4:00 P.M. with Simran Baidwan, Damian Marcano and Dr. Gita Pensa

This school festival is just about to start. And then it's open. No, I'm not. This city is my safe space. Hmm, do you have anything to say about it?

Yeah, exactly. This city is the city of Stoiapp, which is simply different. The town of Stoudium, Job, or Unzug. The town of Stoiapp? Of course, I don't like Stoia.

Stoia is the lead. Stoia is the lead. Stoia? Stoia? And I can't rent this hand already.

Oh, man. There's 1,000 milligrams of seed of metafine or olive, 4 milligrams of dead to trough under the tongue, and trough the clear flow is. Seriously, it says all that.

It's not in the text with the emojis. You kids can't rent this shit. Welcome to the pit podcast. The official companion to the pit on HBO Max. I'm Hunter Harris.

And I'm Dr. Lok Patel, four p.m. in the pit. That's episode 10. We're going to talk to one of the show's writers, Simran Badewan, and the director of this episode, Damian Marcano.

We are all trying to find the truth in the scene. We're not trying to overact. No one's trying to get that special shot and whipping the glasses off and saying that, you know, prolific thing.

We're just trying to say, if these doctors are working as a team in order to

“create these miracles, then I think we have to”

fashion ourselves in the same way. And then we'll go outside the pit and talk to Dr. Gita, Pensa, a medical malpractice expert who consulted on the season. Nobody wants to have anything bad happen to any of their patients,

and inevitably sometimes things do. And when you are the steward for that person's life, you take that really, you take the responsibility very, very heavily. Just saying medical malpractice gives me hypertension.

Today's shift starts now. 4 p.m. is not everyone's finest hour for better or worse. Like it seems like no one in this episode is having a good time. Everyone is at a boiling point, but what are the moments that stand out to you, Hunter?

Here's what I can't stop thinking about.

The scene of Robbie and Dr. Mohan, because he totally loses his temper with her. In a way that I'm like, I don't think we've ever seen him. This curt, this short, this almost cruel.

When you realize that Dr. Mohan is actually having a panic attack, and not having a heart attack as she thought. It all pined out and know everything's just out the window. Wait a minute. Is this a panic attack because of your mommy issues?

What, no. She's just, do you need to go home? You should go home. No, I'm fine. I don't need the fucking liability.

Go home. And the rest of you. Last time I checked the eating is a shit show. So let's all get back to work, huh? The moment he realizes when he flips a switch,

he goes from being concerned about a heart attack. And he's like, is this about your mommy issues? I'm not happy with Dr. Robbie right now. But the way that he almost is so dismissive, and he's like, go home.

Go home. I was like, oh my gosh. It's like giving housewives his reaction. It's so over the top. I did not appreciate that.

But I think this is the first time

that we really seen him be like actively cruel in a way that's like something is going on with him. He's like, he's very, I don't know, very dark.

“He also, I think there's maybe a little bit of the generational thing.”

He might come from a generation where any type of mental health issue or struggles was seen as weakness, which is added to stigma. People not wanting to open up about it. So I do like that.

Dr. Al Hashmi, you immediately seen that scene. Her eyes are kind of like, like, Brody doing. And then later on, she pulls them aside. And she's like, don't be a dick. Yeah.

And I think it was a realistic scene. There's people out there in healthcare who are afraid of saying, like, I'm having a hard time or acknowledging it's a panic attack. But the setup to her panic attack was real.

Like, I want to talk about that because in my head, as someone who's had panic attacks, I'm like, wouldn't you know, like your doctor? Why would you think it's a heart attack? I'm, like, my instinct tells me she's,

she doesn't ever been that position before. You know, she's sweating. Her heart's racing. She doesn't know. I don't know.

She doesn't know. I'm like, sister, your doctor. Come on. But I, I wonder though. Do you think Dr. Robby is harder on Dr.

