It drove forward the careers of such Hollywood heavyweights as Helen Hunt, Denzel Washington, Howie Mandel, and Ed Begley Jr., but it was also the beginning of one of the most interesting factoids in all of television trivia.

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If you watched television in the mid 1980s, there’s a good chance you saw, or at least have heard of, a little medical drama called St. Elsewhere. It drove forward the careers of such Hollywood heavyweights as Helen Hunt, Denzel Washington, Howie Mandel, and Ed Begley Jr., but it was also the beginning of one of the most interesting factoids in all of television trivia. Right now, television buffs are probably screaming at their computer screens about snow globes and children with autism, but that’s not even the half of it. There’s a much larger story to be told about the series. Put simply, St. Elsewhere may have ruined television.

If you are of the population not fortunate enough to have seen St. Elsewhere, it was the first of the modern ilk of medical dramas. What separated it from its predecessors was the reality with which it treated its subject matter. The television portrayal of doctors until that point was more in line with what we think of as super heroes. The patients always got better, the doctors never made mistakes, and everyone, as Garrison Keillor might put it, was above-average. The thinking of the time was, “Who wants to turn on their television only to be depressed? The advertisers certainly wouldn’t like that.” That strategy worked fine for many years, but it turned out not to work on the slightly-more-cynical younger generation. St. Elsewhere followed this new direction, and almost the entirety of the current hour-long medical genre owes its place on TV to “a show that ruined television.”

Welcome to the Multiverse

How does a show like this, with all the good it did for its craft, end up ruining television? The answer comes in two parts. The first is that St. Elsewhere was a very popular, and it continues to be well-respected among people who make decisions for television. The show did numerous crossover episodes where characters from one series appeared on St. Elsewhere or vice-versa. Crossing Jordan, Cheers, Boston Public, Chicago Hope, The Bob Newhart Show, M*A*S*H, and Homicide: Life on the Street are among the shows where this happened. Outside of this, there are shows that reference St. Elsewhere in a way that makes it clear they are intended to be in the same world. The hospital’s PA system on St. Elsewhere was used at various times to call doctors from other series, even though they were not appearing in that episode. The reverse of this was used on the Canadian show, Degrassi Junior High, where doctors from St. Elsewhere were paged through the school’s announcements system.

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The crossovers don’t stop there, though. For example, you’ll notice that St. Elsewhere crossed over with Cheers at one point. This happened in an episode when characters from St. Elsewhere visited the Cheers bar. Cheers, being as successful as it was in its day, ended up creating crossovers with other series on its own. Cheers begat Frasier and another short-lived spin-off called The Tortellis. Since a crossover or spin-off is essentially a signal that the shows happen in the same television universe, all shows connected to Cheers in that way are also connected to St. Elsewhere. The same goes for all the other shows that St. Elsewhere crossed with. They are all, through common characters, happening in the same television universe.

In all, there are around 280 shows linked to St. Elsewhere. The oldest is I Love Lucy, which traces its lineage in this order: I Love Lucy, The Lucy-Desi Comedy Hour, The Danny Thomas Show, The Dick Van Dyke Show, Mad About You, Friends, Caroline in the City, Frasier, Cheers, and finally, St. Elsewhere. Current shows such as Lost, ER, CSI, Law & Order, and Heroes all have their own lineage tied to St. Elsewhere.

Life is but a Dream

The second part of the answer is the bit of trivia mentioned in the opening. In the final moments of the series finale of St. Elsewhere it is heavily implied that the entire series had been a dream of one of the characters. Dr. Donald Westphall discusses his son, Tommy Westphall, which includes this bit of dialogue:

“I don’t understand this autism thing, Pop. Here’s my son. I talk to him. I don’t even know if he can hear me, because he sits there, all day long, in his own world, staring at that toy. What’s he thinkin’ about?”

The next part, the answer to that rhetorical question, shows Tommy Westphall shake a toy snow globe containing a model of the show’s hospital, while real snow begins to fall over the real hospital.

This is the moment that may have ruined television. St. Elsewhere takes place in the same universe as over 280 other shows, and that universe was revealed to be entirely in the mind of Tommy Westphall. So the next time you watch I Love Lucy, Cheers, CSI, Lost, Heroes, The Andy Griffith Show, Law & Order, or any of the other shows connected to St. Elsewhere, keep in mind and take solace in the fact that they are at least two layers of fiction removed from our reality: They are the fictional creations of Tommy Westphall, an already fictional character. Most television, as it turns out, is more fictional than you would have thought.

If you’d like to explore Tommy Westphall’s multiverse on your own, this excellent site has complete documentation of the phenomenon that continues to be updated by contributors. You can take a look at the diagram of all the shows, and check the key to see exactly how they link together. If your friends are good enough at television trivia, you might be able to play a game of Six Degrees of Tommy Westphall.