The Pitt Part 1 

DH 00:00 

You know, when I went through med school, I had this whole imposter syndrome thing, and it took me, like, 17 years as a professional to get over it. Now it’s back. I’m watching these clerks outperform me, and I feel like I don’t belong as a doctor again. 

DH 00:18 

Welcome to Apollo On Call, the podcast of MedHum.org 

DH 00:22 

I’m your host, Dr. David Hsu. Hope you enjoy the show. 

DH 00:30 

All right. Welcome back to Apollo On Call. And if I sound really excited, it is because I am excited to talk to my buddy today about The Pitt, all right, and so first I’ve got to introduce my co-host for this episode. It’s Dr. Stuart Harman. He’s a pediatric emergency room physician and the director of the pediatrics residency training program at the University of Ottawa. More importantly, he co-hosts the Medical Dads podcast with me, so people who want to check out a discussion about parenting can head over there. And why is he appearing on Apollo On Call and why is he here with MedHum is because all those things I said about Dr. Harman are true and accurate, but most importantly, he is an expert on comic books, cartoons, sitcoms. So really, he is the guru of pop culture, and that’s what we’re going to do. He’s going to be a recurring person on MedHum whenever we have something about pop culture that we need to discuss. So, Dr. Harman, welcome to the show.  

SH 01:34 

Thank you for having me on the show. That description you gave is exactly how they introduced me the last time I presented at the Canadian Paediatric Society. 

DH 01:42 

Excellent, excellent. All right, and so that’s why here today. We’re going to talk about The Pitt, which is the show that everyone in medicine seems to be talking about lately, but it’s also appearing everywhere, like, it’s been in the news. This is a big thing, and for people who haven’t heard about it, The Pitt is a medical TV drama. It is airing on HBO Max, which in Canada is available on Crave. And it’s sort of maybe kind of a sequel to ER, but not officially. So all of these things combined to make it something that everyone in medicine is talking about it. So at Apollo On Call and MedHum, we need to talk about it, right? Because this is a medical humanity site. We’re trying to talk about the intersection of medicine, literature, the arts and, quite frankly, TV doesn’t get enough attention as a version of the arts, right? It’s generally considered a little bit too low brow, probably for academic medical humanities discussion, but we’re gonna change that today, because we need to talk about this. We need to bring medical humanities to the masses.  

SH 02:50 

You know, I was worried when you asked me to come on to this podcast, that I wouldn’t be able to handle the increased level of sophistication that I expect on this compared to when we’re doing our Medical Dads podcast talking about just our lives but now I realize we’re talking about television. Okay, I’m up to speed. 

DH 03:06 

Exactly, exactly. We invited you here for a reason, so let me just tell for people who don’t know what The Pitt is, The Pitt is a 15-hour television series. It’s the first season of this series that has just recently aired on HBO Max, so there’s one episode per week, and it’s a little bit different than what most fancy TV dramas are in this day and age. First of all, the length of the show is very long. There’s 15 hours. Most shows kind of cap it at seven or 13 hours, so it’s a little bit longer than most shows. So I had to ask Dr. Harman, are you in? You gotta watch The Pitt with me, okay? 15 hours. We gotta commit this amount of time to it, which is a little bit hard, we haven’t even started the show. We don’t know if we’re gonna like it. 15 hours seems like it could be a big ask, but we are getting there. 

SH 03:54 

There’s so many other aspects of our lives that if we just committed to doing 15 hours of we’d be such better people. 

DH 04:01 

Not necessarily, okay, because this podcast is gonna be really good. It’s hard to imagine that something would make us better than the 15 hours we spent watching this show.  

SH 04:10 

That’s right, you heard it here first, that watching this show is better than 15 hours of volunteer work. We’ve done more for the world than we could have with 15 hours of cleaning the environment.  

DH 04:20 

Hey, this is volunteer work, man, last I checked you were not getting paid for it, I’m not getting paid for it. We are doing medical humanities for the love of medical humanities and TV. 

SH 04:30 

Excellent observation.  

DH 04:31 

We’re gonna do at least two episodes talking about The Pitt, right? So today, the first episode, we’re gonna give a bit of background about the show. We’re going to talk around the show, but we’re not going to talk too much about the actual content of the specific plot developments. So in regular terms, this means there’s going to be no spoilers today, because so far, neither Dr. Harman nor I have finished the entire season. We’ve only watched part of it.  

SH 05:03 

That’s right.  

DH 05:03 

I’m about three-quarters of the way through. I think you’re about two-thirds to three-quarters of the way through, yeah, so we don’t know how it ends.  

SH 05:10 

Yeah, right.  

DH 05:11 

And so we’re approaching this as we’re gonna talk to you guys and gals out there who have not watched the show yet, and we’ll give you an opinion on how we feel about the show as medical doctors, and how we feel about it from a medical humanities point of view. And if you do end up taking us up on the offer and watching the rest of the show, you can come back in a little while, when we’ve had our follow-up discussion where we break down the thing in more detail, all right, with spoilers. 

SH 05:36 

That’s right, we’ll spoil the heck out of it.  

DH 05:38 

Okay, so now I have to tell you to start this conversation how I got into this thing called The Pitt, because actually, people who listen to me or talk to me know that I don’t watch a ton of TV anymore, right? And so I was happy, 

SH 05:53 

I will say that that’s not necessarily generally known.  

