Ep 5: When Pop Culture Hits Home: Doctors React to The Pitt

In this episode of the PLA Podcast, host Stephanie Costa (Director of the Alumni Program at the Physicians Leadership Academy) sits down with PLA alum and pediatrician Dr. Mary Lynn Niland for a candid and powerful conversation about The Pitt, an HBO Max medical drama that’s strikingly resonant with physicians across the country.

Far from just another TV show, The Pitt dives into the realities of working in emergency medicine—depicting burnout, moral injury, staffing shortages, and the deep emotional toll of caregiving. Dr. Costa and Dr. Niland explore why this series is hitting home for so many clinicians, and how it reflects the current state of healthcare in a post-pandemic world.

Together, they unpack the show's realism, the power of peer support, and how storytelling like this can foster empathy, reflection, and change in the culture of medicine. Whether you’ve watched the show or not, this episode is a must-listen for anyone navigating or supporting the healthcare profession.

Produced by the Columbus Medical Association

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Transcript

Welcome to the play podcast. I'm Stephanie Costa, director of the alumni program at the Physicians Leadership Academy. We created this podcast to help graduates of the PLA maintain connection to the PLA community and mindset. Today, we're going to dive into a bit of pop culture. The HBO Max series The Pitt has resonated with many physicians. It takes place in Pittsburgh, and some of the scenes were filmed at Allegheny Hospital.
I had heard about this show and kind of dismissed it, thinking, I don't need to watch another medical drama that doesn't quite reflect what it's like to be in medicine. In my current work, I have the good fortune of being a teammate and friend with play alum and COPC pediatrician doctor Mary-Lynn Niland. Dr. Niland has a special love for physicians and works tirelessly to help them enjoy a sustainable career in medicine.
When Doctor Niland looked at me in the eye a couple of months ago and said, are you watching The Pitt? I think you need to watch it. Doctors are reacting to it. It's pretty real. I decided to subscribe to HBO for the first time in my life and check it out. Most of you may not be aware that the love of my life is an emergency medicine doc.
When I played the trailer for him and asked if he would like to watch the series with me, he was a bit hesitant and understandably so. But Marilyn made a suggestion and like most of us, he trusted it. We pop some popcorn and dove in. And here we are today bringing a discussion about the Pitt to the PLA community.
Doctor Mary-Lynn Niland, welcome. I'm really excited to have this time with you for so many reasons. Well thank you Steph. I cannot believe that it's been three years since I graduated from the PLA. The class of 2022. I am, remain proud to be a part of the PLA alumni community, and I listen to so many podcasts, but this is my first time being a guest on a podcast, so this is really a great honor.
So thank you so. This is, us leaning into, our leadership as we create this podcast. Mary-Lynn, I am always amazed at how much information you take in on a daily basis through podcasts, articles and shows. And I'm always grateful that you share the especially juicy nuggets with me, particularly the ones that I can use as a coach and, that I can use to support clinicians and their leadership development.
And well-being. The Pitt has really turned out to be so much more than a medical drama. Can you give us a bit of background on how the show came to be and how physicians gave input to the script and the scenes? So of course, yes. So first step, thanks for considering me a reliable source for pop culture and well-being recommendations, including binge worthy TV shows.
I take a lot of pride in that. So I, like you, do not, tend to watch many medical shows. I did watch E.R. for many years because it started when I was in medical school. I would occasionally catch an episode of scrubs, and years ago I binged a few seasons of Gray's Anatomy because my daughter was into it for a time.
But in general, medical shows are not my typical must see TV. I think that I decided to give the pit a look because it's on HBO and they create, many of my all time favorite TV series. They just have great programing and, Derek and I watched it and we were hooked from episode one. As I can be prone to do when I like something, I can go down a rabbit hole of trying to learn and read everything I can about it.
So I'm going to give you a little brief history of how The Pitt came to be. So Noah Wiley, who's best known as Doctor John Carter for 15 seasons on E.R., had shied away from playing another physician or doing another medical show. But in his personal life, he remained a huge supporter of health care workers, supporting charitable organizations and maintaining ties to the health care community.
