4:00 P.M. with Simran Baidwan, Damian Marcano and Dr. Gita Pensa

Summary

The Pitt Podcast – Episode Summary

Episode Title: 4:00 P.M. with Simran Baidwan, Damian Marcano, and Dr. Gita Pensa

Release Date: March 13, 2026
Hosts: Dr. Alok Patel & Hunter Harris
Guests:

• Simran Baidwan (Writer)
• Damian Marcano (Director)
• Dr. Gita Pensa (Medical Malpractice Expert/Consultant)

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Overview

This episode provides a deep dive into episode 10 of The Pitt, with hosts Dr. Alok Patel and Hunter Harris examining both the fictional drama and the real-life medical, ethical, and cultural issues at play. They are joined by writer Simran Baidwan and director Damian Marcano to discuss character dynamics, realism in the storytelling, and the beloved and problematic personalities in the hospital. Medical malpractice consultant Dr. Gita Pensa offers a robust look at the realities of lawsuits in medicine. The episode is animated, direct, and emotionally candid, mirroring the tension and complexity onscreen.

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Key Discussion Points

1. Emotional Boiling Point in the ER (02:15–04:04)

• Theme: The 4pm shift is fraught with exhaustion and high emotions; every character seems at their breaking point.
• Observations:
  • Many staff are losing their tempers, acting out of character, or displaying new vulnerabilities.
  • Major focus on Dr. Robbie’s uncharacteristic cruelty towards Dr. Mohan during her panic attack, raising issues of generational stigma and emotional support in medicine.
  • Notable Quote (03:01):

    "I don't need the fucking liability. Go home. And the rest of you, last time I checked, the ED is a shit show. So let's all get back to work, huh?" — Dr. Robbie (as recalled by Dr. Lok Patel)

2. Character Interpersonal Dynamics (04:32–05:59; 10:26–13:19)

• Hierarchies and Expectations:
  • Dr. Robbie holds differing standards for his team, being especially critical of Dr. Mohan.
  • Discussions about his relationships with Dr. Mohan, Whitaker, Javadi, and Langdon highlight both mentoring and toxic behaviors.
• Workplace Relationships:
  • The fraught and flirtatious relationship between Dr. Santos and Dr. Garcia comes to the foreground, especially as boundaries between personal and professional lives blur.
  • Memorable exchange as Dr. Garcia calls out Santos' attitude:

    "Or maybe you're a pariah because you don't play well with others. If you've still got beef with Langden, go tell him... put on your big girl panties and work it out." — Dr. Garcia (10:57–11:09)

  • Hosts note the “situationship” confirmation and discuss the fine line between emotional support and workplace professionalism.

3. The Humbling of Ogilvy (06:14–08:03)

• Theme: Overconfidence and learning humility
  • Ogilvy, a usually arrogant student, is humbled during a critical moment (receiving a severed leg on the helipad).
  • There’s attention to the process by which medical students move from textbook perfection to real-life messiness.
  • Notable Quote (06:54):

    "They go into an actual clinical scenario thinking they're hot. And after a few hours, like, they're like, oh, my gosh. And they get humbled by actual experience..." — Dr. Lok Patel

4. The Arrival of "Park the Shark" (08:36–09:51)

• Character Spotlight:
  • Park “the Shark,” an orthopedic surgeon, steals scenes as an arrogant, intensely competent, but not particularly nice operator.
  • The hosts delight in his "deluxe diva" energy, deadpan dialogue, and dramatic presence.
  • Notable Quote:

    "He literally... I, like, heard the Jaws theme as he walks into the OR. Like, seeing him in profile was incredible." — Hunter Harris (09:51)

  • Discussion of the archetype: sometimes the confidence and eccentricity are exactly what’s needed in a crisis.

5. Clinical Realism and Medical Set Pieces (14:47–17:09)

• Emergency Procedures:
  • In-depth examination of the “slash” tracheostomy procedure, including technical accuracy and the emotional stakes for providers.
    • Dr. Alhashmi’s command decision-making is lauded, as is the show’s dedication to getting the details right.
  • The operation’s aftermath, medical facts, and the unusual but accurate depiction for pediatric trauma are discussed.
  • Notable Quote:

    "Shout out to the medical writing because, like, I fact-checked this, and I was reading some journals from emergency medicine. Emergency medicine journals. And it's totally accurate how she describes it, handles herself under pressure." — Dr. Lok Patel (15:45)

6. Writing & Directing Collaboration (22:25–35:11)

• Simran Baidwan and Damian Marcano Speak:
  • Simran discusses structuring the season and building tension so episode 10 acts as a pivot into the season’s final arc.
  • Damian reflects on surprises between seasons and the ensemble dynamic.
  • Directorial Philosophy:

    "We're not trying to overact. No one's trying to get that special shot and whipping the glasses off and saying that prolific thing. We're just trying to say, if these doctors are working as a team in order to create these miracles, then I think we have to fashion ourselves in the same way." — Damian Marcano (03:33 & 27:34)

  • The duo describes their respectful, collaborative working relationship, grounded in mutual cultural understanding and their immigrant backgrounds.

7. Why “The Pitt” Resonates Broadly (32:00–35:11)

• Cross-Audience Appeal:
  • The show reaches both medical insiders and the lay public because of its focus on humanity and character, not just technical detail.
  • Notable Quotes:

    "There is so much humanity, there is so much heart... and you're seeing that in the impact of these doctors and nurses. As much as they have to be stoic and do a job, they are also human." — Simran Baidwan (34:14) "I spread so much sunshine on everybody, I forget I need a little ray for myself. I think our show is that little ray of sunshine back to you guys." — Damian Marcano (33:16)

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SPECIAL SEGMENT: Medical Malpractice in Focus (36:18–48:57)

• With Dr. Gita Pensa
• Key Questions:
  • How common are malpractice suits, and how do they affect doctors?
    • "Between a third and a half of all doctors in all specialties will be sued at some point... If you’re in a higher risk specialty... 90% chance.” (38:25–39:29)
  • What’s the emotional toll and the culture of silence?
    • Doctors rarely talk about being sued, leading to shame, guilt, and isolation.
    • Explains the legal guidance: "You're not allowed to talk about it." But stresses the importance of being able to discuss the process and one’s emotional response.
    • Notable Quote:

      "This is actually a real threat to identity for us. But when you take a person who's dealing with all of that and you tell them now you're not allowed to talk to anybody... it really does something to us." — Dr. Gita Pensa (41:56)

  • Types of cases and trends:
    • Half of suits go nowhere; often brought out of systemic frustration or lack of communication.
    • Rise in “nuclear verdicts”—huge settlements.
    • Most true malpractice is settled, not taken to trial; doctors who go to trial are usually confident in their care.
  • Celebrates the show’s attention to medical accuracy and psychological reality, especially around competence and its portrayal.

