Always Listen to the Nurses - The Pitt s02e06

Halfway through the episode, Nurse Kim finishes Whitaker’s sentence about what Brandon (yet another victim of a motorcycle crash) needs for a flourescein injection. “Wood’s lamp, 1% lido with epi, sterile saline, sterile basin, sterile fluorostrip, 18 and 27 gauge needles, 5 and 60cc syringes.” How does she know all that? Dr. Robby says “she just does.”

It’s outrageously impressive, but mostly because it’s a standout moment from a background player I truly feel like I hadn’t noticed before. “Who is this? Has she been here the whole time?”

That one line of dialogue rewired my brain. Every time she was in a scene (which was at least 3 times) I clocked her presence. Like I hadn’t seen her before. After the episode I looked her up to see where she’s been. Turns out she’s been a mostly uncredited character dating back to the first episode. Always support staff, never as subject of a scene. Hell, the most memorable moment from her comes in season one, where she pins the right arm of the crazy dude who pees on Whitaker. She offers to get him replacement scrubs after.

I’ve seen every episode of this show twice, and it’s insane that she didn’t register until this week. More than anything, she’s the secret to why this is the best episode of The Pitt so far.

All the best shows make episodes that break the format of how they tell stories. Breaking Bad is a great show, but “The Fly” and “Ozymandias” send it to the stratosphere. Ditto Mad Men’s “The Suitcase”, Star Trek’s “The City on the Edge of Forever”, Buffy’s “Once More With Feeling”, LOST’s “The Constant”, Community’s “Certified Mixology”, 30 Rock’s “Queen of Jordan”, Game of Thrones’s “Blackwater”, and countless others.

If The Pitt is going to enter that pantheon of great television, it’s difficult to imagine it doing so without making great standalone and/or experimental episodes within the context of its larger narrative. The real-time structure (both within each day and between each season) makes that structure difficult to break.

Six episodes into the second season, The Pitt’s first candidate is here.

It’s a subtle move, and the show doesn’t completely break format. This isn’t a full flashback ep or one that leaves the hospital so they can go to some bar or does the full hour focusing only on one character or shoots the whole episode as one continous shot… but this is undeniably the show spreading its wings and testing the limits of its storytelling capacity. Cards on the table: while I’m looking forward to the rest of this season, I’m not sure how in the world they’re going to top this installment.

Because for the first time the show has made an episode that isn’t about the doctors.

Attending empathy

Dr. Robby: We are a safety net, but nets have holes. We are not admitting him ’cause this is not about social justice.

Dr. Al: Everything I’ve done in my career is an effort to improve the system. Just because you know it’s broken doesn’t mean you stop trying. Excuse me.

The differing philosophies of Robby vs Dr. Al as the department’s attendings have been a major push/pull this season. The incoming has focused on procedure, making sure the staff dot all the i’s and cross all the t’s. Meanwhile, Robby’s many years of experience with this daily grind have made him adept at diagnosing situations and moving patients through as efficiently as possible, ignoring extraneous (yet standard) procedures where he knows they get in the way.

But Robby’s practicality snags when it comes to inmate Gus. He recognizes that the combination of no room upstairs (the hospital’s limits) and prison as a viable residence for housing and feeding Gus during recovery (incarceration’s “benefits”) means he can discharge the man in the name of keeping the department running smoothly. Despite most of his time butting heads with her, this weirdly aligns with Gloria’s administrative goals and so feels out of step for him even if it is internally consistent in what we’ve seen.

As for Dr. Al, she more or less makes it clear that if this were tomorrow Gus would get a room upstairs to help him recover, the proper nutrition rebuilding his strength. These are the hard calls an attending needs to make, but it’s impossible to be frustrated at Dr. Al for wanting to provide the best quality of care to the most people.