And then, during the Covid pandemic, he started to get numerous messages, from first responders and health care workers. Asking Carter, where are you? We need you. And he tells these stories on podcast and and interviews. And he's really engaging. But he knew that there were there was another story to tell. And so he rejoined forces with the creators of ER, where they first considered rebooting E.R., where he would go back and play Doctor Carter, just 15 years older, at a different place and time and medicine and but for a number of reasons, this idea, couldn't work out.
But instead, and thankfully, I think The Pitt was born. So the creative team is Noah, along with the producers, John Wells, Scott Gamble, and then Doctor Joe Sacks, who is actually an emergency medicine physician who was a crucial part of E.R. as a writer and a medical advisor. And now he scripts the medical cases for the Pit.
And so this team wanted to tell the story of what is now different and health care, specifically emergency medicine, and specifically the toll that the pandemic has taken and the struggles of health care workers in today's medical climate. So also interesting with the show structure and background is that they employ health care workers, including seven physicians. And my little research, I learned that most medical shows have one physician involved, but the pit has seven.
And these physicians offer ideas, write, consult, and then coach the actors to make the storylines as realistic as possible. So there's even, a person whose job is to manage the blood trajectories in every scene to make sure that it all looks realistic. Next level. The actors all took part in a two week medical bootcamp to learn the language, the procedures, the flow, kind of the choreography of a busy emergency department.
1 or 2 E.R. docs are routinely on set making sure that the details are all correct, and then many of the background actors are actually real life nurses and EMTs. And then if you haven't watched the show, I think it's helpful to know that the structure is like the, the old show 24, where each one hour episode represents one hour of Noah Wiley's character, Doctor Robbie's e.R shift on the anniversary of his beloved mentor's death from Covid.
And so, in this deep dive, I've already given you way too much information about the background of the pit, but I read a New York Times article that began by asking physicians, when was the moment you realized that the pit wasn't like other medical shows stuff? What did you notice? As you watched the first episode? Well, one of the first things I noticed immediately in that first episode was the way the doctors were speaking and interacting.
I guess not just the doctors, but all of the actors, and their language was very focused and efficient and very reflective of how medical teams really operate. And I was kind of surprised I found myself getting really excited, because I was kind of in this circle of knowing that style of communication. And then as the episode went on, you know, I was still pretty excited because I was recalling, you know, what it was like as a med student to show up.
The first day of a rotation or as the intern, you know, being kind of that, that super green member of the team and then also kind of that confidence that I felt as, an efficient and skilled senior resident. And then, even, you know, as, attendings, those intense situations where we led a team, to, to provide care in a pretty tense situation.
So, yeah, it all just kind of came back and, you know, and I'm realizing, gosh, what happened 30 years ago all of a sudden seemed pretty fresh. How about for you? Well, I think the first episode, first off, when Doctor Ravi walks into the, emergency department at 7 a.m. for a shift, like everything about him, his look, his demeanor, the I've been here and done that way about him.
He is just so perfect. As a seasoned E.R. attending. It's the first day of a new rotation, so all of the students and the residents are new, and we all know what that can feel like. The charge nurse Dana, is just complete perfection. So, like, the best charge nurses that I worked with in the children's emergency department many years ago.
And if there are emergency medicine docs listening to this, they will understand. I mean, she's so spot on. Nothing is going to frazzle her. And then about ten minutes into the shift, the white coated administrator shows up to the insanity that is the emergency department. There's a full lobby. There is a naked guy running in the hallway. There are admitted boarders who had been waiting days for an inpatient bed.
She's there to chew out Robbie for his metrics and discuss his press. Gagne scores. Now I am the wife of somebody in health care administration who hates the US versus them mentality, and we talk about that a lot. But with the show, I was like, oh boy, they are going there and this is going to be good.
So let's get into it. Yeah. And I also had the thought, you know, this is pretty darn realistic. As soon as I started seeing them at at the the bedsides, you know, but the care of the patients. But then also how the medical team was interacting with one another and, kind of that hierarchy that can take place.