Mohan than other doctors? Well, last season, he was called her slow mo. She's like, well, I have the highest patient satisfaction rating, whatever. But then this, this episode,

we really see her lose her temper. Like, everyone's losing their temper with everyone. That's a good take. I feel like she recovered from the slow mo.

Sarah type he gave her in the first season.

Yeah. He came around and he started to really appreciate her approach. Yeah. And you know, Dr. Alhashmi came in really appreciated Dr. Mohan's work as well.

“And I think to your point, I think it's just the moment.”

The fact that Dr. Robby has checked out, you got this code black happening. Like, all this is going on. And he's like, I cannot lose one of my physicians. And I think the mental switch he had from Oh, my gosh. This is a cardiac issue to damage.

I need you in the ERB stronger or go home.

But I'm glad that he came back around later.

And it was like, Oh, my gosh. I was wrong. I was like, Oh, my gosh. That was wrong. He's like, Hey, it's very, like, deadbeat dad.

Like, hey, sorry. Let's get back to work. I'm a deadbeat dad card. Okay. Yeah, because there's something different about the way that he treats Whittaker and Javadi, which feels a lot.

Like, Whittaker feels very like friend like landed replacement. Javadi feels very paternal, which I like. Because he's very like defensive of her to her mom. But then with Dr. Mohan, I don't know. He's very harsh.

Maybe that's because he knows she's like a really good doctor. Yeah. Maybe he's holding you to a higher standard. Similar to probably what is going on with Langdon. Well, he's obviously hard on Langdon.

And that's a talk to Langdon. That's like a weird love. Yeah. That's like angry toxic. You hurt me, father.

Like, re-enter my, that's, that's a whole of the category. Yes. He feels very betrayed by Langdon. I know Ovelvi gets a bad rap. But this episode, I'm like, kind of you deserve it.

Like, what do you, when he's on the, um, like helicopter pad talking

Dr. Robbie, not Robbie's like, you know, has your first day going,

checking in and Ovelvi is like, I think we have a very different idea of normal. Now, for everyone, I'm not sure it's helped me for anybody. Here's your leg. Choose.

I love that that ends with, like, him being, like, a leg being placed in his hand and him, like, not knowing what to do. I love seeing Ovelvi uncomfortable like that because it's like, you don't know everything.

“Maybe you should get checked a little bit.”

What did you think of that? This happens to forth your medicines all the time, who have spent three years studying the textbook. And they think they know everything and maybe they do really well on their tests and their boards.

And then they go into an actual clinical scenario, thinking their hot shit. And after a few hours, like, they're like, oh, my gosh. And they get humbled by actual experience and by the spontaneity and the craziness.

Yeah. I think this is a good turning point. So I said earlier that people were known as having a good time in this episode, but this, this might wind up being a good pivotal moment for Ovelvi. With Ovelvi, I mean, he is just such a jerk.

Sometimes in so obnoxious that I'm like, how is Ovelvi kind of like, playing they know what all what the others, he means. He means like, dr. Jay's stuff this episode. But then, did you notice that when he, he sees the English teacher, like, checks it on him, that's his patient.

And he gives him a copy of a book that he's reading and it's James Baldwin, notes of a native son. I'm like, okay, sorry, hold on. How do you have so much, like, how are you reading Baldwin? Like, you're obviously very educated,

and then also have no empathy for like the plus-sized patient for the woman who's like, he's like, give more of more kind of me. Like, we can't deal with her right now. Like, I don't know. I didn't know that.

“I think that's a big part also of these clinical rotations for students.”

And as learning those interpersonal skills, and we see kind of a, we see kind of a trace of this with San Dosa Garcia, and she's like, clearly we need to work on a decorum for R2s. So it goes back again to appropriate behavior and speaking. And like, you learn.

So Ogleby, like, I think he's going to emerge. I think he's emerged from this big guy. A little bit of humility's needed. The orthopedic surgeon rolls in, park the shark. And he, like, also tells Ogleby in so few words to zip it.

