How a Real-Life Tragedy and a Returning Star Helped ER Sign Off: Secrets About the Full-Circle Series Finale You Probably Forgot

It was the end of an era. (Or an ER-a, if you want to be cute about it.)

When ER signed off for good a decade ago with a two-hour episode that forced fans of the NBC hit to say goodbye to the fictional County General hospital for the last time, it did so as the reigning longest-running primetime medical drama in American TV history, sitting pretty at 331 groundbreaking episodes. (The show has, of course, since been supplanted, with Grey’s Anatomy  recently laying claim to that particular honorific with no signs of letting up and no real challenger coming up behind it.) And it did so with an ending that had, in some form or another, been in the works since as far back as the show’s sixth season.

Of course, making that happen meant that executive producer John Wells needed to get his onetime star Noah Wyle—who’d left the show’s main cast after season 11 and last appeared in any capacity in season 12—back into Dr. John Carter’s scrubs. 

As Wells told reporters in the months leading up to the finale, he figured that the show wouldn’t make it past season eight. “So I started doing some planning, and I still have those notes,” he  said. “They’ve gotten a little old and smudged, but one of the reasons Noah Wyle is coming back at the very end is we had always planned that the end of the series would involve Noah returning because he was so central as a character at the very beginning.”

It had been a final season of returning favorites, stopping by for one final appearance—all the all-stars were there: George Clooney, Julianna Marguiles, even Anthony Edwards‘ deceased Dr. Mark Greene popped up in a flashback episode—but none more central than Wyle’s Carter. While the show’s pilot focused on the then-third-year medical student arriving at County for his rocky first day, the final season saw the seasoned vet—who’d seen some things over the last 15 years—return to County in episode 16 to work, get a kidney transplant, and, in the finale, open his very own clinic for the underprivileged, prompting the influx of familiar faces, there to celebrate their former colleague, in those last two hours. 

With Carter in the role of County’s elder statesman, Wells was able to neatly allow the finale, entitled “And in the End…,” to not only be structured like that game-changing first episode from 1994—which was filmed nearly word-for-word from creator Michael Crichton‘s original screenplay written all the back in 1974—but directly call back to it in ways both big and small.

Set over the course of 24 hours, just like the pilot, we watched as new intern Dr. Julia Wise (guest star Alexis Bledel, fresh out of Stars Hollow) went about her first day at County, having about as much luck as Carter did on his. Veteran nurse Lydia Wright (Ellen Crawford, returning for the first time since 2003) woke up Scott Grimes‘ Dr. Archie Morris exactly as she had done with Edwards’ Dr. Greene. The full-length opening credits from the first season, abandoned years earlier, were back with the James Newton Howard theme song—you can almost hear it now, can’t you?—and beloved Benton (Eriq La Salle) fist-pump in tact. The episodes even shared a director, Rod Holcomb.

And to add to the whole “circle of life” goings on, County General was in the process of welcoming a next-generation Dr. Greene, in the form of the beloved doc’s daughter Rachel (played by returning guest star Hallee Hirsh), who was interviewing for a spot in the hospital’s teaching program. In the process, Carter got to show her how to start an IV exactly as Benton, his mentor, had in the pilot, and utter the words “Dr. Greene” as one of the show’s final lines—mirroring, you guessed it, the first line ever uttered on ER.

ER‘s final season almost ended a few episodes earlier, with NBC extending the show by three episodes when a production delay on its replacement, Southland (also from Wells), left a gap in the network’s schedule. It was a good thing, too. “I probably had about 200 more pages to do to wrap up all the things we had coming. … They clearly couldn’t all get done in that episode,” Wells told reporters. “When we actually started to get towards the end, there’s this tremendous feeling of, oh, there’s this one and there’s that one that we haven’t done, so it’s actually very exciting.”

It also allowed for him to let a little bit of real-life tragedy influence one of the cases seen in the two-hour episode. One of the last patients we see Dr. Tony Gates (John Stamos) treat, a young teen brought in with alcohol poisoning after playing a drinking game with friends, was inspired the December 2008 death of 17-year-old Shelby Lyn Allen, Wells’ niece. “What seems like teenage fun can actually be warning signs for a significantly dangerous medical situation,” the producer told Fox News ahead of the finale’s premiere.

