6:00 P.M. with Brandon Mendez Homer, Laëtitia Hollard and Dr. Italo Brown

Summary

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The Pitt Podcast – Episode 6:00 P.M.

Hosts: Dr. Alok Patel & Hunter Harris
Guests: Brandon Mendez Homer (Nurse Donahue), Laëtitia Hollard (Nurse Emma), Dr. Italo Brown
Release Date: March 27, 2026
Focus: Breakdown of The Pitt Episode 12, with real-world medical insights and cast/crew reflections

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Episode Overview

This week’s episode delves deep into the drama and realities depicted in Episode 12 of The Pitt. Hosts Dr. Alok Patel and Hunter Harris dissect the episode’s most intense moments—ranging from a nurse assault in the ED to ethical conundrums regarding medication administration, workplace violence, the ongoing mental health crisis among healthcare workers, and the real-world implications of rural healthcare collapse. Cast members Brandon Mendez Homer (Nurse Donahue) and Laëtitia Hollard (Nurse Emma) join to share behind-the-scenes perspectives, while Dr. Italo Brown from Stanford brings authenticity and context to the on-screen medical world.

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Key Discussion Points and Insights

Critical Incident: Nurse Attack & Medication Ethics

• Recap of the Assault – The episode opens on the fallout after Nurse Emma is put in a headlock by a violent patient, referred to as “the golfer, kind of cokehead.” (02:12)
  • “Nurse Emma is in a headlock. Now we see the golfer, kind of cokehead who — medical term — cokehead, that he got very aggressive…” — Hunter Harris (02:12)
  • Versed (Midazolam), a controlled sedative, is administered by Nurse Dana to subdue the patient, raising questions about protocol.
• Ethical Dilemma – Dr. Robbie questions Dana’s possession and use of Versed without a direct order, highlighting the complex gray areas nurses navigate during crises. (03:01)
• Real Medical Insight – Dr. Patel clarifies real ER procedures:
  • “Nurses are so badass. They should not have to put up with this…usually amidst holding somebody down is when they're calling out, ‘We need something…’ I've never had a nurse give something and then later on be like, oh, whoops, I gave a medication just because I had it in my pocket.” — Dr. Alok Patel (04:52)

Interpersonal Dynamics: Accountability and Double Standards

• Dana vs. Robbie – Charge Nurse Dana is held to a different standard than doctors, emblematic of workplace hierarchies:
  • “Anyone else steps up, they're considered a hero. But nurses, healthcare professionals have to defend themselves.” — Dr. Alok Patel (03:03)
• Parallels and Contrasts – Dana challenges Dr. Robbie about his double standards, especially when compared to Dr. Langdon’s past pill theft (04:43–04:52).
• Underlying Issues – The episode explores how self-accountability is often pushed aside in favor of saving face or maintaining authority.

Character Mental Health and Burnout

• Robbie at a Breaking Point – Multiple characters comment on Dr. Robbie’s mounting stress:
  • “There are multiple moments in this episode that hint at Dr. Robbie's breaking point or walking to the edge... The darkness is coming in, Dr. Robbie.” — Dr. Alok Patel (09:11)
• Support Systems – The need for therapy, support, and accountability among healthcare workers is woven throughout.

Realistic Patient Cases & Medical Education

• Elderly Couple Case – A poignant vignette highlights an elderly couple’s resistance to assistance and family interventions around independence:
  • “I just became very emotional watching these two elderly people trying to, like, stay independent... Their stubbornness and resistance to having any type of help...” — Hunter Harris (11:50)
• Valuable Medical Nugget – Dr. Patel expounds on the Romberg test for balance, translating on-screen medicine to real-life use (13:15–13:54).

Rural Healthcare & Systemic Issues

• Dialysis Patient Case – The show's portrayal of a patient suffering due to missed dialysis underscores the closing of rural hospitals—a nation-wide crisis. (15:07–17:24)
• Healthcare Costs – Orlando Diaz’s storyline embodies the link between medical costs, fear, and delayed care:
  • “He was even thinking it's insulin versus... clothes and food and stuff like that... having to make these decisions... it's awful.” — Dr. Alok Patel (18:52)

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Cast Interviews: Real Life Meets TV Drama

Parallel Journeys: Parenthood On and Off-Screen

• Brandon Mendez Homer reveals how becoming a new father paralleled his character’s narrative:
  • “It's method acting. I didn't have to fake anything. It's all real. I'm actually tired.” — Brandon Mendez Homer (20:53)

First Days: Fiction vs. Reality

• Laëtitia Hollard on channeling her nervous first day on set into her performance as Emma (21:56–22:44).

Crafting Nuanced Nurses

• Both actors discuss notes from showrunners:
  • Leticia: Avoiding too much emotional reaction to stay authentic as a SANE nurse for a sexual assault victim. (23:08)
  • Brandon: Transitioning Donahue from an “always on top of newbies” hardliner to a mentor, reflecting real-world development for nurse practitioners. (23:46)

Juilliard Connection & On-Set Camaraderie

• Leticia jokes about outing Brandon’s Juilliard background and describes their shorthand and resourcefulness, both hallmarks of their training (25:12–26:55).
  • “I tease Brandon all the time because there is that familiarity from being from the same school and…” — Leticia Hollard (25:27)
• Brandon: “…when the camera's rolling, we both have that shorthand of, like, oh, now it's time to drop in. Now it's time to deliver.” (26:44)

Behind the Scenes: Filming the Headlock Scene & Mentorship

• Leticia shares her commitment to portraying workplace violence sensitively and authentically to inspire discourse on safety for nurses (27:33–28:23).
• She highlights the mentoring relationship between Emma and Dana, and what it says about generational shifts in nursing (28:46–29:32).

Donnie and Langdon: Redemption and Professional Shame

• Brandon explores Donnie’s shame and renewed motivation after Langdon’s return:
  • “I always say, like, at the end of the Mass Casualty, I think that Donnie is experiencing a lot of shame, actually about how much he can do for the team…” (29:55)

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Real Medicine: Dr. Italo Brown Unpacks the ER

Fast-Paced Chaos and Mental Multitasking

• Dr. Brown offers a firsthand account of the organized chaos in busy ERs (34:36–35:57).
  • “You have to keep a presence of mind at all times, know what's urgent, who's sick, who's kind of sick, and who needs to get out as fast as possible.” — Dr. Italo Brown (35:32)
• He outlines the importance of checklists, running priorities, and collaborating with everyone from techs to X-ray staff.

Mental Health Progress and Wellness

• There’s new openness around therapy, self-care, and peer support:
  • “The space has now shifted to where these are encouraged, welcomed, and we celebrate it... one of the greatest things that's changed in the last… 10, 15 years.” — Dr. Italo Brown (37:32)

The Emotional Toll and Support Structures

• Dr. Brown does not sugarcoat the burdens of emergency medicine:
  • “Every single time you do this, it demands its pound of flesh. So it's an undertaking. But I think that the reward is extremely high.” (38:46)
• He emphasizes the “imprinting on the soul,” teamwork, and vulnerability.

Personal Story: Workplace Violence

• Brown shares a candid account of being physically assaulted by a patient, contracting a severe infection, and culture change around reporting and team support (40:58–44:19).
  • “My team members recognized before I cared to recognize because I didn't think that the culture was to admit when I had been assaulted…” (43:10)
• He praises recent legislative efforts and nurse-driven advocacy for safer hospitals.

