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

Up next is Red Flair and his new band. Oh my god, I'm back again. On that vacation, oh everybody's been Gonna bring new games, gonna show you now. New game party, find new... Dropping hits every week, find the new slots. On that vacation tonight. 18 plus be gamblerware total. That's right! PtMC, go ahead, medic command. Where are all the nurses? There was a code whoop in central 14. Oh no. What's that? Hospital worker assault. Who? The new nurse, Emma. Is she okay? I don't know, I think so. Smoke him if you got him. This place is going tits up. Welcome to the pit podcast, the one and only official companion to the pit right here on HBO Max. I'm Dr. Luke Patel. And I'm Hunter Harris. It's six o'clock in the pit this week or an episode 12. We will be joined by Brannam Ness Homer, who plays nurse Donahue, and Leticia Holler, who plays nurse Emma. I'm super shy. I don't... Everybody I worked with on season one didn't find out till season two I went to Juilliard because of Leticia. They were like, oh, really? You guys same time? But I also... I'm like, no, I'm old. I'm so old. Today's shift starts now. At the end of last week, cut to black, nurse Emma is in a headlock. Now we see the golfer kind of cokehead who... Medical term, cokehead. Cokehead. And then he got very aggressive. Somehow we don't know what happened. Nurse Dana came into the room to the rescue. It was a cold hula hoop and the man ends up with a bloody nose. Dana had given him Versed. Versed. Versed. A tranquilizer of some or sedative of some sort. It's a benzo, benzo diastropane. Call it a sedative. Totally. And then now Robbie is like, where did you get that? You can't prescribe that. And Dana's like, it was in my pocket. And what am I supposed to do? Just let this man choke nurse Emma. It's her first day. You just haven't had a while of her sedative in your pocket. It was extra from the medics. A good time then I guess. Are we wasting controlled substance? We need a witness to sign off. I was on my way too when I spotted that asshole attacking our girl. Anything else Nancy Drew? Where are you going? Taking a pee. Do I need your permission to do that too now? This is a terrible situation and I feel this predicament where George is like, what do you want me to do? And people are running in there. This is presumably a situation where you hopefully had security jumping on this person too. But then on the flip side, looking at where Dr. Robbie's coming from, what if this individual couldn't get, Versed, for whatever reason? What if it caused a medical complication? How is this going to hold up in court? If you actually look up when someone can defend themselves in a hospital setting, it's like, yeah, if you have to defend yourself for your own safety, cool. But everything gets different if a patient is incapacitated or they have confirmed. Or if they are agitated beyond their control or if you do something and less or force could have been used. I mean, it's all these little shades of gray. But Charger Stana makes a good point where she's like, anyone else steps up, they're considered a hero, but nurses, health professionals have to defend themselves. And it really sets off a series of little confrontations between Charger Stana and Dr. Robbie. First, he says, okay, why did you have that on you? What were you thinking? She calls him Nancy Drew, which is so good, by the way, which I know you love. Yes. And then later she kind of corners him again and she's like, what is going on with you? You've been kind of on one all day. And then they talk again outside. And this is the part that I'm very stuck on. Robbie telling Nurse Stana, how did you get, what is it called again? The Versed. Yeah. How'd you get Versed? You could get your license taken away, blah, blah, blah. I'm like, okay, so where was that energy when Dr. Langdon was stealing pills from the ED? I just want to go back to one thing about the assault and the Versed. So I've been in this situation, nurses are so badass. They should not have to put up with this. But in real scenarios where a nurse gets assaulted one-on-one, you have a gang rushing in there. The nurses will basically, whatever they need to do, four-on-one, five-on-one, a big aggressive patient, you'll have anyone who's on the floor, Russian doctors, respiratory therapists, everyone. And usually amidst holding somebody down is when they're calling out, we need something. We need a medication. I've never had a nurse give something. And then later on, be like, oh, whoops, I gave a medication just because I had it in my pocket. Yeah. Sometimes we have as needed medications on the patients chart. So we call it PRN. If I wrote Versed PRN, that means that if this patient is agitated, you can give a dose of this medication. Okay. You don't need to ask my permission because I already ordered it. Okay. But usually, I've seen nurses hold patients down and scream, I need something right now. Oh, wow. And they have something called a PIXIS, like an emergency, basically a place on hospital floors where you can go and get medications out. And so if I give a verbal order or I put it in the computer, they can run and get a medication and it's into that patient in minutes. Just had to do this last week. Oh, wow. So it's fresh in my memory. Yeah. Well, I mean, I don't know. I guess it is like, it makes me uneasy that like, nurse Dana was alone with Emma and that man and Emma didn't see anything. The man said he didn't remember even choking her, but remember getting punched. I said, hmm, hmm. Hmm. Hmm. That's right. I was like, you're making that up too. Interesting. Trying to get out of trouble right now. Interesting. And he said, oh, you're going to ruin my life. I was like, all right, dude. I do want to take a moment and sort of compare and contrast what we're seeing between Robbie and Charger Dana and Robbie and Dr. Ohashimi because kind of a reveal that I hadn't really considered before is that Dr. Ohashimi does not know about Langdon's history. She just knows that he came back from rehab and it's his first day back and that Santos is like really kind of raw, like energy wise with him. And Robbie says, okay, yes, he had a Benzo addiction. He was stealing drugs from the ED. And just the look of like incredulousness on Dr. Ohashimi's face was like, oh, right. Something about the way that Dr. Robbie is defending Langdon, Dr. Ohashimi