#tv analysis

Back in February, I decided to start The Pitt on a bit of a whim. I’m not one who typically gravitates towards medical dramas; I have a tolerance of about 0% for gore and blood and there is a very good reason I chose healthcare adjacency over actual healthcare for my career path. But, I had heard enough buzz about how good the show handled character writing and mental health and the issues of US healthcare in the 21st century; so I figured, “sure, I’ll give it a shot.” And here we are, a few months later. I have not been this insane about a TV show since 2023, but something about The Pitt hooked me.

I’ve rewatched season 1 a handful of times now, and watched through bits and pieces of season 2 a few times over as well. What I keep coming back to, amidst my rewatches and reexaminations, is that The Pitt is fundamentally a story of radical hope. It is an embodiment of all the best and brightest parts of healthcare that I know, while also being cuttingly honest about the skeletons barely being held behind the closet doors.

--

What do I mean when I invoke “radical hope”?

Radical hope is a key part of both my personal worldview as well as the framework with which I approach public health and science (hi! biochem x global health student here). Radical hope is not empty platitudes, it’s not blind belief in the future, it’s not toxic positivity, and it’s not foolishly believing things will simply “work themselves out.”

To tell you what radical hope is to me, I bring you a quote from a piece I wrote titled GRAB THE LIVE WIRE:

What people often misunderstand in discussions of hope is the labor that goes into it. […] Hope is gritty and raw and jagged. Hope is homegrown and fought for. Hope is bloody knuckled and unrelenting. In other words, hope is not nice and it does not ask nicely. Hope demands. Demands better, demands us to work harder, to fight harder. Hope is the voice in your ear telling you to get back up and keep pushing; pushing for a kinder world, pushing for a brighter future, pushing for a softer fall the next time you go down.

In short, hope is not the voice of baseless positivity that tells you you won’t ever go down again. Rather, it’s the voice that says “well shit. you have to get up and you have to make the next fall hurt less. even if you’re not the one being pushed down next time.” Hope is an action, it is the labor of loving.

In the same piece this quote comes from, I lay the groundwork for an outlook on life I termed “grab the live wire.” To me, this is an invocation of the intensity with which many of us have to choose to stay alive. It is an acknowledgement that for a lot of us, we are not alive passively but because we chose— violently and viscerally and perhaps even heartbreakingly— that we were not going to die. Not yet.

To grab the live wire is to understand that being alive will rip you into yourself and that this process will be intense and messy and shattering.

--

Crash Course: Public Health Nerd Shit

Section I: Alma-Ata

A thought that runs through my mind not infrequently while watching The Pitt is, “If Alma-Ata had worked, this show wouldn’t exist. Not like this.”

The Alma-Ata Conference was held in 1978 and attended by 168 countries; it was convened with the main goal of defining primary healthcare and launching a global vision of “health for all by the year 2000.” It’s Six Key Principles are as follows:

(1) Health is a fundamental human right

achieving health for all requires intersectoral work and collaboration

social determinants of health (such as education, nutrition, poverty reduction, agriculture, and public works) are necessary to achieve health for all

health outcomes are only fundamentally improved by tackling root causes of injustice

(2) Economic and social development must be equitable

the Global North has a moral imperative to support infrastructure and social betterment in the Global South

resource extraction from the Global South must be limited if not completely eliminated

the Global North must stop perpetuating colonial dynamics and should instead invest in community based care

(3) Governments are the primary stewards of health

governments have a moral imperative to support and foster health amongst their citizens

(4) International cooperation is imperative

(5) The definition of Primary Healthcare (PHC) as a system of healthcare

health systems should be appropriate, accessible, affordable, and acceptable to the communities they serve

(6) “Health for all” requires reallocating resources from the military to social service

The US acted as a key geopolitical opponent to the implementation of PHC globally and the decolonization of public health writ large. The US benefits from vertical programs (siloed programs centering one disease or health target) because it keeps developing nations reliant on external funding. Alma-Ata attempted to lay the ground work for a version of healthcare that is in direct opposition to vertical programs.

Alma-Ata was, in many ways, rooted in liberation based politics that aim to foster agency and independence, rather than building systems that leave the subjugated beholden to the funding whims of those who extracted their resources and left their systems shattered. However, in their opposition to Alma-Ata and similar efforts to create equitable and adequate health systems, the United States has left their own citizens in the dust as well.

