The Pitt Recap: Savior Complex
Finally catch your breath after last week’s unflinching look at the carnage that fills the ER of Pittsburgh Medical Trauma Center after an active shooter situation at Pitt Fest? I’m so happy for you, but also, don’t get used to it. The nightmare is not over! Actually, it might be even worse! How is this possible when The Pitt has already ruined my life (compliment), you ask? Consider “7:00 P.M.”, or, A Relentless, Traumazing Look at the Chaos Following a Mass Shooting Event, Part II: This Time It’s Personal. Watching our doctors work through this harrowing situation was hard enough when it was simply about them trying their best to save anonymous patients, but in this hour, a familiar face enters the ER and ups the emotional stakes of this whole thing. Noah Wyle has several options when it comes to which episode he’s going to submit for his inevitable Emmy nomination but, like, maybe it should be this one?
Things start out more or less the same way last week ended. It seems no one over at The Pitt got my memo about never wanting to see the wound from a bullet through the jaw again, because we get up close and personal with that cop, Richie, and it remains as horrific as I remembered. The good news, however, is that after a struggle to get this guy an airway — Dr. Robby needs to crike him but with fewer and fewer supplies, he’s going in with only “an 11 blade and prayer” — Dr. Abbott, like Dora the Explorer before him, reveals what’s in his backpack and it is a lifesaving control crike kit that makes the procedure so quick and easy, he could do it in the dark. “Why don’t we stock these?” Mohan asks, impressed. Robby’s answer basically sums up the issues at PMTC and with our healthcare system in general: “No room in the budget.”
Elsewhere, even though the night shift has begun to show up, including Charge Nurse Bridget who I instantly love (how does The Pitt continue to do this? A superpower!), it’s growing increasingly dicey over in the Yellow Section where King, Santos, and Whitaker are running the show. Some of this is their fault: Whitaker drills an IO into the arm of a very much conscious and alert clown (not a typo!), which sounds awful but does allow Taylor Dearden to gift us with the line reading of “okay, um, why’d you do that?” as King and Bridget explain that IOs are strictly for unresponsive patients. But most of the crises cropping up in Yellow are simply bad luck — once stable patients who are getting worse, or whose injuries are much more severe than they originally presented.
Take our sweet hippie with the head lac, Mr. Grayson. They find him unconscious and with no chance of getting the guy a head CT anytime soon, Whitaker gets resourceful — he uses a portable ultrasound to measure the pressure on his retina and it’s wildly high. He’s been bleeding into his brain this entire time. He needs burr holes to relieve the pressure, so King runs off to find an attending, but Mohan knows there’s no time. She uses an IO drill to drain the hemorrhage in Grayson’s head, keeping him stable enough to get him up to an OR.
Then there’s Carmen, who was running a food booth at the fest and wound up with a inguinal gunshot wound. It’s bleeding profusely and with no room to put a tourniquet above it, she could bleed out. Not even a junctional tourniquet does the trick. Again left without any available attendings, our residents and members of the First Day Club are left to figure this out on their own. While I mostly trust Mohan — a third-year resident —to drill a hole in my head when necessary, I’m less convinced I want a rogue Santos anywhere near me. And yet, the overly confident intern decides to perform a REBOA even though literally everyone who hears she is going to do this — thread a balloon into Carmen’s aorta to stop further blood loss until they can get her to surgery — begs her not to. She’s cutting off all the blood flow to the lower half of Carmen’s body, which, if it lasts too long, could do major damage. I’m still not totally sure what lesson The Pitt wants us to take away from how it treats Santos since, yeah, she pulls off the REBOA and Abbott chastises her but then also tells her she’s badass and saved Carmen’s life — are we saying going rogue and disobeying protocol is a good and safe thing? People could die! Anyway, Carmen doesn’t.
The ER is consumed with chaos. In addition to what’s going down in Yellow, all the laryngoscopes have run out of battery, making intubations a gazillon times more difficult; a man with a concealed gun freaks everyone out (Perlah diving on her patient? She is too good for this world); and yes, a certain someone does take an IO drill to her ankle monitor when it starts malfunctioning in the middle of everything else. Incel David, too, shows up to get his mom, but is tackled by police. He’s angry, he swears had nothing to do with the shooting, but they put him in a room until they can figure everything out. Through all of this, Robby has remained in charge, our fearless leader — even finding time to check in on the First Day group and make sure they’re okay. But about halfway through the episode, things take a turn.
You knew it was going to happen at some point. While outside checking on Shen and Ellis at triage, a parks department truck rolls up to the ambulance bay with four more victims (as Ahmad informs us, we’re already up to 85 patients that have come into PTMC this evening, a staggering number) and one of them is Jake, panicking as he tries to keep his girlfriend Leah alive. A bullet ripped through her heart. You know she’s a goner before they even get her inside the hospital. (Let’s be serious: You knew she was a goner the moment she hopped on that FaceTime with Robby.)