and the way that Charger Dana is like, you need to own up to your part in this. You have an issue with yourself, not with Langdon anymore. I know what you said last week that Dr. Robbie has to really take some accountability himself about what went down with Langdon. Charger Dana calls him out. Yeah. The thing that's fascinating too is that Dr. Ohashimi completely changes how she treats him after she finds out. Yeah, no, true. But again, I mean, you know, it's ironic then it's very do as I say, not as I do, that this is an episode where Robbie tells Santos, okay, like, you know, you need to work out yourself with Langdon. He's here to stay whatever. I want you to like go to therapy or like see the trauma counselor while I'm gone. I'm like, oh my goodness. So you should actually take that call coming from inside the house, bringing off the hook in fact. This department is clearly too much for one person to handle. It's not healthy for you or the patients. And I'm very concerned by what I've witnessed today with some of the staff. What is going on with Langdon and Santos? I saw them having it out like it was fight night. Dr. Langdon hasn't even been here for 10 months and you told me this morning that there was nothing to worry about with you and Santos. There isn't. Santos and Langdon have beef because she's the one who turned in the room for taking meds. I'm sorry. What? Santos is responsible for revealing Langdon's benzobidish. Was he stealing drugs from this ED? This ED is the best of the best. And I would put it up against any emergency department in the country and it is going to be yours to fuck up. So don't fuck it up. Any emergency department and challenge me on this viewers and listeners. Any emergency department that's this busy is going to have more than one attending on staff. But she's like, we need two and he's like, whoa, we got a good thing going. I was like, no, no, no, no, dude, you're going to have two, you're going to have three. It goes back to Dana being like, you're acting like a martyr. You are making your life intentionally so difficult. You're suffering when you don't really have to just because he is very controlling and wants eyes on everything. But it's like to whose detriment the patients and the staff. There are multiple moments in this episode that hint at Dr. Robbie's like breaking point or walking to the edge. Yeah. Like McCain makes that comment. I've had many people kind of flirt with this line and Duke makes references to it as well. Charger Dana makes references to it. Like we're the darkness is coming and Dr. Robbie. I wonder who can like get clarity, make him see clearly that like this is off for you. Maybe it's going to be Abbott. I think it could also be Djavadi. I think she kind of has a way in with him that I like, but we'll see. Or it's Duke because he didn't give a shit. I had Duke said I'm tired. I've been here all day. Take me home. And so many of us say it and I won't move out. Okay. I'm not going to be doing much of Robbie's going to be taken in his mail and rewatering his plants. Say what? Admit that you like having me as your roommate. You are such a fuckelberry. Have fun with Robbie's plants. I'm so happy that Whitaker stood on his ground on this one. Why am I not surprised that Sandis wouldn't just say she enjoys having around even like loses it calls him fuckelberry. That's not nice. Well, I mean, of course, look, look at how the day has gone for her. She tried to, you know, talk to Dr. Arsia, tell her how she feels and she was rejected low key twice. So I understand her being a little bit more cautious, but they have a funny like, you know, brother, sister dynamic that I think is fun. I got a couple of bad ones. How old is he? 84. Metclyzine for vertigo. Anticholinergic effects can cause drowsiness. It's pure and so maybe he doesn't take it all the time. He's also been prescribed metocarbomol, another anticholinergic. Could definitely impair driving. And metoclopramide for stomach. That could cause gait problems. Exactly. Thank you. There is a pharmacist in the emergency department making an appearance. Dr. Megan Nort. I looked at her badge. I'm just so happy because pharmacists are so incredibly important in hospitals. This is just one of the many times we rely on them to look through a patient's medication list, are there interactions, are there side effects, you know, help with dosing, like whatever it may be. And even if they're not in the person, like this fabulous pharmacist was, they are available on the phone. And she immediately says like, Hey, metclyzine, metacarbomol, metaclopramide, these are medications that may cause confusion, issues with drowsiness, basically things that would put this person at risk of falling or not being able to drive a car. Clutch. It's almost like they responded to our viewer questions who were like, Hey, where are the pharmacists? And I was like, I'm with you. A viewer question. That was your question. And viewers. Like, you know, I'm, listen, I brought it out. I definitely brought it up, but we've had viewers also chime in and be like, what up? Pharmacists, where are you at? Okay. Interesting. I, this was one of my favorite cases. I think this whole season, I felt very personally like, I just became very emotional watching these two elderly people trying to like stay independent, but like the daughter saying they can't like half of their house is inaccessible to them was so, so sad. And then they're like stubbornness and resistance to having any type of help. But I want to focus specifically on a moment where Dr. Mohan and Dr. King present this case, Dr. Robbie, that like, okay, we have some opportunities for them. We have some options for them. And then Dr. Robbie almost as a slight says Dr. Mohan. Hey, Dr. Mohan, I heard a rumor that you were looking for an elective. Have you considered geriatrics as much of an artist as science? There's usually an opening and you seem to have a disposition to the pace. It's like, oh my goodness. Dr. Robbie is really putting Dr. Mohan through it, this shift. And it's like making me a bit mad. And it was, it was almost like a not to slow mo from last season. 