There’s a tragicomic moment in the hit TV series The Pitt when attending emergency physician Michael “Robby” Robinavitch almost gets a moment of relief, but he’s interrupted when yet another trauma case is wheeled onto the ward.
“It’s just so true to life,” says Samina Ali, who knows from her work as a practising pediatric emergency physician at the Stollery Children’s Hospital, professor of pediatrics and adjunct professor of emergency medicine. She’s also married to an emergency doc who had a much different reaction to the show.
“Sometimes you literally can’t heed your bodily functions — like, “I’m thirsty” and “I need to pee” — because you’re on your way to the bathroom and someone calls a critical patient to the resuscitation room. Your body shuts it all down and just keeps going.”
The Crave series depicts a 15-hour shift at a Pittsburgh emergency department, following Robby and a cast of nurses, residents and medical students as they handle the chaos of cases ranging from life-threatening (heart attacks, overdoses, stab wounds and acute diseases) to absurd (an angry girlfriend glues a dog collar to her boyfriend’s neck as he sleeps).
The show scores 95 per cent on the Tomatometer and has 13 nominations for Emmy Awards, to be handed out in Los Angeles this weekend.
The show is already a winner among those who actually work in Canadian emergency rooms and teaching hospitals.
“It got so much buzz about how realistic it was purported to be that it really made me want to watch it,” says Nicole Harley, an award-winning clinical nursing professor who used to work in local emergency departments and just finished binge-watching the show.
After giving The Pitt a reality check, here’s what these two University of Alberta experts have to say about which parts of the show truly reflect a day in the life of a teaching and trauma hospital — and which ones are just a little too Hollywood for real life.
The pace is fast and the trauma is real … but there’s also a lot more paperwork.
Actor Noah Wyle, who plays Robby, had previous “medical” experience as a rookie on TV’s ER 30 years ago, but he told the Canadian podcast The Skeptics’ Guide to Emergency Medicine that The Pitt gets the details right more often than the ’90s show did.
The Pitt producers consulted with medical expert Mel Herbert, creator of EM:RAP (Emergency Medicine Reviews and Perspectives), and it even won the seal of approval from Wyle’s mom, who worked as an ER nurse.
More than 100 patients are treated during the course of the show. And though the balance of trauma to non-acute cases is higher than in a real emergency department, says Ali, the volume and intensity are realistic.
“From the patient perspective, nobody wakes up in the morning expecting to go to the ER, so they are having one of the toughest days of their lives, whether the problem is little or big, and we have to be present for it all,” says Ali, research director and principal investigator for the Pediatric Emergency: Advancing Knowledge (PEAK) Research Team and chair of Pediatric Emergency Research Canada.
One thing Ali is firm on is that there’s a lot more (digital) paperwork to be done than is depicted on the show.
“That waiting room doesn’t look much different from our waiting rooms at the Stollery these days, and when it’s backed up like that we often push our documentation until after hours, because it would paralyze the department if we did it any other way,” she says.
Students get to try everything.
Nicole Harley regularly takes groups of nursing students onto medicine, surgery and mental health wards at local hospitals, and some may also get practical experience in emergency departments later in their training.
These clinical placements are the students’ chance to practise all the things they’ve learned in lectures and labs, and they take full advantage, whether it’s putting in a catheter, starting an IV or giving narcotic medications.
“We really do try to support students in working to their full scope at whatever level they’re at, and that changes weekly,” Harley says. “It’s the best way for them to develop and grow. And we make sure they do it safely.”
Same goes for medical students, says Ali, who may have up to three learners working with her on any given shift in emergency.
But they never do anything without supervision. “It’s unrealistic in the show when Dr. Robby pops his head in and says, ‘You’re doing well with that chest tube, carry on.’ There’s no world in which I would walk out of a room where a critical procedure was being done,” says Ali.
“It would probably be a pretty boring show if we just watched Dr. Robby supervising everybody all day long, but the reality is we stay in the room. We don’t send in residents to tell someone a patient has died or has cancer,” Ali adds. “Those are really critical moments that need to be handled with empathy and love, given how difficult it will be for the family.”
Post-COVID PTSD is still with us.
Ali says it’s no coincidence that a hit show about the strain faced by health-care workers would come out right after the COVID pandemic put their work under a spotlight.
“A show that demonstrates the humanity of health-care providers and their intent to try to do their best with whatever limited resources they have, it’s pretty close to home for us and many of our colleagues,” Ali states.
