Best We Can Do - The Pitt s02e13

When The Pitt ended last season with the Pittfest shooting, it established a precedent that would have been unwise to follow. If the show were to continue the trend of the fifteen episode season (yes please), there needed to be excuses to get the day shift to stick around after their twelve hours were up. They also had to do so in a way that wasn't so sensationalist and dramatic. Regardless of how unfortunately frequent they are in this country, mass casualty events are the sort of big trick a long-form narrative can only pull off once before needing to put it into a long cooldown. Returning to it means decaying a glorious dramatic trick into diminishing returns.

So the question remains: if the show is going to routinely extend these shifts by three hours, how will they do that in a way that's believable?

It's easy enough considering that doctors usually chart in the hours after they're off the clock. The network crash means everyone has to scan all their charts in anyways, and Robby still has to work through the ongoing Duke diagnosis.

In the mean time, the night shift's arrival to relieve the day shift is absolutely thrilling. Recurring guests like Abbot and Shen and Mateo and Ellis step into roles the last twelve episodes (and last season really) have shown almost exclusively in the hands of day shift. There was a little of this last season, with the measles case being the big obvious crossover. But watching Abbot's crew settle into their rhythms makes it feel like watching an entirely different show. We've seen Abbot as steady hand, but never in charge like this. His presence immediately displays care for his shift while delineating what the jurisdiction between the outgoing shift and the incoming. His absence makes him feel cold and distant, like he's busy and on the clock and not having the fun he had when he who smirked at Dr. Al. This Abbot isn't the one who tended to his own wound while bonding with Mohan or escorted Howard Knox through his E.D. journey.

Most importantly, it's a gift to the show itself. Excited as I am to see this season's conclusion, if the show just continued weekly and we followed the night shift through the next twelve hours, I would be perfectly happy. The character work that has so extended to the background characters and guest star patients grafts onto these recurring folk and shows they're just as capable of carrying narratives as their daytime counterparts.

But it also gives the show an opportunity to slow down. At this point, there's nothing for Santos or Whitaker or Mel to do except scan the hard copies of the past few hours' work, handle the odd leftover patient, and figure out their intra-and-interpersonal issues.

Same with Robby, who is not the guy running the show anymore, but whose focus has shifted to figuring out what the hell is going on with Dr. Al and also scrapping with Dana while louding musing about a comatose patient's suicidal ideation.

It's not the fireworks of Pittfest, but it's much more compelling and proof that this show is (and has always been) about its characters, who they are, and how this job affects them. Pittfest wasn't "easy", but it was inherently dramatic. This long tail of denouement is hardly that, but it's just as compelling albeit in a totally different way.

The student becomes the mentor

With Santos and Whitaker relegated to the scanner, it gives them an opportunity to talk through the past few hours and start to hash out this rift between them. Santos still refuses to admit she wants Whitaker to stay even though her roommate is giving her every option. It's great character work, and forcing them into this helps make up for the hours of them passing like ships in the night.

This, though, is still a work in progress, something that will probably linger through the rest of the season, a background to their own individual ad-hocassignments.

Santos gets an opportunity to examine a jaundice patient (Ashley Davis) and dig into how this happened if she's not eating meat or other typical sources of liver problems. The solution is funny enough, but even funnier that Santos talks about assuming that people are doing the stupidest thing imaginable. And... overdosing on tumeric is peak homeopathic idiocy. If nothing else, after a shift that has strained her like this, seeing her in a comfortable sweet spot of diagnosing weird problems is tremendously encouraging for her prospects in the future.

And it's nice to have the show turn into House for a scene or two.

Meanwhile, Whitaker goes out to help Ogilvie process the death of Austin Green.

It's hard to not feel bad for Ogilvie. Regardless of how much of an arrogant asshole he's been all day, no one deserves to have a death fall so squarely on their shoulders. And on his first day too. This is a guy who got shat on, suffered potential TB exposure, and had to carry then baste someone's severed leg. But he's also the guy who tried to prove how hot he was. He vacillated wildly between being miserable at the valleys of the job and being over the moon at the peaky medical opportunities that same job afforded to him.

