10:00 A.M. with Fiona Dourif and Shabana Azeez

Welcome everyone to the pit podcast, the official companion to the pit on HBO Max. I'm Dr. Alok Patel I'm a doctor, a journalist and I'm a fan of all things related to medical storytelling And I'm Hunter Harris, a screenwriter and cultural critic This week we're going inside episode 4 of The Pit and talking about the 10 o'clock hour We're also joined by two stars of the show Fiona Durif, who plays Dr. McKay and Shibana Aziz, who plays Dr. Javadi You'd hear Fiona doing a scene if you weren't in a scene with her and if you were doing background and you hear like, I don't know, I just have drugs. I'm like, fuck. Again, I'm sorry, I'm sorry. Because every time there's a huge reset, right? Because there's like a hundred people behind you like acting out their own medical scenes. So every time you mess up, you're like, God, I'm so sorry, everybody. It was really fun. And then we'll go outside the pit to talk about real world healthcare issues that show up inside the show. There's a lot to discuss, especially in this episode. Today's shift starts now. I love when you do that. But also, your shift just ended, no? It actually did. Listen, I wish I could say I was kind of putting on a character, but I literally have been up all night on a night shift, rolled up, haven't shaved, haven't changed. I mean, listen, I'm in character. Thank you for the commitment. I appreciate it. Another week, another episode, Hunter. I, like, took notes on this episode. My notes are loaded. A lot happened. Catch us up. Look, you take notes on every episode. But this time, there's a lot. There's so many little moments. Okay, so there's so much going on in this episode. First, there's a code black at Westbridge down the street, and a lot of patients are coming in, diverted from the hospital, which is down. So we're expecting a lot of, I guess, increased traffic at the pit right now. And then Dr. Al-Hashimi has some choice words for Santos, saying that she's behind on her charting, and she won't want her to repeat her R2 year. And that to me was like, oh my gosh. Timely documentation is essential. Let's fix this before end of shift. I'm on it, boss. Good. You wouldn't want to repeat your R2 year again because of this. Fuck. I mean, I'll be honest, like charting sucks. It's a lot of paperwork. But we're in hour four, I think, of this specific shift to, listen, I like Dr. Al-Hashimi. I like the energy she's bringing, but I don't know if I'm immediately saying you're potentially gonna have to repeat your R2 year. Like that's, that's not a thing. We're not, we're not failing residents because they didn't chart properly in the first four hours of a shift in July. Yeah, no, that was the thing. It's like, okay, you're coming in a little bit hot right now and you don't even know Santos that well. One of the patients in this episode is Tanya and Vince who like fell in a parkour accident. They've been spelled 10 feet, and so he's being assessed in trauma one. And then Whitaker has a big win this episode when he suspects a posterior MI. Can you tell me about that? Posterior MI, think about it like this. It's a heart attack that's affecting the back of your heart, and it's a lot less common than routine MIs. And there's a scene when Whitaker is looking at the EKG, and he notices some of these changes that are a little different, not typical of a heart attack. So he goes and gets the approval from Dr. Robbie to do an EKG on his back. And then he sees those ST elevations. I mean, I'm with you. That is a huge medical win for Whittaker. I love it. Let's take a look. Hey, I could use a second set of hands here. Pulseless VTAC. Start compressions. Charging to 200. Okay, clear. Okay, resume compressions. Code STEMI. It was posterior. Yeah, good call. You put the deep foot pads on? Yeah, just in case. Hold compressions. Normal sinus. All right. Got a strong post, take a BP. All right, we'll prep him for calf lab. Hey, Mr. Samba. You're going to be okay. No pearly gates today. Really good pickup, Whitaker. Thank you. Whitaker's a character you always root for, and those are rare. So if you have a posterior MI as part of a bigger heart attack, it's not that common. But a posterior MI on its own is even more rare. But the part that cracks me up, I shouldn't say cracks up because we're in a heavy situation, is when Whitaker sees this event happening. He's like, I need an extra set of hands here. As if someone like had an accident on the floor. I'd be hitting the code button or something or screaming, call the code. We have a patient potentially dying. Also this week, we get an update on Jackson Davis. So when he came into the ER, he was like very erratic. He had just been tased by a school security guard. And now when his sister Jada comes, she's like, wait, this is not the brother that I know. He's so gentle and careful. And this is not behavior that I've ever seen him display before. So that's a mystery that we need to solve. And then we have a really sad story with Orlando Diaz and his family. He has been like having his insulin doses to afford the medication. and his daughter, once she learns that her parents don't have insurance, starts a GoFundMe and he does not react to that very well. This little scene is a gut punch. It kind of illuminates these social factors that play into people's ability to manage their health, their chronic medical conditions. This one got to me, Hunter. This one