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Notable Quotes & Memorable Moments with Timestamps

• Dr. Robbie’s Outburst toward Dr. Mohan
  "I don't need the fucking liability. Go home. And the rest of you, last time I checked, the ED is a shit show. So let's all get back to work, huh?" (03:01)
• Dr. Garcia’s Advice to Santos
  "Or maybe you're a pariah because you don't play well with others. If you've still got beef with Langden...put on your big girl panties and work it out." (10:57–11:09)
• Damian Marcano’s Directing Philosophy:
  "We're not trying to overact... We have to fashion ourselves in the same way [as the team of doctors]." (03:33 & 27:34)
• Medical Writing Praise:
  "Shout out to the medical writing because...it's totally accurate how she describes it, handles herself under pressure." — Dr. Lok Patel (15:45)
• Humanity in Medicine:
  "There is so much humanity...as much as they have to be stoic and do a job, they are also human. That's true resilience. That deserves respect." — Simran Baidwan (34:14)

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Other Highlights & Listeners’ Comments

• Community Engagement:
  • The hosts read and celebrate a listener’s comment about being inspired by the show despite disabilities preventing a medical career (50:13).
  • Lighthearted chat about volunteers in the hospital, service dogs, and the need for more “music therapy” and human touch on the show.

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Conclusion

This episode is a rich, multifaceted exploration of the drama and reality of emergency medicine. It combines sharp analysis of character and plot with honest reflections on the emotional challenges of healthcare, both on screen and in real life. Guests Baidwan and Marcano offer candid behind-the-scenes insights, and Dr. Pensa’s segment is a powerful primer on the realities and toll of medical malpractice.

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Timestamps for Key Segments

• 02:15 – Emotional Boiling Points & Character Tension
• 06:14 – The Humbling of Ogilvy
• 08:36 – “Park the Shark” Arrives
• 14:47 – Technical Breakdown: Emergency Airway & Tracheostomy
• 22:25 – Simran Baidwan & Damian Marcano: Writing & Directing
• 32:00 – Why the Show Resonates
• 36:18 – Dr. Gita Pensa: Medical Malpractice, Realities & Trends
• 50:13 – Listener Comments & Community Reflections

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Tone & Takeaways:
The episode is lively, irreverent, and deeply sincere—mirroring the show it celebrates. Both the fictional and real-life medicine are treated with humanity and rigor, making this a must-listen for fans, healthcare professionals, and anyone engaged by stories of resilience and care.

Transcript

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[Hunter Harris]

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[Dr. Gita Pensa]

You know, I can't read this handwriting. 1,000 milligrams of cetaminophen orally, 4 milligrams of denditron under the tongue and triloclear fluids. Seriously, it says all that? It's not in the text with the emojis. You kids can't read this shit.

[Hunter Harris]

Welcome to the Pitt Podcast, the official companion to The Pit on HBO Max. I'm Hunter Harris.

[Dr. Lok Patel]

And I'm Dr. Lok Patel. 4pm in the Pit. That's episode 10. We're going to talk to one of the show's writers, Simran Baduan, and the director of this episode, Damian Marcano.

[Damian Marcano]

We are all trying to find the truth in the scene. We're not trying to overact. No one's trying to get that special shot and whipping the glasses off and saying that, you know, prolific thing. We're just trying to say, if these doctors are working as a team in order to create these miracles, then I think we have to fashion ourselves in the same way.

[Hunter Harris]

And then we'll go outside the pit and talk to Dr. Geeta Pensa, a medical malpractice expert who consulted on the season.

[Dr. Gita Pensa]

Nobody wants to have anything bad happen to any of their patients. And inevitably, sometimes things do. And when you are a steward for that person's life, you take that. Really, you take that responsibility very, very heavily.

[Dr. Lok Patel]

Just saying. Medical malpractice gives me hypertension. Today's shift starts 4pm is not everyone's finest hour, for better or worse. Like, it seems like no one in this episode is having a good time. Everyone is at a boiling point. But what are the moments that stand out to you, Hunter?

[Hunter Harris]

Here's what I can't stop thinking about the scene of Robbie and Dr. Mohan because he totally loses his temper. With her in a way that I'm like, I don't think we've ever seen him this curt, this short, this almost cruel when he realizes Dr. Mohan is actually having a panic attack and not having a heart attack as she thought.

[Dr. Gita Pensa]

I had it all planned out, and now everything's just out the window.

[Dr. Lok Patel]

Wait a min. Is this a panic attack because of your mommy issues?

[Dr. Gita Pensa]

What? No.

[Dr. Lok Patel]

Jesus. Do you need to go home? You should go home.

[Simran Beidouan]

No, I'm fine.

[Dr. Lok Patel]

I don't need the fucking liability. Go home. And the rest of you, last time I checked, the ED is a shit show. So let's all get back to work, huh? The moment he realizes when he, like, flips a switch, he goes from being concerned about a heart attack, and he's like, is this about your mommy issues? I was like, damn it, I'm not happy with Dr. Robbie right now.

[Hunter Harris]

But the way that he likes, almost, like, is so dismissive, and he's like, go home. Go home. I was like, oh, my gosh. It's like giving housewives his reaction. It's so over the top. I. I did not appreciate that. But I think this is the first time that we've really seen him be, like, actively cruel in a way that's like, something is going on with him. He's like. He's very. I don't know, very dark.

[Dr. Lok Patel]

He also. I think there's maybe a little bit of the generational thing. He might come from a generation where any type of mental health issue or struggle was seen as weakness, which just added a stigma, people not wanting to open up about it. So I do like that. Dr. Al Hashmi, you immediately seen that scene. Her eyes are kind of like. Like, bro, what are you doing? And then later on, she pulls him aside and she's like, don't be a dick.

[Hunter Harris]

Yeah.

[Dr. Lok Patel]

And I think it was a realistic scene. I bet there's. There's people out there in healthcare who are afraid of saying, like, I'm having a hard time, or acknowledging it's a panic attack. But the setup to her panic attack was real, okay?

[Hunter Harris]

She was like, I want to talk about that. Because in my head, as someone who's had panic attacks, I'm like, wouldn't, you know, like, you're a doctor. Why would you think it's a heart attack?

[Dr. Lok Patel]

I'm. I'm like, my instinct tells me she. She has never been in that position before. You know, she's sweating, her heart's racing. She doesn't know. I don't know. She doesn't know.

[Hunter Harris]

I'm like, sister, you're a doctor. Come on. But I. I wonder though, do you think Dr. Robbie is harder on Dr. Mohan than other doctors? Because last season he was calling her slow mo. She's like, well, I have the highest, like, patient satisfaction rating. Whatever. But then this. This episode, we really see her lose her temper. Like everyone's losing their temper with everyone.

[Dr. Lok Patel]

That's a good take. I feel like she recovered from the slow mo stereotype he gave her in the first season. And he came around and he started to really appreciate her approach.

[Hunter Harris]

Yeah.

[Dr. Lok Patel]

And you know, Dr. Alhashmi came in, really appreciated Dr. Mohan's work as well. And I think, to your point, I think it's just the moment, the fact that Dr. Rabi has checked out, you got this code black happening, like all this is going on. And he's like, I cannot lose one of my physicians. And I think the mental switch he had from, oh my gosh, this is a cardiac issue, to damn it, I need you in the er. Be stronger or go home. I think he just had this moment. But I'm glad that he came back around later and was like, oh, my gosh, I was wrong.

[Hunter Harris]

I don't think he's like, oh, my gosh, that was wrong. He's like, hey, it's very like deadbeat dad. Like, hey, sorry, let's get back to work.

[Dr. Lok Patel]

You're giving me the deadbeat dad card. Okay.

[Hunter Harris]

Yeah. Because there's something different about the way that he treats Whitaker and Javadi, which feels a lot like Whitaker feels very like friend, like lanon replacement. Javati feels very paternal, which I like. Cuz he's very, like, defensive of her to her mom. But then with Dr. Mohan, I don't know, he's very harsh. But maybe that's cuz he knows she's like a really good doctor.

