WARNING: Spoilers ahead.
As “The Pitt” concludes its second season, MedPage Today takes a closer look at the finale through the perspective of an emergency physician.
Practicing emergency room (ER) doctor Jeremy Faust, MD, editor-in-chief of MedPage Today, reacts to the episode’s most intense moments — from a life-threatening case of eclampsia requiring an emergency resuscitative hysterotomy to the emotional closing scenes centered on physician burnout and mental health.
Click here for more analyses from Season 2 of “The Pitt.”
The following is a transcript of his remarks:
Faust: Hello everybody. Jeremy Faust, editor-in-chief of MedPage Today, and it is the season finale of “The Pitt” Season 2. So let’s get into it.
“The Pitt” clip: 4 Minute Rule
OK, so what’s happened here is the patient’s progressed from preeclampsia to eclampsia. They had seizures. They actually intubated the patient and paralyzed the patient. Meanwhile, because this patient is pregnant and is full term, there is this issue that you have really two patients at once. You have the mother and the fetus. The patient does go into a cardiac arrest and so they have to start doing CPR and we’ll see what happens here.
So you see there that what he’s saying there is we’re about to have two patients, not one. We’ve got a mother who’s full term, but we’re about to have two patients because “prep the belly” means we’re going to do an emergency c-section in the ER. And we’ll discuss that as it comes.
So a lot going on here. Again, correct. The postmortem c-section — meaning the mother dies but they do a c-section to try to save the baby — that’s not a term that’s really useful anymore, and we use the term resuscitative hysterotomy. The other issue here is of consent. The patient came in, kept saying they didn’t want anything, but it’s pretty much assumed consent when somebody dies, unless they have said otherwise, that you should take all the measures that you can to save both the mother and the fetus.
What I will just say is people are going to ask, “How realistic was that?” And the answer is: quite.
Preeclampsia — high blood pressure in a pregnant patient with other symptoms, very frequently headaches, other things like protein in the urine, which can cause kind of a bubbly urine — this is in itself a risk factor to go to a much more serious condition, which can be threatening to the mother and the fetus, of eclampsia, which is marked by the seizures we saw, which can lead to cardiac arrest, and in this case, the need for an emergency crash, resuscitative hysterotomy right there in the ER.
“The Pitt” clip: Robby’s Demons
All right. The one patient who has been there the whole shift, but who has not really been seeking care, and that is Dr. Michael Robinavitch, Dr. Robby.
And his mental state has really deteriorated over time, over this shift, and he has in some ways made a lot of progress. He’s gone from not talking about it to actually saying the words that are concerning enough that you wouldn’t have to be a psychiatrist or an ER doctor or any other kind of clinician to know that he’s having suicidal thoughts. He comes out and basically says, “I don’t know if I want to be here anymore,” meaning here alive. And his colleague here, Dr. Abbot, is talking him through what’s difficult about their job and why it’s important to seek help.
I think it’s so important that they have this conversation right after, as Dr. Abbot points out, an amazing lifesaving intervention that these two doctors were a part of. So for Robby to say, to feel this way in this moment tells you how much bigger it is than just a bad case or burnout.
Even in a moment where you did the most heroic thing, it’s hard to overcome a mental health struggle like suicidality. And what Dr. Abbot’s saying here is, that’s OK, but you have to own that.
And lastly, we come to the end of this all of this season, the final scene, which is not so medical, but I do think that it’s about balance and it’s about burnout and it’s about mental health. And Robby has been struggling with these issues as we’ve been discussing. And it really made me think watching this that you have to have something outside of those walls that yes, as Abbot and Robby said, the best things they ever do maybe are in that hospital, but actually, is that really true?
Well, let’s watch.
“The Pitt” clip: You Are Not Alone
I think it speaks for itself. It’s beautiful, sad, and hopeful. And I guess we’ll see what happens in Season 3.
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