got to me. Let's see this clip. Do you have a glucose monitor? Oh, yes. But I can't afford the test strips every week. They're too expensive. Can we not talk about this in front of my family? Hi. They're my girls. Did you call your brothers? They're still a soccer. I have good news. I started a GoFundMe for Dad. A what? To help raise money for Dad's medical care since we don't have insurance. No. Take it down. Now. But why? I work hard. I don't need charity. But Dad, we've already... Anna! You heard me. Take it down. You know, I saw a meme once And it said, America does have universal health care. It's called GoFundMe, which I should not laugh at, but it sucks how many GoFundMe pages we see or we get shared on social media about people who are just trying to pay their medical bills. On this shift that I'm still dressed for, just like 10 hours ago, I was talking to a family who's worried about how they're going to pay medical bills. And we've seen people get bankrupted, have to ration care. We see so much of it. oh man, I'm glad that the writers included this little subplot, but I wish they didn't have to. Yeah. Yeah. I mean, a big internet forward episode, because we also found out that Dr. Javadi has a little side project that she is a TikToker with more followers than you would think. And a patient comes in with her eye glued shut from trying to apply lashes. Listen, been there. and she says, I want Dr. J. And Langdon is like, I don't know who Dr. J is. It turns out that it's Dr. Javadi. Which is kind of awesome. Also, can we stop for a second? You said you've been there before. Is it really? Have you actually glued your eyelashes shut? I haven't glued my eyelashes shut, but I have had some mishaps with trying to apply lashes. I love my lashes. Sue me. Your lashes look great. I'm guessing that this is based off a real case. The fact that Javadi is an influencer is such a good twist because I didn't see that coming. Dr. J, finally. It is so nice to meet you, Dr. J. This is Willow, your new patient. I'm actually a student doctor. I, uh, watched all of your videos. The one about coping with difficult coworkers was super helpful. I gotta watch that. Um, so what is Willow's health issue? Uh, my eye. It's super glued shut. Halfway trim and mineral oil didn't work. No. then I would suggest cutting the full lash down. I concur, Dr. J. As long as you're the one doing it. Oh. Okay. Yeah, sure. It feels a little shady when the patient is like, oh, I loved your TikTok about, like, working with difficult people. And he's like, hmm, I might have to watch that. Like, we'll see. Acting with your eyes. There's some subtleties there. Can we talk a little bit more about Dr. Langdon for a second? because after Robbie basically like banishes him to triage, Dr. Al Hashimi says, okay, we have too many patients coming in. We need to bring Langdon back. She's his advocate, but it seems like she also kind of believes in the process. And she's like, hey, you went through therapy, this program, and like you're a great doctor, we need you. But, you know, Dr. Al Hashimi advocates for him to come back. So does Nurse Dana. But I think Dr. Robbie still has that internal struggle. Yeah, I don't like that Dr. Al Hashimi is like ready to go easy on LinkedIn, but then there's like really writing Santos. Good call. Thank you. Dr. McKay is kind of flirting with her patient and they make a plan to go on a date for an art walk. That was a very sweet moment. Fun detail. He's got an England national football jersey on with those three lions. So I was like, that's cool. Okay. I don't know my football well enough. I hope that means he has good taste. I mean, if he likes Dr. McKay, then he must. Then this was kind of the moment of the episode for me is that we're in the trauma room. The patient, Vince, who fell from the parkour accident is stable. But then there's like a little piece of glass that I think they missed on a CT and Ogilvy, so eager as always, rushes to pull it out. He's like, I've got eyes on it. I can get it out right now. And okay, you'll have to explain to me exactly how this happens. But when the glass comes loose, then the patient starts like bleeding and is not stable anymore. And I love the moment Dr. Garcia coming in and saying, okay, why don't you let the adults make the decisions from now on? Yeah, she came in and she was rightfully angry and anxious about the situation. You know I not a trauma surgeon or a vascular surgeon but like simply put if there is something puncturing into your body there a possibility that it is also tamponading or putting pressure on areas around it and almost kind of controlling the bleeding And then when you remove it all of a sudden you've removed that pressure so blood can happen. This is why people have probably heard or seen that age-old advice that if you get stabbed with something and it's still in your body, do not remove it. Have it removed in a hospital. Another big scene this episode that I was really intrigued by is Dr. Jefferson having a moment with Dr. Robbie to talk about the motorcycle trip that he's taking. And I really liked Dr. Robbie saying that like, you know, he hasn't found the right therapist. He's still trying to feel it all out. And that moment of him going, I've got therapy. It's like me on my bike. It was so cool. It was that was a good interaction because you can tell that they have some type of past. And Dr. Robbie immediately says like, hey, I'm