The HBO-Max TV show is set in a fictional institution called the
"Pittsburgh Trauma Medical Center, affectionally nicknamed The Pitt. We
referred to my former hospital as The Hurst. Even with a brand-name change, the nurses at another hospital kept the nostalgic name San Lucas.
Season 1 had 15 episodes, smartly presented as one-hour
shifts for this team of healthcare team. The usual 12-hour shift was extended
to 15, after a mass shooting disrupted an already-crowded ER. Season 2 is also
scheduled for 15 episodes. This time, the ER is bursting at the seams on the Fourth of
July weekend with patients diverted from another hospital. For certain, there
will be fireworks injuries, maybe traumatic amputations?
Authentic, real, and intense
In just a few minutes, at the start of the TV show The Pitt,
I knew that this was as raw and authentic as any show about an inner-city ER
will ever be. Dr. Robby walked through a crowded waiting room, was met by
Filipino nurses, and had to talk a fellow doctor out of suicide.
With 35 years in ED nursing (newly retired), I
consider myself an OG. Some say OG means “old generals or older generation”; I
strongly approve of being called Original Gangster. With just five of my fellow Baby
Boomer ER nurses, we can probably account for 90% of the cases shown so far. And
we approve this show as the best, most well-written, and most authentic medical
show ever.
This show is highly realistic in its portrayal of the
chaotic, intense ER setting; most hardened ER nurses would suggest there is
organization amid the chaos that would have driven off a less courageous nurse
on their first day. Yes, we have seen maggots, lice, bedbugs, and other
crawling insects (fortunately not rats). We have seen many foreign bodies from
all orifices. One time, a patient presented to Triage with a live vibrator inside
her vagina that kept buzzing, and she had to stop her narrative because of
orgasmic bursts (Psst, Pitt writers, maybe you can use this). There is mayhem
and gore, but this is what makes the ER exciting for the adrenaline junkies
that we are.
The ER producers hired real doctors and nurses to serve as
consultants in the show. Some even act as nurses in the different episodes. To
master the emergency skills, the cast underwent a 2-week bootcamp where they
were taught the steps to intubate, put a chest tube, perform CPR,
suture wounds, perform pericardiocentesis, and other procedures. They were also
taught to confidently speak medical tongue-twister terms such as cauda equina, Sengstaken-Blakemore
tube, Phytophotodermatitis, and methemoglobinemia.
The cacophony of sounds is not masked by background music. As
in a real setting, we hear cardiac monitors, ventilator alarms, ambulance
sirens, unit announcements, ringing phones, vomit sounds, the conversations
between the healthcare team, and the groans and curses of the impatient
patients and the short-staffed medical staff alike.
Like in all ERs (and other units), there is constant talk about staffing shortage, work stress, PTSD, diversions, overcrowding, burnout, mental health, substance abuse, insurance costs, and even patient satisfaction scores. What impresses me is that the ER staff came together in solidarity to save and care for their patients; the camaraderie was borne out of their shared experiences. The debrief after the mass shooting included everyone, including the ancillary staff, housekeepers, clerks, and Security.
When I wondered where the nursing leaders (Chief nursing officer, director, manager, supervisor) and other healthcare members were, my son explained that in a TV show, it may not be efficient to include so many characters. That will require more story lines, more characters to write for. So, it is artistic license, I realize. I am happy enough that I see Filipino nurses, at least.
The Cast
The cast is top-notch. Dr. Robby is played by Noah Wyle, formerly
Dr. Carter from my other favorite show, “ER”. He expertly led the ER team in
Season 1 to navigate an active-shooter disaster scenario. In Season 1, he
welcomed new residents (of varying confidence and one with a predilection for
bodily fluids splashing on his person) and a medical student (who fainted at
the sight of a degloved foot). Throughout the show, he struggled with the
traumatic memories of the COVID-19 nightmare when his mentor died. In Season 2,
he is supposed to go on a 3-month Sabbatical after this last shift, like riding
into the sunset, purportedly without a helmet (smh, as the Gen Z’s lingo). The
team of doctors from both seasons includes Al-Hashimi, Abbott, Shen, Ellis, Langdon,
Collins, Mohan, McKay, Santos, Whitaker, Mel King, and med students Javadi, Joy,
and Ogilvie.
Dana, played by Katherine LaNasa, is the ringleader who
keeps the combustible atmosphere from exploding into a sloppy mess. She reads
the room, controls the patient board, and juggles patient rooms to accommodate
new arrivals; most importantly, she knows who needs help at any given time.
