Every time I finish an episode of The Pitt, I wish I could just jump ahead to watch the next one. That’s especially true of “11:00 A.M.,” which introduces some wildly compelling new threads to the season but also ends before any of them really have a chance to get anywhere. This is the premise of the show, of course. The real-time, limited perspective of the ER setting means we often leave stories dangling, with no clear resolution on what will happen next—like the septic waitress who heads up to surgery, where other doctors will now be fighting to save both her life and her leg. But the best episodes of the show manage to find some kind of central theme anyway, and I’m not entirely sure “11:00 A.M.” does.

Then again, maybe the lack of cohesion is the theme of the week. This episode features some of the most dramatic but also some of the goofiest storylines of the season. And perhaps that’s the best way to sum up the true ER experience. In one room, someone is dealing with an embarrassing but also easily treatable bout of constipation. In another, someone is fighting to stay alive. And in another, someone is trying to face death with dignity. How could that kind of environment ever feel cohesive? 

What’s most notable about “11:00 A.M.” is that this is the episode where Dr. Robby first starts to crack. Only this time around, it’s not because of an overwhelming case load or a particularly challenging patient—it’s because he finally has to interact with Langdon. Last week we got the (I think new) information that Langdon was only called into work today because someone else called out. Robby planned to head off on his sabbatical before his old mentee returned to work. In fact, there’s a chance that avoiding Langdon is actually what inspired Robby’s sabbatical in the first place. Only now there’s nowhere to run in the close quarters of the ER, and that’s clearly sending Robby reeling. 

Where most of Langdon’s colleagues are almost over-the-top in their show of support, Robby is bitter and snarky and sometimes downright cruel to his former protégé—who he blames for letting the infected waitress fall into sepsis. But is that because Robby truly feels like he can’t trust Langdon anymore? Or is our dear attending just letting his feeling of betrayal get in the way of his medical objectivity? Either way, Robby and Langdon’s fights over the waitress’ treatment are brutal—especially when it spills over into Robby yelling at a surgical intern. Yet the way they instantly fall into sync while helping Louie in the episode’s cliffhanger suggests their former chemistry is still buried in there somewhere too. 

Beyond the cracks in Robby’s façade, the most interesting thing about “11:00 A.M.” is the new patients it introduces. From the confused way the doctors react to the protocol around prisoner patients, it seems pretty clear that Westbridge is the hospital that usually handles medical cases from the local prison. And that brings back some of that sense of discovery I talked about in my recap of the premiere. Where the PTMC doctors set their watches by the morning rush of elderly patients from nursing homes, they don’t know anything about handcuff protocol or prison malnutrition or prison-security-guard demeanor. And that gives them a whole new world to discover as they figure out how best to treat their patient’s brutal wounds. 

It’s a storyline that could go in any number of different directions from here. It’s possible we’ll get some big twist about why the prisoner is locked up or what he was jumped for. Or it’s possible the show will just keep this story grounded in an exploration of the inhumanity of the U.S. prison system. Either way, I’m really curious to see how The Pitt handles this new kind of patient archetype.  

I feel the same way about the home hospice care couple and their “death doula,” night shift charge nurse Lena (Lesley Boone), who turns out to have a very unique side gig. The whole storyline introduces a brand-new energy to the series. There’s an immediate crisis that brings the couple to the ER—the wife had a seizure and injured her leg in the process. But her impending death adds different stakes to how the hospital treats her. For most patients, the fact that their injury doesn’t need surgery and will heal in six weeks is good news. But for Roxie, it’s a reminder that she may not be alive in six weeks. 

It’s a quiet tragedy—as is the moment Roxie loses yet another bit of dignity by having to use a bedpan when she can’t walk to the bathroom. But the addition of a warm, comforting, pragmatic death doula adds another emotional layer to the dynamic. Part of The Pitt’s mission statement is to teach the American public about elements of health care they might not know about. And death doulas are a welcome addition to that list. 

With all that heaviness in the mix, The Pitt makes the fascinating choice to go full-on comedy of errors this week too. While Joy proves her mettle by thinking outside of the box about medical bills, Ogilvie follows in Whitaker’s footsteps by having the worst possible first week in the ER. Not only is he exposed to tuberculosis (apparently 70 percent of doctors in training at urban hospitals are), he also gets to perform a fecal disimpaction that turns into literally explosive diarrhea. 

In fact, this episode is downright goofy at times—from Langdon and Donnie immediately agreeing that they want to watch the video of their patient getting willingly branded with dry ice (I laughed so hard) to the poor dislocated shoulder patient getting transferred from PTMC to Westbridge to PTMC again. But in its own way, that only adds to the madness. We’re officially a third of the way through this shift/season, and while the train isn’t fully off the tracks yet, this “normal” day is starting to get a whole lot more complicated. And with dear, sweet Louie coding, there’s no signs of things getting easier next hour either. 

Stray observations 

• An upside of Robby’s frustration with Langdon is that it inspires him to yell at the waitress’ boss that she’ll sue if he tries to fire her. Love to see it! 
• I also love how the waitress keeps anxiously asking questions as the doctors rush to save her. Their life-or-death work is usually on unconscious patients, and it’s interesting to see them work on someone who can spot their panic. 
• This week’s deep dive into how the diabetes patient can reduce his medical bills is exactly the level of detail I was missing from that “just buy insurance through the ACA marketplace!” chat last week. I’m glad the show didn’t just leave it there, even if there’s no “magic fix” that entirely takes away the impending medical debt.
• I’m a little worried that Samira still has no discernable storyline of her own this season. Supriya Ganesh is a captivating performer, and the character feels specifically drawn, but for some reason the show has consistently struggled to give her a compelling arc of her own. 
• I still can’t get onboard with Al-Hashimi’s love of AI, but I like the way she immediately calls out Robby for treating her like one of his residents, not a co-attending. She’s also really attentive about teaching and complimenting the people who work under her. 
• What do we make of Robby’s decision to bring Louie a beer? I’m not sure if we’re supposed to see it as him bending the rules in a charming way or an irresponsible one. 
• Gnarliest moment of the week: I thought nothing was going to top that gaping wound on the prisoner’s arm, and then Robby sliced into the septic waitress’ leg. That’s an image that won’t be leaving my head anytime soon.  

Caroline Siede is a contributor to The A.V. Club.