Why it was so hard to watch The Pitt
Dr Sarah Whitelaw
Emergency Physicians Specialty Group Representative, AMA Federal Council
It took me four months to watch The Pitt. I kept stopping mid-episode, and while I always looked forward to the next one, I knew I might cry.
I’ve never seen my work so accurately reflected back at me – the clinical scenarios, the colleagues, and the system issues that are so fundamental to the joys and challenges of emergency medicine.
The show takes its name from the Pittsburgh Trauma Medical Hospital emergency department (ED), though I’ve heard EDs generally referred to as “the pit” throughout my career – both affectionately and not, depending on which colleague is commenting. I’m increasingly asked about the show: “It’s only like that in America though, isn’t it?”
I’ve shocked quite a few friends now by explaining almost everything in it could be happening right now in EDs across Australia. The waiting room chaos, the occupational violence, the lack of beds to admit patients when they’ve completed their emergency care.
The clinical cases are also wildly accurate (though they don’t usually occur all in one shift). And, unfortunately, so too are the burnout and moral injury of the staff. This is particularly true for senior emergency physicians, who are exhausted by being unable to provide the clinical care they know their patients deserve, and seeing those patients slip through the cracks of the healthcare system.
The Pitt’s incredible realism is surely a reflection of the showrunners’ brilliant medical consultants – one of whom is our own Australian, but US-trained, Dr Mel Herbert. They’ve insisted on clinical accuracy – no added drama or blood, just what we manage every day.
Their mass casualty incident management is a familiar orchestra of teamwork we all prepare for; that many of us have participated in, although on a much smaller scale.
The shadow of the COVID-19 pandemic still lingers, though our experience was different. Putting N95s back on after wearing them every shift for almost three years will never cease to stir memories, many of which haven’t yet been fully reconciled.
“I had to pause the show because of the memories of patients coming back to me. And I think my tears were from relief. That somewhere, they’re all still there. Deep in my memory, in my heart and my head.
Granted, we don’t usually do brain death studies in Australian EDs, and I’ve never ordered a mercury level. But if I did, it’s unlikely it would be back before the end of my shift! The relentless progression from one case to the next, however, with zero decompression in between is beautifully depicted, as is the approximately four minutes between interruptions for emergency physicians; although it feels like the Pitt doctors often get the luxury of time to focus on their individual patients. In reality, we are often dividing our time much more thinly between multiple patients simultaneously. They also never seem to write notes, jostle to find a computer or a chair, wrangle a fax, or wait for a page to be answered.
The thousands of hours of non-clinical work, research, training and continuous study it takes to lead an ED and manage hundreds of multidisciplinary staff don’t lend themselves to good television, and they’re not visible in this season. But the incredible collegiality and dark humour of the whole ED team, the reliance on each other to understand the indescribable parts of our job, and the coping strategies we have, are all there.
So too is the pressure on our doctors in training, many of whom must juggle their primary carer duties, while under increasing financial pressure and stress to complete training requirements and tough exams. One senior resident in the show, Dr Collins, suffers a miscarriage and then continues her shift. The scene took my breath away with its accuracy, as I’m sure it would for so many of Australia’s female doctors.
I felt the constant vigilance required for potentially very sick and sometimes dying patients whom we can’t get to – in the waiting room and ramped in ambulances – and the need to create space for them when there isn’t any.
I loved Dr Whitaker and “the rat”, where he takes matters into his own hands (literally). It shows the absurdities that crop up every shift – things I used to be frustrated by, but now have come to find simply funny. There’s always some bizarre scenario you have no training for, that needs a solution right now, that’s nowhere in the hospital protocols, that falls to you and the nurse floor coordinator (Dana) to sort out because you’re the “in-charge emergency physician”. And somehow, we always do. These writers have spent some serious time in emergency medicine.
I had to pause the show though, because of the memories of patients coming back to me. And I think my tears were from relief. That somewhere, they’re all still there. Deep in my memory, in my heart and my head. Because at times I’ve worried they weren’t, that my coping strategy was to just move on unaffected.
My lovely director once asked if I was ok after a neonatal death in my care. I was surprised at being asked, and because I had nothing to say. I felt completely fine. We had managed the case as well as we could, and we needed to get back on to the floor because it was busy.
I’ve wondered about us as a profession, and all the other first responders. What does it do to you to have to move on so quickly from tragedies? And how do we snap back into being partners and friends and parents and carers for the other people in our lives? I’m nowhere near the level of burnout as Dr Robby, but I have been, and I see it in our specialty.
A sabbatical and some long-service leave with my family, and some great coaching, have rekindled my true love for emergency medicine. It has also helped me accept that I can’t fix the healthcare system while I’m at work.
I save that for the time I spend participating in the AMA, and I truly don’t think I could continue my clinical work if I didn’t have the opportunity to try to improve the system issues that impact all our patients through AMA advocacy.
The patience, gratitude and grace of patients and their families, and the societal impacts on their health, are all included in the show. The pride we have in our team, our commitment to excellent clinical care, the diversity of our teams, and the strengths of that diversity in being able to care for our patients. The satisfied exhaustion that comes from bringing order to chaos; the importance of leadership in setting culture and in facilitating early career doctors and the ED team to utilise their skills and deliver the care they have been trained for.
I truly think my job as an emergency physician is one of the best there is, but I’ve never been able to explain why, or why it contributes so significantly to who I am as a person, even when I know my job does not define me.
We all know the value of storytelling, and I agree wholeheartedly with Dr Robby in his final speech to his ED team.
“This place will break your heart… but it is also full of miracles.”
It really does, and it really is. And being able to show our friends and family is a rare gift.
Make no mistake, The Pitt is an edited and compressed television show, but it is an eerily accurate depiction of work in an ED, even the one nearest you.