100% was. I think it was very shady. Dr. Robbie came across a little too fast on it. Again, this is a shift when he's been talking about her anxiety and can you handle the walls in here? And she says maybe this place isn't for me. So maybe he's trying to steer her in a different direction from a nurturing standpoint, but it's coming across as harsh. Yeah, because she does have this like TLC with the elderly. She like, she really takes the gentleman's shoes off and she's like, let's do an examination and she's patient with them. Great little medical pro too is when she mentions the Romberg test. Again, like this is a big assessment. Like, can these two actually live safely? And the Romberg test, you're essentially going to have someone stand up barefoot feet together and can they balance with your eyes open? You have this extra sensation of your body being on the center because you can look around when you close your eyes, it becomes harder for people. And so if you close your eyes and all of a sudden you lose your balance, that's telling people like, Hey, this person might have some type of nervous system issue that's causing them to lose balance. Oh, wow. If anybody listening wants to try it out the next time, if you do become inebriated, close your eyes and stand up and see how well you can balance. Interesting. OK. Yeah. So all these tests are important to see if somebody needs assisted living, if they need a caretaker. So we can go home. That can't take care of Momo by yourself. We'll manage. You guys, you need to be realistic. I don't want strangers hanging around in the house. It's not strangers. It's helpers. No, no, no, thanks. Doctors, please. And like the conversation that this couple has with their daughter is a very realistic one as we have an aging population. Oh, my goodness, like the stubbornness with some otherly people not wanting to receive care, especially I think in Black families, as my family is, like a sort of systemic distrust of systems, of medicine, even, that it makes it a lot more emotional to try to talk someone out of wanting to live alone. I need you to talk me through this case with Oliver, who drove his dad what an hour, like to find him in emergency room because he missed a dialysis treatment. What was going on there? So like there's the medical side and then there's the larger statement about rural health care. So medical side shows up. The guy is having breathing difficulty and he's coughing up that. I immediately saw it and I was like, oh, pink sputum, which tells us that there's fluid backed up in his lungs that's mixed with the fluid in your little air sac. So it has that like bubbly pink look to it. And that is telling you restorative stress. We have an issue. Think about this. So he mentions this guy missed a dialysis treatment. Then Whitaker very astutely notices, he says there is a left arm dialysis shunt. So what some people will have is they'll have a shunt on an arm, usually a non-dominant arm, where surgeons can basically connect in artery and vein and create very easy access for dialysis. Okay. So it's a reliable place to get that dialysis going. Sun says we missed dialysis treatment. You now have him coughing up liquid from his lungs. This is called flash pulmonary edema until proven otherwise. Meaning if you can't get rid of fluid from your kidneys, it's got to go somewhere. You get a fluid backup. We worry that it's going to wind up in your lungs. So he's got a bunch of fluid in his lungs, which is why they're now trying to get fluid off of his body. They make that joke about medieval bloodletting where they're basically pulling fluid off of him. They're giving him respiratory support, that high pressure, that bipap to kind of push some of that fluid out while they're essentially looking at the fact that this guy has kidney failure. So your kidneys are not only pulling fluid out of your body, but they're also making sure that your body has good ion balance. So his potassium level is really high. So then you have this other conversation about dropping down his potassium levels. You can do that with insulin and glucose, which will shift potassium into your cells, albuterol, which is a medication used for asthma, dilators, bronchodilators, that will also push potassium into your cell. And all this conversation is happening in the span of minutes. Like this is a great kind of case report that's happening in the pit in real time. I can I pause for a second. I'm stuck on pink spewed sputum. Frothy pink sputum. I wish I could be in your brain. That's so crazy. I wish you could be in your brain and have these like one liner is that just, you know, fly up the handle. Incredible full pink sputum. OK, so, but then there's the other issue, which is that there wasn't a hospital closer to them, that there are hospitals that are shut down and not just because of the code black. I was just like, I'm knotting my head and with disappointment at this part. So the reality is, is hundreds of rural hospitals across the country are at risk of closing. A lot of rural hospitals are operating at a negative margin. And then when you have cuts to government programs like Medicare and Medicaid, they squeeze rural hospitals even more. So you start losing necessary services for patients who live out there. And we've already seen rural hospitals close. We've seen emergency departments close. We've seen primary care close, and we've seen birthing centers close. So you have this growing amount of a rural health care gap. You also have way too many counties in this country that don't have a birthing center. There's no maternity care. So this was almost a very scary symptom of a massive problem that's happening, which they pick up on immediately when they say, like, Medicaid cuts are doing this right now. So unfortunately, there are going to be more situations like Oliver's dad, unless something changes in this country. So this show is just touching on all these massive issues with health care policy and the economics in a country that spends more per capita on health care than any developed nation without better outcomes. Well, we're talking about costs. I mean, we have to talk about what this episode ends, which is who comes back into the E.D. but Orlando Diaz, who left earlier. Dr. Mohan said, please don't leave. I'll get you everything you need. I mean, is that not the same symptom where Orlando Diaz was afraid of the medical costs and so he left and now look what's happened. Yes. Now he's found his way back in. He's found his way back in. And it's awful. The fact that he was even thinking it's insulin versus, I think he said, clothes and food and stuff like that. And people having