7:00 A.M. with Noah Wyle and Dr. Joe Sachs

This episode is brought to you by SimplySafe. As the evenings get darker and colder, this... SimplySafe on. ...is the sound of peace of mind. SimplySafe's sensors, HD cameras and 24-7 security monitoring, protect your home inside and out against break-ins, fires, water leaks and more. So you can relax. Visit SimplySafe.co.uk slash pod for an exclusive discount. ... Nice to see you to join us. Hey, Dr. Linden! Dear One Trauma ETA, six minutes. And so it begins. Welcome to the PIT podcast, the official companion to HBO Max's The PIT. I'm Dr. Alok Patel, physician, journalist, public health effects shinato. And I'm Hunter Harris, a screenwriter and cultural critic. Each week we'll take you inside the PIT and talk about what's going on with the characters, the cases, the patients at the Pittsburgh Trauma Medical Center. Today we're talking about the very first episode of season two, you've been waiting for this moment. We're talking to none other than the man himself, Dr. Robbie or Noah Wiley. You know, that the audience is privy to a clue that the characters around the character, protagonists aren't aware of. We also have the chance to talk to Dr. Joe Sachs, a writer and executive producer on the PIT. Also a emergency medicine position, real deal. I love having two doctors talk in terms that no one in the right mind would understand unless they went to medical school, but the passion and the emotion and the conflict of it is palpable. And if you missed it, definitely make sure to watch our Pre-Permior episode where we talk about season one with executive producers Arska Gimel and John Wells. There's tremendous amount of research that actually goes into determining what I want to talk about, rather than doing it kind of top down in the sense of what of the things that you want to see. A lot of it comes from talking to their two physicians who are in the room full time who are writers on the show. We have a lot to get into. The shift starts now. Come back. It takes some time. I can hold trail horse always climb away back home. Hunser, come with it. What character or duo were you most excited to see in this return to the PIT in season two? It has been a long time without charge nurse Dana. I was ready to see her. Is there a writer? I'm not sure. I'm in Bracer with open arms. I said my sister, my Shaila. Also, I want to say Javati and Dr. McKay. I think they have a very good partnership chemistry. I loved that scene last season where Javati was sort of third wheeling herself on the date between Dr. McKay and the nurse. And I like their like, no, they're like girl time friendship. It's good. What about you? I like that. Listen, I think the, I don't want to say obvious answer, but I've had a lot of people watching the show are excited to see like Langdon get back. How is it going to be with Langdon Robbie Langdon and Dana? I'm going to try to be a little bit more original. I'm really excited to see Whitaker and Santos. The roommate. The roommates. That was the end of season one. We did not say, I mean, are they going to be lovers now? Are they going to be enemies now? Like, I don't know. I, I feel like it's hard working with someone who you also like go home. Go home to see like it's hard working with a roommate. So I think they'll be like, let's not talk at work. We can talk at home. I get it, but it's, you know, I'm just, I'm just saying there's, there's a really fun difference in energy between them with it. Whitaker, like the softer comes from a farm. Yeah. Santos who's got, just got some demons, but she's an amazing doctor and advocate. She's fierce. And I think the two of them together are going to make for like an interesting setup. I mean, how does it feel for you to be back in the pit, though? Because I am like, I've come home. Let me get my set the scope out. I'm ready to like do some practice and medicine, even, but also with Dr. Allhoshmi coming. I'm a little bit like, I'm such a Dr. Robbie, like pit loyalist. I'm Leo. What can I say? Where I'm like, well, not too much. Like, you're coming in our pit. You can't just come in here and start wanting to change things. I feel a little bit observed. I don't know. It makes a little bit of control. How do you feel? I love the ownership you still have. You're coming into our pit. I love it. Let me think about this for a second. In this episode, if I go directly to this nerdy Dr. Brain, what immediately captivated me is you have this new attending role in Dr. Allhoshmi. I'm excited to see how everyone has grown and matured over the past 10 months. You know, people are one year ahead in residency. Like, I'm curious to see how the dynamic change. Yeah. Well, this was great episode. Let's talk about what happened in episode one. New characters, new interns, new haircuts. Hunter. Catch us up. Okay. So Dr. Robbie is going on sabbatical. We see him. And I want to talk about this because I know that this bumps you a lot. We see him writing into work on the motorcycle. No helmet. I know. Kuku bananas. We're talking on sabbatical. He's going on. What is it like a three month thing? But I think there's a little bit of joking as to how long he'll actually be gone. And running the ER or the EDI should say in his stead is Dr. Allhoshmi, who is I don't think she's like very like prickly, but she definitely has different ideas about how the EDI should be run. And there's a bit of attention between them where Dr. Robbie feels both very observed and a little bit second guest. And she is like, let me in. I want to, if I'm supposed to take over for you, how am I supposed to do that without you kind of helping me and telling me what to