This need to give Gus the best possible chance in recovery leads Dana to do whatever she does to temporarily drop his oxygen (something so subtle the prison guard had no indication any wrongdoing. It leaves Robby with no choice but to admit him for observation. It probably helps that Dana bonds with Gus (he worked at the bar where she had her first kiss), but this is the sort of intimacy building that nurses do on the regular. It’s the same as Princess saying “that’s what I’m here for” or Donnie explaining what his wrist tattoos mean. Gus’s is a case where Robby is absolutely wrong, and Dana is experienced enough to swing the situation towards a more Hippocratically ideal solution.

Robby is clearly not heartless, but any given philosophy of treatment is going to have its own roadblocks that limit the remit of “do the most good for the most people.” Gus isn’t any less valuable than Digby (the homeless man), but Dr. Al’s idealism/naivete and Dana’s infinite well of compassion and empathy can recognize that just a few small moves can make a huge difference for someone in Gus’s situation. Moving him upstairs shifts the load bearing to another part of the hospital, but does get him out of the trauma department. That, more than anything, should be the goal for Robby et al. To use his own philosophy: who cares what Gloria wants?

It’s not all bad for Robby, though. He takes a minute after receiving bad news about Debbie (the cellulitis patient from last week) to check in on Whitaker and see how he’s doing with the news of Louie’s death. He offers himself as a resource for the young resident to lean on, especially considering that Louie was his patient for his final hours.

And, of course, in the final minutes it’s Dr. Robby who reveals Louie’s absolutely tragic life’s story. Years ago, filling in on a very slow night shift, Louie told Robby about his wife and unborn child and how they died in a car crash. If Robby had started his sabbatical before today, the viewing room would not have gotten the answer to the mystery of the picture of Rhonda in Louie’s pocket.

That quality of Robby bonding with the staff over the loss of Louie is more powerful than any other moment in an already affecting episode. And it comes from the trauma center’s attending taking the time to do a job outside of his usual description.

Empathetic Statlers & Waldorfs

Most of that affecting nature of this episode comes from Louie’s death. It casts a pall over this episode. The news ripples through the trauma center as more and more staff learn about the passing of their “frequent flyer”.

And yet, from the second Louie dies it’s clear that something has narratively shifted. Perlah stumbles out of Louie’s room bereft and makes eye contact with Princess. The two of them have been almost Rosencrantz & Guildenstern-esque sideline characters for the entire series so far, but this provides an opportunity for them to have their own emotional realism as opposed to their usual quippy asides.

The Pitt has spent so much time with the trauma center’s doctors that it’s easy to miss all the invisible work the nurses do to keep the operations functioning. It’s one thing for the show to say how important the nurses are, yet something else entirely to show it. Their work is not nearly as flashy and exciting as fixing an urgent medical need, but they fill the void in remarkably important ways. Nursing requires not just the hardened exterior that can withstand this intense pressure cooker. Their empathy, recognition of humanity/dignity, and establishing rapid emotional connection with patients are all vital qualities that enable them to do their best work.

To compare, consider the absolutely tasteless way Ogilvie dismisses the news of Louie’s death: “Chronic alcoholic. Go figure” and then to Whitaker his casual, tossed off “he croaked.” It’s so completely tasteless and (like Joy’s comment about the “he’s dead already anyways” patient in the premiere) speaks to his inexperience. Perlah immediately spits at his lack of tact in speaking about sensitive topics.

It’s not something the show limits to newbies, either. Santos’s falling behind on her charts has aggravated her, but that’s no excuse for her being so dismissive and impatient towards the Harlow’s need for an ASL interpreter. Princess’s rudimentary signing is not enough for “a million questions” and the “I can’t do it this way” (to say nothing of her saying “I got stuck with a patient” as though they’re somehow a burden for the “real work”) speaks to an impatience that’s hardly Harlow’s fault.

Javadi makes an insensitive comment to Jayda about Jackson’s mental state and Princess has to pull the young woman into a private room to console her. Even something as minor as Whitaker not feeling up to the task of calling Louie’s emergency contact speaks to the emotional distance that can come from full time doctoring. Knowing who cared would probably help bring him closure. He still leaves it to Langdon.

