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This post contains spoilers for the latest episode of The Pitt, now streaming on Max.
The eighth episode of the Max medical drama The Pitt is the chronological midpoint of the show’s 15-episode first season, which is covering 15 consecutive hours in the same hospital emergency department shift. It is also the creative high point so far for the excellent rookie drama, featuring a trio of stories that pack an emotional wallop.
One is the conclusion to a story that has been playing out since the series premiere, involving the fentanyl overdose of a college student. In the eighth episode, the boy’s parents agree to donate their brain-dead son’s organs, and the doctors and nurses line up for an honor walk as the parents and their son are led off to meet up with the transplant team. The others are stories introduced this week: A little girl dies from drowning after diving into a swimming pool to rescue her sister, and an elderly patient turns out to be a former driver for the Freedom House Ambulance Service, a local Pittsburgh program from the late Sixties that serviced the Black community and played a crucial role in developing the field of emergency medicine in a non-military context.
The episode was written by Joe Sachs, an emergency physician himself who has spent the last few decades going back and forth between medical work and penning scripts for TV dramas, most famously NBC’s groundbreaking Nineties smash-hit ER. Not coincidentally, The Pitt was created by ER alum R. Scott Gemill, is produced by longtime ER showrunner John Wells, and stars (and is also produced by) original ER cast member Noah Wyle.
The link in genre and creative DNA between the two series has led to a lawsuit by the estate of ER creator Michael Crichton, alleging that Wells proposed doing an ER sequel, to be set in real time and starring Wyle as an older version of Dr. John Carter, and proceeded with the idea over their objections, simply changing the names and setting (from Chicago to Pittsburgh) to avoid paying Crichton’s family. Wells, Gemill, and Wyle aren’t allowed to publicly comment on the suit:”We’ve got it tattooed on our foreheads, from Warner Bros. legal,” says Wells. But in a joint interview last week with Rolling Stone, the three longtime colleagues discussed the many ways The Pitt differs from their former work together.
Certainly, there have been big changes in the field of medicine since ER ended in 2009. The Pitt includes physicians like Wyle’s Dr. Michael “Robby” Robinavitch struggling with PTSD from the early days of Covid, plus a nationwide boarding crisis, where patients are often kept in emergency departments for days on end because hospitals don’t have the staff to admit them to regular hospital beds. There’s also the starker look and sound of The Pitt compared to its predecessor, as well as that real-time structure, which allows the series to cover some stories like the overdose over many episodes, and have other patients come and go within the span of an hour.
A few days after this interview, Max announced that The Pitt was renewed for a second season.
Was there a point after a few seasons of making ER and using the technical jargon every day that any of you began to feel like you could actually fake your way through a medical procedure or two?
Noah Wyle: I think I suffer from delusions of grandeur in just about every area of my life. Medicine is one of them. You get familiar enough with the terminology and the procedures that you gain a lot of theoretical knowledge. Whether you can put it into practice or not in a moment of need is a totally other question.
John Wells: I always like to tell people we know just enough to be terrified in the emergency room.
Had any of that knowledge stuck in the 15 years since you last did that show?
NW: A lot of the terms have changed. A lot of the medicines have changed. A lot of the procedures have updated. Just for example, intubations, which everyone who watched ER knows how to do, you used to have to do it blind, and now it’s all fiber optic with GlideScopes.
When this new character of Dr. Robby was being crafted for Noah, what were the goals?
R. Scott Gemill: We wanted him to be the head of the department, and we wanted to address what every first responder went through with Covid, how detrimental that was to their well-being, mentally and physically, and what they went through trying to keep everyone else alive. And that character, being a man who, like most men, probably just avoids any of those feelings that he doesn’t want to deal with, just shoves them down. And that’s not a good idea. And eventually they’re going to come to the surface, and this is the day when they finally find their way out.
