That Painful, Lonely Silence - The Pitt s02e09

Being in a trauma center means staring death in the face.

Whitaker learned this the hard way when he lost the patient early in the series, something that's rippled all the way into this most recent episode. That season also featured a consistent wave of deaths, including an episode that was about the deaths of multiple children and a final arc in which all the characters pushed to their breaking point to save all casualties in the Pittfest shootingk.

In the last episode, Cassie confronted Robby about Roxie's morphine dosage. Running high enough that Cassie didn't have any ideas of what else to do, Robby gave her the hard truth:

Are you familiar with the doctrine of double effect? It is an ethical principle in palliative care. We treat pain. And if, in doing so, there's a negative side effect, we accept it... In some cases [death] could be the best outcome.

Towards the end of this episode, Cassie gets a quiet moment to check in with Roxie. The room is dark, lit only by a bedside light. She seems in pain, but at peace. Scared, but assured in her decision (which everyone paying attention knows at this point). It's a beautiful, wonderful scene about the unfairness of life and the fear of what comes after.

Roxie: I'm sure you've seen a lot of death.
Cassie: I have seen my share.
Roxie: Any advice? I've never died before.

It's the quiet grace note to an episode where everyone in the trauma center has to look death in the face. And... sure, there's the metaphorical idea of Mel having a potential death should this deposition go poorly. If the hospital fires her, we won't see her on the show. But this also means her sister's Becca's UTI would not receive the timely and efficient care that comes with Mel's ability to prioritize her.

But this death in its most literal sense takes many forms: the humbling of Dr. J, the coin toss that will define Howard Knox's life, the bold defiance of a once-retired, now relevant again nurse clerk. This looming spectre of death haunts season two of The Pitt and has slowly started to bleed into the narrative since Louie's death. Like his was the harbinger of so much more suffering to come.

I hope I'm wrong.

Dr. J and the missing chart

So... Javadi almost killed a person.

Let's back up.

With the department in total disarray, it's a smart move to open the episode with a recenter on Dana's central hub. After an hour of moving back to an analog system, it's prudent for everyone to take bearings and figure out where problems are arising. This radical shift means things are going to fall through. Whatever they can do to shore that up is important.

They set this this crash up last episode, when Javadi and Ogilvie had a miscommunication about the protocol for picking up the margarita burn patient. Javadi pulled the chart, but Ogilvie laid claim to the patient on the white board. An easy mistake, and not so bad considering. Better a double claim on a patient than something falling through the cracks.

Javadi pulling the chart and not transferring the patient (Mrs. Burns) to the white board? Turns out, Mrs. Burns isn't in the nurses' rotation of checking in. It isn't long before that patient crashes and requires immediate life-saving attention.

While Robby, Whitaker, and others try to save her life, Javadi shuts down.

All through the series, Javadi has been a golden child, the prodigy nepobaby of two other high profile doctors in this hospital. She has been extremely lucky, and her inherent talents have really pulled her through every situation. But she's also a child of the digital era. It's hardly a coincidence that the 21-year old Tik Tok influencer basically withers as soon as technology she's never lived without vanishes from her utility.

Because she's Javadi, she remains very, very lucky. In some ways, it's learning the insanely hard lesson that Whitaker learned last year. The difference is that instead of carrying around the guilt like an albatross, she has to live with the knowledge of how her arrogance can blind her. This is probably worse for her, as her confidence has been one of her strengths til now.

Fortune will not always be so kind.

Two fingers down

If this episode is about staring death in the face, it seems weird that Jude & Chantal would be the emotional core. But given the weight and impact of their situation, it's hard to imagine a more bleak existence than the one through which Chantal is trying to navigate in raising her brother.

First of all, fuck ICE. And fuck the Trump Administration's absolutely monstrous behaviors in their mass arrest and incarceration of individuals who are here. Those both legally and illegally. Fuck the racial profiling, fearmongering, and anti-American actions that have resulted in arresting individuals without warrants, detaining them without due process, and deporting them to gulags in foreign countries. Fuck the suspension of habeas corpus and the mass building of detention camps larger than the biggest prisons in our already far-too-carceral state. Fuck the ICE occupation of cities and the terrorization of citizens. Fuck them operating like a secret police force, covering their faces and driving around in unmarked cars without identification and abducting people off the streets and sending them to god knows where. ICE is a government entity with a budget the size of the Israeli military's, and White House Senior Adviser Stephen Miller has tasked them with making something like 3,000 arrests per day. His quota has become the paramount imperative of this anti-immigrant action. All other considerations (including constitutional rights) secondary.

It shouldn't take something like The Pitt to hammer home just how horrible this is, but the second Chantal explained that her parents got deported back to Haiti I let out a massive groan. The constitution's provision for birthright citizenship has kept her (and her brother) "safe" from immigration enforcement's wrath, but that's cold comfort considering that ICE doesn't seem to care if it scoops up citizens in its dragnet. It still meant she had to drop out of college and move back home to take care of her 12 year-old little brother. Less than a year later, he's drinking and playing with firecrackers. And now he's down two fingers. There's only so much Chantal can be responsible for. Would this have happened if their parents were still here?

