The foremost interpretation of this scene is that the entire series of events in "St. Elsewhere" were dreamt by Tommy Westphall, and thus, products of his imagination. According to Lindsey Freeman, the narrative framing of Tommy's imagination as within a snow globe occurs because, as an "oneiric and mnemonic gadget", a snow globe "often finds itself as a companion piece to the dream sequences found in television and movies". He adds that, "while a controversial and maddening ending for some loyal viewers, the final episode of "St. Elsewhere" illustrates the rich and often blurred boundaries in how we experience the world."