7:00 P.M with Johanna Coelho and Dr. Jacob Lentz

Meet the new Hoker Speed Goat 7. Proven grip, comfort and control. For runners who meet the wild head on. From steep climbs, to slick descents, and loose rock. Speed Goat 7. Run Wilder. Explore more on hoker.com. Hikers. When either of my kids was acting like this, I gave them a time out in their room. Oh, whoa, whoa, you're not my mother. Yeah? Well, too bad. You need one. No, I had one. She left. I don't need another one. Would I need someone who can actually run this place while I'm gone? I'm sorry. I didn't know. Nobody knows who needs to know. Give the fuck. I think you need a break. Welcome to the Pit podcast. The official companion to the pit right here. On HBO Max. I'm Dr. Loc Patel. And I'm Hunter Harris. It's seven o'clock on the pit this week. We're on episode 13. Can you believe we only have two more episodes left of this season? We're going to talk about how the show was filmed. The chaos, the choreography, all the movement, everything. We're talking the director of photography, Joanna Coelho. Finding the right angles. That's it. The moment it's cut, then we can't do that cut anymore on the prosthetics. So we have to find two angles that works for that work at the same time that allows you to see well and are visually interesting. Today's shift, Lights, Camera, Action starts now. Age squared. It is good to be back. I feel like we are turning a corner on this roller coaster and starting to get towards some climactic endings. Multiple patient cases and character arcs starting to develop. I find it hard to believe that this is still all just one ER shift. But what's your overall assessment on this episode? What's the vibe? How are you feeling? This one is a stressful one. I mean, we say that every week, but this time I think we're really getting a sense of the depth of Robbie's despair, honestly, the depth of his loneliness. That fight with Charger and Stena, where they're kind of in the corner, really having it out was the first moment that I felt like he had said that it landed for him, that he actually has a suicidal ideation. He'd mentioned it with Whitaker when he asked, maybe I'm not going to come back and you'd have a bachelor pad. But this moment was, I felt like his throat caught and he was actually really emotional over it. And I wonder, I mean, I don't know, I kind of feel like the sabbatical is really an exit strategy for him to really cover up how lonely he feels, how much he doesn't want to be with us anymore. I also don't know if Langdon is going to relapse. I don't know if Whitaker is going to be able to take care of my shit. I don't know if Givati is going to give up on what she's good at or if Samira is going to flame up because it's a bullshit with her mother. Is there anything else? Yeah, you. I don't know about you running around with both syringe and verset in your pocket. I'm worried about the people that I care about. We'll all manage until you come back. We always do. Yeah, what if I don't come back? You almost get this sense of almost like a co-dependency issue that I think Dr. Ravi has with the ER when he starts going through the entire line of staff. He's like, I don't know if I can trust Dr. Alhashimi. I don't know if Langdon is going to relapse. I don't know if Givati is going to live up to her potential or go to a different career. Like that's a new one that he's now carrying with him. Like he really does have this, this interesting emotional dependency and responsibility towards every little corner of quote his ER. Something else that I want to talk about that is a very brief moment, but I think we need to talk about it a lot is Dr. Ravi says that he grew up without a mother that his mom left when he was young. Did you catch that? I did catch that when he was talking to George and Dana. Like I don't need another mother. I had one and she left. I think it's very satisfying as an audience member to catch something like that. Like a very important character detail, but sort of been passing because that is how something like that would come up. And I liked that charge and Dana is like, well, I didn't know that. And he's like, why would you? That felt very real to me. And I wonder, I mean, I think obviously, Robby growing up without a mother or without just, you know, like this very big parent figure definitely has a lot to do with how, how accountable he feels to others and also how like responsible he feels for the people that he's leading. I think that was, it made me emotional. Er, Erygen, it has a five millimeter mesh that vibrates over 120,000 times per second. Dr. Ahashimi. You okay? Dr. Ahashimi is an impressive position in general, but it's impressive how she knows these details about medical supplies like Erygen and she could spit out facts, but she has another one of these moments. These moments where she kind of zones out and freezes for a bit. Hunter, what's your take? I have a couple theories, but I'm going to know your take. We know that she was on the phone with a, like someone from Neuro. She called earlier in the shift. But this one I think is more like the most concerning because she sort of pauses and then like kind of rushed out of the room and we see Robbie watching her through glass and then her like kind of continuing on like down the hall. So I don't know what it could be. What a fascinating character because she has, she's very human. She has this side of what's happening, but on top of that, she is just an efficient machine. But this all adds into Robbie's stress about leaving because he sees this and he's like, oh my gosh, she talks to Mohan about it. He's like, dude, have you seen something like what is going on? So we have this moment between Whitaker and Ogilvy or Whitaker and Evil Whitaker where Ogilvy's patient dies, the patient with the AAA that he missed and he's in a state of like basically shock over having like sat in on the surgery. He has still blood all over his gown and Whitaker is, it honestly reminds me of like a very McKay moment where he's like, I understand why, you know, this job is really difficult, but it's