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- [00:00]
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- [00:32]
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- [01:04]
Dr. Langdon
I've never understood drug addiction.
- [01:07]
Dr. Ravi
Well, you need to try a little empathy goes a long way in this job.
- [01:11]
Dr. Langdon
I am empathetic. I don't understand how an intelligent person
- [01:14]
Dr. Ravi
allows themselves, can make mistakes, heal themselves, take away the pain, hide from the abuse. We're healers, not judges.
- [01:23]
Dr. Langdon
Shouldn't we go to the crosswalk?
- [01:26]
Dr. Ravi
No.
- [01:27]
Dr. Langdon
Okay, this is what we're doing.
- [01:35]
Alok Patel
Welcome to the Pit Podcast, the official companion to The Pit on HBO. Max. I'm Dr. Alok Patel.
- [01:41]
Eczema Sponsor
And I'm Hunter Harris.
- [01:43]
Hunter Harris
It's five o' clock in the pit this week and we're in episode 11, and we get to hear about this episode from Alexandra metz, who plays Dr. Garcia.
- [01:50]
Alexandra Metz (Dr. Garcia)
I've heard pretty much overwhelmingly that I'm like every trauma surgeon someone knows, which is wonderful to hear. I've heard maybe from one or two out of the, you know, 100, let's say I've pulled or heard from that, you know, they're not all like that. There are nice trauma surgeons.
- [02:10]
Alok Patel
And then we'll get some insight on what it takes to make an episode by talking to executive producer Michael Hissrich.
- [02:17]
Michael Hissrich
We're not going into every episode and saying, you know, what message can we try to correct in this episode? We're trying to tell a great story and we're trying to champion the people who do this job.
- [02:28]
Alok Patel
Today's shift starts now. Hunter, you called it on the last episode when you mentioned that we're almost at a boiling point. Like we're boiled over now. Now the water's coming out of the tea kettle. Episode 11. There's a lot happening. I'm curious how we have four more episodes after this. Like, what could possibly go wrong?
- [02:49]
Hunter Harris
Well, I feel like everyone keeps saying, oh, only two more hours left, Only three more hours left. And I'm like. But we have, like, a few more episodes than that, so how are they gonna. How are they gonna extend the shift? I don't know.
- [02:59]
Alok Patel
Oh, you're. I see you're doing. You're timing it based on the length of a shift, 12 hours. And you know that we've got, what, 15 episodes, so clearly something is gonna go awry.
- [03:09]
Hunter Harris
I'm. I'm waiting. I'm nervous. I don't know. I don't. I don't think that, like, these people can stay in this ed any longer. Like, that's how tense everything is right now.
- [03:18]
Dr. Langdon
You know, patients come in here for help, right, because they're either sick or they're injured. And documented or undocumented, they have a right to emergency care. Tb, measles, fractures, none of it's getting treated because everybody's too scared to come in. But then they end up here anyway. But then it's too fucking late. So, please, for the love of God, can you just go wait over there in the room with your detainees so I don't lose any more patients or staff?
- [03:39]
Alok Patel
Listen, I have endless thoughts regarding this entire scenario, regardless of what stance people have on immigration policy. Like, the facts are the facts, like, ICE raids are impeding healthcare. And, you know, I've heard reports from colleagues across the country, and we have studies to show that, you know, people are afraid of going to ERs, going to clinics, they're missing appointments, they're showing up to get medical care in really late stages of symptoms because they're afraid of ice. And I think Dr. Robbie makes a very important point when he talks about the fact that everybody has a right to healthcare, and we're seeing it play out right now across the country.
- [04:15]
Hunter Harris
No, that's a good point. I mean, I. I guess I hadn't considered when ICE shows up, how much, like, the ripple effects that has on the entire emergency department, where suddenly nurses are going home. Other, like, support staff is going home, patients in the waiting room are going home. And then Nurse Jessie, who's literally only doing his job, who. I mean, that's a man I would call in a crisis. Suddenly he's on the floor getting arrested. Just the entire, like, I don't know, physicality of those ICE agents was very scary. To me, the fact that one of them like doesn't take off his mask was very scary to me. And I just cannot Im imagine like the unrest that is like this is already a stressful day. It's already fourth of July. The computers are down, no one knows what they're doing. And now here comes these men who are just fully disrupting.
- [04:56]
Alok Patel
So you have these scenarios people are seeing on TV and even scenarios involving legal American citizens following the right process. So people are afraid left and right. And I think it's smart that they put in that part, as you mentioned, of people leaving the waiting room. And then Dr. Ravi makes that point. He's like, I'm losing patients, but also like members of my environmental services, my custodial staff are also leaving. They're, they're afraid for their, their kids, their families.
- [05:21]
Hunter Harris
And also people who are citizens are leaving because out of fear of ice, because they can do whatever without any recourse.
- [05:28]
Alok Patel
Anybody who tells a healthcare professional to stay out of politics has not spent a day working in American health care because politics and policy directly impact public health every day. And these ICE immigration rates are yet another example. And like I, I have colleagues who are writing letters and looking at what's actually happening in the detention center with kids. There's a massive long term effect that this could have on children. The long term stress issues with education, with healthcare and so forth. This is a whole other podcast episode.
- [06:02]
Hunter Harris
How do you detain a child? That's kidnapping. That's crazy.
- [06:05]
Alok Patel
Let alone hundreds of children. That's hundreds of children.
- [06:07]
Hunter Harris
Absolutely insane. There's a big fight. This episode that really is like kind of in the center of the action that Dr. Alhashmi sees. And it's Langdon and Santos kind of having it out. Laura Langdon comes to Santos and says, I'm sorry for how I treated you on your first day. Santos says, not good enough. You stole drugs from the ed. Only three people here know that. And you can never atone enough. And I think, you know, it's a really loaded conversation on both sides. But it was one of the more tense moments of this episode and it's about time. You should have lost your license and gone to prison.