not on your couch right now. You know, and he's like, I don't need to be talked out of going on my sabbatical. And like, Jefferson's kind of like pushing back a little bit. Like, that's a good, that's a good moment. And also, we know he wasn't wearing a helmet at the top of the season. Okay, let's kind of dig in a little bit more to this episode because there's a lot to discuss. I mean, starting with, what do you think the code black is? Like, what would you put money on on the board? I love that they start out immediately by just making bets. Like, half the ER is like, oh my gosh, it's an emergency. You know, we can't, like, we can't get you a break. And then meanwhile, the guard's like, let's make some money rain. And then everyone's character kind of comes out. Dr. Al-Hashmi gets in on it. I love seeing Whitaker throw down 40 bucks. I mean, like, I got the direct deposit, cash money. Anyway, I struggle with this. And I worry just because I know how this show rolls that it's going to be something kind of dramatic. Maybe it's a bomb threat. Am I going too dark here? Yeah. Oh, geez. I mean, what if they brought Robbie was like, it could be an exploded toilet. Who knows? It could be. It could be. But I just, I don't know. I just feel in my mind, I'm like an exploded toilet would lead to flooding, which could cause the code black. But I feel like I think there's going to be a social element to it. OK, but this is the kind of thing that will that you think can it'll be a runner this season that will be will keep seeing a lot of patients from the code black. I think so. And I think that we're going to the code black is either going to be related to something really dramatic or it's going to be a longer discussion about health care. So if you just generically say code black, it's basically a non-medical emergency. It could be flooding. It could be a natural disaster. It could also be a staff shortage. It could be a situation where a hospital doesn't have the resources, the nurses or whatever, to be able to properly staff or open their hospital. So it could be something of that nature also. It just depends. The term code black is going to differ from institution to institution. So I don't know. We could be going into social commentary or it could just be some dramatic TV. I don't know. I mean, I think it's definitely some added intrigue this season. And I mean, already the ER is being overrun. So we'll see what happens. You know, Hunter, I love how much you're analyzing the Langdon, Dr. Robbie kind of back and forth. And so in this specific episode, we see Dr. Robbie again say Langdon is back in triage. He's not coming up here. So I'm curious, what do you make of all this? But also, how do you think Dr. Al-Hashmi kind of making her own decision about Langdon is then going to affect the triangle of relationship between Al-Hashmi and Rabi, Dr. Rabi and Langdon, Langdon and Al-Hashmi? Like, give me some thoughts. Yeah. Well, I think it's a really good escalation in this, you know, Rabi-Langdon drama for Rabi to keep trying to push Langdon away. Langdon is like not really sure what, you know, how to put his best foot forward and come back into Dr. Rabi's life. And Dr. Al-Hashubi is like, okay, we can't have like a doctor this senior still in triage. Like he needs to come back. We need the help. So I like that these two men are going to be kind of pushed together. But at the same time, it's just another relationship where Dr. Robby doesn't really know where it stands or how even he feels, I think. and that's maybe the most complicated part of this is that we're seeing Dr. Robbie, like not seeing him make up his mind, but seeing him like try not to make up his mind, try to keep pushing this away, kind of procrastinating his emotional, his emotional confrontation here, I guess. And I like that it's also coupled in the same episode with this moment that we get about Dr. Collins, who has, we hear Dr. Whitaker say, moved to Portland and had a baby. And the fact that in that scene, we have the camera on Dr. Robbie's face and seeing that kind of like a little bit of emotion, a little bit of sadness, a little bit of like, like it's a somber beat, I think, to see him in the same scene, trying, you know, not knowing how he feels about Dr. Landon being back. Also maybe not knowing how he feels about Dr. Collins being gone. And again, it's like, yeah, Robbie is kind of running from his emotions. And as Dr. Jefferson says, that's not a place to be. That's not especially in someone of his position. Speaking of complexity, let's go to something that's actually very fun that I'm super stoked about. And that's McKay. And the fact that she is just like Cupid's arrow right now. So you have like previously she was dancing with this guy who seems like he's got an issue with his tailbone and he's hitting on her earlier. But Casanova over here in the England national soccer jersey, sorry, football for my European friends jersey he kind of like talks to her about how he's sad he doesn't get to have her as a doctor anymore she drops this line where she's like you know you're not going to see me anymore as a patient are you as giddy about all this as i am and what do you make of this in terms of kind of like the the ongoing blurring between dr mckay's personal and work life like where are you at in this i was i was gonna go check out a few of the art galleries in lawrenceville tonight Have you been to that one on 40th