really nice being there for someone on like the hardest day of their lives. And I think this is like a really, a really sweet character moment for both of them. I honestly have been waiting for Ogilvy to be humbled. I'm sorry that it came at the expense of this really nice English teacher, but this was a very sweet scene that really tugged at my heart strings. You know what I think? What? I think you should go home. I think you should sleep on it and I think you should at least wait till the morning to decide if you want to come back. I don't really want to go back in there and see anybody. Yeah. Okay, pull off your gown. I'll take it in. Shift is over. Go home. I think it's very satisfying to see Ogilvy, after all of this, finally he seems humbled and he really has like a lot of shame about how he has acted during the day, which I think is, is, you know, sad, but meaningful to see. All got to get humbled. All egotistical boys. It doesn't matter if you are a businessman, doctor, or an athlete, there's going to be that moment you're always going to remember. Ogilvy is going to remember this shift forever. And it's going to be a pivotal, important one. I have this conversation with new trainees all the time on the first shift or the first patient case where all of a sudden they realize that all that textbook medical knowledge doesn't always come through the way you think it's going to. Oh, look, there's a lot of tension in the trauma room. Whenever Orlando Diaz comes in, Dr. Mohan really kind of snaps back at Dr. Ellis and says, I'm helping the patient. Like, she completely dodges the question, like punts it on. And then whenever the chief of neuro comes down and asks for an assist, she looks to Javadi because she has known Javadi's mother for years and Javadi is a little bit apprehensive. Like, it's the end of my shift. I'm trying to go home. It's kind of an amazing opportunity. I'm exhausted. The chief of neurosurgery is here. She's kind of a legend. Maybe one of the night residents can do it. This is about the vulgulous case from earlier because if it is, you made a mistake and you need to move on. I do not want to come back here and find that you've applied for residency in Durham. Step up to the plate. Do it. Javadi will assist. Excellent. It was tension balanced by Dr. Robbie looking up and having reverence for this chief of the division of neurosurgery who's, quote, working on a weekend. She's obviously, she's badass and she's super cool with it and so helpful. And Dr. Mohan, Samira rejects the procedure first. She's like, I don't want to do it. And then Javadi started and like honestly, like fourth year of medical school, those rotations are painful memories because you're kind of a non-addition. You're the first one to show up. You're the last one to leave traditionally speaking and you want to impress everyone while also learning while potentially getting letters of recommendation while trying to figure out what you're going to apply to that dictates the next 20, 30, 40 years of your life. You can tell I have repressed memories of this. And so I understand where Javadi's coming from. She's like, I want to go home and exhausted. But dang, I should probably stick around and do this. She earns Dr. Robbie's approval at the end of the two thumbs up. And you know, it's there, there's a lot happening. There's also Dr. Robbie ignoring what Samira, Dr. Mohan is clearly going through as she tried so hard to protect Orlando, keep him from leaving, getting him resources. And she probably sees this as her as a failure, even though she did everything she could. Yeah, no. I mean, completely, you can see the guilt on her face, especially when his wife shows and she's like, we did everything we could. I try to get him to say I tried to send him home with everything that, you know, he needed to take care of himself and still like against medical advice, he left. There's nothing I could do. And we know we saw there's nothing that she could have done to keep him there. That part is so sad when she walks into and she's like, I have a chicken burger chicken sandwich for him. And it's just lettuce. And they're going to try to explain, hey, it might be a long time before we see how he's doing. They're pretty quick. I mean, in general in the pit, they're pretty quick with giving out discharge dates and how long somebody's going to be in the hospital. There's a lot of I don't know in medicine or explaining to families what the next one to two days look like. And when Orlando's wife is like, hey, it's going to be better. Like it's going to be a few weeks before we know. And he's probably going to be, you know, needing some type of assistance for a year or it's like they're very prescriptive with how they tell him. And I think there is an importance in doing that and being realistic. I was just caught off by how fast they are with those specific numbers. Does he take any other medications? Jesse Albuterol, he used to be on Montelucan and Simacort. Why did you stop that? Because he lost his medicaid two months ago. So tight. Nothing's getting through. No, happy pen. On it. 0.3 milligrams. That may open as long as something that's coming up. All right, Grady, shot the thigh. Can we talk about Grady and what was the big thing that Dr. Langdon missed? Was it a pneumothorax he wanted to intubate? What was going on in that scene? Dr. Langdon really carried this one with him. So essentially you have a asthma exacerbation or an asthma case that has gone terribly poorly. And if you even backtrack a little bit on what presumably is happening with Grady, this guy's got asthma, his mother knows what to do. She says Simacort, which is a combination inhaler, isn't she what helps him, loses their medications because they've gotten kicked off of medicaid, which by the way is unfortunately a massive problem all over this country. We see it in the ER all the time and people can't afford their meds. And then this happens. And what you essentially have is the tiny tubes that bring air throughout your lungs are swelling. And when you start to open them up with bronchodilators or