- [06:40]
Dr. Langdon
You don't know what I've been through
- [06:41]
Hunter Harris
that you've been through.
- [06:42]
Dr. Langdon
My wife threatened to divorce me. Okay? I almost lost my kids.
- [06:45]
Dr. Ravi
Yeah, that's what happens when you fuck up.
- [06:50]
Dr. Langdon
You don't have to accept my apology. I just, I wanted to say it. Okay.
- [06:55]
Dr. Ravi
You really want to atone for your sins? Tell everyone here you stole Drugs and got kicked out of the ED because of it. Until then, stay out of my way.
- [07:07]
Hunter Harris
I mean, it's an apology. I wouldn't call it a great apology. Right. Because he says, like, oh, I'm sorry that was an asshole to you on your first day. But he wasn't just an asshole to Santos on the first day. He was, like, telling Robbie that she was, like, a weasel and that she shouldn't be trusted and, like, really cutting her down at every opportunity. And the fact that he can get so specific about, like, what he's lost or what he almost lost, but not actually speak to, like, anything that Santos had to suffer through on that day, like, by really going out on a limb and reporting him, is a little bit crazy to me.
- [07:41]
Alok Patel
There's definitely a personal hit.
- [07:44]
Hunter Harris
Yeah.
- [07:44]
Alok Patel
For. For Santos. I. I get that. It's interesting when she mentions I should have reported you to the state medical board because by assumption, Dr. Robbie knows all about this. Yeah, he knows that Langdon stole drugs. He knows about the addiction, and it was on him whether or not there is some further action. You can't just send a resident for 10 months or so or a year or so to rehab and have the hospital on the board not find out.
- [08:10]
Hunter Harris
That means that drugs should be taken from the hospital, correct? From the hospital. From the hospital.
- [08:14]
Alok Patel
Like, Dr. Robbie, did you report this? I mean, it's not out. It's out of her hands now. Like, Dr. Robbie made the decision regardless if she agrees or not. That was a decision that was made.
- [08:23]
Hunter Harris
Yeah.
- [08:24]
Dr. Ravi
Just tell me, why are you yelling? I'm not yelling.
- [08:27]
Volvo Sponsor
It's just.
- [08:28]
Dr. Ravi
Look, it's really important that I know you're definitely yelling.
- [08:30]
Dr. Langdon
Becca, maybe we should step outside for a minute. Why won't you tell me, Dr. King? Why don't you get some air?
- [08:41]
Alok Patel
This is an interesting one.
- [08:43]
Hunter Harris
This was, like, one of my favorite storylines of this episode because I think there's the dynamic between Mel and Becca, where Mel first is checking with Becca, like, okay, you're having sex. You didn't tell me you have this boyfriend. I don't know who he is. And her first instinct is to make sure that Becca is not being, you know, abused or manipulated in some way. She kind of.
- [09:02]
Alok Patel
Right on, right on, 100%.
- [09:05]
Hunter Harris
But then it turns from that. When Becca says, like, I wanted to have sex, I initiated this. Then it becomes Mel, I would say a little bit of, like, resentment and a little bit of jealousy, as we see later in the conversation with her and Dr. Langdon, and then again with her and Dana, where She feels like she's given up so much of her life and her days to be a good sister to Becca, who she genuinely obviously loves. And yet she feels like, okay, now Becca has secrets. She has this whole other life. She's able to, like, you know, what did she say? She's like, I've watched Elf 164 times, and Becca couldn't even tell me that she has a boyfriend. Like, on a sister level, I would feel very hurt. And I. Sorry, I can go on.
- [09:47]
Alok Patel
No, please do.
- [09:47]
Hunter Harris
Well, I was gonna say, I do also, like, you know the flip side of this, that Becca, who is on the spectrum, is shown having sexual agency and, like, a really valuable and rich personal life. I thought that was really wonderful to see. But I. I wanna ask your opinion, because we see Mel talking to Langdon, and I know people ship them, but I think they do very special relationship where he can get through to her and say, you want your sister to be empowered, and so she's exercising that agency versus Mel and nurse Dana, who's like, you just kind of have to grin and bear it. Like, does it feel better saying that you're, like, mad that your sister's a liar? Not really. So you just kind of have to get over yourself.
- [10:26]
Alok Patel
I feel like all three are needed.
- [10:28]
Dr. Ravi
It's.
- [10:28]
Alok Patel
The. Langdon is approaching it from a very kind of textbook medical standpoint. He's like, hey, like, go ask her about the uti. Do you have durable power of attorney?
- [10:38]
Hunter Harris
Yeah.
- [10:39]
Alok Patel
Mel clarifies and says that she does have durable power of attorney. So she has the ability to make medical decisions on Becca's behalf if Becca is, you know, incapacitated for whatever reason. But they have shared decision making. So Langdon's like, all right, dude, like, let her be your own person.
- [10:55]
Alexandra Metz (Dr. Garcia)
Yeah.
- [10:55]
Hunter Harris
This is shared decision making in action. And I thought that was, like, a very gentle correction from Langdon. Okay, I have something for you. Alok. There's a really good Giovanni moment this episode.
- [11:04]
Dr. Ravi
Yeah.
- [11:04]
Hunter Harris
With the internal compression. But the best part is that it came on the heels of a terrible Ogilvy moment where he completely, like, overlooked what exactly? Something with this man's heart.
- [11:16]
Dr. Ravi
Aorta's clamped heart is empty.
- [11:19]
Dr. Langdon
Okay, Javada, get in there. Internal compressions.