do? I like that she comes in like napalm. And she's like, you know, she's like, I worked on this project at the VA hospital. We got patient passports. Here's how we're going to make things more efficient. Like good for her. Stand up. I'm a loyalist. We'll see. Let's hear from her words. If Sarah comes in. That's even better. Hi, I know you're crazy busy. But I figured we should really go over a few things before you're gone. Sure. Where would you look to start? One little thing that I think would have a big impact with staff and patients alike is if we launched a campaign to eradicate referring to this wonderful department as the parents. Really? I know you think it's silly and petty. No, I think it's just kind of endearing. Pretty damn accurate. I would argue the opposite. I think subconsciously it affects those who work here. It also lowers expectations, which in turn lowers patients' satisfaction. Well, you've been talking to Gloria. Yes. And she agrees with me. But I'm not going to be talking to her for a moment. You can't read it. Yeah, you can't read it in the pit. No, it's our pit. It's my pit. We share it all. I felt like she came in a little bit hot. But I also want to talk about the choreography of that scene where a doctor all hashmi is like kind of right on top of Dr. Robbie. And he feels very like. Can you kind of get away a little bit? I'm a big personal space person. So that really got under my skin. I mean, that's by design. Gotta be. And no, bold, for sure. I think I love them. I mean, I think he is. But I understand Dr. Robbie being a little bit like, relax. So what I think is interesting also is laying in his back. And we are inevitably going to see his interaction with his colleagues, with the nurses. But I'm curious to see how it plays out when he revisits patients. And like, there is a pretty pivotal scene where he just comes to Louis and he just owns it. He owns what happened. Yeah. And I was nervous because it's like, that takes a lot of, um, a lot of, where with all to come to someone and say, I apologize and something that happened that you didn't even know about maybe. Also like, Louis the man. Anyway, let's relive that moment. It was heartfelt. There's something I need to tell you. Last time I saw you about 10 months ago, I treated you and I took some of your medicine. I'm not sure I follow. I have an addiction to benzose and I helped myself to some of the lybrium I prescribed you for your withdrawal. You stole my pills? Yeah. Yes. Um, I'm sorry. It was, uh, it was not only wrong and utterly unprofessional, but it was a betrayal of my hebocritic oath and it was a fucking crime. That's where I've been. Rehab and counseling. Huh. I'm sorry. I understand if you prefer a different doctor. Hey, Doc, we have a situation. Excuse me. What kind of situation? Someone left a little baby in the restroom. LinkedIn hit on so many check boxes there from owning it, explaining it, talked about the process. He did tours recovery and saying like it was a fucking crime. Yeah. Just like saying that phrase. Maybe from my point of view, I'm so stuck on Louis, not really like, what do you mean? Like he seems so confused because he obviously trust LinkedIn a lot and it seems very discordant with everything you've seen from LinkedIn before that he would be like lying to him in this way. But then we end the scene with a baby left in the ED abandoned. I'm like, what could possibly, oh, baby, is so cute. What could possibly happen? That was wild. Yeah. I mean, if there's anything that's going to pull him away from Louis in that moment, it had to be an abandoned baby. A truly crime baby in a bathroom. But the other big piece of drama this episode is that Mel, our beloved Dr. King, is being named in a malpractice suit. When I heard that, I'm like, oh my god, call Aaron Brockovich. Are you like that happens all the time? Mel, the threat of lawsuits happens all the time. Okay. Like, it's from a third party or from a law firm that's like, hey, this patient did this or patients themselves screaming in the ER and saying, like, we're going to sue you. And then some states have laws that protect physicians differently than others. And the reality is, as I can imagine a situation where Mel herself would be named in a lawsuit and it wouldn't be something that's also involving the rest of the pit. I don't know. But she's a lot of anxiety about it. A lot of emotions. Should we take a look at those? Yeah. I mean, I felt her emotion and meant like, in anyone who's like, hey, I'm going to sue you. Like, you worry about, I feel for Mel. Mel, we got you. Yeah. What's up with you today, Mel? Lynn and Galia. Make sure to think there's something up with me. You're moping around here all day. Like, somebody can gun down your favorite K-pop band. I don't really have a favorite K-pop band. That was that I don't like the genre. Okay, forget K-pop. What's going on with you? Usually ride in here on your unicorns, tossing wildflowers. Unicorn? I never mind. Is everything okay with your sister? Oh, yes, she's great. It's just this. I'll be. Spale, girl. Well, a couple of months ago, I got named in a... Elp practice list. And so, today is the... Deppesition. That's it? Every emergency medicine doc gets sued sooner or later. Seriously, that's what it. You're still a resident. We're protected by the hospital. You could cut somebody's head off and get away with it. Wait, not like... Don't... Taylor, Deeridon's acting, is phenomenal. I don't have a favorite K-pop band. It's so good. It's actually like she's really thinking about it in real time. Like, do I? No, I don't think so, actually. I have to say, Santos is so clever. Mel and Collia, Mel