medications that can open up those tubes, they're also giving him epinephrine. They're doing whatever they can to get air in there. Because they're swelling, you could sometimes get air in, but it's hard to get air out. So you could get this dynamic hyperinflation. And I'm presumably that is what happened to his lung. And so anytime that we are treating these asthmatics and we're giving him all these medications and we're trying to open up their lungs, you're also doing a lot of listening. Sometimes you don't hear any air at all. And you're like, oh my gosh, where you'll hear people say like, oh my gosh, he sounds really tight. Because you don't hear any air. And then you slowly open up the lungs with medications and it sounds like whistling and wheezing. And so if you put too much air in too fast, you can cause a little bit of trauma. And that's essentially what happened. So when they listened and said, hey, I don't hear any air, Langdon was like, okay, well, we, he's obviously working too hard. He's not able to move air anymore. And that's when Chen is like, or we blew a hole in his lung. And that's why the lung collapses. So essentially what happens is you have this little puncture in the lung and then air can fill up in between the space outside your lung and the chest wall. And then that can collapse your lung. And so you got to get rid of the air so the lung can reinflate. Like there's a whole, there's a process to it. But again, if you intubate someone and they already have a hyperinflation problem, that's an issue. Okay. Okay. So the lungs, the lungs are phenomenal in the way that they can close off lungs. Part of the lung can close off on its own to protect the rest of the lung. And they're really responsive to these external forces. And so getting rid of some of that air can allow for the chest wall to re-expand, which is why immediately when they did that, Grady is like, oh my gosh, I feel better. I can breathe again. Hunter, how are your cinematography skills? I feel like you are a one-stop shop for all things social media and traditional media. I don't know. My celebrity crush is a cinematographer though. Really? Roger Deakins. Yeah. Looking up. That's very documented. That is so cultured. I think the people who have not had the privilege of going to the pit set as we have, may not understand how cool and how truly 360 it is. And I don't know how you shoot a show like this without so much complicated blocking and choreography. And I'm so curious about that on this show. Likewise. I think even watching the very first episode, season one, going into this season, you almost feel like you're part of the pit and you're moving with the characters. And then if you take a step back, you're like, somebody has got to have a very slick camera set up. And so I've been reading about the cinematography of the pit, handheld cameras, 360 degrees, having it being shot like live theater. I've read a little bit about Joanna Cuello in her background in documentary filmmaking and how she brings that to the set. She called the ER quote a living organism and she wanted to shoot it that way. I have so many questions. I'm so excited that we get to talk to director of photography, Joanna Cuello. Let's do it. Two cameras. Tail zombie. Set. Set. And background. Action. Joanna, thank you so much for taking the time to chat with us. I hope everyone understands how important your role is on the show and bringing the drama and the action and all of it with your camera. It's phenomenal. Could you start out and just please tell us what exactly is a director of photography and what is your role on the show aside from everything, but what is your role in the show? Absolutely. So director of photography is the person that really brings to life in images. What's on the script. So working with the showrunner and directors, vision and putting in visuals completely. So that involves all the camera department and all the grip and lighting department. Can you tell us a little bit about shooting the pit and what makes this show different from other shows that you've worked on? Yes, shooting the pit is something that I've never really approached anything like that before. It really is a mix of different formats of different kind of genres and experiences in a way. There's the documentary approach to it that is very interesting that gives you this feeling that you're living something real. And there's obviously the narrative approach that really gives you this cinematic experience. And in addition to that, you have a little bit or so I feel of kind of mixing with documentary, a little bit of TV reality where there's a lot of things going on at the same times and you always need to be open to grab it and emphasize more on the story by these little moments that are not always expected. You know, on that note, Joanne, it almost feels the way the show is filmed. It almost feels like someone watching the show is in the room with them and kind of running around and following them. I know that sounds like common sense, but I wanted to ask you, what do you feel is the visual home base of the show? What is the kind of net perspective you're trying to achieve? Yes, when the first time I read the scripts, you know, it was so intense and it's continuous obviously. And there was really this feeling of immersion that was in the script. And I thought it was so important visually to give the same feeling. So the only way to do that was really to get the camera in the middle of everything and following, you know, the characters really close to them so we could experience the same shift as them as an audience. So that was all the elements that were very important. So it's a very immersive style. It's all handled. We're using different tools that, you know, give us the handled feelings but that help us to do specific camera moves that are not always easy to do just handled. It's really following them and seeing things as they happen in their own perspective. There's something about the pit that, you know, even though it's a single location, it takes place in one hospital. But it's an out of trauma