I haven’t watched ER on any kind of regular basis for years. I started losing interest after Dr. Mark Greene — wonderfully played by Anthony Edwards of Top Gun fame — died of a brain tumor in Season Eight, leaving Noah Wyle’s Dr. John Carter as the only remnant of the show’s original cast. Nothing against any of the actors who rotated into County General as the old folks left, but I just never found any of the newer characters as compelling as the first group. Also, while the really over-the-top “event” episodes were still in the future (I think… it’s hard to recall quite what happened when, considering I haven’t seen many of these episodes in years), the show was already evolving toward sensationalistic (and frequently ridiculous) sweeps-week plotlines and a tangled soap-opera-esque preoccupation with who was hooking up with whom in between patients. (Honestly, was there any woman around that hospital that Luka didn’t have a go at? Maybe Kerri Weaver, but that’s only because she turned out to be a lesbian…)

And yet, I never did give up entirely on the show. I kept tuning in from time to time, even after I’d reached the point of not knowing the names of any of the characters anymore, and I was thinking of them only as “John Stamos,” “the Rock and Roll Kid,” “Red-head Dude with the Beard,” and “Cute Nurse with the Big Watchband.” Oh, and, of course, Neela, whose name stuck because I thought she was a babe. I guess I took the show for granted; I always knew that if I couldn’t think of anything better to occupy my attention on Thursday nights around 9 PM, well, there was always ER.

It’s difficult now to remember just how fresh and exciting this series was when it first debuted 15 years ago. There’ve been lots of medical shows over the years, of course, but where ER broke new ground was in its efforts to capture the genuine rhythm of life in an urban emergency room: long, long days divided into stretches of relative inactivity followed by sudden bursts of intense action, as well as patients coming and going without any resolution to their stories. To viewers who had been trained by earlier television to expect three acts, a climax, and a denouement, the open-ended narratives of ER could be frustrating. We frequently became emotionally invested in patients during their visit to the ER, only for them to vanish at the episode’s end with no further mention of whether they recovered or died or what. But that’s how it would actually be, isn’t it? I imagine real ER staffers experience that all the time; people come into their lives for a brief moment and then they’re gone, one way or another. And in the meantime, there are always more people coming that require attention, leaving little opportunity to reflect on that one guy from last week. This was revolutionary storytelling; as I recall, even St. Elsewhere, the last major network series set in a hospital prior to ER, and which was often lauded for its realism by the standards of the early ’80s, generally presented more traditional (if serialized) story arcs.

Further nods to realism on ER included the use of sometimes dense technical language, with no effort to explain to viewers what any of it meant (if you watched it often enough, you started picking up on the jargon from the context), and of course, there was the gore. The dainty streamers of blood occasionally seen on M*A*S*H were nothing compared to ER‘s routine arterial gouts and insert shots of actual surgery, complete with wiggling organs. Before CSI came along and upped the ante when it came to icky stuff, the show could sometimes be difficult to watch.

As for the characters, again, ER strove for realism, at least in the early days. The doctors and nurses at County General weren’t the Marcus Welby-style benevolent gods of earlier medical shows. They were flawed, riven by insecurities and personal problems, sometimes arrogant and unlikable and redeemed only by their skills and knowledge. This wasn’t a complete innovation — St. Elsewhere also presented more nuanced medical characters than previously seen. But St. Elsewhere always had a flavor of the absurd to it, which I think made it difficult at times to accept that its characters were real people (although it did lead to one of the most remarkably weird finales in television history). The cast of ER, before the show’s decline into soap opera, felt much more human, and thus much more affecting.

For evidence of just how affecting those original characters were, consider the parts of the final episode that moved me the most: the “high school reunion” scenes featuring people who haven’t been on the show in years, and especially seeing the children of two characters — Mark Greene’s daughter Rachel and Dr. Benton’s son Reese — now grown up (or mostly so, in Reese’s case). As lame as it sounds, my eyes welled up when Dr. Carter figured out Rachel’s identity (she showed up as part of a gaggle of medical students). All the dramas being played out by the current cast — the characters whose names I barely know — paled in comparison to that one simple moment, so honest and natural.

If you missed the finale, the show ended essentially as it began, with a big disaster sending a flood of multiple casualties to the ER, and a stirring “hero moment” as the entire cast waits in the driveway for the incoming ambulances. Dr. Carter is pressed into service and he can’t resist lending a helping hand; as he pushes a gurney inside, he calls out to Rachel, who’s been observing the triage from the sidelines, “Coming, Dr. Greene?” She bursts into a grin and runs after, the eager naif that Carter himself was years ago in the series’ pilot episode, and Carter himself now grown into the mentor figure. The camera pulls back, revealing County General for the first time in a wonderfully well-done F/X shot. More ambulances are arriving, an el-train passes, and the rhythm that we’ve grown accustomed to over the past 15 seasons goes on as it always has.

Business as usual.

For a show I’d become fairly indifferent to, it was a remarkably satisfying conclusion.