practice. All of those little nicknames. I'm like, okay, Santos is the quickest wit in the ED. And like them, them intermixing in that situation. And you can tell that Santos cares. Because she's like, what's going on? But her way of showing care is hilarious. Yeah. Okay. We've seen a return patient, Louis, who I loved from season one. Love Louis. I mean, is it possible for patients to light up a room where you're like, I'm actually so happy to see you, but I wish you weren't here exactly. Like, how often are repeat patients like that, I think? It definitely happens. Some places will use these offensive names for them, like repeat offender, frequent flyer. Frequent flyer is funny. Frequent flyer is funny. That one's kind of cute. Yeah. And the question comes down to is, is why are they continuously coming back? And like, Louis is actually so well written so well because, yes, you have the situation in which he's continuously drinking, probably not following some type of lifestyle modification. But he's like such a joy in the yard that people are like, oh, hey, it's Louis back. And you have those patients for sure. Yeah. I think the question that people always wonder is, okay, is it because somebody has a social situation where they can't take care of their own health? Do they, can they not afford their medications? Do they not have access to primary care? Like, why do you continuously come back? So when you have these quote unquote, frequent flyers, you essentially are always looking to say like, what can we do so that you can take care of yourself in whatever situation you're in? And again, second shout out to social workers because they definitely help with making sure that resources are met. And then what you mentioned earlier, but other some patients that just light up the room absolutely. There are some patients and like, I will, doctors will see the family and say like, hey, it's so good to see you, but like not in this scenario. Like I wish I was seeing you like at the grocery store. Yeah. But that definitely happens. Is there ever a moment though where you're like, okay, I'm giving you the same advice four times in a row. Like you can't come back. You're already, at least I feel like if someone doesn't take my advice, I'm a little bit like annoyed about it. Do you ever feel it with a patient who's like a frequent flyer? Oh, I think that, yes, I think that not only do I feel it, I think like many of my colleagues feel it. Okay. But this, this, this, this topic goes back to something that John Wells was telling us. And that as more people don't have access to primary care or can't afford basic preventative health services like where are they going? They're going to the emergency departments. And so I think like we're going to continuously possibly see more of this theme in season two is like when, when basic access to health care is shook a little bit, they're unfortunately might be more lilies. Maybe not as pleasant as him either. I'm going to say, yeah, usually on his pleasant. It's not pleasant as me. It's uniquely jolly, I would say. So Robbie and Langdon, I can see that Langdon's like trying to get back into kind of that casual conversation. And he's asking about the motorcycle trip and Robbie still kind of has this guard up. Like where do you think this relationship is going? He's like, you go to triage. Don't be around me right now. But where do you, where are we going with this? I'll tell you where it came from middle school. That feels like bullying. I'm like, wait, no, let him sit with you at that cool kids table. Like, please, like let him back in. I understand though that Dr. Robbie feels a real sense of like being violated because he and Langdon were so close before they did have that kind of boyish affection with each other. Very felt like brotherly love. And I mean, we, we can talk about like the last season where there's that amazing scene where Robbie confronts Langdon and you can see the personal hurt as well as the like professional hurt in his face and in his eyes. And I don't know. I mean, it's hard to watch Langdon try to get Robbie's attention, try to get back in his good graces. But I truly feel like on a busy day, I don't know how much time Robbie is going to have to truly like come to terms with how he feels about Langdon. And I hope we get to see that by much as that we will. What do you think? I think there's, there's something to be said about the last 10 months, like Langdon went on this, on this path for himself and went to rehab. Presently spent more time with his family, like God has stuff together and like what was Robbie doing in the past 10 months? Did he not give himself time to heal? Did the hurt of Langdon with pit facet, all this, you know, come down on him and he has not moved past things because you would think that he'd also be like, hey, you took the time to get better and get over your addiction. And I took the time to like forgive you or friends again. I, there seems to be a discontinuity. No, I think that's what happens after addiction where it's like, you know, someone who has done the work is healing starts from a place of here. But you know, Dr. Robbie, obviously he still feels like the open wound and especially the fact that Langdon, you know, was dismissed right before the MCI when Robbie needed him the most, I feel like that has a lot to do. I think Dr. Robbie's healing. Well, if, if like he could have gone and done his process and then if Dr. Robbie's like, yo, I'm not ready to lend him needs to be like, I understand. I don't know. Some people need to take space and I think I hope that Langdon is open to that and doesn't take it as just, you