How Did ‘St. Elsewhere’ End? A Look at One to Television’s Most Infamous Finales

ST. ELSEWHERE, Ed Begley Jr, Cindy Pickett, Bruce Greenwood, David Morse, Denzel Washington, 1982-1988 — Everett Collection

What To Know

The series finale of St. Elsewhere featured emotional farewells and major character departures.
This ambiguous and unconventional ending became one of television’s most debated and memorable finales.

When St. Elsewhere premiered on NBC in 1982, it took viewers inside St. Eligius, a struggling Boston teaching hospital nicknamed “St. Elsewhere” because it was the place patients ended up when they had nowhere better to go. It was a perfect mix of funny, yet heartbreaking, and even strange, which is why it stood apart from so many other medical dramas.

The series ran for six seasons and helped launch or boost the careers of actors like Denzel Washington, Howie Mandel, David Morse, Ed Begley Jr., Mark Harmon, William Daniels, Bonnie Bartlett, and Norman Lloyd. But even with all of those big stars, St. Elsewhere is still best remembered for one thing: its final scene. If you have ever heard someone mention the very strange “snow globe ending,” this is the finale they are talking about.

The final episode was called “The Last One”

ST. ELSEWHERE, Ed Begley, Jr., Season 6, May 25, 1988. Ep. 'The Last One'. 1982-1988

NBC/Everett Collection

The series finale of St. Elsewhere aired on May 25, 1988, and was titled “The Last One.” For most of the episode, it was basically a farewell to the hospital and its employees, as both underwent several changes. Dr. Fiscus, played by Howie Mandel, and Dr. Morrison, played by David Morse, were gearing up to leave St. Eligius. Dr. Gideon, played by Ronny Cox, was also preparing to move on to another hospital in San Jose, California. Dr. Westphall, played by Ed Flanders, returned to an active leadership role after the hospital is sold back to the Boston archdiocese. One of the most important moments in the episode is the death of Dr. Daniel Auschlander, played by Norman Lloyd. Auschlander suffered a stroke and died, giving the finale one of its heaviest emotional scenes.

Then, near the end of the finale, Westphall and his son Tommy, played by Chad Allen, are seen in Dr. Auschlander’s office watching snow fall outside. Tommy, who has autism, had appeared on the series before, but the final scene suddenly makes him the center of the entire series. The image cuts from St. Eligius to an apartment, where Tommy is sitting on the floor playing with a snow globe. Donald talks about Tommy staring at the toy all day and wonders what his son is thinking about. Auschlander is there too, but he is not Donald’s colleague.

In this scene, he is Donald’s father and Tommy’s grandfather. Finally, the shot gets closer and closer to the snow globe, which reveals that inside is a tiny replica of St. Eligius.

What did the ending mean?

The most common interpretation is that the world of St. Elsewhere existed inside Tommy Westphall’s imagination. The hospital, the doctors, the patients, the tragedies, and all those years of stories may have come from Tommy looking into the snow globe. The show never explains it clearly and was likely meant to make fans second-guess everything that happened. After spending years with the doctors of St. Eligius, not everyone wanted to be told that the entire series might have been imagined by a child staring at a toy. But whether people loved it or hated it, the ending will always be remembered by fans.

Even the closing credits were different. The finale changed the usual MTM Productions closing logo. Instead of the normal Mimsie the Cat logo, the credits showed Mimsie hooked up to medical equipment, with a heart monitor that eventually flatlined.

Tell us in the comments what you think of the finale of St. Elsewhere?