Not even, okay. Park isn't orthopedic surgeon you said. It's not a big surgeon. Everything about him love. It's been off now.

Oh. Obsessed with him. You like this dude. Oh, my God. Are you kidding?

He's a diva deluxe. Like, he walks into the trauma room and he's like, does he even say hi to anyone? Park. Park the shark with the pedic surgeon. This is a favorable reputation.

Pretty clean cat. Then slice through like a gating. X-ray. Too bad. Stop tying off a couple of materials.

I'm not blind. Just walks in laser focus. Picks up the leg. He's like talking to himself in a way that I loved. And then, I mean, poor wooddocker whenever he's like, yeah,

you needed like, do like three wrenches or whatever. And when it goes like of saline, he's like, yeah. Do. I'm obsessed. Sorry.

It's funny.

“I think they were trying to portray the typical arrogant toxic surgeon.”

Yeah. Who might be really great at their job. But it's just not nice people. Yeah. And in your eyes, he's a deluxe diva.

Absolutely. No. That's the man I want operating on me. No, don't have to be nice. Just like get the job done. Get my leg reattacked.

Did his hair style fit deluxe diva? Look, this is like-- Of course. And I was named a shark. He literally, I like hurt the jaws theme as he walks into the OR.

Like seeing him and profile was incredible.

This take is so good. It's hard to say. Imagine if the real life park the shark. If you're like, hey, man, you're a deluxe diva. I don't know what he would throw at you.

I hope you would say thank you. And then walk back out. I need like a group shot of the shark, abit, and Garcia. Yeah. Like they need those three in a room together. Because like their energy is incredible.

Oh, yeah. I wonder who would out alpha whom in that trio? Mm. I think Garcia is the alpha of both of them. I don't think she'd back sound from anyone.

I want to know if you clocked how Garcia is very

“Rudroctor, Alhashmi when they're doing the slash tray.”

Mm-hmm.

Because it's like incredible Dr. Alhashmi pulled this off

that she directed everyone through it. And then Garcia's like, wow. Like, what'd you do? Like, now we're about to go back in the OR. Like, we'll have to clean up your mess.

Whatever. And Dr. Alhashmi is like, or they'll be happy that I saved this kid's life. And then, it's Dr. Garcia, who was like checking Santos about being Rudroctor Langdon.

I've been a goddamn pariah for the last 10 months for doing the right thing. Or maybe you're a pariah, because you don't play well with others. If he stood up, he felt Langdon.

Go tell him. He's here to stay. So put on your big girl panties and work it out. No. You want to have sex and eat ramen in bed?

I'm your girl. But if I'm not talking about this Langdon shit, again, call their wrist. What do you think about a two woman Broadway show

called Sex and Ramen in bed?

Starting Garcia and Santos, would it do well? I don't like eating in bed. I don't like eating in bed culture. It's, I don't know. It's a little bit gross to me.

No. Okay, but we have confirmation now.

“I think we kind of had confirmation a little bit earlier”

that because of the toothbrush thing, but now we know for sure that was when that was in the, it was a can't end. People are like, I call. Yes, now we know for sure that Santos and Garcia have

a little situation chip. And I don't know. I think I like that Garcia is willing to check Santos, like she's very so able to compartmentalize. The hierarchy and the egos in medicine do exist

and the inter-hospital situation ships that happen. It's like, I'm not going to say this from personal experience. Okay, this is professional setting. Because I'm not, I don't, I don't, would like to say I don't have a huge ego in that setting,

but I've heard from people who have dated superiors or they've dated medical students and like that's up happen. So when they're like, wait a minute, I'm, I'm your supervisor, but I'm also sleeping with you.

Like this is again why this is not appropriate and should be handled very carefully. And so I think this little scenario that we're seeing kind of a relatable one. Yeah.

