Expected Job Hazard - The Pitt s02e05

As the prison guard minder stalks through the trauma center, following a patient as the Pitt team wheels him into the trauma room, he remains insistent that the cuffs stay on the injured man. There is procedure and process. These rules exist for a reason. No one's going to keep him from doing that job. He ignores rough shape of the gurney-bound, orange-jumpsuit’s occupant: malnutrition (“prison food”), bruising from where someone stomped him, cracked ribs, fractured mandible, and the second gnarliest skin split in the episode.

Prison inmate Gus Varney is not going anywhere.

And yet the procedure is understandable. Hospitals are busy, hectic places, and we’ve already seen one suspect evade police this season (knocking over Mel in the process). One momentary lapse and this dude (were he capable) would be gone in a flash. The cuffs do come off at times, but it’s only for as long as necessary. The guard remains, watching the dude like a hawk with all the empathy you’d assume from a minder who now has to babysit this prisoner instead of doing his usual job.

The highlight of this story is the methodical way that Mel and Whitaker work to treat Varney. They work as quickly as they can to get him out of the trauma center so they can bring someone else in. While not in danger of immediately crashing, he’s soaking up valuable department resources.

Subtly, though, it speaks to this episode’s meditation on trust, its limits, its luxuries, the reliefs that come when it’s present, and the struggles that arise when it’s not. Regulations don’t trust anyone like Varney. The color of his jumpsuit obliges the officer to keep the cuffs on. It doesn’t delay the man’s care, but it does provide small, inconvenient checkpoints the team has to work around as they conduct treatment. Hardly roadblocks to success.

Others aren’t so lucky.

Never heard of a death doula before…

Roxie Hamler is dying.

She’s in relatively good spirits all things considered. Hospice care seems to be keeping her relatively comfortable, and in just one quick scene the show weaponizes its economic storytelling to show how much she and her husband Paul (Taylor Handley, who also played Oliver on The O.C.) care for each other. The empathy is immediate. Within one scene both writing and performance convey years of agonizing radiation, devastating chemo, and a culminating resolve in accepting Roxie’s imminent death.

Abetting all of this is Lena Handzo (Lesley Boone), who tends to the Hamlers as Roxie’s “death doula”. She is helping to make Roxie’s “transition to death a more peaceful process.”

It’s a weird position, and it becomes clear quickly that Lena functionally has tremendous discretion (almost power of attorney) when it comes to Lena’s medical care. Her time as caretaker has attuned her to what Lena might need at a given moment, juggling her right to dignity with the limitations of her illness. These decisions can be difficult, and without her it would give the Handzo’s something tangible to focus on. There might not be any solutions, but the busy work can distract from the all-encompassing grief that threatens to overwhelm without warning.

And yet, Lena helps to manage her clients’ needs. Such a role is helpful if they can support the emotional weight of this situation. Outsourcing all of their medical care decisions allows Paul and Roxie to celebrate and treasure what dwindling time they have together. It’s a hell of a thing to do. Tapping into the endless well of feeling and emotion will only do so much to prepare for the unpreparable. Embracing it might make the pain all the worse when the inevitable happens.

The joy and pain and suffering, though. There is beauty in it. And by relying on their doula, it allows the two of them to not define the waning days of their time together by the suffering and agony of something they can’t control.

You ever let your kid watch TV so you can get a little peace and quiet?

Poor Santos. After Dr. Al rode her ass last episode for falling behind on her charting, she’s trying to catch up in the middle of her shift so she doesn’t have to be here for hours after she’s off the clock. This lasts basically no time at all, with Dana constantly tasking her with other patients. The Pitt’s churn keeps the show active and moving, but charting (or the show’s lack thereof) is (in my understanding) the biggest inaccuracy of the show. The Pitt serves up Santos as this sacrificial lamb. She takes to it about as well as we could imagine.

Where Dana saves Santos is in suggesting she conscript Ogilvie to handle her assignments, supervising him while she dictates her charts.

Ogilvie has been a know-it-all over the first four hours, but based on last episode, the shard of glass incident seems to have done a number on his confidence. He’s making mistakes. He’s showboating less. The eagerness with which he helps Santos at the beginning of this episode dwindles as he has to handle more and more miserable cases. He gets a TB exposure and shit on. And there is a sense that he doesn’t quite have the stomach for all this. It’s so much different being in the trenches than back in the safety of the med school library. When Santos calls all of this “an expected job hazard. You get used to it.” Ogilvie’s “no thanks” says a lot about how far he’s come from the plucky show-off who spoke Farsi to Dr. Al.