Both Harley and Ali find Dr. Robby’s COVID flashbacks realistic, although they say not everyone has anxiety attacks, and different things trigger it in different health-care workers. For Harley, it’s seeing violence against her colleagues — including verbal abuse, punches and other assaults — which she says is under-recognized in health care.
For Ali, it’s putting on an N95 mask. “Every so often it just hits you and your voice hitches and you feel all that stress, that fear you had in 2021 when I thought — and I don’t think I was alone — that I was going to die caring for somebody else’s child while my children were alone at home.”
It’s especially hard when a patient or parent challenges her on why the mask is needed. “This is what keeps people safe from infectious disease, because the child in the next room has cancer and your child’s flu or measles could kill them,” she responds.
Part of the stress comes from being ready to switch gears on a dime.
Ali says the biggest challenge on the job in emergency is having to be ready for anything at any hour. Most emergency department patients aren’t critically ill all the time, but staff are always prepared to switch gears and deal with the chaos of a mass casualty event or a highly violent or critically ill patient.
“Unlike in The Pitt, we’re not doing it every hour, but we’re always ready to respond in the way they do on that show.”
That’s why it takes a team, including people like the uber-competent charge nurse on the show, who constantly walks a fine line between kindness and tough-mindedness, but also the respiratory therapists and lab technicians and residents.
Ironically, their biggest enemy is the thing that drives them to try to do everything right — perfectionism.
“We’re dealing with human lives, so we want zero mistakes. But what that model fails to acknowledge is that we are human beings providing health care and mistakes will happen,” Ali points out. “When mistakes happen, you internalize it and think you’ve failed. And it’s not just med students. It can happen in residents, in staff. We saw a lot of that through COVID when so many adults were dying that health-care providers started to feel like their efforts were futile.”
They can’t fix everyone — but almost.
Harley confesses it took her a long time to accept that sometimes patients will die despite the staff’s best efforts.
“Sometimes you can do all the right things and it still happens, and that’s really hard,” Harley says.
Dealing with grief is a daily reality in emergency departments.
“What I try to remember is that 99 per cent of the time the patients I treat get better and go home, whether it’s the same day or a few days later,” Ali says. “Unfortunately, the losses cut so deep that they stay with us and we sometimes can forget the wins. I try to remind myself that for every one child we lose, there were hundreds if not thousands of kids we supported and they went home. But every loss still hurts, and we grieve alongside the family.”
Group debriefs are essential when something goes wrong.
The Pitt team goes through several formal debriefs immediately following a loss, to examine what happened, what they learned and how to cope.
“There’s ample evidence that group debriefing is essential and effective,” says Ali. “You should debrief as a group, and very close to the event, which is why many of our teams in Alberta now do it on the spot, same day. It’s a huge improvement for the well-being of our teams.”
It’s also about self-care, whether that’s finding support from colleagues or seeking out stress-busting activities after work. Harley won a 2023 Teaching Innovation Award for her self-care program for nursing students — a response to the pandemic, workforce shortages and burnout.
“For me, I have really strong support systems outside of work. I try to go to the gym and work out,” Harley says. “And since the pandemic, I’ve really noticed the importance of connection with others and being outside in nature. It’s little things and habits you need to do every day. It’s not about that one big self-care moment.”
Patient satisfaction surveys are real, but…
There are a few notable differences between the American health-care system depicted in The Pitt and the hospitals where the U of A trains future medical professionals. Every hospital here is a teaching hospital, including in rural Alberta. Canadian patients don’t get to pick which hospital an ambulance will take them to in an emergency, and finance managers don’t usually show up during a shift, but they do take patient satisfaction very seriously.
“In the show you really see that it’s hard to satisfy everybody in the emergency department,” says Harley. “You go from spending two hours doing CPR and coding to keep a patient alive, then someone else is yelling at you because they had to wait. We often see people at their worst.”
In fact, for some health-care workers, The Pitt gets it all a little too right.
“My husband (also an emergency doc) walked out of the show,” says Ali. “He said, ‘This is too close to reality. I don’t need more of this. I do this at work already.’ So he left.”
But for Ali, watching the show is affirming.
“I found some solace and comfort and felt seen watching the show, seeing the empathetic lens with which people who do the work I do are being presented on TV,” she says.
“It’s not exactly like our daily lives, but it’s probably the most realistic portrayal of emergency I’ve ever seen.”