Subtle Signs of Colleague Distress

• Stress and burnout can manifest as irritability, substance use, or more subtle signs. Brown calls for more open, supportive, and bi-directional workplace relationships (44:40–46:12).

The Draw of the ER: Problem-Solving and Impact

• “It's honestly the nonstop problem solving. It's like a Rubik's Cube every time you walk into the department… meeting more people than anyone. Typically, on a standard day, right? You're talking about 30 to 50 people that you just meet every day.” — Dr. Italo Brown (47:34)

Decompressing After the Shift

• “I put on some music, try to vibe out and think about the cases… But once I hit the threshold of the door of my apartment, I'm done. I have nothing left to do.” (48:50)

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Notable Quotes & Memorable Moments

• On nurse heroism:
  “Anyone else, steps up, they're considered a hero. But nurses, healthcare professionals have to defend themselves.”
  — Dr. Alok Patel (03:03)

• On burnout:
  “…You're acting like a martyr. You're making your life intentionally so difficult. You're suffering when you don't really have to. Just because he is very controlling and wants eyes on everything. But it's like. To whose detriment? The patients and the staff.”
  — Hunter Harris (08:56)

• On the ER's emotional toll:
  “All of this gets imprinted on your soul. And so I try to make sure they understand that this specialty requires a lot of self awareness.”
  — Dr. Italo Brown (38:46)

• On rural healthcare crisis:
  “Hundreds of rural hospitals… are at risk of closing… you have this growing amount of a rural healthcare gap…”
  — Dr. Alok Patel (17:24)

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Important Timestamps

• 02:12—06:42: Assault on Nurse Emma & medication ethics
• 09:11—10:19: Dr. Robbie's mental state and team dynamics
• 11:42—14:04: Elderly patient case, Romberg test, pharmacists’ role
• 15:07—18:33: Rural hospital closure and dialysis patient
• 19:37—31:28: Cast interviews: Brandon Mendez Homer & Laëtitia Hollard
• 32:16—51:15: Dr. Italo Brown on real-life ER challenges, mental health, and violence

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Final Thoughts & Reflections

This episode offers a multi-layered take on healthcare’s frontlines—where medical drama collides with very real systemic issues and personal challenges. The blend of show breakdown, cast revelations, and expert commentary makes it essential listening for fans and anyone interested in the realities behind the curtain. The Pitt Podcast continues to push conversations about workplace violence, rural collapse, mental health, and the everyday heroics of medical professionals—both on screen and in the real world.

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Transcript

[Hunter Harris]

When life gets unpredictable, preparation matters. In medicine, it's all about staying alert, ready for whatever comes through the door. On the road, it's no different. That's why Volvo designs vehicles to help anticipate risk, reduce harm and protect lives. The Volvo XC90's advanced safety systems inspire confident decisions wherever the road takes you. The Volvo XC90 for life. Proud sponsor of the Pitt podcast Life. Learn [e-mail] US score more with the college branded Venmo debit card and earn up to 5% cash back with Venmo stash. Got paid back with the Venmo debit card. You can instantly access your balance and spend on what you want, like game day, snacks, gear, tickets and more.

[Dr. Alok Patel]

The more you do, the more cash

[Hunter Harris]

back you can earn. Plus, there's no monthly fee or minimum balance. Sign up [e-mail] collegecard the Venmo Mastercard is issued by the Bancorp Bank NA Select Schools available Venmo Stash terms and exclusions apply at venmo.me stash terms $100 cash back per month. Ptmc. Go ahead. Medic command. Where are all the nurses? There was a code hula hoop in Central 14. Oh, no. What's that? Hospital worker assault. Ooh. The new nurse, Emma.

[Dr. Alok Patel]

Is she okay? I don't know.

[Hunter Harris]

I think so. Smoke them if you got them. This place is going tits.

[Dr. Alok Patel]

Welcome to the Pit podcast, the one and only official companion to the pit right here on HBO Max. I'm Dr. Alok Patel.

[Hunter Harris]

And I'm Hunter Harris. It's six o' clock in the pit this week. We're on episode 12. We will be joined by Brandon, Nez Homer, who plays nurse Donahue and Leticia Holler, who plays nurse Emma.

[Brandon Mendez]

I'm super shy.

[Dr. Alok Patel]

I don't.

[Brandon Mendez]

Everybody I worked with on season one didn't find out till season two. I went to Juilliard because of Leticia. They were like, oh, really, you guys? Same time, but old.

[Dr. Alok Patel]

Today's shift starts now.

[Hunter Harris]

At the end of last week. Cut to black. Nurse Emma is in a headlock. Now we see the golfer, kind of cokehead who medical term cokehead. Cokehead that he got very aggressive somehow. We don't know what happened. Or Sana came into the room to the rescue. It was a cold hula hoop and the man ends up with a bloody nose. Dana had given him Versad.

[Dr. Alok Patel]

Versed.

[Hunter Harris]

Versed. A tranquilizer of some or sedative of some sort.

[Dr. Alok Patel]

It's a benzo. Benzodiazepine.

[Hunter Harris]

Okay.

[Dr. Alok Patel]

Call it A sedative. Totally.

[Hunter Harris]

And then now Robbie is like, where did you get that? You can't prescribe that. And Dana's like, it was in my pocket. And what am I supposed to do? Just let this man choke nurse Emma? It's her first day.

[Dr. Alok Patel]

You just happen to have a vial of her set in your pocket?

[Hunter Harris]

It was extra from the medics. Good timing, I guess.

[Dr. Alok Patel]

We waste a controlled substance.

[Hunter Harris]

We need a witness to sign off. I was on my way to when I spotted that asshole attacking our girl. Anything else, Nancy Drew?

[Dr. Alok Patel]

Where you going? Taking a pee.

[Hunter Harris]

Do I need your permission to do that, too now?

[Dr. Alok Patel]

This is a terrible situation, and I. I feel. I feel this predicament where charge of stain is like, what do you want me to do? You know? And people are running in there. This is presumably a situation where you hopefully had security jumping on this person, too. But then, on the flip side, looking at where Dr. Robbie's coming from, what if this individual couldn't get versed for whatever reason? What if it caused a medical complication? How is this going to hold up in court? You know, if you actually look up when someone can defend themselves in a hospital setting, it's like, yeah, if you have to defend yourself for your own safety, cool. But everything gets different if a patient is incapacitated or they're. They have confusion, or if they are agitated beyond their control, or if you do something and lesser force could have been used. I mean, it's all these little shades of gray. Yeah, but Charge understanding makes a good point where she's like, anyone else, steps up, they're considered a hero. But nurses, healthcare professionals have to defend themselves.

[Hunter Harris]

Right? And it really sets off a series of, like, little confrontations between Charge Nurse Dana and Dr. Robbie. First he says, okay, why did you have that on you? Like, what were you thinking? She calls him Nancy Drew, which is so good, by the way, which I know you love. Yes. And then later, she, you know, kind of corners him again, and she's like, what is going on with you? You've been kind of on one all day. And then they talk again outside. And this is the part that I'm, like, very stuck on Robbie telling nurse Dana, like, how did you get. What is it called again?

[Dr. Alok Patel]

The Versed.

