“The Pitt” review: Noah Wyle anchors a ruthlessly realistic ER drama

The second episode of The Pitt — the new Max medical drama starring Noah Wyle as the chief attending doctor in an overwhelmed emergency room in Pittsburgh — ends with the grimmest four minutes I've seen on TV in a while.

Just two hours into his shift, Dr. “Robby” Rabinavitch (Wyle) must inform a teenager’s parents that their son is brain-dead after an accidental fentanyl overdose. As the anguished wails from the boy’s mother, Lily (Samantha Sloyan), echo through the department’s halls, a somber Dr. Robby walks to the next room and reluctantly prepares to insert a breathing tube into an elderly man with dementia (Madison Mason) — having failed to convince the man’s adult children (Rebecca Tilney and Mackenzie Astin) that doing so will only prolong their dying dad’s suffering. In another room, student doctor Whitaker (Gerran Howell) insists on continuing chest compressions on his patient (David Reivers) because the reality — that he just lost his first patient — is too much to bear. Then the credits roll.

Consider this example both an enticement and a warning. Created by ER alum R. Scott Gemmill, The Pitt takes a ruthlessly realistic approach to its depiction of our beleaguered/broken healthcare system — but it’s also the most engrossing and addictive medical drama to come along since Grey’s Anatomy and, well, ER.

The waiting room at Pittsburgh Trauma Medical Hospital is already packed when Dr. Robby arrives for his shift. And he’s barely in the door before nurses Princess (Kristin Villanueva) and Perlah (Amielynn Abellera) start peppering him with questions about rumors that the struggling hospital is going to be sold. “They’re always threatening to shut us down, but they never do,” he assures them. Into this atmosphere of barely controlled chaos walk a gaggle of eager doctors-in-training — residents Melissa King (Taylor Dearden) and Trinity Santos (Isa Briones), and med students Victoria Javadi (Shabana Azeez), and Whitaker — who will spend their first day getting slapped in the face by the ugly and sometimes wrenching realities of working in an under-resourced, overcrowded urban hospital.

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It's a pretty standard setup for a modern medical drama: Dedicated but overworked vets — including Robby, charge nurse Dana Evans (Katherine LaNasa), and senior residents Dr. Langdon (Patrick Ball) and Dr. Collins (Tracy Ifeachor) — lead a group of fresh-faced students through the trial-by-fire pandemonium of their first day on the job. The Pitt (premiering Jan. 9) adds a real-time element to the mix, with each episode chronicling one hour in Robby’s 15-hour shift. It’s a choice that could come across as gimmicky, but here it adds to the immersive feel of the storytelling, as no one (including viewers) gets more than a few seconds of respite from the frenetic, fluorescent-lit action. The real-time format also allows Gemmill and his writers to spend multiple hours with patients and the ongoing social issues — including homelessness, caretaker’s fatigue, addiction, sex trafficking, and the youth mental health crises — that their cases highlight.

Those who like their medical shows to come with more than 10 ccs of romance should probably stick with Grey’s Anatomy. The Pitt doesn’t make time for love triangles or steamy on-call room hookups (at least, not in the 10 episodes released to critics). Instead, we get snatches of personal backstories and glimpses of developing personal dynamics between the characters in the brief pauses between crises. Robby is still grieving — though not coping with — the death of his mentor during the COVID pandemic, and he’s clearly got some kind of unresolved romantic history with Dr. Collins. In addition to being a child prodigy who started college at 13, Dr. Javadi now has the added pressure of working in the same hospital as her mother, Dr. Shamsi (Deepti Gupta), a respected surgeon. Meanwhile, amiable head of triage, Dr. McKay (Fiona Dourif), has her movements monitored by an ankle bracelet — for reasons that have yet to be revealed.

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The Pitt will only work if viewers want to spend 15 hours in close, unchanging quarters with these characters — something that would be difficult to pull off if the cast weren’t so good. Wyle, a master at compassionate calm, makes Robby the perfect counterbalance for the series' often-bleak setting. Though beset by soul-breaking external pressures — including frequent scoldings from his boss, Gloria (Michael Hyatt), for the hospital’s low patient-satisfaction scores — Robby is a bottomless vessel for the pain, anger, fear, frustration, and heartbreak of those around him. LaNasa is immensely endearing as Nurse Evans, a den-mother type who ensures that no one — from the anxious med students to the oddball emergency department regulars — feels unsupported in her presence. Dearden is a standout as Dr. King, an earnest, sensitive student whose only ambition is to learn. Howell is heartfelt and amusingly hapless as Whitaker, whose first day features an onslaught of comedic misfortunes — think George “OO7” O’Malley from Grey’s or even Wyle’s ER character, John Carter, in his med-student days.

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At this point, it’s probably worth noting that The Pitt is currently the subject of a breach-of-contract lawsuit from the estate of Michael Crichton — who created ER — which claims that the show is a “derivative work” of the groundbreaking NBC series. (“The Pitt is a completely different show from ER,” responds Warner Bros. Television, the studio behind both shows.) We’ll let the lawyers sort that out, but as a professional TV watcher, I can confirm that almost every medical show since ER, including The Pitt, bears at least some of its hallmarks. Plenty of medical dramas have tried to replicate ER in the 31 years since it premiered; inevitably, they failed. But The Pitt and its characters earn your attention, which is something a mere rip-off couldn’t do. (Note: This opinion is not admissible in a court of law.)

Unlike ER, the writing on The Pitt is sometimes clunky. Twice, people quote Luke 4:23 — “Physician, heal thyself!” — while talking to Robby, and the dialogue occasionally veers didactic (“Violence against healthcare workers is a national problem!”). I will also vow to donate blood every year for the rest of my life if TV writers will stop making characters say things like, “In case you didn’t realize, I use sarcasm and comedy as a shield, or so I’ve been told,” as Santos informs Victoria early in the season. (Nobody talks like that, folks!) These ailments are minor, however, and don't detract from the series' overall creative success. As difficult as The Pitt can be to watch, I'm looking forward to spending another 15 hours in this ER. Grade: A-

The Pitt premieres with two episodes on Thursday, Jan, 9 at 9 p.m. ET on Max.

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