Producers of “The Pitt” insist the show doesn’t pick medical cases for shock value. But they are still often shocking.
Throughout its run so far, the series, about a Pittsburgh emergency room, routinely presents cases that test viewers’ gag reflexes with protruding bones, visible organs and buckets of blood. (Season 2 is still arriving weekly on HBO Max.)
In a video interview, R. Scott Gemmill, the creator, explained that the writers rarely start with the medicine, looking instead for circumstances that fit the stories they want to tell about the Pitt’s medics. (One exception: the nun who came in earlier this season with gonorrhea in her eye.) Then doctors on staff like Dr. Joe Sachs, an executive producer who is still a practicing emergency physician, suggest ailments drawn from their professional experience.
“We always send out these emails that have visual warnings, because they’re real stuff,” Gemmill said. “Some people don’t respond well to that, whereas some of us are like, Oh that’s gnarly, cool, let’s do that.”
Once the scripts are written, Myriam Arougheti, the head of makeup, and her team work with the props and special effects departments to get the grossness just right. Here’s how they created seven gory afflictions.
The degloved foot (Season 1, Episode 1)
One of the first questions Sachs got in the writers’ room was: What would make a medical student like Victoria Javadi (Shabana Azeez) faint on the job?
“It’s like, OK, we’ve seen the chest open,” he said. “And I thought back to a case that I had with the degloved leg, fracture dislocation, pulling a degloved foot back into place.” In the show, a woman (Arun Storrs) is pushed onto train tracks, and viewers see the bloody effects of the skin being pulled away from the limb.
For any piece, Sachs sends Arougheti reference photos that she shares with a special effects shop. In this case, the effects house took a cast of the actor’s leg and sculpted the exposed veins and muscles on top of it. Arougheti then painted the silicone leg to match the actor’s skin tone. For shooting purposes, the crew built a trick gurney and hid the performer’s real leg inside.
“We strap the fake leg at her hip, and it’s hidden with clothes, and her leg is in the table,” Arougheti said. “And then we can do whatever we want to it, because it’s not hers”
The baseball to the eye (Season 1, Episode 10)
Arougheti is rarely phased when she watches footage of real medical procedures for reference, but even she was unnerved by a clip in which doctors cut into a patient’s eyeball in order to relieve pressure.
“I had to watch it over and over,” she said. “That one really freaked me out.”
On the show, Pitt doctors must do this to a teen (Mac Jarman) who was hit in the face with a baseball. Arougheti determined that the only way to get the close-up shot the producers wanted was to make an entire fake head.
“We did as much as we could with the real actor, and then we took him out of there and this head was on a pole,” she said. A puppeteer was stationed underneath the gurney to push the eyeball in and out and make it look like it was bulging.
The arm maggots (Season 2, Episode 2)
An unhoused man named Mr. Digby (Charles Baker) is a recurring character in Season 2. He arrives in the emergency room filthy, with a cast on his wrist. When Dr. Samira Mohan (Supriya Ganesh) cuts off the cast, there are maggots crawling on his arm.
“The reality is with unhoused people, the worst thing is sometimes they wear their socks for so long that their skin grows through them, and you can’t even take their socks off,” Gemmill said. “So we were trying to capture an element of that.” (He didn’t know how to recreate that specific phenomenon, he said, but “maybe one day I will challenge my art department, my prosthetics people to do that.”)
The diseased skin beneath the cast required “a bit more artistic creativity” than most cases, Arougheti said. Then came the maggots, for which living wax worms, a kind of moth larvae, were used, monitored by a representative of the Humane World for Animals (formerly called the Humane Society of the United States).
“Wax worms don’t stink,” said Rick Ladomade, the props master. “They move around a lot, so that’s why they are so good on TV.”
The transected trachea gunshot wound (Season 2, Episode 7)
In last week’s episode, Dr. Jack Abbot (Shawn Hatosy) arrives with a SWAT officer who was shot in the neck during a robbery. For reference, Sachs said, they watched a real trauma center video of a transected trachea, or a windpipe that has been cut crosswise, jeopardizing airflow. Dr. Abbot intubates in the field, so the patient arrives with a balloon already in his neck. When it is removed, the blood starts bubbling.
How do they achieve this? “Honestly, I use Mr. Bubble,” Rob Nary, the special effects coordinator, said. “I have a lot of secrets.”
The Pitt doctors worked on an assemblage of prosthetic throat organs that had been glued onto the actor’s neck. A hidden tube ran behind the gurney and connected to a hose that controlled the blood.
The tongue laceration (Season 2, Episode 8)
This week’s episode included one of Arougheti’s favorite sequences of this season. A drunk girl (Briana Burnside) arrives at the Pitt having nearly bitten through her tongue while posing for a photo with her equally drunk friend. The tricky thing is: The laceration is at the back of her tongue, a scenario Sachs has encountered in a real E.R.
“You can’t access it to sew it, so you put a giant suture in the tip of the tongue and pull the tongue way out like a Tex Avery cartoon,” he said.
Arougheti said the team considered building a fake head, but the character had to be awake. Instead they made a cast of the actor’s tongue and built three different versions of the injured organ, attached to a retainer. For each step in the process of stitching the tongue together, they popped a new tongue into the performer’s mouth.
The margarita burn (Season 2, Episode 8)
Because the current season takes place during a July 4 shift, the writers brainstormed ideas about what could go wrong during the festive holiday.
One of the grossest and most unexpected ailments they landed on was phytophotodermatitis. Known as a margarita burn, it is a rash caused by exposure to sunlight with certain plant chemicals — in this case lime juice.
“I didn’t even know that could happen, and I’m a margarita drinker,” Gemmill said.
Rather than give the afflicted actor (Ryan Brophy) prosthetic limbs, Arougheti’s team painstakingly applied fake blisters to his real skin. Getting the right color and feel required a lot of testing.
“The margarita burn was incredible, incredible fun,” Arougheti said.
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