rooms, an out of exam rooms. How do you keep the show looking interesting and not just, you know, so flatly single location? You know, there was a bit of the worry at the beginning to have so many episodes in the same space and with the same characters and you write it's like how do we keep it interesting? But the really core of the pit is, you know, they are getting into different situations and different stories in every single episode, even though it's all continuous. And the shots are really designed around the blocking. So every single blocking in every different scene is actually different. The way they move, the way, you know, they interact with each other, the emotion, you know, point of the scene, what perspective are we following. And so with all these elements that really help us actually to have a different feel to everything. It's in the same visual language and style, but, you know, it never feels like the same camera movement or the same blocking. It's always very different just because the situation is different. So I feel like you would be the most fun and informative person to watch this show with, to explain to people, you know, how all of it really comes to life. And so we're talking about episode 13 today and I was hoping we could watch a scene with you and you could walk us through, you know, how you captured it and give us your perspective. Can we do this? Absolutely. Let's do it. Stay perpendicular. Good. All right. Now four turns to get through the outer table. Yep. Then half turns till you penetrate the skull. Four. So cool. Sorry. Joanna Hunter and I visited set and, you know, ceiling floor four walls, like you really have to be in the mix. And so in this specific scene, could you tell us how exactly this was filmed? How were you able to capture everything that was happening while also preserving the clarity and the detail of the procedure? These scenes with prosthetic work and big surgery involved are always, you know, a little more complicated and tricky to do and to really make sure we get all the elements. This is actually a full body prosthetic. And so that's what allows us to really do these cuts, you know, while we're shooting and not having anything really hidden in a way. I think you mostly see one camera on this shot, but there's a second one because there's two monitors. You could see the second one. And it's really trying to find the, especially for these moments that are involving cuts, there's a special effects in there that I think on that behind the scene was not working, but it was supposed to blow a little bit on the head and then we managed to get it work later. But finding the right angles that that's it. The moment it's cut, then we can do that cut anymore on the prosthetic. We have to find two angles that works for that work at the same time that allows you to see well and are visually interesting for this moment. That's why you can hear or so do you mind moving a bit the phone? It's covering a bit right there on this camera. We want to make sure it's clear on both cameras. So it's really a collaboration with the prosthetic and makeup team to make sure how does all of this work? How many texts can we do? And here in that case, when it's a cut, it's cut so we can really switch the head, you know, it's only one. And so we know that when we do that cut, that's the moment and it has to happen. There's a bit of special effects involved. So we have to get to hide the special effects people in between everyone around the table and the two camera operators and some special effects hiding under as well. So it's really, you know, making sure everyone has this space to do their job and to be in the right position and really working together that we get the best angle possible. And the best special effects and, you know, the best parts of the prosthetic. That's very actually different from another scene. If you take a scene that, you know, that's happening in the central of the of the ER and everyone is walking with background distance goes from beginning to the end without any interruption. And so that's very specific choreography, you know, with everyone and the cameras moving and we don't stop in the middle here for prosthetic work and intense surgery will stop in the middle because it's so much. Here we go from the injection. Let's let's overlap you picking it up and bringing it in. There we are. We are set and background action. Now this shot again was showing a lot about the cuts here, you know, and making sure we got it correctly. But sometimes we do shot in the surgery room, of course, that is more coverage. So then in that case, you know, we'll be more on the facing, the faces getting the dialogue and all that. And hopefully sometime we'll be able to connect from the dialogue to the cuts or the prosthetic work at the same time. So then it feels real and it feels like it doesn't stop. Right. So it's all like figuring out really the possibilities of the prosthetic, the placement of everyone and making sure they have medical resources to make sure they all dialed in so we can actually capture everything at the same time when possible. Wow, that is so much of one shot incredible. I have two follow ups. First, how long does the scene like this typically take and second, does like the, I don't know, like scope of the procedure impact that like if it's this is like quite a small incision but what if it's you know like you're opening someone up or like digging into someone's chest. Yes, so I think this scene, I know there was multiple scenes with Orlando and we can always we're showing in order most of the time. So, you know, we don't really block shoot. So, you know, I think there were little scenes spread out through the episode and I would say, you know, a scene like that probably takes two hours. I would say because of the prosthetic work, you know, it has to work specifically in a specific way. If it's not as complicated in a surgery room, sometimes it might be shorter if there's less pages on the script as well. And then, you know, when there's work that is fully open a chest, for example, like a bigger