and Butler? No, I was, um, gonna go by, maybe around nine. Okay. Cool. Cool. Is he gonna change clothes or is he gonna wear that soccer jersey? Hmm. Hmm. Maybe he'll wear the soccer. No, he'll definitely change clothes. I'm happy that McKay was so, um, for how, you know, harried she was in season one with this ankle bracelet on her ankle monitor on her now she's like a lot more relaxed without that piece of uh jewelry and also you know a few love connections same with dr javadi who's really coming into her own this season as an influencer but also as a doctor of course and we actually got to talk to the actors who play these characters fiona durif and shibana aziz and this was maybe the most fun interview we've had this season so far they're so funny. I actually didn't know that Shibana was also an Australian. Like, super impressive portrayal of Javadi. Yes, her American accent is so good. Let's take a look. First question. I am obsessed with Javadi being an influencer. When a patient says that Dr. J is, quote, the best doctor in Pittsburgh and that she has more followers than you would think. Can you kind of tell us about that development, about how Javadi's youthfulness shows up in her work? I'm so grateful to be representing Gen Z in the show. I think that, like, young people in social media, like, so maligned and we think of it when we're talking about these, like, biases that people have about it and, like, how I think you might think it's, it's, like, anti-intellectual or, like, you know, she's smart, but she does this influencer thing, but actually I think it's all part of the same package of, like, a smart young woman who's using the tools at her disposal to make the world a better place with the tools she has, you know? Like, she knows about medicine and she has social media. And she has such a unique perspective after experiencing something like the mass casualty with everybody on what it's like to be a frontline worker. And I'm looking forward to playing with people's expectations about that storyline. Can you also tell me about this kind of almost rivalry she has now with the new character Ogilvy? Yeah. That he is just as smart as she is, but they kind of, it gets tense between them. Yeah, I think he's going down. I think that's the writing's on the wall for him. No, I'm really excited by his character. I think it's really exciting to show a different side of Javadi. I think last season we see her sort of be like Santos' punching bag a little bit and not know quite what to do about it, but she's grown in that time and she's thickened her skin and become a little stronger. And then separate to that, I think Ogilvy has come in and he triggers this part of her brain that nobody else ever has and she becomes this snappy, competitive person that she's like, what is going on? She doesn't think of herself like this, but he's inspired this version of her that is like, mean. And he's going down. He's going down. What is it like playing those scenes that are so quick? So fun. Yeah, so much medical jargon. So quick, because we're answering these, all these scenes are, somebody goes, and what's this thing? And we go, we just like, like a bunch of medical jargon, trying to compete with each other. It's really intense. We do a lot of, Lucas and I did a lot of line running beforehand and a lot of checking accent for me because I didn't, there are some words where I go, no, I'm saying that in an American accent. And then, I used to say insulin, but it's insulin. Insulin. Or like, oh God, I've been saying all sorts of things, like just adding a use there. Neurosurgery, I thought it was like neurosurgery, but it's neurosurgery, neurosurgery. Fiona, I'm pretty sure we all were cheering when Dr. McKay put the drill to the ankle monitor. I gotta tell you, I feel like McKay is a drama show within a drama show. Season one, you see- McKay's personal life is a drama show. It's a drama show. I mean, season one, you have this single mother who's handling all this drama at home, but also compassionate doctor. And then in this episode, you have this patient flirting with McKay. So I just wanted to ask you, with McKay, why do you think the line between work and personal life is a little bit blurrier and a little bit more apparent than the other characters? I think it's her age, right? Like, at this point, you know, she's 43, and she has been devoting years and years of her life to taking care of other people. You know, she's at home taking care of her son when she's not working, and then when she's in the ER, or ED, she is taking care of other people, and it can be years and years of that, you know? And it come to a breaking point I think after probably the mass casualty a little bit where it feels like self-care is sort of needed and it's time to kind of look inside and make sure that she is also taking care of herself a little bit. And that was a really vulnerable moment. I don't know how many times you guys have asked somebody out in person. Well, I mean, that's, Javadi's done that. Yeah, Javadi's done it. That's right. Yeah, yeah. Yeah. There's, I can think of, I think maybe I've done it once. But yeah, there's a lot of like heart palpitations and vulnerability that goes into that. It's like, if not now, when? Did it work when you did that one time? You know what it did, yeah. See? And I think with McKay, I'm telling you. It's a long time ago. But it's like you mentioned there's a lot of medical