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In those cold, dark days before House, even before Grey’s Anatomy and ER and Scrubs and Chicago Hope, there was St. Elsewhere. M*A*S*H might have come first, but St. Elsewhere made it a pattern – despite my squeamishness, I was hooked on medical shows, with their black humour pervading the life-or-death patient stories and frenetic personal lives of sleep-deprived, adrenaline-high doctors and nurses.

The first season of St. Elsewhere is now available on DVD and available to those of us with fond memories of the show that ran from 1982-88, and to a new audience who can discover this much-acclaimed but never highly rated show.

Producer and director Mark Tinker (NYPD Blue, Deadwood) remarks in an episode commentary that ER is like St. Elsewhere on speed. Watching this 25-year-old show now makes the reverse seem more accurate: St. Elsewhere is like ER on valium.

It’s easy to see how much modern medical shows owe to this series, with its stylish and thoughtful exploration of multiple storylines, self-contained episode stories combined with ongoing serial arcs, social commentary, and the slice of life realism with an absurd twist.

Inner-city Boston is the setting for St. Eligius, the run-down teaching hospital known derisively as St. Elsewhere, the perfect dumping ground for those who can’t afford treatment at the often-referenced rival Boston General.

Times have changed since the show broke new ground, and not just in the size of ’80s hair, shoulder pads, eyeglasses, and syringes. The show spells things out more than today’s audiences are generally used to, from spot-on dialogue that cements each character’s position on any given issue down to explaining the medical jargon that these days usually flies by unremarked. However, adjusting to the slower pace of the show brings the huge rewards of a show that does show its age, but also its ample heart and brain.

Most of the series’ pet issues could easily fit on today’s schedule, including commentary on health care costs, hospital politics, medical ethics, racism, and inner city problems of homelessness, poverty, and violence. Some of its pet topics have changed enough in the past 25 years to make the show’s take seem dated, including a female doctor’s regret at pursuing a career at the expense of a more traditional role, for example. Which isn’t to say the issue of women finding the balance between career and marriage/motherhood doesn’t exist anymore, but the dialogue around the issue has moved on.

The series follows a core group of residents under the direction of Dr. Donald Westphall (Ed Flanders), cancer-stricken Dr. Daniel Auschlander (Norman Lloyd), arrogant heart surgeon Dr. Mark Craig (William Daniels), and womanizing surgeon Dr. Ben Samuels (David Birney, who left the series after the first season). The distinctive characters are not all easy – or even possible – to like, but they’re all complex and compelling and impossible not to care about.

There are a slew of familiar faces in the regular cast who weren’t familiar at the time. Season one is, sadly, pre-Mark Harmon, but Denzel Washington appears in his breakout role as Dr. Philip Chandler, though one smaller than his placement on the DVD box would suggest. David Morse, most recently seen in a recurring guest role on that other medical drama, House, is Dr. Jack Morrison, the soul of this season one. Howie Mandel, with abundant hair and a meatier role than that of game show host, is the hyperactive Dr. Wayne Fiscus; Terence Knox is the troubled and troubling Dr. Peter White; and Ed Begley, Jr. is perfectly cast as the flaky but competent Dr. Victor Ehrlich. Nurse Helen Rosenthal is played by Christina Pickles, with a warmth that might surprise those of us who know her as Ross and Monica’s brittle mother on Friends.

The names behind the cameras are impressive, too. St. Elsewhere was created by Joshua Brand and John Falsey, who went on to create Northern Exposure. The late Bruce Paltrow, father of Gwyneth but, more to the point, respected producer and director, and Tom Fontana, a writer and producer on shows such as Oz and Homicide: Life on the Street, also contributed to the show.

It’s fun to play spot the famous guest star, with glimpses of before-they-were-famous names in often tiny roles, like Ray Liotta, Michael Madsen, Ally Sheedy, Christopher Guest, Judith Light, Jane Kaczmarek, a very young Candace Cameron, and, in a three-episode arc, Tim Robbins as a “terrorist” who set off a bomb in bank (the word is more jarring today than it would have been then).

Fortunately no one watched this show for the music, because even the cover songs they used – because they couldn’t afford the originals they wanted – are replaced with different versions for the DVD release. The incidental music is little better; when things get intense, the elevator music gets a little louder.

The 22-episode set comes on four double-sided discs, and don’t expect anything impressive on the technical side of things. The audio is stereo, and the non-anamorphic video is in the original full screen. No apparent restoration has been done, so the picture is as washed out and grainy as would be expected for video from that era.

The extras aren’t abundant, but what’s there is great. Producer/director Mark Tinker keeps a running commentary and tries his hardest to draw a few words from guest star Doris Roberts on the episode Cora and Arnie, which won Roberts her first of five Emmys.

A few featurettes splice together interviews with Tinker and some of the actors, including David Morse and Christina Pickles, to focus on that particular episode, Morse’s character Jack Morrison, and the show and its setting. The most fun is to be had in the featurette that centres around someone who had his first big break on the show – Tim Robbins, talking about his bad attitude as the terrorist character and as a young actor.

The extras are appropriately appreciative of St. Elsewhere‘s place in TV history, if the technical aspects of this DVD release aren’t. Though obviously a product of its time in many ways, St. Elsewhere was groundbreaking and timeless enough to be thoughtful entertainment for today, and deserving of a place in any DVD collection.