- [11:21]
Michael Hissrich
Go.
- [11:26]
Dr. Langdon
Put two more units on the Raven diffuser, please.
- [11:28]
Dr. Ravi
They'll be unit seven and eight.
- [11:35]
Alok Patel
There's so much happening in this scene.
- [11:38]
Michael Hissrich
The.
- [11:39]
Alok Patel
This guy comes in and he's got the abdominal pain, back pain. They think that it's related to his kidneys.
- [11:45]
Hunter Harris
And he usually had a history of kidney Stones, I think he says.
- [11:47]
Alok Patel
Right. And that ultrasound kind of confirmed what Ogilvy thought, But on the ultrasound, they missed that he had what everyone reverses as a aaa. That's an abdominal aortic aneurysm. That's what Ogilvy missed.
- [12:00]
Alexandra Metz (Dr. Garcia)
Okay.
- [12:00]
Alok Patel
Even though ogilvy is a 4th year medical student and we don't just rely on their assessment. So think an aneurysm. So a bulging of the artery. We're in the. We're in the abdominal area. So your aorta, huge artery going down your abdomen. And people call it the silent killer because you can have it bulge and you don't actually get symptoms until it ruptures or starts bleeding. And if that happens, people can have intense abdominal pain, back pain, their blood pressure can drop. All these things can happen. So presumably this dude had an in a aaa. He had this aneurysm and didn't get symptoms until it bursted. So which is why they looked on the ultrasound and they saw he was actively bleeding. So that's presumably why he was like, oh, I'm fine. I didn't have any symptoms. And all of a sudden he was unconscious.
- [12:41]
Hunter Harris
Yeah.
- [12:42]
Alok Patel
But again, like, I mean, Ogilvy, yes, he missed it, but it is really on other people to review that ultrasound if radiology didn't catch it because, you know, they're human. And maybe it's an. An intern or it's a radiology resident. The radiology attending confirms that. And if they saw a AAA that was burst or huge, they would call the emergency part and like, right away and be like, yo, this patient has a aaa. It's burst. This is an emergency. Like, that's usually how that would go. Wouldn't just be like, go home now. No one saw this. Here's ketorolac, which is like ibuprofen's big brother. Good luck with your kidneys. Have a nice life. And I think it was funny when mine was like, you said it was normal and Ogle's like, yeah, I said the other kidney was normal. I wasn't referring to anything else.
- [13:25]
Hunter Harris
And you like watching that moment happen where on Mohan's face and on Robbie's face, it's just like, are you joking? Oh, my gosh.
- [13:33]
Alok Patel
As we've seen, the interns and the medical students have a lot of autonomy in the pit, like Javati doing internal compression. So think cpr, but inside the chest cavity with your hand physically on a heart, kind of wild. Like, that's a pretty serious move.
- [13:50]
Hunter Harris
Yeah.
- [13:50]
Alok Patel
It can be effective if done appropriately. In a very specific situation. But I would imagine that Dr. Robbie would be right there. I mean, this is life or death. And he instead is like, prove to your mom you belong here.
- [14:01]
Hunter Harris
Well, I think that there is kind of a cold war going on between Dr. Ravi and Javati's mom where he's like, what? I think he thinks in his mind that he's, like, advocating for Javadi, who wants to be in the ed. But I think in reality, he's probably more advocating for himself. That, like, he is just as skilled as the people upstairs. Cause that's what her mom says, that in that one line, that, like, the people upstairs are doing real medicine. The people down here are just like, trying to put stuff together, like, really slap dash, which I think is interesting.
- [14:28]
Alok Patel
It's an arrogant, arrogant surgeon moment there to kind of dismiss the editor.
- [14:34]
Hunter Harris
Which is why I think Dr. Ravi is like, so adamant that Javati, like, in mentoring Javati specifically, other than just like, them having really good rapport.
- [14:41]
Dr. Ravi
So what's happening with you? My legs getting stinky again?
- [14:45]
Dr. Langdon
Yeah.
- [14:47]
Dr. Ravi
Okay, let's take a look.
- [14:53]
Dr. Langdon
Is that an injection site?
- [14:55]
Dr. Ravi
No, no. Xylazine wounds can show up anywhere.
- [14:59]
Hunter Harris
First of all, can you tell me what street team is and how that works? And how is that different from, like, triage?
- [15:06]
Alok Patel
Not every hospital is going to have the same type of services for unhoused, at risk, vulnerable populations.
- [15:13]
Alexandra Metz (Dr. Garcia)
Okay.
- [15:13]
Alok Patel
Like, you've got some places where they have teams working with community centers and social workers. For example, Pittsburgh does have a street medicine team, but from what I understand, it's a volunteer organization.
- [15:24]
Hunter Harris
Okay?
- [15:24]
Alok Patel
It's student run, nonprofit. They work with clinicians and community partners. And they have more of, like, weekly rounds where they're going to specific areas on a weekly basis. They have awareness campaigns, they run emergency drives. Like, they do really, really great work. I don't know if that would involve people just kind of getting up and leaving in the middle of an ER shift.
- [15:45]
Hunter Harris
Asthma treatment will be outside.
- [15:47]
Alok Patel
Okay. Unless that is something that is specifically determined being like, hey, you are also today, you are also on call for these patients if they call in as a form, as you mentioned, to triage. And if that was the case, Dr. Robbie would know about it. So I don't know the way this is set up. I like the compassion. I like the altruism. It is important medicine. I really, really appreciate what McKay says when she says, you know, we aren't. We're healers. We're not judges, and we need to meet people where they are. That's very True, but I don't know if you're just walking away from this busy ED shift to do that without checking in with your. With your boss.
