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Though it was never an outright hit, St. Elsewhere punched way above its weight in terms of the careers it helped launch and a style that set the template for medical dramas that followed it. The show can also boast one of the more memorable series finales in TV history.

Created by Joshua Brand and John Falsey, St. Elsewhere followed the staff and patients at a struggling Boston hospital over six seasons on NBC, from 1982 to 1988. Like its fellow NBC show Hill Street Blues (both were from MTM Enterprises), St. Elsewhere pioneered a new kind of storytelling. Hospital dramas that came before it focused mainly on a lead character whose personal struggles didn’t interfere with their work and presented the health care system as orderly and well functioning (see Marcus Welby, M.D., Trapper John, M.D.). St. Elsewhere instead took a grittier tack, with overlapping, serialized stories and medical professionals who had complicated lives and sometimes could not save patients ­— traits that are recognizable in its successors, from ER to Grey’s Anatomy to The Pitt.

When the series debuted, that style was seen as a barrier to success: Reviewing the show in November 1982, THR critic Richard Hack wrote, “So real and graphic is the drama being presented here that we cannot believe that 20 million people across this country will find it entertaining enough to flip to.”

Nonetheless, St. Elsewhere would win 13 Emmys over its run, including six for its fourth season in 1986. It was nominated for best drama series in all six seasons, though it never took home that honor.

Three of the show’s regulars — William Daniels, Bonnie Bartlett and Ed Flanders — won acting Emmys for their roles. Equally impressive was the show’s eye for emerging talent: It helped kick-start the careers of Denzel Washington, Mark Harmon and David Morse, as well as comedian Howie Mandel, playing against type in a dramatic role.

The 1988 series finale cemented St. Elsewhere‘s place in TV lore by suggesting that the entire show may have taken place inside the imagination of Tommy Westphall (played by Chad Allen), the autistic son of Flanders’ Dr. Donald Westphall. It was perhaps the most audacious choice an already groundbreaking show ever made.

This story first appeared in an August stand-alone issue of The Hollywood Reporter magazine. To receive the magazine, click here to subscribe.