But I also, I'm glad that Dr. Garcia was like, the reason why people don't like you and in the E.D. is because of your behavior, not because of like the LinkedIn golden boy. Because even, I mean,

LinkedIn wasn't like that popular. He was obviously Robby's, one of Robby's favorites, but like everyone else was kind of like bringing their eyes at him to like,

you know, glass season, the previous day that we've seen, like he's not beloved by every single person. We just need to see that Santos LinkedIn conversation.

We just need to see the two of them finally sit down, maybe it's in the break room and just hash it out. Yeah. There's some healing that needs to happen.

We need to take it to the red table.

“But do you think that Santos does not like being taught?”

A hundred percent. Yeah. I don't think she likes being taught. I don't want to think she likes being told what to do. Yeah.

Definitely not corrected. She's got that Sonya Blade Mortal Kombat Viper. She's like, I'm in charge. I don't need anyone's help.

Yes. I got to say real quick. We're talking about like the tension of the room. I love the subtle line. When.

I think it's I think Santos says something along like there is no tension. And she's referring to the the chest of pulmonary cavity. Mm-hmm. And Garcia's like at least on a newmo because she's referring to the two of them have tension. Wait.

I did not even. She's really subtle little little line. Okay. But tell me who was more. I guess.

Can you explain to me like the differences and maybe what they were thinking between Santos and LinkedIn? I couldn't really understand like how their approaches were different. And why his was better than hers.

What they're essentially first kind of talking about is there was blood

in this around this patient's lung. A chemo pneumothorax. So the first the first kind of situation that they are disagreeing upon is whether or not they need to drain the blood from the chest. Sanders like there's blood.

We got to drain it. And LinkedIn is like the patient's stable. He don't need to drain it unless it's a certain size. And then he's like yeah, we can wait before we drain the blood. Then the second scenario is how to get the air out of this patient's chest.

She's like we need a chest tube and we need to drain it. And he's like you can use this thing called a Thor event. And that way, you know, you can keep it in there for a longer period of time. You can suck out the air. And it's this good teachable moment because LinkedIn has gone through more of these

procedures than she has. Yeah. And he's not being mean. He's like listen. Like you don't need to do more of the patient.

And just listen for a second. Yeah, like something more invasive versus less invasive. Yeah, more or less. Okay. Now it's a tactile procedure.

Two centimeter incision through the tracheal ratings. Finger in the trachea. Boozy into the airway. That's what's next, Dr. Whitaker. Insert the ET tube into the trachea.

Subption. Lots of blood in the LA. So like this is pretty complicated. I talked to an ER doctor, a trauma surgeon and a pediatric surgeon just casually about this procedure. And so essentially, you got to create an airway.

You either can't intubate someone or you can't oxygenate them through their mouth. And perhaps there's an upper airway obstruction. There's trauma.

You need to go in through through a throat.

“And in certain situations and kids, it's actually better in an emergency to do a slash.”

So basically vertical incision.

The more permanent solution, I should say, like the more controlled solution would be a horizontal traditional surgical tracheostomy, which is why I landed makes that comment. Like this is going to take 20 minutes. Yeah. So she's like, it's emergency time.

And so people may have heard that term "crank." Where you go, that's a little bit higher. Where you're going to create that airway. And you might not be able to do it in kids. So long story short, because of this situation.

And it's an emergency. And the anatomy, the unique anatomy of kids. That's where I tried to draw all Hashemies. Like, we got to go vertical. This is an emergency.

So they just call it a slash. So there's a lot happening. But, you know, shout out to the medical writing. Because like, I fact checked this and I was reading some journals for emergency medicine. Emergency medicine journals.

And it's totally accurate how she describes it. Handlers are self-underpressure. And even Dr. Robby is like, damn.

The one thing, there is something you're unrealistic though.

Okay. When Garcia walks in and she's annoyed. Yeah. I did not hear that. I've not seen that.