I take some issue with the premise of Alma-Ata in its goal for “health for all” as it doesn’t account for disabled lives within this imagined future framework for health. I believe more so in healthcare for all, because while some of us will never “be healthy,” we still deserve quality of life. That said, I find Alma-Ata to have laid useful groundwork for discussing the core issues of inequitable health systems; in this case, the United States’ healthcare system.

The United States’ healthcare system is predicated on maximizing profit first and foremost. It is, for all intents and purposes, a business. PHC defines the government as the primary steward of health; so, it follows, that to implement PHC effectively we would also need to implement universal healthcare (UHC). The US’s lack of UHC shapes every aspect of health in America. From the high rates of medical debt to the inaccessibility of life saving medication to the absolute hell of finding a provider who takes you specific insurance, Americans are left being scolded for our unhealthy lifestyles in a system that seems determined to keep us from health at all costs.

Section II: Public Health, Collective Care, and Radical Hope Politics

I pursued public health academically because I view the work of public health as a hope based form of collective care. Public health work, on all levels, is predicated on the belief that healthcare should not be treated as a privilege. Public health work is focused on improving community health via targeting social determinants of health (e.g., education, poverty, clean water) as well as on making sure the populous is informed on the health issues of the moment.

I may be “the radical hope guy” to a lot of people, but that doesn’t mean hope is inherently easy to come by in my life. The moments in the human story that I always return to as beacons of hope—as reminders that we have done so much good, as reminders that we have achieved the impossible— are always moments in public health history. I think of smallpox eradication; of the massive global, international cooperation it was born out of. I think of PEPFAR; of how the United States (yes!! the US!!) made the single largest contribution by any one nation towards disease prevention. I think of the tireless work to make the COVID-19 mRNA vaccines available to the masses. And while this may not be directly public health work, I also think of the long history of disabled people, scholars, and activists who have worked throughout the decades to make our world just a little bit more accessible.

For me, the work of healthcare, writ large, is a hope based practice. To participate in providing healthcare— whether it be directly as a nurse, doctor, or medical assistant or indirectly as a researcher or communicator— is to place yourself within a lineage of individuals who have said, “people deserve to have a chance.” To treat someone’s illness, to give them the aids that make the world more accessible to them, to give them access to the resources that will improve their quality of life, is to give people a chance. To quote one of my favorite books, The Anthropocene Reviewed by John Green, “I guess, I believe, in spite of it all, that the human enterprise has value.” That is the sentiment I bring to public health work, that is the sentiment that I believe fuels all earnest engagement in healthcare, that is the sentiment that guides how I engage with healthcare and the stories it tells.

--

Public Health Praxis and The Pitt

Before I get into a character by character analysis of The Pitt as understood by my own radically hopeful public health-pilled brain, I want to talk about the show as a whole.

This show exists within a very specific, very American political context that I hope I’ve laid out well enough. Many of these story lines only exist due to the lack of UHC in the US. For example: the kid with asthma who lost access to Medicaid or the man with diabetes who can’t afford his insulin and is in massive medical debt.

I find The Pitt to be one of the best depictions of the injustices inherent to life in America, both within and outside of healthcare. Healthcare just so happens to be an incredibly effective lens with which to magnify injustices. Within healthcare we are able to see who is granted the dignity of personhood, and who is left behind. When are the unhoused granted dignity? How much must an addict suffer before they are worthy of our sympathy? How much dehumanization will we allow immigrants to go through before we decide to step in?

Models of Public Health:

There are five main models of public health:

Biomedical

Views healthcare through a strictly biological and scientific lens

Health issues are contained within the body and not influenced by non-scientific, outside factors

Behavioral

Health issues and outcomes are the direct result of individual choice

Assumes everyone is a completely free agent with the access and ability to make the “best” choices for their health

Life Course

Frames health temporally and asks us to examine how long term exposures shape final health outcomes

Long term exposures include things like poverty, food security, and job security

Includes consideration of the impact current health based decisions will have on future generations

Especially pertinent when discussing childhood health and mortality

Political-Economic

Key to critical global health

Health is inherently political

Political status, immigration status, economic standing & debt, labor rights & conditions, access to and quality of public infrastructure all play a roll in determining one’s health outcomes

Implores us to center justice and liberation based politics in public health efforts

Social-Ecological

Frames our social experiences as being nested within one another

The Individual is contained by the Relationship is contained by the Community is contained by the Societal

Emphasizes that individual behaviors do not exist within a vacuum, rather they are heavily influenced and impacted by the people and spaces we exist around and within

Gives us good tools to decide where to look but doesn’t do a great job of answering why things are the way they are

I bring up these models for understanding health because in watching The Pitt it seems to me that the show is trying to emphasize the importance of political-economic and social-ecological models of health over bio-behavioral models.