to make these decisions and you've got this selfless father who's like, no, I'm going to take care of my family before I take care of myself. I'm going to put their oxygen mask on first before I pull my own oxygen mask down, which is awful that this is the situation people are in. So much went down in the pit this week. I think we should go a little bit deeper inside the pit and hear from some people who were boots on the ground, on the front lines, nurses who were really making the day happen. I love the cast of characters with the nurses on the show. You've got Nurse Donahue, who has these really great heartfelt moments and then really funny one liners. Yes. You know, he's been through some training. He's now got a new kid. He's all over the place. And you have Nurse Emma, who has like the craziest first day ever. So without further ado, let's talk to Nurse Emma and Nurse Donahue, AKA Leticia Hallard and Brandon Mendes Homer. Let's do it. Lucky, this was just a pope. Spare the muscle. See, it could have been worse. No shit, Sherman. The triangular bayonets they created back then were designed to leave wounds that are nearly impossible to stitch. Those bayonets have never met me. Leticia and Brandon, thank you so much for joining us. This is going to be great. Thank you for having us. I'm not used to saying Leticia and Brandon. I want to be like Nurse Emma, Nurse Donahue, like what's good, but no, it's awesome to have you here. You both add so much dimension and, you know, highs and lows to the season, to the show. Brandon, I want to start with you. Fun, fun parallel is like, yes, I will admit, I was stalking your Instagram, but I saw that you became a new father. Congratulations. Also Nurse Donahue became a new father in between seasons one and two. Like I'm not sure if this is just the most brilliant method acting ever, but can you tell us a little bit about how you becoming a new father informed your work and what you brought to set? Yeah, and your role. It's method acting. I didn't have to fake anything. It's all real. I'm actually tired. Um, you know, we shoot over the course of several months. So I just completed my, you know, my wife would say I didn't complete postpartum because she's very much still in it, but our daughter just turned one yesterday. Oh my God, congratulations. Awesome. Yeah. The whole, the show was marking the journey of a parenthood. So, uh, yeah, it's been, it's been an incredible journey to kind of marry that with Donnie because I think the character also is stepping into new territory and the uneven terrain of being a nurse practitioner and trying to show up more fully professionally as well as a father at home. So there's, I mean, we're trading notes all the time, you know, when I'm working on the character. So yeah, I was really honored by that, that the show decided to do that and that the writers have brought it into the character. So yeah, it's been exciting. It's so real. Leticia, you are new to this show this season. I want to know how does, how did your first day compare to nurse Emma's first day and what was it like joining this big ensemble? Oh, I took so much inspiration from Emma's first day from my first day doing medical boot camp. I got there, I was ready to see Kristen, Amy Lynn and Catherine and I thought that that was it. I wouldn't see anybody else. I got there. There was Noah on his little swivelly chair, chilling in the cool kids table. And there was Patrick and like the whole main cast and I was like, yeah, Kristen literally said to me, she's like, you look like a deer in headlights. And I was like, oh, this is probably what Emma feels like. So especially that first episode, I was like, we're going to really take from what it was to come to set for the first time in a big TV show. So cool. That is real life experience, meet your character. Now, I got a fun question. We talked to Lucas Iverson, Ogilvy. Yes. And, you know, he was telling us about his first kind of takes and how he was told you're not being enough of a jerk. And so some of those character notes, I'm curious what notes you both got when you were filming Nurse Emma and Nurse Donnie. Actually, yeah, I did get a note. It was for the sexual assault case. I think that Emma's a very caring person. So a lot of times when we first met our patient, I was like smiling and I was like really like feeling like me as Leticia. When I'm talking to someone, I'm like, oh, I'm like making all these types of faces and they're like, the same nurses. Like, don't do that. She's like, we can't make them feel any type of way because you just have to be as, you know, scientific and just help them. Don't don't make them feel bad or don't make them feel any type of way. Just give them help. So. Yeah, I got two notes. The first was in my final call back from John Wells. He told me my character changed drastically as they met me as a person. I think they started to write closer to who I am. But in my final call back, he was like, these newbies are always fucking shit up. So you're always like on top of them. And then my character became a little less aggressive and demanding as the story developed. And then in season two, looking at the scope of the nurse practitioner role, I had a lot of conversations with our MP and PA on set who kind of took me through my boot camp and she said, look, this is a practice that is important in the country, but it's different from being a doctor. And there's a lot of conversation around what that role is and what the scope of that work is while also respecting the scope of what it means to be a doctor and how those teams come together, especially when throughout the country, hospitals are on short supply and everybody is trying to achieve the same thing. So it was interesting to navigate that and try to sprinkle that into some of the scenes and relationships throughout the season. So that was fun. Very cool. There's depth to this. Yeah. OK, I have a question for both of you because, correct me, for both of you went to Juilliard. Is there like a sort of shorthand between two Juilliard actors or like just you come in and you immediately have like some kind of relationship or vocabulary together? How does that work? Yeah. Well, Brandon pretends he didn't go to Juilliard. I'll be upset and I'll be like, hey, you know, like we went to the same alma mater and he's like, like this in the corner, like as though he hadn't gone to