[Hunter Harris]

Yeah, how'd you get Versed? Like, you know, you. You can get your license taken away, blah, blah, blah. I'm like, okay, so where was that energy when Dr. Langdon was stealing pills from. Pills from the ED?

[Dr. Alok Patel]

I just want to go back to one thing about the. The assault and The Versed. So I've been in this situation. Nurses are so badass. They should not have to put up with this. But in real scenarios where a nurse gets assaulted, one on one, you have a gang rushing in there. The nurses will basically whatever they need to do. 4 on 1, 5 on 1. A big aggressive patient. You'll have anyone who's on the floor, Russian doctors, respiratory therapists, everyone. And usually amidst holding somebody down is when they're calling out, we need something. We need a medication. I've never had a nurse give something and then later on be like, oh, whoops, I gave a medication just because I had it in my pocket. Sometimes we have as needed medications on the patient's chart. So, like, we call it prn. Like, if I wrote Versed prn, that means that if this patient is agitated, you can give a dose of this medication. Okay. You don't need to ask my permission because I already ordered it.

[Hunter Harris]

Okay.

[Dr. Alok Patel]

But usually, like, I've seen nurses hold patients down and scream, I need something right now. And, you know, and they have something called a pyxis, like an emergency. Basically a place on hospital floors where you can go and get medications out. And so if I give a verbal order or I put it in the computer, they can run and get a medication, and it's into that patient in minutes. Just had to do this last week, so it's fresh in my memory.

[Hunter Harris]

Yeah, well, I mean, I. I don't know. I guess it is, like, it makes me uneasy that, like, nurse Dana was alone with Emma and that man and Emma didn't see anything. The man said he didn't remember even choking her, but remembered getting punched.

[Dr. Alok Patel]

I said, hmm, that's right. I was like, you're making that up, dude.

[Hunter Harris]

Interesting.

[Dr. Alok Patel]

Trying to get out of trouble right now.

[Hunter Harris]

Interesting.

[Dr. Alok Patel]

And he said, oh, you're gonna ruin my life. I was like, all right, dude.

[Hunter Harris]

I do want to take a moment and sort of compare and contrast what we're seeing between Robbie and charge nurse Dana and Robbie and Dr. Alhashmi. Because kind of a reveal that I hadn't really considered before is that Dr. Alhashmi does not know about Langdon's history, just knows that he came back from rehab and it's his first day back. And that Santos is, like, really kind of raw, like, energy wise with him. And Robby says, okay, yes, he had a benzo addiction. He was stealing drugs from the ED and just the look of, like, incredulousness on Dr. Alhashmi's face was like, oh, right. Something about the way that Dr. Robbie is defending Langdon, Dr. Alhashmi, and the way that charge nurse Dana is like, you need to own up to your part in this. You have an issue with yourself, not with Langdon anymore. Remind me of what you said last week, that Dr. Rabi has to really take some accountability himself about what went down with Langdon.

[Dr. Alok Patel]

Jarjust Dana calls him out.

[Hunter Harris]

Yeah.

[Dr. Alok Patel]

The thing that's fascinating, too, is that Dr. Alhashmi completely changes how she treats him after she finds out.

[Hunter Harris]

Yeah, no, true, but again, I mean, you know, it's ironic. Then it's very. Do as I say, not as I do that. This is an episode where Robbie tells Santos, okay, like, you know, you need to work out yourself with Langdon. He's here to stay. Whatever. I want you to, like, go to therapy or, like, see the trauma counselor while I'm gone. I'm like, oh, my goodness. So you should actually take that call coming from inside the house, ringing off the hook, in fact. This department is clearly too much for one person to handle. It's not healthy for you or the patients. And I'm very concerned by what I've witnessed today with some of the staff. What is going on with Langdon and Santos? I saw them having it out like it was fight night. Dr. Langdon hasn't even been here for 10 months. And you told me this morning there was nothing to worry about with your Santos.

[Dr. Alok Patel]

There isn't. Santos and Langdon have beef because she's the one who turned into him for taking meds.

[Hunter Harris]

I'm sorry, what?

[Dr. Alok Patel]

Santos is responsible for revealing Langdon's bins of addiction.

[Hunter Harris]

Was he stealing drugs from this Ed?

[Dr. Italo Brown]

This Ed is the best of the best.

[Dr. Alok Patel]

And I would put it up against any emergency department in the country, and it is going to be yours to fuck up.

[Dr. Italo Brown]

So don't fuck it up.

[Dr. Alok Patel]

Any emergency department and challenge me on this. Viewers and listeners, any emergency department that's this busy is going to have more than one attending on staff. When she's like, we need two. And he's like, whoa, we got a good thing going. I was like, no, no, no, no, dude. You're gonna have two, you're gonna have three.

[Hunter Harris]

It goes back. You're acting like a martyr. You are making your life intentionally so difficult. You're suffering when you don't really have to. Just because he is very controlling and wants eyes on everything. But it's like. To whose detriment? The patients and the staff.

[Dr. Alok Patel]

There are multiple moments in this episode that hint at Dr. Robbie's, like, breaking point or walking to the edge. Yeah, like, McKay makes that comment. Like, I've had many people kind of flirt with this line. And Duke makes references to it as well. Charge. Dana makes references to it like, we're. The darkness is coming in. Dr. Robbie.

[Hunter Harris]

I. I wonder who can, like, get clarity, make him see clearly that, like, this is not for you. Maybe it's gonna be Abbott. I think it could also be Javadi. I think she kind of has a way in with him that I like, but we'll see.

[Dr. Alok Patel]

Or it's Duke. Cause he doesn't give a shit.

[Hunter Harris]

I had Duke said, I'm tired. I've been here all day. Take me home, consume so many, it's disgusting. I say it, and I won't move out.

[Dr. Alok Patel]

Okay.

[Brandon Mendez]

I'm not gonna be doing much, and

[Hunter Harris]

Robbie's not gonna be taking in his mail and re watering his plants. Say what? Admit that you like having me as your roommate. You are such a berry. Have fun with Robbie's plants.

[Dr. Alok Patel]

I'm so happy that Whitaker stood on his ground on this one. Why am I not surprised that Sandis wouldn't just say she enjoys having him around, even, like, loses it, calls himberry. That's not nice.

[Hunter Harris]

Well, I mean, of course. Look. Look at how the day has gone for her. She tried to, you know, talk to Dr. Garcia, tell her how she feels, and she was rejected. Low key, twice. So I understand her being a little bit more cautious, but they have a funny, like, you know, brother, sister dynamic that I think is fun.

[Leticia Holler]

Got a couple of bad ones. How old is he?

[Hunter Harris]

84. Meclizine for vertigo. Anticholinergic effects can cause drowsiness. It's PRN. So maybe he doesn't take it all the time. He's also been prescribed methylcarbamol, another anticholinergic. Could definitely impair driving. And metoclopramide for his stomach. That could cause gait problems. Exactly.

[Dr. Alok Patel]

Thank you. There is a pharmacist in the emergency department making an appearance. Dr. Megan Nort. I looked at her badge. I'm just so happy because pharmacists are so incredibly important in hospitals. This is just one of the many times we rely on them to look through a patient's medication list. Are there interactions? Are there side effects? You know, help with dosing, like, whatever it may be. And even if they're not in the person, like this fabulous pharmacist was, they are available on the phone, and she immediately says, like, hey, meclizine, methocarbamol, metoclopramide. These are medications that may cause confusion. Issues with drowsiness. Basically things that would put this person at risk of falling or not being able to drive a car clutch. It's almost like they responded to our viewer questions who were like, hey, where are the pharmacists? And I was like, I'm with you.