[Dr. Gita Pensa]

Yeah.

[Dr. Lok Patel]

Maybe he's holding her to a higher standard. Similar to probably. What is going on with Langdon. Well, he's obviously hard on Langdon.

[Hunter Harris]

He doesn't talk to Langdon.

[Dr. Lok Patel]

Yeah, it's like a weird level.

[Dr. Gita Pensa]

Yeah.

[Dr. Lok Patel]

That's like angry, toxic. You hurt me, father. Like, re. Enter my. That's. That's a whole other category.

[Hunter Harris]

Yes, he feels very betrayed by Langdon. I know Ogilvy gets a bad rap, but this episode, I'm like, kind of, you deserve it. Like, what do you. When he's on the helicopter pad talking to Dr. Robbie, Dr. Robbie's like, you know, how's your first day going? Checking in? And Ogilvy is like, I think we

[Dr. Gita Pensa]

have a very different idea of normal now for everyone.

[Hunter Harris]

I'm not sure it's healthy for anybody.

[Dr. Gita Pensa]

Here's your leg.

[Damian Marcano]

Jesus.

[Hunter Harris]

I love that. That ends with, like, him being, like, a leg being placed in his hands and him, like, not knowing what to do. I love seeing uncle be uncomfortable like that because it, like, you don't know everything. Maybe you should get checked a little bit. What did you think of that?

[Dr. Lok Patel]

This happens to fourth year med students all the time who have spent three years studying the textbook and they think they know everything and maybe they do really well on their tests and their boards, and then they go into an actual clinical scenario thinking they're hot. And after a few hours, like, they're like, oh, my gosh. And they get humbled by actual experience and by the spontaneity and the craziness. I think this is a good turning point. So I said earlier that people were. No one was having a good time in this episode, but this might wind up being a good pivotal moment for Ogilvy.

[Hunter Harris]

With Ogilvy, I mean, he is just such a jerk sometimes and so obnoxious that I'm like, how is Ogilvy kind of like playing the know it all with the other students? I mean, he means like, giovanni about the Dr. J stuff, this episode. But then did you notice that when he sees the English teacher, he, like, checks it on him. That's his patient. And he. He gives him a copy of a book that he's reading and it's James Baldwin, Notes of a Native Son. I'm like, okay, sorry, hold on. How do you have so much, like, how are you reading, Baldwin? Like, you're. You're obviously very educated, but then also have no empathy for, like, the plus sized patient for the woman who's like, he's like, give her more ketamine. Like, we can't deal with her right now.

[Simran Beidouan]

Like.

[Hunter Harris]

Like, I don't know. I didn't like that.

[Dr. Lok Patel]

I think that's a big part also of these clinical rotations for students and is learning those interpersonal skills. And we see kind of a. We see kind of a trace of this with Santos and Garcia. And she's like, clearly, we need to work on a decorum for R2s.

[Hunter Harris]

Oh, my God.

[Dr. Lok Patel]

So it goes back again to appropriate behavior and speaking. And like, you. You learn. So Ogilvy, like, I think he's going to emerge. I think he's going to emerge from this and be like, all right, a little bit of humility is needed. The orthopedic surgeon rolls in, park the Shark. And he, like, also tells Ogilvy in so few words to zip it.

[Hunter Harris]

Not even. Okay. Park is an orthopedic surgeon.

[Dr. Lok Patel]

You said he's an orthopedic surgeon.

[Hunter Harris]

Everything about him. Love, spinoff now. Oh, obsessed with him.

[Dr. Lok Patel]

You like this dude?

[Hunter Harris]

Oh, my God. Are you kidding? He's a diva deluxe. The way he walks into the trauma room and he's, like, doesn't even say hi to anyone.

[Simran Beidouan]

Park.

[Dr. Lok Patel]

Park the shark. Orthopedic surgeon.

[Damian Marcano]

Is this a favorable amputation?

[Dr. Gita Pensa]

Pretty clean. Cut and slice through like a guillotine X ray.

[Dr. Lok Patel]

Not too bad. Stop tying off a couple materials.

[Damian Marcano]

I'm not blind.

[Hunter Harris]

Just walks in, laser focus, picks up the leg. He's, like, talking to himself in a way that I loved. And then, I mean, poor Whitaker, whenever he's like, yeah, you need to, like, do, like, three rinses or whatever. And Whitaker's, like, of saline. He's like, yeah, duh. I'm obsessed. Sorry.

[Dr. Lok Patel]

It's funny. I think they were trying to portray the typical, arrogant, toxic surgeon who might be really great at their job, but it's just not nice people.

[Hunter Harris]

Yeah.

[Dr. Lok Patel]

And in your eyes, he's a deluxe diva.

[Dr. Gita Pensa]

Absolutely.

[Hunter Harris]

No. That's the man I want operating on me. I'm like, you don't have to be nice. Just, like, get the job done, get my leg reattached.

[Dr. Lok Patel]

Did his hairstyle fit the deluxe diva like this?

[Hunter Harris]

Of course I know his name is Shark. He literally. I. I, like, heard the Jaws theme as he walks into the or. Like, seeing him in profile was incredible.

[Dr. Lok Patel]

This take is so good. Imagine if there was the relay, park, the shark. If you're like, hey, man, you're a deluxe diva, I don't know what he would throw at you.

[Hunter Harris]

I would hope he would say thank

[Dr. Lok Patel]

you and then walk back out.

[Hunter Harris]

I need, like, a group chat of the shark, Abbott and Garcia. Like, I need those three in a room together because, like, their energy is incredible.

[Dr. Lok Patel]

Oh, yeah. I wonder who would out alpha whom in that trio. I think Garcia is the alpha of both of them. I don't think she backs down from anyone.

[Hunter Harris]

Okay. And speaking of Garcia being the alpha, I want to know if you clocked how Garcia is very rude to Dr. Alhashmi when they're doing the slash trade because it's, like, incredible. Dr. Alhashmi pulled this off that she directed everyone through it, and then Garcia's like, wow, like, what'd you do? Like, now we're about to go back in the or. Like, we'll have to clean up your mess, whatever. And Dr. Alhashmi is like, or they'll be happy that I saved this kid's life. And then it's Dr. Garcia who was like, checking Santos about being rude to Dr. Langdon.

[Dr. Gita Pensa]

I've been a goddamn pariah for the

[Hunter Harris]

last 10 months for doing the right thing. Or maybe you're Brian because you don't play well with others.

[Dr. Gita Pensa]

If you've still got beef with Langton,

[Hunter Harris]

go tell him he's here to stay.

[Dr. Gita Pensa]

So put on your big girl panties

[Hunter Harris]

and work it out.

[Dr. Lok Patel]

No, he's not.

[Hunter Harris]

You want to have sex and eat ramen in bed, I'm your girl.

[Dr. Gita Pensa]

But if you want to talk about this Langdon shit again, call a therapist.

[Dr. Lok Patel]

What do you think about a two woman Broadway show called Sex and Ramen in Bed starring Garcia and Santos? Would it do?

[Hunter Harris]

Well, I'm. I don't like eating in bed. I don't like eating in bed culture. It's. I don't know, it's a little bit gross to me. No. Okay. But we have confirmation now. I think we kind of had confirmation a little bit earlier that because of the toothbrush thing, but now we know for sure that was when.