terminology that Javadi knows. And then with McKay, there's also a lot of medical terminology. But then there's a different aspect of bedside manner and really getting to know the patients, those interpersonal skills. I'm curious, what was it like for both of you to have to step into that role, learn that character, learn the terminology, learn how to do all that, and then memorize it and recite it? What was that process like? um i found i figured out that if i were to repeat the medical jargon 40 times four zero times before i get to set i can reliably say it and then there's a lot of research in exactly what it means so i'll remember you know um ceftriaxone example and you know i'll remember exactly what it is for probably like three days after and then it's gone um but yeah there's just a lot of prep work for me to to to remember the lines and then be able to say them portraying skill right because uh I'm not my character is in the second year of residency I really there's a lot of these procedures I've done before um and so that was extra intimidating to to deliver it and be technically doing a lot of it because we really try to portray realism and really feel like I know what I'm talking about. Yeah, it got me lucky in comparison. Because you had to look like you knew what you were doing. I could be like, what's that? And that was really useful. Yeah, there was a lot of pacing for me in season one before I pace a lot. I was like, I'm going to be able to get all this out. It was a lot of like, you'd hear if you're only doing a scene, if you weren't in the scene with her and if you were doing background, you'd hear like, I don't know, Steph drags. Fuck! Again. I'm sorry, I'm sorry. Because every time there's a huge reset, right? Because there's like a hundred people behind you like acting out their own medical scenes. So every time you mess up, you're like, God, I'm so sorry, everybody. It was really fun. Yeah. She's very charming about it. It was really fun. um I also think there's something about like the the world is so immersive like everybody's doing so much stuff that you do it helps you get into it like in terms of like the jargon and the equipment I think for me it's harder when you're cheating equipment too like you know when you're doing like because you're doing the job that you're saying the words and then you're doing the procedure but then you're also doing the procedure for tv which is sometimes the same procedure because you're suturing say on a silicon pad that's been stuck to a person's arm and then you don't have to fake anything because you've got the fake pad but if say you're doing your lines and you're stopping at the right word to take a fake intubation tube out and put the you know or take the real intubation tube out and put the real one in you're stopping and starting a lot too in your lines and so there's it's like another dance you're doing on top of the top of the surgery dance you're doing the acting dance you're doing the words dance it's like a really it's like a layered kind of approach for sure and I think this season I've done a lot more medicine like last season obviously it's my first day I faint day one episode one so so I'm sort of on the back foot a little bit and don't get so much trust until the mass casualty event where I they just have to trust me to do like 100 test tubes um but this season it's more it's more hands-on for Javadi because she's not new anymore and the trust has been rebuilt and so yeah it was a lot more like oh I gotta practice this straight up surgery times you know what a really hard thing to do was was when I was doing CPR to save somebody and it was an actual body, it wasn't a mannequin, you can't actually press, but you need your body to look like you're pressing. And that took so long to figure out how to do, and I'm still kind of bad at it, I think. Yeah. I haven't seen you. Sorry, I didn't mean that like that. I meant that like, yeah, I hear you. I meant that like, I'm sorry. I think CPR is probably the most challenging. CPR in a real body. It's easy to look ridiculous, but you don't want... If that's a real person there. Like, for me, even as an actor, I go, the stakes for their safety is more important than the stakes for my performance, always, obviously. Some of the background during the mass casualty, like, deserved awards for the amount of time they had, like, things in their mouth, like fake intubation tubes in their mouth for just, like, hours and hours and hours on end. Just fake chest tubes taped to them all the time. They'd get up and go to lunch with, like, these tubes hanging off. It takes a village, man. And the pit takes a village. Yeah. I think all those details is why this is the most medically accurate show on television ever. And exciting. We're so stoked for the rest of it. Thank you both. Thank you. Hunter, the part that cracks me up is this discussion about how they learned the medical terminology and how to resettle these procedures. And then like Shyvana dropping F-bombs, imitating Fiona. Hilarious. Yes, I think my favorite part of this interview was you asking Fiona if she's ever asked someone out, like if she ever shoots her shot. And I feel like I was like, what's going to happen? And she said, yes, that was cool. Now we're going outside the pit. And this week we have a special privilege. Our guest is our own Dr. Alok Patel. Privilege and curse. No, not at all. I have so many questions