[Hunter Harris]

That was your question.

[Dr. Alok Patel]

And viewers listen. I brought it up. I definitely brought it up. We've had viewers also chime in and been like, what up, pharmacists? Where you at?

[Hunter Harris]

Okay. Interesting. I. This was one of my favorite cases. I think this whole season, I felt very personally, like, I. I just became very emotional watching these two elderly people trying to, like, stay independent. But, like, the daughter saying they can't. Like, half of their house is inaccessible to them was so, so sad. And the. Their, like, stubbornness and resistance to having any type of help. But I want to focus specifically on a moment where Dr. Mohan and Dr. King present this case. Dr. Rabi, that, like, okay, we have some opportunities for them. We have some options for them. And then Dr. Robbie, almost as a slight, says Dr. Mohan, hey, Dr. Mohan, I heard a rumor that you were

[Dr. Italo Brown]

looking for an elective.

[Dr. Alok Patel]

Would you consider geriatrics? It's as much of an art as a science. There's usually an opening.

[Dr. Italo Brown]

And you seem to have a predisposition took pace.

[Hunter Harris]

It's like, oh, my goodness. Dr. Robbie is really putting Dr. Mohan through this shift. And it's, like, making me a bit mad.

[Dr. Alok Patel]

I know. It was almost like a nod to slow mo from last night.

[Hunter Harris]

No, it 100% was. I think it was very shady.

[Dr. Alok Patel]

Dr. Robbie came across a little too fast on it. Again, this is the shift when he's been talking about her anxiety and can you handle the walls in here? And she says, maybe this place isn't for me. So maybe he's trying to steer her in a different direction from a nurturing standpoint, but it's coming across as harsh.

[Hunter Harris]

Yeah.

[Dr. Alok Patel]

Because she does have this, like, TLC with the elderly. She, like, nicely takes this gentleman's shoes off, and she's like, let's do an examination. And she's patient with them. Great. Little medical pearl, too, is when she mentions the Romberg test again. Like, there's a big assessment, like, can these two actually live safely? And the Romberg test, you're essentially going to have someone stand up barefoot, feet together, and can they balance with your eyes open? You have this extra sensation of your body be on the center because you can look around when you close your eyes, it becomes harder for people and so if you close your eyes and all of a sudden you lose your balance, that's telling people, like, hey, this person might have some type of nervous system issue that's causing them to lose balance.

[Hunter Harris]

Oh, wow.

[Dr. Alok Patel]

If anybody listening wants to try it out the next time, if you do become inebriated, close your eyes and stand up and see how well you can balance.

[Hunter Harris]

Interesting.

[Dr. Alok Patel]

Okay.

[Hunter Harris]

I. Yeah.

[Dr. Alok Patel]

So all these tests are important to see if somebody needs assisted living, if they need a caretaker, so we can go home. Dad, you can't take care of moma by yourself.

[Hunter Harris]

Oh, we'll manage. You guys, you need to be realistic. I don't want strangers hanging around in the house.

[Dr. Alok Patel]

It's not strangers, it's helpers.

[Brandon Mendez]

No, no, thanks.

[Dr. Italo Brown]

Doctors, please.

[Dr. Alok Patel]

And like, the conversation that this couple has with their daughter is a very realistic one Asian population.

[Hunter Harris]

Oh, my goodness. Like, the stubbornness with some elderly people not wanting to receive care, especially I think in black families, as my family, is like a sort of systemic distrust of systems of medicine, even that it makes it a lot more emotional to. To try to talk someone out of wanting to live alone. I need you to talk me through this case with Oliver, who drove his dad, what, an hour, like, to find him in emergency room because he missed a dialysis treatment. What was going on there?

[Dr. Alok Patel]

So, like, there's the medical side and then there's the larger statement about rural healthcare. So the medical side shows up. The guy is having breathing difficulty and he's coughing up that. I immediately saw it and I was like, oh, pink sputum. Which tells us that there's fluid backed up in his lungs that's mixed with the fluid in your little air sac. So it has that like, bubbly pink look to it, and that is telling you respiratory distress. We have an issue. Think about this. So they mentions this guy missed a dialysis treatment. Then Whitaker very astutely notices. He says there is a left arm dialysis shunt. So what. What some people will have is they'll have a shunt on an arm, usually a non dominant arm, where surgeons can basically connect an artery and a vein and create very easy access for dialysis.

[Hunter Harris]

Okay.

[Dr. Alok Patel]

So it's a reliable place to get that dialysis going. Son says we missed dialysis treatment. You now have him coughing up liquid from his lungs. This is called flash pulmonary edema until proven otherwise. Meaning if you can't get rid of fluid from your kidneys, it's gotta go somewhere. You get a fluid backup. We worry that it's gonna wind up in your lungs. So he's got a bunch of fluid in his lungs, which is why they're now trying to get fluid off of his body. They make that joke about medieval bloodletting where they're basically pulling fluid off of him. They're giving him respiratory support, that high pressure, that bipap, to kind of push some of that fluid out, while they're essentially looking at the fact that this guy has kidney failure. So your kidneys are not only pulling fluid out of your body, but they're also making sure that your body has good ion balance. So his potassium level is really high. So then you have this other conversation about dropping down his potassium levels. You can do that with insulin and glucose, which will shift potassium into your cells. Albuterol, which is a medication used for asthma, dilators, bronchodilators, that'll also push potassium into your cell. And all this conversation is happening in the span of minutes. Like, this is a. This is a great kind of case report that's happening in the pit in real time.

[Hunter Harris]

I. Can I pause for a second? I'm stuck on pink. Pink spewed sputum.

[Dr. Alok Patel]

Frothy pink sputum.

[Hunter Harris]

I wish I could be in your brain. That's so crazy.

[Dr. Alok Patel]

I wish you could be in your brain and have these, like, one liners

[Hunter Harris]

that just, you know, incredible handle pink sputum. Okay, so, but then there's the other issue, which is that there wasn't a hospital closer to them, that there are hospitals that are shut down and not just because of the code black.

[Dr. Alok Patel]

I was just like, I'm nodding my head with disappointment at this part. So the reality is, is hundreds of rural hospitals across the country are at risk of closing. A lot of rural hospitals are operating at a negative margin. And then when you have cuts to government programs like Medicare and Medicaid, they squeeze rural hospitals even more. So you start losing necessary services for patients who live out there. And we've already seen rural hospitals close. We've seen emergency departments close, we've seen primary care close, and we've seen birthing centers close. So you have this growing amount of a rural healthcare gap. You also have way too many counties in this country that don't have a birthing center. There's no maternity care. So this was almost a very scary symptom of a massive problem that's happening, which they pick up on immediately when they say, like, hey, Medicaid cuts are doing this right now. It's like, unfortunately, there are going to be more situations like Oliver's dad, unless something changes. In this country. So this show is just touching on all these massive issues with healthcare policy and the economics in a country that spends more per capita on healthcare than any developed nation without better outcomes.