[Dr. Lok Patel]

That was when it was like, hinted and people were like, all right, cool.

[Hunter Harris]

Yes. Now we know for sure that Sandos and Garcia have a little situation chip. And I don't know, I think I like that Garcia is willing to check Santos. Like, she's very so able to compartmentalize

[Dr. Lok Patel]

the hierarchy and the egos in medicine do exist and the inter hospital situationships that happen. It's like, I'm not gonna say this from personal experience. Okay. This is professional, professional setting. Because I'm not. I don't. Would like to say I don't have a huge ego in that setting, but I've heard from people who have dated superiors or they've dated medical students and like that stuff happens when they're like, wait a minute, I'm. I'm your supervisor, but I'm also sleeping with you. Like, this is again, why this is not appropriate and should be handled very carefully. And so I think this little scenario that we're seeing, it's kind of a relatable one.

[Hunter Harris]

Yeah. But I also, I'm glad that Dr. Garcia was like, the reason why people don't like you in, in the ED is because of your behavior, not because of like the Langdon golden boy. Because even, I mean, Langdon wasn't like that popular. He was obviously Robbie's one of Robbie's favorites, but like, everyone else was kind of like rolling Their ey to, like, you know, last season, the previous day that we've seen, like, he's not beloved by every single person.

[Dr. Lok Patel]

We just need to see that Santos Langdon conversation. We just need to see the two of them finally sit down, maybe it's in the break room, and just hash it out.

[Hunter Harris]

Yeah. There's some healing that needs to happen. We need to take it to the red table. But do you think that Santos does not like being taught

[Dr. Lok Patel]

100%? Yeah, I don't think she likes being taught. I don't think she likes being told what to do.

[Hunter Harris]

Yeah, definitely not corrected.

[Dr. Lok Patel]

She's got that Sonya Blade, Mortal Kombat vibe where she's like, I'm in charge. I don't need anyone's health.

[Hunter Harris]

Yes.

[Dr. Lok Patel]

I got to say real quick, we're talking about, like, the tension of the room. I love the subtle line when I think it's. I think Santos says something along, like, there is no tension. And she's referring to the. The chest, the pulmonary cavity. And Garcia is like, at least not a pneumo, because she's referring to the two of them have tension.

[Hunter Harris]

Wait, I did not even close this

[Dr. Lok Patel]

really subtle little, little line.

[Hunter Harris]

Okay, but tell me who was more. I guess, can you explain to me, like, the differences and maybe what they were thinking between Santos and Langdon? I couldn't really understand, like, how their approaches were different and why his was better than hers.

[Dr. Lok Patel]

What they're essentially first kind of talking about is there's blood in this. Around this patient's lung. A hemo pneumothorax. So the first. The first kind of situation that they are disagreeing upon is whether or not they need to drain the blood from the chest. Santa's like, there's blood. We got to drain it. And Langdon is like, the patient's stable. You don't need to drain it unless it's a certain size. And then a Dr. Al Hashem is like, yeah, we can wait before we drain the blood. Then the second scenario is how to get the air out of this patient's chest when she's like, we need a chest tube, and we need to drain it. And he's like, you can use this thing called a Thor event, and that way, you know, you can keep it in there for a longer period of time. You can suck out the. The air. And it's this good teachable moment because Langdon has gone through more of these procedures than she has.

[Hunter Harris]

Yeah.

[Dr. Lok Patel]

And he's not being mean. He's like, listen, like, you don't need to do more to the patient and just listen for a second.

[Hunter Harris]

Yeah, like something more invasive versus less invasive.

[Dr. Lok Patel]

Yeah, more or less.

[Hunter Harris]

Okay.

[Dr. Gita Pensa]

Now it's a tactile procedure. 2 centimeter incision through the tracheal rings, finger in the trachea, bougie into the airway. Thoughts on what's next, Dr. Whitaker?

[Dr. Lok Patel]

Insert the ET tube into the trachea.

[Dr. Gita Pensa]

Suction. Lots of blood in the airway.

[Dr. Lok Patel]

So, like, this is pretty complicated. I talked to an ER doctor, a trauma surgeon, and a pediatric surgeon just casually about this procedure. And so essentially, you got to create an airway. You either can't intubate someone or you can't oxygenate them through their mouth. And perhaps there's an upper airway obstruction. There's trauma. There's some reasons you need to go in through their throat. And in certain situations in kids, it's actually better in an emergency to do a slash. So basically, a vertical incision, the more permanent solution, or I should say, like, the more controlled solution, would be a horizontal, traditional surgical tracheostomy. Which is why Langdon makes that comment. Like, this is going to take 20 minutes.

[Dr. Gita Pensa]

Yeah.

[Dr. Lok Patel]

So she's like, it's emergency time. And so people may have heard that term, crike, where you like, go, that's a little bit higher, where you're going to create that airway, and you might not be able to do it in kids. So long story short, because of the situation and it's an emergency and the anatomy, the unique anatomy of kids, that's why I talked to all Hashmi is like, we got to go vertical. This is an emergency. So they just call it a slash. So there's a lot happening. But, you know, shout out to the medical writing because, like, I. I fact checked this, and I was reading some journals from emergency medicine. Emergency medicine journals. And it's totally accurate how she describes it, handles herself under pressure. And even Dr. Robbie is like, damn. The one thing there is something you're unrealistic, though. Okay. When Garcia walks in and she's annoyed. Yeah, I do not hear that. I have not seen that. I don't think that would actually happen. I think a surgeon would come down and understand, like, okay, this is a kid. Yeah, this was an emergency. What matters is that the kid's life is saved. And it's pretty common knowledge in the ER in trauma worlds that if you get an emergency airway, that it can be repaired and stabilized in the OR. That's why Dr. Alhashmi is like, yeah, they'll fix it in the OR. But patient is alive. That's what matters, right?

[Hunter Harris]

I mean, Dr. Alhashmi kind of like rolling her eyes as she's walking out, like, loved it. Couldn't get enough of it. I do like how it's like Dr. Alhashmi checks Dr. Garcia, Dr. Garcia checks Dr. Santos, and then like, Dr. Rabbit won't even talk to Dr. Langdon and

[Dr. Lok Patel]

park the shark checked everyone.

[Hunter Harris]

Yeah, like there's just.

[Dr. Lok Patel]

There's a lot of just checks in

[Hunter Harris]

this episode because everyone's like, at the end of their row. But that was. That was like a very cool scene to see. But then I'm also like, wait, they just put their fingers in a child's, like, throat?

[Dr. Lok Patel]

I will say, in my. In med school, I did several months of rotations in surgery. That's what I thought I was going to do before Pediatrics and tracheostomies are like, my favorite thing to do.

[Simran Beidouan]

Oh, wow.

[Dr. Lok Patel]

In the majority of the situation, they are controlled surgical tracheostomies in the or.

[Simran Beidouan]

Okay.

[Dr. Lok Patel]

And oftentimes it's somebody, for whatever reason needs a long term, long term breathing tube. And a tracheostomy is in most cases, if not all cases, the safer, more comfortable way to do that.

[Hunter Harris]

Okay.

[Dr. Lok Patel]

And they're. They're very satisfying to play surgically. It kind of like pops in and you like, sew it down anyway. What's your name?

[Hunter Harris]

My leg hurts really bad. They didn't break it. I wouldn't say that it's broken exactly.