DH 05:57 

Okay, I don’t watch a ton of TV, right? I don’t have an active television show that I’m super into. I’m not a person who knows what’s coming up next, you know, for the new season on TV. But a few months ago, my sister was like, have you heard of The Pitt? I’m like, Yeah, whatever, The Pitt what is that? And she doesn’t ask me these type of questions very often, so I clicked on the link she sent me. I’m like, What? It sort of felt like a reboot of ER which instantly made my whole body go soft, right? Like, I didn’t know what to do. 

SH 06:31 

Yeah, so obviously, was the great density that parts of your body work, because it sounds like you’re really excited about this. 

DH 06:37 

Yeah, no, like you’re weak-kneed, right? Like you’re about to faint, right? So the reason for this is because the original show, ER, was this seminal thing that happened to me in high school, that television show probably led to me becoming a doctor more than any other thing in the world. And I hate to admit it, because sometimes my mom, people will be like, Oh, why did he end up getting into medicine? And she’ll say to her friends, well, there used to be this TV show called ER, that he was really into, and it just sounds like the hokiest thing ever and I really hate it when she prefaces this story by telling people about how I used to stay up on Thursday nights to watch ER, but it actually is kind of true, right? So what actually happened was, if you remember, in the early 90s, there was this crazy, big movie about dinosaurs on an island that were genetically re-modified, called Jurassic Park. So that movie came out, and I was super hyped, loved it, and it was based on a novel written by Michael Crichton. So then I got really into Michael Crichton, and I realized, Oh, he’s a medical doctor, and there’s a new show coming out on NBC. Because Jurassic Park was so popular, they took some of his other stuff and said, Okay, let’s finally put this on the air. So he had an old script for a medical movie called ER. They spun it into the pilot episode of what turned out to be a really, really successful television series. So I was there right at the beginning, the first episode of ER came on Thursday night. I think it might have been 1993 or 1994 and I was there watching it, and within 20 minutes, 40 minutes, I was hooked, right? And so I was a huge ER fan. And this was not a show that a lot of my friends were watching in 10th grade. A few of us watched it so, so I was really into this show. I watched it consistently for five or six years through university. I remember freshman year at Cornell University, Thursday night, 10pm. This was back in the day when people didn’t have streaming. There wasn’t anything on your computer that you could watch. You had to go down in the dorm, in the res to the TV lounge, right? And there’d be these two TVs mounted up high, two TVs for the entire dorm.  

SH 08:46 

Wow.  

DH 08:47 

And Thursday night, felt like the room was packed, right? I would go down sometimes to watch football or basketball, and there’d be nobody there. But Thursday night, 10pm tons of people were there. Everyone was watching ER, I did that a few times. Loved the show. Gradually, the show kind of petered out for me because the original cast started leaving. So if people who follow TV, they know George Clooney got his big break on ER, he went from being just another face on TV to, you know, megastar.  

SH 09:20 

You’re forgetting his seminal role on the TV series, The Facts of Life?  

DH 09:24 

It wasn’t The Facts of Life, he was on Roseanne. So you even forgot it yourself. 

SH 09:29 

Before Roseanne, before the later seasons, The Facts of Life, George Clooney. 

DH 09:34 

Really?  

SH 09:35 

Yeah, this is after the girls left the boarding school and they owned a restaurant with Mrs. Edna. See, that’s why you got me here on the show. That’s what I’m here for.  

DH 09:47 

I did not know he was there. Okay, so there, I stand corrected. But either way, he ends up leapfrogging into Hollywood. And then most of the original cast eventually, they move on to other things, and the show becomes a bit too soapy, too sensationalized, and I gradually lost interest in it. I did discover, though, as I went through my medical training, I went through medical school, I went into residency. At some point in residency, I realized, Hey, these guys are still watching, ER. My residency buddies, some of them, would meet up on Thursday night at 10pm to watch, ER, I’m like, What? You guys are still watching that show that I used to watch back in high school, it’s not even good anymore, right? But at that point, I think there was this draw that if you’re a medical trainee, that a lot of the things that are happening on the show are very realistic, so that so these doctors in training would stand, would sit there, trying to figure out what’s the next thing you would do in this case, which test would you order? There was this whole procedural aspect to the show which I was oblivious to.  

SH 10:43 

Yeah, you know, for our generation, we, you and I ,are probably at the edge of that age group of physicians who were inspired to go into medicine largely because of ER, I feel like people who are just a little bit older than us, who would have been the right age when that show was newer, and really just taking off a lot of people in that cohort, I remember coming from med school interviews, and some of the upper-year students meeting me and saying to me, Okay, yeah, so there’s pretty much two groups of people here, those who are really into ER and those who don’t really watch it. So which group are you in?  

DH 11:17 

Wow, yeah. So the crazy thing is, it’s been many years, and now I’m teaching med students. I’m teaching residents. Sometimes they’ll be like, Well, why did you get into medicine? I’ll be like, Well, there used to be this show called ER, and then they’ll kind of look at me blankly, and I’ll realize, I guess they weren’t even born when ER started, which just makes me feel so old. And then I’ll mention something like, you know who George Clooney is, right? And they’ll be like, they’ll look at me blankly, like they don’t know who George Clooney is, which I just find unbelievable. To me, he’s, like, one of the five biggest male movie stars in the world. But maybe I’m just really old now, right? So nothing dates a thing more than their understanding. Nothing dates a person more than their understanding of pop culture, because pop culture just rebirths itself so quickly that what’s hot today is gone tomorrow, but it is really nice that suddenly, in 2024, I caught wind that this sort of remake of the show has come on. It’s not really a remake because, because there’s this whole legal thing happening, right? So I don’t know if you’ve heard about this, but basically, apparently, they were supposed to make a sequel to ER, but the talks between Michael Crichton’s wife, because Michael Crichton has since passed away, his wife, who manages his estate, and the producers of the original ER, including the actor, Noah Wyle, who’s the star of the show, talks broke down, so they went off and made this new show called The Pitt, and she found that the show was a little bit too similar to ER, so there’s this whole controversy, and she’s suing them for making a clone of ER, but they’re saying, Well, this show is actually quite different, and it is a little bit different, right, other than the fact that the main character is the same actor from ER, but he’s playing a different person, and it is set in an emergency room, and the pacing is kind of similar. The other big difference is the show set in a different city, and the show is set over 15 consecutive hours. So each episode of the show is intended to be one hour of real-time drama, right? So we’re gonna go through a 15-hour shift. And so all of that’s set up a little bit like the old action show 24 right, where every episode was one hour of a season. So it has enough differences for me, and that’s where we land on the show. 