Hard to remember, but Whitaker and Ogilvie have been together pretty much all day. They were in Dr. Al's simulation when Robby arrived. The two took care of Louie for the hours he was around. Whitaker helped Ogilvie with the leg and also conscripted him for the bowel evacuation. Ogilvie is also the one who told disparaged Louie "croaked" (amongst many other tasteless comments). While Whitaker doesn't deliver the news about Austin Green, he doesn't throw anything in Ogilvie's face when he so easily could.

One of Whitaker's defining characteristics last season was losing that patient not two hours into his first shift. He beat himself up for it all day and then saved a number of people during the Pittfest shooting. Today, though, while he might have lost Louie he managed to save Mr. Samba by catching the posterior STEMI just in time. Whitaker has never been arrogant like Santos or quick to show off his knowledge like Dr. J. But that makes the speech he gives to Ogilvie an act of tremendous grace. People have told him over and over again that his first death was not his fault. This death on Ogilvie's hands, though, is entirely on the young medical student. Whitaker does not make him feel any worse than he already does.

Whitaker has made some serious progress. Explaining that this is a thing that never gets easier, but it can be a thing he can accepts speaks to his rapid growth and maturity as a doctor. More than any other worker here, he seems to really love the pace and challenge of the emergency department. If anything, this threatens to make Whitaker the most boring character on the show, someone who can handle this job with confidence and a steady hand. But the show is smart enough to know that even beyond the situation with Amy the farmer's widow, they can kick the shit out of him better than probably any other character on the show and it will still work.

Blame Gerran Howell's puppy dog eyes.

It's not always the doctor's fault

Given how much this day has emotionally wrecked Dr. Mohan and proven that emergency medicine is not where her capacity lies, it's especially cruel to feature her first hour off the clock as one where she has to both deal with the absolute horror of seeing Orlando Diaz's medical catastrophe and also learn the news that Austin Green died on the operating table. While the latter's death is mostly on Ogilvie, it being in part Mohan's fault is the sort of thing that she can't really escape.

As the show continues the thread of the healthcare system being in a state of critical failure, it's worth noting that Austin Green's medical chart showed that the thing that killed him (the abdominal aortic aneurysm or Triple-A) was starting to show 18 months earlier. He was supposed to return for a check up every six months to monitor the situation. In a more just and caring society, the culture would exist for him to have monitored this with regularity. But going to the hospital is a pain. Emergency medicine is the default destination for the modern healthcare system. And they're all overcrowded with wait times that can last hours and hours and hours. It means time off work. Making regular check-ups. Admitting that one's body is not a beacon of health. Hell, there's less of a stigma getting a regular oil change. Had all of this been different, Green's death never would have happened. Ogilvie's actions made his death needless. But even outside of the med student, the death would remain so.

In that, there is somewhat of an absolution for Mohan (and Ogilvie, really). It's not their job to make sure Mr. Green kept up with his medical needs.

This is even more true for Orlando Diaz, a man Mohan did everything short of physically restraining to keep him safe. He's now far, far worse off than he was just a few hours ago. What would have been a 48 hour stay to monitor his status is now a cataclysmic coma. They won't know for several weeks if he will wake up at all. And even if he does, he will not be independent at home for at least a year with a worst case scenario of needing "round-the-clock nursing care for extreme disability" if this all went the way the doctors fear.

All this because he couldn't afford to miss a paycheck.

Now he's missing paychecks indefinitely.

For being the richest country in the world, it's disgusting that this is something that happens every day. Hospitals closing. People randomly thrown off their healthcare and losing access to Albuterol. Creating a system that encourages critical intervention rather than routine maintenance. Orlando Diaz just lost access to insulin, and his pride kept him from accepting help from others when everyone from his daughter to strangers pulled out all the stops for him. Now he has nothing but the help of others enabling his continued existence.

If there's a silver lining, it's that he now automatically qualifies for Medicare and Medicaid. Some comfort. It just cost him... his entire life.

This is completely unacceptable, and it's insane that we as a country have decided that this is any way to treat not just our communities but also ourselves. This mentality of wanting to drain swimming pools rather than integrate them is a travesty. It's even worse to hear those on the Right excoriate the idea of working together to make our society healthy and prosperous. Nevermind lifting up Jesus, the Bible, and both's teachings as a model for society. Then again, the Secretary of Defense is also saying that divine providence has guided America's hand during its war with Iran. So... cool to see it's there at war time and not around for people like Orlando. Or our healthcare system.

