Dr. Alok Patel (1:48)

The Pit is by far the most medically accurate show that I think has ever been created. And I'm not the only one to share that opinion. I hear that a lot from my colleagues.

Michael Rupbrecht (1:59)

That's Dr. Alok Patel. He's a pediatrician at Stanford Medicine Children's Health, and he's obviously a fan of the show.

Regina Barber (2:06)

Yeah, I mean, I'm a fan too. I'm not in the medical field. I'm a different kind of doctor. But I found it really resonated with me, like, especially the way they portray political division and mistrust in science, which we've definitely talked about in Short Wave.

Michael Rupbrecht (2:20)

Yeah, totally. Not to mention even the corporatization of healthcare. On the whole, it's pretty realistic.

Hospital Nurse (2:26)

Patients, they check in for registration here, a nurse eyeballs them, makes sure they're not dying. If not, they're moved to one of two triage rooms for Vitals and a quick chair exam where you can go to your labs and your X rays and then they come back to waiting room til bed opens up.

Michael Rupbrecht (2:42)

Is it always this busy?

Hospital Nurse (2:45)

No, it gets a lot busier.

Regina Barber (2:48)

And the new season, it just started. Michael, I heard you gotta watch it early.

Michael Rupbrecht (2:52)

Yeah, Gina, it was so cool. And the show's new season is streaming on HBO Max now, so we're here to discuss whether it really holds up to the last one.

Regina Barber (3:02)

Today on the show, we dive headfirst into the pit. The medical drama that's breaking barriers on how hospitals are portrayed and why healthcare workers are obsessed with it.

Michael Rupbrecht (3:13)

Plus, a sneak peek at what season two has in store, from AI to misinformation and the realities of healthcare insurance.

Regina Barber (3:21)

You're listening to Short Wave, the science podcast from npr.

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Regina Barber (4:33)

Going to dive into season two of the pit. But before we do that, let's get a quick recap of season one.

Michael Rupbrecht (4:39)

Totally. So the first season centers on the main character and veteran attending physician, Dr. Michael Robinovich, also known as Dr. Robbie. He's played by Noah Wylie.

Regina Barber (4:49)

Okay, I remember him from er, but what's an attending physician?

Michael Rupbrecht (4:54)

Yeah, that can get pretty confusing. So attendings are doctors who have finished years of training and they manage the students, residents and fellows on their teams. They're basically the Boss, just like Dr. Robbie is the boss in the pit. Plus his right hand man, a woman, that's the charge nurse.

Regina Barber (5:12)

This makes sense to me. You got your attending and the charge nurse. They go hand in hand. It's the blonde lady that I remember, but you had mentioned, you know, Med students, fellows, residents. What do those terms all mean? Like, who are these people?

Michael Rupbrecht (5:26)

Yeah, totally, Gina. It's a lot to keep track of. So let's start with med students. That's me. I'm in my fourth year. And med students typically start working in the hospital in their third year of school. Their job is to examine patients on their own and learn how to start diagnosing them. Okay, next up on the totem pole, we've got residents. They're doctors who've just finished med school, and they're training in some kind of specialty, and that training lasts for several years. And then we have fellows. Those are doctors who already finished residency training, and they want to specialize even further. Finally, they're the nurses, the physician assistants, the social workers, and other people. They're just as vital to the ER and how it functions.

Regina Barber (6:09)

Yeah, I'm still in season one right now, and I was very surprised, and I know I shouldn't be, but there's, like, a social worker that's there all the time.

Michael Rupbrecht (6:17)

Yeah. And Speaking of season one, to finish the summary, Dr. Robbie's struggling to cope with some pretty traumatic memories while also treating patients and managing all those members on his team who themselves are also going through some personal struggles.

Regina Barber (6:32)

Yeah, it sounds like so much. Plus, he has to remember all the patients he's, like, working with all day. It was kind of boggling my mind.

Michael Rupbrecht (6:40)

Yeah. And Dr. Patel told me that that's one of the most realistic parts of the show.