SH 13:35 

Huh, I did not know at all about this. It seems hard to sue for somebody making a medical drama, it seems like there are many, many of those out there that are similar to each other, or just even in general, right? All kinds of genres. Can somebody sue somebody else for making a Western show? Can the makers of Bonanza come and sue you if you  

DH 13:56 

Exactly, well, the jury is still out. We’ll see where that actually goes, but that has been brewing in kind of the background as people talk about the show. But anyways, that’s just the background. Let’s talk a little bit around what we think about the show now that we’re kind of two thirds of the way through.  

SH 14:11 

Yeah, absolutely. And for the makers of that show, please don’t have any characters have sex in a closet, or the makers of Grey’s Anatomy may also come after you, and you’ll have two bosses on your hand.  

DH 14:21 

All right. The thing that everyone wants to know, because you and I are doctors, I’m not an emergency room doctor, you’re not an adult emergency room doctor, but the thing that everyone wants to know is, is this show realistic or not? So as the pediatric emergency room doctor, you’re the closest to that that we can, closest person that can answer this question, yeah, what do you think? Is it realistic? 

SH 14:44 

Overall no, well, actually, that’s not fair for me to say. I hate giving an answer that’s sort of an in between answer, right? But the cases that are happening in the show, you could tell are very much based off of somebody’s stories. That someone like me has a wacky case that came in, and I told that story to somebody who made it into a show. When you’re watching the cases, it’s very much like that. Especially for me as a pediatrician, I mostly pay attention when the when the pediatric cases come in, and some of those cases, like, as soon as the patient comes in, I’m thinking to myself, Okay, what’s a wacky story that I could think of, that maybe I didn’t have, but that circulates amongst pediatricians. What’s a wacky story that I can think of, and just based on that alone, it’s, oh, yeah, it’s going to be this, not necessarily because that’s the only possible medical explanation, but because that’s the only possible medical explanation that makes one of my really cool stories. So in that sense, the stories do feel like they are real. 

DH 15:52 

Okay, give me one example. I mean, we’re not gonna spoil the show, but give me one example of a case that walked in the door on the show that you’re kind of like, Okay, that’s a wacky thing that happened.  

SH 16:02 

Okay, I won’t reveal the diagnosis, but there’s a point at which they bring in a five-month-old who’s irritable, and it struck me right away that, wow, they’re bringing this child straight to resuscitation, and they start having characters rhyming off all the craziest, worst case scenario, things that this could be and really having this elevated level of panic.  

DH 16:26 

Oh, right. I called that one. I knew what that case was because of that. And I had never actually seen that specific thing in real life, but I had heard other doctors talking about it at a study meeting. They’re like, Oh, we saw this really cool thing, and they taught us about it, and none of us have ever seen it, yeah. But I was like, It has to be this.  

SH 16:47 

I’ve seen this diagnosis several times, but I’ve never actually seen it present as we thought it was this super serious thing, and we were going down that pathway, and then we realized it was this. For me, when I’ve seen it in real life, it’s more like, Yeah, the parents kind of figured out this thing was wrong and brought in, and we knew what it we knew what it was. But when we tell this story to medical students, when we tell medical students, Okay, you got to look out for this diagnosis, because somebody might think it’s this super serious thing, and then it turns out to be this. We tell students this story of how this could happen, but for the show, it happens the one in 100 ways that it could happen, not the way that it actually. 

DH 17:26 

I think we have to spoil this particular … 

SH 17:29 

No, don’t spoil it, we just promised people. 

DH 17:31 

But it’s not that important.  

SH 17:33 

Oh, that’s what people who give spoilers always say. 

DH 17:36 

Oh, come on. But it’s really weird to be talking to our audience like, Well, this thing happened, and then this and then this, and then but they have no idea what we’re talking about.  

SH 17:42 

They won’t until they watch the show.  

DH 17:43 

All right, fine.  

SH 17:45 

The point is there are a lot of these stories, a lot of these things that happen on the show where you can tell it’s based on somebody’s extreme case, or someone’s really interesting story with a wacky ending. It’s just not that realistic that all those things are happening simultaneously in an hour. 

DH 18:04 

Yeah, right. So I’ve been watching the show with my wife, which is an interesting experience, because she trained as an internist, and now she’s a GI specialist. So she’s actually seen a lot of these things in real life. So as we’re going through the show, I’m like, This isn’t realistic for some reason, and usually my complaint is this is not realistic because of the pace, the pace of this is insane. And she’s like, No, these cases are real. Like that case, I’ve seen that, I’ve seen that. And I know she’s seen it because she can almost predict what the next action is going to be with remarkable clarity, right? So, I will say, I married a real doctor, right? But I do feel like, in terms of reality-wise, the actual individual cases are all based in reality. They’re not making this stuff up at all. Individual-case-wise. 