for you. So as someone who like has a fake job watching TV all day, it's like really a privilege to talk to someone who has a real job, which is saving lives. I'm so honored by that. But also that is a real job, Hunter Harris. Your legion of fans agree with me. Oh my gosh, you're too kind. Okay. In this episode, we get a real sense of PTSD and trauma from people in the medical community, medical staff, support staff. And there's a moment where Dr. Jefferson talks to Dr. Robbie about like, how are you taking care of yourself in this chaotic and high stress environment. And so I want to ask you some sort of the same question, like, how do you manage the stresses and the complications of this work? And how do you see others in the medical community doing that? Great question, loaded question, and an important one, because you almost get the sense that Dr. Robbie dismisses it, maybe he doesn't at all. And he kind of puts his heart and soul into his work at the expense of his own. I mean, that's what we saw in season one when he like has that breakdown. And it's like, well, if you if you kind of push your own mental health to the side, then you can't really be a caregiver, which is what his job is. And let me just come out, come out with it and tell you that a lot of health care workers push their mental health issues to the side. Whether that is anxiety, depression, substance use, it's PTSD, whatever it may be. There's many reasons why if you look at statistics and studies, healthcare workers are less likely than the general public to seek treatment for a mental health condition, which is alarming. And part of it might be related to awareness of symptoms. It's hard to tell if what you're feeling is burnout, or if it's just exhaustion, or if it's actual depression. It's undertones that happen in healthcare as well, where someone might say, Oh, my gosh, if I say that I have anxiety, my boss may be like, Oh, you're not resilient, or you're not tough. And then all of a sudden, you feel pressure, and you see it happening in the pit, you feel pressure because you work in a busy clinic or hospital, maybe there isn't backup. You know, I've been at the hospital in shifts, for example, where somebody was going through something personal. But all of a sudden, was like, I can't leave because we're overbooked, or you know, we have a full ICU, there's no extra doctor and we've had to band together, but you need to go home. And so people kind of feel that pressure also. And then the system knows that we're willing to do that. So they almost take advantage of the altruism, but long story short, doctors are terrible at separating and actually going and seeking help. And now for me personally, I had to go through a breaking point. I mean, we're going to, you and I are getting like a therapy session right now on the podcast, but I actually had my own form of an emotional moment in residency and it was triggered by a breakup. Really? Listen, everyone's been through a breakup. But somehow this one breakup knocked me over like a house of cards. And I was like, why is this destroying me so much? And it was one of my mentors were like, something else is happening. You should go talk to a therapist. And it took that for me to go talk to a therapist and be like, oh, I need to develop some tools, unpack a few things, but also get awareness of what those symptoms are. So now fast forward. That was 12 years ago. fast forward for me now and some of my colleagues I talked to, it's awareness of what you're feeling. Is it something you should seek help with? Is it something you might just need to go and sleep? Do you need a day off? But it's also forcing us to detach. And when I see detach, it could be reality television. It could be scuba diving. It could be dancing. For me, it's martial arts, but something that is taking your brain away from work. And like, for me, that's been everything. Perhaps that is what Dr. Robbie is seeking with the sabbatical. I think so. I mean, he like wants to get out on the road. He wants to like get, but I don't know if that's gonna work. I mean, we'll see, I guess. But I wanna know as like a doctor, as a leader, how do you maybe identify or check in with people who you work with who might not be taking that time for themselves? Like what's the gentle way to address that? It's exactly, you kind of hinted there, it's just checking in. Even if it's like, how's your day? Do you wanna grab lunch together? Is everything cool? And doing it in kind of a bar conversation as opposed to a interrogation or a lecture, for example. It gets that scene again with Dr. Robbie when he's like, I'm not on your couch right now. But just checking with friends, like, hey, is everything cool? I do need a minute. I've seen my colleagues talk to residents, for example, and say, hey, difficult patient scenario. This was a lot. Why don't you just take 10 minutes? Go get a coffee. 