray Liotta, Jane Kaczmarek, Judith Light, Laraine Newman, Christopher Guest, Tom Hulce and David Duchovny — who has a brief but memorable bit role in the fifth episode.
One of the strongest episodes comes early on. “Cora and Arnie”, which contrasts the separate paths taken through the medical establishment by two older couples: one well-to-do middle-class, the other indigent, a bag lady and her retarded boyfriend, played by Doris Roberts and James Coco. The show doesn’t settle for any easy rich folks vs. poor folks homilies, but merely observes the very different experiences these two couples have and their very different mental outlooks. The well-to-do couple is catered to and given a battery of tests; in the end, there’s nothing wrong with the woman, but she’s faced with an exorbitant hospital bill, anyway. Cora, the bag lady, will need to have both her feet amputated in response to spreading gangrene. But where will this leave her with Arnie, whom she needs to look after as if he were a child? In roles that could have devolved into the cheesiest, most sentimental clichés, Roberts and Coco both give life-size, richly detailed performances that deservedly won Emmys. Roberts in particular is stunning as a weary, beaten-down woman who knows what matters most to her, almost making up for all those years of lazy coasting on Everybody Loves Raymond.
What’s remarkable about St. Elsewhere, in contrast to most network shows today, is how much of the drama is understated and implicit. There is, thank God, no voice over extracting pithy morals from every situation. The characters themselves are not wholly articulate. And, notwithstanding some dips into corny melodrama, the show accepts characters and situations as complex and multi-sided. We don’t need to be told why the buppie Dr. Chandler has an ongoing feud with an older, more traditional black nurse; we don’t need to be told why Dr. Fiscus, so skinny and frizzy-haired and perpetually joking, is the kind of guy a woman will date for a while but won’t seriously consider settling down with. Dr. Craig may be an arrogant, smug pill of a man, but he’s also a brilliant doctor, and the show doesn’t ask us to see him as either villainous or secretly vulnerable (unlike, say, the supposedly tough Dr. Bailey on Grey’s Anatomy, who these days cries if someone calls her “ma’am.”) — he is what he is and we accept that as part of the fabric of everyday life.
The show has a much broader canvas and dispersed focus than most hour-long shows today. No one character dominates — Dr. Morrison may have a major storyline in one episode, and then be a bit player in the next three. Storylines disappear and recur, and sometimes are only advanced in a scene or two per episode. The show often conveys a strong sense of an overwhelming flow, of the diurnal life of the hospital.
Of course, most TV shows are still getting their sea legs the first season, and this one was also innovating a genre. Several of the more boring or mismanaged characters — like Cynthia Sikes as Dr. Annie Cavanero and Terrence Knox as Dr. Peter White — don’t make it through the whole run of the series (you can see why), while Birney, G.W. Bailey and Kavi Raz don’t even survive the first season. (Birney was a popular TV star in the late ’70s/early ’80s, and may have thought that his lothario character was going to be the de facto leading man; as it turned out, he was outshined by nearly all of the supporting cast and was gradually phased out, to the extent that he barely appears in the last few episodes of the season).
You can see, as the season progresses, the show figuring itself out, seeing which elements are the strongest: Ehrlich and Fiscus, and their testy friendship, gradually become more and more prominent, as does Craig and Ehrlich’s wonderfully complicated relationship (it’s so obvious that Craig’s continual disparagement of Ehrlich is secretly a sign of respect for him that it’s almost regrettable when someone finally articulates this). Recurring characters that would go on to become regulars also prove their stripes in the first season, upstaging some of the nominal stars: Ellen Bry’s cutie-pie Nurse Daniels; Norman Lloyd’s ailing Dr. Auschlander (the world’s longest case of liver cancer); and Barbara Whinnery’s Looney Tunes pathologist Dr. Cathy Martin, the show’s one, sustained note of total surrealism.
The show was still figuring out how to bring serialized storytelling to the hospital show, and sometimes there is a structural awkwardness. A few storylines — such as Dr. Samuels’ affair with a visiting endocrinologist, or Dr. White’s pimping of malpractice cases to a shady lawyer — are begun and then mysteriously abandoned. Dr. White in particular is a confusing character; he’s not so much complex as unfinished (you get the sense that the producers’ changed their minds at least three times during the season about what kind of character he was going to be). He starts out as a charming, hapless, slightly incompetent resident. Then, in short order, his marriage implodes; he nearly rapes his wife; he sleeps his way through the nurses’ station; he gets one of his girlfriends to pay for his wife’s abortion of her child by another man; he maybe-sort of reconciles with the wife; then suddenly he’s a drug addict, a corrupt, bad-ass doctor, and finally he’s in rehab and somehow still working at the hospital. Maybe it would help if Knox were a better actor, but White’s precipitous swoops in behavior and temperament seem wildly under-motivated; he’s barely become a drug addict before he instantaneously bottoms out and totals his car.
St. Elsewhere also suffers from the Liberal White Martyr Complex, though thankfully Dr. Morrison doesn’t dominate nearly as much as Anthony Edwards did on ER. David Morse, with his hoarse voice, floppy perm and strenuously low-key demeanor makes Morrison an overwhelmingly insufferable character. Every single case is an opportunity for him to act aggrieved and put out about something; he never once evinces any compassion for his patients, only for his own suffering noblesse. In one episode, an Eastern European man shanghais Morrison into making house calls in an immigrant neighborhood. The man tries to teach Morrison lessons in “compassion”, while Morrison whines about his right to privacy; the whole storyline is like a contest to see which of them can be more self-righteous.
Other bumpy spots: “Samuels and the Kid”, an ickily sentimental episode about Dr. Samuels’ friendship with an ailing tyke who’s so cute you know he’s not going to live through the episode; “Brothers”, which features a ham-fisted euthanasia plot; and “Legionnaires”, in which performing a hysterectomy launches Dr. Cavanero into a hackneyed career vs. family monologue seemingly cribbed from a 1981 issue of Cosmo. (The first half of the season intermittently suffers from Monologue-it is — aka Aaron Sorkin’s Disease — but it eventually embraces the healing powers of Dialogue and Subtlety). More than once, the “A” plot of the week — the primary medical case — is overshadowed by more engaging subplots and the personal hijinks of the doctors.
But television, ultimately, is about the long haul. St. Elsewhere may have been still figuring itself out in the first season, but it already had the two most important elements in place: a distinctive, original tone, and a number of compelling characters that you want to watch week after week, for years on end. In future seasons, the already promising cast would expand to include the likes of Mark Harmon, Helen Hunt, Alfre Woodard and Bruce Greenwood. I say, bring on the second season.
Extras are pretty extensive, including a feature on the creation of the series; a rambling interview with a possibly stoned Tim Robbins; and a “WTF?” special entitled “Dr. Jack Morrison: The Spirit of Care and Empathy” (that’s certainly how Morrison would refer to himself…). There’s also a “Making Of” feature on “Cora and Arnie”, as well as a commentary track with Doris Roberts and director Mark Tinker. Neither are particularly revealing, but they are a fitting tribute to what is probably the first season’s best episode.