Whether or not Santos realizes this, her choice to delegate has the potential of creating huge problems down the line. Just the few years of experience she has over Ogilvie has given her insight to how the department works and possible diagnoses. Meanwhile, Ogilvie’s inexperience means he recommends standard tests based on established procedure: ordering x-rays, blood tests, screenings… It’s not so dissimilar from the contrast between Robby and Al at the beginnings of the shift. They might be right, but they’re impractical when the name of the game is moving quickly and keeping care as efficient and streamlined as possible.

Because… isn’t it easier with Santos immediately diagnosing the tuberculosis, which she knows to check for based on her extensive experience?

Meanwhile, Santos’s falling behind has fallen right into Dr. Al’s hands. Threatening her and then later (when the the resident continues to fall behind) seizing the opportunity to pimp out her generative A.I. solution to help is so pernicious. It’s remarkably shitty behavior from a Doctor who (while clearly talented) is remains opportunistic when she can make herself look better. Shouldn’t the focus be on diligent care for patients?

All of this feels like a lot more dangerous than Santos realizes. She’s taking it very seriously, but the department is already starting to stretch itself pretty thin. Outsourcing her skills (and she’s a very good doctor) to someone as inexperienced as Ogilvie only exposes microfractures weaknesses that threaten compound as the shift goes on. This is almost working for now. There’s no guarantee it will long term.

Keeping Langdon on the bench

The most interesting story, though is Robby and his continued struggles in trusting Langdon. The episode begins with it, where the two consult on caring for Debbie (the sepsis patient who cliffhanger’d last week. It ends with them convening in Louie’s room to find him completely flatlined.

It sucks for Langdon because… he’s not doing anything wrong. And yet, the stink of his benzos boosting has created distrust within the department. Robby distrusts him, but Whitaker’s jumping in to order Louie’s new meds shows how deep that concern goes. He’s overseeing Louie, true, but it’s no coincidence that this is patient from whom Langdon got busted for stealing. Everyone knows that’s why Whitaker pulls rank on a doctor many years his senior.

While this has the effect of Whitaker slapping Langdon in the face, the man doesn’t have much of a leg to stand on here. It will take time to rebuild the credibility he’d spent so many years building. And yet, he takes it on the chin and moves on (while knowing full what this is). By all accounts, Langdon has committed himself to restitution and redemption. At the end of last season he was doing everything in his power to bargain his way out of his situation. He threatened Robby with the knowledge of the man’s choking during the Pittfest event. So far, though, he’s owning his mistakes and misbehavior. It says a lot about him.

We’re still only a few hours in, and though his confessing to Louie might have been difficult, deep down he knew Louie (one of the most easygoing patients who passes through their doors) would forgive him for his indiscretion. What made Louie such an ideal target also makes him a soft entry to this step of the process. (And it helps that Louie himself is an alcoholic; the dude understands addiction). Likewise, Mel’s immediate affection at his return made for an easy test run in confessing to colleagues. This might be manipulative and calculated, but it’s hard to blame people for working their way up to the more expert level problems. But we’ll have to see what happens when he comes clean to Robby and Santos. Every time he sees Robby he’s trying to steal time to talk to him (presumably about this) and it is inevitable at this point. Santos… Well, we’ll see.

To pivot to Dr. Robby, there is the question of why he’s working today rather than starting his sabbatical before a shift he knows is going to be especially chaotic. Hell, just take the holiday. But is it possible that Robby stuck around because he knew Langdon would be back today? No one seemed surprised at his arrival, and is this Robby’s subconscious wanting to give Langdon a chance before he doesn’t get the chance to? There is a sense that this is the sabbatical that comes after the long ten months since the Pittfest shooting. That also means this is the opportunity for him to finally allow this lingering wound to scar over as a part of his long-needed decompression.

By all appearances, though, he has no interest in giving Langdon even the time of day. His interactions extend exactly as far as a current medical situation requires. A lot of this is lingering betrayal, but it’s also the fact that Robby doesn’t trust Langdon to work next to him. Rebuilding that trust will take time, and it’s probably not going to happen today. Not without some cataclysm and/or Langdon confessing everything and apologizing for the way he threw the incident into Robby’s face.

To add to this, Dr. Al calls Robby on his treating her like a resident and not the co-attending she is. My partner pointed out a great moment, where the camera racks focus to an overhearing Langdon as she talks about it. As this day compounds and gets crazier and crazier, having a second attending is going to help Dr. Robby be functionally in two places at once. Still, it shows how his delegating (that is to say, his trust in his staff) does not extend to him ceding any of his oversight of the department. Everything with Dr. Al is still very new, and he’s able to outthink her when she demands to “know every case” just like him… but it’s still feeding into this theme of him not opening up his true emotional state to anyone.