It was important for Wells for the finale to evoke that same “life goes on” ethos that ER had deployed throughout its storied run. And that’s why in the final moments, the entire County General team jumps into action to triage patients arriving by ambulance after an industrial explosion as the camera slowly pulls out, showing the entire exterior of the hospital for the first and only time in the show’s history before fading to black while that iconic theme song played for the very last time.

“I would hate to give the impression that the difficulties of running a county hospital and the problems within the system come to an end because conveniently the hospital gets closed for a new one or something like that,” Wells said. “The only way to really do justice to the show is to continue what has worked, which is we just sort of showed up on one day in 1994 as an audience and caught what was happening. … My inclination will be to feel as if we’ve simply walked away from the hospital with the cameras.”

While it was clear to Wells that it was time for ER to say goodbye—”It’s very odd to say, but it really was time to end. It’s ending at a time when we’re all still very proud of it,” he told the New York Times weeks before the finale aired—at least one cast member was decidedly not ready to hang up his scrubs. 

“I think they’re canceling it prematurely,” Stamos told the newspaper as part of the same oral history. “I still have a lot of energy for the show. I think you could keep doing it as a spinoff.”

While a spinoff never came to be—and almost certainly never will—it wasn’t hard to imagine a world in which Bledel’s Dr. Wise teamed up with Hirsh’s Dr. Greene for an ER: The Next Generation. The casting of the Gilmore Girls vet in the role of the green newcomer was rather inspired—and could only happen as a bit of stunt casting, as Bledel admitted at the time she was wary of any lengthy television commitments so soon after the 2007 cancellation of the WB/CW series—and indicative of the sort of stellar guest stars ER had been able to pull in throughout its 15-season run. To see how ER’s guests stack up against those of its record-breaking successor, read on!

ER, Greys Anatomy, Guest Stars, Leslie Bibb (ER)/Matthew Morrison (Grey’s)

NBC, Richard Cartwright via Getty Images

After the WB canceled Ryan Murphy‘s first series, Popular, in 2001, his leading lady Leslie Bibb rebounded with an eight-episode stint on the NBC drama as med student Erin Harkins, who romanced Goran Visnjic‘s Luka before nearly dying in a car accident and leaving town. Similarly, after Murphy’s Glee wrapped in 2015, his star Matthew Morrison chose the ABC soap as one of his first few high-profile guest-star gigs, appearing in four episodes as the abusive ex-husband of Camilla Luddington‘s Jo.

ER, Greys Anatomy, Guest Stars, Holland Taylor, Sarah Paulson


In 1999, Holland Taylor appeared in one episode of the NBC series as County General patient Phyllis Farr. Meanwhile, her future girlfriend Sarah Paulson popped up in the ABC series in 2010 as a far more important character—a young Ellis Grey, mother to Ellen Pompeo‘s Meredith Grey. The two began dating in early 2015.

ER, Greys Anatomy, Guest Stars, Alexis Bledel (ER)/Edward Hermann (Grey’s)

NBC, Ron Tom/ABC via Getty Images

Two years after her last regular episode as Rory Gilmore, Alexis Bledel returned to TV as Dr. Julia Wise in the NBC hit’s very last episode ever. Meanwhile, her TV grandpa Edward Hermann showed up on the ABC soap in 2007 as surprisingly mature intern Norman Shales. Only one would return to their Gilmore roles when Netflix revived the series for 2016’s Gilmore Girls: A Year in the Life. Hermann had passed away on Dec. 31, 2014 at the age of 71.

ER, Greys Anatomy, Guest Stars, Cress Williams (ER)/Kyle Chandler (Grey’s)

NBC, Peter ‘Hopper’ Stone/ABC via Getty Images

Before he was Ornette Howard in the fourth season of NBC’s beloved football drama, Cress Williams appeared in 18 episodes of ER as Officer Reggie Moore. And before he was Coach, Kyle Chandler played bomb squad leader Dylan Young in Grey’s‘ season two post-Super Bowl episode. Only one of them literally blew up though.

