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The star of "ER" has always been the ER itself, and if you somehow forgot that point during its 15-year run, John Wells and his team offered a poignant reminder Thursday night in the final shot of the final episode called, fittingly, "And in the End."

After an hour and a half of reunions and reminiscing, of subtle and not-so-subtle references to past episodes, of story lines that highlighted the inevitable but still shocking nature of death, "ER" drew its final breath with its doctors and nurses greeting a phalanx of ambulances coming from a power plant explosion.

For all its grim backdrop -- early morning Chicago after a night of storms, the horrifying wounds -- it was a joyful scene, coming to a close with a newly rejuvenated John Carter ( Noah Wyle) beckoning Rachel Greene (Hallee Hirsh), daughter of Mark Greene ( Anthony Edwards) and now a medical student, to join in what another doctor called "the fun part."

It's over, but it isn't. In the ER, the dying never stops, but then neither does the living.

Still, it's difficult not to see the end of an era. Fifteen years ago, "ER" brought us a new sort of television show, full of medical jargon uttered at a breakneck pace as gurneys and saline drips careened down corridors, narrowly missing the camera and the viewer. Blood sprayed onto lab coats and medical personnel -- summoned from supply room trysts -- put on their serious faces and saved, or neglected to save, the lives of every sort of person imaginable.

For 15 years, it served as a template not only for countless medical shows but for the hourlong nonprocedural drama that for a while was a staple of television and now seems in danger of extinction. How do you end such a thing?

"ER" has never been stingy with sentiment, and nostalgia has been part of its palette for years. These last few months, Wells and his writers used Carter as the through line from past to present, and Thursday night, the opening of the Joshua Carter Center not only allowed Wylie to deliver a tear-jerking speech about the son he lost but it also gave old-timers including Susan Lewis (Sherry Stringfield), Kerry Weaver (Laura Innes), Elizabeth Corday (Alex Kingston) and Peter Benton ( Eriq La Salle) an excuse to go out for a drink or two, along with Rachel, as a next-generation stand-in for her dead father.

But it didn't stiff its current cast in the process. After treating a young girl suffering from alcohol poisoning, Tony Gates ( John Stamos) offered the show's final public service meltdown (kids, it takes only 6 ounces to do serious damage), while Samantha Taggart (Linda Cardellini) realized that as bad as her mother may have been, she's still her mother.

Rachel, who appeared as a child in the pilot, was not the only full-circle reference. "And in the End" opened with the mirror image of the scene that opened "24 Hours": A sleeping doctor is awakened by a nurse whose shadow forms a silhouette on the wall beside the bed. In the pilot, it was Mark Greene, in the final episode it was Archie Morris (Scott Grimes). But in the beginning as in the end, the doctor was summoned by the same nurse: Lydia Wright (Ellen Crawford). Love interests and sex partners have come and gone on "ER," but sleep, and the peace of mind it requires, remains the ultimate object of desire.

It would take an encyclopedic (or at least Wikipedic) knowledge of the show to catch all the grace notes -- the bloody death of a delivering pregnant woman certainly stood out for me, but then I still have not recovered from "Love's Labor Lost" -- and anyway, such things were not the point.

The point of the episode was endings. That delivery room tragedy; a man serenely accepting that AIDS is finally killing him after 20 years; another ( Ernest Borgnine) who must finally let go of the woman he has loved for 57 years; the woman whose dementia has left her stranded but happy in her childhood; even Frank Martin ( Troy Evans) telling Jerry Markovic (Abraham Benrubi), "Look, my in-box, it's empty" -- all pointed one way or another to the daily fact of finality.

Fittingly, it was Haleh Adams (Yvette Freeman), one of six characters who have been on every season of "ER," who had the big line, delivered, as so many of her lines were over the years, in passing. "Tough day?" asks Jerry. "About the same as every other," she answers.

For a show that has broken and then stood its ground for 15 years, that's the ultimate compliment.