Meanwhile, Perlah tells Princess about Louie’s death.

Not thirty seconds later the latter is helping lift Roxie off her bedpan, casting a bright “that’s what I’m here for!” as though nothing outside the room matters. As though Louie didn’t just die. As though cleaning up the shit of someone who can’t for themselves is not the utterly humiliating experience it is. For the nurse, Roxie’s current predicament is her highest priority in that moment. This isn’t just empathy Princess is demonstrating, it’s recognizing patients’ valuable right to dignity. Even Cassie’s arrival moments later feels like an affect of care rather than the authentic empathy coming from Princess.

Nursing means treating patients like humans with needs, not problems for doctors to solve.

Ritual hazing without the hazing

Earlier, Dana threw Emma into the deep end with Mr. Digby, accompanying her while he washed all the filth off his body or while Dr. Mohan excavated the maggots from his cast. Emma herself dropped the vial of Joy’s blood sample a few episodes ago. BIg first day jitters.

Cleaning up Louie is something Dana conscripts Emma to help her with. Yes, it’s a teaching moment, but it’s also the charge nurse imparting an almost sacred ritual to a new student. This is their final opportunity to bestow Louie dignity in death, and there’s so much thought and intent to every step of the cleanup process. They roll him over and clean him multiple times (first wet residue, then the dried blood after). They tuck in the sheets. They leave the single hand left out of the bed sheet so a loved one can hold their hand as a final moment of physical intimacy. A deliberate sequence of procedure.

Six hours in, this is all the Dana we’ve been wanting for the past several episodes. We finally get an answer about what happened with the guy who assaulted her last season (arrested, but Dana didn’t press charges) and she squares things with Langdon (mirroring their interaction in the first season’s finale when he tried to excuse away his addiction). We also get her ranting about the donuts admin sent down. “Admin’s blood pastries” she calls them (incredible line) and then later rips down one of those emotional posters that replaces quality of life (increased pay, more nurses on the floor) with empty words as graphic design. There’s still other mysteries. Emma asks her “why do you keep coming back?” Dana doesn’t answer. The closest we get is her telling Langdon she “got bored”, but it feels like there’s so much more to learn.

And then there’s her speaking about the emotional toll of seeing frequent flyers: “They can be a real pain in the ass, but… you miss them when they’re gone.” For all that it might be inconvenient to see patients over and over again, death is no wonderful alternative. She says Emma will “get used to” the cleaning process and it’s many steps. But even after all her years doing this, the grief still overpowers her as she wipes up Louie’s blood. Nursing’s empathy means these things will always leave an emotional scar.

As it turns out, Emma is the one who take’s Louie’s hand in the final scene. It’s a small moment, Emma taking a comfort for herself, but it mirrors her first moments in the episode when the hallway patient snatches her arm in frustration. Dana’s Mama Bear yelling about the felony assault of hospital workers reflects her PTSD, but it’s the manner in which these physical interactions play out that makes all the difference. It’s a lot for Emma to handle, and her first day jitters play a role. But mostly it’s the openness that is going to make her a phenomenal nurse as her career blossoms. After all this weighty emotion, the bright smile that comes with “haven’t killed anyone yet” is absolutely infectious.

The world can absolutely use all the Dana’s and Emma’s and Perlah’s and Princess’s and Donnie’s and Kim’s it can get.

God dammit what an episode.

Meanwhile, around the Trauma Center…

• The blood flooding out of Louie’s mouth during their attempts to resuscitate him. Beyond upsetting.

• On the flip side, cutting from blood gushing out of Louie’s breathing tube to the woman slurping fruit punch out of a juice box straw is one of the craziest transitions I’ve seen on television in years. Noah Wyle in the director’s chair is one sick fuck. I love it.

