Content note – discussion of suicide, drug use, workplace violence, mass shootings, probably some other grim emergency room material

The Pitt is a 2025 TV medical drama set in a fictional ER in Pittsburgh. It won three Emmys the other night, partly for being very well acted and well written, with great characters, but also because it speaks to us. It says something about modern labour, about what work means in the modern day. It feels like a memoir of its time. I think that’s part of its success. In concept, the show is a cross between 24 and ER: it’s set in an American emergency room (and stars Noah Wyle from ER as the main character), and each episode is a subsequent hour of a single day’s shift. Episode One starts at 7am, and Episode Fifteen closes out at 10pm. It feels relentless. It’s slow but fast – everything is urgent and very little gets done. There’s always a crisis, always something coming in, someone new who needs life-saving medical care with no warning or prior notice. Staff lurch between disasters. They work in a constant state of catastrophe, either present in the moment or about to occur – and you just stop me when this starts to sound like the modern workforce. The show is set in the context of the emergency department, in the specific historical conditions of that environment, but it speaks to broader trends across society. It resonates with a labour market built on fixed-term contracts, layoffs, restructures, and the constant churn of corporate enterprise that cultivates a sense of precarity within the workforce. Nothing is ever stable: the next hit is always coming.

For the newer doctors on the show, the environment is overwhelming, and several of them step out to self-regulate, or break down as they encounter early fatalities. Older hands are more jaded, but suffer in different ways, as the long-term exposure to stress takes a toll on their bodies. Key themes among senior staff include suicidality, drug abuse, and burnout. They keep going because the work has to be done, but it’s not a sustainable system. The idea that the work has to be done is again a key pillar of modern labour. The setting of the emergency department gives the claim weight – it presents very concrete, flesh and blood demands. If the work’s not done, the patient in front of you will bleed out and die. The show uses that immediacy to lionize health workers, presenting them as exemplars of modern labour. The work must be done. Look, they go to work because they must. It’s a real clap for the NHS moment – focused on the heroism of individuals to keep the commentary on an individualistic level, to avoid accountability for the structural problems. It is, in a sense, myth-making, an exercise in fantasy. Many of us would love to have a job that felt meaningful and important, where the work actually mattered. I think many people feel like they work because they have to – not because they believe in the mission, but because they need to feed the kids, pay the mortgage. The very idea of purposeful work is almost a piece of propaganda, fantasy-making to inspire the masses. Look how they persevere, despite the costs. Look at their heroism.

At times it’s unclear whether The Pitt is a critique or a celebration of modern labour. It’s in the same class as Saving Private Ryan. You can say that it’s anti-war, or that it’s a critique of the healthcare sector, but it’s also kinda excited by the whole affair. It’s a despite-the-odds story of brave little battlers. The Pitt in particular shows how workers are routinely emotionally impacted by their work but expected to overcome that emotional response in order to continue to function. The work is horrific, routinely, and the doctors are expected to compartmentalize and continue to function. On seeing a degloved patient, one new doctor faints, which is treated as the response of someone new and inexperienced rather than as a normal, appropriate response to a sickening event. In The Pitt, labour is inherently emotional work where workers are expected to override their emotional response in order to function. Again, it’s emblematic of our modern experience. In my last job we laid off maybe twenty percent of the company in one go – my team of nine was cut down to three and a little bit. We had a meeting, and we talked about it, and there were a lot of feelings, and then we got on with our deadlines. Labour is inherently emotional work where workers are expected to override their emotional responses. Layoffs happen. People lose their jobs, they have their livelihood threatened – sometimes on an industrial scale – and that’s just a normal thing that you’re supposed to accept and pass by. Not to mention trying to work during Covid, during lockdowns, during bushfire season – you have to suppress this constant screaming alarm telling you something’s wrong. The Pitt expresses that feeling through the context of the emergency room, where it’s a known, integral part of the working environment. Yes, it says, the alarm is real. It’s not good, and it will have long-term impacts on your health, but you have to suppress it if you want to get anything done. And the work has to get done. The ER environment in The Pitt is presented as only the most acute expression of our underlying condition. We differ in degree, but not in kind. It is the highest, purest form of our shared circumstance.

That said, The Pitt‘s not shy about listing the economic issues. Gloria, the hospital’s chief medical officer (and functionally the show’s villain), comes down to the ER every couple episodes to argue with Noah Wyle’s character Dr Robbie, the senior attending. Robbie accuses her of understaffing the hospital, of failing to pay nurses a living wage (“our budget can’t support that”), and of instigating inefficient patient processing for the same reason (“the hospital saves money keeping patients down here in the Pitt, it’s way cheaper than staffing upstairs”). When a nurse is attacked, Robbie ambushes Gloria with his other nurses, telling them that Gloria had refused three separate requests for extra security over the past month. Everyone knows what the issue is, but nobody in the ER is really able to solve it. Knowing the issue doesn’t give Robbie extra power. The money people hold all the cards. By the end of the season, Gloria’s ultimatum – improve patient satisfaction scores or I’m selling the unit – is delayed but not defeated. In this way, The Pitt explores the tension between knowing and acting. The ER is staffed with very highly qualified, educated individuals. All the doctors and nurses have a staggering depth of education. They know so much, and yet they’re not really able to do anything. They can’t fix the economic issues, they can’t stop the money people, and a lot of the time they can’t even help their patients. They routinely have to wrestle with difficult, uncooperative people. One kid comes in, unvaccinated and unconscious with measles, at genuine risk of death. The doctors explain the procedure needed to confirm the cure – a lumbar puncture – and the mother kicks off, refusing the procedure as potentially dangerous to her comatose child. The doctors know the risk of measles, and they know the solution, but their knowledge isn’t enough. They can’t act without parental consent. Knowledge here is presented as impotent. The situation is ultimately resolved through a repudiation of knowledge, through false knowledge and knowledge withheld. The child’s spineless father goes behind his wife’s back and asks the doctors to perform the lumbar puncture while his wife is moving the car. He lies to the doctors, telling them she’s consented – in other words, she doesn’t know what’s going on, and neither do the doctors. The successful outcome depends on knowledge withheld, knowledge falsified. Knowledge in itself can’t fix the issue. It has to be undermined and disestablished for the child to get better. The same principle applies to the economic issues threatening the hospital. The doctors know that they’re being understaffed, but their knowledge won’t help them. In some ways it only accentuates their sense of frustration and powerlessness. They know what’s going on, but they can’t do anything about it. That’s very much our contemporary experience of work.