Robby can no longer see anyone else but Leah — he has to save this girl for Jake. Everyone can see him going to extreme measures to try and keep her alive. He was the one who reminded everyone that each patient only gets two liters of blood, but he gives Leah four and calls for a self-transfusion, among other things. There is a crushing moment when for a second, Robby and Dana each feel a pulse, but by the time Dr. Walsh comes over to determine if Leah can go up to the OR, the pulse is gone. She can’t take her up. From across the room, Abbott can see what’s happening to his friend; he isn’t able to separate his feelings from what needs to be done here. It’s Dana who finally looks over at Abbott, pleading with her eyes for him to do something, to snap Robby out of this, to help his friend let go. Abbott comes over and quietly reminds Robby that with these injuries, they most likely wouldn’t be able to save her even if she was their only patient and that 10 other patients will die if he stays here. He still can’t stop. Finally, he gets a vascular Doppler to check one more time for even the faintest sign of a pulse — there is none. “Okay, we’re done,” he says, holding back tears. You see it in his face: He thinks he’s failed Jake. His heart is already breaking.
Speaking of, Dana absolutely crushes my heart more than once throughout this entire sequence. The way she asks Robby if he wants her to go with him when he talks to Jake. The way she tenderly places the sheet on Leah’s body after she’s declared dead. Am I maybe just stalling for time here before I get into the truly soul-crushing moments of this episode? Sure. But that doesn’t make those moments any less emotionally impactful, okay? Okay?!
These two scenes with Robby and Jake are about as devastating as we’ve probably all imagined they would be. He takes his surrogate son into the family viewing room and as slowly and clearly as he can, explains what happened with Leah. They tried everything they could but were “unable to get ahead of the massive blood loss.” He’s doing everything he can not to fully break down here. When Jake asks if he can go see Leah’s body, Robby knows it’s not really allowed but also how can he say no?
Robby wheels Jake — who took some shrapnel to his leg — into the peds room that’s being used as a makeshift morgue. As if those fucking woodland creatures haven’t witnessed enough trauma in their lives! Jake looks at Leah’s body and immediately blames himself for getting her killed and then almost as quickly, starts to blame Robby. “Why couldn’t you save her?” Whatever little bit of glue that was holding Robby together evaporates. He’s reliving “letting” Adamson die (in this very room!) and begging Jake to believe how hard he tried. When he starts on about how if this had been any other day — bad move, my man! — Jake calls him on it. “What the fuck does that mean?” Does it mean he could’ve saved her?
There is no doubt this will torture Robby. That “yes, no, I don’t know, I don’t know” has been replaying in my head since I first heard it. He is desperate and broken and grasping for any way not to completely break down, but he never finds one. “You didn’t save Leah,” Jake, also in tears, says to him. Robby starts sobbing. “I don’t know how many people I’ve helped today but I can tell you every other person who has died,” he says before going on to list every patient he — and we — have watched die during this shift. Mr. Spencer. Nick Bradley. Mr. Milton. Sweet Amber. “And I’m going to remember Leah long after you’ve forgotten her,” he practically yells. Every single death leaves a mark on him and finally he is feeling all of the ones he’s tried to keep at bay today.
The flashbacks to Adamson dying kick in, Robby hears that ringing in his ears, and this time he cannot stop what’s about to happen. He gets Jake out of the room as fast as possible. It’s clumsy and almost cruel — “oh fuck, oh fuck I’m sorry” he blurts out — but Robby knows he is having a full on breakdown and he doesn’t want Jake to see it. Alone, save for the dead bodies, he drops to the floor and can barely breathe, he is crying so hard. There, against the mural of those friendly cartoon forest animals, Robby has cracked wide open.
Discharge Papers
• Noah Fucking Wyle, everybody!!!
• Aside from everything with Jake and Robby, the other moment that brought me to full on tears was watching Kiara and Lupe solemnly taking photos of one of the dead bodies to match with family members sending in pictures. All the noise outside that room goes away in a moment that is both chilling and full of reverence.
• Also chilling: When Javadi returns to the ER with a blood delivery and asks who needs some, the room gets silent until Nurse Jesse replies, “everybody.”
• When King explains to Whitaker that he should not have drilled into that clown’s arm and that IOs are only for unconscious patients, Santos adds “Unless it’s a mime, they can’t scream.” Say what you want about the woman but that’s a solid joke. (The fact that even in a crisis like this she is still walking around cherry-picking the most interesting cases? Not as funny.)
• King is so kind and gentle with the woman in the sling who is clearly in some form of shock, another moment to break your heart.
• My list of horrific injuries I never need to see again continues to grow! Add to it: Langdon’s popped carotid wound. No thank you!
• I love that The Pitt is showing us how much these younger doctors have grown, even in the course of one shift. It’s especially apparent in Mohan, who is adapting to the time constraints and making quick decisions for her patients here. She watches Robby, Abbott, and Langdon all pull off some fast-thinking, resourceful moves and then she goes and saves a guy with an IO drill to the skull.
• Was anyone else hoping Collins would burst through the ER doors and swoop in for some incredible assist? We need her! I mean, they need her!
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