• Chekov’s baby shows up again. Just to remind us all that she’s still here. And she gives a little social smile. So sweet.

• There’s yet another motorcycle accident. Almost like the universe is telling Robby that this is a bad idea. Luckily, this time, the dude (Brandon) doesn’t even need sedation and stays on his phone while the team stitches his knee closed. Hopefully Brandon’s insistence of getting back on the bike as soon as possible (even if his arm is in a splint) doesn’t bode poorly for Robbie’s forthcoming trip.

• The mystery of Jackson continues. His repetition of “they don’t want me to pass the bar” sounds like him talking about his peers, but maybe he’s talking about the security who attacked him? We’re still missing part of the picture, and the idea that he’s been experiencing auditory hallucinations and paranoid delusions is extremely concerning.

• The PTMC being Louie’s emergency contact. Ugh.

• Looks like Roxie’s sticking around for another episode or so. My partner and I have her on major intentional morphine O.D. watch. It feels like it’s guilt about her husband having to take such care of her to the detriment of his own life, but… maybe there’s more here? I doubt it’s abuse (especially with the nurse attending)… though this is a mighty powerful guilt if that’s what this is.

• Dana saying “Everyone has family.” Ugh.

• Crushing news that Debbie is receiving an above-the-knee amputation. Last episode saw a rapid diagnosis from Robby and Langdon, but the slowness of the O.R. to respond ended up costing Debbie so much. Had Robby not done the avant-garde scalpel slice to prove what she had, who knows how much worse that infection would have gotten.

• Catharsis for Louie’s death takes many forms. For Robby it’s sharing Louie’s story, for Dana it’s cleaning his body… but for Langdon it’s helping Rocky, the dude who keeps vomiting because he ate 36 hot dogs at a hot dog eating contest. The dude fits Louie’s physical profile (black male on the bigger side), and watching Rocky leave at the end of the hour feels… right. And there’s even the hint that the hot dog addiction might see a return visit. “I’ll be back next year! Gotta defend my title.” So it goes.

• Concerns about Harlow’s stomach ache and headache. She’s been around since the first episode and I have no idea where it’s going. The delay of care (because of the lack of ASL interpreter) gives me an uneasy feeling. I hope I’m wrong.

• The Santos charting snafu is not ideal. Dr. Al is quick to blame Santos for not proofreading (which Santos should do anyways), but it adds to the idea that the hospital’s needs overworks the staff. There’s not enough time/resources to get everything done in a reasonable window. No amount of admin blood pastries can fix that problem.

• Donnie’s tattoos being “Death & Chaos” (which he got after Pittfest) and “Miracles & Blessings” (after his daughter was born) reveals a lot about the emotional toll of last season’s climax. Incredible moment. Less incredible is them constantly bringing up that he’s a new father. Concerning.

• Just an episode ago Ogilvie was like “this sucks” and now he’s like “I was born to do this”. Talk about an emotional rollercoaster, my guy.

• Future Watch…

  • Santos is crashing out a bit while doing her charting, so Perlah gives her a 5-hour energy. While not quite enough to get her through the rest of the shift, it’s something to help pick her up and get her through the next leg. Start the clock, methinks. We’ll see how she’s doing at the supposed end of her shift.

  • We also get another reminder that Jackson and Jayda’s parents are still on the way. So… they gotta show up at some point…

• Gross-out Moment of the Week: Everything about Brandon’s split-open knee was completely and totally gnarly. The stitching was crazy to watch. All of it. Yeeeeesh.

Next time…

It looks like Abbot is back! That’s great. Love Abbot. Though bringing in Abbot really portends something larger and scarier. No reason to bring him back just for a cameo, right? We already have two attendings on duty. Are we really going to need a third?

This episode was emotionally heavy, but it was also very quiet and slow. Storm is still a-comin’. We’re due for some fireworks.

(Though I’m not looking forward to the inevitable exploded fingers…)