Review of Episode 4 of ‘The Pitt’: “At 10:00 A.M.”

Emotions crested in Episode 3 of The Pitt, when the emergency department treated two college kids for accidental fentanyl overdoses. Jenna (Mika Abdalla) returned to the land of the living after taking what she thought was Xanax, while Nick, her fellow freshman, succumbed to indefinite brain death. “You killed my fucking son!” Nick’s father shouted at her in the trauma bay, and honestly, Jenna’s response – “Your son gave me the drugs, asshole” – was jarring. But for what it’s worth, she gets that now. In Episode 4, which was written by Noah Wyle and marks the 10 AM hour of Dr. Robby’s shift, as Santos and Mohan give Jenna a final check before discharge, she is startled by her own callousness. “A very sweet boy that I barely knew is dead, and just fucking made it worse.”

It’s a poignant moment of clarity, and later, she will apologize to Nick’s parents. But the scene at her bedside is also a teaching moment for Dr. Santos, whose brusque manner is sharply critiqued by Dr. Mohan, a more experienced third-year resident. Santos, the intern, gets defensive, and asserts that her life experience informs her work. Mohan shuts that down. As doctors, they bring their education to the job, not their personal baggage. And besides: “Are you aware you have an aggressive energy, Trinity? Even this conversation feels confrontational.” Jenna wasn’t interested in engaging with Santos. But she came around to owning her insensitivity over Nick’s fate. Caregiver could learn from patient here, since they harbor similar levels of defensiveness.

As for Robby, the intubate/extubate ordeal with Mr. Spencer (Madison Mason) and the dying elderly man’s adult children has entered a phase of acceptance and confluence. A packed Pitt has pushed Spencer’s progression toward a natural death into a pediatric recovery room, where whimsical forest creatures are painted on the walls. And while the attending guides the man’s family toward finality with a surehanded blend of empathy and medical authority, encouraging them with wisdom he learned from his late mentor Dr. Adamson, these same moments offer Robby himself an acute recall: this is the same hospital room where Adamson died from COVID, and we get another flashback as Robby recalls himself in PPE, amid those dangerous early days of the pandemic. 

Wyle is so, so powerful in this sequence. (And natural! “The Pitt is like ER” yadda yadda yadda – it’s just a fact that playing a compassionate but quietly jaded doctor is a definite Wyle strength.) Even as Mr. Spencer’s children express their heartfelt farewells, and Robby maintains his professional demeanor, we can see it as his personal ordeal with PTSD cascades across his features. It’s all he can do to reassure them, signal the nurse to keep him updated, and duck into the restroom before he loses it completely. It is these emotions – the death of his friend and colleague, the overwhelming helplessness of COVID  – that always kept Robby from working this particular shift. But the pace of the day won’t wait for anyone’s personal baggage – not an intern’s, not an attending’s –  though at least he gets a chance to pee while in the bathroom. And once the stress of memory has passed, it’s naturally Dana Evans, the Pitt’s genius and all-knowing charge nurse, who pauses the managed chaos of their workday to ask after her boss and buddy.

While this episode of The Pitt includes the usual staff snapshots – Langdon using saline to extract a cockroach from a woman’s ear, doctors Mohan and King diagnosing a fretting newborn, Whitaker getting another initiation as a patient urinates on the med student – it’s a walk-in treated by the enjoyable doctoring duo of McKay and Javadi which provides another moment for social commentary. “It’s Tasha,” the transgender woman (played by Eva Everett Irving) corrects the waiting room nurse. And after Javadi stitches up the gash in her arm, and McKay marvels at how the sommelier once sold a French burgundy for 18 grand, Tasha feels further valued when Javadi makes a point to adjust her misgendered pronouns in the hospital database. That wine was the best she ever tasted or sold, she tells McKay. “It was life-changing. And I know something about life-changing.”

Respect for the trans community. Acknowledgement of the scourge of fentanyl-laced street drugs. COVID as lingering specter. The Pitt is capitalizing on the trending cultural topics portion of its storylines. Of course this has always been a trademark of the TV medical drama as a form. But as Dr. Robby’s shift continues in real time, and we get to know his staff, their capabilities, and their swings and misses – “You need to run every order by a senior resident or attending,” Langdon warns Santos when she oversteps her authority, narrowly avoiding killing a patient – The Pitt does well to align its ripped-from-the-headlines cases with compelling team-ups to treat them. 

It’s Dr. Heather Collins who takes over for Jack Abbott, the doctor who initially met with a mother and her teenage daughter during his night-into-day shift. They have returned to the emergency department for the young woman’s medical abortion procedure, and Collins – remember, no one besides us and Dana Evans knows that she herself is pregnant – assures them the cursory examination she performs is only to familiarize herself with the case. Which, during the resulting ultrasound, is exactly when a flash of concern appears on the senior resident’s face. We’re going to have to wait until episode 5 of The Pitt for a resolution. But just like Robby processing his emotional damage in the exact same second he’s managing the grief of his patient’s loved ones, the challenges Collins is experiencing in her own life could be twining with her work as an ER doc.

Johnny Loftus (@glennganges) is an independent writer and editor living at large in Chicagoland. His work has appeared in The Village Voice, All Music Guide, Pitchfork Media, and Nicki Swift.