Inside The Pitt’s Stunning Mass-Shooting Episode: “It Felt Intimidatingly Important”

This article contains spoilers for the 12th episode of The Pitt, “6:00 P.M.”

Noah Wyle has felt a bit disingenuous talking about The Pitt with friends and family. Until now, the star and executive producer of Max’s hit medical drama has had to keep its trajectory to himself—specifically the sharp, harrowing turn of this week’s episode. “You can look at the first 11 episodes as one series,” he tells me, “and then it becomes a whole other show in its final act.”

Structured like ER meets 24, The Pitt’s first season depicts a full shift at a Pittsburgh emergency room, one hour at a time. Max accepted this initial pitch from creator R. Scott Gemmill with one caveat: The network wanted the first season to consist of 15 episodes, not the 12 hours that would be covered during a typical ER shift. So for the first 11 installments of The Pitt, viewers bear witness to an ordinary, if unusually dramatic day in the ER. “The question was, what would keep people around for another three hours?” says Joe Sachs, a real-life emergency physician and Gemmill’s cowriter on this episode. (The pair previously worked together on ER.) The 11th episode’s devastating cliff-hanger revealed the answer: a mass shooting at a nearby music festival. As a result, all of the doctors and nurses we’ve come to know must stay in the hospital—with intensely raised stakes.

television critics and actual medical workers. Here, as in the rest of the show, authenticity ruled the day. “With mass shootings, they’re in the newspaper every week. Everybody’s numb to it,” says Sachs. “We thought, Let’s see the tragedy of what really happens—the families that have to deal with grief and loss, and the tragedy of the psychological and moral trauma to the emergency physicians.” Episode 12 follows couples separated by violence, parents wondering if their children are alive or dead, and impossible choices on how to allocate care amid so much trauma.

When he first got to devising The Pitt, Gemmill had about 100 scenarios he’d jotted down for potential exploration in the show. Gun violence was one of them. “We are as strong or as fragile as the mental health of our practitioners, and nobody gets out of this experience of being a career physician unscathed,” as Wyle puts it. “They’re dedicated and fallible and human, but also hurting and burning out and in a system that lends itself to madness.”

Sachs serves as a medical adviser on The Pitt. For this episode, he spoke with physicians who were present for a range of real-life mass-casualty events: Columbine in 1999, Aurora in 2012, Las Vegas in 2017. He put all of the research together and, with Gemmill, scripted a version of events as realistic and detailed as possible.

This meant essentially rebooting the production. “The first day of episode 12 was very much like the first day of episode one,” Sachs says. In mass-casualty events, hospitals clear out ERs to make room for the dozens, maybe hundreds of victims in critical condition who are arriving near-simultaneously. And so it went on The Pitt: The many patients who’d been in the background for the preceding 11 episodes were removed. The segmented spaces for shooting had to be collapsed together.

Production designer Nina Ruscio built a mini model of the set that took up a whole conference table, filled with small beds and gurneys demarcated by scene number. “We had 50 patients in these big, open spaces, meaning that anytime you’re working on one patient, you might see 12 other patients all being worked on at once—that background all had to look real,” says Sachs. Amanda Marsalis, who directed the episode, adds, “We took pictures for every single scene, where every single patient was going to be and where they were going to move to and who was going to be next to them.” Any error in any corner of the frame—a prop mishap, a missed shot, a flubbed line—required a full reset.

“We love doing thoracotomies, and we do them very well. When we’re feeling really ambitious, we might stage two traumas in rival rooms so we can cut back and forth,” says Wyle. “We were doing that times 100 here. We had thoracotomies going six deep. We were intubating seven deep. Everybody was all hands on deck. Everybody’s in frame the entire time. Everybody’s in the shot the entire time because the camera’s spinning 360.”

This weighed particularly on Shawn Hatosy, who portrays Dr. Jack Abbott, the senior attending physician alongside Wyle’s Dr. Michael “Robby” Robinavitch. Hatosy hadn’t appeared onscreen since the pilot, where we see Abbott reeling from a difficult shift and gearing up for his day off. With all hands on deck, he returns to help out as best he can.

While Abbott is one of the most senior people in the hospital, Hatosy felt like a total newcomer when he arrived back on set. His costars had been in the Pitt trenches for months since he’d last acted alongside them. “It’s all choreographed so thoughtfully, and everybody’s working together in synchronicity, and there’s 100 people for one take—and then all of a sudden it’s your turn to talk, and you’ve got to say something crazy like ‘widened symphysis anteriorly,’ and you hope you don’t screw up. Because if you do, the resets are intense,” Hatosy says. “I felt pressure. I’m sure other guys did too. But I’m sure Noah feels no pressure, because he secretly has some sort of training that we don’t all know about. He seriously is the Laurence Olivier of doctor acting.”

