
[I planned to write this post two weeks ago, but then international travel got in the way. In the interim, my book Track Changes won the British Science Fiction Association award for best long non-fiction. You can read more about that, and the now-open voting for the Hugo awards, where Track Changes is also nominated, on my blog.]
In the summer of 2024, the estate of Michael Crichton sued Warner Brothers for breach of contract. The estate had been in negotiations with the studio to produce a sequel to 90s megahit hospital series ER, which Crichton created. After negotiations broke down, WB greenlit a show called The Pitt, starring ER alumnus Noah Wyle and produced by two of that show’s former showrunners, John Wells and R. Scott Gemmill. The estate’s claim is that The Pitt, which is set in a Pittsburgh emergency room where Wyle’s character is the chief attending physician, is just an ER reboot with the serial numbers filed off.
The Pitt aired its first season on Max in the winter and spring of 2025, and having watched that season, I have to say that the Crichton estate has a strong case. And since I don’t actually care about Hollywood legal shenanigans, let’s talk instead about why that is a remarkable and unlikely achievement. These days, ER is probably best remembered for launching George Clooney’s stratospheric career, or for killing characters by dropping helicopters on them, but besides being a hit on a scale that simply doesn’t exist on TV anymore, it was also a major stepping stone in the 90s ramp-up to what eventually became known as the Golden Age of TV. There were hospital shows before ER, but what it brought to the table was a raft of formal innovations—cinematic-style shooting techniques, high-octane storytelling, and a deliberately contained setting (in its early seasons the show rarely left the emergency room, and details about the doctors’ and nurses’ lives were scarce)—as well as seriously skillful writing. A typical ER episode would weave together the stories of one-off patients who show up in the emergency room and then move on, follow up on patients whose sagas were more complex, dip into the staff’s personal dramas, and tie all these storylines together into something that not only felt like a single, complete episode of television, but that usually left you feeling breathless and wrung-out by the time the credits rolled.
In the era of steaming TV, these achievements are at once commonplace and vanishingly rare. The technical aspects that once made ER look like nothing else on TV are now mostly par for the course, while the ability to write a coherent episode—much less craft one out of multiple storylines—is nearly a lost art. It was hard to imagine that a show in 2025 could capture what made ER special, and yet within a few minutes of watching The Pitt‘s premiere, it was clear that this had happened. To be sure, there are places where the newer show falls short—in particular, the dialogue is sometimes clunky and over-obvious, with characters delivering what feel like PSAs rather than organic speech. But for the most part, watching The Pitt feels very much like tuning into the latest episode of ER back in the 90s—the same intense, propulsive shooting style (Film Crit Hulk has a very good essay about the deceptive simplicity of the show’s trauma scenes; how they convey an immense amount of information and emotional impact while remaining entirely coherent, usually without ER‘s go-to pulse-pounding music and raised voices); the same well-crafted, episode-focused storytelling; the same feeling, at the end of each hour, that you are both exhausted and desperate for more.
What’s particularly impressive is how The Pitt does all this while also setting itself the goal of talking about how medicine has changed in the last thirty years, and how that reflects changes in the society and country outside the hospital. It feels almost like a thesis statement for the show when, halfway through its premiere episode, an elderly patient is transported to the emergency room ensconced in a halo which is operating an arm that presses rhythmically on her chest—an automatic CPR machine. Other technical innovations are either constant background presences—the increased use of computers and tablets to keep track of patients—or suddenly startling—did you know that if you need to quickly start a fluid line, there’s a device that lets you do that by drilling directly into the bone? Often when doctors on the show perform risky or unorthodox procedures, they cite papers that turn out to be real, published case studies.
For the most part, however, the changes The Pitt charts are of a darker variety. Wyle’s character, Dr. Michael “Robby” Robinavitch, has to shepherd nurses, residents, and a gaggle of newbie doctors on their first day of an emergency medicine rotation, not to mention an endless stream of patients complaining of everything from scrapes and bruises to full-body burns and injuries from being pushed under a subway train. But at the same time he also has to juggle the hospital’s demands that he raise patient satisfaction scores even as management refuses to hire more nurses. To manage patients who will spend their entire hospitalization in an emergency room bed even as a whole ward remains closed because the hospital hasn’t allocated funds to staff it. To fob off a private equity firm looking to take over the unprofitable emergency department by advising doctors to pad their charts.