know, they're hurt and a rejection. He's still got great hair. So last season, um, wasn't a holiday, it was just like a regular day, but now we are on the 4th of July weekend, which I'm like, okay, I have every radar on. I'm so nervous. I don't know what's going to happen. I just hope that no one brings like a firework to this hospital or there's nothing, you know, like the dumb summer stuff that happens in the 4th of July weekend. How do you feel going into this weekend? Oh, I am absolutely pessimistic. I think you were holidays, right? Oh, yeah. Oh, and I worry that there's going to be some form of pyrotechnics, some form of firecracker sparkler or something and like limbs might get blown off, eyes might get damaged, burns may happen, fires may happen. That's what I just, the burns, all of it. I mean, it's, people wind up in ERs every single year during the 4th of July because people are messing on fireworks. They're not taking the safety precautions. Do I worry warnings there are? When I was a resident, I saw a rising star basketball player blow off his right hand from a firework. Oh my gosh. And you see this happen and I'm like, oh my gosh. And so this, this setup that it's 4th of July weekend, I'm with you. I'm already like, oh my gosh. I almost have to wonder why couldn't Dr. Robbie just finesse the schedule a little bit and his last weekend was like the last weekend of July or June or something like that, you know, just like get out a little bit. So I'm watching this as a person who like barely has a PCP, but I want to know for you, like, are you watching this and noticing specific details, specific moments that really say now to you as a medical professional? Oh, totally. Okay. And it makes it fun because it's almost like they insert these medical Easter eggs in the show that you're like, if you, if you miss them completely, it doesn't change your experience. Yeah. But if you catch them, you're like, oh my gosh, that's a really subtle, funny little moment. Like, I'll give you one. Okay. Dr. Al Hashemi when she has like the residents practicing like CPR on that mannequin. And then she comes in and she's like, Hey, like it was the wrong rhythm. The rhythm that it showed is something that we just called tursads. And what she says, she says, that's actually tursads de poins. Like she says, the proper French pronunciation, which is a very specific little quirk in medicine. When you say these eponymous names, you pronounce them by their like origin language. And people don't usually do that. It's almost kind of like a flex. But that French word tursad de poins means like twisting of the points, which is what that patient had. But we would just say tursads. But like she went this extra little, I love that shoot that on her first day. It's like, let him know. It's tursads de poins, like a little, little, little something. She's like medical protocols being followed. New little medical details, like they give the entire medical audience a little bit kind of, they give, they add a little something for the medical audience to say glued to it, which I think is super cool. We had the privilege, talk to the man himself. And I let me get all this down. Excuse me. Sorry, actor, writer, executive producer, director, and Emmy award winner and advocate, and advocate. Amazing. No, a wily. I was like, oh my gosh, we get to meet the legend himself. What an honor. It was amazing. Great to be here with you. No, no. So Dr. Robbie walks into season two. I should say he motorcycles in. We'll get back to that later. Okay. And off the bat, you're introduced to Dr. Al Hishimi. The audience is introduced to her, not only as you're equal, as another ER attending, but someone who's going to be potentially stepping in in your former role during your sabbatical, within the first few minutes, there's already some hot phrases dropped, like she's torturing the interns. You know, she is the one that the QI doctor, the one who is the informatics, you hear that phrase? I believe I'm quoting this correctly. Great balls of disrespect. And I just wanted to ask you, giant balls of respect. I think of it as a clarification. These are medical terms. Medical jargon. So I want to ask you about how Dr. Robbie and Dr. Al Hishimi approach ER differently, and where is the friction? Well, I think it's slightly generational in a way, even though we're not that far apart at age, totally different schools of medicine. I think Robbie came up through people that put a lot of emphasis on diagnostics, pans on, you know, real sort of palliative care and hands-on diagnostic acumen. And Al Hishimi is really excited by the breakthroughs in technology, and not just what they could do in terms of diagnosing disease earlier, but how they can improve the interaction between physicians and patients when you're taking a history. It's the ability to record and have something immediately download into a chart and allowing you to keep eye contact with the patient, to sit bedside, to not feel like you have to only type things into a screen and not have that personal connection. And then the efficiency of being able to pull up that chart, see that it's the proper format and just have to go through it for factual and spelling mistakes, freeze up a lot of time in a physician's day that's oftentimes spent after shift doing all that catch up work. So it's an incredibly interesting tool. You know, Robbie's counterargument to efficiency is that they give you more work when you are given more time. You'll be asked to see more patients given that you now no longer will have to spend that time charting, that there's always a blowback to these advancements and God forbid the power