I think this is a great analysis of a show I will absolutely never watch and really look forward to never having to hear about again, because of how triggering it is. I am a former ER doctor, and I didn't last long after finishing my residency, because I finished residency in the mid-2010s as private equity really started to eat up physician owned practices and stable hospital jobs also fell away with an increase in hospital mergers and downsizing staff as "cost-savings". I loved so much about the medical care that we did in the ER. I loved the variety, the intensity, I loved being there for people on their absolute worst day. I did not love how I was treated by abusive patients and their family members, by other staff (usually on the in-patient side who were also overwhelmed, but who never quite understood just how much we were holding back from them and who never quite understood that emergency medicine is a specialization, that we are skilled at this thing, that we are not medical students for our whole career), and of course by hospital administrators and insurance companies who operated from a very different set of priorities. I decided this job was too close to killing me and that I was good at too many other things for this to be my only option.
I left to work in medical humanitarian aid and am now a medical advisor for the biggest humanitarian aid organization I could find, so I didn't exactly choose something easier...
In the years since I've quit, I still get SO MANY PEOPLE who say "Oh don't you miss clinical work? You can always go back, like that's always an option for you." And I am so very tired of insisting that no, I can never go back, not unless I want to die. I can never watch this show, but I really do hope that all the people who do watch it finally understand why so many of us have left and stop insisting that we can always go back to it. When I was a medical student, ER residencies were among the most difficult to match into, the demand was so high, because the business model was different. It's no surprise that today, it's harder to fill the seats in this program, because who wants to sign up for this torture, no matter how fun the medical part is.
Yep, my 20 year ED doc husband has zero interest either. "Why would I watch something I live every day as entertainment?" that being said, he reports a LOT of colleagues watch and love it! So YMMV.
I am an RN who no longer works in the clinical setting. I think the distance I have allowed me to really enjoy this show but I understand your unwillingness to watch. I work in public health/ emergency preparedness now so, like you, not exactly easier but SO much better for my mental health. The Pitt did a great job at showing how unrelenting clinical work is. I have never seen my experience so clearly articulated.
One of my best friends from residency has gone to be an EM doc in New Zealand. He loves it - better quality of life, patients and families who understand when it's time to accept death, and a beautiful place to live.
I have a couple of colleagues who’ve moved to NZ to practice EM. They have reported similar improvements in their personal and professional quality of life.
I wonder all the time about whether this show is FOR an audience who doesn't have baggage around hospitals and the medical system. But who, in the United States anyway, would that be? Is anyone so fortunate?
And yet...I keep trying to watch it because I do have friends who are watching it and love it. But it took me a full hour to chill out after the first episode, so I'm taking it one episode at a time.
On Reddit I've seen multiple former and current ER staff say it's triggered PTSD episodes for them, especially the COVID flashbacks. So, you know, take care of yourself.
I’ve been to the ER as a patient five times this year and watched one episode after the second or third time and realized this is not for me. (Also my ER in Pittsburgh is not this bad but this show basically tells me never to go to the other hospital chain in town.)
I am an RN and kept hearing about this show and decided to watch the first episode. I think Noah Wyle is an incredible actor and it's probably a great show. However I don't think i can watch this show for the same reasons other healthcare workers have said they can't watch it on this thread. Work stresses me out as a nurse and watching this show isn't what I need with my off time. I'm glad it is popular though and giving folks an idea of what the healthcare system is actually like.
Thank you for spotlighting The Pitt—I felt so moved by every episode and blown away by their mastery of medically-laced dialogue. I recommend listening to the recent Fresh Air podcast interview with Noah Wyle. He describes how they deliberately separated the actors who played different levels of doctors/nurses into different groups and kept them apart when rehearsing and shooting—e.g., they ate lunch together in their own groups, so they'd bond—and that helped them feel and play the hierarchical order. Also, Noah is a great guy and a humanitarian (we went to the same high school; I was friends with his older sister). I'm grateful the show has been renewed for another season. They portray the goodness, selflessness, dedication, and work ethic that I hope will get our country through dark times.
I have nothing but admiration for those who work in these conditions, but I object to the premise that the goodness, selflessness, dedication, and work ethic of ordinary people should shoulder the burden of getting our country through dark times - because those dark times (in health care and so many other spheres) are being deliberately manufactured FOR PROFIT by the 1% who have little (or no) goodness, selflessness, and work ethic.
Every American should watch this show for exactly the reasons you describe. I finished medical training in 2018 and was a fresh attending when COVID hit. This show was 💯 reflective of the experiences I’ve had in the trenches of American healthcare. It’s an endless cycle of human suffering layered with profiteering from the erosion of the social safety nets.
What’s happening right now with the hostility against medical expertise- a skill set many of us have spent decades developing- is demoralizing on a level that’s impossible to describe. Especially for those of us who served on the front lines of the pandemic, it feels like an eviscerating betrayal.
I’m in the process of saying goodbye to my clinical patients in the US in preparation for a move to Canada. I’m being welcomed with open arms and I’m not the only US doctor making the move. I’m overjoyed about my new social insurance number.
Thank you for doing what you do and I'm sorry that you have to leave the country to feel appreciated and valued. The aggression toward the concept of "expertise" right now is brutal; I think a lot about how all this effort pushing back on expertise/specialization of roles is basically an argument against society and interdependence, which you also see crop up with the obsession re: homesteading, homeschooling, etc. What storyline do you think represented this best? I felt like the measles plotline brought it out most directly but you definitely see it crop up a lot throughout the show.
The mask fight was what really stuck out to me, especially at the end of the exchange with Langdon about the surgeons wearing masks. It felt like a real encapsulation of everything we’ve been through especially since 2020 but I’d say going back to long before that, too.
Yes to all of this; The Pitt is captivating. For me, the structure is everything; real-time shows/movies can be gimmicky, but The Pitt is so well-planned, it feels urgent and real instead.
