Mrs. Fiscus says that her son Wayne has been a resident at St. Eligius for two and a half years but that it seems more like five. This is a reference to the fact that the first five seasons of the series took place over the course of a two and a half years, creating numerous timeline inconsistencies.
The title is from the play "A Moon for the Misbegotten" by Eugene O'Neill. Ed Flanders from the cast of "St. Elsewhere" won a 1973 Tony during a revival of the play. The original production opened at the Bijou Theater in New York on May 2, 1957 and ran for 68 performances. The 1973 production opened at the Morosco Theater on December 29, 1973 and ran for 313 performances earning six Tony nominations, and winning four.
In the scene where Dr. Auschlander tries to persuade his old friend Dr. Westphall not to quit, he says: "I met you in this very room. Sixteen years old. You were a bastard then and you're still one now." This refers to an encounter depicted in Time Heals: Part 2 (1986) in which Auschlander, newly arrived at the hospital in 1945, walks into Father McCabe's office to find him reprimanding young Westphall for stealing money from a patient.
In the opening teaser, Eileen smears whipped cream on Dr. Fiscus' face. He replies saying, "Eileen, you brassy Tijuana, you." This is a reference to Herb Alpert & The Tijuana Brass' album "Whipped Cream & Other Delights."
Wayne's mother tells him about the death of his Aunt Serka. She says, "I came to bury Serka, not to praise her." She chuckles at her own pun on the words of Marc Antony in Shakespeare's Julius Caesar: "I come to bury Caesar, not to praise him" (III,ii,74).