St. Elsewhere's Infamous Ending Shocked Fans, And Some Of The Show's Stars Thought It Was 'Terrible'

The final episode of "St. Elsewhere" is often listed among the worst ever TV show finales, and that's largely because of its closing scene: It reveals that the whole series took place in the imagination of an autistic boy staring at a snow globe. The boy is an alternate version of Tommy Westphall (Chad Allen), son of leading man Dr. Donald Westphall (Ed Flanders). The final shot before the credits roll is a slow zoom in on the snow globe, revealing a replica of St. Eligius Hospital inside.

A week after the episode aired, TV critic Eric Mink described receiving countless calls from the show's fans asking him, "What the heck was the ending of 'St. Elsewhere' about?" Mink spoke to the show's executive producer, Bruce Paltrow, who acknowledged the unhappy fans. "A lot of people found it very disturbing, and others were absolutely blown away," Paltrow said. "I'm delighted with those who liked it, and I'm very sorry about those who didn't."

In a 2012 retrospective published by Entertainment Weekly, several "St. Elsewhere" cast members offered their thoughts on the episode's reveal. "[The writers] wanted to do an ending to the show in a way so that it could never be brought back again," said Bonnie Bartlett, who played Ellen Craig. "They really wanted to kill the show. ... And I was very upset. I thought it was terrible."

David Morse, who played Dr. Jack "Boomer" Morrison, recalled enjoying the idea for the finale when he first read the script, only to change his mind when he saw it on screen: "I thought, 'It's too much. It's just too big a leap." Norman Lloyd, who played Dr. Daniel Auschlander, recalled declaring the scene "a cheat" while filming it. He added, "I thought it was a letdown. We went through this experience and I wanted it to be maintained as a real one, not a dream." Auschlander dies earlier in the finale but returns in the final scene as the "real" Tommy Westphall's grandfather. 

While Lloyd stayed fully negative about the finale, Morse noted that he "loved that [the writers] took the leap, and that was in the spirit of the show." Chad Allen, whose character is the central figure in the show's big twist, also thought the ending stayed true to what made the provocative medical drama's special.

"It was neat," Allen said. "As far as I could tell, there was always controversy around 'St. Elsewhere.' It was a show that never did amazing in the ratings, but it held on because it was always pressing the boundaries of what was okay on TV."

Critics sometimes argue that the "St. Elsewhere" finale was judged too harshly, and at least one member of the show's cast has since softened on it. "When I first saw it, I had some real reservations," said Eric Laneuville, who played Luther Hawkins. "I look back on it now and say, 'Well, it kinda worked.'"

Executive producer Bruce Paltrow explained back in 1988 that the idea for the surreal ending had been thought up over three seasons in advance. "The program has, over the years, addressed our sense of reality," Paltrow said. "In a way, the ending was quintessentially 'St. Elsewhere.'" Producer Tom Fontana revealed in a 2018 interview that he had thought up other abrupt endings for the show, one of which involved the characters dying in a sudden nuclear explosion. Paltrow reportedly described the snow globe ending as the "least bad option" that Fontana gave him. 

Fontana defended his show's finale, praising the similarly controversial finale of "The Sopranos" in the process: "I guess you could say ["The Sopranos" ending] was audacious because people would have expected the shootout." About his own show, he said, "I think we were consciously trying to be audacious. I think the most important thing, especially for an hour drama if you have a number of characters, is you shouldn't wrap up every single story, because in the world of the show the story's going to continue."