NW: I think John, Scott, and I all share an interesting sensibility and desire to depict something that is difficult to articulate, but when people are watching it, they’re really responding to — especially people in the medical community. It’s very honest and it’s very relatable. The Pitt being almost a metaphor for what we’ve all been in in the last five years, trying to figure out our own way out. Robby becomes an avatar for a lot of people to project onto about how it feels to be beset by responsibilities without any kind of break and no time to process, no time to analyze — and, as Scott said, the ability to compartmentalize and the professional mask are both wearing thin.
Where did the idea first come from to do the whole season as one shift?
RSG: I don’t want to say it was out of necessity, but we’d done so many medical stories that it was really about trying to find a way to make the show feel different and fresh. I don’t think any one of us wanted to go back to doing what we’d done in the past. We need to be challenged, and we need to challenge ourselves. The one thing that separates the ER from everything else in the medical profession is that it is an emergency, time is a factor. No one makes an appointment, no one wakes up thinking they’re going to go to the ER. So time, obviously, became an issue in terms of what’s a differentiating factor for this kind of medicine. So, we leaned into that and said, “Let’s just stay with them for the whole shift. Let’s hang out to see what’s going on.” That’s the part that we’ve never really captured, where they’re in there for 12 hours on their feet, getting pulled away to God knows what. They never know what’s coming through that door. What kind of horror are you going to see in the next 10 minutes? By making it one shift, I think you suck the audience right in, and they don’t get to go home until our doctors and nurses do.
Were there certain aspects of doing it this way that proved especially challenging versus how you’d structured this before?
[Wyle and Wells both begin to laugh, while beckoning Gemill to answer.]
RSG: They’re laughing, because for about six months, until we got the first cut, I wasn’t sure it was going to work. We had them design the sets first, so we had something to write to. And then it was like a giant game of Risk. There’s no cutting away, no act breaks, and you’re going to follow through the next day. There’s a lot of logistics involved. And to do a show in real time, which I’d never done, that was a whole learning process for myself and everyone else.
JW: The show is shot in continuity [scenes shot in the order in which they take place], which is very unusual. It’s minute to minute, so each episode is blocked out for what’s happening in each minute and where the characters are. So the logistics of the whole thing were challenging, exciting, frustrating, depending on the day.
NW: Appealing if you have massive OCD.
Was there anything that was somehow easier doing it this way?
NW: I don’t know about easier, but I think it forced a discipline that none of us have ever really had to delve into before, which made it exciting and novel. And with every restriction or limitation, there was another kind of discovery and possibility. I think what Scott’s saying we didn’t know was going to work was, when you tell a patient your labs will be back in an hour, and then I don’t see you for an hour, whether or not audiences are going to remember that case and that patient when they come back an hour later with those labs. It was a bit of a gamble, because there was some concern that audiences wouldn’t have the recall to really be invested over an ongoing storyline. And that has been proven to be not the case. I think people found it really refreshing to be able to watch these characters evolve over each subsequent episode.
How do you figure out how much is too much to be happening to the doctors in a single day? In the eighth episode, for instance, Garcia scolds Santos for making accusations against another doctor after having worked there for only a few hours. And in this same shift, Santos has also accidentally stabbed Garcia with a scalpel, and confronted a patient who reminded her of her past trauma about being molested. Collins miscarried her pregnancy in last week’s episode, and some significant personal things happen to various doctors and nurses later on. It’s a very busy day for the staff of this hospital. A season of ER could be this eventful, but that was playing out over months in the characters’ lives. Did you have any concern about that?
RSG: I didn’t really. That’s what we do. That’s what the audience comes for: to be surprised, and challenged. The compression in one day is a conceit, but I think it worked. What was really amazing is how quickly the cast and crew adapted to it. The first day was a little crazy. We had all this background, and two script supervisors, and people just in charge of background. But by the end of the first episode, we were just humming along like we’ve been doing it for 10 years. It was really, really impressive how quickly everyone fell into that rhythm.
In future seasons, would you continue with this structure?
RSG: If it ain’t broke, don’t fix it
How do you figure out how to balance stories that wrap up quickly with ones that will run across multiple episodes?