Situational awareness and mutual support make her the quintessential charge
nurse. She organized the team to restrain a violent patient who needed to be
sedated. She directed the new grad nurse to assist in showering/decontaminating
an unhoused patient. She noticed the nurse, Perlah, fighting to control her
emotions, so she took over in the post-mortem care of a patient. Her team of
nurses includes Lena, Perlah, Princess, Donnie, Jesse, Kim, Mateo, Sophie, and
Emma.
https://www.townandcountrymag.com/leisure/arts-and-culture/a64355242/the-pitt-cast-characters-guide/
The show won many Primetime Emmy Awards, including Outstanding Drama Series, Lead Actor (Wyle), Supporting Actress (LaNasa), and
Guest Actor (Shawn Hatosy, who played Dr. Abbott). At the end of Season 1, we learn that Dr. Abbott, a military veteran, is a single-leg amputee who walks around with a prosthesis.
A Patient’s Death
After episode 6 of Season 2, I bawled my eyes out, not only
for Louie, but for all those frequent flyers I lost over the years, for those
who we tried to help but couldn’t. Death is a constant in an ER, but there are some cases that hit us harder.
Louie (played by Ernest Harden, Jr) was a frequent flyer, a
chronic alcoholic patient who appeared in Season 1. He was well-liked by the
staff because he was well-mannered and always smiling, even with a blood
alcohol level of 400. This time, it was the end of the road for him. Despite
the paracentesis to relieve his ascites, he went into cardiac arrest. After the
intubation, blood gushed out of the ET tube: pulmonary hemorrhage caused by
liver failure. Even with the staff’s heroic efforts, Louie remained in
asystole. Dr. Robby finally ended the resuscitation and pronounced him dead.
The debrief was heart-rending. For most ER staff who knew
Louie, it was a surprise to learn the patient’s backstory. Dr. Robby relayed
that Louie confided that he lost his wife and unborn child in a road accident,
which catapulted him into a life of despair and led him to alcoholism.
The patient’s death, although not surprising given his
worsening liver failure, was a shock to the staff who had cared for him in his
frequent admissions to the ER. The staff paid their respects to a patient who
had somehow been part of the ER family. A moment of silence; a gesture of humanity. Dignity even in death. Robby offered a Jewish mourning phrase
to remember Louie: “May his memory be a blessing.”
There are so many stories behind the misfortune of our
patients, if we only listen. Years ago, when I was a bedside ER nurse, I cried
with the nursing staff when one of our favorite “regular’ drunks died from
hypothermia when he collapsed in the street. He was quiet, never violent, never
cursed us, never hit us, just smiled through our lectures. Before his alcohol
addiction rendered him homeless (now called un-housed), he had a good job and a
loving family. We used to bring a hot meal for “Mr. G”; there was no price tag on
hunger, no restriction on being kind to vulnerable patients battling their own demons.
Workplace Violence
It is an unfortunate reality, but the world is not a safe
place. In an overcrowded environment, emotions run high among some patients,
who feel they deserve to be seen first. Dana was sucker-punched by one of those
disgruntled patients (in Season 1). The whole staff was shaken by the assault
on one of their own.
Instead of going home, Dana chose to finish her shift, to
power through when a mass shooting called for a hands-on-deck response from the
ER staff. The SWAT team showed up in the ER, just in case the shooter came in
to finish his evil mission. It was scary. There was even a question if Dana was
coming back to work.
According to the New York State Penal Code, “Assault in the
Second Degree in New York allows felony charges, instead of misdemeanor
charges, to be brought against someone who acts, “with intent to cause physical
injury to a registered nurse or licensed practical nurse…while such employee is
performing an assigned duty.”
In episode 6 of Season 2, we learned that the person who
assaulted Dana was apprehended, but she refused to press charges. In real life,
I have always persuaded the nurses to demand felony charges. It looked like
Dana was still struggling with her decision to let go and may not have come to
terms with the trauma to herself. She
didn’t even answer the student nurse's question about why she stayed.
Humor in the ER
To survive in the ER, the healthcare team often shares jokes
with each other, reports on what new foreign object the patient ingested or
inserted. Tongue-in-cheek humor; anything to brighten the day and to lighten
the load. A chuckle a day keeps us sane.
Ruined Scrubs: In Season 1, Whitaker made several trips to
the scrub vending machine due to several accidents from bodily fluids (blood,
urine, vomit, and spilled liquid medication). In Season 2, Ogilvie had the
dubious honor of poop exploding on him after a fecal disimpaction. A "poop
cannon" or "assplosion" is a great rite of passage for an
obnoxious medical student.
Dr. Shen held on to his Dunkin' iced coffee, even while
acting as a Triage officer during the disaster. I think it is a “bird flip” to
the Infection Control team.
A journalist faked an injury to slip into the ER, then
slipped on a wet floor after being discovered. Santos then discarded his phone
in a bucket of bloody water. Ooops, karma indeed.