the same school. And so I informed a lot of people on set that he went to Juilliard and he's the person like any time I'm having difficulty, he's the person I will talk to first and then Catherine second. They're my go tos and I tease Brandon all the time because there is that familiarity from from being from the same school. And yeah. Yeah. No, this is so true. There's a lot of kinship between us and like I'm super shy. I don't even everybody I worked with on season one didn't find out till season two. I went to Juilliard because of the TCR. They were like, oh, really? You guys same time. But I also feel like. What Juilliard does, it makes you really resourceful as an artist. You know, like I often use the analogy that like you're put on an island with a knife of artistry. You have to make fire food shelter through Shakespeare tragedy, check off and you create a lot out of nothing. No costumes, no said dressing. And so coming to the pit when I saw the TCR was coming on, I was like, oh, she's going to be able to carry any story here forward. And that's just always what I told her and the journey of what we were working on. I was like, look, you have everything that you need. So, you know, when we joke and everything we play a lot between takes, because I know that like when the cameras rolling, we both have that shorthand of like, oh, now it's time to drop in. Now it's time to deliver. So it was really nice, really fun to, you know, build that relationship on set. It was good. One of the things that Brandon would do as Donnie is him and Patrick, actually Patrick as Langdon, they would say, hey, Emily, how is it? How is it? They would change like my name every time and it would make me like genuinely like mad. I was like, I hope they don't see any of these takes of me being like, guys, don't say that to me. I feel like that. I feel like this constant, like, Leticia, you constantly roasting Brandon as part of the Juilliard vibe or the fact that you two have this kinship. It's hilarious. Yeah, that's great. I got a question though, Leticia. We're talking about episode 12. There's been many moments when Hunter and I have wanted to jump into the screen and fight somebody. We see a patient put Leticia into a headlock, dramatic. How did you prepare for that scene? What was that like? Yeah, I actually was part of my audition and I put a lot of care and thought into it. And I think it's really important that a show about a hospital shows that nurses do often like get assaulted by patients and hopefully it leads to a conversation about how we can help mitigate that. Most nurses I've talked to have had some sort of bad interaction if it's even verbal assault or know someone who has. Far too often. Yeah. Yeah. I want to ask about the relationship between Nurse Emma and Charged Nurse Dana because I love that they're paired together through most of the season where Nurse Emma is so excited and happy and Charged Nurse Dana, it gives her perspective shift that it's good for her to teach someone and be a mentor. How do you see the relationship and what is the dynamic like between you and Catherine? I think it's beautiful. I think it's really great writing that like I think Emma allows is like a mirror for Dana can see herself as a young nurse and you can kind of as an audience member through the journey of wait like Robbie at one point says that you're not that type of nurse anymore. How maybe Dana used to have a lot of care and go the extra mile and what makes it happen so that she stops doing that. And is that going to happen to Emma? Is Gen Z, do Gen Z have a better hold grasp of mental health that that's not going to happen to Emma? I think there's a lot of interesting conversations that you get when you put us right next to each other. Earlier in the season there's this great kind of like Bro Dad bonding moment with Nurse Dana Langdon and this father who brings his child in and I'm I want to ask you what it was like filming that scene and also how Nurse Dana feels about Langdon's return. Is there is there some momentary bonding about being fathers? Does is he also have tension? I don't know. What are your thoughts? Yeah, no, I first off it was great working with Patrick like we immediately dropped in. I mean my North Star was like kind of lethal weapon. I was like we kind of have like a Donny Glover, Mel Gibson, like thing going there. But yeah, when he working specifically in the storytelling of it, his return at the same time is the start of my journey with the nurse practitioner part. And I always say like at the end of the mass casualty, I think that Donny is experiencing a lot of shame actually about how much he can do for the team, right? Because he's surrounded by Whitaker who's new, surrounded by Santos who's new and these people are on fire for their job. And I think it's the story of many people that when you're working in an environment for a period of time, you somehow just kind of float underneath the radar and not give it your all. And I think in that nine months span after he left that, having had that experience, he comes back on fire to do more, to take on triage, to kind of lighten the load for his team members. And then here comes Patrick basically trying to be become a part of the team and heal and repair. So for us to both have that collision course, I think it is in fact the moment he shares that antidote about being a father that brings them together and he kind of gives them the green light of like, okay, I know we need you from a professional lens, but I didn't even know you had this emotional canvas to you. So that was really sort of exciting for me to kind of find that with Patrick and find that shorthand because we didn't have much season one at all. Wow, what a great answer. Both of you, this was so fascinating. Thank you for taking the time. No, thank you. Of course, this was so fun. Under a natural place, I feel, for people to fact-checked the pit or look for accuracy is in the actual medical procedures in the terminology and the pathophysiology, but there's a whole other arc our characters go through as it relates to these systemic and social issues, mental illness, workplace violence, not having a moment to decompress, carrying all that energy with you from patient to patient, all of that. And so let's get the real deal about what it's really like to work in a busy ER. We'll talk to Dr. Italo Brown, a board-certified emergency