TV Review -- cont.

Of course, The Pitt is unrealistic in the ways TV shows generally have to be. The recurrent characters, unless there's a good reason for them not to be, are generally quite physically attractive. That's obviously a quality that helps actors get parts -- for some of them it's about the only one that matters. And their characters are interesting and charismatic, which is not necessarily true of doctors and nurses. I mean, that's okay, they want people to watch.

 

None of the cases that come into The Pitt are routine and boring. Mostly what happens in EDs is standard stuff -- broken bones, lacerations needing stitches, acute appendicitis, heart attacks (oops, I meant acute myocardial infarctions), chest pains that might be AMIs but aren't after all, and all kinds of other stuff that doesn't produce a lot of drama. The people with the broken fifth metatarsal or inflamed appendix might well have interesting lives or qualities, but the ER staff don't know that, or much of anything about them at all. The writers have to resort to a lot of contrivance to pull interesting stories from the outside world into their universe. That includes a lot of highly unlikely coincidental connections between the staff and the patients, but obviously implausible coincidences are fairly ubiquitous in fictional plots and we just accept it.

One thing I should have mentioned when I talked about physicians treating people like shit is that the doctors and nurses in The Pitt are entirely free of any sort of prejudice. It doesn't matter if you're gay, or Black, or don't speak a word of English, or you're overdosing on opioids or drowning in ethanol, you get total acceptance and respect. I can assure you, there is plenty of evidence that all of those characteristics can result in unequal treatment. (Actually, Unequal Treatment is the title of a well-known book length study by the Institute of Medicine.) A few years back, the editor of the Journal of the American Medical Association got fired for publishing an editorial in which the authors denied this. As I say, the writers want to present an idealized world and they want their heroes to be heroic. I understand that, but don't believe it's real.

Finally, I'll close with the finale. Season one ends with a mass shooting at a music festival, obviously modeled on the horrific incident in Las Vegas in 2017. Level One trauma centers most certainly do drill for mass casualty events and yes, they do happen. And this one definitely did create an opportunity for the writers' heroes to be heroic, as indeed ED staff generally will be when such a thing happens. But such a thing, while very noteworthy and highly memorable, is actually quite rare. 

 

We call it a mass shooting when four people get shot, and certainly there have been incidents since 2017 with bigger numbers than four, but in fact five or six people showing up in the ED with gunshot wounds is a lot, and in this episode The Pitt got dozens, nearly all of them very serious and life threatening. That may be realistic in the sense that if it were to happen, it would look a lot like what the show presented. But unless you live in Orlando, Boston (marathon bombing, not a shooting) or Las Vegas, it hasn't happened in your city. For example, the worst mass shooting in Sacramento history resulted in four people being taken to the nearby Level One trauma center. (Believe it or not, there were very few serious injuries from the 9/11 attack in Manhattan because either the people got out, or they ended up under the rubble. The EDs braced for mass casualties that never came.)

So, in short, it's a TV show. I will say that what it depicts about the pernicious influence of financial pressures in medicine is salutary, but it probably doesn't go far enough. The long hours and dedication, and the emotional burdens that go with medical training and the practice of emergency medicine are rightly respected and we should all be appreciative. But realistic is a relative term.