If you were stuck in the waiting room at the fictional Pittsburgh trauma medical center (PTMC) – and, as is the case with most real emergency rooms, to be at “the Pitt” almost certainly means waiting for hours (unless you’re imminently dying, but even then …) – you would at least have a lot to read. Paperwork and entry forms, for one. Signs warning that “aggressive behavior will not be tolerated”, a response to the real uptick in violence against healthcare workers. A memorial plaque to the victims of the mass shooting at PittFest, which drenched the back half of the acclaimed HBO Max show’s first season in unbelievably harrowing, bloody, very American trauma. Labels on the many homeopathic remedies carried, in Ziploc bags, by a prospective patient deeply skeptical of western medicine and big pharma. Promotional literature on the larger hospital system, for which The Pitt is its cash-strapped, paint-stripped, constantly beleaguered front door.
And, in its second season, which premiered earlier this month, so-called “patient passports” that supposedly help you understand the procedures and expected wait times at an urban emergency room. The leaflets are the brainchild of Dr Baran Al-Hashimi (Sepideh Moafi), the tech-affectionate, norms-challenging attending physician introduced this season as a foil to the more by-the-books Dr Michael “Robby” Robinavitch, the series anchor played by recent Golden Globe winner Noah Wyle. Dr Robby, the show’s raison d’être and the core of viewer sentiment, is skeptical of the patient passports, as he seems to be of most change at the Pitt; their introduction is one of many seeds planted in what will surely become a larger thematic battle between tradition and innovation, emotion and rationality, old, haunted attending physician and his upstart replacement.
But I took to the risible passports, as somewhat of a metaphor for why the medical drama, with its jam-packed plots and real-time pacing and occasional didacticism, feels somehow fresher in its second season than its Emmy-winning first – as a viewer passport, of sorts, to the combustible, confounding world of US healthcare. A window into a constellation of work and care that is constantly in the news and yet difficult to understand, beyond personal contact with a system that will charge you an arm and a leg for even a brief visit.
The Pitt has rightly been heralded as the most medically accurate drama ever developed for US television (though the bar is low), a show that largely does not sacrifice scientific realism for entertainment. Created by R Scott Gemmill and executive produced by ER showrunner John Wells, The Pitt finally cracked the code of a medical drama for the streaming era, seasoning the old recipe of network TV procedural with HBO-standard nudity, swearing and graphic detail; the recently aired second episode included the syringe drainage of a (visible!) eight-hour erection, the discovery of (real!) maggots living under an unhoused man’s cast and the relocation of a protruding arm bone that I watched through my fingers.
But the show earned its following less for the copious (and convincing) fake blood than its attention to the mundane details and challenges usually cut for time, with a wider scope of the healthcare ecosystem than television usually allows – the traditionally glorified doctors, of course, but also nurses, administrative staff, custodians, EMS drivers and social workers. What other medical drama has devoted time to explaining, with compassion, the process of draining fluid from an alcoholic’s distended abdomen?
Even in such quiet moments, the Pitt simmers with combustible anxiety: at any moment, something could go catastrophically awry, and it often does. Such is the nature of procedural entertainment, which even when striving for accuracy demands contrived stakes, juiced timelines and routine drama. But the makers of The Pitt, which openly advertises said accuracy, know that such also is the state of US healthcare, a perilously tenuous system where individual heroism and systemic cruelty exist side by side, whose inherent capriciousness has been supercharged by the current administration.
Isa Briones, Ayesha Harris, Fiona Dourif and Ken Kirby in The Pitt. Photograph: Warrick Page/HBO Max
The Pitt depicts realities of healthcare work that transcend nationality – the psychological weight of caring for another person, the routine presence of death – but it is, at its core, a show about the United States, where healthcare remains a for-profit system. The most medicalized country on Earth, which spends roughly twice per capita on healthcare than comparable countries, while excluding millions from it and suffering, across all income levels, from higher rates of disease and death. A country where tech companies and ungodly wealthy CEOs like OpenAI’s Sam Altman pour money into life-extension technology – some $12.5bn over the last 25 years – while the vast majority of Americans cannot afford an ER visit. A place where average life expectancy is shorter now than it was in 2010. A country facing an impending wave of hospital closures in rural areas, and financial distress for urban “safety-net” ones. The Pitt’s second season premiered just as insurance premiums soared for about 20 million people, following the Trump administration’s decision to end federal subsidies. US patients and providers endure, on a near daily basis, absolute chaos, with billions of critical funding – for mental healthcare, substance use programs and more – now political footballs subject to swift cancellation.
All of this is largely outside the scope of The Pitt, which maintains focus on the steadily dropping bottom floor of the system (literally – the Pitt’s affectionate moniker refers to its location in the basement of the larger hospital) and primarily serves as agitprop for the healthcare profession. But it very much informs the show’s overarching tension and larger project. After playing Whac-A-Mole with US societal issues in season one – state-level abortion restrictions, gun violence, medical racism and anti-vaxxers, to name a few – season two has settled two looming, long-term bogeymen: insurance and the rapid adoption of generative AI in healthcare. The former, represented by Nurse Noelle Hastings (Meta Golding), a case manager at PTMC who navigates the distinctly American problem of finding patients a hospital that accepts their coverage; the latter, by Dr Al-Hashimi, who is bullish on AI transcription services’ potential to help with physician burnout, liberate them from documentation drudgery (the dreaded “charting”) and provide more face time with patients. (Or, as Robby points out, a reason for hospital administrators to demand doctors see even more patients.)
There’s something cathartic about seeing a TV show even attempt to address this colossal mess, ham-fisted as the AI conversation may feel (to be fair, that’s how any AI conversation feels). Like most Americans, I have friends and family in healthcare. I keep up with the news. I stress about the costs of routine checkups, medications and procedures, and endure the intentional frustration of insurance claims. I care deeply about the availability and affordability of healthcare in my country and about those who work in it. Yet there is so much I do not understand, on every level. So much is infuriating. It touches every facet of our lives – it is, literally, our lives – and still remains largely invisible, seemingly impossible. So I tune into The Pitt, as a passport to a million grittier and more complicated daily realities, a safe window into a strained system dressed up as entertainment. The simulation may be simplified, turbo-charged, glossy, but the anxiety coursing through it is hyper-real.