And it struck me pretty quickly, what are patients thinking as they're watching this? And maybe they shouldn't see this side of medicine, but with the reality of how students and residents train and substance use disorder in a resident, or the coldness and lack of compassion in a resident who was just all about getting the procedures. You know, as physicians, there's this expectation that we are going to be perfect.
And, and people really shouldn't see that side, that reality of the training and, and the environment. Mary Lynn, you worked in a pediatric emergency department early in your career. What's coming up for you as I talk about this real side of, medicine that maybe wouldn't be great for patients to see? Yeah. So here's here's where being a PLA alum kind of comes into place.
And I feel okay, like being vulnerable and talking about the hard stuff. I think what makes the pit resonate so deeply is that while it is telling the story of an emergency department shift through patient stories, it really is practitioner or focused. And it shows the toll that health care workers face after a shift or a year or a career.
Just compartmentalize other people's trauma. Helping people on often the worst days of their lives, they see the most horrible things. Losing patients. So often failing to talk about or work through these difficult things. And so many health care workers, physicians included, destroy, ourselves in the process. I've spoken before at other venues and meetings about one of my transition points in medicine as a children's er, attending back in 2006, where I lost four patients, from a house fire.
And then my next shift. Just 36 hours later, I had another child die in a tragic car accident. And it wasn't until maybe two years ago that I work this out with my therapist, who explained that this, you know, secondary trauma has stuck with me so viscerally for so long because I didn't have the time or the energy or the space or the support to even begin to process it.
And so it got internalized and then stacked upon by another terrible event. You know, and when I think about it in this way, I truly don't know how many physicians specifically like emergency department or ICU docs do their work. Day in and day out. And then in the work that we do staff with wellbeing, we talked a lot about secondary trauma or second victim syndrome.
And I don't think I've ever seen this depicted so accurately. As you know what Noah Wiley's character is going through and how he is, is, portraying it. It's just so powerful to watch. I will say that the debriefing that Doctor Ravi tries to do with his team after a death or an especially difficult, patient case is admirable.
I mean, it usually gets derailed in the middle because there's another, trauma or sick patient to go, tend to. But I think that him trying is is, worth noting none of that happened during my time working in the emergency department, you know, almost two decades ago. And I'd be curious to know how often that truly happens in real life.
Ers today. Thanks for sharing all of that. I know I heard you speak about that a few times and, and, gosh, it just moves me. And, you know, I feel so much compassion for physicians when we see and hear what they go through on a day to day basis. And as people are listening to this, you know, I'm sure there are some vivid or perhaps even painful memories that are coming up for people we all remember.
You know, those particularly difficult or painful cases. They're just a part of our careers. And boy, do we get good at compartmentalizing, pushing down our feelings or reactions and we just move on to the next patient or the next task. And that's not what we're supposed to do as humans, but it's what we're expected to do in health care.
I think some units are putting resources in place to do debriefs and check in on, you know, the health care workers who have been through something traumatic. But I don't know that it's consistently practiced. And I think that's where we do need a bit of a culture shift. And, and take away the stigma around asking other people, hey, are you okay?
And if you're not being willing to, accept some help or ask for some help. Yeah, absolutely. You know, not taking the time to process the trauma or the pain, to feel the feelings or talk things out with a colleague or a trusted confidant or a peer supporter that really takes its toll over time. And we as physicians are often told, you know, you just need to be tougher and you need to suck it up and you need to be more resilient, like, we are some of the most resilient people on the planet.
This isn't about resiliency. This is about tending to and not ignoring our very human needs. I feel that this is why, you know, one of the reasons that the play is so unique and special is that it works to humanize medicine and, play. Graduates have learned and develop those skill sets to better handle the stressors in medicine.
But to keep making bigger scale change, perhaps people need to see the reality of today's medicine. And the pit is is a great entry point for that. Yeah. So let's just mention some of the realities that were portrayed in the emergency department on the pit. You know, they're looking at things like the number of patients in the waiting room, the anger in patients, the prioritizing and the triage of patients, and why someone is seen sooner than another.
