Although St. Elsewhere is famous for its cast turnover, a large number of characters appeared on the first episode and right through to the last. They are Dr. Daniel Auschlander (Norman Lloyd), Dr. Mark Craig (William Daniels), Dr. Victor Ehrlich (Ed Begley Jr.), Dr. Wayne Fiscus (Howie Mandel), Luther Hawkins (Eric Laneuville), Dr. Jack Morrison (David Morse), Nurse Lucy Papandrao (Jennifer Savidge) and Nurse Helen Rosenthal (Christina Pickles). Dr. Donald Westphall (Ed Flanders) also appeared in the first and last episodes, but he was not a regular cast member in the sixth season.
Mark: why didn't you ask me to go along?
Ellen: Well,I just assumed you wouldn't go.
Mark: Yes, well for the record I would leave Boston, St. Eligus. Move to Cleveland. I mean I have done some more checking. They have a lot of culture there, fine symphony orchestra, the Great Lakes Shakespeare festival.
Ellen: The Rock and Roll Hall of Fame.
Mark: Yeah, yeah, yeah.
Helen: Oh, by the way, congratulations on Ellen's job opportunity. The way she's blossomed this past year, becoming her own person with her own career. You must be very proud.
Mark: Why don't you slide back to the valley of the dolls?
Fiscus: Dr. Fiscus.
Viking: Neil Duban.
Fiscus: If your going to dress like a viking, make it Frank Tarkenton.
Dr. Axelrod is now deceased and Dr. Chandler quit his job in the previous episode - and left St. Eligius with Roxanne Turner. Still, Stephen Furst and Denzel Washington are credited in the opening credits. They do not appear in this episode.
Among the patients admitted to the Emergency Room this episode is a hefty opera singer who has lost her voice. Wayne Fiscus's career at St. Eligius comes to an end when the fat lady sings.
During the end credits, you can see Mimsie the MTM Cat hooked up to life support. During the MTM logo sequence, she goes flatline and dies. This is also due to Mimsie's old-age demise the same year.
Fiscus briefly references the long-gone Dr. Ben Samuels and Annie Cavanero. He also mentions Elliot Axelrod and Donald Wesphall as 'gone'.
Valley of the Dolls
During a conversation between Mark & Helen discussing how she had just come out of treatment for her dependency on drugs, a Reference is made to the Valley of the Dolls, a book which was later made into a movie.
Inside jokes to other TV series finales --and episodes where characters are written out-- abound, including The Fugitive (chasing a one armed-man who is a patient of "Dr. Kimble"), M*A*S*H (Novino is performing an autopsy the man whose plane crashed into St. Eligius, one "Henry Blake"), and a reenactment of the group hug scene in the finale of The Mary Tyler Show, complete with the group shuffling over to get a tissue.