Bio-behavioral models of health are especially common in Western, colonial outlooks on health. This is in large part due to their ability to ignore how things like political decisions and social infrastructure shape health outcomes for individuals. Bio-behavioral models turn health into issues of the individual person, rather than issues of the social order at large. They function under the belief that everyone is able to make the “correct” or “best” decisions for their health, and those who experience adverse outcomes simply weren’t willing enough.

The Pitt, in my view, works to push against that. They routinely emphasize the social, political, and economic strains that leave people in poor health. We see it in the young boy who loses his fingers because he was left unsupervised with other children. He ended up with those kids playing with explosives because he’s in his sister’s care, because his parents were deported, and his sister can’t afford childcare while she works or studies. We see it in the man rushed in by his son in critical need of dialysis who drove great lengths because the closer hospital to their home was shut down. We see it in the boy who lost access to his asthma medication because his family lost access to government subsidized insurance. We see it in the diabetic man who goes into DKA because he’s rationing insulin, because he doesn’t have health insurance, because his family makes just enough to not qualify for Medicare or Medicaid.

Over and over again The Pitt urges us to understand that most otherwise healthy people, or those with manageable illness, do not end up on death’s door completely out of nowhere. There are many dozens of compounding and intersecting factors that land you in the ER more often than not. If we look at any one of these cases through a bio-behavioral model of health, we would think that the health emergencies being experienced by these patients can be chocked up to mere happenstance. The boy just made a bad choice to hang out with the wrong kids. The man just didn’t get his dialysis. The diabetic man just decided to take too little insulin. Bio-behavioral models of health fundamentally work to isolate the individual, make them into an entirely free agent who exists separately and entirely cut off from everyone and everything around them.

Conversely, political-economic and social-ecological models ask us to interrogate the societal and political symptoms that worked to create the biological symptoms. They force us to bear witness to the failings of our government, social order, and infrastructure. To circle back to Alma-Ata, The Pitt shows us quite starkly what happens when the government does not assume their roll as the primary steward of their citizens’ health.

--

Michael “Robby” Robinavitch — Hope as a choice, life as inevitability

The Pitt is fundamentally a show about Robby and his journey through, with, and around mental illness. Season 2 in particular shows us the messy, ugly, viscerally uncomfortable realities of mental illness. We watch as Robby pushes away the people he cares about most, we watch as he blows up at them, we watch as he shrouds his worries and cares and fears in a thick coat of anger and ambivalence.

And yeah, it’s ugly. It’s difficult to watch. I see a lot of the angry self I used to be in Robby. I know intimately that mental crisis has a habit of turning you into the worst version of yourself. More than anything, though, I look at Robby and I see a man who is desperately trying to outrun himself. He’s trying to outrun the care and love he’s filled with. He’s trying to outrun the ghosts that haunt him. He’s trying to convince himself he isn’t needed because if he is needed then how can he justify leaving? For good?

I found that in season 2 we watched in real time as Robby was ripped into himself, in that “grab the live wire” way I spoke about earlier. By the end of the shift, he’s said a lot of things that I think he’ll come to regret. Some people he cares about deeply didn’t pick their words as wisely as they could have because they are all on the brink. But he was told, more than once, that he is needed. And when you’re confronted head on with all those skeletons you’ve tried to push behind the closet doors you are left with an ultimatum of sorts. Do you choose to engage with the terrifying prospect of not just surviving, but living, being really and truly alive? Or do you turn to the unimaginable?

Maybe you look at Robby and you see a cynical, nihilistic man with no hope for the future. But I don’t. I look at Robby and I see someone who so desperately chases a reason to keep going. I see a man who has contemplated death so often because he faces it so frequently; but who still wants to keep helping people. A man who feels as though he’s dying because he has witnessed so much death, and he does not know how to separate himself from those he watches die.

I see a man who has watched the system fail so often— who has seen the people he cares about be failed— and who has internalized those failings as his own. I see a man who feels as though he has something to atone for. Robby is a gritty and raw and imperfectly hopeful man. He needed someone to ask what lesson he wanted to leave the kids with, he needed people to tell him he was needed, he needed to hear it from the outside looking in that the space he takes up within the world is not simply disposable.