medicine doctor at Stanford and see what it's all about in that crazy place called the ER. I'm ready. This episode is brought to you by Expedia and Visit Scotland. Start your story in Scotland. Experience the pool of wide untamed landscapes and fresh cuisine that feels rooted in place. Discover castles steeped in legend and feel the genuine warmth from locals you meet in a place that will stay with you long after you leave. Start planning your own Scottish holiday today at Expedia.co.uk slash Visit Scotland. Dr. Italo Brown, legend. It's an honor to have you here. Thanks for taking the time. And it's a pleasure to be with you both. You know what people don't know is Italo and I have been friends on social media for years, but met each other IRL in the airport, which is kind of funny. Anyway, Italo, something that probably doesn't surprise you or I is how fast-paced, you know, this show really is and how many times these doctors are going from room to room. They don't get time to really decompress or kind of sit with their thoughts for a second. Now you trained in the Bronx at two of the busiest ERs. What was it experience for you like in having to run from room to room and not even get a second to think? Rooms. That's funny. Honestly, a lot of times it's just a curtain drawn in between and sometimes patients are right next to each other. Sometimes they're staggered in triplicate. And so it wasn't really a run from room to room, but really just wherever the space was and the patient was. But that experience is something that I remember. Even when I first interviewed there, I remember saying, if I can manage this, then I could probably go anywhere. The emergency department is just such a unique environment where we have so many different types of pathology or problems in the same space. And the ability to try to like think through it is something that we rely upon. The speed, the fact that there can be a code one minute and then the next minute somebody chucking some urine and a urinal onto the ground. The department is just such a very interesting environment. A lot of things that are unpredictable. And you have to keep a presence of mind at all times like know what's urgent, who's sick, who's kind of sick and who needs to get out as fast as possible. And so that's kind of how I navigated it and really got good at relying upon all resources, nursing, our support staff, techs, unit secretaries, x-ray techs. Anybody who can move a patient, anybody who can see a person sick and yell out help is someone who I wanted on the team. I'm curious, like what are some helpful tools when you're going back to back between difficult patients and difficult cases? A lot of times the most helpful tool is making sure that you have working differentials, right? So this list of diagnoses that you're working up for a person, being able to really hone in on them two or the three things that you're trying to address and then keeping that in the forefront as you move to the next patient. The other thing that I thought was extremely helpful is like constantly going through mental checklists like are the labs back? Is the imaging back? Did this person get the pain medication? Are the antibiotics started for the septic patient? Did we get fluids on board? Did we call this consult? Have they called back yet? Like constantly running through this checklist and then moving things based upon the prioritization, right? So super sick person, top priority. Somebody who's had, you know, the same issue for a year, a little lower on the list, still important, but definitely not somebody who I'm worried about in terms of like turning the corner really quickly. Master of the multitask. Incredible. Spending all the plates at the same time and making sure that none crashed. That's all it is. But what we've seen on the show and in real life is sometimes spinning all those plates does not involve paying attention to collective mental health. And we know that there's mental health struggles all over healthcare. We see it show up in this show for different characters. We're starting to learn a little bit more about each character's kind of personal mental health journey. How do you see mental health show up in for your team, for your residents? Are we making progress and being able to talk about it and spot it? What I have learned to rely upon is this team environment, right? Just because we're friendly, we're a family. We spend a lot more time with each other than we do sometimes with our own families. I think one of the greatest changes that's happened recently is the development of like a wellness initiative across emergency medicine, where we see wellness fellowships. We see a lot of importance placed on balance and making sure that our lives outside of the hospital are as good as possible so that we can be performed at a high level within the hospital. And then finally, like this change in the stigma around therapy. So a lot of people used to not want to say, I'm a doctor and I go to therapy or I'm a doctor and I take medication or I'm a doctor and I talk to somebody about the trauma and the struggles that I experienced on the shift. This space has now shifted to where these are encouraged, welcomed, and we celebrate it. And so that to me has been like one of the greatest things that's changed in the last like 10, 15 years. So you are an assistant professor of emergency medicine at Stanford. And I want to know like how realistic are you with students when they're going into this line of work about the mental health, you know, risks or how to take care of their mental health in these positions? I should go code nothing. They know I will tell you the absolute truth. 