Setting an Example, Not a Cautionary Tale - The Pitt s02e02

My partner started watching The Pitt this weekend.

It was unintentional. Mostly the tacked on “behind the episode” from this week came with a detailed behind the scenes look at last episode’s “clamshell” and the extensive effects that went into making it work. It reminded me of The Thing and how enthralled she was at the practical creature effects at play. The props in The Pitt all move and breathe and have texture. The skin separates beautifully and it adds to the verisimilitude of the whole show.

Rewatching it though (we slammed out the first six in basically one sitting), it’s remarkable to revisit the show with the foresight of where it’s all going to end up. From the opening minutes of the season the show establishes that Dr. Robby is going to be on edge, and six episodes in the deaths have already started to pile up. It’s nothing compared to the carnage of later, but it’s the beginnings of the battering ram that will knock him out at the end of the season and the absolute breakdown he suffers when it all becomes too much.

Looking at episode two, the show has already put some of these pieces into motion, and once it’s over I’m interested to see how much these early hours are going to ripple forward to create the waves at the end of this fifteen hour day. Something is coming, and given that the show didn’t start seeding Pittfest until episode three, it feels impossible to guess what is in store. Fourth of July definitely is definitely going to play a role, but outside of some massive firework accident (blown off fingers have to be coming)… what?

For now, though, let’s talk about Langdon, Mel, Dr. Al-Ashimi, and the fresh recruits…

Dr. Mel gets a nice goose egg

It’s gonna be hard spending the next fourteen reviews not talking exclusively about Dr. Mel. Presumably, this would be because Mel is my favorite character on the show, but really it’s all to do with her upcoming deposition later today. It’s stressing her out and has provided something for her obsessive personality to focus on. Metatextually, it’s a gun the show has placed on the mantle and something for the audience to look forward to and anticipate. Any Mel scene from now til then will have an undercurrent of that tension infecting her anxiety.

So when the shoplifter pushes her over and she bumps her head, it’s one of the most visceral moments in an episode that includes a cast full of maggots, a graphic shoulder relocation, and drawing blood out of a fully erect penis. Immediately it’s concerns about her having a concussion and/or how this will affect her deposition.

It also leads to the most wonderful scene in the episode, where Langdon treats Mel for any head trauma and comes clean to her about his addiction. Their interaction is remarkably tender, and speaks to a greater relationship between the two even with limited connection last season. They had good rapport in the first half, but because Langdon’s storyline in the back half of last season centered around his addiction, resultant expulsion, and fallout with Dr. Robby (and Santos at the margins), it’s hard to remember Mel/Langdon. Luckily, Taylor Dearden has an expressive face and a big heart while Patrick Ball is suave and charismatic. It sells their relationship even if their time together was minimal.

And the moment when he sees her freaking out because the cops advise her that she might have to testify after they catch this perp? The way she doesn’t know what to do with her hands. How he knows to turn out the lights and keep the world quiet so she can cool down her neurodivergence. Absolutely wonderful.

The show also works well enough that it realizes there’s no need to show Mel coming back to the world. There’s no moment where she emerges, no deep breath. It gives her the privacy to center herself and the next time we see her she’s up and working on de-erecting the penis, albeit still with her mind elsewhere. She’s doing just fine all things considered.

Applying the personal touch

Three people speak to Mel about her deposition. Langdon does, obviously, and Dr. Robby takes a moment to tell her that he himself has been a name in four lawsuits in his career. But Dr. Al-Ashimi is quick to note that she remains lawsuit free, doing nothing to assuage Mel’s simmering panic.

Dr. Al-Ashimi has provided the most dynamic contour of the new season so far. With Dr. Robby’s centrality, his “I’m one day from retirement vacation”, and his intuitive (yet avant-garde) medical practices, this isn’t terribly surprising. It feels like Gloria Underwood has tapped her as interim replacement as a test program for how The Pitt can work in Robby’s absence. Al-Ashimi aligns with the more business aspects of the hospital that date back to last season and has ideas about rebranding the colloquial name, introducing patient passports, integrating A.I., and standardizing operating procedures to maximize efficiency.

Also, no one’s ever sued her.

It would be easy for the show to portray her as cold and unfeeling, but that’s not what’s happening here. She’s out of her depth, coming as she does from the VA (which is also where Mel came from last season). Her obsession with rules and procedure conflicts with the day-in, day-out mentality of an overwhelmed emergency department. Robby’s value isn’t in his slightly maverick medical practices, but rather as the man who’s spent years learning where breakpoints are. All of that experience keeps the trauma center operating as smooth as it can with the limited resources it has.

Eventually, she does circle back to Mel and give her words of encouragement, speaking to resident’s professionalism and reputation and how that is going to help her through the upcoming deposition. Sure, she’s doing barely more than reading off a chart, but the gesture matters for Mel’s headspace (and morale), and it’s unfair to assume the incoming attending would be able to speak to more than that. She’s doing the best she can.

There will undoubtedly be a point (or points) where Al-Ashimi’s measured approach is going to prove valuable. For now, though, this caution is in the path of Robby’s (and his team’s) well-established groove. For all that she thinks she can come in and prove the trauma center can be more efficient and better organized, that arrogance dismisses Robby’s prerogative to get patients through the doors, processed, treated, and out of their system as fast as possible. Had the doctors listened to Dr. Al-Ashimi and gone through the procedure with the patient who choked on a piece of broccoli, it would have slowed down the entire machine, taking up bedspace and intubating for an entire episode. With Dr. Robby knowing all the potential pitfalls, they’re already wheeling the man out by episode’s end.

Had she gotten her way, procedure would have put a strain on already-stretched-thin resources. Imagining the entire department operating like this is going to slow the department to a crawl, increase waiting times, and tank already low patient satisfaction scores.