And I like that this wasn’t easy for him. I like that he runs from these truths even when it’s what he so desperately needed to hear. Because it solidifies that he is well and truly being ripped in. He is being pulled kicking and screaming back to the land of the living and he does not know what to do with himself. The hope I see in Robby is not one that comes naturally, but rather one that is a hard fought choice.

At the end of season 2, we see Robby cradle Baby Jane Doe in his arms and tell her that she has so many people to love ahead of her. That it will be okay. That she has so many wonderful things to see and people to love ahead of her and it will be okay. In that moment, I see Robby make the choice to hope. I see him choose life; radically and willingly and viscerally and against all the terror that surrounds it. He has chosen life, he has chosen to believe there is love ahead of all of us. Even in our darkest moments when nothing seems more impossible.

Even in his most fraught relationships, his fundamental kindness and care cannot help but to seep through. In season 2, he is angrier than we’ve ever seen him (and, it seems, angrier than anyone at PTMC has seen him). But he still urges Duke, his friend, to come in to get checked out. Because he cares, he worries, he wants the people he loves to be okay. Even in his incredibly fraught and fragile relationship with Langdon, we see glimpses of a man who wants people to be okay. He didn’t fire Langdon outright, he didn’t just send him off; instead, he told Langdon that he needed help. I don’t labor under the belief that he handled his frustration with Langdon perfectly, but I do think it is a key show of Robby’s character that he told Langdon that he could come back after rehab. Through his anger, through the pain and frustration, he sees an opportunity for someone to manage to heal. Even when he doesn’t see those opportunities in himself.

Michael Robinavitch will always, unwaveringly, be a character who I point to as an example of what it means to grab the live wire. He is an embodiment of how life is a choice, how to hope is to do the work of loving, how words alone do not save us but they can very well help guide us and those we love towards a softer fall the next time we go down. Because we will go down again, so we might as well do our best to build safety nets to land in instead of making do with the rocks at the bottom.

--

Trinity Santos and Dennis Whitaker — The Work of Dreaming

What is “the work of dreaming”?

The notion that there is labor to dreaming is a concept I first encountered while reading Leah Lakshmi Piepzna-Samarasinha’s essay collection The Future is Disabled, though this concept exists beyond their work in the wider space of disabled theory and scholarship.

As I understand it, and as I will invoke it in this essay, the work of dreaming is the labor required to dream and create better futures, better worlds, better lives. A lot of disabled theory and scholarship centers the notion that disabled futures and possibilities are endless if you allow yourself to think outside the box. Disabled existences are ones that are oftentimes predicated on creativity and finding radical and new ways of moving through the world.

As it turns out, a lot of oppressed communities have a lot of practice dreaming in the middle of complete despair.

— Leah Lakshmi Piepzna-Samarasinha, The Future is Disabled

We cannot build new futures and existences for ourselves if we do not first allow ourselves to imagine possibilities far beyond the scope of our current social order and systems. This is where the work of dreaming lies. It lies in the quiet moments with friends where you ask “what if?” It lies in late nights spent studying where you can’t help but consider “why this system of things?” It lies in the careers we choose, the fields of study we pursue, the ones we joined because we wanted to “make a difference.” Fundamentally, how do we make a difference if we have not first spent the time to imagine, in detail, what those differences would entail?

And while neither Dennis or Trinity are disabled characters, I find that their participation in the medical field is one that aligns well with the idea that there is work to dreaming. I’ve chosen to discuss them together rather than individually because what enamors me most about their characters is the way they interact with and reflect one another.

I find the work of dreaming to be most present when you are intimately familiar with the ways in which the system not only has failed (past tense), but continues to fail (actively). When all you know is your community falling through the cracks, can you really help but to imagine alternative futures?

“We were maybe not going to save the world, but we were going to save each other”

— San Alland, as quoted by Leah Lakshmi Piepzna-Samarasinha in The Future is Disabled

I see this in Dennis and his call to rural emergency medicine. I find him to be the more overtly hopeful character. He’s a first generation college student, he’s becoming a doctor, he wants to serve the communities that raised him. I can’t help but wonder if Dennis watched hospitals that his community relied on be shut down. I wonder how many people he knew died because medical care was too out of reach— too far to drive, too much to pay. Dennis’ desire to participate in an unforgiving system, one that is constantly on the brink, because he cares deeply for the people it serves is an embodiment of laboring through dreams. Laboring into dreams.

One of the foundational principles of disability justice is that nothing has to be the way it is. And there is no law saying that protests always have to be thousands of people in the streets chanting.