[Dr. Lok Patel]

We're gonna get an X ray to determine that. Put that on the gurney. Line it up for X ray. Keep your fucking mouth shut.

[Hunter Harris]

Okay, Alok, we need to get specific, like, what is happening with the leg? And like, what. What does a surgeon in this case look for? That it can be reattached or that it can't be reattached. I wanna get into the medical stuff.

[Dr. Lok Patel]

Yeah. There's so much happening in this short, dramatic scene. I mean, obviously you got ogilvy, like, shaking with the leg. But the first thing I noticed is the leg was wrapped and presumably stored appropriately.

[Hunter Harris]

Okay.

[Dr. Lok Patel]

Everything is clean. You know, you want to keep the limb slightly cold but not frozen, which could kill some of the tissue. But it's like, clean. It's in a waterproof bag. I don't know why he's unwrapping it just yet, because no one's told him to unwrap it.

[Hunter Harris]

But I mean, he's also about to tell this woman that she doesn't have a broken neck or something. It's like, you don't know that.

[Dr. Lok Patel]

Now, what's interesting is, like, you could lose your leg, but because of being in shock and a ton of adrenaline, you may not feel it right away, but you've cut nerves in half. So you're gonna feel it.

[Dr. Gita Pensa]

Yeah.

[Dr. Lok Patel]

Then you're gonna start going into panic. You know, you hear Donnie mention that she's gotten some fentanyl for pain. Then, you know, they want to give her some ketamine, which is another. You know, you can preserve someone's blood pressure while also handling pain.

[Hunter Harris]

They take ketamine all the time on this show.

[Dr. Lok Patel]

Yeah.

[Hunter Harris]

It's like Bushwick.

[Dr. Lok Patel]

It's like Bushwick. Yeah. It's used often in ers. And then Whitaker mentions the popliteal nerve blocks, so, like, regionally blocking all the sensation going downward on that leg. Okay. Just to keep her as comfortable as possible. And then when your deluxe diva, as you call him, park the Shark, rolls in, what I'm guessing he's looking at in this brief moment is looking how. How clean the separation is on the limb. And he's looking at the limb, and he's looking presumably looking at the vessels, the bone, et cetera. Like, can I reattach this in the or? Because you don't want to have a poorly reattached limb that may not take or cause an infection. So I think based on park the Shark's experience, he's like, okay, we can. We can give this a go.

[Dr. Gita Pensa]

It's not about us. It's about them.

[Hunter Harris]

She's so calm.

[Dr. Gita Pensa]

She had a long time to prepare for this moment, what she's doing for her sons, managing this with so much grace, the real gift of love.

[Hunter Harris]

I feel like an

[Dr. Gita Pensa]

all they want

[Hunter Harris]

is more time with their mother. All I want is less time with mine.

[Dr. Lok Patel]

We've just experienced this moment with Roxy and as we talked about with Justin Baker, kind of a hallmark example of the doctrine of double effect. And, you know, McKay explained to her, like, we're giving you more pain medications. It may slow your breathing. Clearly, as mentioned, Roxy's, like, thought through this. The family's there, husband's supportive. He's like, this is where I need to be. Like, they know what's happening. You know, I was reading journals about how often palliative care happens in the emergency department, and it's interesting. Like, there's statistics about how many times people go to ers in their last months of living because they're in pain, they have chronic illness, whatever it may be. So I do think that the conversation is happening more in ERs as people need to find a way to really preserve their quality of life. The one thing that's that I think is so real is having to compartmentalize your feelings and go from patient to patient. And Jafani has that moment where she steps out. But I'm just gonna say it's okay to cry in front of a patient or like be pissed or swear or be human. And the few times like I've had emotional moments in front of patients in whatever way, like it makes you more real, it makes you human. I've seen experienced surgeons get teary eyed in front of families just because you're all going through this together. Hunter, as we talk to Simran and Damian, what are you most curious to know about how this episode was written and created?

[Hunter Harris]

I want to know all about the Santos Garcia situationship, how, how this happened, how like kind of the slow rollout of this, like we've gotten ideas like hints that maybe they're together or like together. Ish. But I don't know. I want to know everything about kind of tracking that throughout the season.

[Dr. Lok Patel]

I'm right there with you. So let's get into it and ask all the questions to show writer Simran Beidouan and the director of this episode, Damian Marcano. Simran, I have to ask you this question. In this episode it feels like we are reaching a boiling point with so many character and social situations. So I have to ask you what was it like to kind of shepherd all the characters to this point without giving too much away too early?

[Simran Beidouan]

You know, I mean we really have to structure the seasons into like a trifold with 15 episodes. So we try to have things, you know, in the first five episodes that there's something that incites us to like, you know, propel us forward into the middle, you know, five. And now with episode 10, it's really heading, you know, we're just freight training it. No breaks to the finale. So you know, we're really trying to make a concerted effort to like, yes, the cases are there but what does that mean to our characters and how are we also in the fact that we're, you know, one hour, you know, per, in one shift, that they've been on shift for 10 hours, people are exhausted, you know, mentally, physically. All these other things that you've been trying to avoid for the day keep crashing back at you. So it's, you know, it's very purposefully constructed to start hitting ahead.

[Dr. Lok Patel]

We can feel that the freight train, it's on its way And Damian, I want to ask you, you directed a few episodes in season one. What was it like coming into season two? What was different? What caught you by surprise?

[Damian Marcano]

I would say every episode of the Pit is a surprise. Right. It's fun even for, I think, us as the directors to kind of find out what's happening and what's coming because we are all a very close knit and close working group of people. So being at the Pit, you run into the writers, you run into Scott, and I'm sure everybody always wants to know, so what do you guys got planned for us? And with season one, we had this larger than life mass casualty for 12 and 13, and maybe I thought maybe that would become our show's format and they would kind of do the same thing again. But I remember when I saw Scott and Simran early on and they just kind of had these smiles about what they had planned, planned for us for this year. And I was actually, you know, without giving too much away, I was just kind of glad to see that we didn't repeat just the same thing from season one. The characters are the same. There's new faces as well, but there is some new exciting life. And I would say that that is what surprised me the most about the Pit. I. I'm in awe of what our writers do and the fact that they were able to put these new characters into our season and to feel as if I think they were there season one. Right. But no, they weren't. These were all new faces and each one of our cast is just. It's like a dial off of each other, but they're all just so specifically different and unique in their own way. And it's so refreshing when you are directing an ensemble like that to be able to have, you know, just that many colors to work with.

[Hunter Harris]

Man, Simran, I want to know. I want to kind of dig into this dynamic that we see in this episode between Langdon, Santos and Garcia. This Santos Garcia, sort of like simmering. Are they together? Are they seeing each other has been like a really kind of fun slow burn to, like, just deduce how much, how well they really know each other. Can you tell us about tracking that and also what they see in each other?