- [16:20]
Hunter Harris
And what happens while she's gone? Roxy dies.
- [16:23]
Alok Patel
Roxy dies. Like Roxy dies while she's gone. It kind of, you know, adds this another layer of why you can't just walk out of the ED without telling someone.
- [16:33]
Hunter Harris
Yeah, I didn't think about it that way. But then her cross is not as pressing as, like, maybe Roxy's case.
- [16:38]
Alok Patel
But Xylazine is wild. You know, they call it Tranq. It's a veterinary tranquilizer, not afda, approved for human use.
- [16:46]
Hunter Harris
Oh, wow.
- [16:47]
Alok Patel
It's not an opioid either. And I say that because you can't reverse its effects with Narcan. Narcan can absolutely save someone's life if they have an opioid overdose, but not with Xylazine. And, you know, this is why it's called Tran, because people, you know, are getting tranked out on it. And there are reports of people getting the skin necrosis. So skin tissue is dying at the site of injection. I've seen some case reports where people are getting skin necrosis even if they snort Tranq, which is wild in their
- [17:16]
Hunter Harris
nose and their face.
- [17:17]
Alok Patel
Yeah, they're still getting some. Some necrosis, which is crazy. But it just kind of. That's an important storyline, not only because of what it takes to treat unhoused patients and earn their trust, but the fact that, like, there are crazy drugs swarming the streets.
- [17:32]
Dr. Ravi
So you're going to want to start at the head, measure the length and then read it off. Approximate weight is 25 kg.
- [17:42]
Dr. Langdon
250 bolus of LR.
- [17:44]
Dr. Ravi
I have doses for ROC and ketamine.
- [17:46]
Alok Patel
That braslo tape whips out, and the tape basically opens up in different panels. Each panel is a different color corresponding to how tall a child is. Red to head, red goes on the very top. And you basically pull the tape down and wherever it stops, gives you an estimate for weight. So it's like height of a child correlating roughly to weight. And then from that, you can look at different measurements, like medication doses, but in this situation, the size of the ET tube and how far down the tube will go. So you're looking based on the tape measurement, you're like, we're going to intubate this child. It's going to be in millimeters. 3, 3, 5, 4, 4.5. And this is the centimeters of how long the tube is going to go in.
- [18:27]
Hunter Harris
Oh, wow.
- [18:27]
Alok Patel
So it's a really, really fast way to give a rough estimate of a child's weight in these emergency situations.
- [18:33]
Hunter Harris
Wow, interesting.
- [18:34]
Alok Patel
Learns you're carrying Brazil tape with you now, like when you're out about town.
- [18:38]
Hunter Harris
No, Just in case. I'm happy to know about it.
- [18:45]
Alexandra Metz (Dr. Garcia)
Oh, hi.
- [18:46]
Michael Hissrich
What the fuck?
- [18:47]
Dr. Ravi
I'm just checking your vital sign.
- [18:49]
Hunter Harris
Oh, where am I?
- [18:52]
Alok Patel
What did you do to me? So this guy who comes in after assaulting people, but on a golf course guy already kind of sucks. Like we already. Sorry, I shouldn't judge patients like that. I'm just kidding. But altercation, it's got some issues. It's gotta be nurse Emma of all people. I was like, damn it. Her first day, she's sort of bright
- [19:13]
Hunter Harris
eyed and bushy tailed and she's like, she's, you know, just watched nurse Donnie handle this man who when he was sedated and now she's like being very patient and he gets her in a headlock. Like what?
- [19:24]
Alok Patel
It's scary.
- [19:25]
Hunter Harris
It was very scary. I mean that guy's like three times
- [19:27]
Alok Patel
her size and you don't suspect that he's going to be combative. So initially when I'm watching this episode, I'm thinking, you know, there should be somebody else with her.
- [19:36]
Hunter Harris
Yeah.
- [19:37]
Alok Patel
Why is she in there alone? But there's many situations where a patient like that, you don't suspect that they're going to wake up.
- [19:41]
Hunter Harris
And that's what I was going to say. Someone who could have known that like when he was going to come back to consciousness.
- [19:46]
Alok Patel
Yeah, but it's, it's a. It's a creepy way to end.
- [19:49]
Hunter Harris
That cut to black was crazy. I'm like, this is too much. This is such a good episode. There's so much to discuss and I think it's time to bring in another doctor, Dr. Garcia, played by Alexandra Metz, who's going to tell us about her
- [20:02]
Alok Patel
experience filming season two, which I'm excited about because she is a badass.
- [20:07]
Hunter Harris
You know the situationship with Dr. Santos. I want to know everything.
- [20:11]
Alok Patel
Yeah. Let's get some tea.
- [20:16]
Dr. Ravi
The X ray was shot an hour ago. Why didn't anybody read it? There's confusion with digital systems down. It wasn't read. We didn't get a report an hour ago I could have fixed this in 60 seconds with a rectal tube. Now she needs major surgery. I'm sorry. Not good enough. Nepo, baby, you fucked up. Don't trust anything or anybody else when the system's down.
- [20:37]
Alok Patel
Alex, I'd love to hear more about what went into your preparation to create Dr. Yolanda Garcia. Humanist, physician, badass. Also kind of a mystery. What preparation did you do as an actor to kind of bring this character to life?
- [20:52]
Alexandra Metz (Dr. Garcia)
You know, I definitely, I pooled my resources. If we back it up a little bit. I was part of the program for liberal medical education at Brown University. I got in as a high schooler. My sister also went through that program. She's a gastroenterologist. And so, you know, I was a math and science oriented person. I didn't necessarily want to be a doctor, but because I got into this program that was kind of part of my undergrad experience, was having a lot of interactions with my 80 or so other cohorts in the same program who were planning on becoming doctors who are now incredible doctors, some of the best doctors in the nation. And I get to call on any of them because they're still dear friends. And I'm so proud of what they're doing and they're so proud of what I'm doing on the pit. So I have an embarrassment of riches when it comes to kind of looking for information on how to play a certain scene. But also I'm pulling together some different personalities that some people might find unsavory. Maybe lacking bedside manner when it comes to patients or colleagues, but more than anything, focused on saving life because that's the most important thing in the room.