SH 18:51 

Yeah, at least as far as the medicine goes, there’s a few things where I’m kind of wondering, did they actually make up? There are a few things where I’m wondering is, did this actually happen, or did they just add some drama to it, in terms of just things that happen with characters that are not really medical, but that are, you could sort of see happening. So some of those stories like that, but yeah, you know, to be fair to the people who are making the show, to that question, is this show realistic? I have to say there’s a high degree of realism on this show that it would be an insult to the efforts that have been put in the show for me to just flippantly say, no, it’s not realistic. The medicine is very realistic, and when I compare it to other medical things I’ve seen on TV, it’s extremely realistic, right? On other shows I’ve seen somebody’s looking at a CT scan and saying, Oh yes, you’ve got three concussions, and I’m yelling at the screaming like, You can’t diagnose a concussion from a CT scan. This show has none of that. And in fact, this show sometimes has characters address things that, like, parents will be asking for something that they’ve seen on TV, and the characters are explaining, no, in real life, that’s not how this works. This is how it goes. So the show does have a high degree of realism. I got to give it some serious credit for that. Also pretty impressed by some of the makeup and stuff that they have. Some of it to me, like, there’s an injury, a gruesome leg injury, right? The beginning that my wife in the first episode was like, All right, you’re watching this on your own. But I’m saying like, Oh no, don’t worry, this is not what it looks like in real life, that doesn’t look real, right? But then there’s some other things where they’re cutting flesh or doing a procedure that I’m saying, Yeah that’s better than any of the mannequins I have at the hospital for simulating something. 

DH 20:32 

Right, it does look very realistic to me overall. So it induces this level of cringiness that even I, as a seasoned TV action movie watcher, I have trouble watching every moment of this show. I have to kind of stare at a spot just to the side of my TV at times, which is really weird, right? And then, and of course, then my wife’s making fun of me. She can tell that I’m kind of cringing, but later in the season, she gets her comeuppance. There’s a part where she can’t handle watching it either. 

DH 21:05 

Now, I have a question. So my comment, though, is just that the sheer volume of stuff is not realistic, right? Like, it was just too much of this happening. I’m like, How many of these things can happen within one hour, right? I know it, there’s different characters involved, but this is nuts. If anyone had this job where this amount of volume was happening in any given hour, even once a month, they’re gonna have a nervous breakdown, right? So the volume of the thing is where I think it’s a bit unrealistic.  

SH 21:36 

I would say that if they told me, we’re just making one season. That’s it. There’s just one season. Because the premise of this season is that it’s just one super statistically anomalous day where all these craziest things all happened, of all these stories all happened on the same day, and sometimes all happening in the same hour. Then I would say, All right, I can give that a bit of artistic license that, 

DH 22:01 

Wow, really? So it’s believable, almost believable, then. 

SH 22:05 

Yeah, the part that’s not realistic in terms of volume, is the speed at which a character will come in the room and say, Okay, yeah, you need this test. And then they’ll cut to another character, and then they’ll come back, and the person is back with those test results already done, and you’re saying, No, that just that’s not even a matter of hospital efficiency. It’s not physically possible to wheel the bed down there that fast, inject the dye, do the image, get the image read, and come back to the room. It’s just not that possible.  

DH 22:31 

Well, that might be the Canadian socialist healthcare system that you’re used to at work, but this is America, baby. Anything can happen.  

SH 22:38 

Just a little bit of that but it’s quite possible. It’s funny because they that part of the premise of the show is that it’s a hospital that feels under-resourced, right? And I’m often watching that being so jealous of what they have available in that hospital. 

DH 22:51 

All right, now, you have been, you’re a seasoned emergency room doctor, but it’s a pediatric ER. You’re working in Canada, and we know in Canada there’s no money for anything. One question I have, because this seems unrealistic to me. There’s a recurrent storyline in the show where the hospital admin like the Ms. money bags, the lady with the money bags, comes down to the emerg and asks the staff to like you guys, got to get your patient satisfaction ratings up, right? But she doesn’t just come down once throughout this season, she appears several times. And it’s not a season, it’s one shift. It’s like she has nothing better to do than every two hours, she’s gonna come downstairs and just bust somebody’s balls about wasting money and poor scores, and then the ER doc has to take a stand in front of everyone, say, Listen, we need more money. We need more beds. Is this an actual interaction that happens in the hospital? Because I know, as an entrepreneur, I manage a medical clinic, sometimes my employees come down and, you know, they’d huddle up, and then they come to us like, Yo, we need a raise, right? But that doesn’t happen four times a day, all right? It happens once in a while, and then we’ll go home and think about it. This is happening recurrently. How realistic is that?  

SH 24:03 

You know what I would say, thinking a lot about this, because doctors I know who’ve watched the show, who aren’t even in adult emergency medicine, where, admittedly, that pace that they’re on that show is much more realistic for adult medicine than is for pediatrics, right? Because we just don’t have that many heart attacks and traumas and stuff like that in a day. But people I’ve talked to are watching some of this stuff about hospital admin being focused on these, on these things like patient satisfaction scores instead of actual patient health. That a lot of people are saying, Oh, that’s so real. That feels just like my experience. And what I would say is watching the show that is what it feels like. What’s happening on the show is what it feels like for a lot of physicians. And I’m not saying that it isn’t what it is like for some physicians, but if I’m just looking at my own hospital, that is what it feels like. But when I’m watching it, I’m saying that’s not what it actually is like. What struck me as really odd in just the very first episode is the directness in which somebody in one of these more like, higher positions comes down and, frankly tells somebody you have to do this for the money in the politics. Whereas in real life, you get much more of that people, and I’m not just not criticizing my hospital admin, I just mean like everybody who’s at that higher level, like beyond hospital, even government, all the way top, you get a lot of more of a No, no, on the face of it, we are sympathetic to you. We understand it’s difficult. You get all these things. But then the frustration is that you feel like, Yeah, but from what’s actually happening, it tells me that, no, you’re not actually. 

