While attempting to distract himself from the anniversary of his mentor's death, Dr. Robby introduces a fresh batch of interns to life in the ER. Robby helps siblings navigate their elderly father's end of life care. Samira fends off cops targeting a woman with a misunderstood condition.
The COVID-19 pandemic was the most overwhelming and traumatic experience the health care industry went through. It left a lasting impact on the profession. Dr. Robby has previously refused to work one specific shift every year. It's the anniversary of his mentor's death. He's in charge of the emergency department. He affectionately refers to it as "the Pitt." It remains chaotic. Everyone is struggling to provide care. The story serves as a commentary on the current state of the industry. Robby talks about the challenges of patients being boarded in the Pitt because there are no beds to admit them elsewhere. He cites the lack of a living wage as the reason why the nation is suffering from a nursing shortage. He believes patients should appreciate his hard work when they leave alive and healthy. That's the only satisfaction he desires. And yet, hospital management expects more from him. They want better reviews. They don't offer the support necessary to streamline the system though. And so, everything remains exactly the same. The doctors and nurses are tasked with going above and beyond to provide care. That means serving in a variety of roles. They have to care for one another too. This shift makes the first day for a new group of interns and medical students. At times, it's difficult to discern their skill levels because they are thrown into the deep end. They are also guided by people who don't want the system to fail anymore than it currently does. That means pointing out when a gallstone may not be the sole source of pain. That means having tough conversations and being completely blunt about what's needed. Javadi doesn't want to be seen as a nepo baby who only got into the rotation because her mother is the chief of surgery. She's the only one with that expectation. Everyone else remarks on how young she is. She's learning. It's important for her to get this experience. That also means people have to be willing to share themselves while going through the most uncertain and painful moments of their lives.
This series serves as an ER reunion between star Noah Wyle and creatives R. Scott Gemmill and John Wells. One can clearly see the influence from the former show in how this one depicts the healthcare system. The narrative clearly strives to be its own thing too. The drama certainly thrives on jumping from one case to the next. The doctors and nurses barely get any time to breathe. The storytelling expertly weaves in and out while certain patients are waiting on results to come back. Some stories are important for more than a few minutes. Some can be treated and resolved in the same amount of time. The staff don't know what to expect. They have to be willing to handle anything. The expectations are established early on that Robby and Collins deserve some grace during the shift. Robby is working despite his trauma from the pandemic pertaining to this specific day. Meanwhile, Collins is pregnant and reluctant to tell anyone because it's still too early. They butt heads. That could infer something more between them. Right now, that doesn't seem likely. The focus is primarily on the cases. That's how these characters are of service. Time is provided to develop personality. It's all a delicate balance. The real-time aspect allows for some uncertainty. It breaks up the typical pace of medical procedurals. That's actually refreshing. It allows the viewer to be grounded in the moment and experience the chaos alongside the ensemble. Humanity is still on display. People are working in a complicated system. One that needs help. They have the resources to treat injuries. They worry about how people are doing. Yet they have to be willing to accept that help too. David runs away when Robby and the social worker want to talk. He doesn't want to confront his dark thoughts. That echoes from the early moment when Robby talks Abbott off the edge of the roof. Everyone makes a choice to keep coming back for this work. That's a start. It's the beginning of a complicated journey that's bond to intensify as the season continues.
Right now, the show is setting expectations. It knows when to pull out the typical dramatic beats associated with this genre. The episode concludes with Whitaker refusing to accept that his patient has died. He was gone the moment he was found unresponsive. The med student was just waiting on lab results. They didn't arrive in time. There was nothing more that he could do. That's brutal to experience within the first two hours of working in the Pitt. Meanwhile, Santos remains excited about all the injuries that come in and the procedures she gets to perform. She aligns better with the spirit of this environment. She has the dark sense of humor that allows everyone to cope with what they experience daily. And yet, she has done nothing to earn the respect of her peers. She bemoans Javadi for being upset over a nickname. To her, it's no big deal. It's a way to make fun of a situation. The staff have moved on from Javadi fainting though. They don't have time to linger. They have to constantly be moving. The Pitt is full of patients who need their attention. Javadi takes care of herself so she can continue to take care of others. She doesn't need the reminder. Of course, she makes assumptions about others when she didn't want others to do so to her. She bonds with McKay. They have a perfectly relaxed dynamic. One that shows McKay as willing to teach. Everything changes the moment Javadi is alerted to McKay's ankle monitor. After that, she's tentative about the dynamic. She wants answers. She doesn't go to the person who can provide them. Instead, she asks the one person who has spent just as much time in the Pitt as she has. The nurses already expect a brawl to break out between Javadi and Santos at some point. Again, that's the show setting expectations. It's commented on now. The nurses serve as surrogate observers for the audience. Robby is impressed Whitaker listened to the nurses. That was the right instinct. The audience should take what they have to say seriously too.
The narrative also understands the priority of character development. The majority of the time is spent on the medical cases. The doctors and nurses don't have any time to do much else. For brief moments, Robby and Collins reach out to the other's humanity. They shut down those appeals rather quickly. It's Robby's job to manage the staff. He has to look out for them. He needs them to be performing at their best. If not, then the entire department suffers. He has to manage these difficult personalities. The system itself demands so much of him. Sometimes, actions are dictated by federal standards to keep funding flowing. Other times, he has to laugh at the expense of management wanting to shut the Pitt down. He aims to respect a patient's advanced directive. And yet, the patient's children don't want to let go just yet. Robby explains how intubation will likely only cause further pain and confusion. They don't listen to him. And so, Robby is stuck having to do something he doesn't want to do. It's achieved through informed consent. Elsewhere, Robby has to break the news to parents that their college-aged son is braindead following a fentanyl poisoning. The lethal drug was probably cut into something generic the patient took to achieve a simple purpose. It proved to have costly consequences. No one wants to accept that brutality. It's what needs to be done. Similarly, Langdon and King are required to report a child testing positive for THC. It was a pure accident. Langdon cynically knows the parents will get off with a warning due to their race. The system operates exactly how everyone expects it to. The social dynamics don't offer many surprises. The doctors and nurses can predict how human beings will react. The medical crises drive the chaos. That's what unlocks the uncertainty and unpredictability of this place. That drives each of them forward. Expectations are set. It's bound to get worse in the Pitt. King notes the danger of only having one operating room on standby for trauma. Mohan is the only one who sympathizes with someone having sickle cell pain. No one is perfect. That applies to the staff. The shift has barely started. They've experienced a lot without making a dent in the waiting room.