- [22:01]
Hunter Harris
So last season there was like some flirtation between Dr. Garcia and Dr. Santos, and this season I think a little, no, Dr. Garcia was playing favorites. Let's not even pretend, a little banter. And this season, this season we have, like, confirmation that they are in a little bit of a situationship. Can you tell us about growing that relationship over time and how you and Issa play it together?
- [22:25]
Alexandra Metz (Dr. Garcia)
I think that I, you know, some months have passed since our first meeting, and so the relationship has grown slowly. We're obviously both very busy with our careers, and I think that from what we've teased out so far, you can tell that, you know, we see each other when we have time. It's not necessarily a locked in relationship. We are just seeing what feels fun and what feels proper and healthy for us individually and as professionals. So in terms of working with Issa, it's just always such a joy and kind of figuring out, like, that first episode, we were like, wait, so why are you over at my house? You're the one who has like the bigger salary. Why are we sharing a toothbrush with Whitaker? Like, how is this possible? And then I was like, girl, it must Be that I'm getting my place renovated like I'm at your place, because I'm kind of just needing to be there momentarily. And yeah, you know, it's cute to think that the three of us might watch a movie and cuddle under a shared blanket and talk about work stuff and that I could also mentor them from a more personal point of view, off duty.
- [23:37]
Hunter Harris
I mean, it's funny to think about that. In contrast to how Dr. Garcia treats Giovanni, which makes a big mistake with the patient, like, it seems like perfection is very important to her. Can you tell us a little bit about playing that?
- [23:49]
Alexandra Metz (Dr. Garcia)
I mean, yeah, the fact that her mother is Dr. Shamsi and, you know, is a superior that I respect greatly. And I know how Dr. Shamsi holds everyone to a high standard and she often probably talks about her daughter and expecting the best of her. So I kind of feel like a proxy for her mother. But also, she's a child. She's the child genius. Maybe she's on her way to that. But, you know, there are high stakes situations, and so I definitely don't want her implicated in anything, especially because her mom is such a big part of my career path and the hospital as a whole.
- [24:27]
Alok Patel
What feedback have you gotten from your. Your friends who are other trauma surgeons or viewers? Have you. Have you got any comments from people about how you portray that role? Because I will tell you, the surgeons I work with love how real Dr. Garcia seems. I'm just curious what you've heard.
- [24:43]
Alexandra Metz (Dr. Garcia)
Yeah, I've heard pretty much overwhelmingly that I'm like every trauma surgeon someone knows, which is wonderful to hear. I've heard maybe from one or two out of the, you know, 100, let's say I've pulled or heard from that, you know, they're not all like that. There are nice trauma surgeons. But it's interesting because ultimately I think that I actually had a conversation with a sports psychologist about this, and he was saying that he has a lot of surgeons as patients, and a lot of them compartmentalize in a way that allows them to survive the setting and do their job, but also take care of themselves. There's just so much trauma. Obviously we're being exposed to as doctors, and you know me personally, Alex, some of these things, I'm looking at them and somatically it feels like, oh, my God, so much cortisol. Knowing that I could see a patient where we have to fully open the clamshell, for instance, and it's like, this is such crazy technical stuff that we engage with. And someone's doing this on a daily basis. Obviously, the cases vary, but it's a lot on the body. And in order to navigate that circumstance and still do your best, you have to know how to take care of yourself ultimately. So I think, yeah, the compartmentalizing of work and the personal life is really important for her.
- [26:18]
Alok Patel
I'm going to take that sound bite, and that is going to be my reel on Instagram. What you just said about balancing cortisol and taking care of people. Dr. Garcia has got a territorial nature, rightfully so. Is she a team player with park the shark or are they adversaries? Park the shark.
- [26:39]
Alexandra Metz (Dr. Garcia)
I love park the shark. When I'm like, when I walk in with park the shark, it feels like, here's my teammate, here's my. My badass. I know what he's gonna do. I know how he's gonna do it. I know I can trust him. And he's also gonna cut through any BS and just get right to the point. I adore him.
- [27:01]
Hunter Harris
Oh, my God. You made me so happy. Because I love. I love their dynamic. No, I think that, like, you can tell that Garcia really respects him and also that they kind of speak the same language, like they are on the same type of time in a way that I think is very cool.
- [27:12]
Alexandra Metz (Dr. Garcia)
Exactly.
- [27:14]
Alok Patel
I have a little bit of a broader question. I know. Listen. We could hyperanalyze Garcia all day long. She becomes a rock star. You and I have messaged and we've talked in person about different issues affecting public health.
- [27:27]
Alexandra Metz (Dr. Garcia)
Absolutely.
- [27:28]
Alok Patel
Social injustice. I truly respect how transparent you are as a human being and how you share your opinions in a thoughtful fashion. How does it feel for you to see the effect that PIT has had in terms of raising these important topics about drug pricing, healthcare access, systemic racism, gender disparity, all these topics. What is it like to be a part of something like this?
- [27:53]
Alexandra Metz (Dr. Garcia)
Oh, boy. I could cry. Talking about how grateful I am to be part of something that actually makes a difference in the world. I think that having done this career for 17 years have landed in a show that is speaking to so many issues that are resolvable. We have within our capacity the ability to change certain systems and make things better for everyone, for all of humanity, but specifically for our healthcare systems in this nation. And to be part of something that gets to speak to that and hopefully positively influence it means everything to me. I think I get giddy with the fact that especially with what's happening all around us with our administration, that we are diametrically opposed to everything that the administration stands for and that we get to speak to real matters and affect change ultimately.