Since finishing the season, I've been fascinated by the production itself, and how the narrative structure influenced the filming. Each episode was filmed in chronological order - so they filmed Scene 1, then Scene 2, etc. Most shows cluster guest actors' schedules so they shoot all of their scenes in 1-4 days; on The Pitt the actors were on set, in costume/makeup, every day, often just to sit in the background in case the camera crew (dressed in scrubs!) caught them in the shot. As you can guess, this really helped the actors calibrate their performances.
As a continuity nerd (I was a film/TV major and thought my most logical never-happened job in the industry would be script supervisor) this choice also makes things much easier for consistent costuming (no need to remember exactly HOW the blood spattered on someone's surgical gown if you filmed Scene 7 before you filmed Scene 11 instead of the other way around) and hair (note how the women have hairdos that are easy to replicate daily, like single braids or hair claws).
I loved the glimpses we got of the marble-and-terrazzo shell of the rest of the hospital surrounding the emergency department; anyone who's been in an old hospital knows that Frankenbuilding architecture.
Also: Jesse, the tall nurse with the curly graying hair? Played by Ned Brower, the drummer for Rooney! He became an EMT and an ER nurse after the band broke up.
Love the continuity nerdery (I think about this stuff too, and was definitely thinking about it with Mel's braid) — bonus that single braids and hairclaws are also what you'd actually want when it comes to hair containment in the ER!
So back in my ER days, I usually started out with my hair down (it's long...) and it was a known observation that when my hair went up into a bun, shit was getting real and it was time to get serious. I had several nurses comment on it over the years. I had never felt so seen!
Love the continuity stuff as well, although I did also hear in a podcast interview Noah Wylie did with The Watch (highly recommended!) that the stuff they specifically filmed in Pittsburgh (which was limited to the two rooftop scenes, chasing David (?) outside, the helicopter landing, and I think the close in the park?) were all filmed at the START of show filming. So for anyone that has finished, it means that the first episode scene with Robby and Abbot on the roof and the last episode scene with Robby and Abbot on the roof (where Abbot congratulates him on a nice speech) were actually filmed together before they'd ever written or filmed the final episode speech or final episode. That blew my mind when I heard it because that last rooftop scene felt so earned and real to me, and their exhaustion seemed like it was filmed at the end of a full season and everything that came before, but actually happened before nearly anything else. Just another note about what an incredible job both Wylie and Sean Hatosy did in the show and that scene.
Yes BUT apparently they filed the exteriors before the interiors, so the last shots of the season were among the first things they filmed--in an interview Wiley said the "nice speech" line on the rooftop was filmed before they had even written the speech. I'm amazed that they managed to write everything towards that last moment in the park and make it feel like it all made sense in the end (and much credit to the editors I'm sure).
Love this show so much, and I love that you've chosen to write about it. At 56, I'm starting nursing school in 3 weeks (total career change from criminal attorney to SAHM to nurse), and I'm hoping to work in the ER. My daughters (one of whom is a PICU nurse) who obv know me as "mom" cannot picture me working in an environment like the ER -- b/c they only know me in one way - "mom." I watch The Pitt and look forward to nursing school and clinicals and future employment, and at the same time, I wonder, "Do I really want to willingly move into that environment of long shifts, fast pace, life/death/trauma when all my husband wants me to do is quietly retire with him and caretake him and any future grandchildren?" Yes, the answer is yes, yes I do want to keep following the thread that's leading me to nursing school and run as far away as possible from retirement and familial expectations of what women do at age 56+
Wow, what a cool story. I'm so excited for you. I have been thinking for a while now that I'd like to go to nursing school, but it feels too late - I did a PhD in my 20s that was, for lack of a better description, a waste of 5 years, and I have a comfortable desk job now, which is what I need while I have young kids. But maybe it's not too late! Thank you for inspiring me today :)
It's never too late! I have 4 kids and my youngest is a senior in HS, heading to college in the fall -- so I did all my prereqs part-time over the past three years. And now is a perfect time to head to FT nursing school, when the demands on me as "mom" are much less and my young adult children (the three older ones) are starting their first jobs, moving, getting established etc. Life is long, and it's never too late! Just hope someone will hire me when I graduate at 59!
I went abck to school and graduated nursinf schol at 58, so glad that I did so. I had about a year before the pandemic hit at my first nursing job, in inpatient psych. About the only thing that has felt wierd to be about the Pitt and I'm only on hour 10, has been the lack of gin shot wounds. The sheer number of gun shot wounds that I saw in my two rotations in big/meduim size city hospitals was eye opening. Not people dying from being shot but having to learn to live with very changed life circumstances.
ANyway go for nursing school!!! its the best and as a mom you have an advantage having dealt with a lot of shit and drama!!
Good for you! Congrats! And thank you for the encouragement! Sometimes I second guess what I'm doing, wonder if anyone will hire me at 59 when I graduate, etc. Not everyone in my family is supportive so that def makes it harder, but it's my life, and if they want to yuck my yum that's on them for not having a broader vision for what a long life can look like.
This is the analysis I’ve been waiting for! One other fold to add that I cannot stop thinking about:
Since I started watching The Pitt a few weeks back, I’ve thought a lot about class representation within “prestige” television, specifically in terms of geography and workplace. With a few notable exceptions (Abbott Elementary comes to mind), the recent critical darlings of TV are often set either in white collar workplaces (Severance, Succession,) or highly gatekept industries (Hacks, The Studio) and almost always in New York or LA. Commercial successes like Yellowstone and even Breaking Bad are widely popular, I think, because their setting, characters, and conflicts are more familiar to the “average” viewer. I call this my Roseanne Theory.
To me, prestige TV feels alienated from the lived experience of so many of us, and that’s where I think The Pitt succeeds. We’ve all experienced frustration with the medical system, most people know someone in the medical field. Healthcare workers make up something like 10 percent of the American workforce. It says something that this show is set in Pittsburgh and gives all “classes” of people fair amount of screentime and narrative for the audience to connect with. The storylines with the schizophrenic elderly mother and her exhausted daughter/caretaker, as well as the concert rigger who keeps working as the ER team works to stabilize him come to mind. Work is so entrenched in the American ideology—even in crisis scenarios, we keep working. This show does an excellent job of showing that with an even hand.