Knowing books and information is one thing, but actually applying that information and synthesizing it with on the job training is far more valuable. Generative A.I. might be 98% accurate, but its creators have built it to absorb information and iterate upon it. It doesn’t derive creative solutions. No way would it have recommended the hylar flip in the last episode. Or most of the things Robby recommends for that matter.

That last scene, where Dr. Al-Ashimi talks to Robby about the implementations she’s thinking about is all well and good. But the second an ambulance rolls up with a screaming patient thrashing from whatever his issue is, she folds.

Once Robby leaves for his long-earned sabbatical, this is going to be her life. It’s not like this is going to get easier. Today is going to be a gauntlet testing for her capacity to do the job. Excited to see it as we go.

The newbies

What makes The Pitt such a strong and engaging show is its ability to flit all around the trauma center and keep audiences engaged with the various characters and their patients at any given moment. As such, the few new med students coming in should throw off the rhythm somewhat, but the show has given the three newbies early space for them to define themselves.

Most charming of this trio is Emma, whom Dana has taken under her wing for what amounts to a hazing of all the weird and gross things she’s going to have to deal with. Last episode it was that dank shower. Here it’s Emma’s presence for the maggot reveal comes with the Dana comment “Never saw that in nursing school, am I right?” This is real life, and it plays into these larger themes about theoretical simulations and practical, lived reality. It’s no accident that Emma is the nurse who has the brightest light and disposition. Not looking forward to the moment when it starts to dim.

The easiest to discuss so far is Joy, a third year medical student who’s spent a lot of these first two hours vaguely engaged and on her phone. She’s the one who rudely commented that the clamshell patient “was dead already anyway” and there isn’t much more to her… yet. Though I’m curious what it is she’s going to bring to the table. The wikipedia article says she has a photographic memory (undoubtedly something in the official character description), though that has yet to bear fruit. Of course, it’s hard for her to stand out when Ogilvie is always standing right next to her.

Already Ogilvie (the last of the newbies) has gone out of his way to show off all of his knowledge. It doesn’t quite come across as explicitly arrogant, but he is always eager to engage with any questions and provide all sorts of solutions and also to narc out anyone who forgets some step or procedure. It’s not a surprise that he bonds immediately with Dr. Al-Ashimi and her rule-following ways (though his speaking to her in Farsi plays a role in his sucking up).

Best of all, though, is the way he threatens Javadi and her know-it-all-ism. Their competition to out-know each other is something Robby shuts down immediately because they’re supposed to be a team. But it’s great to see someone Javadi can go toe-to-toe with, and it’ll be interesting to see if the show makes her an avatar of Robby while Ogilvie becomes some avatar of his interim replacement. This is all set up for things to come down the line.

But all of this knowledge is just… knowledge. Javadi has already had to test herself in last season’s baptism of fire, but for now Ogilvie is living in a world of books and specifics and procedures. That’s just the springboard to get to Robby’s level. In managing the daily operations of The Pitt, he is always asking if his staff have any hunches or suspicions. That goes far beyond book learning and med school time and forces those working with him to use their brains in ways that extend beyond their job descriptions so they can capture the soul of what it is they embody.

This is how the real world works, after all.

Stray Observations

• Keeping Langdon in triage is a great way to get him back up to speed. He desperately wants to be elsewhere, but he still dedicates himself to doing the best job he possibly can to help the department move through quickly-solved cases. I forgot that the two operating in triage last season were Javadi and McCay, which shows you how far he’s fallen from his senior resident status. Robby is going to keep benching him, and I’m curious what (if anything) it’ll take to get him out of there. It’ll be a long day for sure, but just one day is not usually enough to undo Robby’s lingering sense of betrayal and loss.
• The nun with eye gonorrhea seems scandalous, but only until it becomes clear how she contracted it in the first place. Love that the show is careful to show that service and patient care extends beyond just the doctors of an overrun trauma center. It’s not so different from when the ancillary staff took bets on the ambulance carjacking last season. This is a whole world and we’re just seeing one extremely detailed part of it. The more specificity we get to even see small glimpses, the more real this place feels.
• New character Noel and Dr. Robby having a thing is an interesting development, especially because it (like Mel’s deposition) creates a clock for us to interact with something later. Last time we heard about Robby having a romantic relationship it manifested in Jake and Pittfest. We all know how that worked out.
• Poor Dennis having to tell this poor woman with alzheimers over and over again that her husband has died. They’re just gonna keep punishing this poor kid because of Gerran Howell’s cute face and puppy dog eyes. Sad.
• Santos and Langdon being in the same space together is delicisou inherent tension. Because of how instrumental she was in his fall from grace, it’s easy to forget that she only met Langdon in the opening minutes of last season and a lot of her exposing him came with that tinge of retribution for his constantly (but rightly) correcting her mistakes and berating her signature ambition. He is going to have to speak with her at some point (at least if he wants to continue this NA path he’s on) and I’m really interested to see what it is he says to her and how Santos (in all of her arrogance) takes it.
• Also, there has to be a point at which Santos colossally fucks up. She ran really hot last season and is basically Dr. Robby on steroids with her “here’s what’s going on and how I can fix it”. She can often be right, and definitely saved lives during Pittfest, but that hubris is going to end up with something really, really bad in the future. Wouldn’t be surprised if it’s something this season (though if that proves wrong, I dread when that bill eventually comes due).
• Gross-out moment of the week: Most would put the maggot moment in here, but the graphic popping in of the shoulder was terrific. This show’s use of props, makeup effects, and puppetry is one of its strongest aspects, and watching a bone pop back into an incision and out of sight is the sort of thing that’s always going to win this category.
• Man that was one gnarly piece of broccoli though. Chew your food, kids.

And we still have thirteen hours left? Heck yes.