10 minutes does not seem like a huge burden And it does seem like someone more able to be like you know what Yeah let me go step away Like take a moment to like refocus recenter Anything just take a moment These scenes in season one that were so incredibly powerful were the flashbacks of COVID. And I cannot even tell you how many colleagues I have who have messaged me. And so like, it was, not only did it hit close to home, but it almost hit too much. I have one friend in particular who loves the show and couldn't watch those scenes. And it caused him to break down because he was like in the he was in the front line in New York in March 2020. And he's like, it was like too much. And then you start thinking about these moments people have where maybe someone didn't check in with them and say, hey, are you OK? Especially when it comes to something like PTSD, which a lot of people in health care have faced. Yeah. I mean, not to generalize, but how much do you think we're still or maybe as like a medical community reckoning with like March 2020, like the height of the coronavirus? Oh, we totally we sadly we we are. directly looking at what COVID did in terms of stressors. You've got the level of burnout went high from 2018 to 2023, burnout skyrocketed across healthcare. But also we've lost funding, we've lost resources, hospitals are still overflowing. Then you have the entire component of public mistrust and the attacks against doctors and nurses, which pisses me off. People can't tell my blood pressure is high right now. You know, there's people in the general public who are like, we don't trust doctors. Doctors are evil. Where are you going to go in an emergency? You're still coming to see us though. Yeah. You know, and it's like doctors are dealing with this every day. So I do think that there's these remnants of COVID that are hitting people. You know, and I've had patients, I've had colleagues actually go through these symptoms when a child is getting intubated or if somebody comes in with a certain scenario or if there's a trauma, for example, and it takes a community to step back and make, are you okay? With more awareness has come more normalization of people going through stuff, people struggling, not just in medicine, but just across the world. When we see celebrated figures, celebrities, artists going through therapy and being public about it, I think it lets everyone know like, oh my gosh, even with fame and money and success, like people go through shit. Therefore, it is okay if I do as well and it makes me a stronger person. If I can celebrate getting a trainer in the gym, I should be able to celebrate getting a therapist in the same way. And so in hospitals, we have physician wellness organizations. There are groups dedicated towards addressing burnout. And there's like, there's teams there specifically looking at that to make sure that people have the tools, they have access, and it's not just pizza parties and yoga picnics, but it's actual like interventional tools to help you. And then people are more open about it. You know, like I have way more colleagues now who talk about seeing their therapist, who like will say things like, hey, I took a lunch break and I like had a video call with my therapist. And we're like, that's awesome. And we like almost celebrate it now. And I see the difference it makes with their patients, with their colleagues. And so with me, what has been more empowering is when I open up about this to colleagues, patients, residents, anyone, the bond instantly. They are like, oh my gosh, that's so cool. And I'm like, because I don't want people to think that any of us are somehow like rock hard and we don't experience things. I want the next generation, if they go through struggles, to know they can be open about it and seek help. I would much rather a resident do that than to hide it and to whittle themselves down because they're trying to be tough and hard and not seem like, you know, they're imperfect because we all are. Yeah. How do you deal with, you know, patients or cases that feel really personally difficult for you? And like how much can you like take that stuff home with you? And how do you not take it home with you? We take it. We take it all home. It's awful. And, you know, everyone, everyone is hit by different scenarios. We see this in the pit and it could involve the personal scenario. It can involve something that pisses you off from a social injustice standpoint, but it hits you differently and you often bring them home. I like when there's breakdowns in social safety nets and somebody is coming to the hospital and they didn't have enough to eat or they were in an abusive scenario or they're homeless and they're going back to that center after the hospital and there's nothing I can do. I'm like enraged. And I think about those cases all the time. if I have a child who's been bullied or assaulted or something, that also really pisses me off. Sexual assault, I'm going to sit there and dwell on that and hope that this person is safe. And you go home and you want to be open about it, but at the same time, I don't want to drop all this on my friends or at the dinner table. So then it becomes normalized. And then it just becomes like a job, like everyone else's job, when I'm dealing with really heavy scenarios, if you know what I mean. that's why it's so important that we have these outlets to go to the break room to go to colleagues and talk about it we see in during pit fest we saw these small moments of dark humor yeah and these moments of the cast kind of making comments to each other like that's cathartic to kind of bond it people use the term trauma bond but to like have those moments when you go out like don't ever go to a doctor happy hour unless you want to hear some stories but that is what we do But I'm sure it's very sort of affirming or gratifying to talk about this stuff with someone who understands it and not with like someone who works in media or art or