cut, like you said, of course it's a prosthetic but sometimes we actually have an actor as well. So, you have the actor sitting down on the gurney. So, his body would be, they would make a special gurney where the actor actually sits down and then the rest of the body is on him, right, on her. So, that's the head is real, the chest, you know, is all prosthetic and and then, you know, when they open it up, then it's a lot of special effects as well because then you see the heart moving. You see the lungs breathing and all this. So, there's a lot of elements that have to work at the same time. And again, it's all about space because we want to be in there right off the shoulders, you know, really in the middle of the action. It's really hard to make sure everyone has their space and we are as close as we can with the cameras. So, there's a huge work that's happening with the camera operators and the actors around the table. So, sometimes they have to army that more so the camera can get a little closer. And then sometimes there's cross sections, tools and stuff above the table and all that. So, they all talk to each other's how, you know, the scene is planned medically with all this action. So, the camera operators can even back up to let them do something and come back in, etc. So, even when we just around the table, that's a choreography as well. On that note about choreography, we've heard from multiple actors about, you know, the long shots you mentioned and everyone kind of is moving in these long sequences. How does the steady cam operator fit into that choreography? Making sure they're moving with the characters, they're capturing things while all having their own space. I think that's really the magic of the pits. It's such a specific dance that the camera operators are doing with the actors. It's a beautiful choreography between cameras, actors, background, you know, and any other elements that be in the scene. Our camera operator that's doing all the long shots is indeed a steady cam operator, though we don't use steady cam on the show. We use another tool that's called the ZG rig. And the ZG rig is what allows us to have it still feel handled without being too smooth like a steady cam. So, you always feel like it's handled all the time. So, that tool basically, it's a steady cam vest with a steady cam arm, but it's another tool you put on it called the ZG that gives you the same control as steady cam, except it looks handled. And that tool is absolutely key and so important to the show because when you think about it, we do like a lot of backwards move that go really fast when we're leading the actors, right? And then you have a gurney passing in front and then the camera goes lower to be a bit lower and go through the gurney to the actors. And when that happens, you know, you need to be able to get the camera down. And if you were handled, you know, you could like bend your knee, but if you have to go really, really lower, it would be too hard. So, that tool helps us changing the height during shots, really moving the camera backwards side without feeling the steps of the operator. And I think that's the key because handheld, you know, is such a great look for the show, but if you were feeling the steps of the operators because of the immersion, it would take you out. In a similar vein, I guess, how often do you practical constraints like, you know, medical equipment or how tight a hallway is or a turn dictate what we're seeing on screen and how you're creating these images? Well, you know, that's one of the things on the pitch. Everything is aimed for realism. So, nothing on our set really move except if it's on wheels. And the rule is that that would be the case in a real emergency room. And we wanted to keep that as a documentary field that the camera should not be able to go places that you could not go in a real world. And so in that way, we are worse on lift up our contours don't move and anything like that. So the only thing that moves that can wheel out our things on wheels. So when, you know, the set really looks like a real hospital. And so when the camera moves with background actors, you know, you have some electricians with light sometimes everyone moves together. Space gets really tight. And so, you know, when we have specific things to capture on the move like this, it's very important that the timing works. So we try to make sure blocking wise. Let's say, you know, there's a gunning by spy. We want to see that it arrives at the right time where the camera can leave the actor for a second, catch it in the background and then come back on the actor, etc. So it's and sometimes, you know, we get into spaces where the camera does have to go around the actor, but the hallway is too small. And because sometimes there's, you know, a cart on wheel part there. So we'll do like a Hollywood switch during the shot without anyone seeing it. So when the camera doesn't see the things wheels out because it's so that's okay. And then camera takes that spot and as the camera keeps rotating, the things come back in. So you never saw that things left for a second. So that's how we make space on set is by sometimes moving things around that can move around during the shot. So we can actually fit everyone in this choreography. There's like integrity in the filming. There's no cheating. It's super cool. There's always a bit of cheating, but nothing too obvious. Are there any characters who pose a unique challenge or you have to do something different when it comes to filming them? I think as a general thing, you know, all the actors are so good at really dancing and working with the cameras. They have such a great collaboration with the camera operators to really help each other in that way. Now in the style of filming, I feel like character wise, there's a bit of a play with Dr. Robby because he goes through so much emotions, you know, especially this season. I mean, I know last season as well, but he has a certain intensity to him. And so the scenes where I feel we have to like get closer with him, get more intense in the way we follow