This is a broken family. Worse, it's needlessly broken. While the United States needs immigration enforcement to help ensure the nation's respective laws, it's also true that failing to act on immigration for decades (a sin both parties committed) has created an opportunity for Miller and his onerous white supremacy to exploit now that he occupies the White House. It allows him to dictate by fiat what to do in the ruins with decades of decaying infrastructure. Now, Jude is an American citizen growing up without parents to guide him, and a country that could be richer for his presence (and theirs) might lose him to a place he doesn't belong.

Theirs is just one story.

The only good thing about it is that the parents count for two arrests, meaning the best case scenario is the government is creating thousands upon thousands of stories like this per day. Is a world where such cruelty is not just possible but government prerogative one we want to abide? Worse than that, do we want to live in where all Chantal has to say is "My parents were deported to Haiti nine months ago" for us to understand the gravity and magnitude of everything that sentence means? She doesn't have to say another thing for us to be emotionally on board with this absolutely horrible situation.

This ripping apart of families is the sort of thing our government currently does and does with glee. Pain and suffering are tools in the toolbox to let "the others" know that they are not welcome in this country. That America is no place for them. That those in charge believe its founding ideals are only meant for the privileged few. That the benefits of America's promise only belong to those lucky enough to fit into whatever Miller and this wretched administration determines as an acceptable existence.

Whenever I think about the people who support this administration, or those who ignored the rights of others in the name of whatever it is they'd hoped they get (lower prices, economic relief, some sort of posterity, a prioritizing of Christian values), this is the situation that makes me ask if it was worth it. Is it worth a story like this? Is it worth Chantal sacrificing the hard work and her parents' decades of savings? Her parents might have broken the law, but is this punishment fitting the crime? Is it worth a youth like Jude having a dimmer future?

If the Trump Administration weren't this moral abomination, would Jude still have his fingers?

This is a world that we voted for. I didn't vote for Trump, but I own the choice, just like those who didn't vote for Obama fit under the umbrella of "America voted for Obama." To call Trump and everything that has happened under his regime a stain on our national psyche is to undersell the magnitude of the pain and suffering at his (and his administration's) ambivalent hand. This is a mutilation of the country's morality and values. Every day it continues is a day that we continue to carve these scars into the tapestry of our flesh.

It is killing us.

Not going quietly

Last season, Robby was the center of every episode. Every episode featured some moment that pushed him emotionally. It culminated in the breakdown he had in the antepenultimate episode, and it's something Langdon exploited in his moment of nasty lashing out.

This season has not focused nearly so much on Robby. The review two episodes ago talked about Robby through the eyes of Langdon, where the attending hazed him after the apology. He's interacting with Dr. Al, but a lot of the focus is about Dr. Al and how she will be running a different ship. Whenever he talks to the psychologist he always lightly brushes him away. He'll talk to Dana, but mostly that's in the context of having one foot out the door and it's quite professional.

Here, though, he becomes unavoidable.

In the most obvious case, this is because he reaches out to Whitaker. Ostensibly, this is to encourage him to have some professional distance with regards to Mrs. Miller and his house calls to her farm. Robby is correct, and whatever is happening with Whitaker here is opaque. It could be chaste and innocent, but it could also be... less.

But in Robby coming up with a solution to this problem we get the most worrying aspect of Robby's imminent sabbatical.

He offers Whitaker an opportunity to house sit. Rent free. And then says "if I don't come back, you got a swinging bachelor pad."

In my head, this feels like Robby giving into the potential death he courts by not wearing a helmet, and all the warnings parading through the PTMC today about how dangerous motorcycles are. Based on past precedent, Robby might be anticipating an ambivalent suicide. Something he can accept given his cavalier actions.

But what if it's different. What if he's just gonna... leave? There was that bit a few episodes ago that involved an update on Collins and how she moved back to Oregon after last season. Three month sabbatical and he could just... disappear. To wherever. What is even keeping him doing this job? The intimacy that was all over the first season feels somehow less here. Like he is creating a distance from his staff that is going to make it easier to disappear into the night. There are so many scenes this season of him on the other side of doors or windows, looking in on his staff from the outside, removed from them.

Robby's deal was so obvious last time. The anniversary of his mentor's death. The onslaught of death on that day. The relentless trauma of nonstop life-saving.

Here, it's less. And maybe that's because Robby himself is trying to disappear from the narrative itself by melting into the background, turning himself into a ghost in his own emergency department...

The saving grace is, of course, Abbot.

First, thank god he's back. But more valuably, there's the moment they share together. In this week's The Pitt podcast, Shawn Hatosy talked about the relationship between Abbot & Robby and compared it to a brotherhood where they can see right through each other. Abbot can see the value that Dr. Al brings to the day shift, something Robby can't see because of how well he's worn his grooves into what he's built.

More importantly, Abbot doesn't question Robby's sabbatical. Just asks him if he's really doing it and then tells him "You just make sure you come back. And if it gets dark, call me." The accountability is powerful, and Abbot making sure Robby comes back somehow implies the idea that he might not. This isn't the sort of thing you'd say to someone about to go on Sabbatical if you thought there was a chance they wouldn't. The immediate idea when he says this is death. It just might be. But if it's Robby leaving to go elsewhere...?