[Simran Beidouan]

You know, I think it's like anything if you've ever dated somebody in the workplace, you know, raising my hand. But you sometimes want to. You want to separate church and state, right? Like, you know, yes, we met here and we like each other, but we each have jobs to do and we have things going on and sometimes that kind of, you know, inevitably comes to a head in that professional workspace. So, yes, you know, we always say that the Pit isn't a show, that you should be folding your laundry, you should be paying attention because there are all these subtle context clues without having to, to say, hey, remember when we went out to dinner last night? It's like, it's just part of what it is. But I think it's also we want to bring about, what is that relationship? Is it just a booty call kind of relationship? Is it something more? Does one person see it as something more and the other person's like, oh, I haven't really defined it. So we're just playing in that pond of what it means for Santos and what it means for Garcia, and we will have a little bit more of that clarity. You know, you see already by the time you get to 10, Santos saying, like, what are you doing? What are you doing after? And maybe like, wanting to hang out more and Garcia keeping it a little bit chill. But I think in this episode you get, I always said when we were on set to Damian and we were talking to our actors, like, this is not a scene between Garcia and Santos. This is a scene between Yolanda and Trinity. So think of that when we have that personal conversation later. It's not about doctor to doctor when we get towards the end of the episode. It's more about, like, I see what's going on, but let me tell you, to somebody who actually genuinely cares about

[Hunter Harris]

you, I like that there's a moment of Santos, like, complaining about how she's felt like a black sheep in a pariah for so long. And Garcia's like, well, but who's made you feel that way?

[Simran Beidouan]

Right?

[Hunter Harris]

Like, I thought that was really interesting. Damien, can you tell us how you approach directing this episode?

[Damian Marcano]

I think, like, I do all of them. We just come to work. Keep your head down. I say this because I, after directing so many things in our lovely Hollywood system, I think it is a very important ingredient to mention. Ever since we started this show, there was a little note from Noah Wiley in each of our binders. Just kind of reminding everybody that we would put egos aside and we would come in here and we would try to recreate as best what this amazing medical community does. Right? I step in like a lowly director in this scenario, right? I am, I am at best trying to do what you didn't have takes or multiple opportunities to do on the day when you perform this life saving miracle. So I attack every single scene of the pit. I do in that exact same way. You know, we get together, we rehearse for, you know, 15 minutes or so before we shoot one, and we more or less have a conversation, I think, in which we are all trying to find the truth in the scene. We're not trying to overact. No one's trying to get that special shot and whipping the glasses off and saying that prolific thing. We're just trying to say, if these doctors are working as a team in order to create these miracles, then I think we have to fashion ourselves in the same way. And that's what we do time and time again.

[Simran Beidouan]

I love how Damien is underselling what a vital component he is to the collaborative process of making this success.

[Damian Marcano]

Listen.

[Hunter Harris]

Very poetic.

[Dr. Lok Patel]

Wow.

[Damian Marcano]

I come from Trinidad, right? And my coat of arms. I keep this. I keep this on set with me every day. This is a hundred dollar bill from Trinidad, right? And what it says on our coat of arms is, together, we aspire, together we achieve. I've given one of these to Noah Wiley. I probably owe Simran a couple of these because it's just a little reminder I need every day to keep myself in check and to put myself in place in order for us as a team to achieve the greatness that we've just achieved. So I know that I'm an important part to the show, but I think one of my most important parts to the show is to sort of keep us on that path. I think if we continue to do the work, that our writers room is blessing us with amazing scripts. Simran is making me direct things that make me go 10, 1 and leave the stage because I'm directing it and I'm crying and I'm like, looking at this lady like, why are you doing this to us? Right? But what I think we've seen now is however we happen to feel on set seems to honestly translate through this negative that we are shooting and getting to this audience in exactly the way that we felt on the day. And I think it's also just sort of our, you know, it's a vibes check, man. I'm a Rasta. I can't help it, man. We tend to talk about ourselves in very minimalistic ways while trying to do great things.

[Hunter Harris]

Simran, can you tell us a little bit more about how the two of you work together, like when you're on set and when you're. When you're talking about the episode?

[Simran Beidouan]

Damian and I had the privilege of working together last year, and then he directed both of the episodes that I had this year. But instantly we. I was calling my brother from another mother. We had this connection because, you know, I'm Indian and that's my heritage. And Damian is Trinidadian and, you know, there's a very large Indian population in Trinidad. And I think maybe just because we are like, both, like, you know, have this immigrant mentality, we come from different worlds. We see things in a different space. We really like the collaboration that television allows writers and directors to have that we just gel and get it. And we can, because we get each other, can have really candid conversations, can have, you know, disagreements that are obviously very, you know, just cordial. They're not like, you know, they're not adversarial, but we can really have in depth conversations about the material and what the characters are going through. And, you know, we. I think we just work together as like a, you know, we come together as a united front when we're on set and just, you know, set a good vibe. Damian, the director, is always the one in charge on set, you know, and Damian leads by example with, like, his, you know, attitude and the way he wants to give the actors agency and the way everybody has a role. He, you know, greeting everybody with a handshake or a hug. And, you know, that tone really matters, especially when you're dealing with such serious subject, you know, matters that we have on the show.

[Dr. Lok Patel]

I had one last question for both of you. So my medical friends, anyone who works in the healthcare system loves this show. Not surprising why, but one thing that does surprise all of them is that people who don't understand medical jargon, terminology, or really understand the procedures also love this show. Why do both of you think that is? Because it's true. People who don't know anything about healthcare still are captivated by the show. Why do both of you think that's the case?

[Damian Marcano]

I would say from the mind of a director and that ingredient that we would put in. We have a lot of medicine on the show, obviously, and we have the doctors there that help us keep it 100% correct. But I'm always directing, looking for the interpersonal relationships during the medicine. But I think maybe for a while, medical dramas maybe haven't done enough of that with the doctors. You know, you guys have always been sort of like in the or, you're the doctor, and outside you're like the lover or the romantic or the divorcee or the whatnot. Our show, I think, kind of collides both worlds and makes even those private moments where a couple like Garcia and Santos have to find a private moment. It's always something fun when we have one of those scenes to do. We're always trying to figure out, yeah, where are you going to go have this private chat? So I think that's the ingredient that we put in. From my own personal life and the things that I've heard, just like you've heard, I like to remind people that we've come out most recently of a time when all of these first responders pretty much saved all of our asses, right? And we were at home and we all thought we were going to die and we needed someone to shine some light on us, man, and they did. You guys saved us in that time. I think just like one of my favorite reggae singers, Bob would say, man, sometimes I spread so much sunshine on everybody, I forget I need a little ray for myself. I think our show is that little ray of sunshine. Back to you guys. So I am more than honored and more than thrilled to even be a part of something like this because, you know, for once we've used some TV to really do some good here and it's just an amazing pleasure.

[Simran Beidouan]

I echo, you know, Damian's sentiments. I think that's exactly it. I live in a multigenerational house. You know, I have a 12 year old, a 17 year old year old, 50 somethings. I've got my parents chiming in from, you know, they're in their 70s and 80s. And I think the reason why it hits so many different people and so many different things because, you know, clearly, I mean, we don't have any doctors in my family, much to my parents chagrin. But you know, I think the reason why the 12 year old gets it and the, you know, 80 year old gets it is because there is so much humanity, there is so much heart, there is hopefulness, you know, and you're seeing that, you're seeing that in the interactions. You're seeing that in the impact of these doctors and nurses. You know, as much as they have to be stoic and do a job, they are also human. That's true resilience. That's, you know, that deserves respect. And I think that, you know, hopefully we are shining a light on that and giving them, you know, healthcare workers their due.

[Hunter Harris]

Damn, what wonderful answers. Incredible.

[Dr. Lok Patel]

May this show run for 10 more seasons.

[Simran Beidouan]

Your lipstick as ears.