[Hunter Harris]

Over talking about cost. I mean, we have to talk about where this episode ends, which is who comes back into the ED but Orlando Diaz, who left earlier, Dr. Mohan said, Please don't leave. I'll get you everything you need. I mean, is that not the same symptom where Orlando Diaz was afraid of the medical costs? And so he left and now look what's happened.

[Dr. Alok Patel]

Yeah.

[Hunter Harris]

Now he's found his way back in.

[Dr. Alok Patel]

He's found his way back in and it's awful. The fact that he was even thinking it's insulin versus, I think he said, clothes and food and stuff like that. And people having to make these decisions. And you've got this selfless father who's like, no, I'm going to take care of my family before I take care of myself. I'm going to put their oxygen mask on first before I pull my own oxygen mask down. Which is awful that this is a situation people are in.

[Hunter Harris]

So much went down in the pit this week. I think we should go a little bit deeper inside the pit and hear from some people who were boots on the ground on the front lines, nurses who were really making the day happen.

[Dr. Alok Patel]

I love the cast of characters with the nurses on the show. You've got nurse Donahue, who, like, has these really great heartfelt moments and then really funny one liners.

[Hunter Harris]

Yes.

[Dr. Alok Patel]

You know, he's been through some training. He's now got a new kid. He's all over the place. And you have Nurse Emma, who has, like, the craziest first day ever. So without further ado, let's talk to nurse Emma and nurse Donahue, AKA Leticia Holler and Brandon Mendez.

[Hunter Harris]

Homer, let's do it.

[Brandon Mendez]

You lucky this was just a poke. Spared the muscle.

[Dr. Alok Patel]

See, it could have been worse.

[Hunter Harris]

No shit, Sherman.

[Dr. Alok Patel]

The triangular bayonets they created back then were designed to leave rooms that are nearly impossible to stitch.

[Brandon Mendez]

Those bayonets that never met me.

[Hunter Harris]

Leticia and Brandon, thank you so much for joining us. This is gonna be great.

[Brandon Mendez]

Thank you for having us.

[Dr. Alok Patel]

I'm not used to saying Leticia and Brandon. I want to be like, nurse Emma, Nurse Donnie, like, what's good? But no, it's awesome to have you here. You both add so much dimension and, you know, highs and lows to the season, to the show. Brandon, I want to start with you. Fun. Fun. Parallel is like, yes, I Will admit I was stalking your Instagram, but I saw that you became a new father. Congratulations. But also, Nurse Donnie became a new father in between seasons one and two. Like, I'm not sure if this is just the most brilliant method acting ever, but can you tell us a little bit about how you becoming a new father informed your work and what you brought to set with that new role?

[Brandon Mendez]

It's method acting. I didn't have to fake anything. It's all real. I'm actually tired. You know, we shoot over the course of several months, so I just completed my. You know, my wife would say I didn't complete postpartum because she's very much still in it, but our daughter just turned one yesterday. Wow.

[Hunter Harris]

Oh, my gosh.

[Dr. Alok Patel]

Awesome.

[Brandon Mendez]

Yeah, the whole. The show is marking the journey of parenthood. So, yeah, it's been. It's been an incredible journey to kind of mirror that with Donnie, because I think the character also is stepping into new territory and the uneven terrain of being a nurse practitioner and trying to show up more fully professionally as well as a father at home. So there's. I mean, we're trading notes all the time, you know, when I'm working on the character. So, yeah, I was really honored by that, that the show decided to do that and that the writers had brought it into the character. So, yeah, it's been exciting.

[Dr. Alok Patel]

It's so real.

[Hunter Harris]

Leticia, you are new to the show this season. I want to know, how did your first day compare to Nurse Emma's first day, and what was it like joining this big ensemble?

[Leticia Holler]

Oh, I took so much inspiration from Emma's first day, from my first day doing medical boot camp. I got there, I was ready to see Kristen, Amy, Lynn, and Katherine, and I thought that that was it. I wouldn't see anybody else. I got there. There was Noah on his little swively

[Hunter Harris]

chair chilling in the cool kids table,

[Leticia Holler]

and there was Patrick and, like, the whole main cast. And I was like, yeah. Kristin literally said to me, she's like, you look like a deer in headlights. And I was like, oh, this is probably what Emma feels like. So especially that first episode, I was like, we're gonna really take from what it was to come to set for the first time in a big TV show.

[Hunter Harris]

So cool.

[Dr. Alok Patel]

That is real life experience meets your character. Now I got a fun question. We talked to Lucas Iverson. Ogilvy.

[Leticia Holler]

Yes.

[Dr. Alok Patel]

And, you know, he was telling us about his first kind of takes and how he was told, you're not being enough of a jerk. And so some of Those character notes. I'm curious what notes you both got when you were filming Nurse Emma, Nurse Donnie?

[Leticia Holler]

Actually, yeah, I did get a note. It was for the sexual assault case. I think that Emma's a very caring person. So a lot of times when we first met our patient, I was, like, smiling, and I was like, really, like, feeling like me as Leticia when I'm talking to someone, I'm like, oh, I'm, like, making all these types of faces, and they're like, the sane nurse is like, don't do that. She's like, we can't make them feel any type of way because you. You just have to be as, you know, scientific and just help them. Don't make them feel or don't make them feel any type of way. Just give them help.

[Brandon Mendez]

So, yeah, I got two notes. The first was in my final callback from John Wells. He told me my character changed drastically as they met me as a person. I think they started to write closer to who I am. But in my final callback, he was like, these newbies are always fucking shit up, so you're always, like, on top of them. And then my character became a little less aggressive and demanding as the story developed. And then in season two, looking at the scope of the nurse practitioner role, I had a lot of conversations with our MP and PA on set, who kind of took me through my boot camp, and she said, look, this is a practice that is important in the country, but it's different from being a doctor. And there's a lot of conversation around what that role is and what the scope of that work is, while also respecting the scope of what it means to be a doctor and how those teams come together, especially when, throughout the country, hospitals are on short supply and everybody's trying to achieve the same thing. So it was interesting to navigate that and try to sprinkle that into some of the scenes and relationships throughout the season. So that was fun.

[Hunter Harris]

Very cool.

[Dr. Alok Patel]

There's depth to this.

[Hunter Harris]

Yeah. Okay, I have a question for both of you, because, correct me if I'm wrong, both of you went to Juilliard. Is there, like, a sort of shorthand between two Juilliard actors? Or, like, just, you know, you come in and you immediately have, like, some kind of relationship or vocabulary together. How does that work?

[Leticia Holler]

Yeah, well, Brandon pretends he didn't go to Juilliard. I'll be on set and I'll be like, hey, you know, like, we went to the same alma mater. And he's like this in the corner, like, as Though he hadn't gone to the same school.

[Hunter Harris]

And so I informed a lot of

[Leticia Holler]

people on set that he went to Juilliard, and he's the person, like, anytime I'm having difficulty, he's the person I will talk to first and then Catherine second. They're my go tos. And I tease Brandon all the time because there is that familiarity from being from the same school and.