goes out, you know, it's his kind of thinking. Which is legit as this technology is while impressive, still not 100% foolproof. But it allowed us to create not an antagonistic character to Robbie, but one that approaches medicine from a different perspective, having had a different journey. And as he thinks about imparting his ED to another attending when he goes on his sabbatical, he feels very parental about this place, very proprietary. He wants to make sure it's going to be in good hands that he leaves it with. How do you feel like Dr. Robbie feels about being so observed? And especially the first episode when Dr. Al has she me is like really kind of looking over his shoulder, not second guessing him, but just asking for him to explain maybe what he's doing or why. I don't think he's used to it. I don't think, you know, he's been kind of a lone wolf attending for a long time and sort of the head of the place. So he's not used to being second-guester question. He's also at a point in his life where he doesn't really want to be examined or looked at too closely. This is his last shift. It's a little bit like getting out under the wire for him before things that he doesn't want to show begin to show. So I hope that answers your question. Yeah. Thank you. Can you tell us a little bit about how your work as an actor on the show informs your work behind the camera as a writer, as a director? How my work on the show informs my work behind the show. I think it's... Or vice versa. The other way around. Yeah, no, it starts at the writing room. It starts at the beginning of the season sitting there with the other writers and taking interviews with people from different aspects of the healthcare system and saying, you know, what should be on TV? What is it on TV? What would be helpful for you to have put on TV? What would be counterproductive to the work you do to have on TV? What's happening out there? What could happen in six months if this doesn't happen? What could happen in 12 months? Which population is going to be the most vulnerable if this happens? Who's most at risk? And then you get all that data and you start to begin to draw storylines through it. You know, how do we talk about the loss of health insurance as somebody in the face of Medicaid cuts? Well, how can we put that into flesh and blood and have it be relatable to a viewer who might be able to identify the experience either from somebody that they know or from their own family? What resources might be made available to them? This becomes traumatic and educational and sort of engaging in a way that makes it topical but also entertaining, hopefully. And puts these issues that are kind of dry on the page into flesh and blood where you can actually sort of see consequence. I think a topic that's very relatable that Noah, the executive producer and writer, brings to Dr. Robbie is the intensity. A doctor facing this awful day in the ER. And you know, it's realistic. You're the intensity in the ER, but then also you have your own personal trauma. Dr. Robbie has these flashbacks. Do you feel that stress on set? Is it hard to separate when you're out there? Do I feel that stress on set? You know, it's a different set of stresses when you're trying to accomplish the execution of production and photography of a moment. You know, there's a lot of variables that go into that and one of those variables is your own performance. And so like a real doctor, you have to do a lot of compartmentalizing in what you're concentrating on and into given moment. I find that set space to be, you know, my real happy place that I get there every day and I just can't wait to put on my costume and hit the floor and immerse myself in that reality and tell that much more of the story with these incredible artists. And you know, this show has been an answered prayer and a dream come true for me. And an opportunity for me to stretch myself as an artist and as a writer and as a director and I'm gratified every day by being part of it. And the blowback, the feedback, the resonance that the show's having globally has been extremely gratifying. In those moments of like, you know, higher stress, higher intensity, how do you disengage or when does Noah come out and Dr. Robbie go away? Well, you know, it's, we're right in the middle of it now. We're shooting episode 13 and it's hard to come out. It's certainly hard to come out and talk about the work objectively when you're really quite in the middle of it trying to land this massive 747 emotionally. And so it's sometimes easier to stay in it when you get into the latter episode because then the aggregate fatigue of the whole shift that you're supposed to be bringing in before we start at 6.30 in the morning, we have to already be playing as if we've been there for 12 or 13 hours already. So it requires more and more focus, the deeper into the season we get. But this is the stuff that I find most exciting about what I do. He's getting to play with this kind of intensity fatigue, specificity, nuance that's like this is as good as it gets. Opening scene, like the very first thing we see is Dr. Robbie motorcycle. There's no way in my mind that Dr. Robbie was not going to be wearing a helmet and I was like, oh my gosh, it really is Dr. Robbie. That has got to be some type of very well thought out character placement moment. Can you tell us a little bit about what went into that idea being like, actually I'm going to tell you audience that I'm on a motorcycle. This is how I live. Well what has Robbie been doing for the last 10 months? What kind of therapy has he sought out? To what ability has he been able to synthesize his experiences? He's