Thank you for finally writing about this! One my favorite scenes was when Dr Collin’s was treating a fat post partum patient who had come in earlier and had been tended to by Dr McKay, who may have succumbed to fat bias in her diagnosis. Her tenderness in checking this possibility out with the junior doctor was *chef’s kiss*.
Yes, that was super well done, and I think it representative of how they apparently approached scripting the show - bringing in a ton of consulting experts and asking what they wanted and didn't want to see on TV. It's also really well scripted and acted, because the show leaves open the possibility that it's not a bias issue at all (they're all spinning a thousand plates, at some point someone will miss something they shouldn't have) but shows Collins being gentle but direct in raising the possibility, and McKay being a little thrown/surprised but receptive to the feedback.
This feels true to what my husband reports (and what's so fascinating to compare an ER to a "regular" workplace) is the culture of feedback. It's so accepted, it's understood you don't know everything and that you're going to get stuff wrong. That's why there's a team. You're direct, you accept it, you get back to work. It's kind of inspiring actually!
And there's a surprising level of humility (not something docs are always known for). Like, genuine appreciation that your resident figured something out that you didn't. I'm sure that's not universally true -- but the urgency and the singular, shared mission (save this person) make for a hostile environment for ego.
What I really liked about that moment was that McKay had already displayed a lot of empathy for women and other marginalized populations, but also: she might have unexamined anti-fat bias. It shows that everyone might have those.
I loved the spotlight on the Freedom House Ambulance Service, set up to serve the predominantly Black Hill District (both patients and practitioners). The training and standards they created have become the model for all current EMT practice in the US (and they were unfortunately victims of their own success). This is important history that I was not aware of prior to seeing it in The Pitt.
One of the things I love about this show is the representation of neurodivergence. Mel's character is never diagnosed for us, and though we come to understand that she is likely on the spectrum, we also see the unique perspective she brings, and her empathy and attentiveness and humour. I feel like the show really demonstrates the adage "If you've met one person with autism, you've met one person with autism". We also meet her sister, and the patient who Mel recognizes as needing a different type of care -- something Langdon was unable to see. As someone with neurodivergent family members, I found the show's approach very moving, and I could see how it might encourage viewers to meet others where they are, and to be accepting and curious and kind.
She was my favorite character, loved her arc. Overall, love how the show highlights that different people bring different skills to the table, and how needed that is. <3
Absolutely- the scene where Mel takes care of the man with ankle sprain brought tears to my eyes. The hot shot doctor was impatient and wasn’t able to treat him at all really.
As an ER stan and a University of Pittsburgh alumna, there was no doubt I was going to eat up The Pitt. Many of you have made more salient points about the social issues at play on the show, so I won't belabor them.
My only criticism is that there isn't enough true Yinzer representation. I think Dana is likely their concession to Yinzerdom, but carries herself with too much Mount Lebo and not enough West Mifflin. In season 2 I really need to hear someone call someone else a jagoff. I need to hear someone say "dahntahn." And if they really want to go for accuracy, an ortho bro in the ER for a consult needs to invoke the name of Freddie Fu.
100%! I was so surprised they didn't go full yinzer with Dana, especially when she broke up the patient fight. The Pitt needs to hire an accent coach and get some of those pancake-flat "a" sounds in there!!
Agreed! I was pretty annoyed at the clear lack of a Pittsburgh consultant to get accents and pronunciations right (the clear mispronunciation of Wholey's by Langdon in one episode made me cringe). It's an incredibly fun and unique accent that would have really added to the realism of the place-making.
It was narratively convenient that the doctors/med students wouldn’t necessarily be from Pittsburgh so they didn’t need to worry about the accent too much. I would always welcome more of it though.
I adored this show. When I started it, I was hoping that there would be some reckoning with the underlying COVID trauma. (Because I really feel the need for that!) But the fact that it was always present and never addressed is so…real.
Yep, same. My other half worked ICU during the pandemic, and the way it's affected our whole family's life is...I don't have words for it. I think part of why I watch The Pitt is so I can process the ways COVID trauma is unseen in my own daily life. My husband changed jobs and we have moved cities, but there's still a list of 2021 departed patients' names in our prayer corner.
Thank you for this, I have been obsessed and am so happy to talk about The Pitt more! I've been rewatching episodes, which on the one hand feels a bit strange since so much of it is so intense, but I also find competency extremely compelling and comforting. Watching people who are SO good at what they do just gets me every time.
A few more things about the show I've been chewing on:
- It does SUCH a good job of flipping your expectations about what some of those social ills actually look like across the season. The brilliant jerk resident guy (Langdon) who is Dr. Robby's mentee is an addict, the young med student (Whitaker) is unhoused.
- I feel like most other medical shows on now (Chicago Fire, 911, etc.) are big on cop solidarity and 'of course we respect our boys in blue' but the Pitt takes a different approach. It acknowledges that social services and cops are in and out of the ER the entire time and there's basic cordiality, but when one of the cops is injured, there are 10 others who are uselessly standing in the way during the MCI, and then they try to later arrest Dr. McKay for a parole violation, even though she was literally saving lives!! They only back down when another cop is like 'well she did save our cop.' There's no monologue about defunding police but it shows that 9/10 of them are macho assholes who fuck with emergency workers when they feel like it.
- Obsessed with how they depicted Dr. Robby's flaws, especially re his handling of the David/list of girls situation. He's a great doctor and mentor, but even he fucks up and his unresolved trauma ripples across the ER. He also is notably a better mentor to his male trainees than his female ones - Whitaker is the one of the newbies he takes under his wing, he submits Langdon for the award without being asked. He argues with his male trainees less, he accepts their diagnoses on difficult cases, he is more comfortable taking them under his wing. The male trainees rarely challenge him, but the female ones do. It takes more effort for the women to argue their point of view on care, which must get exhausting. I appreciate this writing choice so much. Dr. Robby is compelling and extremely likeable and he makes the right call for his female patients many times. He is supportive of the women in his department and wants them to do well. But it's still there, and he doesn't even realize it.
- Love that they brought in Brad Dourif to play Dr. McKay's dad, as he's her actual dad.
- Love that many of the nurses and background actors are actually healthcare workers.