Santos is someone who you would either hate or love. I think
there is a soft, sad side to her that she tried to hide behind her snarky
remarks and nicknames for her colleagues (Crash and Huckleberry). When a nun’s
conjunctivitis culture came out positive for gonorrhea, Santos quipped, “Immaculate
infection.” Perlah and Princess were gossiping, then Santos interjected in
Tagalog. Santos also sang a Tagalog lullaby to calm a patient; in real life,
Isa Briones is a Broadway actress.
Rats!!!! Four rats scampered out
from an unhoused patient’s clothes. The staff was so grossed out, and Dr.
Collins jumped on the stretcher, wielding an IV pole. In a dramatic moment,
Whitaker captured one of the rats, covered it with bed linen, and effectively
broke its neck, just like an efficient former farm boy would. The staff broke
into applause.
Dr. Mehta, the resident stroke neurologist, delivers dumb
dad jokes. The staff just rolls their eyes behind his back.
The patient, Earl, witnessed Javadi flirting with nurse
Mateo. With a raised eyebrow, he asked, “Am I at a hospital or in a romcom?”
Myrna was a gutter-mouth patient who wheeled herself around
the ER, poking fun at anyone she encountered with her sexual innuendos, even
calling Robby “fruitcake”.
Mel is neurodivergent and socially awkward. Her enthusiasm
manifested in her inappropriate “high fives” and fist bumps after an exciting
case.
Joy, the new medical student, is funny and sassy with her one-liners. After Ogilvie bragged about learning Farsi from his friends, Joy
deadpanned, “I’m surprised he has friends.” As she was picking out glass shards
from a bloody leg, Joy nonchalantly remarked, “Thrilling - totally worth
$200,000 in student loans”.
A patient who used Super-glue on her fake eyelash dismissed
Dr. Langdon (the actress’s real-life boyfriend) and asked to be treated by the
super-popular medical influencer on TikTok, Dr. J, who was revealed to be the
medical student Javadi.
At last, Pinoy Nurses in an ER medical drama
“The Pitt” features two Filipino nurses, Perlah (Amielynn Abellera) and Princess (Kristin Villanueva), as part of their ER team. Not just background players, but crucial to the emergency department team and highly respected for their expertise in the crazy, hectic world of emergency medicine. They provide comic relief when they speak Tagalog to each other, perhaps a coping mechanism to the work stressors. There is something therapeutic about bantering in your language, and sometimes communicating just with your eyes (and pointing with your lips).
The duo seemed to be planning a surprise 21st-birthday party
for the med student Javadi. I hope that they will
order the famous Filipino party food, lumpia and pancit. I am sure the ER staff
would prefer these to pizza and donuts. If there were a betting pool like the
one the security officer, Ahmad, ran, I would bet there would be lumpia and
pancit at the party. After all, we don’t need any excuse to throw a party in
the ER. I will be amazed and impressed if that happens.
After 15 seasons of “ER” without Filipino nurses, we see
these bad-ass nurses and work besties claim their rightful place as part of the
PITT team. As an ER nurse for 35 years, I felt represented. Finally.
Episode 6 “12:00 PM”, Season 2- a homage to nurses
This episode was directed by Noah Wyle and written by
Valerie Chu. Thank you for showing what the nurses do best- caring and being
excellent.
Kudos to Dana, Perlah, Princess, Donnie, Lena, Jesse, Kim,
Mateo, Sophie, and Emma.
Whitaker echoed what Robby told him before: “Always
listen to the nurses. They run the ER; we just try and stay out of their way.” I
am glad to say that real-life doctors have said the same thing to their new
interns and residents every time they start their ER rotation, usually in July.
A doctor I worked with advised his residents: “If the nurses like you
because you gave them the respect they deserve, they will have your back.”
Dana is a queen, part-Mama Bear and part Incredible Hulk.
Lena, the night charge nurse/ part-time death doula, is a great partner to
Dana.
It is true that many nurses have saved lives by suggesting
alternative interventions, as when multilingual Princess suggested an EKG for
an abdominal patient. Perlah took over Charge when Dana was hurt. Donnie was
ready for his new role as a nurse practitioner and impressed the new interns
with his suturing skills. Mateo’s triage skills were on point; he’s someone you
would want with you when the going gets tough. Kim and Jessie not only play
nurses on TV, but they are real-life ER nurses. Kim expertly recited the steps
for a Fluorescein injection. Silver-haired Jesse (also a drummer) knew what he was doing, an expert among other actors. Sophie is
actually a physician assistant who also taught in the cast bootcamp.
I see myself and my friends in all these nurses. We were
like Emma once, naïve, unsure if the ER was right for her. When she reached for
Louis’s hand during the debrief, I knew she would make a great ER nurse.
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