telling everybody that they should make full use of all the mental health resources available. He hasn't made much use of them himself. But he has been restoring this old motorcycle with an aim of taking up three months sabbatical and riding it off on the kind of utopian journey. And then as the shift goes on, we begin to question his motivations for taking this trip and what this trip really is representing for him. And early on, obviously in the writing stages, we planned on me writing to work on this motorcycle that I've been restoring. And it was always intentions that I would be wearing a helmet as any doctor would. And then we got to shooting it in Pittsburgh. And I had dinner with John Wilson night before we shot the scene. He was directing it. I said, you know, I don't know that he wears that helmet. I think he puts it on the back of his backpack and tells everybody he wears it. But if we see him without it and he tells people he wears it, we won't know what's true and what isn't. And it will be an interesting experiment for the audience to gauge his level of sincerity going forward. And the example that I use, which is sort of a famous one, is that Jean Waulder supposedly said he would not be participating in Willy Wonka and the Chocolate Factory. He wouldn't play Willy Wonka unless his character could come out the front door of the Chocolate Factory as his introduction with a limp and a cane. And then at a certain point, fall forward and come up in a summer salt and then take bow. And the director was like, why? And he said, because they won't know where I'm coming from after that. They won't know whether they can believe me or not. They'll be absolutely on unsure footing from the second. The character introduces himself. And I thought, well, that's so smart. That the audience is privy to a clue that the characters around the character protagonists aren't aware of. They're ahead of the storytelling just by witnessing that. Getting that was deep. That was great. Thank you. Wow. Like, knows the real deal. Yeah. That was a great interview. And I also, I mean, you really had him with the helmet question. That was so good. I had no idea that it was that thought out. They had such a conversation about what that meant. Yeah. The ride, no pun intended. It was going to take the audience on. I thought he was just going to be like, oh, I'm bad ass. Yeah. Something that I think about a lot with Dr. Robbie is that if you have both hands extended to care for everyone else, who was caring for you and how can you, you know, give from an empty cup? Oh, dang. That was like deep. I'm going to go to commercial breaks. I can like sit. Sit with that for a second. A look. I need to go outside the pit for a minute. Get some fresh air. Now, I'm so happy to have you as a doctor in my life. We also have Dr. Joe Sacks, who is a writer and executive producer on the pit with us to talk about the bigger themes. And he's an ER doctor. He's a real deal. He knows what's up. Before we even start, I just have to say Dr. Joe Sacks, it is a huge honor to be able to talk to you, emergency medicine, physician, television, writer, producer, executive producer, Emmy winner. Like, basically, sir, I want to be you when I grow up, just saying, well, it's a pleasure to be here. And I'm just Joe. Well, thank you so much for being here. This is going to be such an honor. I want to start with asking, you know, the pit gets so much attention for its medical accuracy as Dr. Alok Patel can attest himself. But you wrote one of the most intense episodes of season one, the aftermath of the pitfest shooting. What kind of research do you do when you're working on an episode and how do you kind of juggle the emotional parts of the show with also like the medical parts of the show? Wow. Well, the first, the first answer is that we never start with the medicine. We always start with the dramatic needs of the character. And then we find the medicine that fits. And what is the medicine that fits? You know, the medicine that fits comes from our well of ideas. And this well is stocked by physician writers who have over a hundred years of experience in emergency medicine and trauma, briefings with experts on every topic that we are going to cover, focus groups with real nurses and real doctors from residency training programs and trauma centers and LA. So we just collect masses and masses of stories. And they're all just waiting for the right time to really, really illustrate what's going on dramatically. I'll give a quick example from season one. It's like, because it's so important. And I'm going to focus on the character, Joadhi, the medical student. So I'm going to do three beats of Joadhi's arc. The first one is the writers room looking to me and saying, what would make a medical student faint on the first day of her rotation? And you know, we've seen thoracotomies, we've seen chesters, we've seen all this. But there was a case from my experience that really, really grabbed people. And that was the de-gloving fracture dislocation of the foot. And to have to put that foot back in season one, episode one was what made Dr., excuse me, medical student Joadhi go down. So then we're going to fast forward a little bit. And nobody knows that Joadhi's mother is a surgeon. And she's trying to keep that on the DL because she doesn't want to broadcast that to the world. The question for this episode is how could Joadhi's mother embarrass her in front of everyone? So Jo, how are we going to do that? So what I did was I had the mom who's a surgeon come down to consult on an appendectomy patient. And she gets the med students in the intern in the room and says, who