DH 25:38 

Right.  

SH 25:40 

And this conveniently puts everything into one easily personified villain who’s coming down and saying that. Whereas my hospital admin, if I think of like my hospital CEO, of which we have a new hospital CEO, she’s right in there with me in a lot of ways, you know, she also is mortified by the reality of the system and the problems we’re having with funding and those type of things. She is not sort of evilly cackling saying, Haha, it’s all about whether or not I could, you know, make the books look balanced while the doctors patients get scared. It’s not that. That’s not what it’s like in real life. But I think for a lot of people watching it, this is what they feel like. This is what they feel like the admin is doing to them.  

DH 26:23 

I think that’s a really good point about the show. And when we asked this question about realism, is that the show is realistic in terms of the medicine, maybe the pacing is unrealistic, but the overall feeling is this is exactly what you just said. The overall feeling is how it feels like to be a doctor, and probably how it feels like to be a patient. You know, in the emergency room, I feel like they capture that feeling thing so well on this show that the rest of it, you know, sometimes, yeah, there’s artistic license, and there are things that and that that’s not exactly how it’s done in in terms of the medicine – doesn’t matter, because they hit the tone and the feeling. So right on this show, yeah, that I will stand on a ledge about. 

SH 27:05 

Yeah, I’ve got colleagues who told me that they watched the show and start to cry. I’ve got colleagues who watched the show and said they couldn’t get past the first 15 minutes because it just felt too much like their day at work. And not that I want to ruin the magic or anything like this. But it’s not that for viewers who are watching that show, they should feel like, Oh my gosh, that’s what Dr. Harman is going through every day. No, I’m not going through that. I’m not at the ledge of the hospital contemplating jumping off the beginning of the shift. But, yeah, there’s a lot of sentiments in there that really is not exaggeration to say that we’ve got patients in the wait room longer than actually what they quoted the wait times being on that show, right? They’re talking about patients being in there for six hours. And I’m like, Oh, I got patients waiting way longer than that. And the degree to which that’s a problem and a danger to people is kind of bang on.  

DH 27:58 

Okay, let’s talk a little bit about the characters. One thing that I noticed as the show started, was that the characters seemed kind of like caricatures, right? So a person walks in, you know, this is the doctor. Oh, that’s the grizzled old Obi-Wan Kenobi, right? He’s been through a lot, he’s very kind, but there’s some things that kind of are unsettling about his past. Or, here’s the supergenius, right? Everyone has, like a supergenius got into med school super early, but a little young, right? Or, here’s the here’s the B, I, T, C, H, resident, right? No one mess with her, right? So everyone kind of, at the beginning at least, fits these caricatures and when you’re talking about TV and books, those type of caricatures, generally, we try to avoid them because they just seem so one-dimensional, right? It’s almost like reading a comic book.  

SH 28:56 

You didn’t tell me when I came on the show we’d be dissing comic books. 

DH 29:00 

Well, I’m just saying it’s like reading a comic. Whether it’s good or bad, it’s up to you. But what I will say is that I thought that the caricatures really work in a way, because in real life, when we’re working in a busy hospital, and you and I went to med school together, when we meet people in our class, all of us, as human beings, unfortunately, we just automatically pigeon hole people as caricatures until we get to know them, right? Like, Oh, that’s the pretty girl, right? That’s the annoying guy. Like, we all do this kind of thing, until we get to know them. I feel like this show did a really good job of starting us off that way, because that’s when you’re working in a hospital and you’re rotating through a different rotation every two weeks, and you have to instantly get along with your supervisor and instantly get along with your team. You got to figure out the lay of the land super fast. And the only way to do that, I feel, is to sort of identify people as certain things and then figure out how to get to get on their good side right away. So I feel like this show actually shows us that. On another show, the caricatures would be kind of that’s one-dimensional. These aren’t real people. But I think in this show, it actually works really well, because, again, that’s what being a resident or a medical trainee is actually like.  

SH 30:12 

Well, I’d certainly agree that the show starts off with a lot of people who are the characters we have in our mind, of people that we work with. But then as the show progresses, they start to reveal a little bit more layers to the character, more depths to the character.  

DH 30:27 

Right. 

SH 30:28 

But even when I was watching, by the time I’m on episode four, which is only four hours into the shift, and I’m seeing some characters who don’t get each other, starting to see each other eye to eye open up. I’m thinking that it does not happen in four hours. On top everything else going in the hospital, you somehow had time for this, Nah, that’s not realistic.  

DH 30:46 

Right, the pacing is weird. Everyone was like, How are you gonna do a season of television over 15 hours straight in real time? Because how much character development can you really have? So they do have to squish everything into this condensed version, but it still feels true, even though there is this thing where you can’t suspend your disbelief that much.  