[Brandon Mendez]

Yeah, yeah, no, this is so true. There's a lot of kinship between us. And, like, I'm super shy. Everybody I worked with on season one didn't find out till season two. I went to Juilliard because of Leticia. They were like, oh, really, you guys? Same time. But I also feel old. I also feel like what Juilliard does, it makes you really resourceful as an artist. You know, like, often use the analogy that, like, you're put on an island with a knife of artistry and you have to make fire, food, shelter through Shakespeare tragedy. Check off, and you create a lot out of nothing. No costumes, no set dressing. And so coming to the pit, when I saw Leticia was coming on, I was like, oh, she's going to be able to carry any story here forward. And that's just always what I told her. And the journey of what we were working on was like, look, you have everything that you need. So, you know, when we joke and everything, we play a lot between takes. Because I know that, like, when the camera's rolling, we both have that shorthand of, like, oh, now it's time to drop in. Now it's time to deliver. So it was really nice, really fun to, you know, build that relationship on set. It was good.

[Leticia Holler]

One of the things that Brandon would do as Donnie is him and Patrick, actually Patrick as Langdon. They would say, hey, Emily, how is it? Like, they would change, like, my name every time? And it would make me, like, genuine, like, mad. I was like, I hope they don't see any of these takes of me being like, guys, don't say that to me.

[Dr. Alok Patel]

I love that. I feel like this constant, like, Leticia, you constantly roasting Brandon is part of the Juilliard vibe, or the fact that you two have this kinship. It's hilarious.

[Brandon Mendez]

But, yeah, it's great.

[Dr. Alok Patel]

I got a question, though. Leticia. So we're talking about episode 12.

[Hunter Harris]

Yeah.

[Dr. Alok Patel]

There's been many moments when Hunter and I have wanted to jump into the screen and fight somebody. We see a patient put Leticia into a headlock. Dramatic. How did you prepare for that scene? What was that like?

[Leticia Holler]

Yeah, I actually was Part of my audition and I put a lot of care and thought into it, and I think it's really important that a show about a hospital shows that nurses do often, like, get assaulted by patients. And hopefully it leads to a conversation about how we can help mitigate that. Most nurses I've talked to have had some sort of bad interaction. If it's even verbal assault or know

[Dr. Alok Patel]

someone who has far too often.

[Hunter Harris]

Yeah, Yeah. I want to ask about the relationship between nurse Emma and charge nurse Dana because I love that they're kind of paired together through most of the season where nurse Emma is so, you know, excited and happy and tried to understand it. It kind of gives her like a perspective shift that, like, it's good for her, I think, to like, teach someone and be like a mentor. How do you see the relationship and what was the dynamic like between you and Katherine?

[Leticia Holler]

Oh, I think it's beautiful. I think it's really great writing that, like, I think Emma allows is like a mirror for Dana can see herself as a young nurse and you can kind of as an audience member, see the journey of like, wait, like Robbie at one point says that you're not that type of nurse anymore. Like how maybe Dana used to have a lot of care and go the extra mile and what makes it happen so that she stops doing that and is that going to happen to Emma? Is Gen Z? Do Gen Z have a better hold grasp of mental health that that's not gonna happen to Emma? I think there's a lot of interesting conversations that you get when you put us right next to each other.

[Dr. Alok Patel]

Earlier in the season, there's this great kind of like, bro dad bonding moment with nurse Donnie Langdon and this father who brings his child in. And I want to ask you what it was like filming that scene and also how nurse Donnie feels about Langdon's return. Is there some momentary bonding of being fathers? Is he also have tension? I don't know. What are your thoughts?

[Brandon Mendez]

Yeah, no. First off, it was great working with Patrick. We immediately dropped in. I mean, my North Star was like kind of lethal Weapon. I was like, we kind of have like a Donnie Glover, Mel Gibson like thing going there. But yeah, when he working specifically in the storytelling of it, his return, at the same time as the start of my journey with the nurse practitioner part. And I always say, like, at the end of the Mass Casualty, I think that Donnie is experiencing a lot of shame, actually about how much he can do for the team. Right. Because he's surrounded by Whitaker, who's new, surrounded by Santos who's new and these people are on fire for their job. And I think it's the story of many people that when you're working in an environment for a period of time, you somehow just kind of float underneath the radar and not give it your all. And I think in that nine month span after he left that having had that experience, he comes back on fire to do more, to take on triage, to kind of lighten the load for his team members. And then here comes Patrick, basically trying to become a part of the team and heal and repair. So for us to both have that collision course, I think it is in fact the moment he shares that antidote about being a father that brings them together and he kind of gives him the green light of like, okay, I know we need you from a professional lens, but I didn't even know you had this emotional canvas to you. So that was really sort of exciting for me to kind of find that with Patrick and find that shorthand because we didn't have much season one at all.

[Hunter Harris]

Wow, what a great answer, both of you. This is, this was so fascinating. Thank you for taking the time.

[Brandon Mendez]

No, thank you.

[Leticia Holler]

This was so fun.

[Dr. Alok Patel]

Enter a natural place. I feel for people to fact check the Pit or look for accuracy is in the actual medical procedures and the terminology and the pathophysiology. But there's a whole other arc our characters go through as it relates to these systemic and social issues. Mental illness, workplace violence, not having a moment to decompress, carrying all that energy with you from patient to patient, all of that. And so let's get the real deal about what it's really like to work in a busy ER. We'll talk to Dr. Italo Brown, a board certified emergency medicine doctor at Stanford, and see what it's all about in that crazy place called the er.

[Hunter Harris]

I'm ready. When life gets unpredictable, preparation matters. In medicine, it's all about staying alert, ready for whatever comes through the door. On the road, it's no different. That's why Volvo designs vehicles to help anticipate risk, reduce harm and protect lives. The Volvo XC90's advanced safety systems inspire confident decisions wherever the road takes you. The Volvo XC C90 for life. Proud sponsor of the Pit podcast. Learn more at volvocars.com US eczema is unpredictable, but you can flare less with Epglis, a once monthly treatment for moderate to severe eczema. After an initial four month or longer dosing phase, about four in 10 people taking Eglis achieved itch relief and clear or almost clear skin at 16 weeks, and most of those people maintain skin that's still more clear at one year with monthly doses.

[Dr. Alok Patel]

Hempglis Lebrekizumab, LBKZ, a 250mg injection, is a prescription medicine used to treat adults and children 12 years of age and older who weigh at least 88 pounds or 40 kilograms with moderate to severe eczema, also called atopic dermatitis, that is not well controlled with prescription therapies used on the skin or topicals or who cannot use topical therapies. EBGLIS can be used with or without topical corticosteroids. Don't use if you are allergic to ebglis. Allergic reactions can occur that can be severe. Eye problems can occur. Tell your doctor if you have New Orleans or worsening eye problems. You should not receive a live vaccine when treated with Eglis. Before starting ebglis, tell your doctor if you have a parasitic infection.

[Hunter Harris]

Ask your doctor about Eglis and Visit or call 1-800-LILYRX or 1-800-545-5979.

[Dr. Alok Patel]

Doctor Italo Brown Legend it's an honor to have you here. Thanks for taking the time,

[Dr. Italo Brown]

man. It's a pleasure to be with you both.

[Dr. Alok Patel]

You know, what people don't know is Italo and I have been friends on social media for years, but met each other IRL in the airport, which is kind of funny. Anyway, Italo, something that probably doesn't surprise you or I is how fast paced this show really is and how many times these doctors are going from room to room. They don't get time to really decompress or kind of sit with their thoughts for a second. Now, you trained in the Bronx at two of the busiest ERs. What was that experience for you like in having to run from room to room and not even get a second to think Rooms?