- [28:59]
Hunter Harris
Thank you.
- [29:01]
Dr. Ravi
Yeah.
- [29:02]
Alok Patel
My gosh. We should go get, like. We should go get, like, Negronis now. Debrief. I'm, like, hyped up.
- [29:08]
Dr. Ravi
Yeah.
- [29:09]
Alexandra Metz (Dr. Garcia)
It's so funny. Like, talking about the background on Garcia is interesting because there's a part of me that really loves leaving her a mystery. Because you go to a hospital and as an audience member, you feel like you're in a hospital and you don't know these doctors personally. You don't know these people. You're just picking up on these little moments and kind of piecing it together for yourself, whether you're the patient or a family member of a patient, just taking in your surroundings. And so I like that people don't know much about us, and they can project whatever they want onto the scenario and have those discussions and disagree with one another about, oh, what was the intention behind that moment? Or is she good? Is she bad? Is there good or bad? I'm happy to give a little bit more insight into Garcia and then also leave some mystery for people because it makes it fun and more realistic.
- [30:02]
Hunter Harris
Yeah. And ultimately being good or bad is like, she's still a great surgeon. She's still really killer at her job.
- [30:08]
Dr. Ravi
Yeah.
- [30:09]
Alexandra Metz (Dr. Garcia)
Thank you.
- [30:10]
Hunter Harris
Is there someone that you want more scenes with?
- [30:12]
Dr. Ravi
Ooh.
- [30:14]
Alexandra Metz (Dr. Garcia)
Oh, my God. I mean, God, I love everyone.
- [30:17]
Hunter Harris
I mean. Yeah, not to play favorites, but, like, someone that you think, okay, this would be a really dramatically rich sort of scene.
- [30:22]
Alexandra Metz (Dr. Garcia)
Okay, yeah, I'm not playing favorites, but, you know, I'd love more scenes with Nurse Donahue. I feel like maybe that's the only person I haven't really had many scenes with. And we're super tight. I adore Brandon, and I'm such a fan of his work. I would love to work with him more.
- [30:47]
Hunter Harris
Very cool. Love that.
- [30:49]
Alok Patel
That's a good answer. He's dope.
- [30:50]
Alexandra Metz (Dr. Garcia)
Thanks. He is. He really is.
- [30:52]
Alok Patel
I have a. I have a last fun question. Kind of goes back to what you mentioned with sports psychology. Cortisol Think. You know, any human being, especially surgeons, have to be able to kind of turn off the stress and do something relaxing, something that just kind of removes them away from the craziness of life in the world. What does Dr. Garcia do in her downtime? What does Alex do in her downtime to de stress?
- [31:14]
Alexandra Metz (Dr. Garcia)
Besides ramen? Besides ramen in bed.
- [31:18]
Alok Patel
Besides ramen.
- [31:19]
Hunter Harris
I was going to say, I think we know maybe not texting Santos back is what she does.
- [31:23]
Alexandra Metz (Dr. Garcia)
Oh, yeah, that's fun, too. You know, I think she works out. If you didn't notice, she's got some guns on her for that reduction. Yeah, cortisol is a big part of our human experience. And I've recently started working out more concertedly with heavier weights, especially as a woman in my 30s. Like, that's something I'm learning about how to maintain longevity and, yeah, just maintain my health. So I've really gotten into kettlebells and squats and, you know, all the weight. So I think there is a tie there between Garcia and myself because she rolled up those sleeves and cracked her back before she got into it.
- [32:13]
Alok Patel
Right. On social activism, ramen, shoulder reductions, weightlifting, all of it.
- [32:19]
Hunter Harris
Cool. Well, thank you.
- [32:21]
Alexandra Metz (Dr. Garcia)
Of course.
- [32:22]
Alok Patel
Thank you.
- [32:23]
Alexandra Metz (Dr. Garcia)
Thanks for having me.
- [32:28]
Alok Patel
I am not surprised in the slightest that the real Dodger Garcia, Alexander Metz, has friends who are physicians and went through, you know, some of the courses you do to become a physician.
- [32:40]
Hunter Harris
I always like when actors are a little bit mysterious about their characters and don't really want to reveal a lot. And I think for someone like Dr. Garcia, who we see, you know, as like, very powerful and sometimes, like, quite aggressive in conversation with other people, especially when she's, like, making medical decisions, it's. I'm just. I don't know, I kind of like keeping, like, a little bit of mystery with her because who knows, like, what she's getting up to, except for not texting Santos back.
- [33:03]
Alok Patel
But again, but serious. No, like, again, it does speak to the show's ability to. To raise awareness about real topics. Like, you don't get to learn everything about your doctor, your nurse in a short amount of time. So why should we as TV viewers learn that as well? And like, and people have struggles. They have dual identities, which is why it was. It was so important that we talked about, you know, people who have stressful jobs, like, need to de. Stress. They need to do something. And I again, I think this show highlights that really well, as it does with many different topics, which is why I was so happy that we got to talk to Michael Hissrich, executive producer, about the Pitt's responsibility with social commentary in the same way, you know, when he worked on the West Wing and the West Wing raising important points about politics, the Pitt is doing that with every single episode with healthcare. And aside from that, it's cool to see all the Pittsburgh nods. And I'm curious to talk to Michael Hissrich about the way they incorporated kind of this love letter to Pittsburgh throughout the show.