RSG: The medicine dictates that. That’s what’s nice about the format; we don’t have to fake anything [in terms of timing]. I think we’ve done a good job of capturing that sometimes, it’s very, very frantic, and seconds count, and sometimes it’s fucking boring for hours when you’re sitting there waiting for someone to see you and no one’s coming, and you’re wondering, Why are they taking people ahead of me? Why am I waiting here? What are they doing back there? But that’s part of what’s going on with the boarding problem and patients being in there for days upon days.
JW: Part of that was, you put a lot of ideas about medicine up on the board, and had many medical experts and doctors and clinicians looking in. You had a sense of how long these cases took: This case will be in the emergency room for seven or eight hours, and this will be there for two hours. And you had literally dozens and dozens of these stories that you were trying to get a balance into a set of stories that made sense. It was cool.
RSG: A lot of choreography is involved as a writer on this show. You have to know the set really well to do all the movement through it. And then, you know, drop it on the director’s lap, and they’re like, “What the hell am I supposed to do with this?”
This is an extremely powerful episode, between the honor walk, the drowned girl, and the Freedom House ambulance driver story. Was it a coincidence that so many huge emotional moments got packed into the same hour? Or was it the plan for this as the midpoint of the season?
RSG: I don’t remember us picking where things necessarily go ahead of time. Once you start the process, there’s a natural progression of these characters. That was a story that Joe Sachs wanted to tell.
NW: It’s an interesting example of the balance we wanted to strike. Because in that episode, we get an interesting case of a guy who had been a Freedom House ambulance driver. We get a sense of what Freedom House was and what it meant to the city of Pittsburgh, which is a really lovely, self-contained storyline with a little bit of information to it. But it’s also theepisode with the payoff to the fentanyl overdose storyline, which you’ve now been watching for eight consecutive hours, which you really couldn’t tell in one or two episodes in order to get the parents on the journey from where they started to where they finished. That required a lot of care and time and thought. So that episode in particular is satisfying on two fronts, one because it gives you a closed-ended storyline, which is satisfying viewing, but also because it pays off something you’ve been invested in for several hours.
The most potent moment of the drowned-girl storyline is when Mel gets so upset talking to the girl’s sister that she has to leave the room. How important is it to demonstrate how these cases are affecting the doctors, versus just presenting various tragedies in the context of the patients?
NW: Where ER was a very patient-centric show, this is a practitioner-centric show. So everything reverts back to the toll that it takes on physicians attending to all of these worst days simultaneously.
Where did the idea come from to show the staff staging an honor walk for the organ donor’s family?
RSG: That was something Joe wanted to do.
JW: He’s a practicing emergency room physician, and has been for many years. One of the things that I really admire about what the writers did is, they spent time with the physicians, asking, “What don’t we know about what you do?” It’s a medical ride-along, for lack of a better term. You are on the shoulder of these physicians and nurses, and watching what they go through. Because we forget, you know — we get frustrated. We’re in the emergency room waiting a long time. What takes so long? The idea is to really show the audience the extraordinary sacrifices that these people are making every single day, to try to take care of you on what’s usually your worst day or one of your worst days. So something like the honor walk is, how do you actually deal with having to see so much of other people’s grief and anxiety? What’s that cost? What do we actually ask these physicians and health professionals to shoulder for us? I think that was very important to all the medical professionals who are involved in the show.
Because I just rewatched all of ER last year, the Freedom House subplot reminded me of one from near the very end of that show, where Dr. Morgenstern comes back and explains that an elderly patient was one of the early pioneers of emergency medicine. Joe wrote both that episode and this one. Is the origin of his specialty something he’s particularly passionate about dramatizing?
NW: Yes, in a nutshell. When Joe writes our doctors, he writes them with a reverence for the discipline, and the knowledge of the origin of verbiage, procedures, tools. He practices an art as well as a science, and part of that art is in the teaching aspect of it, and he brings to bear just about every discipline and metaphor in order to impart his knowledge.