In many other ways, too, the state of America in 2025 is reflected in what occurs in The Pitt‘s emergency room. The ER’s dedicated, no-nonsense charge nurse (Katherine LaNasa) is attacked by disgruntled patient who was previously raving about how he now lives in a “third world country”. Patients scoff at masks and vaccines. An attending who is a veteran brings techniques he learned on the battlefield to a mass casualty event. And looming over it all is the lingering trauma of COVID, of the intense demands made on medical teams, and of the losses they suffered.
The Pitt‘s one innovation on ER‘s structure—what will presumably form the backbone of WB’s defense against the Crichton estate’s lawsuit—is the fact that the whole season takes place over the course of a single shift. This poses some storytelling challenges. For one thing, even without the aforementioned mass casualty event, the single shift that the series follows encompasses a simply dizzying number of complicated traumas and tragic cases—as a real emergency room doctor told Vulture halfway through the season, if any real shift was like this, all doctors would quit their jobs. For another, it means the scope for character growth and change among the show’s main cast is necessarily limited, and reserved mostly to the new doctors who spend the day figuring out emergency medicine from the ground up—nervous, nerdy medical student Whitaker (Ludwig‘s Gerran Howell) who slowly reveals a steely core; confident hotshot Santos (Star Trek: Picard‘s Isa Briones) who struggles to accept that she still has things to learn. For the more experienced characters, the season does more work revealing their characters and relationships than developing them, and one wonders how sustainable this will be going forward. (For that matter, the format of a single shift per season practically demands that some of the cast will not return next season, which will be difficult for a television production to do.)
At the same time, the compressed structure can help put audiences in the characters’ headspace, and bring home the reality of the kind of work they do. Patients can feel incredibly important and urgent for the two or three episodes in which they appear, and then like a distant memory just a few hours later, because to the doctors, as well as to us, so many other cases have turned up to demand our attention. The first half of the season is spent accompanying two shellshocked parents (Brandon Keener and Samantha Sloyan) who rush their son to the emergency room with a fentanyl overdose, as they first come to terms with the fact that he is brain dead, and then adjust to the idea of donating his organs. By the time they leave, they feel like main characters, and yet by the end of the season they’ve almost been forgotten in the rush of other cases.
Other times, stories are left unfinished. A concerned mother brings her son to the ER on false pretenses because she fears he’s planning to commit a crime; at the end of the shift, Robby observes that the boy will probably spend his entire 72-hour psychiatric hold in the ER, and who knows whether that will do him any good. Most startling is the handling of the mass casualty event. For two hours, the show—and the emergency room—transform into a field hospital, as over a hundred severe cases are treated with furious, and sometimes ruthless, efficiency. And then the cases stop coming, the blood is mopped up, and everything goes back to normal. The sprained wrists and spiking fever cases wander back in, and you realize that what felt like a culminating storytelling event is just one part of the day, after which everyone has to get on with doing their job. For some of the doctors on The Pitt, this is a reality they can still cope with; for others, it may be more than they can bear.
Much of the conversation that The Pitt has inspired since becoming a runaway success (the show has already been renewed for a second season, which its producers promise to deliver next year) has focused on its uniquness in the current television landscape. “It’s a streaming show that feels like a network show” is the narrative that has emerged, and inasmuch as that’s true (and it is mostly true) that is a black mark on the entire streaming ecosystem, and its failure to create a model that attracts and retains audiences. But I don’t think that’s the conversation The Pitt itself wants us to have. I think it would rather leave us thinking about how there are scores of talented, hardworking, dedicated people who show up every day to clean up the mess that occurs when every other system has failed, and how, as those systems fail more and more, those people will eventually fall away. A show with the reach and visibility of ER could make a critical mass of people think about these issues; let’s hope The Pitt can as well.
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