[Hunter Harris]

Thank you. Thank you guys so much. Something that I did not realize is that Damian has directed so many episodes of the Pit that he directed stuff from season one and now in season two. And I think that he knows the cast really well and knows, like, how everyone, you know, what works best for every actor, which I think is always really interesting.

[Dr. Lok Patel]

He probably knows how to, you know, bring out different elements of them that they're going to appreciate. It also speaks to his character that at the premiere everyone was so happy to see him. I remember this because I remember being like, that must be Damian. You know, I've seen pictures of him. But everyone was so excited when he was there and there was like a different vibe around it. I was like, oh yeah. I mean, Simran too, when they were around, everyone was so excited. I saw her then both kind of joking with the cast and, you know, dancing and everything like that. I'm like, all right. They clearly have a great relationship between the writers and the directors of the

[Hunter Harris]

show and the actors, but I think those two specifically seem to have a really good rapport. I think, you know, Simran talking about being on set with Damien, I'm. I don't know, I think that they really, like, have a certain magic between the two of them.

[Dr. Lok Patel]

You know, we've, we talked about Santos and Garcia and how this episode is really reaching a boiling point. And the other boiling point that's happening is with Mel and the Mel practice issue. And again, in typical Pit fashion, I love the fact that they brought in the real world experts to make sure that this was drafted in a realistic fashion. So that is why we've got medical malpractice expert Dr. Gita Pensa who consulted on the show this season to tell us more as we go outside the pit to talk about medical malpractice, which, oh my God, every doctor just loves talking about so much.

[Hunter Harris]

I feel like you're like trick, like you're 10.

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[Dr. Lok Patel]

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[Damian Marcano]

his kids will outgrow tomorrow.

[Dr. Lok Patel]

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[Dr. Gita Pensa]

Spill, girl.

[Hunter Harris]

Well, a couple of months ago, I got named in a malpractice lawsuit. And so today is the deposition.

[Dr. Gita Pensa]

That's it.

[Dr. Lok Patel]

Dr. Guidapensa, thank you so much for joining us today. You know, Hunter and I have talked about this before, about how it's not totally uncommon for doctors to be sued or threatened with a lawsuit. Can you tell us a little bit more about that?

[Dr. Gita Pensa]

Oh, yeah, absolutely. So I, and I come from this is the Lenses. I'm a practicing emergency physician and also somebody who spends a lot of time in the medical malpractice world. And I work with doctors who have been sued and help them kind of get acclimated to the environment and then perform in that environment. Depending on whose numbers you look at, between a third and a half of all doctors in all specialties will be sued at some point during their careers. However, if you're in a higher risk specialty, such as emergency medicine, some are probably like, top third. The really, really highest risk are fields like ob, gyn, neurosurgery. A lot of the procedural specialties, the surgical specialties are way up there. And if you are, for instance, a practicing OBGYN, 90 something percent of you are going to get sued. And even in emergency medicine, which is, you know, what we're really focused on here in this show, if you practice for 30 years as an ER doc, there's a 90% chance that you'll be named in a lawsuit at least once.

[Hunter Harris]

So the Pit is known for highlighting issues that exist in the real medical community. What were your conversations like with the writers and with the executive producers about malpractice and how the Pit could cover this subject?

[Dr. Gita Pensa]

I was so excited when I heard that they were going to go there. And I have to say, it was a virtual session over Zoom, and the whole writing room was there. And I didn't know enough about the show at the time to know that Noah Wiley was also one of the writers. And so when I got on the Zoom and I met all the writers and they tilted the camera towards him, I have to say, I'm not someone who's prone to being starstruck, but I think there was perhaps a little squeal of, oh, my gosh. So it was really, it was very exciting. And then we really just got down to work and we had a really nuanced and, to my mind, a really thorough discussion about the impact that medical malpractice litigation has on physicians who are named, but really the conversations were around what happens to. What happens to the physician, what happens to their confidence, what happens to their sense of self, what kind of emotion are they experiencing? And it really does tend to be this really kind of toxic stew of shame, guilt. Whether or not you were responsible for whatever the harm was that happened, whatever the adverse outcome that happened, whether or not you are responsible for that, there's always some sort of very difficult mix of emotions to contend with because nobody wants to have anything bad happen to any of their patients. And inevitably, sometimes things do. And when you are a steward for that person's life, you take that, really, you take that responsibility very, very heavily. And there's always a sort of mix between responsibility and culpability, responsibility and blame. That it's a hard line to walk for a lot of us. And so we had a really wonderful conversation around all of those issues.

[Hunter Harris]

Can you maybe tell us about how, like, the, like, privacy of these cases? If I were being named a malpractice suit, it's like, who can you even talk to about it on your team or on your staff? And how does that contribute to, like, a culture of like, sh. Or just not feeling comfortable in that circumstance?

[Dr. Gita Pensa]

That's such a great question. And that's so much of what I work around. So historically, physicians really haven't talked about this. Even though I just gave you those numbers and I said that in a high risk specialty like ours, we're practically all gonna get named at some point. We don't talk about it. We don't talk about it because there's this perception that it's shameful and people don't know how to talk about it. And a lot of times you'll show up in someone's office. The first day you'll be in a claims person's office or a risk manager, then maybe the attorney. And the first thing they'll say to you is, I know this is hard, but you're not allowed to talk about it. Now, I never want to talk about this without acknowledging the other side of the equation, like that there are patients who have been harmed. Sometimes it is because of error. Many times it's not. Many times it's sort of a systemic problem. Or it's, as we've seen on the. On the show, you can get stuck between a rock and a hard place. And one doc can say, we're going rock, and the other one says, we're going hard place. And one of those choices is, in retrospect, may not have been the right choice. And we face these choices all the time in medicine. But then you have this outcome that none of us ever wanted, and we have our own feelings around that. And then you are blamed in a way. I mean, the process is really highly adversarial. And they'll come at you with all sorts of really, really harsh language and using words like, you know, malpractice and negligence and malfeasance and just making you feel like just the worst possible human being. So this is actually a real threat to identity for us. But when you take a person who's dealing with all of that and you tell them now you're not allowed to talk to anybody. I mean, and we tend to be, except for Robbie, like a lot of us are rule followers. You tell us not to talk about it, we're not going to talk about it, but it really does something to us. And I don't know really any other scenario in which you take and you really, truly traumatize them like this. And then the party line is you're not allowed to talk to anybody. And so part of what the work that we did together in the writer's room was getting. I was so excited to see Robbie say this to Mel. To be able to draw that line between talking about and revealing important details of your case versus talking about the process is happening. This is how I feel about it. This is the ways in which this is, like, really stressing me out. This is what I wish I could do. Like, these things are not your case details. And we need, just as human beings doing really difficult work and being caught in a really tough position, many of us, we need to be able to talk to somebody who can receive it empathetically from us.

[Dr. Lok Patel]

I wanted to ask you also, Geeta, about any potential trends in malpractice cases that you may have seen over the years. I bring this up, it's like I had a family threaten to sue me once because the MRI machine was down. This was not my fault. I did not break the MRI machine. But they were so frustrated with this delay in care because of that machine. And what scares me is I can see some law firm being like, yeah, let's do it. Let's sue everyone at that hospital for millions of dollars. And so I'm curious if you've seen in your consulting work and your personal experience a trend, you know, are there. You. You mentioned some of the specialties who are more likely to be named in lawsuits. Is there. Is it always error? Is it, you know, something you mentioned with systemic issues, are More cases being dismissed. Is there any light you can shed about the direction we're going to?