SH 31:09 

Yeah, I think one could make the criticism. This is stupid, like these episodes, even when you watch them in a lot of ways, the episodes feel like different days, almost like some of the episodes you think they should have just made this a series. And then this happens this day, and this happens that day. But I gotta say that there was some utility in this gimmick of having it go hour by hour. It does give you a little bit more of that sort of feeling of how things change over the course of a day, how the energy level, the attitude, the tolerance of characters, what’s going on around them shifts over the course of the day. And that, even that you start to feel a little bit along with the character of like, Okay, yeah, they just can’t wait for you to get through this day.  

DH 31:54 

Yeah, there’s a moment late, at least it’s relatively late, in the shift where, where one of the characters finally says, Today has just been crazy. And I’m like, finally someone said it, right, because that was my feeling the whole way through like this. This must be the nuttiest day in the history of medicine, yeah.  

SH 32:12 

But actually, if that was the premise of the show, is that they’re calling the show the craziest day ever that you can sort of be like, All right, I can believe that. But if you’re trying to sell me on the idea that they’re going to come back tomorrow and have the same day tomorrow, it’s like, Come on, in fact, they’ll run out of stories.  

DH 32:28 

Well, that’s my problem, is that, I mean, I’m pretty sure this show is going to be green lit for season two, so that means a year from now, there’s going to be another nutty day in the ER, like, how can they top this, right? But okay, we’ll deal with that when they actually get to season two. 

SH 32:43 

In a way I would, I would really kind of hope that they don’t, that it’s just that this stands alone, and it feels much more like a piece of art if it does standalone as like, this is just a slice of the life. This is just this crazy day. These are the characters. Here’s what happened. Inevitably, if they started to make this go on for first like Season 2, 3, 4, 5. First of all, you’re going to run out of these classic medical stories, because already they’ve used up some of the best. If they went to some peds emergency doctors, and we’re like, Okay, what are some of the stories that we could put on the show, that you got them right there, you’re going to be running out of good ones, I feel like.  

DH 33:18 

Hmm I don’t know. I feel like medicine has a well of stories. I mean, medical humanities has a well of stuff to talk about, there could be way more. But you are right, they hit on a lot of the big ones, right, end-of-life care, abuse, when you uncover abuse, what is the role of children’s aid and things like that. They talk about these things on the show, so they do hit on a lot of them, but honestly, in the world of medicine and medical humanities, you can come back to these stories from different angles there. This never ends, right? You’re an emergency room doctor, man, it never gets boring that way.  

SH 33:51 

Yeah, well you know what, that’s fair to say. I guess I was thinking of this more analogous to something like The Avengers, right? You make The Avengers movie, and you use your best superheroes up front, right? Those were the best superheroes Marvel had, in many ways, and Marvel has tons of more superheroes that you can give a show to. But you’re wondering, how come the Moon Knight show isn’t taken away, taken off the way Captain America does. It’s like, yeah, you use your best ones up front. But you’re right, there is a never ending well stories to tell, I suppose. But I mean, even the beloved ER eventually got to the point where a doctor’s arms are getting cut off by helicopters, like, come on. 

DH 34:31 

I mean, every TV show suffers from this. So everything needs to have a finite lifespan. Shows need to figure out a way to end at the right moment, right, and actually Wayne Gretzky, the great Canadian hockey player, he said it best: you always want to go out while your fans think you still have one more year to give. That’s when you need to go out.  

SH 34:52 

Yeah, right.  

DH 34:53 

That’s the perfect moment. When he was about to retire, he was playing for the New York Rangers. He always tells the story. I’ve heard it a few times that his dad was telling him, Wayne, just play another season. He’s like, Dad, I scored, like, 10 goals this year. I used to score that in a good week, I’m not that good anymore. But the fans still thought he could play, and even his dad thought he could still play. That’s the perfect time to go out. Means your level hasn’t really dipped yet, and you’re getting out ahead of the curve. But anyway, that’s just an aside. All right, now, you mentioned something before we started recording that I thought was an interesting point that we should touch on. Was you felt like, in terms of realism, some of the stuff that’s going on, in terms of the hierarchy of the medical training structure was a little bit off, and I think this is worth talking about because I don’t think too many people are talking about this.  

SH 35:40 

Yeah, I think it fits with the general public’s perception of what it’s like to be a medical trainee. And probably that’s partly informed by some of these older shows, and older doctor shows that the medical student can get dumped on, that the resident can get dumped on, that the staff person can speak so harshly to the medical student or that the resident could give another resident a mean nickname or something like that, right off the bat, and that struck me as odd in the first couple of episodes. And this is from the point of view, I guess, that I’m a program director for residents, and 

DH 36:20 

Right. You deal with this every day, right? As soon as someone gives someone a nickname, that issue is bouncing back up the chain of command to Dr. Harman to deal with.  

SH 36:29 

Certainly, some of the way that the more senior characters interact with more the junior characters, it just would be a complete non-starter, no-go and I don’t just necessarily mean that we have rules, because I don’t want people to get the impression that no abuse could possibly happen in a hospital, or that, you know, that if it happened in my hospital, I’d say, Oh, that’s impossible, nothing like that can happen here. But just even the idea that the students would just take it and accept it the way they do on the show seems really out of touch. You would have students quickly pushing back. And maybe this is different, because it’s American and not Canadian, right? And I don’t know what the union is like for medical trainees in the US compared to Canada, but staff would not be able to get away with a lot of the stuff that they’re saying to these to these characters.  

DH 37:20 

Hmm okay, fair. I thought I didn’t really register that. But because I feel like in medicine, there are a fair amount of people grating on each other, getting on each other’s nerves. But now that you spell it out that way, yeah, some of the characters are way over the line at different points, and they never really get called out on it in a real-world kind of way.  

