Medical TV is so back
One of TV’s most exciting debuts this year has been The Pitt on Max (HBO). In many ways, it’s a callback to the legendary 90s hospital drama ER. I’m not sure if it was originally imagined as reboot of ER, as it takes place in a different city with different characters. But given the fact that ER star Noah Wyle is the lead of The Pitt—as well as an executive producer and even wrote a few episodes—combined with the format of the show being similar to ER’s, the parallels are obvious. The show has actually run into some legal hurdles because the estate of Michael Crichton (creator of ER) is claiming that The Pitt is a derivative of ER and Crichton should be credited on it.
In any case, we can definitely see the legacy of ER in The Pitt. It’s kind of a brilliant idea to take Noah Wyle, whose career began as the clueless, ingenue medical student John Carter on ER, and put him into the role of jaded mentor 30 years later. Wyle is amazing as Dr. Robby, the attending physician of a severely overcrowded ER at a Pittsburgh hospital. Six episodes into a 15-episode season, which is structured like the show 24 (each episode represents an hour in one 15-hour shift), we can see both similarities and differences from ER.
We’re following around 10 doctors/students - ranging from residents to interns to medical students - so it’s a lot of new characters and basically unknown actors to get used to. Not all of the characters seem well fleshed-out/written at this point, but I’m open to seeing how they progress. I also found the extremely fast pace of the show and heavy use of medical jargon very jarring in the first episode or two—but I think it’s partly because I’ve gotten so used to shows with a lot less action and a lot more talking and character development. There’s little time for character development on The Pitt, because the ER is such a chaotic place and life/death decisions must be made within seconds.
However, unlike with ER, where we followed maybe 3 to 5 patients in each episode and their storylines were almost always resolved within the episode, in The Pitt, each episode represents an hour for the characters. So we’re seeing patients’ storylines continue across the episodes. That’s quite a big difference from ER, in that we get a lot more time with these patients and see how the doctors interact with them over the course of their shift.
There is one patient storyline that began in ep 1 and concluded in ep 4 that felt particularly resonant for me because of the similar circumstances to my mom’s death. Without spoiling what happens, I’ll just say that an elderly man is brought into the ER with pneumonia and his two adult kids have to decide whether to intubate him or not. Wyle’s performance within this storyline is really moving.
The audience is also navigating a backstory related to Dr. Robby, whose details are being doled out pretty slowly across the episodes. He seems to be experiencing PTSD from the early days of the pandemic, and the fact that his mentor died from Covid. The day this 15-hour shift falls on is the anniversary of his mentor’s death. So we see him really trying to tamp down his feelings of grief as he’s being pulled in thousands of directions at once.
And while Dr. Robby is in general a fantastic mentor to the younger doctors and incredibly empathetic with patients, The Pitt is also showing us some of the clashes he’s having with his mentees, and they’re written in a very nuanced way. In thinking about two disagreements we’ve seen him have with his residents, I can honestly say I see both of their points - he’s not wrong, and also they’re not wrong. Morality is not being treated as some facile exercise on The Pitt, and I think that’s the aspect that makes the show feel darker and more complex than dramas of the 90s were allowed to be.
There’s also some pretty interesting social commentary being made via the patients, which I think was also the case in ER, but feels more explicit in The Pitt - gun violence perpetrated by young men, the difficult position providers are in with respect to limits on abortion, the lack of cultural competence in treating Black patients, the treatment of trans patients, and the massive pressure ER doctors are subjected to by hospital administrators worried more about the bottom line than treating patients. (The hospital admin lady seemed very caricatured/villainy early in the season, which felt a bit clumsy to me, but then again, what do I know? Maybe they really are that insensitive.)
Apparently, a lot of people who work in ERs are saying The Pitt is incredibly realistic, particularly the chaos. And here is where I think there’s a pretty clear difference between the two shows. ER, which stood out in the early-mid 90s for its realism and fast pace, seems pretty glossy and feel-good in comparison.
That said, I’ve started a rewatch of ER this year, and what I’m realizing is how good it was! The writing, the charismatic characters, the compelling patient stories. What strikes me as particularly skillful is how the show managed to balance storytelling for its six lead characters: Mark Greene, Susan Lewis, Doug Ross, Carol Hathaway, Peter Benton, and John Carter. I can truly say there were six leads in this show (at least in the first season) and they received a pretty equal amount of screen time and personal backstory. I don’t think this is a feat many other shows have accomplished - Friends did it, which is why it’s amazing that they both debuted the same month and year (September 1994)! (Remember when NBC Thursday nights reigned supreme for 20 years - from the beginning of Seinfeld through Will and Grace, Scrubs and The Office?
On ER we saw the lead characters’ lives outside the hospital (tho less of Carter’s), whether it was Mark’s marriage, Doug’s empty one night stands, Susan’s nightmare of a sister, or Peter’s failure to balance caring for his ailing mom with advancing his career as a surgeon. And we saw the ups and downs of their interpersonal relationships with each other, like the prickly Benton matched with naive Carter and Doug and Carol’s will they-won’t they arc. Every episode, in less than 45 minutes, ER gave us 3-4 interesting patient cases and plenty of non-medical content. And they made 22-24 episodes every season!
ER ran for an incredible 15 seasons, so of course the quality varied a lot, especially when the six leads were gradually replaced by other characters as they left the show. Still, even when new characters were brought on, a few of them were able to fill the hole left by their predecessors and become fan favorites - Abby (Maura Tierney) eventually filling Carol Hathaway’s role was probably the clearest example.
Revisiting ER has me reflecting on how the post-Sopranos era was called “prestige TV,” as if the best dramas of the 90s like ER and NYPD Blue weren’t also really compelling and well-made. Perhaps it’s less about a difference in quality and more about formulaic/procedural storytelling versus serialized storytelling - by which I mean, 80s and 90s dramas had a procedural aspect (new cases every week, with some serialized storytelling about characters’ personal lives going on in the background). That’s why we had cop shows, doctor shows, and lawyer shows with new cases each week. In the era of prestige TV, the procedural element dropped out and serialized storytelling became king, as characters’ personal and psychological challenges and moral dilemmas became the focus. As someone who listens to and reads a lot of TV criticism, I can tell you that the focus of networks and streamers right now is to return to more procedural storytelling, which they see as a better financial investment; this is why you have a show like Matlock being rebooted. In this climate, The Pitt being more focused on interesting patient cases instead of character development makes sense.
It’s hard to imagine a show getting 15 seasons in our current TV landscape - although Grey’s Anatomy is still going, 21 years in! (I stopped watching years ago when I saw story arcs repeating themselves and simply didn’t care about the characters anymore). But it’s already looking like The Pitt is enough of a hit for Max to make it likely that it will be renewed. The show feels like a great throwback structurally, and a nice contrast to the “people talking in rooms” prestige model that I admittedly love. But The Pitt also has a darkness/realism that feels appropriate for our era of declining American empire.