One of the little brilliant things with Whitaker is when Kiara gently and matter-of-factly corrects him with "we say 'unhoused'" when he refers to someone as "homeless." That comes full circle at the very end when you realized that he is, himself, unhoused.
I love your analysis on gender. That the show is able to present Robby as an excellent, sometimes heroic doctor and person and also very deftly show these dynamics is pretty great storytelling. It jumped out most for me with Mohan - he's really aggressive with her, especially over the mercury patient, and I think it's to the credit of the show that he's clearly *wrong* about that. And also the resolution/lack of resolution is true to life - Robby hears that she caught the mercury thing, you see in his face that he appreciates it - but he doesn't actually pull her aside to be like "you were right and I was wrong." I actually think Mohan's entire arc is great on this point, because you see how capable she is on the fly during the MCI, and the approach that Abbot takes with her is wildly different. She has zero reason to lose confidence in her skills.
ETA: It's also not a binary "Mohan is perfect, Robby's wrong" story either - he's right about the fact that she needs to lean harder to get consent for intubation from their patient with sickle cell, because delays could threaten her life. And she knows that, too.
I want to watch it, because I've heard SUCH great things!!! But I am a healthcare worker in America and I just don't think I can right now. I'm finally out of training and in a job that feels less like a conveyor belt of sadness, but just reading your review dredged up all the feelings of residency mid-pandemic. ER workers are actual saints (and also a lot of them have a lot of shit going on! it's a type!).
I have a friend who is an ER nurse who says the same thing, that it's too close to daily life. I quote, "I noticed they had the correct rhythms on the cardiac monitors, which almost made me want to watch it, and then I turned on A Bug's Life instead."
Sometime in middle school I read a local firefighter's autobiography for a school project, and this detail that I have somehow always retained from that book is that city firefighters and ER nurses have to date each other because nobody else can get on their level or has the same baggage.
I remember learning it for the first time about long-term expat aid workers when I was in college and thinking about what that life would look like. People who do the VERY DIFFICULT jobs in our world often come with trauma.
Yes! I couldn't make it through the first episode because I am the type of person whose vision starts tunneling with a blood draw. And I checked in with my healthcare worker friends and they couldn't stomach the spot-on grief and covid trauma. So I really appreciate reading this piece and thinking about the broader impact of the show.
-I'm on episode 6 i think, so I'm not up the mass casualty event I know is coming, but after about 3 episodes I did say to my mother and husband, I find the Pitt almost relaxing hahaha. Like what darkness is that. I was an ICU nurse for ten years and now am a nursing director, and I felt so relieved to see an accurate portrayal of hospital life, like the wackiness and the pressures from the inside and the outside, and the doctors and the nurses and everyone else just trying their best with the broken pieces. (I should say, I did NOT find the storyline with the intubating the man who was a DNR/DNI relaxing, that filled me with unbridled rage at the daughter.)
-AHP you're so right too about the unprocessed pandemic trauma that kind of hangs over everything too. The covid hangover is long and it will remain unprocessed. There are not neat ends to things like that.
-The nurse Jesse who is the nurse in real life, it's so funny to watch him because he moves exactly like a nurse. Everyone else is acting and that guy is just going to work.
-I used to sometimes lament that my family would never see me work in the hospital that there was this whole other weird life I had that they would never get a glimpse of, and I'm glad that now they have. I would say, in real life there is def more laughing. one has to have some levity.
I'm a mental health therapist, and after finishing the series, I went back and rewatched it -- but had to skip over the storyline of the daughter who forced them to intubate her father. Something about that storyline bothered me way more than the degloved foot (although that was a queasy moment for me too)!
That storyline was so, so hard for me — the daughter is so clearly acting out her own deep sadness/anger at her father by trying to save him (and has also clearly had to stake a claim in her life as someone who 'knows what's best') without empathy for how those actions will affect her father. I think the story does a good job of softening her from a shrill know-it-all/flat character, but oof.
Agreed, they do a nice job showing her humanity. I loved the four sentiments from Ho'oponopono culture that Dr. Robby shares with her; I'm in a death doula training and we were taught the four statements/sentiments/reflections as well. I think maybe the storylines that veered more emotional (rather than more physiological) were also harder for me to not respond to emotionally... which, to be fair, was probably the writers' goal.
Following your metaphor through ... if The Pitt IS the country writ small(er), then all those already-inadequate systems completely fall apart when people without skill and heart are running the show, which is basically where we are now.
Something that prevented me from getting into the show was a casting stereotype that I find difficult to overlook. As David Graeber wrote in THE UTOPIA OF RULES, movies about broken bureaucracies frequently cast a white male lead as the truth speaking maverick, while a bureaucrat enforcing dysfunctional rules is Black. I saw this casting in the trailer and just could not get excited about the show, however excellent its redeeming qualities are.
It is also irritating that a male lead is cast in a feminized industry. When industries feminize, wages drop. The misogyny in medicine is not to be believed. The impact on women, on our bodies and psyches, is staggering. There are more men in critical care and the ER, and more women in long term care and med-surg, and the working conditions in those fields are horrific.
White men are the architects of healthcare capitalism and its greatest beneficiaries.
I think this is a great analysis of a show I will absolutely never watch and really look forward to never having to hear about again, because of how triggering it is. I am a former ER doctor, and I didn't last long after finishing my residency, because I finished residency in the mid-2010s as private equity really started to eat up physician owned practices and stable hospital jobs also fell away with an increase in hospital mergers and downsizing staff as "cost-savings". I loved so much about the medical care that we did in the ER. I loved the variety, the intensity, I loved being there for people on their absolute worst day. I did not love how I was treated by abusive patients and their family members, by other staff (usually on the in-patient side who were also overwhelmed, but who never quite understood just how much we were holding back from them and who never quite understood that emergency medicine is a specialization, that we are skilled at this thing, that we are not medical students for our whole career), and of course by hospital administrators and insurance companies who operated from a very different set of priorities. I decided this job was too close to killing me and that I was good at too many other things for this to be my only option.
