‘The Pitt’ Isn’t ‘ER.’ But It Might Be Just as Good

I spent a few hundred hours last year rewatching every episode of ER while on the treadmill. I even rewatched some episodes multiple times, because there are just days when the only way to power through is with the help of the one where Noah Wyle’s John Carter takes command of the emergency room after a benzene spill and saves the day. Often, as the closing credits rolled and the treadmill went into cool-down mode, I would think, They don’t make ’em like this anymore. The hospital show landed on NBC in the fall of 1994 like a thunderbolt and stuck around for 15 years. In the process, it made stars of George Clooney, Julianna Margulies, Wyle, and many other actors, and literally changed the pace at which television drama moved. It was a groundbreaker, but also in a lot of ways the pinnacle of the pre-cable revolution era of TV: a television show structured like so many others had been before, but executed at an incredibly high level of acting, writing, direction, production values, and everything else. It could follow one character arc over a long period of time, like Carter going from naive and overwhelmed med student to the most seasoned and cynical doctor in the place. Or it could just floor you with a medical case that only lasted for a scene or two. 

As we move into a post-Peak TV era — when you’re lucky if your favorite show makes 10 episodes in a season (as opposed to eight or, more likely, six), and when all but a handful of very old shows from a different time(*) are lucky enough to stick around for more than a few seasons — it’s hard to imagine a new show debuting and sticking around for a decade, making lots of hours every year while keeping its creative ambitions relatively high. But dammit if the new Max hospital drama The Pitt, which reunites several key ER contributors, including Wyle himself in the lead role, isn’t going to try. 

(*) One of those, Grey’s Anatomy, even overlapped with the last few years of ER, and you could see the latter show straining to make itself resemble the hot newcomer. ER was in its 11th season when Grey’s debuted; Grey’s is currently in its 21st. Time is a flat circle. 

Starring Wyle as Pittsburgh doc Michael “Robby” Rabinavitch, The Pitt is an attempt to make television that looks and functions like television, rather than a long and bloated “10-hour movie” from filmmakers who don’t like or understand this medium. Here, the creator is ER veteran R. Scott Gemmill, and one of the producers (as well as director of the first episode) is longtime ER showrunner John Wells (whose list of series credits also includes The West Wing, Shameless, Southland, and China Beach). There are 15 episodes in its first season — not quite the traditional 22 of the ER glory years, but a length that feels like a proper meal rather than the amuse bouche of six episodes — and after a two-episode premiere, we’ll get one a week, just as God and Philo T. Farnsworth intended. Though there are many serialized elements, it understands the importance of making sure each hour is a satisfying unit in and of itself. And it cares about dramatizing the process of its characters’ work at least as much as it cares about any ongoing personal problems these doctors and nurses are dealing with. Not all of it works, but it’s incredibly satisfying to see just how effective this old idea can still be. 

The estate of Michael Crichton, who is credited as the creator of ER because the series used an old script of his for its pilot episode, has filed a lawsuit alleging that Wells and Gemmill are attempting to make an ER sequel in everything but name, after negotiations fell through to do an official revival about an older John Carter training a new generation of emergency physicians. Certainly, there are moments throughout The Pitt that riff on Wyle’s screen history with this profession. The first episode shows Dr. Robby leading a group of young medical students and residents on a tour of their new workplace, their faces just as much a mixture of terror and wonder as Carter’s was when his gruff mentor Peter Benton led him around County General on his first day. That sense of history rhyming with itself keeps returning, as Wyle frequently winds up playing familiar John Carter scenes, only now he’s the senior doctor dispensing wisdom — and, on occasion, anger — in moments where he was once the screwup. ER obsessives might, for instance, latch onto a scene where Robby coaches senior resident Dr. Langdon (Patrick Ball) and med student Whitaker (Gerran Howell) through an escharotomy procedure, where they cut deeply into the flash of a burn victim to offer him relief, and recall that when Carter was once in that position, he got nauseous and couldn’t finish. (No spoilers on how it goes here for young Whitaker.) Even Robby’s salt-and-pepper beard could be read as a callback, since Carter occasionally grew out his facial hair (much to the chagrin of fans of Wyle’s baby face) when he was feeling particularly sour about the state of his life and career. 

But that kind of knowledge isn’t necessary to appreciate The Pitt. And in (non-legally-binding) defense of Gemmill and Co., the various elements of the show that feel familiar have also popped up in a few dozen other hospital dramas over the years, several of them long predating ER. It’s a genre with only so many themes, and only so many variations on those. (Good luck finding a hospital drama whose pilot episode doesn’t have a scene where an anxious newcomer is given the lay of the land.) ER frequently came loaded with clichés, but it presented those clichés with so much energy, so much technical brilliance, and so much charisma from its cast that it didn’t matter.  

The Pitt is set in the present, and if you’ve been following TV hospital shows for years — or if you’ve been unlucky enough to spend a lot of time in real hospitals — you know that some things have changed substantially. For starters, nobody calls them emergency rooms anymore; it’s an emergency department, so Robby and everyone else refer to it as “the ED.” Medical technology has improved, while the health care system overall is far, far worse. The triage room of Pittsburgh Trauma Medical Hospital is constantly overflowing with patients waiting eight-plus hours just to be seen, in part because the ED has to board too many patients who should be admitted to other parts of the hospital, but who instead stay down there for hours or days because the hospital is too understaffed to properly tend to them all. Everyone is on edge all the time, from frustrated patients who scream things like “This place sucks! I will destroy you on Yelp!” to nurses who have grown numb to the horrors and dangers of the job. (When one of them is attacked and injured, another matter-of-factly tells a newcomer, “We’ve all been assaulted.”) 