ER, Greys Anatomy, Guest Stars, Guillermo Diaz (ER)/Jeff Perry and Scott Foley (GREY'S)

NBC, Eric McCandless/ABC via Getty Images, Adam Taylor/ABC via Getty Images

Before he was Huck on Shonda Rhimes‘ twisty political thriller, Guillermo Diaz booked a 1995 episode of ER for what would be one of his earliest TV roles. And before they were the devious Cyrus Beene and Jake Ballard, respectively, Jeff Perry and Scott Foley popped up on Rhimes’ first ABC series. Perry famously played Meredith’s estranged father Thatcher, while Foley guested as Henry, the ill-fated husband of Kim Raver‘s Teddy Altman.

ER, Greys Anatomy, Guest Stars, David Krumholtz (ER)/Christina Ricci (Grey’s)

NBC, Peter ‘Hopper’ Stone/ABC via Getty Images

Nothing creepy or kooky about this! Years after they appeared in the 1993 sequel as Wednesday Addams and her Camp Chippewa love interest Joel Glicker, Christina Ricci and David Krumholtz popped up in one of TV’s long-running medical dramas a piece. Krumholtz arrived in season six of the NBC series as schizophrenic patient Paul Sobriki who, you might recall, was the one who broke our hearts when he stabbed Kellie Martin‘s poor Lucy Knight to death during a psychotic break. Ricci’s arrival on Grey’s in season two was not quite as heartbreaking—she played the paramedic with her hand dangerously trapped on an explosive in the post-Super Bowl episode—though it was just as intense.

ER, Greys Anatomy, Guest Stars, Keke Palmer


Keke Palmer is one of the few actors who have appeared on both shows. In one of her earliest acting gigs, she appeared in one of Noah Wyle‘s last episodes ever as a series regular after a decade of playing Dr. John Carter. Nearly a decade later, she would appear in a 2014 episode of Grey’s as well.

ER, Greys Anatomy, Guest Stars, Corey Stoll, Neve Campbell


Before either of them were—spoiler alert!—meeting grisly demises on Netflix’s House of Cards, both Corey Stoll and Neve Campbell made medical show guest appearances. Stoll showed up in one 2005 episode of ER as Dr. Teddy Marsh, while Campbell appeared in two season nine episodes of Grey’s as Liz Shepherd, one of four sisters belonging to Patrick Dempsey‘s late Derek.

ER, Greys Anatomy, Guest Stars, Octavia Spencer, Jessica Chastain, Chris Lowell


Before either Octavia Spencer or Jessica Chastain could bond as Minny Jackson and her employer Celia Foote in 2011’s The Help, they both appeared on ER early in their careers. Meanwhile, their co-star Chris Lowell—who played the boyfriend of Emma Stone’s Skeeter Phelan—appeared in two episodes of Grey’s before moving on to spinoff Private Practice for another 54 more as Dell.

ER, Greys Anatomy, Guest Stars, Nasim Pedrad, Casey Wilson

Getty Images; ABC

A year before she joined the cast of Saturday Night Live in 2009, Nasim Pedrad recurred on what would become her home network’s medical drama as Nurse Suri. Meanwhile, seven years after she was let go from the late-night comedy, Casey Wilson popped up as a patient pregnant with quadruplets on the ABC soap, returning to the network three years after it canceled her beloved Happy Endings.

ER, Greys Anatomy, Guest Stars, Martha Plimpton, Bernadette Peters


Who doesn’t love a Tony-nominated star of stage? In 1999, Martha Plimpton began a four-episode stint on the NBC drama as pregnant out-of-work waitress Meg whom Julianna Marguiles‘ Nurse Carol Hathaway tries to help get on her feet. Meanwhile, the legendary Bernadette Peters arrived on Grey’s in 2008 for a two-part season five episode.

ER, Greys Anatomy, Guest Stars, Anna Gunn, Aaron Paul, Jesse Plemons


Before either would go on to have their lives ruined by Walter White as his wife Skyler and former student-turned-fellow meth cook Jesse Pinkman on the iconic AMC drama, Anna Gunn and Aaron Paul would pop up on NBC’s medical drama in 1999 and 2003, respectively. Meanwhile, before Jesse Plemmons sent chills down our spines as he charming psychopath Todd Alquist in Breaking Bad‘s final season, he appeared in a 2006 episode of the ABC soap.