I left to work in medical humanitarian aid and am now a medical advisor for the biggest humanitarian aid organization I could find, so I didn't exactly choose something easier...
In the years since I've quit, I still get SO MANY PEOPLE who say "Oh don't you miss clinical work? You can always go back, like that's always an option for you." And I am so very tired of insisting that no, I can never go back, not unless I want to die. I can never watch this show, but I really do hope that all the people who do watch it finally understand why so many of us have left and stop insisting that we can always go back to it. When I was a medical student, ER residencies were among the most difficult to match into, the demand was so high, because the business model was different. It's no surprise that today, it's harder to fill the seats in this program, because who wants to sign up for this torture, no matter how fun the medical part is.
My partner is an ED nurse with 10 years of experience at Level 1 trauma centers in DFW, St. Louis, and Phoenix. He won’t watch either, and I get it.
Yep, my 20 year ED doc husband has zero interest either. "Why would I watch something I live every day as entertainment?" that being said, he reports a LOT of colleagues watch and love it! So YMMV.
I am an RN who no longer works in the clinical setting. I think the distance I have allowed me to really enjoy this show but I understand your unwillingness to watch. I work in public health/ emergency preparedness now so, like you, not exactly easier but SO much better for my mental health. The Pitt did a great job at showing how unrelenting clinical work is. I have never seen my experience so clearly articulated.
So much solidarity! I’m leaving the United States because of the healthcare system here.
One of my best friends from residency has gone to be an EM doc in New Zealand. He loves it - better quality of life, patients and families who understand when it's time to accept death, and a beautiful place to live.
I have a couple of colleagues who’ve moved to NZ to practice EM. They have reported similar improvements in their personal and professional quality of life.
came here for THIS! ^^^
I wonder all the time about whether this show is FOR an audience who doesn't have baggage around hospitals and the medical system. But who, in the United States anyway, would that be? Is anyone so fortunate?
And yet...I keep trying to watch it because I do have friends who are watching it and love it. But it took me a full hour to chill out after the first episode, so I'm taking it one episode at a time.
On Reddit I've seen multiple former and current ER staff say it's triggered PTSD episodes for them, especially the COVID flashbacks. So, you know, take care of yourself.
I’ve been to the ER as a patient five times this year and watched one episode after the second or third time and realized this is not for me. (Also my ER in Pittsburgh is not this bad but this show basically tells me never to go to the other hospital chain in town.)
I am an RN and kept hearing about this show and decided to watch the first episode. I think Noah Wyle is an incredible actor and it's probably a great show. However I don't think i can watch this show for the same reasons other healthcare workers have said they can't watch it on this thread. Work stresses me out as a nurse and watching this show isn't what I need with my off time. I'm glad it is popular though and giving folks an idea of what the healthcare system is actually like.
Thank you for spotlighting The Pitt—I felt so moved by every episode and blown away by their mastery of medically-laced dialogue. I recommend listening to the recent Fresh Air podcast interview with Noah Wyle. He describes how they deliberately separated the actors who played different levels of doctors/nurses into different groups and kept them apart when rehearsing and shooting—e.g., they ate lunch together in their own groups, so they'd bond—and that helped them feel and play the hierarchical order. Also, Noah is a great guy and a humanitarian (we went to the same high school; I was friends with his older sister). I'm grateful the show has been renewed for another season. They portray the goodness, selflessness, dedication, and work ethic that I hope will get our country through dark times.
I have nothing but admiration for those who work in these conditions, but I object to the premise that the goodness, selflessness, dedication, and work ethic of ordinary people should shoulder the burden of getting our country through dark times - because those dark times (in health care and so many other spheres) are being deliberately manufactured FOR PROFIT by the 1% who have little (or no) goodness, selflessness, and work ethic.
I watched an interview with Noah Wyle where he said he asked the casting director for actors who were "good at prop work" which gave me a chuckle.
I also thought that was interesting that they chose more theatre actors because of their comfort with props!
Every American should watch this show for exactly the reasons you describe. I finished medical training in 2018 and was a fresh attending when COVID hit. This show was 💯 reflective of the experiences I’ve had in the trenches of American healthcare. It’s an endless cycle of human suffering layered with profiteering from the erosion of the social safety nets.
What’s happening right now with the hostility against medical expertise- a skill set many of us have spent decades developing- is demoralizing on a level that’s impossible to describe. Especially for those of us who served on the front lines of the pandemic, it feels like an eviscerating betrayal.
I’m in the process of saying goodbye to my clinical patients in the US in preparation for a move to Canada. I’m being welcomed with open arms and I’m not the only US doctor making the move. I’m overjoyed about my new social insurance number.
Thank you for doing what you do and I'm sorry that you have to leave the country to feel appreciated and valued. The aggression toward the concept of "expertise" right now is brutal; I think a lot about how all this effort pushing back on expertise/specialization of roles is basically an argument against society and interdependence, which you also see crop up with the obsession re: homesteading, homeschooling, etc. What storyline do you think represented this best? I felt like the measles plotline brought it out most directly but you definitely see it crop up a lot throughout the show.
The mask fight was what really stuck out to me, especially at the end of the exchange with Langdon about the surgeons wearing masks. It felt like a real encapsulation of everything we’ve been through especially since 2020 but I’d say going back to long before that, too.
Such a good point, Kristen.
Yes to all of this; The Pitt is captivating. For me, the structure is everything; real-time shows/movies can be gimmicky, but The Pitt is so well-planned, it feels urgent and real instead.
Since finishing the season, I've been fascinated by the production itself, and how the narrative structure influenced the filming. Each episode was filmed in chronological order - so they filmed Scene 1, then Scene 2, etc. Most shows cluster guest actors' schedules so they shoot all of their scenes in 1-4 days; on The Pitt the actors were on set, in costume/makeup, every day, often just to sit in the background in case the camera crew (dressed in scrubs!) caught them in the shot. As you can guess, this really helped the actors calibrate their performances.
As a continuity nerd (I was a film/TV major and thought my most logical never-happened job in the industry would be script supervisor) this choice also makes things much easier for consistent costuming (no need to remember exactly HOW the blood spattered on someone's surgical gown if you filmed Scene 7 before you filmed Scene 11 instead of the other way around) and hair (note how the women have hairdos that are easy to replicate daily, like single braids or hair claws).
