A Mass Shooting Brings Out the Show’s Best

This post contains spoilers for this week’s episode of The Pitt, now streaming on Max. 

The hospital is running out of blood. 

It’s early evening at Pittsburgh Trauma Medical Center. There has been a mass shooting at a local music festival, and most of the victims have been sent to the PTMC emergency department. The place has become, as night shift doctor and military veteran Jack Abbott puts it, a no-frills MASH unit. There are so many patients, coming so quickly, that there is no time to wait for lab results, or to do X-rays or ultrasounds — nor, with the sheer number of casualties, is there room for that kind of equipment. 

And they’re running out of blood. 

Mel King, a diligent but anxious young resident on her first day of work at the hospital, has a patient, Sylvia, who’s bleeding out. All of the operating rooms are filled up with victims in even more critical condition than Sylvia appeared to be when she arrived, so she can’t even be taken up for surgery to repair the injury that’s causing the blood loss. Dana Evans, the veteran charge nurse, tells Mel that they’ve just used up the last of the O-negative (known as the “universal” blood type) on hand. A new blood supply will be there in 10 minutes, but Mel, who even in her very first shift has demonstrated a real gift for emergency medicine, knows that Sylvia will not survive that long without more blood. She flags down her new boss, attending physician Dr. Robby, and asks for permission to donate her own blood to Sylvia. He notes that this is against hospital policy, as donated blood has to be screened for HIV, hepatitis, and so forth — a time-consuming step they can’t afford. But Mel won’t let the idea go, insisting that she donates often and has recently been screened. Finally, Robby looks around the emergency department, and all the patients like Sylvia who might need blood faster than the next helicopter can get it to them, and decides that the benefits outweigh the risks. Dana rushes to draw Mel’s blood, while also ordering every doctor and nurse within earshot who’s a universal donor to get in line behind Mel. And Mel’s blood proves to be just enough to keep Sylvia stable until an operating room finally becomes available for her. 

This exchange between Mel (Taylor Dearden), Dana (Katherine LaNasa), and Robby (Noah Wyle) is just one small moment of heroism-amidst-desperation in an incredible hour of television drama that’s full of them. It’s the best episode yet of The Pitt, which is the TV show of the year so far — we should be so lucky to see it get real competition for that title. Despite the grim, all-too-real subject matter, despite the graphic depictions of gunshot wounds and broken bones, despite how overwhelming the spectacle is meant to be for both the hospital staff and the audience, it is thrilling to see all the ways these healthcare workers acquit themselves so well on a day when their skills have never been more desperately needed.   

This is the 12th of 15 episodes for the series, which unfolds largely in real time over the course of a single PTMC shift. Dramatic license is definitely taken regarding just how many things might happen during that time, like Trinity Santos (Isa Briones), also on her first day at the hospital, almost immediately sniffing out that respected senior resident Frank Langdon (Patrick Ball) is a possible drug addict stealing medicine from patients. But anecdotally, The Pitt has proven to be that rarest of beasts: a medical drama that actual medical professionals watch without complaining about the lack of realism. The series employs multiple emergency medicine doctors as consultants and/or writers — this one was co-written by veteran physician Joe Sachs and Pitt creator R. Scott Gemill — and the attention to detail is obvious(*), particularly in a heightened episode like this week’s. 

(*) Every now and then, an episode will have a scene that plays nakedly as a point that one of the consultants wanted to make about the modern state of American health care, like a scene where, after Dana is sucker-punched by an angry patient, one of the other nurses complains, “Violence against hospital workers is a national problem.” Usually, though, the writers are able to more naturally weave the arguments into the ongoing drama.  

It takes more than 10 minutes into the episode for the first shooting victims to arrive, which allows Sachs and Gemill to properly set the scene. Robby and Abbott (Shawn Hatosy) gather together the whole emergency department, plus whatever surgeons are already available, to explain how things will work to ensure that they save as many lives as possible under such extreme circumstances. Their briefing accomplishes two things for the audience. First, it makes it easier for us to understand what is happening and why, even amid the sheer number of stories being told simultaneously and how quickly the action jumps from one patient to the next. And more subtly, it establishes that hospitals like these prepare for big tragedies like this. There is already a plan in place for mass shootings — Robby at one point mentions a “mass casualty faculty meeting” — and one that allows for the level of improvisation also required as the patients keep piling up. Even hospital administrator Gloria (Michael Hyatt) — who has spent the previous hours of the shift badgering Robby about the need to improve patient satisfaction scores or else risk sale of the hospital to a for-profit management group — immediately shifts into teamwork mode and assures Robby that his staff will get every single thing he asks for to weather this incoming storm.

