The Pitt: Not Your Average Medical Drama

The Pitt grabbed my attention primarily because of its location. I’m immensely proud to say that I was born and raised in Pittsburgh, Pennsylvania. I attended the University of Pittsburgh, as did my brother and many other members of my family (we prefer not to acknowledge that some members of my family also attended Penn State). I’m a lifelong Pittsburgh sports fan, particularly the Pittsburgh Pirates.

My first “real” job was working for UPMC (University of Pittsburgh Medical Center), where I learned medical ethics. I met my now wife during her internship at UPMC. I love my city and will always carry it as a part of me. So, when a new medical show is actively set in Pittsburgh, it immediately piques my interest.

After the Novelty Wore Off 

A synopsis of The Pitt (imdb.com) describes the show this way:  “The daily lives of healthcare professionals in a Pittsburgh hospital as they juggle personal crises, workplace politics, and the emotional toll of treating critically ill patients, revealing the resilience required in their noble calling.”

The show that premiered on Max on January 9, 2025, is set in Pittsburgh Trauma Medical Hospital, but any Pittsburgher will recognize that it’s actually set at Allegheny General Hospital (AGH) on the North Shore. With eager anticipation, my wife and I started watching the show, expecting the next Grey’s Anatomy, House, or Nurse Jackie. It was incredibly fun starting out, as my wife had worked for Allegheny Health Network and had an office at AGH. It’s fun to reminisce, see the exterior shots of the city, and notice little inconsistencies.

After the novelty of the setting wore off, I was struck by its realistic nature. The scene that really hit home was early in the first episode. The medical team huddles for morning rounds, and the conversation goes:

• “Good morning, good morning. Come on over. Starting with second-year resident Dr. Melissa King, fresh from the VA.”
• “Everyone calls me Mel. I’m so happy to be here.”
• “Trinity Santos, intern.”
• “Victoria Javadi, MS3.”
• “Uh, Dennis Whitaker, MS4.”
• “Welcome to the Pitt.”
• “I’m… We’ve got two traumas from the T.”
• “Five minutes out.”
• “Okay, copy that.”

Shared Language

And after hearing that dialogue, I knew this wasn’t going to be your average medical drama.

There’s a reality in the way that healthcare professionals communicate with each other. It’s something we learn and becomes a part of us. To me, and based on my experience, this style of communication is something that easily identifies you as someone who’s been through the rigors of healthcare work.

It’s similar to the shared language found in other unique professions, but the one that stands out most to me is the military. Having family and many friends who were members of the United States Marine Corps, I’ve observed that their way of speaking isn’t just a shared language—it’s a shared life experience. The acronyms, pace, and other subtleties speak volumes. If you’re unfamiliar with that style, it’s easy to miss, but once you’re attuned to it, it’s unmistakable.

During patient encounters, the main doctor is teaching the residents and medical students. He presents the patient’s condition and asks what they think the underlying condition might be, and then what treatment options would be appropriate. The students list possibility after possibility, trying to figure out what’s best for the patient.

It’s a challenging balance of the highest level of complexity, directly tied to the life and health of people. We want to make sure the patient doesn’t suffer from any mistakes while also giving the students the best opportunity to practice and learn. It’s our job to do what’s best for the patient while also teaching the next generation the realities of what it means to be a doctor in the emergency room.

Intubation Creates Moral Distress

It’s these realities that kept me eagerly anticipating each new episode. What really impacted me was the stark juxtaposition between the patients in the waiting room and the healthcare workers on the other side—struggling to navigate life-and-death situations, all while managing their own challenges. There’s a recurring character of a frustrated patient, waiting in the ED as he sees other patients take priority over him. You can see him becoming increasingly frustrated as others go through the door before him. You can see the growing anger and resentment towards the hospital and the healthcare team as he feels ignored.

But as the patient waits, everyone works frantically on situations involving life and death. A doctor becomes involved with a patient who has dementia and is suffering from respiratory distress. The medical team needs to intubate the patient to keep him alive, but that would violate the patient’s advance directive, which states he wouldn’t want to be put on a ventilator. The patient’s two children (son and daughter) disagree regarding the best course of action. Should we intubate the patient and keep him alive, or honor the patient’s advance directive and medical preference and let him naturally pass away? The son believes they should respect the advance directives, while the daughter cannot make a decision that results in death. Eventually, the son defers to the daughter, and the doctor begrudgingly goes forward with intubation, clearly knowing it’s not what the patient had stated he would want. All the while, the main doctor is experiencing flashbacks and trauma from when his mentor was in the same room, on the ventilator, and dying of COVID-19. Immediately afterward, he’s called to the next patient.

Time for Ethics?

That is the truth about working in healthcare. Beyond the common images of a white lab coat, stethoscope, and heart monitors, healthcare is an extremely unpleasant profession. It’s constant, high-level stress, difficulty, complexity, and moral challenges. Healthcare workers give their all for their patients, doing everything we can to improve their lives—yet we are often accused of prioritizing money and other concerns. We certainly understand the frustration of a patient being passed over during triage, but there’s only so much we can do. And while it never feels good to the patients who feel ignored, the truth is that the healthcare team is not relaxing on the other side of the door. We’re dealing with difficulties and struggles that very few are capable of handling. Most could be successful in easier, less stressful jobs, but most never even consider leaving the work. It’s not just a profession; it truly is a calling. That’s why healthcare workers are called to the field.

While the show gets many things correct, of course, it’s not perfect or exactly like my own personal experiences. For one, the show is set in a busy emergency department. I’ve had many clinical ethics consultations in the ED, but the majority of my work has been in areas such as the ICU and Med/Surg units. The major issue is the pace of work. The ED is known for acting at a different speed than the rest of the hospital. Decisions must be made quickly, while other units have the luxury of moving at a slower speed. That doesn’t mean they’re not as intense, just a different pace. There’s a scene in The Pitt where the doctors face a dilemma, and one asks if they should involve the ethics committee. To which another says, “There’s no time.” I didn’t agree with that, as we have rapid ethics consults, dropping everything and rushing to a patient and/or physician, but the meaning is understood. The ED, just like the NICU, is its own beast.

Humans Performing Miracles

After watching several episodes, the main takeaway for me is the amazingly true representation of the humanity of the work. Not just the compassion that everyone has for their patients, but the struggles that everyone goes through individually. We hold doctors to exacting standards and expect miracles from them because, quite frankly, they perform miracles every day. But the reality is this: these are humans. These are people. They are amazing people, incredible at what they do, and put themselves through a lot, but at the end of the day, they are still just humans. They have their struggles and demons, regrets and challenges, insecurities, and doubts—but they also have an overriding commitment to use their profession to help others.

The most telling example for me is a scene where a resident, in the middle of his shift after treating a dying patient, has a patient with a mild ankle sprain. The patient has autism, and the doctor doesn’t take the time to notice this but rather sees the patient as a challenge. Another doctor, who has more experience with similar patients, steps in and has a better interaction with the patient. When it’s all done, the one who struggled to connect with the patient asks the other doctor how she did it.

That’s the reality of working in healthcare. The job is challenging, and we will make mistakes, but we also want to learn how to be better for our patients. You can look at that situation and focus on how the doctor was rude and uncaring in his first interaction with the patient with autism and see him in a negative light. Or you can see that he’s failing to connect with a patient but wants to learn how to improve so he can be better for the next one.

Healthcare workers bear a heavy burden for the people we serve, but we are also always looking forward to using our skills to hopefully benefit our next patient. Just as I, and many others, are looking forward to the next episode of this wonderful new medical drama.

By Ryan Pferdehirt, D.Bioethics, HEC-C