The key demarcation between ER and The Pitt is a roughly real-time format. Though the episodes here are all at least a little shorter than 60 minutes, they take place on consecutive hours across a single shift at the hospital — which happens to be the first day here for med students Whitaker and Javadi (Shabana Azeez), intern Dr. Santos (Isa Briones), and second-year resident Dr. King (Taylor Dearden). 

The structure is a mixed bag, and seems to exist primarily as a way to make clear that, no, this is not ER 2025. On the plus side, the compact nature of it forces a greater emphasis on the medical stories. There are still subplots about personal lives — senior resident Dr. Collins (Tracey Ifeachor) begins her shift discovering that she’s pregnant, a secret she shares only with wise head nurse Dana (Katherine LaNasa), while we gradually learn that Dr. McKay (Fiona Dourif) has a complicated personal life she’d rather not share with new co-worker Javadi — but it never feels like romance is becoming the primary narrative engine(*). There’s also a chance to follow cases for an extended period of time without the show having to stretch the boundaries of what emergency doctors do. Whether the outcomes are happy or tragic, the impact of seeing them play out over multiple hours can be very potent. And every now and then, The Pitt even gets to be playful with the gimmick: Unlike Jack Bauer on 24, we see Robby struggle to find an opportunity to pee amid one crisis after another. 

(*) For some viewers — say, ones who watched ER first and foremost for Doug and Carol, or who watched Grey’s for Meredith and McDreamy more than for the surgery — this may be more bug than feature.    

But there are also plenty of times where it feels genuinely insane that all of these things are happening in a single shift. It’s not the patient load, since a busy urban trauma center would of course have lots of cases of varying degrees of severity on any given day. Rather, it’s that characters over this one day go through the kinds of arcs that ER — or any other medical procedural — would let play out over months in its doctors’ lives. One of the med students alone goes through so much emotional and professional growth through the season’s first 10 hours that it’s a wonder Dr. Robby doesn’t tell them that they’ve been granted special permission to skip their last two years of school and begin their residency immediately. When Langdon and Santos have a disagreement, he comes across as an arrogant jerk, but also observes, not unfairly, that she is questioning how things work after being on the job for literally seven hours. Arguments repeat over and over — say, hospital administrator Gloria (Michael Hyatt) complaining to Robby about patient satisfaction scores, and Robby in turn asking her to solve the boarding problem — in a way that makes sense over multiple weeks, but not all in the same day. There’s also awkward exposition designed to remind the audience about patients and subplots we last saw weeks ago, even though it hasn’t been nearly that long for the doctors. (Robby to Dr. Mohan, played by Supriya Ganesh: “How’s Joyce, our sickle cell patient, doing?” Mohan for some reason does not reply, “I know she has sickle cell. Why did you feel like you had to tell me that?”) 

In success, The Pitt would probably do well to ditch the real-time idea, especially since there are plenty of other ways the new show distinguishes itself from the one that it is not an official continuation of ER. There’s Pittsburgh flavor sprinkled throughout, including an end-stage dementia patient who used to build sets for Mister Rogers’ Neighborhood, and a loved one sending all the doctors sandwiches from Primanti’s for lunch. The ED itself is all stark and sterile white, as opposed to the messy greens and yellows of Cook County. And while the tempo can ratchet up quickly during traumas, The Pitt at many other times is deliberate in showing the ebbs and flows of the job, including several scenes where Robby pulls everyone aside to spend a few minutes reflecting on the loss of a patient, and/or the ways a particular case went poorly.  

It’s a big ensemble, and the mix of ED veterans and rookies makes it tough for anyone but Wyle, as the most known quantity, to pop for a while. Over time, though, every character becomes more fully rounded, and the supporting actors get moments to shine. (This is another advantage of doing 15 episodes. Make TV seasons longer! I am not a crackpot.) Dearden and Dourif are particularly good at opposite ends of the temperamental spectrum. King cares for her autistic sister, seems to be somewhere on the autism spectrum herself, and struggles to feel at ease around so many new people, even though she’s clearly a gifted and empathetic doctor. McKay, meanwhile, swaggers around like this is the place she was always meant to be, though she can be prone to letting her emotions override her judgment. 

But the star attraction is, of course, Noah Wyle himself. Whether you watched him for some or all of the dozen years he spent playing Carter (before leaving for most of the ER home stretch), know him from later shows like Falling Skies or The Librarians, or have never seen him before, he fits into this world with incredible ease. This is a hard day for Robby, not only because of the patient load and the presence of so many new faces in need of guidance, but because it’s the anniversary of the death of his mentor. So Wyle plays him as a very weary man who’s on edge for most of the time we’re watching him. But he also radiates competence and compassion, both for the patients and for the younger doctors who haven’t seen everything he has, good and bad. The nature of his job as attending doctor at a teaching hospital means he’s often hanging back during traumas and letting the kids learn by doing. Every now and then, though, he has to step in and make the save himself, and there’s a palpable surge in energy whenever the guy who best knows what he’s doing moves to the forefront. There’s also a scene where Robby recalls the loss of a five-year-old patient during his own residency (which pointedly took place in New Orleans, not Chicago), and there’s a terrible ache in Wyle’s voice that makes clear how fresh the memory feels, even 30 years later. 

It’s great to have him working in this setting again, and to have this creative team along for the ambulance ride. The Pitt isn’t doing anything fancy — and, in fact, its biggest deviation from the familiar is by far its biggest weakness. But for the most part, it’s a powerful reminder of why certain formulas are so durable, how satisfying they can still be when done well, and why we shouldn’t be so eager to throw out all of the things that have made TV TV for so long. 

The first two episodes of The Pitt begin streaming Jan. 9 on Max, with additional episodes releasing weekly. I’ve seen the first 10 of 15 episodes this season.