SH 37:41 

Yeah, you know, that’s without giving anything away. There’s like a character who gives another character a nickname and is using it, and the character tells them to stop, and they don’t stop. That would be a problem that maybe it’s they’re too busy and after maybe season two is just 15 hours in real time of the program director having to deal with all these complaints that start arising from the residents who have been treated poorly by other residents and staff. But the other thing that I was going to ask you about: because we’re Canadian doctors, do you have trouble figuring out whose rank is what in that show sometimes? 

DH 38:17 

A little bit. I thought it was kind of odd that, in terms of the rankings, it took me a while to figure out that Noah Wyle is the only attending doctor on the ship. Which, I thought this was kind of crazy. I’m like, so you got one Obi-Wan Kenobi, and everyone below him is a trainee, right. And it’s like this crazy busy hospital, which to the characters, it feels like this is just another one of their days that they would man a hospital with just one experienced person and everyone else as a trainee. I then thought back to the times I’ve done emergency room shifts back as a trainee, and I was like, even those little community ERs had at least two staff or sometimes three at the same time. So, Dr. Harman, is it possible that one guy would be in charge of so many different things at the same time?  

SH 39:02 

Not in any hospital that I’ve ever seen in Canada, I mean during the daytime. If it was overnight, that would make some sense. You know, my hospital, there are periods of the night where there’s just one doctor. But this guy comes in at seven o’clock in the morning, takes over, and that’s it. It’s just him, and he just seems to like go. He seems to go from room to room, overseeing things, and then occasionally, will also seem to have time to spend a significant amount of time talking to a patient himself. And nobody seems to have to do any charting. There’s one point where a character does comment to another character to if they don’t mind charting something, but you never see them doing it. 

DH 39:41 

Right. So, I will agree. It took me a few episodes to figure out, Oh, wait, this person is actually still a resident. Because for a while it’s like, maybe Collins is an attending, because she acts a little bit like an attending. I’m like, maybe there is another attending. My wife and I both thought that, until it was revealed she was just a later year resident. And then the clerks, like, the medical students. These are third or fourth-year med students. The closest I ever got to the show in terms of hierarchy was I was once a third and fourth year clerk in the ER. I couldn’t do 1% of the stuff that the third-year clerk is doing on this show, right? The stuff that those two clerks are doing blows my mind, right? I feel so inferior watching. You know, when I went through med school, I had this whole imposter syndrome thing, and it took me like 17 years as a professional to get over it. Now it’s back. I’m watching these clerks outperform me and I feel like I don’t belong as a doctor again.  

SH 40:36 

Well, you know, where some of my colleagues do say that they watch the show and they can’t take it. I am finding a little bit of inspiration from the way that the efficiency of the characters on the show, even though they’re talking about how their wait times are long, and this kind of stuff, when I can when I see how quickly they’re on top of things and the smoothness with which they do it. I mean, most of my life, I’ve lived by watching what’s happening on TV and then trying to live up to that ideal, right? Never mind what Bill Cosby does in real life, but Dr. Huxtable, I try to try to be what Dr. Huxtable is, even though it’s not realistic. This show makes me feel the same way. It’s like, I can be that doctor. I can try harder to be that doctor.  

DH 41:18 

All right, so if anyone is ever in the Ottawa region, and they have a children’s emergency and you walk in the emergency room and you see this grizzled, scruffy looking version of Dr. Harman, you will know that he has been inspired by Dr. Rock.  

SH 41:31 

It starts with growing the beard of the main character on the show.  

DH 41:34 

Well, that’s the easiest way to emulate your role models in real life. It’s just to wear what they wear.  

SH 41:40 

But I love the way characters, they know doses off the top of their head, even for obscure things, they’re ready to talk through procedures that they probably don’t do every day, and yeah, they just move quickly from thing to thing. I like that. 

DH 41:57 

Now, you mentioned that a lot of people in medicine are being affected by the show. I guess this is what you’re talking about. 

SH 42:03 

Yeah, absolutely. I mean, I just say this because I only heard about the show when you told me about the show, when you said, Okay, I want you to start watching the show so we can talk about it. So then I started saying to people, Oh, have you heard about the show? And sometimes, once you become aware of something, you see it everywhere. Well, that’s what this was like. Once you told me about the show, suddenly I’m realizing all these people are talking about it, and the themes I’m getting are very similar. People I’m working with. I mentioned it before earlier, but someone saying that I was two episodes in and I got tears streaming down my face. And people are saying that about not just the cases, not just this all reminded me of a sad case, but those things, like the waiting room being super crowded and you not being able to do anything about it. You want to get something done, you can’t because you don’t have the resources. Or having a patient who you want something better for but the patient doesn’t buy into it, and you can’t get it for them. Those type of things, the person who represents that character, who represents the hospital or the government, or whatever she represents, who’s the person to tell you, I don’t care about people, I just care about the bottom line. That character, just people see that, and some of them just feel that, even though there’s no one in our hospital that I would point to say, Oh, that’s the person like that in my hospital, but just that sentiment that she represents, that this seems to tag people.  