[Dr. Gita Pensa]

Sure. So there's a couple of trends that are interesting that we probably should unpack. But just sort of overall, of all these medical malpractice suits that are begun, probably half of them don't go anywhere. Like, half of them just eventually go away. There's really no fault that can be found. They can't really weave a story around it. They can't find an expert to support it. So there are a lot of medical malpractice suits that are initiated because something bad has happened or because a family is frustrated or sometimes they can't get answers. They can't get answers from a hospital system that's very opaque, more and more corporate. It's really tough to get to get help or answers when something has gone wrong. And that frustration, where does it go if you can't get help from this side of things? Right. Someone will tell you, go talk to an attorney. And the attorney is often more than happy to figure out, like, oh, is there a case here? Is there an expert who will support it? And. And I don't really fault anybody in this situation. I mean, like patients, it's very frustrating to be a patient these days. So the more frustrated the public gets at the fragmentation of care, at the inaccessibility of care, and the harder it truly is to access care. The sicker people are when they get to care, the more likely there is going to be some outcome that nobody wanted. Right. And then when the system, if they are being obstructionist, if it is a circle the wagon kind of mentality, which is not what I advocate for at all. But if it is that kind of mentality and the patient is really overly frustrated, they're going to take one of two avenues. Oftentimes, either they'll file a board complaint. We're seeing that really like, so medical boards as an outlet for this, which control our licenses. And so we're seeing a lot of a big increase in medical board complaints or they're going to try to find file a lawsuit and the plaintiff's attorneys are. They're going to go through them and see what seems like it has grounds or what doesn't. And the worse the out. This is horrible, but the worse the outcome and the younger the patient, the more likely it is that they're going to try to pursue an action. Again, very complicated, very nuanced. There's pain on all sides. And the other trend that we're seeing is the rise in These so called nuclear verdicts, you'll see these like millions and millions and millions of dollars. One point I want to make is that if a doctor is going to trial, unlike other things, if you hear a doctor is going to trial to defend themselves, they usually believe that they did a good job. That's like true malpractice is settled. Not all settlements are malpractice, but usually we're going to try to settle that out of court. The doctors that go to trial and I, as a doctor who spent 12 years in one malpractice, a suit and went to trial twice defending it again, I mean, a huge part of my career, I will tell you, it's this extraordinarily difficult. It's just a long and very, very arduous path. But we're seeing now perhaps the doctor usually will win in those times like 80 to 90% of the time. And the pit is, you know, to my mind, one of the greatest things that happened to healthcare in years because it tells the story of our competence. And that's a story that I want to see every single day is a story about our competence because by and large, we are very competent and we want to do the right thing. But shows like this, where you get to start a conversation even about it, to me are just, they're just the beginning and I hope we can keep the ball rolling.

[Dr. Lok Patel]

This is great. This is great life advice.

[Dr. Gita Pensa]

I'm really glad, I'm really glad to have been here. I'm so excited and grateful to the writers that they're moving with the storyline. I can't wait to see what comes next. And thank you.

[Hunter Harris]

Awesome. Well, thank you so much. This was wonderful. I learned so much. I think the most interesting thing about talking to Dr. Gita Penso was that there's not a lot of ways for like patients to feel heard. And so sometimes like taking it directly to a lawsuit. Very extreme. Is the way to like feel like you've accomplished something or that you've like recouped something in some way, which is like actually quite sad.

[Dr. Lok Patel]

It's awful. And you have to feel for patients like we have a very, very frustrating, broken, fragmented healthcare system. And if something goes wrong, if there's an error, like patients don't always know who the culprit is, but they're angry. And inevitably there are law firms who will say like, hey, like, let's go sue this hospital. And then like I mentioned earlier, there's situations where, yes, there should be an investigation. And I'm glad. Yeah, I'm glad she brought that up. I'm glad you brought the emotions and also the fact that some physicians feel truly scared and lost.

[Hunter Harris]

Alok, let's go back into the comment section. I'm feeling brave today. I'm feeling brave and curious. Let's see what people have to say.

[Dr. Lok Patel]

Again, I want to read this comment because it deserves, like a slow clap around the world. I love the Pit. In your podcast, I wanted to be involved in the medical role, but because of my mild CP cerebral palsy, I was limited to what I could do. And I just learned so much from watching you all. Bless your heart. I'm 70 now, but things like volunteering in food pantries, working on a suicide helpline, ringing bells for the Salvation army, and working at a preschool for handicapped kids for 23 years. Who is this Nobel laureate?

[Simran Beidouan]

I love that.

[Dr. Lok Patel]

Like, amazing. What a. What a well hearted, amazing individual. Yeah, that deserved its shout out.

[Hunter Harris]

I do kind of want to see more, like, volunteers on the Pit. That's like a role that I see.

[Dr. Lok Patel]

Well, they have. They have them show up in the code Black. Remember volunteers? So they go be runners.

[Hunter Harris]

Yeah, but you're right.

[Dr. Lok Patel]

They should have, like, more volunteers playing a pivotal role of patient care.

[Hunter Harris]

Yes.

[Dr. Lok Patel]

Singing to them and stuff.

[Hunter Harris]

Yeah, I want to see, like, a volunteer like Chuck Ogilvy, like, in volunteer release school. Like, one of the med students. That could be cute.

[Dr. Lok Patel]

Ogilvy's not gonna let him. He's too. He's gonna be a. You're a volunteer. I have an ego.

[Hunter Harris]

Yeah, he's too busy reading James Baldwin to focus on people in his actual life.

[Dr. Lok Patel]

Actually, we made a joke about. I made a joke about volunteer singing. Music therapy would be a fun one to see. We have music therapists.

[Dr. Gita Pensa]

Okay.

[Dr. Lok Patel]

That'd be a good one. No, like. Like one of the ERs I work at has a dog, like a service dog who, like, rolls around. Service dog's name is Barker Posey. And, like, rolls around and, like, keeps patients calm. Like, that would be. Give me a service dog, too.

[Hunter Harris]

My dog Remy is auditioning. Not a service dog, but she's a service to humanity.

[Dr. Lok Patel]

That's it for today's episode of the Pit podcast. I cannot wait to talk about episode 11. Hope you'll join us. We'll be right here every Thursday after for each new episode.

[Hunter Harris]

You can watch us on HBO Max or listen wherever you get your podcast. And please leave us a comment, a question or reflection, anything. We would love to hear from you. The Pit podcast is a production of HBO Max in collaboration with prx. The executive producer of PRX is Jocelyn Gonzalez. Our managing producer is Courtney Florentine. Our editor is Lucy Perkins. Our production managers are Ebua Choa and Tony Karl Carlson. Our video producer and editor is Anthony Q. Artis with Assistant editor Damon Durrell Hinson. This show is engineered by Tommy Bazerian. Special thanks to Joe Carlito.

[Dr. Lok Patel]

The executive producer of HBO Podcasts is Michael Gluckstadt. The Senior producer is Alison Cohen, Sirocac and the Associate producer is Aaron Kelly. Technical director is Insang Huang. I'm Alok Patel.

[Hunter Harris]

And I'm Hunter Harris. We'll see you next week in the Pit.

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[Dr. Lok Patel]

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