The Pitt is a Show About

The Sickest Patient in the Show Seems to Be the Country Itself

I don’t usually focus a piece on a single piece of media, but The Pitt has affected me in unanticipated ways — ways that make me want to talk about the entire show with anyone else who’s watched it and cajole others into watching it as well.

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THE PITT IS A SHOW ABOUT AN EMERGENCY ROOM

In the city of Pittsburgh, sometime around the present. It was created by R. Scott Gemmill and John Wells (who were also responsible for ER, arguably the most important and successful drama of the ‘90s and the anchor of NBC’s Thursday Night “Must See TV,” and Noah Wyle, the actor who stayed with ER the longest (from its launch, in 1994, through its eleventh season, in 2005). Wyle has starred in various other series and films, but nothing that comes close to compromising the vague feeling that John Carter (his character in ER) has simply aged a few decades, moved a few hundred miles east, and become Dr. Michael Robinavitch aka Dr. Robby on The Pitt.

Unlike ER, which often focused on a single shift but also guided us through weeks and months in the lives of a Chicago emergency room, The Pitt takes place in “real-time” — there are fifteen episodes for fifteen hours on a single Monday in what we’re to understand as an under-resourced and over-burdened hospital in urban Pittsburgh.

The Pitt is also, somewhat surprisingly, on Max: surprising because it’s in many ways a classic network show, albeit with more leeway (it’s far more graphic than ER ever could be) and, I’d argue, more verve; it’s shot in a seamless but effective style (but the aesthetic never feels cheap the way Netflix genre series often do).

The Pitt has also been widely heralded as a return to what makes television good: tightly plotted, non-flashy, wonderfully but not overly acted, a show that is about stuff but also, plainly, about an emergency room. It’s spectacularly good television, and like many of you, I tore through it. And apart from its narrative brilliance, I also think it’s doing some pretty deft ideological work — using very micro examples to create the space and empathy necessary to understand various macro issues and the difficulties in confronting and resolving them.

So here’s a semi-formed thoughts, with the hopes we can arrive at more together. (Mild spoilers ahead in terms of a major-but- strongly -telegraphed plot point; nothing that will ruin watching or finishing the show)

THE PITT IS A SHOW ABOUT SYSTEMS

These systems are the show’s canister — and a big part of what makes it so narratively pleasurable. First, there are the legible (but always gently interrogated) hierarchies of the personnel. Doctors are different from nurses, but doctors couldn’t do shit without nurses. Then there are residents, attendings, people who come downstairs from upstairs and people who only stay downstairs, you can ask questions but you also have to take orders.

The dynamics of a teaching hospital make the systems especially visible: a patient comes in, and the senior doctor asks the junior to articulate exactly what’s happening and what could happen. Then there are protocols to follow: if A, then B, if B, then C. Sometimes the protocols get scrambled, but the deviations don’t ultimately undercut the protocols. Instead, they reinforce them: you do this, and if this doesn’t work, then you get creative. If you’re in trouble, you call for someone who’s your senior, and they’ll arrive and help, unannoyed, because that’s just what you do.

If you come into the hospital in an ambulance, you go straight to the back. That’s just what you do. If you come in on your own, you sit in the waiting room for hours upon hours. That’s also just what you do. If a probation ankle bracelet thinks you’ve left your approved workplace, but you definitely have not, it still blares. If you sign an involuntary commitment order and change your mind, it cannot be rescinded. If you sign a DNR but you give your children power of attorney, it can be ignored. If you doubt your son is declared brain dead and you don’t believe it, two tests can be performed to definitively prove otherwise; if you decide to follow his declaration to donate his organs, there is an ornate choreography that follows.

Some of these systems work as intended and others do not. Exploring their effectiveness is the pulse (sorry) of the series: why have these systems in place, if they’re so tattered as to become meaningless? Is their depiction here meant to change our thinking on their effectiveness? What does the existence of a mass casualty protocol tell us about the society we’ve created?

THE PITT IS A SHOW ABOUT TRIAGE

There are multiple moments in the final episodes of Season One — when the emergency room is in the throes of responding to the mass shooting — where the cameras leave the fluorescent lights of the emergency room to follow the doctors stationed outside the hospital in charge of triage.

When a vehicle pulls up, the physicians have ten seconds to assess the severity of their wounds and slap a bracelet on them that corresponds to how they’ll be treated — from stabilized to dead to on arrival. During the peak of the three episode stretch of mass shooting pandemonium, the cameras linger on the triage doctors as a fresh batch of critical patients arrive, replacing the set they’ve just sent inside to trauma units. “Is this ever going to end?” one doctor asks. Another responds: “the only way out is through.”