The lack of beds, staffing shortages, pressures from hospital administrators and how that conflicts, you know, their priorities versus, the caregivers priorities. There's also threats of violence and danger every time you go into work. I mean, we see this in our own emergency departments and, hospital units. Also that very large volume of psychiatric and substance use disorder care, that's taking place in the emergency departments, in hospitals.
You know, I because of my, work early on at the children's, it is I now take care of the kids of, you know, several of the E.R. docs there, the nurses there, and then several of, like, prior OSU, er residents who would rotate through there. And just literally yesterday or earlier this week, I saw that wife of, E.R. doc at one of the hospital, systems, and I was asking how he was doing because the show has, like, really made me feel this, I don't know, like the E.R..
Like it's hard, right? And I was like, how how how's he doing? And she was like, well, we're taking a vacation. And that's really good because, his last shift, he went in at, like, I don't know, 4 p.m. and there were 62 admitted boarding patients and the department and 40 people in the lobby. So it's like, how do you how do you, you know, manage that?
You know, when the resources are so limited with there's, you know, there's beds, but there's not nurses. Like what the paint is showing is so like it's happening every day in, in our hospitals. I think that the other thing that the show, depicts, is that people working in health care are human. And they give of themselves to an extreme.
And, you know, I think that sometimes we're kind of put up on this pedestal as, like the hero or, you know, the superhero and like, we're human, like, we have stuff to, you know, spoiler alert, I guess if you haven't watched The Pit, but, you know, it's one of the storylines is a physician who suffers a miscarriage at work and just keeps on with her shift.
Doctor Robbie is experiencing flashbacks and PTSD. There's divorce and parenting issues and single parenting issues, and then, you know, there's lots of examples of, moral injury when you, are more or less forced or unable, to do something that aligns with your personal values or the oath that you took as a physician when we don't have those resources, or the insurance is pushing back or the administration is, you know, that maybe the priorities are not aligned.
I think that it shows that. And then it also. Yeah, with Whittaker, it shows, you know, the financial stressors. You know, there's a homeless medical student like, you know, living in one of the call rooms. And so I think this just does a beautiful job of showing our humanity and the toll that, a career in medicine can, can take on, on the caregivers.
And, you know, as you get deeper into this series with each show or each episode, and, it is a season long shift that is unrealistic, busy and intense. But we do have these, you know, in our day to day that are super busy and intense. But a viewer would certainly think, how long could a person do this type of work?
And so there is accurate demonstration of the physical, mental and emotional toll on the caregivers. Yeah. I think, you know, just thinking of some of the scenes that were most impactful. So, Doctor Rabbi's like, buddy at work is, is another Ed physician. Doctor Abbott. And the series starts, at the end of Abbott's shift, and he's up on the roof, of the hospital, kind of contemplating the shift that he had and a death that he had.
And then he comes in, to take over for Doctor Ravi, who is now on the the roof. And, Doctor Abbott says, you're in my spot. And that was so, like, gut wrenching, like, you know, the the toll that burnout takes, you know, and potentially leading to suicidal thoughts and, you know, I think that that in that scene, those two scenes were so like just bookends of the, the series that I saw that were so powerful.
I think, you know, showing that Doctor Ravi is human and he gets mad about things like, there are patients coming in, not wanting to listen to the medical expert, like they've got the phone and they're, you know, saying that they did their research and they're trusting Doctor Google instead of their actual doctor. And, you know, Noah Wylie speaks a lot about this, when he's being interviewed about how people so many people no longer trust experts.
Instead, they more so will will trust, like a TikTok influencer or somebody who's, you know, in a, in a moms group on a, on a Facebook feed, instead of their actual, you know, health care professional who went to school for years and keeps up with the literature. So I think that, you know, it also shows that, you know, kind of struggles, that we have obstacles sometimes that we have when our, credibility and knowledge and training and experience get called into question.
Versus somebody who just happens to have a big social media following. Yeah. And, you know, so importantly, Mary, and you touched on this earlier in many of the scenes, this show so beautifully demonstrates that our presence and our connection with patients has the ability to heal. And, you know, being present at the present is definitely something that we learned the value of during our time in play and and beyond.