5:00 P.M. with Alexandra Metz and Michael Hissrich

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