I loved the glimpses we got of the marble-and-terrazzo shell of the rest of the hospital surrounding the emergency department; anyone who's been in an old hospital knows that Frankenbuilding architecture.
Also: Jesse, the tall nurse with the curly graying hair? Played by Ned Brower, the drummer for Rooney! He became an EMT and an ER nurse after the band broke up.
Love the continuity nerdery (I think about this stuff too, and was definitely thinking about it with Mel's braid) — bonus that single braids and hairclaws are also what you'd actually want when it comes to hair containment in the ER!
So back in my ER days, I usually started out with my hair down (it's long...) and it was a known observation that when my hair went up into a bun, shit was getting real and it was time to get serious. I had several nurses comment on it over the years. I had never felt so seen!
Love the continuity stuff as well, although I did also hear in a podcast interview Noah Wylie did with The Watch (highly recommended!) that the stuff they specifically filmed in Pittsburgh (which was limited to the two rooftop scenes, chasing David (?) outside, the helicopter landing, and I think the close in the park?) were all filmed at the START of show filming. So for anyone that has finished, it means that the first episode scene with Robby and Abbot on the roof and the last episode scene with Robby and Abbot on the roof (where Abbot congratulates him on a nice speech) were actually filmed together before they'd ever written or filmed the final episode speech or final episode. That blew my mind when I heard it because that last rooftop scene felt so earned and real to me, and their exhaustion seemed like it was filmed at the end of a full season and everything that came before, but actually happened before nearly anything else. Just another note about what an incredible job both Wylie and Sean Hatosy did in the show and that scene.
What a couple of pros! (I think they've each been acting professionally for 30 years or so?)
Yes BUT apparently they filed the exteriors before the interiors, so the last shots of the season were among the first things they filmed--in an interview Wiley said the "nice speech" line on the rooftop was filmed before they had even written the speech. I'm amazed that they managed to write everything towards that last moment in the park and make it feel like it all made sense in the end (and much credit to the editors I'm sure).
Love this show so much, and I love that you've chosen to write about it. At 56, I'm starting nursing school in 3 weeks (total career change from criminal attorney to SAHM to nurse), and I'm hoping to work in the ER. My daughters (one of whom is a PICU nurse) who obv know me as "mom" cannot picture me working in an environment like the ER -- b/c they only know me in one way - "mom." I watch The Pitt and look forward to nursing school and clinicals and future employment, and at the same time, I wonder, "Do I really want to willingly move into that environment of long shifts, fast pace, life/death/trauma when all my husband wants me to do is quietly retire with him and caretake him and any future grandchildren?" Yes, the answer is yes, yes I do want to keep following the thread that's leading me to nursing school and run as far away as possible from retirement and familial expectations of what women do at age 56+
In nursing school at 43, I’m excited, fascinated and terrified!
Wow, what a cool story. I'm so excited for you. I have been thinking for a while now that I'd like to go to nursing school, but it feels too late - I did a PhD in my 20s that was, for lack of a better description, a waste of 5 years, and I have a comfortable desk job now, which is what I need while I have young kids. But maybe it's not too late! Thank you for inspiring me today :)
It's never too late! I have 4 kids and my youngest is a senior in HS, heading to college in the fall -- so I did all my prereqs part-time over the past three years. And now is a perfect time to head to FT nursing school, when the demands on me as "mom" are much less and my young adult children (the three older ones) are starting their first jobs, moving, getting established etc. Life is long, and it's never too late! Just hope someone will hire me when I graduate at 59!
I went abck to school and graduated nursinf schol at 58, so glad that I did so. I had about a year before the pandemic hit at my first nursing job, in inpatient psych. About the only thing that has felt wierd to be about the Pitt and I'm only on hour 10, has been the lack of gin shot wounds. The sheer number of gun shot wounds that I saw in my two rotations in big/meduim size city hospitals was eye opening. Not people dying from being shot but having to learn to live with very changed life circumstances.
ANyway go for nursing school!!! its the best and as a mom you have an advantage having dealt with a lot of shit and drama!!
Good for you! Congrats! And thank you for the encouragement! Sometimes I second guess what I'm doing, wonder if anyone will hire me at 59 when I graduate, etc. Not everyone in my family is supportive so that def makes it harder, but it's my life, and if they want to yuck my yum that's on them for not having a broader vision for what a long life can look like.
This is the analysis I’ve been waiting for! One other fold to add that I cannot stop thinking about:
Since I started watching The Pitt a few weeks back, I’ve thought a lot about class representation within “prestige” television, specifically in terms of geography and workplace. With a few notable exceptions (Abbott Elementary comes to mind), the recent critical darlings of TV are often set either in white collar workplaces (Severance, Succession,) or highly gatekept industries (Hacks, The Studio) and almost always in New York or LA. Commercial successes like Yellowstone and even Breaking Bad are widely popular, I think, because their setting, characters, and conflicts are more familiar to the “average” viewer. I call this my Roseanne Theory.
To me, prestige TV feels alienated from the lived experience of so many of us, and that’s where I think The Pitt succeeds. We’ve all experienced frustration with the medical system, most people know someone in the medical field. Healthcare workers make up something like 10 percent of the American workforce. It says something that this show is set in Pittsburgh and gives all “classes” of people fair amount of screentime and narrative for the audience to connect with. The storylines with the schizophrenic elderly mother and her exhausted daughter/caretaker, as well as the concert rigger who keeps working as the ER team works to stabilize him come to mind. Work is so entrenched in the American ideology—even in crisis scenarios, we keep working. This show does an excellent job of showing that with an even hand.
LOVE LOVE LOVE that it's in Pittsburgh, MID-SIZE (or larger than mid-size, more like large-sized but not ULTRA-LARGE size) cities forever!!!!