can tell me about the COTA study? It was a study in the New England Journal of Medicine where antibiotics alone rather than surgery was effective in quite a few of the patients showing that you didn't always need surgery for appendectomy. So she says, who can tell me? And her daughter kind of freezes in a different medical student answers the question. And she says, come on, honey, we talked about that at the dinner table. And she's more than a fine and would a graphic look at her and goes, honey? So she's revealed. She's unmasked as being someone who perhaps has some nepotism going on. And so I wrote, one, eight, which was, how can Jovati want up her mother? How can Jovati have a victory over her mother? And the case that I picked was, again, a case that I had, which is a black widow spider bite that can give you a rigid abdomen that can make it seem as though you have a life-threatening infection parotonitis. And very often people with black widow spider bites have such intense pain and a rigid abdomen that they've gone to the operating room for an appendectomy when, in fact, they need muscle relaxants for the black widow spider bite. So Jovati won up her mother by discovering the black widow spider in the clog. So these are the kinds of things. And again, the stories that we're picking are real. They're kind of obscure and they're kind of interesting, things that people haven't seen before. But again, they serve the dramatic purpose. And if you want to talk about episode 201, the season premiere, I can just go down a few of the cases and explain what the dramatic needs of the scene are and why we picked that particular case. Yeah, that sounds great, please. Yeah, so the biggest case, the big trauma case, is what's called a clamshell thoracotomy. We're not only do you open one side of the chest, but you open the other and then you cut across the breastbone and it's called popping the hood. The whole chest opens up. And this particular John Doe is stabbed by a kitchen knife from a restaurant. And the whole purpose of that scene was to show the difference in the conflict between Robbie and Alhasheedee, the new attendant. So she's new. She doesn't know how things work. Robbie is dialed in and here's an interloper coming into his space who has different ideas about how to do things. So that conflict plays through the whole scene as does Samira's phone consistently beeping with text from her mother because her mother is packing up the house and trying to get rid of all of her stuff from her childhood, much to her dismay. So especially while she's opening a chest in doing this, her phone is going off consistently, which kind of sets that story in motion for her. So there's always something else going on in the scene. We can talk about Louis, who's the alcoholic, frequent flyer. Louis, everybody, he has frequent flyers. And you know, it's, it's Langdon. That's there for Langdon. Langdon's first day back and who does he see? But Louis, who he stole some Librium from because of his Benzardé's addiction and has to make amends to Louis for doing what he did. So that kind of sets that in motion. That Louis is back just with the toothache. But by the way, he's got a giant belly from a sideys, from alcoholism, cirrhosis, and gets handed off to Whitaker. And that'll become an important story for Whitaker. And then I'm going to end with Ethan Bostrick, who's the old man who comes in from a nursing home who has a cardiac arrest. He has a pulse, a physician order for life-saving treatment, which some people would call a DNR, do not resuscitate. I prefer the term A and D, allow natural death because that's what mother nature is intending with somebody. And Whitaker is now teaching two new medical students, you know, Ogle V and Joy. And everything that he learned last year shines with the patient, the way he's respecting the patient, the way he's explaining to them about treating him with respect, about taking a moment of silence and asking them to turn their phones off. Because last year in the moment of silence is when his phone went off with some very funky music playing that was inappropriate for the time. And I think Robbie passes by and just looks into the room and sees Whitaker imparting the same wisdom that Robbie imparted to him here before. So all these stories, you know, there's 21 patients in episode two, you know, the old medical shows used to have one or two patients. We're going to be 21 patients. And what's wonderful and what's exciting about the pit is you never know, are you going to spend one minute with this patient or is this patient going to blossom into a patient that you're going to see for five or 10 or 15 episodes because it's all in one day. And patients often stay there for that long. So that's kind of the thrill of the pit. And if people go back after, if people go back after 10 or 12 episodes and look in that waiting room from episode 201, they're going to go, oh, wow. A person who finally made it back in episode five, they were there. They were just sitting there because they were waiting. So that's part of the fun of the episode that there are some Easter eggs in the waiting room. Oh, so many Easter eggs. I love that term. Joe, I'm glad that you brought up the dramatic inclusion of patients and how we go on a journey. We don't know how long it's going to be. And sometimes when people watch these cases unfold in the pit, it changes their own behavior. It raises awareness. I bet a lot of people are shaking their shoes now to make sure there's no black widows in there. Something that we used to do growing up in Arizona. But I saw an interview with you a few months ago and you were specifically