I don't think that would actually happen. I think a surgeon would come down and understand. Like, oh, this is a kid. Yeah. This was an emergency.

“What matters is that the kid's life is saved.”

And it's pretty common knowledge in trauma worlds. That if you get it in emergency airway, that it can be repaired and stabilized in the OR. That's why Dr. Allash means like, yeah, a little fix in in the OR. But patient is alive. That's what matters.

Right. I mean, Dr. Allash means kind of like rolling her eyes as she's walking out. Like, loved it. Couldn't get enough of it. Yeah.

I do like how it's like, Dr. Allash means. Check, Dr. Garcia, Dr. Garcia, check, Doctors, Santos. And then like, Dr. Robby wouldn't even talk to Dr. Langdon.

And park the shark checked everyone. Yeah. Like, does there still a lot of just checks in this episode? Because everyone's like at the end of their row. But that was that was like a very cool scene to see.

But that I'm also like, wait. They just put their fingers in a child's like throat. I will say in my in med school, at it several months of rotations in surgery. So I thought I was going to do before pediatrics.

And tracheostomies are like my favorite thing to do in the majority of the situation. They are controlled surgical tracheostomies in the OR. Okay. And oftentimes it's somebody for whatever reason needs a long term, long term breathing tube.

And it tracheostomies in most cases. And if not all cases, the safer more control way to do that. Okay. And they're they're very satisfying to play surgically. Kind of like pops in and you like sew it down.

Anyway. What's your name? I'm like, I truly bad. Did I break it? Um, I went to that it's broken.

Exactly. We're going to get an X-ray to determine that. Put that on the gurney, line it up for X-ray. Keep your fucking pouch out. Okay.

A look, we need to get specific. Like, what is happening with the leg? And like, what what is a surgeon in this case look for that it can be reattached that it can't be reattached. I want to get into the medical stuff.

Yeah, there's so much happening in this short dramatic scene. I mean, obviously you got Olga will be like shaking with the leg.

But the first thing I noticed is the leg was wrapped and presumably stored appropriately.

Okay. Everything is is clean. You know, you want to keep the limb slightly cold, but not frozen, which could kill some of the tissue. But it's like clean.

It's in a waterproof bag. I don't know why he's unwrapping it just yet because no one's told him to unwrapping it. I mean, he's also about to tell those woman that she doesn't have a broken neck or something. It's like, you don't know that. And now what's interesting is like, you could lose your leg but because of being in shock.

And a ton of adrenaline, you may not feel it right away. But you've cut nerves and halves. You're going to feel it. Yeah. But you're going to start going to panic.

You know, you hear Donnie mentioned that she's gotten some fentanyl for pain. Then, you know, they want to give her some ketamine, which is another, you know, you could preserve someone's blood pressure while also handling pain. They take ketamine all the time on this show. Yeah.

It's like bushwork. Yeah. It's like bushwork. Yeah. It's used often ERs.

And then, what are your mentions? The pop lidial nerve blocks. So like, regionally blocking all the sensation going down or down that leg. Okay. Just to keep her as comfortable as possible.

And then when your deluxe diva, as you call him Park the shark rolls in, what I'm guessing he's looking at in his brief moment is looking how clean the separation is on the limb. And he's looking at the limb. He's looking, presumably, looking at the vessels.

The bone, et cetera. Like, can I reattach this in the OR? Because you don't want to have a poorly reattached limb that may not take or cause an infection.

“So I think based on Park the shark's experience, he's like,”

okay, we can, we can give this a go. It's not about us. It's about them. She's so calm. She's a long time to repair this moment.

But she's doing for her sons. Man, I see this was so much grace. Don't give to love. I feel like an asshole. All they want is more time with their mother.

All I want is less time with mine. We've just experienced this moment with Roxy and as we talked about with Justin Baker, kind of a homework example of the doctrine of double effect.

Clearly, as mentioned, Roxy's like thought through this, the family's there.