- [33:59]
Hunter Harris
Totally. I mean, this shows like, responsibility to Pittsburgh, which is obviously both the setting but also a part of the culture, the fabric of the show.
- [34:07]
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- [35:41]
Alok Patel
Michael, I want to ask you kind of a very basic question. I don't want to assume that everyone truly understands the role of an executive producer versus the other roles on tv. Can you just give us an overview of what an executive producer actually does and your specific role on the pit?
- [35:58]
Michael Hissrich
Look, there are a handful of people that have that title, and some are John Wells or Scott Gemmell or Noah Wiley. It's just a matter of what your job is. My job is to oversee the entire production of the show. I don't write Scott. Scott and a brilliant team of writers write the show, but everything else as they Hand us a script. It's my job and a magnificent team of people to take that script and make it into the episode that you see on television months later. That's working with the directors, casting, the production designer, the doctors, our amazing makeup effects team, and all the nuts and bolts of the show all fall under my office.
- [36:53]
Alok Patel
So you said something that I want to just kind of stop and really. And really analyze, as you said, months, months later. And I think one thing that Pitt does brilliantly is it speaks to what is happening nationally, what's happening right now in healthcare. And episode 11, we're talking about many different little subplots, but we have ICE agents coming into the hospital. Big moment. And anyone who is watching or listening to this podcast has also probably seen headlines about what's happening across the country, not only with ice rays, but also how it might be impacting people's ability to go to an ER or go seek medical care. When did you all decide? This is a storyline that we want to include regarding ice. And how do you feel the pit is doing in terms of its role of raising awareness about these broader healthcare topics?
- [37:43]
Michael Hissrich
Well, the first part that was in the works for months, well back into October, before I think we all kind of realized what was happening and could kind of sadly not anticipate where we're at today, but see that there was going to be this issue. As far as the second part, I hope we're doing a great job of that. The response has been pretty fantastic. But I think the most important thing for us was the lines that Robby has. And that look, people's fear. It's not that there's ICE agents at every door. It's the fear that they may be there. And that's why people aren't going to seek the medical help they need. And that's really, I think, the message that people are entitled to emergency medical care regardless of who they are or where they are. And that's the story. So hopefully people will glean it for that and not some overarching political statement other than, hey, this is still available to you.
- [39:00]
Alok Patel
Listen, I'm biased. And I personally appreciate that, because anytime a healthcare professional talks about politics and somebody says, stay in your lane, I'm like, then keep politics out of healthcare and we'll be happy.
- [39:11]
Michael Hissrich
Exactly. Exactly Right. Exactly right. And there's a lot of discussion about making this balanced and things, and. But the end of the day is the. We are battling fear and we're battling social media and everything that is just. We're inundated with. And that can't stop people from getting the help they need anywhere at any time.
- [39:37]
Hunter Harris
You see it on the show too, like how many people are leaving the waiting room, how many people are leaving the er. And it's not something I thought about before in that way.
- [39:46]
Michael Hissrich
And I think there's also a brilliant. This episode is written really, really well. And it's brilliant that Robbie points out that if people don't get the care that they could get in an emergency room now, it's going to end up being a bigger problem and a more expensive problem to the system downstream. And that's all the more reason to deal with something right here and right now than have people go away, hide for three months and then come back with a much worse case.
- [40:17]
Alok Patel
I really appreciate Dr. Ravi's role there in kind of letting everyone know that people have a right to be treated and be cared for. And that is the role of the emergency department. I want to kind of go even further in what the Pitt's done for awareness is there's other shows, the West Wing, for example, that kind of had a big role in social commentary. How do you see the Pitt's role right now in raising awareness about many different health issues? Does it feel like this is the moment where this truly is where the pit needs to exist, or did it just happen at the right time?
- [40:52]
Michael Hissrich
It's funny you mentioned the West Wing when you asked me the previous question about timing on the West Wing. We saw it more than a handful of times in that we would do a story about something going on somewhere in the world. And by the time we shot it and aired it, something very similar was happening somewhere in the world. I hope we don't get into that rhythm again where everything stories that we tell while we're producing the show come to fruition downstream. That gets us into a really scary place. I think Noah says it really well when he talks on the subject, is that the reason the show exists is because of what has happened to healthcare in the last five years or so since COVID that so many healthcare professionals have left the profession. Some sadly died. People chose to retire than to go through what has happened. And this show is a call to them and saying, look, this is so, so important. And the things that we're seeing, the Dr. Google of it all and that you are, if you're a healthcare professional in an emergency department today, you kind of have to justify yourself and your decisions against what people are reading on their phones in real time. And that is no way to get help. Is it our responsibility to say it? I think it's all of our. As a society, it's our responsibility, but it's not. We're not going into every episode and saying, what message can we try to correct in this episode? We're trying to tell a great story, and we're trying to champion the people who do this job. So is it our responsibility? I don't know. As filmmakers and storytellers, I think it's all of our responsibility, but nobody gave us that charge when we started.
- [43:03]
Hunter Harris
I want to talk about Pittsburgh for a moment. You're from Pittsburgh. Why do you think the city is such a great setting for this show?