ER, Greys Anatomy, Guest Stars, Chris Pine, Chris O'Donnell


Every show needs a visit from a famous Chris. ER got theirs in 2003 when Chris Pine appeared in an episode in what would be his first acting role. Grey’s, on the other hand, saw their famous Chris arrive in the form of Chris O’Donnell, who recurred as Meredith’s vet and short-lived love interest Finn Dandridge.

ER, Greys Anatomy, Guest Stars, Lucy Liu (ER)/Greg Germann (Grey’s)

NBC, Mitch Haaseth/ABC via Getty Images

Once upon a time, Lucy Liu and Greg Germann got frisky on camera as Ally McBeal‘s oddball Ling Woo and Richard Fish, respectively. They also each appeared on one of the shows in question, with Liu appearing in three 1995 episodes of ER, while Germann currently recurs as Dr. Tom Koracick on Grey’s.

ER, Greys Anatomy, Guest Stars, Josh Radnor


Another of the few actors to appear on both shows, Josh Radnor played the gay lover of a Chicago alderman who contracted syphilis in ER‘s ninth season. Meanwhile, he popped up on Grey’s in 2018 as one of Meredith’s ill-fated season 15 dates.

ER, Greys Anatomy, Guest Stars, Jeffrey Dean Morgan


We all know Jeffrey Dean Morgan played the heartbreaking Denny Duquette in season two of Grey’s—and again during season five’s ill-advised ghost sex storyline—but did you know he appeared on ER first? In a 2001 episode, Morgan guest-starred as a firefighter.

ER, Greys Anatomy, Guest Stars, Don Cheadle and Chadwick Boseman (ER)/Tessa Thompson (Grey’s)

NBC, Gale Adler/ABC via Getty Images

Before they joined the Marvel Cinematic Universe as  War Machine and and Black Panther, respectively, Don Cheadle and Chadwick Boseman both appeared on the NBC drama. Cheadle appeared in four episodes in 2002 as Dr. Paul Nathan, while Boseman appeared in one 2008 episode as a patient named Derek Taylor. Meanwhile, over on Grey’s, a pre-Valkyrie Tessa Thompson appeared in two 2006 episodes as Camille Travis, niece of James Pickens, Jr.‘s Richard Webber.

ER, Greys Anatomy, Guest Stars, Jessica Capshaw


While we all know that Jessica Capshaw starred as the beloved Dr. Arizona Robbins for 10 seasons on Grey’s Anatomy, she also holds the distinction of being the only series regular on either show to have guest starred on the other. The actress appeared in one 1999 episode of ER as Sally McKenna.

ER, Greys Anatomy, Guest Stars, Sally Field, Rita Moreno


When ER needed someone to come in to play Maggie Wyczenski, the bipolar mother of Maura Tierney‘s Abby Lockhart, they turned to Oscar-winning legend Sally Field, who played the character in 12 episodes from 2000-2006. Similarly, when Grey’s Anatomy needed someone to guest star in season 12 as the angry wife of a patient who shows up at the hospital wondering if her husband is dead yet, they looked no further than EGOT icon Rita Moreno. Sadly, Moreno’s Gayle only appeared in the one incredible episode.

ER, Greys Anatomy, Guest Stars, Dakota Fanning, Abigail Breslin


Audiences got their first taste of future child star Dakota Fanning when she appeared in a 2000 episode of ER, playing Delia Chadsey, a car crash victim suffering from leukemia. Grey’s, meanwhile, gave us one of our earlier glimpses at the preternatural talents of Abigail Breslin when she appeared in a 2006 episode as Megan Clover, a young patient who can’t feel pain.

ER, Grey's Anatomy, Guest Stars, Alan Alda, Marion Ross


It was a return to the genre that made him a star when M*A*S*H icon Alan Alda joined ER for a five-episode stint in 1999 as Dr. Gabriel Lawrence, County General’s new attending physician who immediately clashed with Anthony Edwards‘ Mark Greene and was ultimately diagnosed with Alzheimer’s disease. Meanwhile, Happy Days fans were in for a treat when Mrs. C herself Marion Ross showed up in a 2010 Grey’s episode as Betty Donahue, an elderly patient who reunites with her long-lost love after they’re both randomly admitted to the E.R. at the same time.