Husband supportive. He's like, this is where I need to be. Like, they know what's happening. Mm-hmm. You know, as reading journals about how often palliative care happens in the emergency department.

Mm-hmm. And it's interesting, like, there's statistics about how many times he will go to ERs and their last months of living. Because they're in pain. They have chronic illness. Whatever it may be.

Mm-hmm. So I do think that the conversation is happening more in ERs as people, need to find a way to really preserve their quality of life. Yeah.

“The one thing that I think is so real is having to compartmentalize your feelings and go from patient to patient.”

Mm-hmm. And your job body has a moment where she steps out. But I'm just going to say, it's okay to cry in front of a patient, or, like, be pissed or swear or be human. And a few times, like, I've had emotional moments in front of patients and whatever way.

Like, it makes you more real. It makes you human. I've seen experienced surgeons get terrified in front of families. Just because you're all going through this together. Mm-hmm.

Hunter, as we talk to Simran and Damien, what are you most curious to know about how this episode was written and created? I want to know all about the Santa's Garcia situation ship, how this happened, how, like, kind of the slow rollout of this. Like, we've gotten ideas, like hints that maybe they were together or, like, together, ish, but I don't know. I want to know everything about kind of tracking that throughout this season.

I'm right there with you. So let's get into it and ask all the questions to show writer Simran Badewan and a director of this episode, Damien Marcano. Simran, I've to ask you this question. In this episode, it feels like we are reaching a boiling point

with so many character and social situations.

“So I have to ask you, what was it like to kind of shepherd all the character?”

To this point, without giving too much away too early? You know, I mean, we really have to structure the seasons into, like, a trifle with 15 episodes.

So we try to have things, you know, in the first five episodes, that there's something that insights us to, like,

you know, propel us forward into the middle, you know, five and now with episode 10, it's really heading, you know, we're just freight training it, no breaks to the finale. So you know, we're really trying to make a concerted effort to, like, yes, the cases are there, but what does that mean to our characters and how are we also in the fact that we're, you know, one hour, you know, per in one shift that they've been on shift for 10 hours.

People are exhausted, you know, mentally, physically, all the other things that you've been trying to avoid for the day to keep crashing back at you. So it's, you know, it's very purposefully constructed to start hitting ahead. We can feel that the freight train is, that's on its way. Damien, I want to ask you, you directed a few episodes and in season one, what was it like coming into season two? What was different? What caught you by surprise?

“I would say every episode of the pit is a surprise, right?”

It's, it's fun even for, I think, us as the directors to kind of find out what's happening and what's coming, because we are all a very close knit and close working group of people. So being at the pit, you run into the writers, you run in the sky.

And I'm sure everybody always wants to know, so what's, what do you guys got planned for us?

And with season one, we had this larger than life, mass casualty, you know, for 12 and 13. And maybe I thought maybe that would become our shows format and they would kind of do the same thing again. But I remember when I saw Scott and Simran early on and they just kind of had these smiles about what they had planned for us. For this year and I was actually, you know, without giving too much away, I was just kind of glad to see that we didn't repeat just the same thing from season one. The characters are the same, there's new faces as well, but there is some new exciting life.

And I would say that that is what surprised me the most about the pit. I mean, all of what our writers do. And the fact that they were able to put these new characters into our season. And to feel as if I think they were there a season one right, but no, they weren't. These were all new faces and each one of our cast is just, it's like a dial off of each other, but they're all just so specifically different and unique in their own way.

And it's so refreshing when you are directing an ensemble like that to be able to have, you know, just that many colors. And that many colors to work with, man. Simon, I want to know, I want to kind of dig into this dynamic that we see in this episode between Langdon, Santos and Garcia. This Santos Garcia sort of like simmering, are they together, do they are they sing each other? Has been like a really kind of fun, slow burn to like just to do's how, how well they really know each other.