him or we lead him. So you can feel a little more the overwhelming feeling he's going through. So I think like in that sense, his character, you know, the anxiety that he can experience gets transmitted a little more on camera in certain shots for him in this choreography. Wow. This has been great, Joanna. Thank you so much. My pleasure. I don't want to say people take it for granted, but people might watch a finished product of a movie, a show and something as incredible as the pit. And because it's so expertly done, they don't really realize how many takes, how much time and thought it takes, experience to actually capture these scenes. The choreography, the lighting, like there's so many really fascinating moving parts. Yeah. And something I hadn't thought about just like from an actor perspective, how it is to, you know, move around the space when you really do have a camera very close to you. Joanna said that sometimes the cameras are almost like in the actor's way because they are trying to get a really tight shot. And I hadn't considered that as like how that changes how you perform a scene or the blocking of the room itself since the pit is a 360 set. There's so many, so many details, so many details. Now that we've gotten all the details inside the pit, I think it's time we go outside the pit and hear from Dr. Jacob Lentz, who is a medical consultant on the show and also an ER doctor at UCLA. Dr. Jacob Lentz, I'm excited to talk to you, honor that you decided to join us. You know, you're in actual attending in the Emergency Medicine Department at UCLA. I have to ask you a question about coaching and teaching actors. Aside from the medical information, the textbooks, the procedural skills, what type of habits, instincts or mental framework are you teaching them so they can truly dive into the role of being an ER doctor? Oh, that's such a good question. Yeah. So when we did, when we do boot camp each season for the new actors, which started in season one, there's like a whole separate section about how doctors think. And I think that kind of begins that teaching of trying to like create a similar acronym of those of those of the mental habits and the kind of like mental modeling that doctors do. One of the people who like the person who's probably most engaged with that and really gets that is Noah. Because he'll ask whenever he is in a scene, he'll say like, what would what am I doing here? And I'm like, oh, that's really good. Like, he's like, where am I looking at? I'm like, just all you're looking at is the monitor, you know, like that you're just you're just obsessing over that pulse ox or like you're obsessing over that blood pressure. Part of what we do is tell the actors who are playing the doctors in a given scene, what they're looking at and the little movements of like the little things that doctors do, like making sure the drip is actually running, checking the IV to make sure that it flushes or those little slightly OCD habits. I think Noah's really good about understanding that and asking those questions. I was just going to say those details, those details make a difference. There's memes of Dr. Robbie and how he how he washes his hands and people make jokes about it. But I'm like, that's actually accurate. That is 100% how we wash our hands and how often we do. Yeah, it's so true. I don't I don't love the gel. Like, I just don't like how it feels. So but I wash my hands obsessively and I wash my hands. I mean, when I'm at work, I wash my hands like 150 times, like just constantly washing hands and because you want to also right. Like, that was kind of gross. You just want to wash your hands so much. And yeah, I probably I'm racking up quite a water bill that UCLA but yeah, I just like it's true. Like, I think you can't function if you are too much of a germaphobe. Like if you think about it too much, you'll start to spiral. But your hand hygiene becomes very, very, very important to you. I have more of a technical question. How do you approach teaching actors, how to, you know, make an incision or how to hold a scalper or something like that, like really technical procedures? I think the best way to approach something is to make it, you know, I think Albert Einstein said like, think whatever science should be as made as simple as possible, but no simpler. But like, I think you try to break it down to like, what's the goal? Why are you doing this? And like what what is the medical reason for what you're doing? And then walk them through it by steps, using my own personnel bias like it just how I do it, you know, and say like, as a medical student, you learn like how surgeons hold pickups and how they hold scissors and I'm like, okay, so you have to hold it this way. Otherwise, we're going to get a lot of trouble. But there's also some variance with other things. Everything is just sets and reps and just doing it enough times. And so like, do a lot of rehearsals. We do a lot of, and the actors are really good about showing up and really paying attention and committing to those. So, you know, a lot of rehearsals, and a lot of just kind of step by step and answering questions as you go. It's, it's, there's no secret formula. It's just sets and reps. Dr. Lentz, you know, we're talking about procedures, performance and reps. There are so many, scientifically speaking, cool procedures in this season, different types of suturing that highlar flip in the first episode. Are there any procedures that stuck with you procedures you oversaw or taught that you're like, ah, we nailed it? I think the one that I was most intrigued by and really thought like that's pretty cool is we did a slash trick on a kid and and that's kind of a, I don't know if it's new, but it's kind of the new guidance about how to approach a pediatric difficult airway. And then like this whole slash trick thing was frankly pretty new to me. So I was really intrigued by it. I did a lot of reading about it and SEPI did a great job with it. I was very happy with how it turned out. And I felt like the core message of what that is, which is that it's a life-saving