Whether you binge the show now or watched it in episode clusters as it was released, you can’t escape the message that these healthcare professionals are, for the most part, just trying to help people — and keep getting punched in the face as they try to do so, literally and metaphorically. The show is fucking ceaseless (there is at least one explicit mention of the myth of Sisyphus).

And how do you deal with ceaselessness? Triage. Technically, triage is a medical sorting procedure, but it is also a mechanism for responding to trauma. It is about adapting to a system under strain and doing one’s best when the circumstances are shitty. Sound familiar?

If The Pitt is a show about systems — some sturdy; most broken — it is also about resiliency and what it takes to adapt to that brokenness. The hospital is resource-strapped; its administrators are focused on bottom lines at the expense of the physicians who keep things running. Life savers are under-appreciated, overworked, and physically abused. The line of ambulances never ends, nor does the parade of weary patients in the waiting rooms. The Pitt takes great pains to show the brokenness of the system, but it also refuses to offer neat solutions or glorify resilience. Triage is not about mending a broken system. It is about surviving it.

At the end of the mass casualty event, Dr. Robby gives a short speech to his beleaguered day-shift team. He lists off the people that came through the emergency room in the last four hours — more than 120 — noting that only six died. It’s a victory speech of sorts, but the show doesn’t revel in those stats. We don’t know, will never know, what happens to the survivors: do they survive another day? What is their road to recovery? What trauma will they endure?

This is the tacit lesson of the show: you can exercise control for a brief, horrible moment in time and do your very best. But you still have to decide how you will confront or ignore what happens next.

THE PITT IS A SHOW ABOUT AMERICA

This isn’t subtle! The creators and writers have infused the show with topical storylines — fentanyl overdoses; sex trafficking; self-harm; vaccine hesitancy; troubled and potentially violent young men; concerns about the unhoused, abortion; mass shootings. The specter and unprocessed trauma of the pandemic hangs over the entire show. Just listing that out makes the show sound heavy-handed but, save for a few brief moments, it isn’t.

I attribute most of that success to The Pitt’s (almost) real-time episode structure. Episodes don’t end neatly as much as they run out, which has the effect of doling out chaos like a continuous IV drip (again, sorry). Some episodes end on cliffhangers or with a gentle resolution, but the major themes of the show and the ceaseless feeling of the crisis bleed through episodic cuts. Nothing ends; we just got older, more weary, and with more understanding of how all of these systems do and do not work.

If I had to dial up a piece of entertainment to give a time traveler a notion of what it means to live in America in 2025, I don’t know that I could do much better than The Pitt. The safety nets that should protect people from concrete harms like child sexual abuse, gun violence, or trafficking are almost non-existent or held together by duct tape. Often the doctors, bound by the rules, must hold their tongues while patients make the wrong choices. One person, even one hospital, can only do so much.

It goes unspoken, but the sickest patient in the show seems to be the country itself. The show knows that just because the main characters who populate the emergency room are mostly brilliant, selfless, type-A adrenaline junkies with stethoscopes solves nothing. Their tireless efforts are band-aids on gaping gunshot wounds. The Pitt rightly demonstrates there is dignity and honor in applying this kind of first-aid. But it is not enough.

Near the end of the show, Dana, the head nurse of the day shift, tells Dr. Robby she’s thinking of calling it quits. If the emergency room is a solar system, Dana is the sun, projecting an unflappability and moral decency in the face of every single setback. When she’s assaulted by an angry patient in the beginning of the season’s third act, she signals that perhaps she’s had enough. It’s unclear if Dana, a fan favorite, will be back for the show’s second season, but her seeming resignation (in the final episode, she takes down the family pictures at her workstation before going home), is part of what makes The Pitt so raw and honest. It is an admission: there are no guardian angels, just people pushing the boulder up the hill. Eventually, everyone reaches their breaking point.

The Pitt gathers all this bleakness and still somehow leaves viewers feeling something akin to hope — a real testament to the final product. But it’s also why the show feels so quintessentially American. For fifteen episodes, we are confronted with the worst of humanity and infuriated by the constraints of overlapping systems of oppression, greed, and inadequacy.

I’ll be real: there are moments when the show feels less like an entertaining respite and more like the feeling of scrolling a social media timeline. The narrative works as a microscope, asking us to examine all that’s wrong with the world and all the ways the helpers are continuously stymied.

But The Pitt refuses to give up. In the end, it asks of us to experience this broken world with the stubbornness bordering on naivete that its protagonists possess. It asks us to keep coming back, knowing full well the trauma in store. And what’s more infuriatingly American than that? ●

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