DH 43:29 

I mean, I guess what we’re saying is that there’s this whole idea of art imitating life, right? So a medical drama, by definition, is like an art imitating real life hospital. But what actually seems to be happening is that life can imitate art imitating life, right? Like the real doctors are getting affected by this show that they’re watching, which is cool. And then I will say also, from a medical humanity standpoint, like most people in the world, do not actively think about medical humanities, right, even doctors are not actively thinking about, we go to work, we do our job, we go home. Yeah, sometimes you’ll read about in the newspaper, you know, someone will write an article about, you know, lack of medical resources, or gun control or abortion, right, and the medical implications of it. So sometimes people start thinking about how medicine and life are starting to interact. This show, through pop culture, is forcing its audience to consider each and every one of these issues that normally you might never think about, right? Which I think is a really good thing. This is exactly what medical humanities is. It’s making us think about, you know, Okay, so we keep talking about poverty and health care. Well, let’s put you into the ER and see what that’s actually like. Make you feel the feels about what happens when people can’t get access to care and bring out that feeling for people. I think this show really does something on the medical humanities level that we don’t get enough. 

SH 45:01 

Yeah, you know, in so many ways, this is very analogous to art, like a painting, right? You know, you take a painting like The Scream, picture where the guys hold this out of his face. So you could criticize that picture and say, Well, that doesn’t look realistic, you know, I don’t have pale, gray skin like the guy in that picture. And when I feel depressed, the background behind me isn’t a bunch of slurred up colors. You could look at this show and say, Oh, all that stuff doesn’t happen in an hour. But I guess it’s more when art works properly, it’s what it sort of represents, and the feeling that it evokes is real, right? And that’s kind of what the show is, there’s a sort of symbolism just in the idea that, Okay, this character just dealt with a patient who’s died, who couldn’t be resuscitated, and all the emotional toll that goes through dealing with it, with the parents. Meanwhile, on the other side of the divider, on that show, there’s all these people in the waiting room, some with very trivial problems in the grand scheme of things, but important problems to them who are getting these impressions and judgments of the doctor without understanding or appreciating what that doctor is actually going through, not just in terms of busy work, but also in terms of just like emotional distress that the doctor has to deal with. And it’s not that it has to have an answer, but just that you watch the show and these things come to your mind and it makes you think about it. I guess that’s what the humanities is about. 

DH 46:26 

Absolutely. Now, last thing then, sounds like you like the show. Sounds like you might love the show. What do you think of the show overall? For people who are thinking about maybe watching it, or who haven’t even heard of it. What do you want to tell them?  

SH 46:41 

Gosh, I will refrain from any of the sort of judgments or expectations that I feel like other physicians might have put on the general public with the show, because I’ve heard people say things like, Well, at least now, when people watch the show, they’ll understand what I’m going through, or they understand how hard it is. I’m not saying you got to get that from the show necessarily, or that you should get that from the show, because it’s still TV. But I think if you are at all curious about what it’s like to be a doctor in an emergency department, at least in this day and age, I’d say give this show a watch, and remember it’s TV, okay, remember it’s not actually real life, but it’s gonna give you some snippets that have a sense of realism that I think are worthwhile, but the show’s not gonna be for everybody. 

DH 47:33 

I will say, as I was watching the show, I had to catch myself several times because I was getting the feels about, you know, something that’s about to happen, one of the patients, or something’s about to happen one of the doctors. And I had to catch myself. I’m like, wait a minute, these are imaginary things. They’re imaginary characters. They’re not real. Why do I care? And I don’t get that feeling that often. You know what it’s like? It’s like, I was watching my children watch a Disney movie a while ago, and this was a few years ago when they were quite small, and when something really dramatic happened on the screen, they got scared, and they stood up, and they had to walk out of the room, and I’m like, kids, it’s not real, relax, right? But I realized this show grabbed me by the throat and made me believe it’s real, it just felt so real that I actually and then emotionally invested in it as a 47-year-old, cynical family doctor, I mean, that says it all, I love this show. And as a former ER fan, like I was gonna get buy-in for this show no matter what, we were gonna watch it whether it was good or bad. From what I’ve seen so far, this show is better than ER. This is just better, and people need to watch it, and then they need to come back and listen to our follow-up discussion about it on MedHum, on Apollo On Call.  

SH 48:48 

I’m certainly glad the show is not a sequel to ER. I’m glad they did a brand new thing. But you know what? The other thing I’ll add about this show is for doctors to maybe watch it, at least doctors in emergency departments to watch it. Because with ER, I knew the show tangentially because I just know stuff about pop culture, I suppose, but I didn’t really watch it religiously by any means. I didn’t watch even, like a fraction of it. I’ve seen clips here and there, but after I had gotten a certain point in medicine and I saw an episode, I realized, you know what, I think it might have helped or enhanced my education as a physician to have watched some of this show, especially at the beginning. And I feel like this show can enhance your education a little bit as a physician, which is a pretty good compliment for the realism of the show, I gotta say, if you’re asking if it’s realistic. 

DH 49:33 

All right, well, if you’ve enjoyed our conversation about The Pitt, come back to Apollo On Call. Dr. Harman and I are going to be talking about our actual impression having watched the entire show, maybe in a month, two months, all right, we’ll give you some time to digest this thing. But yeah, take that time, enjoy the show. Dr. Harman, it’s always a pleasure to get to talk to you. I know you need to run off to your emerg shift, so have a good shift. But we will see you back on Apollo On Call in not too long. 

SH 50:02 

Thank you very much. I guess after this talk about the show, even if I didn’t have a shift now, I’d have to pretend I do because I have to prove to people I’m as busy as Dr Robby. 

DH 50:13 

Apollo On Call is produced by MedHum.org. Special thanks to my co-host today, Dr. Stuart Harman. To hear some more of Stu and I discussing parenting and comic books, check out the Medical Dads podcast, available on Spotify or Apple or wherever you get your podcasts. The theme song is Un Sospiro, performed by Dr. Justina Sam. For more medical humanities content, please check out MedHum.org. Thanks for listening.