something like maybe doesn't understand like the specifics of like a high stress environment. Oh, for sure. It would be a much more boring episode of the pit. But we have moments where we will have all faculty meetings to talk about specific cases. And like 30 of us will get in a meeting and we'll talk about a really difficult case. And that's like kind of unpacking it and doing like a debrief emotionally as well as like medically. Exactly. Okay. Exactly that from both. Sometimes people will share stories or talk about like what they would have or could have done differently. And then there's teachable moments as well. And it could be, you know, a patient who is doing better now. It could be people who have passed away. Like someone may have died and we sit and reflect on it. And it's crazy because if I think about the cases that hit me the hardest, they hit me. These are the ones that stick with me. It's the teens who were living their awesome usual teen lives. They were taken away from us way too early. And it puts you back in a place of being a teenager. It puts you back in a place where you were not yet jaded by the world. Some of us were cynical teenagers. So let me just say. But they were just trying to be teens. And the way I see that with teenagers is they might have this horrific illness, but they can still find happiness in anything. which some of us adults have a hard time doing but one of the most impactful things i ever did i've ever done in my entire medical career was with a terminally ill teenager we watched devil wears prada okay yeah i love that we're not gonna cry right now um she passed away though oh i'm sorry um but oh man am i welling up right now we didn't talk about our disease we didn't talk about treatment plans nothing we like we literally sat down it was like towards the end of my shift and one of my colleagues was like you only have 30 minutes left go chill We just watched Devil Wears Prada. Wow. Oh my gosh, you're such a good doctor. At that time, I was being a homie. And it's funny because we were talking about how like Anne Hathaway's character wasn't being properly supported to pursue her dream. We talked about the fashion. We like went all into it. Yes, her bad friends, her bad boyfriend. I have two questions for you to close. First, what can we as potential patients do to help, I guess, lessen the load of medical professionals? Or like, how can we do our jobs better as patients to help the medical community? A. And B, how can the medical community itself, you know, combat burnout, combat all of these maybe trauma responses within the community itself? I think what the general public can do is stay empowered, stay curious, realize that so much of your health is in your own hands with respect to movement, sleep, managing stress, what you're eating, what you're not consuming and not drinking. Like there is a very large amount of preventative health that doesn't cost a ton of money. You don't need to be in an expensive longevity clinic to do all this. I would respectfully ask the general public to stop blaming everything that they find wrong in healthcare on doctors and nurses. It is not our fault. Medical costs in this country are not our fault. The long wait lines you see in ERs, again, like nurses take the brunt of that. Like we see it play out. Patients have to realize that we are all working together in this completely imperfect healthcare system. We've got the same frustrations you do. So I've had families yell at me, straight up yelling that an MRI machine wasn't free for their child. And I'm like, I wish it was. I was like, I think this sucks as much as you do. For doctors, again, I think it comes down to listening. And it's a skill that can never quite be perfected because there's always something for us to learn. But it's learning how to just stop talking, understand where a patient is coming from as a total individual with unique features and then asking for help. And asking for help could be in the form of a colleague. It could be asking a patient if they have an advocate they want to call. It could be calling for spiritual services in the hospital, whatever it may be to realize that like, hey, we are all multifaceted humans doing this together. I like that. Thank you for the work that you do. And thank you for talking to us about it being so open. This was a lot of fun. Oh, this is a deep dive. I appreciate you. That's it for today's episode of the Pit Podcast. You can find us every Thursday right here after an episode drops. And do us a favor, Pitt fans, leave us a question, a comment, a critique, whatever, and maybe we'll include it in a future episode. And a very important personal note from all of us at the podcast. If you or a loved one are struggling with a mental health condition, please talk to a friend, a colleague, a healthcare professional, or use the 988 Suicide and Crisis Lifeline. Help is there. We are all in this together. 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 Edwin Ochoa and Tony Carlson. Our video producer and editor is Anthony Q. Artis with assistant editor Damon Durrell Hinson. This show is engineered by Tommy Bazarian. Special thanks to Joe Carlino. The executive producer of HBO Podcast is Michael Gluckstadt. The senior producer is Alison Cohen-Sorokach, and the associate producer is Aaron Kelly. Technical director is In Sung Huang. I'm Alok Patel. And I'm Hunter Harris. We'll see you next week in The Pit.