The Pitt and the Presentation of Mass Shootings in Mainstream Entertainment
In its series finale, the hit medical drama takes on the chaotic tragedy of a mass shooting
By: Matt Valentine
So far, critics love the new Max medical drama, The Pitt. Told in real time (like Fox’s long-running 24), each episode recounts one hour of a shift for the emergency room staff at a Pittsburgh hospital. A typical ER shift is 12 hours, but the network wanted a 15-episode season, so the writers had to come up with a scenario that would keep these characters on duty for an extra three hours. That’s why the plot takes a heavy turn in episode 12, when the hospital staff receive mass casualties from a shooting at a nearby music festival.
Television has struggled to depict mass shootings accurately and ethically. How, in entertainment media, do you portray horrific violence in a way that doesn’t seem exploitative or gratuitous? Often, television represents mass shootings without actually showing any dead bodies or wounded victims.
For example, the season six premier of Sons of Anarchy ended with a student entering a parochial school with a fully automatic weapon, accompanied by screams and the sounds of offscreen gunfire. Similarly, an episode of Glee depicted a school shooting from the vantage point of students sheltering in the choir room.
They can hear the violence around them, but they don’t witness it — and neither do viewers watching at home.
In The Pitt, we don’t see anybody getting shot (at least not in the episodes that have aired so far), but we do see grievous injuries and dead bodies. One dumbfounded patient tells a doctor that the same bullet that went through her arm also struck her husband in the head. A police officer is treated for a bullet wound that entered his neck and exited through his cheek, destroying half his face. Custodial staff continuously mop blood from the floor, but there’s still so much that people slip in it. The pediatric unit is repurposed as a temporary morgue.
This violence is extreme, but not gratuitous. It serves a purpose — to demonstrate how a single gunman can overwhelm the talents, training, and resources of an entire hospital staff.
Throughout the series, protagonist Dr. Michael “Robby” Robinavitch (Noah Wyle) has been haunted by traumatic memories from the COVID pandemic, another experience that pushed medical professionals beyond their capacities. Unlike the novel viral pandemic though, mass shootings are foreseeable, and hospitals have detailed protocols about what to do when one occurs.
The showrunners felt an obligation to portray these procedures accurately, and brought on real-world medical professionals to consult and even co-write episodes.
When the hospital gets word of the shooting, the intercom announces “code triage,” and the senior staff jump into action telling new doctors and medical students what to expect and how to help. They clear the existing patients out of the emergency room and wheel out huge plastic storage tubs marked “MCI” (Mass Casualty Incident).
They produce color-coded slap-on wristbands, which they will use to separate victims into categories: those who are dead or beyond saving; those who will die in minutes without medical intervention; those who could die within hours; and those with less serious injuries. Since there’s not enough time to determine each patient’s blood type, everybody gets type O (O positive for older patients who are more likely to tolerate it, O negative for everyone else). And since there’s not enough type O on hand, more is delivered by helicopter or donated by staff onsite.
There’s no time for lab work or imaging. When supplies run short, doctors improvise. “A tube is a tube” says one medical student, MacGyverring a method to drain a patient’s chest cavity — a detail clearly cribbed from actual accounts of heroic medical efforts following the Pulse Nightclub shooting in Orlando.
Doctors arrive from the night shift, including one with military experience who has brought his “go bag” containing first aid supplies typically only used on the battlefield. Some patients arrive by ambulance, but most by car, sometimes stacked in a back seat or cargo area. Instead of placing an intravenous line, doctors drill into bones to place intraosseous access points, so they can transfuse blood and medicine directly into marrow (it’s faster).
Another aspect of mass shootings that The Pitt attempts to illustrate is the uncertainty and panic of friends and family trying to find loved ones who might be among the victims. A hospital social worker asks the gathering crowd to submit names and photos of missing people. She uses a smartphone to photograph identifying features of the dead, such as tattoos, to show to possible relatives. These scenes are a glut of grief that many viewers will find overwhelming.
There is plenty of real-world source material about how American hospitals respond to mass shootings. Most American cities, including Pittsburgh, have had to face these horrors in real life. In what has become a grim demonstration of solidarity, hospital staff who have previously responded to a mass shooting will commonly send pizzas to staff at the next hospital to face a similar nightmare.
The Pitt gets a lot right.
But this is a TV drama, and the show still has a storytelling obligation to advance plot lines established earlier in the season. Doctors squabble with each other about personal and professional grievances; family problems follow people into the ER; there are even a couple of jokes. Some of these moments feel out of place.
In my reporting on gun violence issues, I’ve interviewed many people directly affected by mass shootings, including doctors, survivors, and the family members of victims. I watched the multiepisode, mass-shooting arc of The Pitt worried that the show might make a misstep that disrespects the real tragedies it aspires to depict. It would be a huge mistake, for example, to make a sympathetic character of the shooter, or to lionize a “good guy with a gun” who saves the day — a circumstance that does sometimes happen, but less frequently than dogs shoot humans.
It looked briefly like the show might pursue one of those problematic story lines. Earlier in the season (meaning earlier in the same day), a woman comes to the ER seeking help for her teenage son, who has composed a list of girls he wants to hurt. Despite some initial misdirection, it appears that her son is not the perpetrator of the mass shooting. Doctors put him on a 72-hour psychiatric hold anyway, all the while debating whether this is an appropriate or effective intervention. (The actual shooter, we’re told, has killed himself.) Even though the show has so far avoided some narrative pitfalls, I recommend that anybody personally affected by gun violence sit it out. It could hit too close to home.
The biggest complaint I have about The Pitt is that it neglects to represent the far more common manifestations of gun violence encountered in hundreds of emergency rooms across the country every week.
Except for a blink-and-you’ll-miss-it glimpse of a gunshot patient being discharged in the first episode, we don’t see anyone injured by commonplace gun crimes, or by a negligent discharge, or in an argument that escalated to a shooting, or by an attempted suicide, or as the consequence of unsafe storage around children.
Mass shootings may indeed be the sort of spectacles that make for hit TV, but they offer only a constricted view of the larger picture of gun violence in America.
The season finale of The Pitt streams tomorrow, Thursday April 10, on Max, at 9 p.m. EST.
Matt Valentine is a writer based in Austin, TX. His commentary on gun violence and related issues has been published in The Atlantic, The Washington Post, The New Republic, Politico Magazine and elsewhere.