procedure. It's going to be bloody. It's going to be messy. If you actually do it, you're going to get a lot of pushback and a lot of, a lot of judgment. But that none of that matters because it's a life-saving procedure and all those, all the mess can be cleaned up later. I'm so glad you said this last trick. I remember watching videos when we were filming the episode from ASIP, the American College emergency positions for everyone aside from Dr. Luntz and these ENT videos and people kind of going through that different, different techniques. And I have a colleague who is an ENT surgeon saw the scene and all he said back was nice. That's great. Awesome. Yeah. That's great. That makes me happy. You know, it's interesting. I do think that those, like you get a lot, you're going to get a lot of judgment, but I think actually like the otolaryngologists are actually probably going to be the ones who are most cool with you. Because they know, they know the anatomy so well. So they'll just be like, the ones I talk to are always like, yeah, everything in the middle we can fix. Like just if you stay in the middle, it'll be okay. We can fix it and, you know, the person's alive. And, but I think you'd still get a lot of, I think, flak from other people, I guess. It's so cool to hear both of you talk about this because this is kind of what plays out when Dr. Garcia comes in, right? And she's like, we're going to have to clean up your mess upstairs. And did you take a meat cleaver to him? And it's like, that is the core experience of, I think, every ER doctor. One of our core experiences is people who weren't there and didn't see it and didn't have to make a decision. Like the retrospective scope is very powerful. And then they come in and they're like, what were you thinking here? Like, what was that about? And it's like, well, this was the best option in the situation. But anyway, I'm glad you drove your sports car here and you brought a bag of judgment. Dr. Lenz, I'll ask you this question and I'll be vulnerable for a moment. This show is so accurate in terms of the workflow and the personalities and the kind of level of perfection, if you will, that certain people like Dr. Robbie are trying to achieve with, with bedside communication. Sometimes I watch a show and I like evaluate my own medical skills. My own interpersonal skills, the hospital. Based on the work you do for the show, have you changed anything about your workflow or how you approach patients? That's such a good question. Yes, probably like you, I've sort of used the show to critique my own performance and my own behavior at work. And I think it's probably, I think one thing that, you know, the character of Dr. Robbie does really well is figures out creative solutions. To like difficult issues. You and I both know so well, like so much of medicine now is like figure out non-medical things like the financial stuff, the social stuff, like how people are going to get home, like how are they going to get up the stairs? I mean, you can spend hours figuring out how you're going to get someone back into their apartment. If you can't do that, then what? And so like, I think, and I think Robbie on the show is very engaged with those like creative solutions to that. So I think it's made me start thinking more and more in a bigger way. Just try to be as creative and engage as possible sorting through those like next steps for someone. I am curious though, in your work on the pit, do you feel like it's changed how you relate to residents or how you're teaching? I think so. So I think I really like working with residents. And further you go out from residency, I think the less current your experiences with residency. So I think for me, the pits been a good reminder that the current crop of residents and interns have issues and challenges that are maybe different than what I remember. I'm not that far out of residency, but it's been a good reminder. I'm like, no, I should like really pay attention to like what's going on with them. Because I think when I started as an attending, I was just like, yeah, I was doing that last week. Like I know what you guys are dealing with. I get it. But things change and some things are better and some things are worse. And so it's been a good reminder that I have to listen and try to find out where they're at. And also it's a good reminder of how exhausted residency is. It's really hard. And I think it's hard for everybody, except for a lot who just cruise through it. But the rest of us, the rest of us struggled. And I know that. Hard play, hard. Yeah. I know that. But then it's a good reminder that to really like give people, you know, like a little bit of space as able. And because like the show does a really good job of communicating how, how tiring and stressful it is. What a thoughtful answer. Thank you. Oh, wait, 100%. I think conveys everything doctors go through that is kind of independent of the medical procedures and treatments. I think the show does a really artful job of portraying the whole spectrum of frustration we deal with on a daily basis as health professionals. So I thank you, Dr. Lentz. I thank you and the entire team for bringing that reality to camera. I take very little credit for it. But yeah, they, the show's done a great job with it. Can you kind of tell us what a typical day is like for you on set just so that people who think that they could do what you do kind of get a clearer sense of how much work you're putting in? Sure. Yeah, yeah, yeah, yeah. So for each episode, we split up the episodes among the different consultants. So last season I did four episodes. So I did two, six, 10 and 14. When you get the script for one of your episodes, you have to go through the whole script. So the script's about 70 pages ish. And then you have to go through each scene and write out for every single scene like what are the props? What's the makeup? What's the wardrobe? Who else is in the room? What's on any video screen, whether it's a monitor or a computer? What kind of, if there's any special effects, like all these things are very distinct, right? Like if