None of this is Mohan's fault. She's just the lightning rod for Mrs. Diaz's bereft response to her husbands vegetative state. She is not under any obligation to take any of this. Not when she went above and beyond to tend to Orlando's medical care. Not when she's trying to do long-distance investigation into the job site to see if there's something his family can sue over (nevermind that she, herself, would probably have to testify that she told him not to go to work and that his accident has nothing to do with the work and everything to do with his own disastrous healthcare decisions).

This is a hard job. And it's too hard for Mohan. Honestly, it's the sort of job that you'd have to be insane to willingly do.

The right kind of crazy

One of the things in The Pitt discourse this season is in how the entire ensemble has suffered due to such an intense focus on Dr. Robby. Given Noah Wyle's presence as executive producer, star, writer, director, and major creative partner on the show, it's not surprising that his character is getting a really involved, complex character arc. More than that, there's a specific complaint that the show's myopia in this respect has resulted in a diminishing of the ensemble.

Perhaps I'm just not as sensitive to this, but there's been a lot of expansion and growth within the entire cast this year. Sure, Mel was a bit of a one-note bit until her deposition, but on the other side of that everything with Becca has been astonishing. Mohan has been a main character since the water slide collapsed. Whitaker has maybe a bunch of a different thing going on, but that's because so much of his current emotional state seems to come from his relationship with the farmer's widow. Santos is having a bad shift, but the drama with Garcia and Langdon is terrific in painting a picture of her loneliness. McKay had the entire arc with Roxie. Dr. J had her own near miss early in the network outage. And Ogilvie... man have they paid that off.

But... Robby? Sure, Robby is getting a really intense, very emotionally rich character to play. But his abuse and assholery infects the entire department. That doesn't mean this is the Robby show.

The final scene with Dana is an incredible tour de force, where he lays out all of his anxieties and insecurities at how the world is falling apart. How he's worried Javadi is going to give up or how Mohan might crash out (which, we know she will) or how Langdon might relapse. But all of these things are outside of his control.

Pushing the staff as he has been is Terror Boss 101™. Mohan would be doing better if he was less of an asshole to her. Yes, getting a teaching moment from the chief of neurosurgery is a massive moment for the young med student but not trusting her to know her limits is not helping anyone. And Langdon... It's easy to assume that Langdon is going to relapse if he doesn't build in the space for Langdon to prove that he won't. And it's especially easy considering just how hard Langdon stabbed him in the back at the end of last season. Robby let him get away with a crime and what does he get for that act of grace and mercy?

The truth is, Robby is a stand in for all of the things wrong with the healthcare system. They both push their workers too hard, demands too much from far too little. They require perfection and those in the employ must have a compulsion to practice healing. All the while they try to slow the spiderwebbing their cracked pane of glass. They hold to it so deeply that they don't realize there's far better alternatives if they just had the courage to let the ashes of what they have.

While all this goes on, the world keeps spinning. The patients keep rolling in. The Pitt keeps churning them through. It isn't perfect, but it's what they have to do, and until someone far above them steps in and fixes it this is how the process is going to be.

In the final beat, Robby asks "what if I don't come back?" It's an incredible moment, perfect and powerful and relating so deeply to what he so wishes he could do. But the problem with Robby (and why he's so good at this) is that he can't help but come back. He needs the Pitt just as much as it needs him.

Existing in these walls is an incredibly demanding, borderline impossible job, but that doesn't mean this needs to be some suicide pact. It is also a calling, the thing Robby can do best. If he leaves, though, and returns to find the place still standing and everything relatively unchanged, it doesn't speak to his uselessness. That's the perseverance of a system that refuses to break even in the face of daily rot and decay. Hospitals will always need to exist because doctors will always need to treat patients. Robby has to accept that the world will not disappear when he closes his eyes. It will keep spinning on and on. The patients will still flood through that revolving door.