This post (not mine) that just came out today, May Day, is one of the best meditations/reflections on work in American ideology that I've ever read: https://sarahmock.substack.com/p/bread-and-roses-in-heaven
Thank you for finally writing about this! One my favorite scenes was when Dr Collin’s was treating a fat post partum patient who had come in earlier and had been tended to by Dr McKay, who may have succumbed to fat bias in her diagnosis. Her tenderness in checking this possibility out with the junior doctor was *chef’s kiss*.
Yes, that was super well done, and I think it representative of how they apparently approached scripting the show - bringing in a ton of consulting experts and asking what they wanted and didn't want to see on TV. It's also really well scripted and acted, because the show leaves open the possibility that it's not a bias issue at all (they're all spinning a thousand plates, at some point someone will miss something they shouldn't have) but shows Collins being gentle but direct in raising the possibility, and McKay being a little thrown/surprised but receptive to the feedback.
This feels true to what my husband reports (and what's so fascinating to compare an ER to a "regular" workplace) is the culture of feedback. It's so accepted, it's understood you don't know everything and that you're going to get stuff wrong. That's why there's a team. You're direct, you accept it, you get back to work. It's kind of inspiring actually!
It's SO striking — you keep expecting everyone to blow up or get weird but instead they just have to figure out how to roll with it
And there's a surprising level of humility (not something docs are always known for). Like, genuine appreciation that your resident figured something out that you didn't. I'm sure that's not universally true -- but the urgency and the singular, shared mission (save this person) make for a hostile environment for ego.
What I really liked about that moment was that McKay had already displayed a lot of empathy for women and other marginalized populations, but also: she might have unexamined anti-fat bias. It shows that everyone might have those.
I loved the spotlight on the Freedom House Ambulance Service, set up to serve the predominantly Black Hill District (both patients and practitioners). The training and standards they created have become the model for all current EMT practice in the US (and they were unfortunately victims of their own success). This is important history that I was not aware of prior to seeing it in The Pitt.
i was unaware as well— so grateful to learn about it
One of the things I love about this show is the representation of neurodivergence. Mel's character is never diagnosed for us, and though we come to understand that she is likely on the spectrum, we also see the unique perspective she brings, and her empathy and attentiveness and humour. I feel like the show really demonstrates the adage "If you've met one person with autism, you've met one person with autism". We also meet her sister, and the patient who Mel recognizes as needing a different type of care -- something Langdon was unable to see. As someone with neurodivergent family members, I found the show's approach very moving, and I could see how it might encourage viewers to meet others where they are, and to be accepting and curious and kind.
She was my favorite character, loved her arc. Overall, love how the show highlights that different people bring different skills to the table, and how needed that is. <3
Absolutely- the scene where Mel takes care of the man with ankle sprain brought tears to my eyes. The hot shot doctor was impatient and wasn’t able to treat him at all really.
Great article about this - https://time.com/7275814/the-pitt-mel-neurodivergence-autism-adhd/
Thank you for this! Great read.
As an ER stan and a University of Pittsburgh alumna, there was no doubt I was going to eat up The Pitt. Many of you have made more salient points about the social issues at play on the show, so I won't belabor them.
My only criticism is that there isn't enough true Yinzer representation. I think Dana is likely their concession to Yinzerdom, but carries herself with too much Mount Lebo and not enough West Mifflin. In season 2 I really need to hear someone call someone else a jagoff. I need to hear someone say "dahntahn." And if they really want to go for accuracy, an ortho bro in the ER for a consult needs to invoke the name of Freddie Fu.
This is a top tier niche PGH comment. I am hoping for more realistic PGH accents in Season 2.
100%! I was so surprised they didn't go full yinzer with Dana, especially when she broke up the patient fight. The Pitt needs to hire an accent coach and get some of those pancake-flat "a" sounds in there!!
Agreed! I was pretty annoyed at the clear lack of a Pittsburgh consultant to get accents and pronunciations right (the clear mispronunciation of Wholey's by Langdon in one episode made me cringe). It's an incredibly fun and unique accent that would have really added to the realism of the place-making.
(I should note I otherwise LOVE the show)
I'm from Pittsburgh and even I can't really do the accent. But agree! I have a few aunts and uncles they can call if they need someone... lol
It was narratively convenient that the doctors/med students wouldn’t necessarily be from Pittsburgh so they didn’t need to worry about the accent too much. I would always welcome more of it though.
This is true, but I expected the nurses and support staff to have a little more Yinzer verve.
I adored this show. When I started it, I was hoping that there would be some reckoning with the underlying COVID trauma. (Because I really feel the need for that!) But the fact that it was always present and never addressed is so…real.
Yep, same. My other half worked ICU during the pandemic, and the way it's affected our whole family's life is...I don't have words for it. I think part of why I watch The Pitt is so I can process the ways COVID trauma is unseen in my own daily life. My husband changed jobs and we have moved cities, but there's still a list of 2021 departed patients' names in our prayer corner.
Thank you for this, I have been obsessed and am so happy to talk about The Pitt more! I've been rewatching episodes, which on the one hand feels a bit strange since so much of it is so intense, but I also find competency extremely compelling and comforting. Watching people who are SO good at what they do just gets me every time.
A few more things about the show I've been chewing on:
- It does SUCH a good job of flipping your expectations about what some of those social ills actually look like across the season. The brilliant jerk resident guy (Langdon) who is Dr. Robby's mentee is an addict, the young med student (Whitaker) is unhoused.
- I feel like most other medical shows on now (Chicago Fire, 911, etc.) are big on cop solidarity and 'of course we respect our boys in blue' but the Pitt takes a different approach. It acknowledges that social services and cops are in and out of the ER the entire time and there's basic cordiality, but when one of the cops is injured, there are 10 others who are uselessly standing in the way during the MCI, and then they try to later arrest Dr. McKay for a parole violation, even though she was literally saving lives!! They only back down when another cop is like 'well she did save our cop.' There's no monologue about defunding police but it shows that 9/10 of them are macho assholes who fuck with emergency workers when they feel like it.