talking about the teenager in season one who had the overdose and then he stuck around for many episodes. And so I wanted to ask you, from your perspective as an emergency medicine doctor, someone who sees the pit as a way to bring PSAs to life and enact some change through television, how do you personally choose? All-care issues to get in the show. Yeah, it's a great question. And I have to go back to saying that the medicine never comes first, the dramatic needs of the character come first, but by being current and accurate with our medicine as a side effect people learn. Not only the public, but also professional audiences learn. I can give you an example of each. We had someone from Hawaii post online that they made the diagnosis of the first pediatric case of measles in Hawaii based on what they saw on the pit. We had another social media post by somebody who recognized methemoglobinemia because of the blue patient in episode 14 and 15. In terms of the public, more interest in organ donation, more interest in advanced directives. And the one example that I'll probably get emotional at was a social media post by a doctor who was working at 2am, very busy night shift, in a 90 something year old woman came in with a massive heart attack, not doing well, going downhill in terms of revival signs. And the doctor knew that the patient didn't have an advanced directive and was like, oh, boy. And you know, when you're single coverage and taking care of 15 other patients at once, that's a huge burden. So this doctor walks in through room and says, we really need to talk about the plan for your mom. And the family interrupted and said, you know, doctor, we've been watching the pit. And we've seen the futility of aggressive treatment and a patient like my mom. And we've seen how it just causes suffering. And so we had a discussion and we decided that if they ever came to be, that we would want we would want comfort measures only. So within a minute, within a minute, this family from watching the pit had this remarkable and very important decision made because they had seen that. So that was a wonderful moment to read that. That's incredible. It's, you know, it's beyond television now. It's enacting change. It's raising awareness. I want to ask for you, what is like the most rewarding part of making a show like this and having this impact on people's lives? Well, I think that's it. We try to be great storytellers. We try to have great dramatic storylines, interesting characters who go through a journey. In season one, everyone was blank canvas. And you got to learn who these people are. And that was wonderful. But now to keep people engaged, new things have to happen. Certainly Langdon is back from 10 months of rehab. And that is his journey and his conflict with Robbie, which is just starting to be touched upon. You know, Robbie wants some triage. Robbie doesn't trust him to be back in the big ER dealing with the most complex patients. But for me, you know, the most rewarding part is telling great stories. And then like I said, the side effect because we're so current and so accurate that people are learning. And professionals are learning. And some individuals may be inspired to pursue a career in healthcare. And that's kind of how this whole show started. No, a whiley received tons of messages during COVID from people saying we are hurting. We are hurting. And we need someone to inspire us. And in doing this show, we've had many, many, many messages from people. We had one from a parent of a 14 year old who binge watched the show and said, I'm going into a career in emergency medicine. This is what I want to do. Victory. Wow. Well, that's awesome. Awesome. Well, thank you so much for joining us. This was such a lovely time. Joe was an honor. Thank you. I wish we had three more hours to talk. Absolutely. It's a pleasure. Thank you so much. Thank you. Let's take a dilemma that happens on the show. And I want your quick and dirty, what you would have done in that scenario. To get the patient's heart beating again, would you have gone with Dr. Allhashmi or Dr. Robbie? If that was the scenario and we were on a deserted island or something, I would be like, which one of you has done this before? But if not, I am calling a cardiothoracic surgeon. I'm calling a trauma surgeon. I'm calling people because usually are not opening up chests and doing this in the ER without the surgical cavalry in there. This procedure, the hyalur twist, which I've seen in literature called the high-lum flip, high-lum twist, high-lar flip. One of my friends who is a trauma surgeon calls it a high-lar twist, regardless. It's a pretty hardcore. You need to have someone in there who's done this before. Maybe not a bunch of interns and residents and one surgeon. I have to say I prefer hyalur twist. It sounds like a dance. Do the twist, the high-lar twist. And that's it for today's episode of the Pit Podcast. You can catch us right here every Thursday after each episode drops. Watch us on HBO Max or listen wherever you get your podcasts. The Pit Podcast is a production of HBO Max and collaboration with PRX. The executive producer of PRX is Jocelyn Gonzalez. Our managing producer is Courtney Florentine. Our editor is Lucy Perkins and our video producer and editor is Anthony Q. Artis with assistant editor Damon Derell Hinson. The show is engineered by Tommy Bazarian. Our production managers are Edwin Achoa and Tony Carlson. The executive producer of HBO Podcast is Michael Gluckstead. The senior producer is Allison Cohen Sarokotch and the associate producer is Aaron Kelly. I'm Alok Patel. And I'm Hunter Harris. We'll see you next week in the Pit.