You know, I think it's like anything if you've ever dated somebody in the workplace, you know, raising my mouth. But you sometimes want to, you want to separate church and state, right? Like, you know, yes, we met here and we like each other, but we each have jobs to do and we have things going on.

And sometimes that kind of, you know, inevitably comes to a head in that professional workspace. So yes, you know, we always say that the pit isn't a show that you should be folding your laundry.

“You should be paying attention because they're all these cell context clues without having to say, hey remember when we went out to dinner last night, it's like, it's just part of what it is.”

But you know, I think it's also, we want to bring about what is, what is that relationship, you know, is it just, you know, a booty call kind of relationship, is it something more does one person see it is something more and the other person's like, oh, I haven't really defined it. So we're just playing in that, you know, in that pond of what it means, you know, for Santos and what it means for Garcia and we will have a little bit more of that clarity, you know, you see already by the time you get to 10 Sanchez saying like, what are you doing, what are you doing after and maybe wanting to hang out more and Garcia keeping it a little bit chill.

But I think in this episode, you get, I always said when we were on set to Damian and we were talking to our actors like this is not a scene between Garcia and Santos. This is a scene between Yolanda and Trinity, right?

So think of that when we have that personal conversation later, it's not about doctor to doctor when we get towards the end of the episode.

It's more about like, I see what's going on, but let me tell you to somebody who actually genuinely cares about you. I like that there's a moment of Santos like complaining about how she's felt like a black sheep and a pariah for so long and Garcia is like, well, but who's made you feel that way, right? Like, that was really interesting. Damian, can you tell us how you are projecting this episode?

“I think like I do all of them, we just come into work, keep you head down. I say this because I after directing so many things in our lovely Hollywood system, I think it is a very important ingredient to mention.”

Ever since we started this show, there was a little note from Noah Wiley and each of our binders just kind of reminding everybody that we would put egos aside and we would come in here and we would try to recreate as best what this amazing medical community does, right? I step in like a lowly director in this scenario, right? I am at best trying to do what you didn't have takes or multiple opportunities to do on the day when you perform this life-saving miracle. So I attack every single scene of the pit I do in that exact same way.

We get together, we rehearse for 15 minutes or so before we shoot one, and we more or less have a conversation I think in which we are all trying to find a truth in the scene. We're not trying to overact, no one's trying to get that special shot and whipping the glasses off and saying that prolific thing. We're just trying to say, if these doctors are working as a team in order to create these miracles, then I think we have to fashion ourselves in the same way.

“And that's what we do time and time again.”

I love how Damian is underselling what a vital component he is to the collaborative process of making this success. Listen, I come from Trinidad, right? And my coat of arms, I keep this on a set with me every day. This is a $100 bill from Trinidad, right? And what it says on our coat of arms is together, we aspire together, we achieve.

I've given one of these to know a wily, I probably owe simmering a couple of these because it's just a little reminder I need every day to keep myself in check. And to put myself in place in order for us as a team to achieve the greatness that we've just achieved.

So I know that I'm an important part to the show, but I think one of my most important parts is to the show is to sort of keep us on that path.

I think if we continue to do the work that a writer's room is blessing us with amazing scripts of simmering is making me direct things that make me go 10-1 and leave the stage. Because I'm directing it and I'm crying and I'm like, looking at this lady like, why are you doing this to us, right? But what I think we've seen now is, however, we happen to feel on set. It seems to honestly translate through this negative that we are shooting and getting to this audience in exactly the way that we felt on the day.

And I think it's also just sort of our, you know, it's a vibe check man. I'm a rasta. I can't help it man. We tend to talk about ourselves in very minimalistic ways while trying to do great things. So can you tell us a little bit more about how the two of you work together like when you're on set and when you're when you're talking about the episode.