The broader conflict inherent in The Pitt‘s hospital system is around the math of life. In theory, hospitals are there to help everyone get better. In practice, there are very obvious logistical barriers around things like resourcing and staffing. Hospital policies dictate the order in which patients are seen – if one person shows up with a sprain and another with a perforated bowel, the bowel guy is going to get seen first. The emergency room operates under a triage system, where more acute or high-risk patients are prioritised, meaning patients with less severe conditions can end up waiting around for hours. Again, that’s primarily a logistical constraint. The ER can’t see everyone as they arrive, or in order of arrival, because they don’t have the staff. They can’t be tied up with a sprain if bowel guy has five minutes to live. The emotional response among non-critical patients is naturally some degree of frustration – if you’re sitting around for six to twelve hours before anyone gets to you, that’s frustrating. The logistics of the environment push patients into these weird, slightly contorted situations, where they end up sitting around half a day doing nothing in a room full of miserable sick people. From a logistical perspective, that’s the best way to run the ER, but from an individual, emotional perspective, it sucks. The doctors in The Pitt are therefore subject to violence from dissatisfied patients bucking against their situation. The logistics of the hospital demand that patients adopt the same sort of emotional override as the doctors – that they sit within the bounds of the system. They are expected to become compliant, to politely wait their turn. Some patients don’t want to do that, and they aren’t at work – they’re not paid to be there – so they’re not constrained by the same rules. So they lash out. They shout, they rage, they physically assault hospital staff. Their behaviour is awful, but in some ways it’s actually the more appropriate response to the environment. As a workplace, as a site of labour, the ER demands that people override their emotional response. It’s unhealthy, but it’s expected. Violent patients refuse that expectation. They’re not heroes – they express their refusal in a destructive way – but they also manifest the idea that this setup isn’t working. Their violence carries the critique that the logistical constraints are too restrictive. They are the consequence of a dysfunctional environment.

The math of life is drawn out to its logical conclusion in a mass shooting at the end of the season. The hospital is flooded by shooting victims, and the ER instigates strict triaging protocols, where people are ranked based on the acuteness of their injuries. “Patient who comes in with a red slap band goes to the red zone … these are the most critical patients who will die without immediate attention.” Less acute cases are graded as less important, while patients who cannot be saved are given black bands and left to die. Patient names and medical records are foregone in favour of a basic numbering system. Tests and scans are abandoned entirely, and the doctors responsible for triage are told to diagnose within ten seconds of seeing the patient. It’s the most brutal, blunt form of healthcare. One doctor describes it as combat medicine: “We’re a MASH unit now.” These demands are enacted in response to the surge in patients – the problem of logistics taken to an extreme. When so many patients turn up with such criticality in such a short span of time, you have to distribute resources as efficiently as possible, to save as many lives as you can. Even the red cases, receiving urgent care, are on a strict timer of allotted resources: “We have five minutes to try and stabilize the reds. After that, it’s OR, ICU, or morgue.”

The mass shooting event draws out all of the show’s key themes of contemporary labour in one place. It is an extreme state of crisis for the workers. The work is purposeful, but in that slightly bruised sort of way – it’s saving lives that shouldn’t need saving, cleaning up after an event that shouldn’t have happened. The logistical demands of the environment remove certain safety rails, with junior doctors being placed in charge of the low-acuity patients. Dr Robbie assigns the ‘yellow zone’ (“mostly extremity wounds – good vitals, talking”) to Dr Mel King, a second-year resident. She shakes her head and looks like she’s about to protest – she’s too junior, she’s out of her depth, she shouldn’t be put in charge – but there’s no time for anything else, and the show moves on. The mental alarm for Mel in this sequence is screaming away. It’s not a safe way to work – and yet she has to park her concern and get the work done. (The work must be done.) Finally, all the doctors know the futility of dealing with gun violence. They know that guns should be better controlled, as they are in every other country, to limit these types of events. They’re only encountering these sorts of horrors because of the strength of the gun lobby and the intrasigence of America’s political class. And, as elsewhere, knowing doesn’t help. It doesn’t fix the issue, it doesn’t solve the problem. They know, but their knowledge is useless. All they can do is do the work – stupid, futile work, work that shouldn’t need to be done, work characterised by a constant state of crisis and insecurity.