The Thrill of Competence: Watching The Pitt
Grief and joy in endless repetition
Every generation gets their own prestige medical drama. I end up watching a lot of them despite my squeamishness. I'm not ashamed to admit that I close my eyes when Dr. Bangs on The Pitt takes a scalpel to a teenager's eye socket.
I had a couple of brain surgeries a few years ago. The first surgery was just to put a shunt in my head. The second surgery was the Big One. They popped open the back of my skull, plucked out a little tumor, and stitched me back up.
After the surgery was complete, the surgeon told my family about a moment that happened during the operation. As I sat, insensate, in a supine position with the back of my head pealed open, he touched the surface of my brain with his scalpel. My heart stopped. When he removed the scalpel, my heart resumed beating. He did it again, for some reason, and my heart stopped again.
This was, apparently, hilarious.
The Pitt is a Pit But it's Also a Pitt
The Pitt is a great name for this show. The title refers to the cute nickname the people of Pittsburgh Regional Hospital have for the emergency department. This is because it's kind of pit-like but also because it takes place in Pittsburgh (which is why they spell it with two Ts).
There are references to Pittsburgh peppered throughout the show and there were only a few little moments that hit my ear wrong (as a 20+ year Pittsburgh resident). For instance, they eat Primanti Bros, but without the requisite “I hate Primate Bros” comment from an aggrieved foodie. My brother Rob observed in the family Discord that they call Pittsburgh’s light rail “the subway” which is a sweeping and grandiose word for what we actually have (we call it “the T” and most people who live here have never ridden it). They drink Iron City and there’s a derisive reference to Philadelphia, so that’s pretty good.
While they don’t always get all the little facts right, they do get one thing right: what it feels like.
The show takes place in the late summer, around the time of a fictional music festival. I read this interview with the producer, John Wells, who went to CMU.
“We shot in early September and there’s that wonderful, muggy, warm, late-summer, early-fall feeling that we wanted to get in,” Wells said. “The way the air feels and the way in which we shot it, we worked hard to get that into those scenes when we were outside, to get that feeling that there’s a heaviness of the air.”
Wells said the crew spent time discussing how to capture the feeling with a camera “and how we were going to move at a certain pace in a way to try and get across that feeling. It’s hard to describe in any kind of specifics. It’s just the way the city feels.” - PPG
He’s so right! The city does feel like that and they captured it so well that I can forgive the tiny little bits that didn’t hit right. Notes for next season: gimme at least 1 yinzer. It’s not Pittsburgh without one! I wonder if Jon Daly is available.
Each episode of The Pitt is an hour of a single day shift in the Emergency Department. There is a palpable dedication to realism1. There are no cartoonish villains or perfect heroes or outrageous scenarios. I really enjoy the tightness of the writing and the economy of story.2
This show also made me miss being in the hospital. I know, I know, but hear me out. When I was in the hospital for those surgeries I didn’t have to worry about anything. The hospital is a building full of people who want to heal you and send you home. They bring you food three times a day. They don’t want anything bad to happen to you. If something really bad happens to your body they will try to fix it.
Out here in the world, anything could happen and I have to find my own meals. Terrible!
I wrote about these subject in previous editions:
The Thrill of Competence
The Pitt is a medical drama, but there’s another genre it belongs to: the unfortunately-named “competence porn.”3
I like watching really smart people do smart things. I like to see problems solved and lives saved by skilled professionals.
As I thought about the thrill of watching competent people I started to realize that this is something a lot of my favorites movies and stories have in common. I also suspect this is one of the reasons why people love sports? Maybe!
Great Examples of Competency as a Genre
The movie Sneakers is about a misfit red team who stumbles onto a device that can break any cryptographic code. They use it better than the guy who invented it, because they’re more competent than everybody else.
The book/movie The Hunt for Red October is about a lowly CIA analyst who figures out how a disgruntled submarine captain is going to arrange his own defection while also delivering a secret prototype into American hands.
The show Slow Horses is about competent (and occasionally incompetent) spies manage to figure things out before anybody else. More competent spies can be found on The Agency and Counterpart.