— Leah Lakshmi Piepzna-Samarasinha, The Future is Disabled

In Trinity, I see someone who has chosen kindness and care against it all. I see someone who has been wounded and traumatized, failed repeatedly by those meant to protect her, and despite it all she still chose to become a caregiver. One of Trinity’s defining moments in her past is her decision to choose life, even when the person she cared for most couldn’t. She may be angry at times, she may shield herself from earnestness with a cynical and sarcastic exterior, but more than anything she is a fundamentally kind individual who believes in giving people a chance. A chance at life, at safety, at honesty.

I see in Trinity someone who watched the systems fail her and her loved ones so brutally that she saw no other option than to work for the better. To fight with gritted teeth and bloodied knuckles to keep more kids from being hurt in the ways that she was. Trinity hasn’t just dreamed better futures, she is willing to fight tooth and nail to make those futures a reality.

--

Baran Al-Hashimi — Bearing Witness to Pain

Al-Hashimi began season 2 as a character I could take or leave, but she finished season 2 as a character I find myself enraptured in. In particular, I find myself captivated by the depiction of chronic illness she brings to the table and how that informs the way she practices medicine.

In the finale we find out that Baran has a seizure disorder that has flared up over the course of the shift. We learn this wasn’t congenital, but rather acquired due to a childhood infection of viral meningitis. She is anything but the perfect patient when it comes to her illness. She is in denial of its impact on her work. She is adamant that it won’t hurt her ability to treat patients. She’s determined to convince Robby that she is not a danger to herself or to others. Despite that, I believe she knows deep down that it does impact her work. I watched Baran break down in her car post shift and I saw every single car breakdown I’ve had due to my chronic illness flash before my eyes. Because to be chronically ill is to grapple with the reality that no amount of hard work will ever dig you out of illness. No amount of determination will break down the walls your body sets for you.

That said, I think that Baran’s experience with chronic illness informs her practice as a physician deeply. I find her to be deeply empathetic with her patients, likely because she has been the person on the bed more times than she can count. We see her spend her time listening to her patients, understanding where their pain lies, understanding the worries they carry with them and I cannot help but believe it’s because she knows intimately the realities of warring with your own body.

Fundamentally, I believe Baran seeks not just to treat but to bear witness to the pain of her patients because she has learned through lived experience that sometimes simply being acknowledged can change the trajectory of your care. To bear witness to pain is to acknowledge the personhood of your patient. To bear witness to pain is not just to affirm its existence, but to understand that despite its reality it does not define a person’s whole. To bear witness to pain is to say, “I see your humanity. I see your struggle, I believe your struggle. But you are more than the sum of this pain.”

--

Cassie McKay — Empathy and the Capacity for Change

Cassie’s character acts as a testament to people’s capacity for change and the tangible effects of doing to the labor of dreaming & hoping.

Cassie is a 40-something year old resident. She’s nine years sober in season 2. She has a kid that she, at some point in time, lost custody of and she was on house arrest in season 1. In Cassie we see the aftermath of a person who chose to dream a better future for herself, for her kid. Who has seen the edge many times, who has watched people step off of it, who very likely contemplated the edge herself. But she made the choice, at some point, to step back. To not just rebuild but build entirely anew.

In her work as a physician we see a doctor who puts empathy first and foremost. Who doesn’t pretend she’s perfect, who listens when she’s called in on her biases, who works to do better moving forward.

What I appreciate so much about Cassie’s character is that she is always working to improve her practice as a doctor because while she knows perfection is unattainable, she also knows intimately that change is always possible. She rarely assumes malice when others let their biases show— whether it’s Whitaker wanting to send the PCOS patient home early, or Ogilvie being undereducated on addiction— but she doesn’t allow them to go unchecked. By choosing to approach these conversations from a place of empathy she is saying, “it’s okay that you didn’t know, but now you can do better next time. We can always do better next time.”

Cassie shows up every day and she works to maintain and bolster the better future she fought so hard to make a reality. She is the tangible outcome of dreaming into better futures.

--

In conclusion, The Pitt is a show that centers empathy and hope as the response to the many injustices of the United States’ healthcare system. I chose to examine these themes through my own academic background as a global health student who spends a lot of time in and around healthcare centered spaces. To circle back to something I mentioned while discussing models for public health, no one and nothing exists within a vacuum and that includes this show. It exists within an American political and social context that is specific to the time we currently inhabit. It tells the stories that go on in emergency departments across the nation every day, and it allows us to interface with the fact that our current systems and infrastructure are killing our healthcare providers from the inside out.