And of course he will come back. He's going to go out into the world to find... something, but he will not find the peace he seeks. That is something he can only find in this emergency department. He just has to accept that as reality and find a tolerable equilibrium.

Meanwhile, around the Trauma Center

• Much as I love Monica Peters, her rudeness and coldness to the staff gives lie to the idea that computers and technology are the only reason she lost her job. She's an unpleasant person to be around, doesn't want to get to know anyone, and seems to have very little care for much of anything.
• The way my body relaxes when Dr. Abbot is on screen. My word...
• Not sure if I had Digby as the one person who would last the entire shift. But he's been a great commentator throughout, and watching him finally get this haircut and good treatment from Emma and Dana is so heartwarming and lovely amidst every bad thing happening.
• The Pitt can go as hard as it wants on the homeopathic remedies gone south cases. Every single one of them is terrific. A woman who gets an outstanding case of jaundice because she ate too much tumeric? God yes. Give me more.
• I about lost my damn mind when Mary McCormack came in as the chief of neurosurgery. God damn she's so good.
• While Robby is being paranoid and dogged about Dr. Al's... lapses, it is curious to see what it is that's going on with her. The show has to give an answer and there have been guesses all season. It's just a question of... what is it? And is it truly so debilitating as Robby suspects?
• Between the heart massage a few episodes ago and the brain drill in this episode, it's a great time to be on the Javadi-does-cool-shit train.
• Inhalers costing $400 a month? Again, America too easily accepts what should be unacceptable.
• Langdon's lack of confidence is a confluence of things. It's the stress of a day like this. It's Robby telling him he doesn't want him around. It's Dr. Al icing him out. It's Santos refusing to absolve him for his actions. And it's ten months' absence leaving him rusty. His desperate attempt to intubate Grady Barnhill would have killed the boy. Luckily the night shift diagnosis of a pneumothorax means a stabilization of his breathing and an end to the asthma attack. Still, this shakes Langdon enough the he has to talk to Mel about it afterwards. It's a mirror of the pep talk he gave her early in the shift about the deposition, but all of this is just Langdon jitters. Regardless of his backstory, it's so easy to believe in him and his road to recovery. That's not to say he's 100% or completely out of the woods. The story of addiction is that it's a lifelong struggle. But he is staying on the path and needs to recognize that just because he knows how to swim doesn't mean he's in shape enough to do twenty laps.
• "Yeah, Nietzsche. Not Kelly Clarkson."
• Robby projecting a death wish onto Orlando Diaz's actions is bad enough, but doing it loud enough that his wife might have been able to hear it is deeply reckless. It's not like he's trying to get fired but like... Jesus.
• On the topic of Orlando's total crash out, several people push forward the idea that this was somehow premeditated. While I'm sure that sort of thing happens with relative regularity, hearing the idea put forward is just awful and demonizes a dude who really did seem like he was working himself to the bone and too full of pride to ask for help. Everything we know about Orlando is that this is his worst nightmare, but it's gotta be common for medical workers to try to ascribe conspiratorial thinking to such behavior. That level of conniving cynicism is far easier to believe in than reckless ignorance.
• Whitaker breaking the magnets apart. Clutch.
• It's insane how easy it is to lose Medicaid because of a bureaucratic error. Even worse is the nightmare of a re-enrollment process. Enrolling everyone into a baseline health insurance would help minimize this sort of common problem. If everyone is on the same program, then there's no reason for anyone to ever be off it.
• Noelle reading Robby by saying she'll see him next week. The show's ability to flit through this relationship over an entire season is not just great storytelling, but a believable execution of the premise. They meet... what? Four times during the entire twelve hour shift? And never for longer than a minute or two. And yet by the end it feels completely satiating to have this picture of their weird flirtatious relationship.
• Mel gives a "beep beep" as she goes to the paper shredder. Girl's tired.
• Mohan shredding her ultrasound application because of hearing how much work that would be. Girl just go into geriatrics. You're gonna have a great time.
• Gross-out Moment of the Week: The clicks and pops of the drill going into Orlando's skull. Brain surgery has got to be a damn nightmare. Ugh.

Next Time...

Someone says "Doctor the fuck up" and there's going to be a lot about... motorcycles I guess? We'll see...