By the time St. Elsewhere Season 5 rolled around in the fall of 1986, the halls of St. Eligius were starting to feel a little haunted. Not by ghosts—though with this show, you never knew—but by the departure of the people who made the "dump" feel like home. Ed Flanders was tired. David Morse was looking at the exit. The show was consistently dodging the NBC cancellation axe despite its abysmal ratings because the "quality demographics" (the people with money) couldn't stop watching.
It was a weird year. It was messy. Honestly, it’s probably the most underrated stretch of the entire series.
The St. Elsewhere Season 5 Identity Crisis
If you look at the landscape of 80s television, most shows peaked around year three and coasted. Not this one. St. Elsewhere Season 5 didn't coast; it vibrated with a kind of nervous energy because the writers knew they were losing their anchor, Dr. Donald Westphall.
The season starts with a literal bang—or a crash, rather—with the two-part "After Life" episode. This is peak 80s prestige TV. Dr. Wayne Fiscus (Howie Mandel) gets shot and has a surreal, near-death experience that basically redefined what a medical drama could do. He meets his dead colleagues. He wanders through a metaphysical version of the hospital. It’s trippy, it's slightly pretentious, and it’s absolutely brilliant. It set the tone for a season that wasn't afraid to be deeply uncomfortable.
The cast changes were brutal this year. You had the arrival of Dr. Paulette Kiem (France Nuyen) and the promotion of various residents, but the hole left by the departing Mark Harmon (whose exit via the "Slow Boat to China" arc in Season 4 was legendary) was still felt. But the real story of Season 5 is the slow-burn disintegration of the old guard.
Why the Writing in Season 5 Hits Different
Most people talk about the "Tommy Westphall" ending from Season 6, but the character development in St. Elsewhere Season 5 is where the real grit lives. Take Dr. Jack Morrison. David Morse played that man with such a weary, battered soul. In Season 5, Jack goes through the absolute ringer—a recurring theme for him—culminating in his traumatic experiences in the prison ward and his general disillusionment with medicine.
It wasn't just "doctor saves patient" anymore. It was "medicine is a bureaucratic nightmare and we are all going to die anyway." Dark? Yeah. But that’s why we loved it.
The show also leaned heavily into its weirdness this year. We had the "Muzak" gag where characters would acknowledge the background music. We had the increasingly bizarre banter between Ehrlich and Auschlander. The writers, led by Tom Fontana and John Masius, were clearly bored with standard tropes. They started deconstructing the genre before "meta" was even a word people used at dinner parties.
The dialogue in Season 5 is snappier than the early years. It’s faster. Characters talk over each other. It feels like a precursor to ER or The West Wing. If you watch the episode "Cheers," which aired in the middle of this season, you see the ultimate crossover. The St. Eligius doctors head over to the actual bar from Cheers. Seeing Dr. Westphall, Dr. Auschlander, and Dr. Ehrlich interact with Norm and Cliff is a fever dream. It’s a reminder that NBC back then was a playground.
Dealing with the Heavy Stuff
St. Elsewhere Season 5 didn't blink when it came to the AIDS crisis, which was still a taboo subject for many networks in 1986. The storyline involving Dr. Bobby Caldwell (Mark Harmon's character from the previous year) and the aftermath of his diagnosis continued to ripple through the hospital's culture. They didn't treat it as a "Very Special Episode." They treated it as a terrifying, evolving reality of 80s healthcare.
Then there’s the "Slip of the Tongue" episode. It’s a masterclass in tension. The show was always at its best when it trapped the characters in a situation they couldn't medicine their way out of.
- Dr. Craig’s ego finally starts to show real cracks. William Daniels played Craig as a monster, but in Season 5, you start to see the pathetic, lonely man underneath the surgical mask.
- The arrival of Dr. Seth Griffin (Bruce Greenwood) brought a new, more cynical energy to the residents' lounge.
- The hospital itself—St. Eligius—is falling apart. The physical decay of the building mirrors the mental state of the staff.
The season isn't perfect. Some of the subplots involving the younger residents feel like the writers were throwing spaghetti at the wall to see what stuck for a potential Season 6. Some of it was mushy. But the core—Flanders, Daniels, and the looming sense of an ending—kept it grounded.
The Departure of Ed Flanders
We have to talk about it. The exit of Dr. Donald Westphall at the end of St. Elsewhere Season 5 is one of the most famous moments in TV history for all the wrong reasons. No, I'm not talking about the snow globe. I'm talking about the "mooning."
After years of dealing with the corporate interference of the Weigert corporation (the company that bought the hospital), Westphall finally snaps. He gives a speech that basically sums up the frustration of every person who has ever worked for a soulless entity. And then? He drops his pants. He moons the boss. He walks out.
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It was a shocking, hilarious, and deeply "St. Elsewhere" way to say goodbye to the show’s moral center. It told the audience: the adults are leaving, and the asylum is being run by the inmates.
Behind the Scenes Chaos
It’s no secret that the production of Season 5 was strained. The show was expensive. The sets were aging. The cast was getting restless. Many fans don't realize that St. Elsewhere Season 5 was actually intended by many to be the final season. The ratings were hovering around 50th or 60th place in the Nielsens.
The fact that we got a Season 6 at all was a miracle of "prestige" branding. NBC President Brandon Tartikoff loved the show. He kept it on life support because it gave the network "class." That's a concept that barely exists in the streaming era, where if a show doesn't hit #1 in the first 48 hours, it's dead.
Key Episodes You Need to Rewatch
If you’re diving back into this season, skip the filler and hit these:
- "After Life": The surrealist masterpiece.
- "Cheers": For the sheer 80s nostalgia of the crossover.
- "A Moon for the Misbegotten": The beginning of the end for Westphall.
- "Last Supper": A heavy, emotional beat that reminds you why this was the best acting ensemble on TV.
Why Season 5 Matters Now
Looking back, St. Elsewhere Season 5 was the bridge between the old-school medical procedural and the hyper-kinetic dramas we have now. It proved that you could lose your lead actor and still have something worth saying. It proved that you could be funny and devastating in the same sixty-minute block.
Honestly, modern shows like Grey's Anatomy or The Good Doctor owe everything to the risks taken during this specific year. They showed that doctors aren't heroes; they're just people trying to survive a crumbling system.
If you're looking for the best way to experience Season 5 today, don't just binge it in the background. It’s too dense for that. You’ll miss the subtle jokes in the PA announcements. You’ll miss the way the camera lingers on Ed Flanders' face when he realizes he can't save his hospital anymore.
To truly appreciate this era of the show, track down the original broadcast versions if you can—the music rights issues on modern streaming services sometimes muffle the intentional sound design the creators used. Pay attention to the background characters. Some of the best writing isn't in the main plot; it's in the two nurses arguing in the hallway or the patient who has been sitting in the waiting room for three episodes.
The next step for any fan is to watch the Season 5 finale back-to-back with the Season 6 premiere. It’s a jarring transition that shows exactly how a TV show tries to reinvent itself when its heart has been ripped out. It’s a masterclass in survival—both for the characters and the production itself.