Oh hey friends, it’s only 8 a.m. on The Pitt and already I have seen something I cannot unsee and that is a floating face fracture. Because what? Also how? And finally WHAT. In case you, like me, are a sicko and want to know more: A floating face fracture, also called a Le Fort III, is when, uh, how do I put this, a person’s face separates from their skull. Here, a dude riding a scooter without wearing a helmet, because people never learn, crashes and Dr. Langdon is left to reset that dude’s face. And if you think that’s gross, I haven’t even started to process the part where a nurse cuts off an unconscious unhoused man’s sweatshirt to begin treating him and three rats pop out of it. Like Dr. Collins, my answer to that is “absolutely not,” and we are moving on.
Let’s talk less about gore and more about the messy emotional stuff, because if the premiere let us know that The Pitt is going to be go, go, go on the medical stories, this second episode lets us know that this show’s focus on the technical aspects of being an emergency-medicine doctor doesn’t mean it won’t also have some major emotional moments. The Pitt is going to be fast moving with a whole bunch of medical jargon, but it’s also going to move you to tears. Prepare yourselves.
The 8 o’clock hour kicks off with the arrival of an 18-year-old named Nick Bradley who was found unresponsive in his bed by his parents. There’s no way to know how long he wasn’t breathing and all of Nick’s symptoms, especially his blown pupils, tell Dr. Robby and his team that Nick is brain dead. His parents are, understandably, confused and out of sorts when they come in and even more so when they learn his urine tests positive for fentanyl — Nick is a good boy, he’s in college but lives at home to focus on his studies, he doesn’t do drugs. Robby is afraid of what might happen if he lays on the news too quickly. He orders some additional testing knowing what the results will be just to give them a little more time. Collins calls him out for giving them false hope, but “hope is hope,” he tells her. They need some time to process what is happening before they can accept it, he says. She wishes he would take his own advice, alluding to the fact that he still hasn’t processed his own trauma around Adamson’s death and whatever else went down at that hospital during the pandemic. Robby, not surprisingly, does not want to hear any of it. Our guy, he is kind, but he is sad.
And hey, maybe Robby needs a little hope himself, too — this shift is already a doozy and it’s barely begun. He’s handling the Bradleys, he’s still trying to be there for Theresa, who can’t get ahold of her son David, the high schooler with the kill list in a notebook, and on top of this, one of his patients from the nursing home is dying.
Mr. Spencer has Alzheimer’s and has developed pneumonia that’s led to sepsis. He also has an advance directive in which he makes clear he doesn’t want machines to keep him alive. No intubation, no CPR. His adult children Helen and Jeremy arrive and are having a difficult time wrapping their minds around the fact that there isn’t much else to be done for their dad. They both have durable power of attorney, though, and regardless of what their father wanted, and regardless of Robby’s warnings that hooking him up to a breathing machine would be a painful process, Helen and Jeremy override the directive and ask for their father to be intubated. It becomes abundantly clear that it’s Helen who is unable to let her father go and Jeremy is just going along with it, seeing his sister in such distress. She justifies it as “not giving up on him,” but she’s scared and sad and grasping at whatever she can to keep her dad alive. It’s not logical, but there’s nothing Robby can do about it — even when Collins tells him that she’ll co-sign him overriding their decision in the best interest of Mr. Spencer. There’s not enough time to go through all of that red tape, he’s going to do what the family wants (or think that they want). Dr. Robby is taking some big Ls this morning.
While Robby will never get used to bad outcomes or hard decisions, he’s very experienced with them. The way Noah Wyle delivers the most horrific news should be studied, should be imitated across the nation. Any time I have to learn bad news, I want Noah Wyle to call me up and tell me about it in his best Dr. Robby voice. The kindness and the tenderness both breaks me and fuels me! While this part of the job is second nature to Robby by now, we also get a look at a young almost-doctor experiencing the loss of a patient for the first time. Remember Whitaker’s gallstone patient Mr. Milton? The one I said I was worried about? Well, that man is dead now. (I do not proclaim to have the bedside manner of Dr. Rabinavitch and I am okay with that.) Whitaker finds Mr. Wilton unresponsive when he goes to check on him out in the hallway, where the guy was moved in order to make room for a higher priority patient while they waited for lab tests. He has no pulse, they don’t know how long he’s been like that, and as Whitaker begins to run a code, Robby knows almost immediately that Mr. Milton isn’t coming back. But this was Whitaker’s first solo patient and the man was kind to him, so he is taking it hard. He is relentless in his compressions, even when other doctors tell him to call it. Robby knows that this kid needs to see this through — again, he needs time to process in order to accept it! — and tells him to run through three rounds of epi, but then he needs to stop. Lest we forget, and as all medical dramas love to remind us, this is a teaching hospital!! Whitaker is about to learn a big, heartbreaking lesson.
Speaking of heartbreaking! Nick Bradley’s tests come back as expected — there is no brain stem function — and Robby can no longer delay the inevitable. He walks into Nick’s room and closes the door. We don’t hear what he says to Nick’s parents, but we know. We know because Nick’s mother lets out a heart-wrenching scream for his son. Her wails ring out all over the ED.
To add a little salt to his own wound, Robby leaves the Bradleys and walks right into Mr. Spencer’s room to intubate a man that he knows should not be intubated. This one-two punch of causing harm and not being able to do anything about it is taking its toll on the good doctor (different from The Good Doctor). Robby, who we already know goes to great lengths to keep his patients and their families calm, who looks them in the eye and is sure to explain everything in ways they understand, is completely silent as he performs the intubation. He has no words, there are none.
Okay, on second thought maybe I do want to go back to the rats. At least then we were laughing, you know?
Discharge Papers
• Maybe people should get off Dr. Mohan’s back about taking too much time listening to patients! She’s the only one who recognizes how much pain Joyce is in when she presents with sickle cell crisis, and bulldozes through to make sure her patient gets exactly what she needs.
• What’s going on with Intern Trinity and Dr. Yolanda Garcia, our resident surgeon? Garcia seems short with almost everyone — especially Langdon, although their friendship is apparently based on being mean to each other — but takes an immediate liking to Trinity. Is she flirting with her when she lets her do a fasciotomy on a man electrocuted from a power line even when Dr. Robby thinks it’s a little too soon?
• Langdon and Mel’s burgeoning mentor/mentee relationship has become kind of lovely. He calms her down when she gets worked up after performing a cric — perfectly, by the way — but having trouble putting in the stitches after. He also checks on her after things escalate with Tyler’s parents and CPS. Mel admits she has issues processing and controlling her emotions properly and when she almost has an outburst, she needs to go get some air…and repeat her calming mantra, which happens to be the lyrics to Megan Thee Stallion’s “Savage.”
• I am deeply interested in whatever history Robby and Collins have. That little flirting moment when Robby sees a cop trying to make a move on Collins (who shuts it down like a pro, teach me your ways) is so fun. Give us the hot goss. Where are Perla and Princess when you need them?!
• Admittedly, I did go on an emotional rollercoaster when I realized Nick’s mom is played by Samantha Sloyan. Medical Drama fans everywhere might know her as Dr. Penny Blake, a major player in Derek Shepherd’s death on Grey’s Anatomy. Just order the head CT, Penny!! (She is heartbreakingly good as Mrs. Bradley.)
• Well isn’t that interesting: Dr. McKay is sporting an ankle monitoring device! It certainly takes Javadi by surprise. I have faith our little prodigy will suss out the details of whatever McKay has going on eventually. We need to know!
• Protect Myrna and her vagina at all costs!