ER, Greys Anatomy, Guest Stars, Christina Hendricks, Elisabeth Moss


Before they were doing what they had to do to get by in a man’s world on the iconic AMC series, Christina Hendricks and Elisabeth Moss each appeared on one of TV’s longest-running medical dramas. Hendricks appeared in four episodes of ER in 2000, playing Joyce Westlake, Abby’s new neighbor stuck in an abusive relationship with her boyfriend. Meanwhile, Moss appeared in one 2007 episode of Grey’s as Nina Rogerson, the daughter of a patient who sadly died after a risky surgery.

ER, Greys Anatomy, Guest Stars, Kirsten Dunst, Millie Bobby Brown


Before she was starring in hits like Bring It On and Dick, Kirsten Dunst had a recurring role on ER, playing Charlie Chemingo, a child prostitute who was cared for by George Clooney‘s Dr. Doug Ross. Dunst appeared in a total of six episodes between 1996-97. Similarly, before she visited the Upside Down as Stranger Things‘ breakout character Eleven, Millie Bobby Brown appeared in a 2015 episode of Grey’s as Ruby, a young girl who needs the help of Kevin McKidd‘s Dr. Owen Hunt after an earthquake hits Seattle.

ER, Greys Anatomy, Guest Stars, Shiri Appleby, Jeanine Mason


Two Roswells means two Lizs, and oddly enough, each of them have appeared on one of these shows. Shiri Appleby, the OG Liz who starred on the WB/UPN series from 1999-2002, actually appeared on ER twice in her career. Her first appearance, as a teen with ectopic pregnancy, took place in the 1994 series premiere, while her second, as intern Daria Wade, took place over the course of nine episodes in the show’s final season. Meanwhile, Jeanine Mason, Liz in the CW’s reboot Roswell, New Mexico, recurred as Dr. Sam Bello for 12 episodes of Grey’s from 2017-18.

ER, Greys Anatomy, Guest Stars, Kal Penn, John Cho


ER got a visit from Kumar himself, Kal Penn, in a 2001 episode when he guest-starred as Narajan, while it was Harold, aka John Cho, who stopped by Grey’s in 2006 to guest as Marshall Stone. And no White Castle was consumed during either appearance.

ER, Greys Anatomy, Guest Stars, Zac Efron, Demi Lovato


Before he began breaking tween hearts everywhere as High School Musical‘s Troy Bolton, Zac Efron appeared in a 2003 episode of ER as Bobby Neville, a shooting victim who didn’t make it out of County General alive. Meanwhile, a year into her Sonny with a Chance run on Disney Channel, Demi Lovato arrived in a 2010 Grey’s episode to show fans that she could handle material darker than anything the Mouse House would ever let air. She played Hayley May, a young diasnosed paranoid schizophrenic who had tried to claw her eyes out.

ER, Grey's Anatomy, Guest Stars, Mariska Hargitay, Mandy Moore


Before Mariska Hargitay became the iconic Det. Olivia Benson on NBC’s long-running Law & Order: SVU, she appeared in 13 episodes of ER in 1997-98 as Cynthia Hooper, a County General desk clerk who developed a relationship with Anthony Edwards‘ Mark Greene. Meanwhile, before she became the mother of the Big Three on This Is Us, Mandy Moore appeared in a handful of 2010 Grey’s episodes as patient Mary Portman, who survived the intense hospital shooting only to not survive her colostomy bag reversal surgery six months later.

ER, Greys Anatomy, Guest Stars, Kyle Richards, Jamie Chung


Before she was giving us life as one of the Real Housewives of Beverly Hills, Kyle Richards appeared in 21 episodes of ER from 1998-2006 as Nurse Dori. Meanwhile, as Real World: San Diego participant Jamie Chung made her transition to acting, she appeared on both shows, visiting ER first in 2007 and Grey’s next in 2010.

ER is available to stream, in its entirely, on Hulu.