Dr. Alok Patel (6:46)

The reality is, if you're working a busy shift and you have things happening in your personal life, the line between personal life and professionalized gets blurred, and people have moments. And the pit highlights that.

Michael Rupbrecht (6:59)

Episode 11 was the climax of season one. In the last few minutes of that episode, Dana, the charge nurse, played by Catherine lanasa, talks with Dr. Robbie outside the ER and she has this big bruise around her eye.

Regina Barber (7:12)

Oh, my gosh. What happened? Like, I. I haven't gotten to that part yet, but it's okay. You can spoil it for me.

Michael Rupbrecht (7:16)

I mean, basically, she got assaulted by a patient just two hours ago, and she tells Dr. Rabi that she feels like she's at her rock bottom. People are angry, our temperature is shorter.

Regina Barber (7:28)

And we're still just trying to help.

Dana (Charge Nurse) (7:30)

I, I, I, I, I. I don't know. I don't know. Maybe what I want, what the patients need, isn't what's best for you anymore.

Michael Rupbrecht (7:35)

Yeah.

Dana (Charge Nurse) (7:38)

I just honestly don't know what I'm gonna do without you.

Regina Barber (7:41)

That's so heartbreaking.

Michael Rupbrecht (7:43)

It is. Gina. And it's also the reality for a lot of people in the medical field. Up to three quarters of healthcare workers have reported experiencing violence. Whether that's verbal abuse or physical threats or even outright assault, it all takes a toll.

Dr. Alok Patel (7:59)

The new season of the Pit still has some of that tension between patients and healthcare professional. And sometimes it's completely projected or misdirected. People are misunderstanding, they're frustrated, they get pissed off. They can't see a doctor in time in the er and they may act out that whole concept of having to suppress this aggression. And then the frustration that there's not enough protection for healthcare workers. That's a very real issue.

Regina Barber (8:24)

Yeah, it's something I hadn't really thought of until I started watching this show. But, Michael, can I ask what other aspects of the PIT are like, similar to what healthcare workers have to deal with in real life? Like, do they go into any new issues in season two?

Michael Rupbrecht (8:39)

Yeah, Gina. You know, the second season gets into some new themes like insurance, AI, and it even gets into the weeds of charting.

Regina Barber (8:47)

Okay, let's take a step back. Let's talk about the first episode of season two, which aired last Friday.

Michael Rupbrecht (8:54)

Yeah, episode one opens with that same busy and crowded ER that we're all familiar with for from season one. But this time around, it's July 4th and we meet a new doctor in the first few minutes of the episode.

Regina Barber (9:10)

Wait, I haven't started it yet. Is Dr. Robby gone?

Michael Rupbrecht (9:13)

Oh, no, no, no, no, no, no. He is still there, don't worry. But there's another physician joining him. Her name is Dr. Al Hashimi. She's played by Seppei Demowafi.

Dana (Charge Nurse) (9:23)

She's some sort of clinical informatics expert. When she started talking about AI, I started thinking about rock robots and kind of stop listening clear.

Michael Rupbrecht (9:32)

That sort of captures the headbutting between her and Dr. Robbie. That kind of becomes evident as we progress through this first episode. Her take on using AI in the er. She actually encourages the residents to use it to take notes.

Regina Barber (9:47)

I just got a new family doctor and she used AI. She recorded our exam and she was like, there. It's. There's going to be a transcript. So I know what we talked about.

Michael Rupbrecht (9:56)

Yeah, totally. This is something that's on our radar and people are excited about it. But there some real concerns like patient privacy and accuracy. And they talk about that in the show.

Regina Barber (10:07)

Yeah.

Michael Rupbrecht (10:07)

Another interesting aspect of this season is how it gets into disability and access.

Regina Barber (10:12)

What do you mean?

Michael Rupbrecht (10:13)

Well, there's this scene in the first episode where we see A patient sitting in the waiting room. And this waiting room is super busy. But as the camera pans over to her, it all goes silent. And we quickly realized that this patient is deaf, which really impacts her experience in the hospital, how the doctors interact with her, the type of care that she gets. And that's unfortunately true in the real world as well.

