noun; a natural or man-made hole in the ground; a home to great nightmares (see Poe, see Star Wars, see Katabasis); a salient location for a trap (see all tropey executions of big-hole-covered-with-unconvincing-leaves); and now, thanks to HBO’s newest hit, an emergency room.
At face value, The Pitt is a medical drama. Certainly, this description is apt. There is medicine, there is drama. Check and check; we can all go home. Grey’s Anatomy tells us exactly what we should expect from shows like this: a soap opera set in a hospital, comforting us in the knowledge that doctors are people too. Perhaps even drawing starry-eyed undergrads to take a few pre-med classes, dazzled with visions of scandalous sex in a hospital closet or a fun flirt-fest with a hot scrub nurse. Medical dramas, as we know them, are glamorous.
But The Pitt is ugly. And its particular brand of ugly somehow allows it to accomplish what few medical dramas have been able to do well: it’s made itself a ghost story.
The show is strictly constructed in an hour-by-hour recount of a single day in an emergency room. No one leaves, least of all the camera. By nature it forces the “drama” to the margins and pulls the “medical” forward: here I am! In so doing, it coincidentally (or purposefully?) adheres to what’s known as “the Aristotelian unity of time”: the idea that theater should take place over exactly the amount of time it takes to consume. Episodes are each an hour long and tell the story of one hour, period. Time is pure. As a bonus, it generally follows “unity of place”: we see the same walls, the same doors, the same waiting room and ambulance bay.
This is groundbreaking for a medical drama and hardly ever done in modern media, simply because there is no place but an emergency room where enough events could happen in a single one-hour time period to make for good, or even bearable, viewing. The purity of time and place in The Pitt is so palpable because there is no “unity of action”, i.e. no central story; every minute a new patient, a new problem, a new question and answer. In clinging to unity of time and place, the show’s strict construction proudly shatters unity of action to dust. There is, in fact, a dizzying disunity of action.
The result is chaos. [Mist billowing out of a room.] It’s not a comfort watch; it’s gory and busy and loud. [Baby crying.] Despite its narrative rules, it’s in no way insulated from the outside world: there are mass shootings, hate crimes, nurses dragged away by ICE. [Victim of partial impalement wandering idly by.] We know what’s happening out there, but in here… it’s still happening, and it is closer to you, and you are now responsible for watching the suffering it causes. [Violent seizure.] Here I am! The characters, in turn, are predictable: a director with a tough exterior, an arrogant wisecracking fourth-year, a child prodigy fighting to escape her parents’ shadow, et cetera. [Complaint about stomach pain.] They more or less behave how you would expect, even amidst the [loud unattributable noise offscreen].
With every episode chock-full of noise, body horror, and healing, we’d expect there to be no downtime for the characters to process what they do. You may have heard that “every surgeon carries within himself a small cemetery, where from time to time he goes to pray”, an idea put into words by French physician René Leriche. But, importantly, Leriche’s surgeon has a time where he is working and a time he “goes to pray”—implying that this theoretical cemetery can be visited or left at will. This is a luxury that emergency rooms do not afford. With the chaos wrought by The Pitt’s Aristotelian unity, there is no opportunity to pray at such a cemetery (multiple moments of silence following various patients’ deaths are comically interrupted by sudden noise). So where, then, do these ghosts go? Early on, fourth-year resident Dennis Whitaker struggles with the death of his first patient, but until the final episodes of the season, he’s the only one seen doing so. When patients die on the table and the camera immediately moves on, where do these ghosts collect themselves?
Instead of an orderly cemetery, what we get is a haunting. Here I am! In her exploration of what she calls “phantasmagoria”, Terry Castle tracks the cultural shift of the phantom from external to internal. She speaks of “spectralization”, or “the absorption of ghosts into the world of thought”: rather than the characters visiting the cemetery, the cemetery visits them. This is the ground from where ghosts emerge and the space they occupy.
In the show’s most famous scene, the emergency room director, Dr. Robby, breaks down sobbing in a corner surrounded by victims of a mass shooting. Having struggled with (and repeatedly banished) intense PTSD from the Covid era, Dr. Robby is literally and figuratively surrounded by ghosts. In a room where he previously witnessed death, the still-warm victims around him explode out of Leriche’s cemetery. Here, amidst the newly dead, we see flashbacks: memories of people who the audience has never truly met, people who passed in this same room before the events of the show. Unity of time is shattered. The dead do not, or cannot, obey it. In a swirling mass of memory, Dr. Robby recalls the dead in the room from the shooting, the dead over the course of the day (which the show has taken great pains to distract the audience from), and the dead who had passed long before this day. He covers his face and clutches a Star of David, reciting a Hebrew prayer: here, he is literally shielding himself from these ghosts. As Castle says, phantasmagoria affirms the idea that thoughts can “materialize before us, like phantoms, in moments of hallucination, waking dream, or reverie”: here, the ghosts say, I am.
And here they are. With painstaking care, Dr. Robby even lists them out loud—the viewer can neither ignore nor forget the deaths that have peppered the day and been hustled quickly away. This, again, is the big distinction between The Pitt and other medical dramas. The dead do not remain politely in their cemeteries for Leriche’s surgeon to visit whenever he sees fit. They bulge out of every pore of every interaction, at times powering the living, at times overwhelming them.
If you can’t already tell, I love this show. As a ghost story, it is incredibly effective. A small girl drowns; a misdiagnosed patient has a heart attack; parents struggle to accept the brain-death of their teenage son. Where are more ghosts to be found than a house of healing? An emergency room, The Pitt shows us, is a haunted house. Success stories are many, and for one death there are dozens of people who leave the emergency room in a much better state than they entered. But over the shoulder of every healthy person looms a loss too great to name.
It is as so in medicine, where the joy of saving hundreds can only be countered by the immense grief of failing to save one. Despite the chaos, each death gets—or, rather, fights for—its due. There is noise around you—there is always noise, there will always be noise—there is no line between the noise around you and the noise in you—mind itself the ghost—cut through the noise?—woven into every corner—technical difficulty—moment of silence—do your good work—these unprecedented times—should you laugh?—band-aid here—hold hands across the table—parsing through this—narcan and sleep—stitches and a hot shower—charge to 200—save amidst the unsaved—waking visions bursting forth—they sing—they sing—listen or not—look, or shield your eyes.
2026