JW: It’s also important to remember that emergency medicine as a specialty is still relatively new. It’s 45 or 50 years old. Some of the doctors who were older on our show, there was no emergency medicine residency when they were going through medical school.
That story’s a pretty deep ER pull, but in general, how aware are you of the possibility that a decent chunk of your audience is going to be looking at various stories through an ER lens? Like, Santos suspects Langdon is doing something fishy with medications, which Dr. Carter was accused of, too.
NW: I never even made that correlation. I’ve been so immersed in this narrative that while there are many similarities and themes that we’ve probably touched on before, they feel so different in this presentation.
JW: There’s so many medical shows and so many hours of medical shows over the entire history of television. I think probably every medical show that’s lasted for a while since the Eighties has had [a version of that storyline]. So it’s, how do you tell these stories? Which we confront constantly in all the genres that we work in: How do we tell them in a new way that’s appropriate to these characters or interesting for the characters that we’re actually seeing? We used to joke on ER that they are really only about seven or eight ER stories. Literally, the things that come in are pretty common. So it’s a rearranging of how the characters actually interact with each other. Who are the characters? What do they do? What is different for them? So it’s not so much the echoes of previous medical shows, as it is: How do you do what you want to do with the characters that you have developed?
What are things you can do now, in 2025, on streaming, that you couldn’t do 30 years ago on NBC?
JW: I think we can show everything. Which was a big thing for me, directorally. There’s nudity in the show. There’s a lot of medical procedures in the show that we could never show before. The nudity and those medical procedures is not gratuitous. It’s actually what the physicians see and what you would see if you were with them. We’re attempting to show you exactly what it is. Some people tell me, “Oh, it’s bloody.” And I go, “We’re trying to show you what these physicians and nurses, what everybody’s doing every day in their work life. So we’re not going to cut away from what they actually go through, because we want you to have the experience that they have.”
How was the decision made to go with such a minimalist score?
NW: That was by design from the beginning.
RSG: I did two episodes of ER without any score. So I knew it could work. They had to be specific. The stories have to move. I have nothing against composers, and I’ve relied on them heavily on other shows. Especially when a scene isn’t working, they can salvage it. But I just felt very strongly that we didn’t want to have music, because we were really going for an authentic portrayal of what goes on in there, and there’s no music in the ER, right? When we tried to put some music in, I find it pushes me back into my couch: Now I’m watching a show. As long as there’s no music, I feel like you’re pulled into it, and as soon as a cue comes up, then, Oh, OK, it’s TV. I think this show benefits from not having it, and I will continue to fight for that.
JW: There’s a challenge when you’re doing it: Have you made the scene and the experience that the audience is having compelling enough that you don’t require that you add an additional layer of something on top of it? Is it enough? Do you feel? And I think it is enough. We had done all of Southland without a score, and it worked, because you were involved in these characters’ lives, you felt like you were really there, and it didn’t feel like there was an artifice on top of it. Music, we’ve all used it. But you know, as soon as you swell the cellos, the audience is being told what they’re supposed to feel, as compared to watching what it is and just deciding what you feel and what your own experience of it is.
John, when you directed the first episode, how did you want the trauma scenes to look? They’re quite a bit different from how you used to shoot them.
JW: We made a lot of choices. One was to go into a lot of emergency rooms and see what things look like now. Which seems sort of silly, but the reality is, nobody wears scrubs in the same way anymore. Nobody has a bunch of blue scrubs on in the emergency rooms. There’s just a very different color palette. And so we wanted the piece to be starker. The sets are basically white, the doctors are all in black. We’re trying to go into the trauma scenes and shoot them just as you would actually see it, as the physician. And because we didn’t have network standards and practices, it changed the flow in the way in which you actually shoot, because you weren’t trying constantly to avoid showing things, you’re actually just documenting what’s what’s being done. The medical rehearsals are very accurate. Then we come in with the cameras afterwards and shoot what they are doing. So it’s not a matter of the director actually telling the physicians who are staging it how to do it. They just do it. And then we come in and document it as if we were a documentary crew that just stepped into the room.