[Dr. Italo Brown]

That's funny. Honestly, a lot of times it's just a curtain drawn in between and sometimes patients are right next to each other, sometimes they're staggered in triplicate. And so it wasn't really a run from room to room, but really just wherever the space was and the patient was. But that experience is something that I remember even when I first interviewed there. I remember saying, if I can manage this, then I could probably go anywhere. The emergency department is just such a unique environment where we have so many different types of pathology or problems in the same space, and the ability to try to think through it is something that we rely upon. The speed, the fact that there can be a code one minute, and then the next minute, somebody chucking some urine and the urinal onto the ground. The department is just such a very interesting environment. A lot of things that are unpredictable, and you have to keep a presence of mind at all times, like know what's urgent, who's sick, who's kind of sick, and who needs to get out as fast as possible. And so that's kind of how I navigated it and really got good at relying upon all resources, nursing our support staff, techs, unit secretaries, X ray techs, Anybody who can move a patient, anybody who can see a person sick and yell out help is someone who I wanted on the team.

[Hunter Harris]

I am curious, like, what are some helpful tools when you're going back to back between difficult patients and difficult cases?

[Dr. Italo Brown]

A lot of times the most helpful tool is making sure that you have working differentials, right? So this list of diagnoses that you're working up for a person, being able to really hone in on them two or the three things that you're trying to address, and then keeping that from in the forefront as you move to the next patient. The other thing that I thought was extremely helpful is, like, constantly going through a mental checklist. Like, are the labs back? Is the imaging back? Did this person get the pain medication? Are the antibiotics started for the septic patient? Did we get fluids on board? Did we call this consult? Have they called back yet? Like, constantly running through this checklist and then moving things based upon the prioritization. Right? So super sick person, top priority. Somebody who's had, you know, the same issue for a year, a little lower on the list. Still important, but definitely not somebody who I'm worried about in terms of, like, turning the corner really quickly.

[Hunter Harris]

Mm. Master of the multitask. Incredible.

[Dr. Italo Brown]

Spinning all the plates at the same time and making sure that none crash. That's all it is.

[Dr. Alok Patel]

But what we've seen on the show and in real life is sometimes spinning all those plates does not involve paying attention to collective mental health. And we know that there's mental health struggles all over healthcare. We see it show up in this show for different characters. We're starting to learn a little bit more about each character's kind of personal mental health journey. How do you see mental health show up for your team, for your residents? Are we making progress in being able to talk about it and spot it?

[Dr. Italo Brown]

What I have learned to rely upon is this team environment, right? Just because we're friendly, we're a family, we spend a lot more time with each other than we do sometimes with our own families. I think one of the greatest changes that's happened recently is the development of like a wellness initiative across emergency medicine where we see wellness fellowships. We see a lot of importance placed on balance and making sure that our lives outside of the hospital are as good as possible so that we can perform at a high level within the hospital. And then finally, like this change in the stigma around therapy. So a lot of people used to not want to say, I'm a doctor and I go to therapy, or I'm a doctor and I take medication, or I'm a doctor and I talk to somebody about the trauma and the struggles that I experience on the shift. This space has now shifted to where these are encouraged, welcomed, and we celebrate it. And so that to me has been like one of the greatest things that's changed in the last, like 10, 15 years.

[Hunter Harris]

So you are an assistant professor of emergency medicine at Stanford. And I want to know, like, how realistic are you with students when they're going into this line of work about the mental health risks or how to take care of their mental health in these positions?

[Dr. Italo Brown]

I sugarcoat nothing. They know I will tell you the absolute truth 10 times out of 10. I start off by asking them, like, what do you want out of this career? You know, it's a lifelong career. You just, you sign up to be a physician, but signing up to be an emergency physician means that you're going to be imprinted upon constantly by people's personal struggles, things that are social and structural, systemic failures. And you're going to see some of the most vivid, gruesome, and sometimes very unbearable things. It could be as bad as someone being shot in the chest or talking to a patient who's been sexually assaulted. All of this gets imprinted on your soul. And so I try to make sure they understand that this specialty requires a lot of self awareness and that if they're wanting, if they want to step into this, that not only are you going to be literally tasked with a lot of things, but you won't be left alone. We have a lot of support, and by support, I mean we have a lot of individuals who experience the same things and they're open to sharing it so you won't feel like you're on a team by yourself. But it is a commitment. And every single time you do this, it demands its pound of flesh. So it's an undertaking. But I think that the reward is extremely high. And we see that experienced over and over again with people Coming back to the field, people making sure that they show up at our meetings, that they do research, they are undercompensated, and still give 110%.

[Dr. Alok Patel]

You know, I really like how you phrased these experiences are imprinted on your soul, the good and the bad. And, you know, the pit does a great job of highlighting many of the struggles that doctors, nurses, techs, all of us go through. And one of them is violence in the workplace. And, you know, people shots heard around the world when charged. Nurstana was punched in season one, and the show really illuminated for a lot of people who didn't know just how prevalent workplace violence is against healthcare professionals. Do you have any personal stories? Have you been through something with workplace violence? And then second part of the question, do you feel like we are finally making progress in terms of addressing it and protecting ourselves and our colleagues against these acts of violence in the hospital and the clinic and healthcare?

[Dr. Italo Brown]

I, unfortunately, do have stories, and I share them first out of honor for all of the healthcare workers who have sustained an injury or been assaulted on the job, verbally or physically. And I want to just acknowledge and hold space for them because this, again, has its own levels of trauma that you have to work through and sift through. And you don't get two, three days to figure it out. You actually get less than a few minutes, sometimes seconds, to figure it out. And so I remember I was a resident, you know, I felt like I knew what I was doing. I was a senior at that time, and I had a patient who was having, like, a brief psychotic episode and thought that everyone who was trying to help her was hurting her. And she was screaming out, she dropped to the floor. Now patient dropped to the floor in front of you. You're like, all right, hold on. Let me either try to help them up, let's stabilize them. And so when we tried to help her up, she started thrashing. And we're trying to make sure now we get her into a stretcher or into a gurney, appropriately take her to a room, and then try to either verbally de escalate her, and if not, we were going to chemically de escalate. So by the time we get her into the room and she's in the stretcher, I have my hands on the rail. She just like reaches up and grabs this part of my arm. Now, I don't know if you can see it, but it's like a really deep kind of gash there. Dug her thumb into my arm. I thought nothing of it. I was like, man, that's crazy. Went to the bathroom, washed off, no problem. Two days later. What started off as just a cut now is about, you know, two to three centimeters circumferentially hurts, not too bad, but I'm like, all right, it's cool. By Friday. That happened on a Monday. By Friday, my whole arm is on hellboy, just straight swole. And I mean this when I say, like, I could not suture a patient's face without every single, like, maneuver hurting my arm. I come back down and sit to sit next to my chief. She's just like, you know, how's the patient doing? And, oh, my God. And looks at my arm and sees how large it is. She's like, tyler, are you okay? I say, yeah, I'm cool. What's up? She literally takes me into the trauma bay, puts an ultrasound on it. Nothing but pus underneath it now. Yeah, yeah. So then the attending cut into my arm and took out about 20cc's of pus because I had essentially started to have more than just a regular infection, but a systemic infection. I share that story not as a cautionary tale, but to say like, one, you never know. Small things can become big things. Two, my team members recognized before I cared to recognize because I didn't think that the culture was to admit when I had been assaulted or the culture was to admit that I needed help. And so we've worked significantly to make the space safe enough for people to talk about things without fear of retaliation, without fear of being looked down upon because you were assaulted. And finally, the way that we've now shifted those types of things, the reporting, those barriers are a lot lower. A lot of times it was hard to report incidents of assault, partially because of the process being very kind of convoluted, but also, you knew nothing was going to happen. And so now we have legislation that is in process, largely being driven by our nurses and our nurse unions who are trying to make sure that there are ways that we can protect all healthcare workers and that there are consequences for assaulting us.

