A lot of other characters provided a mix of humor and pathos over the years, especially that of Mandel’s Fiscus, which extended behind-the-scenes as well. “It was always very hard to work with Howie and Ed (Begley) because we would always start laughing, and Howie was a big practical joker,” said Stephen Furst, who appeared three times in the second season as medical student Elliot Axelrod before becoming a regular and a resident in the third season. Still, for all six years, the interplay between Begley and Daniels kept matters from becoming too dark. “He’s got a mean head butt,” Begley said, referring to Daniels in their first surgery scene as Craig and Ehrlich. “He nailed me pretty good and it got my attention. It was wonderful. It woke me up, which I think was the stated purpose.”
The first season focused more frequently on issues in health care, beyond diagnosis and treatment, than later years did (if memory serves—I’ve been deprived of access to the rest of seasons two through six since TVLand stopped airing reruns around 13 years ago). Keeping the hospital open and fighting administrative penny pinchers always remained issues on the series, but that first season also dealt more openly with scalpel jockeys, the high costs of fruitless tests, and doctors on the take. “We were sort of influenced by the Paddy Chayefsky movie The Hospital. I think the tone did shift, and I think it was probably the desire of a lot of people to have the tone be a little lighter and the surrealistic aspect of it might have been something that might or might not have been related to that,” Brand said. “I have a deeply emotional reaction to the idea of a St. Elsewhere because of the health care system in this country,” Pickles said. A British native and naturalized citizen, Pickles came to the U.S. in 1958, though her character Helen arrived in 1965, as we learned in the fourth season episode “Time Heals.” “If you go to England and you cut your finger," she said, "you’ll be taken care of automatically for no money. This country is absurdly behind the times, which creates awful stories of people waiting around in emergency rooms.”
The first season episode “Cora and Arnie” (story by Brand, Falsey and Neil Cuthbert; teleplay by Cuthbert; directed by Mark Tinker) stays with original viewers mainly due to the Emmy-winning performances by guest stars Doris Roberts and the late James Coco as a homeless couple who wander into the ER because of Cora’s various problems, which she doesn’t want to face because she’s mentally disabled Arnie’s sole protector. However, another storyline within that episode that I had forgotten until I rewatched it struck even more of a chord with me. Bernard Behrens and Anne Gerety portray a couple visiting Boston; the trip takes a strange turn when she passes out in their hotel room. As Fat Tony once said on The Simpsons, “It’s funny ‘cause it’s true” and we’ve made it the centerpiece of this montage.
As Brand says, “Thirty years on, the problems are still there. They’ve only become more pronounced. You’ve got a lot of very powerful groups that are sort of feeding at the trough. Nobody wants to give up their piece of the pie.” At the end of the first season, Brand and Falsey moved on from St. Elsewhere. The team would go on to create the short-lived but critically acclaimed and award-winning series A Year in the Life and I’ll Fly Away as well as another show involving a doctor--this one practicing in tiny Cicely, Alaska, in Northern Exposure. “There were a lot of chefs, and it just seemed like it was the best thing for everybody, for myself individually and for the show, to pack our bags and move on . . . There was the genesis of the show and how the show evolved,” Brand said. “At the time, it seemed like the right thing to do. Looking back, I think it was the right thing to do. Certainly, for me.”
In that first season, you can spot many up-and-coming actors such as Ray Liotta and Michael Madsen in small roles, and Tim Robbins in a multi-episode arc as a heartless sociopath turned domestic terrorist that Morse’s Jack Morrison had to treat, despite his misgivings. Robbins and Morse reunited years later in different capacities, when Robbins directed two episodes of Morse’s current series, Treme on HBO. “[Robbins’s role was] certainly one of the most memorable characters that I got to work with on that show, but I don’t know if it was because of what Tim became after that or how vivid a character that really was. Probably a combination,” Morse said.