I love it when smart, capable, people solve problems because they’re smart and capable. It’s thrilling! That probably explains why it’s so common in the thriller genre lol
Entering Into the Chaos of Another
The competency is nice, but I don’t think I would enjoy a show about auto mechanics. The urgency and enormous stakes of medicine make it fertile ground for drama (which is why we get so many medical dramas).
I worked for Carlow University for a few years. Carlow was founded by the Sisters of Mercy, Catholic nuns whose devotion to helping people is summed up nicely by this quote by John Keenan:
“Mercy is the willingness to enter into the chaos of another.”
People who work in emergency rooms leap into the chaos of the acutely sick and suffering. They heal and fix and work to save people and join them on the worst days of their lives. The Pitt is fiction but it vibrates with emotional truth. I can’t tell you if it’s factually accurate, but it understands big feelings pretty well. I know a lot about those.
Grief > Joy > Grief; Repeat
In the first episode of the show, elder attending physician Dr Robby gives a med student some advice about how to deal with the constant seesaw of joy into grief and then joy again in emergency medicine.
During a chaotic crisis, Dr Robby, who has shouldered the burdens of these feelings both in himself and in his staff and patients, and the weight of the billion little decisions they make that can unravel into terrible consequences or bloom into ecstatic relief, breaks down, finally, huddled in the pediatric care room. For him, and for us, the suffering is just too great, as his past and his present collide and collapse, a staggering overload that drops him to the floor. We can't take anymore and neither can he.
The med student he advised finds him and, not knowing what else to do, joins him. Robby tells him to get up and get moving. But he’s saying this as he, himself, can’t.
There’s no monologue at the right moment that breaks the spell. They just get up and keep going. They’re not cured or refreshed, they just continue. All they can do is continue. They open the door and go back into the chaos of the dead and dying.4
They continue on, and the crisis winds down as the day ends. We follow the doctors out of the building, through the waiting room that’s already full again.
But before that, the student and Dr Robby reconnect for a minute. The med student repeats back the advice Robby gave him earlier, and tells him he knows the prayer that Robby had been repeating, in biblical english rather than Robby's talmudic Hebrew.
She-ma yisrael, adonai eloheinu, adonai echad
Baruch shem kavod malchuto l’olam va-ed -- the Shema prayer
The tension from the crisis has abated but not with a narratively easy or convenient explosive release. We do get our release, but this is it: a quiet moment between mentor and student. The story closes its long loop from beginning to end, the wise elder has imparted his wisdom and the young student has metabolized the advice into something greater for both of them.
Robby’s advice is the thesis of the show: you can’t help people on the worst days of their lives and not feel the joy and the grief as if it’s your own — the best you can do is find a balance. The only way out is through, unfortunately.
These Are Spoilers
The last few episodes of the show take place during a mass casualty event. There’s a shooting at the music festival and the Pitt is the closest hospital to the disaster, so they get the worst of it.
When the news hits, the whole hospital mobilizes to deal with the crisis, citing their own “mass shooting training.” They wheel in giant bins of emergency medical supplies. One of the doctors has military experience (we learn along the way), so he has tricks he learned by treating victims of warfare.
The ease with which the hospital moves into mass casualty mass gunshot mode is depressing and scary and sad and infuriating. I hope this is not the world we will live in forever but it's the world we live in now. Like a lot happening lately, I wish it weren’t.
no tv show can be completely realistic, of course. Drama requires the laws of reality to bend to fit the demands of the story. There are good discussions on the subreddit for the Pitt if you’re curious.
it’s a nice counterbalance to the over-written tragedy of shows like The Boys or The Last of Us, which never have relationships or subtexts that they don’t love announcing in direct dialogue between characters who already know about them
People on the internet like to apply the blank porn appellation to lots of things and I dislike every one of them. Porn is famously hard to define but anything called porn is very specifically intended to serve a function beyond simply entertaining or telling a story. The Pitt is good drama about competent people doing their jobs well.
you can watch this scene yourself for as long as the video stays up (I expect it to be taken down because these clips always are). I recommend watching everything that leads up to it first, though. I will say I also forgot the little detail of Robby pushing Whitaker away after he helps him up. The little touches like that are a different kind of competence — the thrill of watching great storytellers, filmmakers, actors, writers, etc.
Loved this show too. The only Pittsburgh inaccuracy that really took me out was when a character pronounced Wholey’s as “Holey’s”instead of “Wool-lees”.