10 times out of 10, I start off by asking them like, what do you want out of this career? You know, it's a lifelong career. You sign up to be a physician, but signing up to be an emergency physician means that you're going to be imprinted upon constantly by people's personal struggles, things that are social and structural systemic failures. And you're going to see some of the most vivid, gruesome, and sometimes very unbearable things. It could be as bad as someone being shot in the chest, or talking to a patient who's been sexually assaulted. All of this gets imprinted on your soul. And so I try to make sure they understand that this specialty requires a lot of self awareness. And that if they're one if they want to step into this, that not only are you going to be literally tasked with a lot of things, but you won't be left alone. We have a lot of support. And by support, I mean, we have a lot of individuals who experience the same things, and they're open to sharing it. So you won't feel like you're on a team by yourself, but it is a commitment. And every single time you do this, it depends, it demands is pound of flesh. So it's an undertaking. But I think that the reward is extremely high. And we see that experienced over and over again, with people coming back to the field, people making sure that they show up at our meetings, that they do research, they are undercompensated and still give 110%. You know, I really like how you phrased the these these experiences are imprinted on your soul, the good and the bad. And, you know, the pit does a great job of highlighting many of the struggles that doctors, nurses, sex, all of us go through. And one of them is violence in the workplace. And, you know, people, shots hurt around the world when charge nurse Dana was punched in season one. And the show really illuminated for a lot of people who didn't know just how prevalent workplace violence is against healthcare professionals. Do you have any personal stories? Have you been through something with workplace violence? And then second part of the question, do you feel like we are finally making progress in terms of addressing it and protecting ourselves and our colleagues against these acts of violence in the hospital, the clinic and healthcare? I unfortunately do have stories. And I share them first out of honor for all of the healthcare workers who have sustained an injury or been assaulted on the job verbally or physically. And I want to just acknowledge and hold space for them because this again has its own levels of trauma that you have to work through and sift through. And you don't get to three days to figure it out, you actually get less than a few minutes, sometimes seconds to figure it out. And so I remember I was a resident, you know, I felt like I knew what I was doing. I was a senior at that time. And I had a patient who was having like a brief psychotic episode and thought that everyone who was trying to help her was hurting her. And she was screaming out, she dropped to the floor. Now a patient dropped to the floor in front of you, you're like, all right, hold on, let me either try to help them up, let's stabilize them. And so when we tried to help her up, she started thrashing and we're trying to make sure now we get her into a stretcher or into a gurney appropriately, take her to a room and then try to either verbally de-escalate her. And if not, we were going to chemically de-escalate. So by the time we get her into the room and she's in the stretcher, I have my hands on the rail, she just like reaches up and grabs this part of my arm. Now I don't know if you can see it, but it's like a really deep kind of gash there. Dug her thumb into my arm. I thought nothing of it. I was like, man, that's crazy. Went to the bathroom, washed off, no problem. Two days later, what started off as just a cut now is about two to three centimeters circumferentially. Hurts, not too bad. But I'm like, all right, it's cool. By Friday, that happened on a Monday, by Friday, my whole arm is on hell, boy. Just straight, swole. And I mean this when I say, I could not suture a patient's face without every single maneuver hurting my arm. I come back down and sit next to my chief. She's just like, how's the patient doing? Oh my God. And looks at my arm and sees how large it is. She's like, you tell her, you okay? I say, yeah, I'm cool. What's up? She literally takes me into the trauma bay, puts an ultrasound on it, nothing but pus underneath it. Now, yeah, yeah. So then the attending cut into my arm and took out about 20 cc's of pus because I had essentially started to have more than just a regular infection, but a systemic infection. I share that story, not as a cautionary tale, but to say like one, you never know. Small things can become big things. Two, my team members recognize before I cared to recognize because I didn't think that the culture was to admit when I had been assaulted, or the culture was to admit that I needed help. And so we've worked significantly to make the space safe enough for people to talk about things without fear of retaliation, without fear of being looked down upon because you were assaulted. And finally, the way that we've now shifted those types of things, the reporting, those barriers are a lot lower. A lot of times it was hard to report incidents of assault partially because of the process being very kind of convoluted, but also you knew nothing was going to happen. And so now we have legislation that is in process, in process, largely being driven by our nurses and our nurse unions who are trying to make sure that there are ways that we can protect all healthcare workers and that there are consequences for assaulting us. Wow. Thank you so much for sharing that story. Oh my goodness. That is wild. I'm curious how you've seen stress in the workplace show up for medical professionals and for doctors. We have a doctor on the show who has some self-harm scars. And I wonder how have you seen stress show up amongst the medical community? That's really a good question. I've seen it and sometimes the signs are really difficult to catch. It can be substance use, it can be self or injurious behavior. And a lot of times it can just be toxicity, like the way they behave in the department, a little bit more sharp or snappy to their colleagues than the normal. And what I've tried to do is to establish relationships that are bi-directional with everyone that I work with. Not only do I ask you for help, I mean, ask you to do something or ask for help or try to help a patient, I try to make sure that you feel safe enough to come to me and talk to me about things that are going on in your world. One of the tasks that I have as an attending is to be able to pick up on these types of changes in behavior. And what we don't do a great job of is having individuals like check in just because. We think that it's always, oh, you're in trouble or your charts are late. It's always this kind of structure of I'm checking in on this person because they owe me something or they need to do something, not just I care about you and I'm worried about you. So leading with that type