Regina Barber (10:45)

What do you mean, the type of care she gets? Like, can you give me an example?

Michael Rupbrecht (10:50)

Well, when a patient, like in this case, needs an interpreter who can sign asl, the doctor patient relationship can thin out. And later in the season, we see this patient's first interaction with the doctor. Instead of making eye contact with the patient, the doctor faces the ASL interpreter during the interaction. And while it's subtle, you know, it can leave patients feeling pretty sidelined or even invisible.

Regina Barber (11:17)

Yeah, that makes total sense. How else does disability make its way into this season?

Michael Rupbrecht (11:24)

You know, later in the season, we also meet a doctor who uses a wheelchair to get around, which is just a reminder that medical experts are not a monolith. Right. And there are both disabled and non disabled people working in the er.

Regina Barber (11:38)

Yeah, that's a really powerful message. You had mentioned earlier that insurance was a theme in season two as well, right?

Michael Rupbrecht (11:46)

Yeah, and we don't quite get into it in the first episode, but viewers will definitely notice in later episodes that insurance takes a big role. You know, it's almost like a character itself, which seems pretty apt for this moment when many Americans are facing a really sharp rise in costs. And in real life, this unfortunately happens pretty regularly. While patients shouldn't have to worry about insurance, they do. Like, sometimes my patients only get what their insurance will reimburse. And, you know, that treatment they do get, it's not always the best or even the standard of care.

Regina Barber (12:26)

Yeah. And along these slightly depressing lines, there's growing misinformation that doctors are battling in the real world. Right.

Michael Rupbrecht (12:35)

Yeah, you'll find it in the pit too, unfortunately. And I don't want to spoil anything here, but it does involve someone getting their information from social media.

Regina Barber (12:46)

My doctors have actually mentioned this.

Michael Rupbrecht (12:49)

Yeah, I mean, it's a pretty accurate representation of how misinformation can spread. I still remember this moment from my pediatrics rotation when I was counseling a parent on immunizations.

Regina Barber (13:01)

Okay.

Michael Rupbrecht (13:01)

And I could tell the parent really, really loved their kiddo, but they ultimately declined to vaccinate their child because they were worried about a debunked myth. And while I think it's incredibly important, patients do their own research and are empowered in their care, the sources they turn to are equally as important.

Regina Barber (13:21)

Yeah. Did Dr. Patel or other experts you talked to say what was less accurate to real life in the show? Like, was there anything the show got wrong?

Michael Rupbrecht (13:32)

Not everything is totally accurate. For instance, med students can't order meds. You need that MD after your name to do that.

Regina Barber (13:41)

That makes sense.

Michael Rupbrecht (13:43)

And another thing that is unlikely is for one shift to have so many complex cases. These cases definitely happen, but usually not all in one day. And one common complaint among all medical dramas is how inaccurate CPR is.

Regina Barber (14:00)

Really? How so?

Michael Rupbrecht (14:02)

Well, CPR is pretty violent, actually. Rib fractures occur in a majority of patients who undergo cpr. And other trauma can happen, too.

Regina Barber (14:10)

Well, it is a show. They can't be too violent with their actors. Michael, thank you so much for talking to me about all this.

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Regina Barber (14:18)

I'm excited to watch the second season.

Michael Rupbrecht (14:20)

Thanks so much for having me. This was such a blast.

Regina Barber (14:25)

If you like this episode, follow us on the NPR app or whatever podcasting app you're listening from. Also, you might want to check out our episode on the history of tuberculosis with John Green or our episode on the closest thing we have to a cure for allergies. We'll link to them in our episode notes. This episode was produced by Hannichin. It was fact checked by Tyler Jones, and it was edited by our showrunner, Rebecca Ramirez. And Maggie Luthar was the audio engineer. Beth Donovan is our vice president of podcasting strategy. And I'm Regina Barber. Thank you for listening to Short Wave from npr.

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