there's blood on clothes, that's makeup or that's sorry, that's wardrobe. If there's blood on a piece of equipment, that's props. If there's blood squirting, that's, that's special effects. And then you have to describe like what the ultrasound is. So you say like there's blood in Morrison's pouch and then you have to like, you know, that's going to, most people don't know what that means. So then you have to describe, you have to then create an addendum to those notes. The medical notes end up being usually 25, 26 pages. And then there's addendums where you like further delineate what things are. And so like you'll put it for like scene, scene 12, like, like even discharge paperwork, you're like, have to have a discharge paperwork for this patient. Please see addendum B. And then you have in addendum B, you write out what the discharge paperwork is. For everything that's on a computer, you have to write out like if they're writing a progress note, because it might be seen, you have to write out what the progress note is. And then once you get those notes done, you have to go then to meetings. There's meetings during the prep time. And then also just separately you meet with props and wardrobe and, oh boy, make up and the art department and everyone and you sit with them and they'll say like, is this what you want? You wrote this word. I looked it up. This is what I got. This is what I found for 14 French pigtails. That's what you meant, you know, and then, like sometimes you'll be like, oh yeah, that's fine. Or like, is this scalpel okay? You have to work with them to figure out how's that going to work, right? Like we're putting a needle into that person's arm, but obviously we're not putting a needle into that person's arm. Like how are we going to achieve that? Or like, you know, obviously you're not cutting into a child's trachea. What's the plan, right? And there's like, that's like a many people involved in figuring that these questions are, they're not easy. There are a lot of people that have to be involved in every scene that has medical things going on. So you have to break it down and you have to break down what each character is doing at every point in that scene. So like that slash trachea scene was like five pages, maybe six. From the time they come off that elevator from the helicopter to the time that Dr. Alhashimi walks out triumphantly, you have to break down what every single character is doing that whole time. And you have to draw it out. And so like you have to first write out what they're doing and kind of sketch things on the script. And then you then draw it out for the actors. And you have to say like, this is what you're doing right here. And you have to make sure it all matches up so that if, you know, a nurse is handing a blood vial to another nurse, you have to make sure that they're both at the right spots at the right time. But you also need them moving because you don't, you want movement because people just standing around. Like we actually do. Like if you have Robbie like handing someone ultrasound gel, like you have to make sure that person is ready to get the ultrasound gel because you don't want him just standing there holding it in the air. So you have to plan that all and like something like the slash trachea, like you're going to get one. Ultimately, you know, we did multiple takes, but you're going to get one take with cutting, right? Cause that's like, that's been built. That's rigged up. It's ready to bleed. It's a prosthetic neck, but like you're not going to get to reset that cause there's a bunch of blood. So like you have to rehearse and prep for all that. So it's a, you know, they're long days. Like you're really tired by the end of it. Okay. We need to send this to everyone who emails you telling you that they should have your job because there's a lot more that goes into it than you think. This is the level of detail that makes the show great. I'm super grateful to be part of it and stuff, but yeah, it's not answering questions on email or while you're on the beach and like you're 45 minutes of free time. Yeah, exactly. Exactly. Exactly. Now, Dr. Lenz, appreciate you. You're a true artist. I appreciate everything you do for the world, for patients and for the show. Thank you for chatting with us. All right. Hunter Alok. Thank you both very much. It's been a pleasure. Thank you. Andra, I'm sure you could tell that Dr. Lenz and I wanted to go on tangents and rant, and this probably could have turned into a five hour interview. You know, aside from asking him about the mentality the actors needed to adopt and the amount of work it takes that other medical colleagues don't really realize when people say like, hey, Dr. Lenz, I want your job to kind of how this has affected his approach towards patients and residents. All of it like really spoke to me, but I'm curious as a non-medical professional, what stood out to you? What insight did you get from this interview? How highly specific it is to both teach someone and train them how to perform all of these complicated medical tasks, but also like the extensive note taking and how, you know, extensively he annotates every single script. That was pretty cool to hear about and something that I hadn't really considered before and like 20 pages of notes on top of, you know, a 70 page script. I cannot imagine how organized he has to be to think about like actual real hospital stuff and then additionally like all of the pit consultation work. That's it for today's episode of the Pit podcast. We'll be here every Thursday right after the new episode drops. And I know there's only a few episodes left, but we're all basically ordinary pit residents at this point. So I want to hear your thoughts, your comments, all of it. Maybe we'll bring them up in a future episode. Watch us right here on HBO 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 Ebora 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 Bizarreian. Special thanks to Joe Carlino. The executive producer of HBO podcast is Michael Gluckstad. 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.