The Pitt’s 12th episode finds Dr. Robby reaching his breaking point. His stepson, Jake, was at the music festival where the shooting occurred, along with his girlfriend. Their fate remains unknown for much of the episode, with Robby having to perform heroic work on a minute-by-minute basis while fearing the worst. “He seems smart, he seems capable, he seems fatherly, he seems competent, he seems compassionate—and then you see him fall down,” says Wyle, who’s also part of the Pitt writers room. “This is a look at the toll that it takes on the people who take care of us…. Patients are getting sicker, patients are getting angrier, but [these doctors] are making less money—it doesn’t compute.”

Especially once you see the work being done. Patients arriving at the hospital receive rapid 10-second evaluations from the professionals assessing them: Can they talk? What’s their pulse? Operating room or ICU? Then off they go. Sachs learned about this process from his research into the 2017 Las Vegas mass shooting. “I was so surprised by the absolute absence of technology in the assessment and management of the patients—no X-rays, no CAT scans, no lab tests,” he says. “Just do what you have to do.”

Sachs asked frontline providers what they wished they could’ve done to save more lives, but weren’t able to execute in the moment. “In Las Vegas, they were either writing on the bedsheets, or actually writing on people’s foreheads, the care needed in the first hour,” he says. In The Pitt, however, medical professionals attach slap-band charts to each new victim of the shooting. It’s a quick, efficient mode of identification and treatment planning. These bands haven’t been used in this kind of mass-casualty setting before—meaning The Pitt effectively presents a new, research-driven path forward.

“We tried to show the best way that the emergency department can react in such a situation,” Gemmill says. Adds Wyle, “I think what [Joe] has come up with is pretty revolutionary and brilliant, and if that ends up ever being implemented and saving lives, the show has a resonance well beyond just being entertaining.”

The next step was visually conveying the wreckage of a mass shooting. The show’s crowd makeup designer, Leesa Simone, created a look book with breakdowns of all 109 patients who enter the hospital in episodes 12 and 13. It detailed every aspect of their needs for makeup, costume, and props. Gemmill explains why this was crucial: “Depending on where the gunshot was, it’s like, ‘Okay, this person is shot in the chest. That means we have to have a wound; we have to have bloody clothes torn apart. And they were working in a food truck, so they have a chef’s towel that they’re holding up to it.’” The prosthetic work also proved elaborate: Makeup people would stand off-camera mid-shoot, blowing into a tube to create the effect of a chest piece filling up with air.

“The air from the lung is seeping in between the skin and the chest wall, so the chest is literally expanding—and then they make cuts, and it goes down deeper,” says Gemmill. “That was a full, blended chest piece, with air bladders underneath.” As with the actors, this process left no room for mistakes. “If you’re going to do a medical procedure where 50 instruments and gauze pads and everything are going to get dirty and bloody—and you’re going to do 12, 15 takes between the master and the close-up shots—the team has to be able to jump in and reset everything to one.”

This episode showcases The Pitt at the top of its game. Thanks to the set’s design, the show’s scenes are filmed mostly in chronological order—a true rarity in TV—and it’s easy for the actors to become one with the environment. “Gurneys are coming in, the blood is real, the people are real—you’re touching them, you’re feeling it, you’re experiencing this stuff with your hands,” Hatosy says. “There’s really no acting involved. You are riding the train, and you’re going where it goes, and you can feel it. It gives you just such a rush.” This episode moves so quickly that though the script ran 76 pages, its final runtime came in under 40 minutes.

Even amid the chaos, each of the show’s main characters gets a spotlight. Third-year medical student Victoria Javadi (Shabana Azeez) finally gets out from the shadow of her mother, a respected veteran doctor in the hospital. After being assaulted a few hours earlier, charge nurse Dana Evans (Katherine LaNasa) outlines an order of operations and keeps things running smoothly. “We tried to give everyone a moment to shine—something unorthodox, to show their creativity and guts,” Gemmill says. The writers worked off of an intricate maze of a story map to connect all of the dots: “It looks like a whole game of life, where we just know every patient, we’re tracking who’s with them and the doctors.”

But of course, the crux of the drama comes down to saving lives—in this episode more than ever. “You’ve got all these characters that are immersed in their own personal dramas and their own storylines, and then when something like this happens, much like in life, that all stops out of necessity,” Wyle says. “It felt intimidatingly important to execute well, in order to land the plane where we wanted to gracefully.”