There is a point, though, at which point trust becomes a luxury. As Langdon walks in to see Louie at the end of the episode, Robby is just a few seconds behind him. As soon as it’s clear that there’s a flatlining and they now have to save Louie’s life all sense of resentment Robby feels for Langdon evaporates (at least for now). It’s a beautiful (if harrowing) final image, where between Robby’s chest compressions and Langdon squeezing the oxygen bag, the two men could not be closer. This level of high intensity situation is both abnormal and unsustainable long term, but it speaks to Robby’s professionalism and dedicated care that the most important thing to him is saving a patient’s life.

If that’s even possible.

Stray Observations…

• Louie’s toast, man. Sorry, everyone. These five episodes have been a farewell tour and now the rest of the season is going to be Louie as the first major loss in a day that will undoubtedly have more of them. They’re gonna start piling up after this.
• Santos’s snapping at Whitaker reveals something interesting: she’s relished the seniority she’s had over him (and Javadi for that matter). Her terseness started last episode with a combination of Dr. Al’s charting threat and Whitaker catching the posterior-STEMI. If Whitaker manages to catch up to her level, that’s a blow to her considerable confidence (and arrogance). She can’t have that.
• Robby threatening Debbie’s boss. Would hate to be that guy. But also I’m not a raging asshole (or a manager), so the chances of that happening are minimal.
• The sepsis creep up the leg is so upsetting. Watching the infection spread as fast as it does gave me the skivvies more than just about anything else in the entire episode. Just the way it crept past the sharpie lines. Shiver.
• The betting wall continues, but Langdon not joining up feels like more contrition on his part. He might belong in the trauma center, but there is something flagellatey about not fully rejoining the community (for now). He hasn’t done his time yet and still feels like he needs to be on probation. Doesn’t matter that he hides behind his rehab bills. Respect.
• The Mr. Diaz storyline is an opportunity to talk about America’s healthcare system writ large. They throw around large numbers (which are no surprise to most people who’ve needed any kind of serious care), but referencing it as “an imperfect system” is seriously understating the situation. Especially when the hospital has the capacity to cover 40% of the bill… just because. Not that everyone gets this treatment, it’s just that there’s so much room for all of this to work better. He doesn’t need the ICU, and Joy’s quick thinking (and Noelle’s acquiesence) means this suffering family doesn’t have to deal with unnecessary upsells. The fact that everyone knows this and (outside of the ACA) we still have not done major work to fix it is a moral stain on America, the richest country in the history of the world. Based on our healthcare system, you wouldn’t think it.
• Ogilvie’s TB exposure follows Joy’s cut from last episode (and I love that she’s still got the band-aid on her finger; that’ll probably last the rest of the day). Easy to look at this as the pitfalls of a first day, this wasn’t a major issue last season. The only major issues then was Santos dropping the scalpel on Garcia’s foot or all of Whitaker’s wardrobe changes. Wonder how many other injuries are still yet to come… We’ll know it’s bad when the more experienced doctors start catching strays.
• A hot branding iron sounds awful enough. But one cooled to dry ice temperatures for a freezing burn sounds absolutely awful. No thanks.
• Also the Penguins’ logo. Lol.
• Around the midpoint in the episode, my partner clocked that “Chekov’s baby” (her phrase) hasn’t made a return as of yet. They’ve left it on the mantle, though Dr. Al’s assertion that her reasons is trying to speed up the charting process is in the name of getting home to spend time with her son. It resonates with the odd cliffhanger of the premiere. What is going on there?
• “Does a Dr. MacGyver work here?” is such an incredible line. I’m sure this show’s demo skews older but there has to be a decent viewing contingent that didn’t clock this joke at all.
• Ogilvie getting shit on was totally gross (and came after the “ice cream scoop” moment), but that fart noise right before the explosion made me cackle. Best one of those I’ve heard in ages.
• On the horizon…: Jada mentions that their parents are coming back from their vacation to help care for Jackson (the college student he campus security tased). Not sure if that means they’ll arrive by EOD (or if there’s even a timeframe), but how this story will resolve itself is… still a rather large question mark.
• Gross-out Moment of the Week: While the inmate’s arm cut (and the sewing) was gnarly, nothing is worse than Robby coating Debbie’s leg with iodine and slicing it open to prove the point about the necrotizing fasciitis. Garcia’s insistence on CT scans might have been procedure, but it was also her way of keeping the O.R.s from these escalating overwhelmings. Robby’s scalpel trick might have been vile, but it was clever enough to short circuit the bullshit that was preventing Debbie from receiving care from the place that could actually help her out.

Next Time…

With the O.R.s starting to fill up, this season’s slow boil it starting to have instances of boiling over. The saving grace of the trauma department is its ability to send patients to where they need so they can cycle through their beds at a steady clip. If the inability to get Debbie into an O.R. is any indication, though, they’ll keep losing these valves that keep the pressure from building up. As that pressure builds, the risk of all out explosion increases.

If Westbridge stays down (and it will), this isonly going to get worse. Hope everyone has started to prepare themselves…