- Obsessed with how they depicted Dr. Robby's flaws, especially re his handling of the David/list of girls situation. He's a great doctor and mentor, but even he fucks up and his unresolved trauma ripples across the ER. He also is notably a better mentor to his male trainees than his female ones - Whitaker is the one of the newbies he takes under his wing, he submits Langdon for the award without being asked. He argues with his male trainees less, he accepts their diagnoses on difficult cases, he is more comfortable taking them under his wing. The male trainees rarely challenge him, but the female ones do. It takes more effort for the women to argue their point of view on care, which must get exhausting. I appreciate this writing choice so much. Dr. Robby is compelling and extremely likeable and he makes the right call for his female patients many times. He is supportive of the women in his department and wants them to do well. But it's still there, and he doesn't even realize it.
- Love that they brought in Brad Dourif to play Dr. McKay's dad, as he's her actual dad.
- Love that many of the nurses and background actors are actually healthcare workers.
One of the little brilliant things with Whitaker is when Kiara gently and matter-of-factly corrects him with "we say 'unhoused'" when he refers to someone as "homeless." That comes full circle at the very end when you realized that he is, himself, unhoused.
I love your analysis on gender. That the show is able to present Robby as an excellent, sometimes heroic doctor and person and also very deftly show these dynamics is pretty great storytelling. It jumped out most for me with Mohan - he's really aggressive with her, especially over the mercury patient, and I think it's to the credit of the show that he's clearly *wrong* about that. And also the resolution/lack of resolution is true to life - Robby hears that she caught the mercury thing, you see in his face that he appreciates it - but he doesn't actually pull her aside to be like "you were right and I was wrong." I actually think Mohan's entire arc is great on this point, because you see how capable she is on the fly during the MCI, and the approach that Abbot takes with her is wildly different. She has zero reason to lose confidence in her skills.
ETA: It's also not a binary "Mohan is perfect, Robby's wrong" story either - he's right about the fact that she needs to lean harder to get consent for intubation from their patient with sickle cell, because delays could threaten her life. And she knows that, too.
I want to watch it, because I've heard SUCH great things!!! But I am a healthcare worker in America and I just don't think I can right now. I'm finally out of training and in a job that feels less like a conveyor belt of sadness, but just reading your review dredged up all the feelings of residency mid-pandemic. ER workers are actual saints (and also a lot of them have a lot of shit going on! it's a type!).
I have a friend who is an ER nurse who says the same thing, that it's too close to daily life. I quote, "I noticed they had the correct rhythms on the cardiac monitors, which almost made me want to watch it, and then I turned on A Bug's Life instead."
Yes, same, I will never watch it because they actually do too good a job at showing what it's like.
Re: your last sentence -
Sometime in middle school I read a local firefighter's autobiography for a school project, and this detail that I have somehow always retained from that book is that city firefighters and ER nurses have to date each other because nobody else can get on their level or has the same baggage.
I remember learning it for the first time about long-term expat aid workers when I was in college and thinking about what that life would look like. People who do the VERY DIFFICULT jobs in our world often come with trauma.
Yes! I couldn't make it through the first episode because I am the type of person whose vision starts tunneling with a blood draw. And I checked in with my healthcare worker friends and they couldn't stomach the spot-on grief and covid trauma. So I really appreciate reading this piece and thinking about the broader impact of the show.
-I'm on episode 6 i think, so I'm not up the mass casualty event I know is coming, but after about 3 episodes I did say to my mother and husband, I find the Pitt almost relaxing hahaha. Like what darkness is that. I was an ICU nurse for ten years and now am a nursing director, and I felt so relieved to see an accurate portrayal of hospital life, like the wackiness and the pressures from the inside and the outside, and the doctors and the nurses and everyone else just trying their best with the broken pieces. (I should say, I did NOT find the storyline with the intubating the man who was a DNR/DNI relaxing, that filled me with unbridled rage at the daughter.)
-AHP you're so right too about the unprocessed pandemic trauma that kind of hangs over everything too. The covid hangover is long and it will remain unprocessed. There are not neat ends to things like that.
-The nurse Jesse who is the nurse in real life, it's so funny to watch him because he moves exactly like a nurse. Everyone else is acting and that guy is just going to work.
-I used to sometimes lament that my family would never see me work in the hospital that there was this whole other weird life I had that they would never get a glimpse of, and I'm glad that now they have. I would say, in real life there is def more laughing. one has to have some levity.
I'm a mental health therapist, and after finishing the series, I went back and rewatched it -- but had to skip over the storyline of the daughter who forced them to intubate her father. Something about that storyline bothered me way more than the degloved foot (although that was a queasy moment for me too)!
That storyline was so, so hard for me — the daughter is so clearly acting out her own deep sadness/anger at her father by trying to save him (and has also clearly had to stake a claim in her life as someone who 'knows what's best') without empathy for how those actions will affect her father. I think the story does a good job of softening her from a shrill know-it-all/flat character, but oof.
Agreed, they do a nice job showing her humanity. I loved the four sentiments from Ho'oponopono culture that Dr. Robby shares with her; I'm in a death doula training and we were taught the four statements/sentiments/reflections as well. I think maybe the storylines that veered more emotional (rather than more physiological) were also harder for me to not respond to emotionally... which, to be fair, was probably the writers' goal.
yes to all of this! the managed chaos and medical speak is calming to me. probably something to work out in therapy ha.
Following your metaphor through ... if The Pitt IS the country writ small(er), then all those already-inadequate systems completely fall apart when people without skill and heart are running the show, which is basically where we are now.
As a nurse, I really appreciate this write up.
Something that prevented me from getting into the show was a casting stereotype that I find difficult to overlook. As David Graeber wrote in THE UTOPIA OF RULES, movies about broken bureaucracies frequently cast a white male lead as the truth speaking maverick, while a bureaucrat enforcing dysfunctional rules is Black. I saw this casting in the trailer and just could not get excited about the show, however excellent its redeeming qualities are.
It is also irritating that a male lead is cast in a feminized industry. When industries feminize, wages drop. The misogyny in medicine is not to be believed. The impact on women, on our bodies and psyches, is staggering. There are more men in critical care and the ER, and more women in long term care and med-surg, and the working conditions in those fields are horrific.
White men are the architects of healthcare capitalism and its greatest beneficiaries.
Such great points. Thank you for sharing your thoughts.