- [43:09]
Michael Hissrich
Pittsburgh's a fantastic city for a number of reasons. It is a perfect little microcosm of America, you know, a couple hundred thousand. It's not 9 million people. You know, there's probably a million people in all the surrounding area of Pittsburgh. But it is well balanced politically. It is well balanced socially, and it's well balanced racially. It is kind of a perfect little version of an American city. It's also a city that has long, long roots in medical care. It's been at the forefront of medical care back to Jonas Salk, and it has. As the steel industry died when I was a kid through the 70s and things, what came in to take its place was education and medicine. The University of Pittsburgh, our Friends at Allegheny, Allegheny Health Network, where I went to school, Carnegie Mellon, these institutions became the biggest employers. And a lot of great minds came to the city to go to these schools, and a lot of them stayed. That education and medical systems. Those systems in Pittsburgh were thriving and growing, and that's where a lot of money was being put toward. So Pittsburgh's a great town for us personally, as a producer, you know, it's where I started in the film industry. It's a great filmmaking community. A lot of shows shoot there. There's some tax benefits in Pennsylvania if you do your whole series there. It's also visually very stunning. When we started talking about the Pit and setting the show there, immediately I thought of Allegheny General Hospital, which is this big gothic building that sits up on a hill overlooking downtown Pittsburgh. I just so happened that my brother had been in public safety and knew a guy who knew a guy, and I called them and said, would you even entertain this idea? The building itself is kind of perfect for what we're. The story we're telling. Nina Ruscio, our spectacular production designer, really took to the photos that I showed her, and we started doing research and Then she and I flew there early on in the process to kind of make sure we were on the right track. So, yeah, Pittsburgh is a huge part of the show and, and they've been really great to us when we're there.
- [45:43]
Hunter Harris
So PTMC is on the north side of town. And can you tell me a little bit more about, like, culturally or socially, what that means and why that specific neighborhood or setting is important?
- [45:54]
Michael Hissrich
The neighborhood was, look, the building was everything. If you look at the building and look at how we shoot it, I knew for a fact that if you were on the roof of that building, you had a spectacular skyline shot of downtown Pittsburgh. It is also a level one trauma center. They have a life flight program that flies in and out of there. You know, 10 times a day those helicopters are landing in and out. It's everything that we needed because it really is a trauma center. So that worked out perfectly. The neighborhood itself is as old as Pittsburgh is. You know, that building was, I think, finished in the early 30s, but that neighborhood had been there for, you know, 150 years before that. Pittsburgh's very old, you know, as a working city, because where the, the rivers come together was a. Had been a fort for whoever had occupied that area. The British and then the colonials and everything. It's. If you could control the rivers, you can control the area. So it has been a thriving city for hundreds of years. And the north side, very, very important in all of that. There's a bar almost next to Allegheny General Hospital where Art Rooney, you know, the owner of the Steelers for years, kind of conducted business out of the, out of the bar there at the corner. I mean, it's just that kind of tight knit, close urban setting. Then also, as they laid out the city, they were smart enough to put a beautiful park across the street. It worked out great for us for filming.
- [47:43]
Alok Patel
Hunter knows this about me, but I love picking out all the little tiny details and the references in the show. And the pits are references. Beers of the Berg. We saw that one. I love when Langdon casually has his Penguins hat. There's a little reference to the Pirates, which I also hold awesome references. I'm just curious, though, about what the feedback from people living in Pittsburgh has been who have seen the show. What are they telling you?
- [48:11]
Michael Hissrich
They love it. They love it. You know, I was home over the weekend doing some family business and I happened to have a Pitt sweatshirt on and I was at a restaurant at lunch and people stopped to ask me about the show and told me how much they love it. Look, they're a very, very proud city and they love to be shown as they really are. I think they would like even more references and more of the dialect. And the reality is, look, it is in Pittsburgh, but we are portraying Pittsburgh as an American city. We don't want to get so detailed and so specific that we alienate the rest of the country or the rest of the world that watch the show. We love dropping little pieces in the sports. You know, the sports teams in Pittsburgh are everything and always have been. So you can't not do that. But yeah, little restaurant names, you know, people come in and they work in a restaurant, mentioning that restaurant that really. People pick up on those things and it's. It's so much fun.
- [49:22]
Hunter Harris
Michael, thank you for joining us.
- [49:24]
Michael Hissrich
My pleasure.
- [49:29]
Hunter Harris
I think the thing that is sticking with me the most about that conversation with Michael is that how like this Ed should feel, you know, very like distinctly Pittsburgh, but also, like, generally it feels like any hospital you've been to, any hospital that you have avoided going to and that everyone sort of feels like, like a stand in for, you know, whatever city or town like someone might be living in, which I think is very cool.
- [49:53]
Alok Patel
I know I didn't think about that and the way he framed it that it's like a slice of the social fabric of all of America. So the Pittsburgh nods are a fun, authentic vibe, but it doesn't make it feel like, hey, this is Pittsburgh and nowhere else.
- [50:08]
Hunter Harris
One quick thing before we go. Did you know you can stream the Pit with ASL on the HBO Max app?
- [50:13]
Alok Patel
I just learned this. It's fascinating to me. I'm glad that they have. This is accessibility and it's been used over a million times. That's awesome.
- [50:20]
Hunter Harris
Just search the Pit ASL and you can find it.
- [50:23]
Alok Patel
Right on.
- [50:27]
Hunter Harris
That's it for today's episode of the Pit podcast. We'll be here every Thursday right after the new episode drops.
- [50:33]
Alok Patel
And remember, super Pitt fans, leave us your comments and your questions. Maybe we'll pick one of them to talk about on a future episode. You can watch us right here on HBO Max or listen wherever you get your podcasts.
- [50:47]
Hunter Harris
The Pitt 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 Ebon Ochoa and Tony Carlson. Our video producer and editor is Anthony Q. Artis with assistant editor Damon Durrell Hinson. This show is engineered by Tommy Bazarian. Special thanks to Joe Carlino.
- [51:11]
Alok Patel
The executive producer of HBO Podcast is Michael Glugstadt. The senior producer is Alison Cohen Sorokac, and the associate producer is Aaron Kelly. Technical director is Insang Kwong. I'm Alok Patel.
- [51:24]
Hunter Harris
And I'm Hunter Harris. We'll see you next week in the pit.
- [51:38]
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