So you have doctors act out the procedures, and that’s the choreography for those scenes?
JW: We have four emergency room doctors who work on the show. One is always on set, oftentimes there are two. Many of the nurses you see, male and female, are practicing ER nurses. They actually just set it up and do it. We have all the equipment there, the exact same equipment, and we step back, and the first thing that happens is they come in and just do the procedure, and then we come in and they show us what the procedure is. So in a way, you’re in the midst of being directed into the procedure by the ER, physicians and nurses.
NW: We found that it’s actually most efficient to rehearse those scenes 24 hours in advance. So if possible, we bring those actors in and we run those sequences while they’re shooting other stuff in another room. So when we come in to shoot those scenes the next day, there’s already a little muscle memory, familiarity with it, and the choreography is already sort of in your bones. And because of all of the lighting being preset into the ceiling, we don’t have any lights or flags or C-stands. There’s no dolly track. We photograph everything with two cameras. One is handheld, and the other ones on a sort of Steadicam rig called a ZeeGee, and they can get into tight, cramped spaces and find interesting angles. We do this great dance with them, that then gets shown to the director, and then they fine-tune it and isolate the moments they really want to focus on for the storytelling.
You’re also being asked to give a performance in the midst of this level of choreography, Noah. What’s the challenge of finding the emotional core of a scene while you’re also making sure that you’re in the right place, that you’re doing the right movements?
NW: [Shakes his head.] There are a lot of degrees of complication. Because in a given trauma scene, you have medical students, you have R1s, R2s, and an attending. All of those energies are looking at the situation differently, and so nobody’s playing the same thing in those scenes. You have medical students who don’t know anything and are terrified and trying to impress the R1s. The R1s are trying to impress the R2s. Everybody’s trying to impress the attending, and the attending is trying to make sure that he’s on top of everybody else. So the rehearsal is not just technical, and can I pronounce the words right? It’s energetic. Am I appropriately conveying the level of tension and anxiety with my medical education at this moment? Those are the things that actually go into building the performance, more than the technical rehearsals. It’s trying to figure out, what is my thought process here? What am I most worried about? Who am I most worried about? Who am I most confident about? You answer those questions and slowly, over the course of a rehearsal, you drop into where you’re supposed to be.
JW: That’s the director’s responsibility when they come into it: to make certain that you’re keeping track of the script and what needs to move forward in the scene, and that everybody has done the kind of detailed work that Noah’s talking about. Because Noah is much more experienced, both as an actor and certainly with the medical procedures, and others are just desperately trying to not drop the scalpel on anybody, some with greater success than others.
After Noah, who was the best at the medical procedures? Who was the worst?
JW: It’s like learning a dance, like any complicated piece of choreography. There are some who had more training literally in dance, or who picked it up faster. But by the end of one, people had started to get there. I came back and did the last one, and I saw marked improvement in the medical skills.
NW: It becomes a point of pride to do it correctly. It becomes a bit of a badge of shame to blow a take. So there’s a kind of quiet competition for competence that gets fostered among the ensemble the deeper into the season you go. You kind of get off on being good at this stuff, and you don’t like making mistakes, and that’s sort of contagious.
JW: If you need sutures, nobody does it better than Noah.
He’s been doing sutures for 30 years, if not consecutively.
NW: The funniest part is, John was bragging about my suture skills in boot camp, and then he put me on the spot: “OK, show them.” And I started to throw a stitch, and I was like, “Oh, wait a second… [mimes putting on glasses] Oh, there we go!”
Is there anything you’d like people to take away from the show by the time they get to the end of the season?
NW: I have been saying, sort of glibly, that I’d like people to believe their doctors again, and stop consulting their phones and thinking it’s analogous to having medical school education. To believe that there’s such a thing as expertise and smart people, and we really need them in their jobs.