“Communicate,” Robby tells the assembled staff. “Ask for help if you need it. Trust your attendings. We will get through this together.” 

The sheer level of competence, preparedness, and dedication on display throughout the hour is stunning, especially at a moment when so many people in power don’t know what they’re doing, and don’t seem to care how their actions will affect anyone but themselves. This is an hour of watching people trying to make it through an absolute nightmare, yet it somehow also feels inspiring to be reminded that even in the darkest times, there are still people who not only want to help others, but are almost superhumanly capable of doing just that. 

I highlighted the scene about Mel and the blood at the start of this column because it so neatly sums up the stakes and the potency of the episode. (And because Dearden and the creative team have made Mel — who cares for her autistic sister and comes across as if she’s neurodivergent herself — among the most endearing TV characters in quite some time.) But I could have easily started in at least a half-dozen other places:

And that’s before we get to Robby himself, with Noah Wyle continuing to do career-best work in a role that somehow feels nothing like John Carter on ER, despite the shared setting and the presence of ER vets like Sachs and Gemill behind the scenes. Above and beyond overseeing all the other doctors while treating patients himself, Robby also has to deal with the panic of not knowing what’s happened to Jake (Taj Speights), the teenage son of an ex-girlfriend, who was attending the festival with tickets Robby got him. This should play as a melodramatic contrivance — along with the possibility that the shooter could be an angry incel teen named David whom Robby saw at the start of his shift. Yet the episode smartly forces Robby to focus on the patients most of the time, to the point where the unconventional saves he pulls off(*) start to seem like a coping mechanism, so he can find something to feel good about rather than thinking about Jake. 

(*) One of them, a five-second airway accomplished with a scalpel and a thin rubber cylinder called a bougie, is something he described to the newbies way back in the series premiere. As the great Russian playwright Anton Chekhov once said, if you explain how to crike a patient with a bougie in the first act…   

The level of sheer storytelling craft throughout the episode is nearly as impressive in its own field as the work that Robby, Mohan, and the others pull off in theirs. Sachs, Gemill, director Amanda Marsalis, and everyone else juggle all of these patients and conflicts without any of it getting confusing. They’re even able to give distinct personalities to several doctors who haven’t previously appeared: night shift doctor Parker Ellis (Ayesha Harris) shows up to help with triage, and when Robby tells her to call for help if she needs it, she strides towards the next carful of patients, even as she quietly whispers “help” to herself. That little moment of vulnerability, and of resolve in the face of fear, from someone we met less than 30 seconds earlier, feels nearly as powerful as other scenes involving obvious tragedies or major characters like Robby or Dana. 

When you are prepared, the episode argues again and again, things tend to work out better, even in impossible situations. The Pitt is great because the people who are making it have put in the work. And victims in and around the PTMC emergency department keep being helped because most of the people who work there have been drilled on what to do. There’s an understated but overwhelming scene late in the hour where social worker Kiara (Krystel V. McNeil) and administrative clerk Lupe (Tracy Vilar) come to the hospital cafeteria to speak with festival-goers who weren’t injured in the shooting, but are awaiting news on friends and family who may have been. They run through the steps everyone needs to follow to make sure their loved ones are identified quickly. As they explain each detail, it becomes impossible to ignore how much time the hospital must have spent setting up an entire system just for this one sadly necessary part of the process of responding to this awful thing that just keeps happening. And at the same time, all of these shell-shocked, blood-stained survivors patiently listen to Kiara and Lupe’s explanation, rather than interrupting and demanding that they should get to jump the queue and be taken care of immediately. It’s a marked contrast to all the anger boiling over in the waiting room earlier in the shift, which is what ultimately led to Dana being assaulted. They want answers, but they can also see that Kiara, Lupe, and everyone else at the hospital is doing everything they possibly can at the moment. 

The hour concludes with many open questions: Is Jake hurt, or worse? Was David the shooter? If the answer to either of those questions is “yes,” will Robby (still struggling with PTSD from Covid and the death of his mentor in the early stages of the pandemic) ever be able to forgive himself? Might the shooter actually come to the hospital, as some of the cops outside begin to speculate? And, as one of the other night shift doctors asks Robby, when will gunshot victims stop flooding into the ambulance bay? Though Max has already ordered a second season, we know there are only three episodes left in this one, so chances are the emergency department will ease sometime between now and the finale. But the artistry, the force, and the empathy of this hour create a paradoxical situation: a crisis you don’t want to see end anytime soon, because you want to keep appreciating how everyone in it keeps rising beautifully to the most terrible of occasions.