[Hunter Harris]

Wow, thank you so much for sharing that story. Oh, my goodness, that is wild. I'm curious how you've seen, you know, stress in the workplace show up for medical professionals and for doctors. We have a doctor on the show who has, you know, some self harm scars. And I, I wonder how have you seen stress show up amongst, like, the medical community?

[Dr. Italo Brown]

That's really a good question. I've seen it, and sometimes the signs are really difficult to catch. It can be substance use, it can be self or injurious behavior. And a lot of times it can just be toxicity, like the way they behave in the department, a little bit more sharp or snappy to their colleagues than normal. And what I've tried to do is to establish relationships that are bi directional with everyone that I work with. Not only do I ask you for help, I mean, ask you to do something or ask for help or try to help a patient. I try to make sure that you feel safe enough to come to me and talk to me about things that are going on in your world. One of the tasks that I have as an attending is to be able to pick up on these types of changes in behavior. And what we don't do a great job of is having individuals check in just because we think that it's always, oh, you're in trouble or your charts are late. It's always this kind of structure of I'm checking in on this person because they owe me something or they need to do something. Not just, I care about you and I'm worried about you. So leading with that type of energy has yielded a lot of these kind of, like, people in my life who've shared that information, and I've been able to help them as best as possible.

[Dr. Alok Patel]

Yeah, Dr. Robbie needs some of that too. You know, both. Yeah, the personal support, but also the push to go and be like, hey, resident, you can see come to me,

[Dr. Italo Brown]

man. I know he tries, and from watching his character arc, it's almost as though, I mean, you could tell he's a little tapped out, but I think that deep down he has that desire to, like, connect with everybody that he's helping, he's training, he's educating, and they view him in a certain way. Right? Like, they see him as like this. This citadel of knowledge, and they understand that he can make decisions and do things that most of the doctors don't do. But I think that you have to layer in a little bit more of that vulnerability, and you got to show them that you're friable, too.

[Hunter Harris]

Yeah, no, that's a good point.

[Dr. Alok Patel]

It's interesting. I. Earlier this season, I was talking to some colleagues, and one of them had mentioned this frustration to me that he heard med students saying, oh, my gosh. Like, we watched the Pit, we want to go into ER medicine because it seems so cool. And these other doctors are like, no, it's not really that crazy. Like, you're not going to get this many wild traumas or zebra cases sort of say, in one shift. Like, you got to Be realistic about it. And I'm like, obviously, it's television, guys. Like, calm down a bit. But I want to ask you, as the real deal, what is your favorite part about being an ER doctor? Like, what gets you up when you're kind of tired, you don't want to get to work, and gets you motivated to get into the hospital and take on a shift?

[Dr. Italo Brown]

It's honestly the nonstop problem solving. It's like a Rubik's Cube every time you walk into the department. And I like the idea of every time I meet a patient. First of all, I'm meeting more people than anyone. Typically, on a standard day, right? You're talking about 30 to 50 people that you just meet every day. And they have backstories, they have real problems. And your job is to get the most information possible in an infinitesimally small amount of time to try to help them move from point A to point B. Now, I'm not gonna lie. I originally was brought to it because of the cool stuff like, oh, man, you're putting in chess tubes. We're intubating patients. We're seeing someone who fell through a roof or whatever. Like, those stories make for great bar conversation. You walk in, it's like, yo, I got a story for you. Let me tell you what I extracted from this patient the other day. But at the end of the day, it's really about these patients and making sure that they're talking about their experience with you in such a high regard that you feel like you honored the specialty and the many other people who came before you.

[Hunter Harris]

So I just have to know, like, practically, you're meeting all of these people in a shift. Like, what is your social battery like at the end of a shift?

[Dr. Italo Brown]

Cooked. Straight cooked. I think what I've learned to do is spend that first hour in reflection, right? So I put on some music, try to vibe out and think about the cases and, like, what I could have done better and criticize myself harder than anybody else. But once I hit the threshold of the door of my apartment, I'm done. I have nothing left to do. I literally turn that off and turn on the endearing side, the side that has fun and jokes and can appreciate everything non medical. It is fun to me to be able to have that duality, to go into intense environments and think very surgically and precise, to talk and communicate at a high level, but then also joke and have fun and be like, a tangible, palpable person with dimension.

[Hunter Harris]

Wow. I mean, that's very instructive. If I Have an emergency, I'm coming to you. So you've really inspired me.

[Dr. Alok Patel]

Amen.

[Leticia Holler]

Thank you.

[Dr. Alok Patel]

I appreciate you do for the world for your patience, my guy.

[Dr. Italo Brown]

And I appreciate both of you for bringing this to the forefront, for honoring our work in a way that is exemplary. Thank you.

[Hunter Harris]

Look, I loved that conversation. And I was so moved by Dr. Brown telling us about this, like, gash that turned into, like, full of pus and how he didn't realize, you know, how he could prioritize his own health in that moment, but that it took a coworker saying, hey, I think we need to look at this a little bit further. Like, your arm is crazy right now. And I think that really applies to a lot of the. A lot of the doctors that we see on the Pit.

[Dr. Alok Patel]

It really felt like a storyline that could have shown up in the pit is, you know, as you mentioned, like, putting your work and ignoring your own stressors, your own symptoms. I really appreciate how eloquent and how open, you know, Italo was with us on this conversation. You can tell that he not only shows up for his patients, but he's probably a phenomenal mentor and attending, and I really appreciate him distinguishing between the cool bar stories, but then the actual motivation of being there for people on what might be an awful day in their life and, you know, trying to treat the entire individual and not just the disease or the condition.

[Hunter Harris]

Yeah. And I mean, I'm. I. I think that, you know, in my head, it seems so stressful and so tense to make a hundred medical decisions in, you know, the span of a few minutes. But I like that he described it as being so energizing and almost empowering to do that. And like you said, showing up for someone and also showing up for your coworkers and colleagues.

[Dr. Alok Patel]

For sure. For sure. I feel like he's the right person where I can call when I'm having a bad day and be like, coach Brown, what do I do to get back in the game? But this is. This is also the person any aspiring ER doctor is who you should reach out to, because he's clearly the real deal. That's it for today's episode of the Pitt Podcast, but you know where to find us, right here on Thursday after each new episode.

[Hunter Harris]

And we want to hear from you. Leave us a comment or a question, and we'd love to talk about it in a future episode. You can watch us on HBO Max or listen wherever you get your podcasts. 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 Edwin 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 Bazerian. Special thanks to Joe Carlino.

[Dr. Alok Patel]

The executive producer of HBO Podcasts is Michael Gluckstadt. The senior producer is Alison Cohen Sorokac 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. Foreign.

[Dr. Alok Patel]

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[Dr. Italo Brown]

So if you've been living in the

[Dr. Alok Patel]

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