of energy has yielded a lot of these kind of like people in my life who've shared that information and I've been able to help them as best as possible. Yeah, Dr. Robbie needs some of that too, you know, both. Yeah. What? The first support but also the push to go and be like, hey, resident, come to me. Man, I know he tries and from watching this character arc, it's almost as though I mean, you could tell he's a little tapped out, but I think that deep down he has that desire to like connect with everybody that he's helping and he's training, he's educating and they view him in a certain way, right? Like they see him as like this, this citadel of knowledge and they understand that he can make decisions and do things that most of the doctors don't do. But I think that you have to layer in a little bit more of that vulnerability and you got to show him that you're friable too. Yeah, no, that's a good point. But Talo, it's interesting. Earlier this season, I was talking to some colleagues and one of them had mentioned this frustration to me that he heard med students saying, oh my gosh, like we watched the pit, we want to go into ER medicine because it seems so cool. And these other doctors are like, no, it's not really that crazy. Like you're not going to get this many, you know, wild traumas or zebra cases sort of say in one shift, like you've got to be realistic about it. And I'm like, obviously it's television guys, like calm down a bit. But I want to ask you as the real deal, what is your favorite part about being an ER doctor? Like what gets you up when you're kind of tired, you don't want to get to work and gets you motivated to get into the hospital and take on a shift? It's honestly the nonstop problem solving. It's like a Rubik's Cube every time you walk into the department. And I like the idea of every time I meet a patient, first of all, I'm meeting more people than anyone typically on a standard day, right? You're talking about 30 to 50 people that you just meet every day. And they have backstories, they have real problems. And your job is to get the most information possible in an infinitesimally small amount of time to try to help them move from point A to point B. Now, I'm not going to lie. I originally was brought to it because of the cool stuff like, oh man, you're putting in chest tubes, we're intubating patients, we're seeing, you know, someone who fell through a roof or whatever. Like those stories make for great bar conversation. You walk in, it's like, oh, I got a story for you. Let me tell you what I extracted from this patient the other day. But at the end of the day, it's really about these patients and making sure that they're talking about their experience with you in such a high regard that you feel like you honor the specialty and the many other people who came before you. So I just have to know like practically, you're meeting all of these people in a shift. Like what is your social battery like at the end of a shift? Cooked. Straight cook. I think what I've learned to do is spend that first hour in reflection, right? So I put on some music, try to vibe out and think about the cases and like what I could have done better and criticize myself harder than anybody else. But once I hit the threshold of the door of my apartment, I'm done. I have nothing left to do. I literally turn that off and turn on the endearing side, the side that has fun and jokes and can appreciate everything non-medical. It is fun to me to be able to have that duality, to go into intense environments and think very surgically and precise, to talk and communicate at a high level, but then also joke and have fun and be like a tangible palpable person with dimension. Wow. I mean, that's very instructive. If I have an emergency, I'm coming to you. So you've really inspired me. Amen. Thank you so much. I appreciate you for the world of your patients, my guy. And I appreciate both of you for bringing this to the forefront, for honoring our work in a way that is exemplary. Thank you. Oh, look, I loved that conversation. And I was so moved by Dr. Brown telling us about this like gas that turned into like full of pus and how he didn't realize how he could prioritize his own health at that moment, but that it took a coworker saying, hey, I think we need to look at this a little bit further. Like your arm is crazy right now. And I think that really applies to a lot of the doctors that we see on the pit. It really felt like a storyline that could have shown up in the pit is, you know, as you mentioned, like putting your work and ignoring your own stressors, your own symptoms. I really appreciate how eloquent and how open it was with us on this conversation. You can tell that he not only shows up for his patients, but he's probably a phenomenal mentor and attending. And I really appreciate him distinguishing between the cool bar stories, but then the actual motivation of being there for people on what might be an awful day in their life and, you know, trying to treat the entire individual and not just the disease or the condition. Yeah. And I mean, I think that, you know, in my head, it seems so stressful and so tense to make a hundred medical decisions in, you know, the span of a few minutes. But I like that he described as being so energizing and almost empowering to do that. And like you said, showing up for someone and also showing up for your coworkers and colleagues. For sure. For sure. I feel like he's the right person where I can call when I'm having a bad day and be like, Coach Brown, what do I do to get back in the game? But this is also the person, any aspiring ER doctors, who you should reach out to because he's clearly the real deal. That's it for today's episode of the pit podcast. But you know where to find us right here on Thursday after each new episode. And we want to hear from you. Leave us a comment or a question and we'd love to talk about it in a future episode. You can watch us on HBO Max or listen wherever you get your podcasts. The 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 Ebuda Choa and Toni Carlson. Our video producer and editor is Anthony Q. Artis with assistant editor Damon Dorell Henson. This show is engineered by Tommy Bazzarian. Special thanks to Joe Carlino. The executive producer of HBO podcast is Michael Gluckstat. The senior producer is Allison Cohen-Cerococch 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.