That leaves an open question about what Robby would do if he wasn't going to come back. Does he... go practice medicine elsewhere? Could he say no? Saving people and practicing medicine is more than just a calling, it's a compulsion. And he can't turn it off. And three months motorcycling up into Canada and maybe never coming back isn't going to change that.

Around the Trauma Center...

• Mel finally gets called into her deposition. I've spent the season expecting some Sorkinesque deposition scene on a whole new set, but that's not what the show was going to do. Instead, Mel leaves and we don't hear a word about her for the rest of the episode. And that black box of where Mel went is worrying. Especially because the show has spent more than half a season building up this deposition as a major component of her arc. No way is it going to be as simple as "Mel got all the questions correct! :)" Gosh I hope she's okay.
• She did a good job with her sister, though. But I did catch some poster on Reddit talking about how it seems like Mel was working really, really hard to keep Becca away from Santos. (She said she didn't want an R2 helping and blanched when Robby offered Santos as the option; Santos is the only R2 on this shift...) Man the shit talking Mel must do about Santos...
• And Becca getting to be with Langdon. Langdon immediately clocking her neurodivergence and also that she has a UTI. Turning off the lights. Taking everything she says in stride. All of it is fabulous.
• If there's a bright light in this episode, it's the arrival of Monica Peters, a retired clerk put out of work by the digital revolution that made her job redundant. She comes in and kicks ass and takes names, single-handedly whipping everyone into shape and operating the administrative upkeep of Dana's central hub like she never missed a day of work.
• The Furry storyline was fabulous, if for no other reason than the show never presents it as something to judge. The most it gets is the odd look when the mascot costume is hanging on the door outside her room (which is odd no matter how you slice it). And the furry community seems happy with how the show represented them. Wins all around.
• Princess getting her winnings from the betting board is so good, especially the bit where Perlah blackmails her for 40% of the winnings to keep her mouth shut about the insider information that effectuated the win. These two...
• Santos having a good bedside manner with Jude is terrific to see, especially considering how rough a day she's been having and how weak she's been interacting with patients so far. On the other hand, Garcia shutting down Santos's offer to see fireworks is a cold slap in the face. "I thought we were keeping it casual" is so brutal.
• The note that the open shoulder injury from the first few episodes is still in surgery? God. They're so backed up up there. This is getting bad.
• Cassie opening up the idea that the polycystic ovarian syndrome (PCOS) patient needs some sort of additional attention is eye-opening for Whitaker. It's not enough to parrot back stats and standard operating procedures. There is value in asking the meta question of why a patient keeps coming back with the same issue and what the team can do differently to help fix the underlying issue. It doesn't fit the remit of "keep patients moving and make bedspace available", but it does enable Cassie to make a material difference where others hadn't.
• Again, the show circles back to Baby Jane Doe. Maybe this foster care will work out, but this is all supposition until they pay it off. Nine episodes in and there's been such little movement. Maybe this is one of those things that exists to see how characters react to it. Dr. Al having a catatonic event because of PTSD or Santos needing to sing. It's led to great moments, but is it leading to something more than that? And if that's the case, what happens when Robby gets a moment in this context?
• Digby in the background while they try to resuscitate Mrs. Burns. Crazy that he's still here, but he's provided some good commentary for the past few episodes. Keep him going.
• In my notes there is a moment where Robby ducks into the bathroom. That was a running bit through the early episodes of the first season, but not following him in continues this trend of keeping Robby at arms' length. Especially notable considering the show did a bathroom scene with Santos and Javadi just a few episodes ago.
• Seeing Mohan grapple with her future given everything with her mother has been mad compelling. Because this is a teaching hospital, everyone is always talking about fields of study they want to enter, but the show taking moments where it can to have Mohan reflect on her life outside the ED is proving fruitful.
• Roxie's family bringing in Jeni's as the ice cream to eat with her. Hell yeah Jeni's.
• Finally, it is devastating to see Knox at the edge of death like this. They need to get him into surgery immediately to give him a 50% chance of survival (as opposed to the 100% chance of death without), but knowing that he refuses to go until he speaks to his sister? Ugh. What does his life matter if he doesn't get a last few minutes of human connection? It's not enough to live if we're going to be alone. Death is awful for those who survive, but it's also horrible because of what we leave behind after we go. My heart absolutely breaks for him and what he is willing to sacrifice for this last gasp of a too-long dormant relationship.
• Gross out moment of the week... In no world is it not Jude's mangled hand. That was... so graphic and awful to see. What's worst is the bit where the "three fingers that matter" still have full mobility. It's the incredible prosthetic work that this show does extremely well, but the negative space below really hammers home the loss of what is gone. Yeesh.

Next Time...

The ominous phone call right at the end of the episode. The water slide collapse at a local water park. Everyone involved coming to the Pitt. Javadi having an emotional breakdown. Santos having to cross paths with Langdon again. Fuck.