We had this connection because, you know, I'm Indian and that's my heritage and Damien is Trinidadian and you know, there's a very large Indian population in Trinidad and I think maybe just because we are like both like, you know, have this immigrant mentality. We come from different worlds. We see things in a different space. We really like the collaboration that television allows writers and directors to have. That we just gel and get it and we can because we get each other can have really candid conversations can have, you know,

disagreements that are obviously very, you know, just cordial. They're not like, you know, they're not adversarial, but we can really have in-depth conversations about the material and what the characters are going through.

“And, you know, we, I think we just worked together as like, you know, we come together as a united front when we're on set and just, you know, set a good vibe Damien.”

The director is always the one in charge on set, you know, and Damien leads by example with, like, is, you know, attitude and the way he wants to give the actors agency and the way everybody has a role. He, you know, greeting everybody with a handshake or a hug and, you know, if that tone really matters, especially when you're dealing with such serious subject, you know, matters that we have on those show. I had one last question for both of you. So my medical friends, anyone who works in the healthcare system loves this show, not surprising why.

But one thing that does surprise all of them is that people who don't understand medical jargon terminology or really understand the procedures also love this show. Well, why do both of you think that is? Because it's true. People who don't know anything about healthcare are still are captivated by the show. Why do both of you think? That's the case. I would say, from my, of a director and that ingredient that we would put in, we have a lot of medicine on the show, obviously.

And we have the doctors there that help us keep it 100% correct, but I'm always directing looking for the interpersonal relationships during the medicine.

“But I think maybe for a while medical dramas, maybe haven't done enough of that with the doctors.”

You know, you guys have always been sort of like in the, in the OR, you're the doctor. And outside, you're like the lover or the romantic or the divorcee or the whatnot. Our show, I think, kind of collides both worlds. And makes even those private moments where a couple like Garcia and Santos have to find a private moment. It's always something fun when we have one of those scenes to do.

I was trying to figure out, yeah, where are you going to go have this private chat? So I think that's the ingredient that we put in from my own personal life and the things that I've heard just like you've heard. I like to remind people that we've come out most recently of a time when all of these first responders pretty much saved all of our asses, right? And we were at home and we all thought we were going to die and we needed someone to shine some light on us, man. And they did you guys saved us in that time.

“I think just like, you know, one of my favorite reggae singers, Bob would say, man, sometimes I spread so much sunshine on everybody.”

I forget I need a little ray for myself. I think our show is that little ray of sunshine back to you guys. So I am more than honored and more than thrilled to even be a part of something like this because, you know, for once we've used some TV to really do some good here.

And it's, it's just an amazing pleasure.

I echo, you know, Damian sentiments, I think that's exactly it. I live in a multi-generational house, you know, I have a 12 year old, a 17 year old, 50 somethings. I've got my parents driving in from, you know, they're in their 70s and 80s. And I think the reason why it hits so many different people and so many different things because, you know, clearly, I mean, I have any doctors in my family, much to my parents' sugar in, but, you know, I think the other reason why the 12 year old gets it.

And the, you know, 80 year old gets it is because there is so much humanity, there is so much heart. There is hopefulness, you know, and you're seeing that, you're seeing that in the interactions, you're seeing that in the impact of these doctors and nurses. You know, as much as they have to be stoic and do a job, they are also human. That's, that's true resilience, that's, you know, that deserves respect. And I think that, you know, hopefully we are shining a light on that and giving them, you know, healthcare workers there do.

Damn, wonderful answers, incredible. Maybe it's show run for 10 more seasons. You're a lipstick adzeer, thank you. Thank you guys so much. Something that I did not realize is that Damian has directed so many episodes of the pit that he directed stuff from season one and now on season two.

And I think that he knows the cast really well and knows, like how everyone, you know, what works best for every actor, which I think is always really interesting.

Yeah.

It also speaks to his character that at the premiere, everyone was so happy to see him.

I remember this because I remember being like that must be Damian, you know, I've seen pictures of him, but everyone was so excited when he was there and there was like a different vibe around it. I was like, oh, yeah, it means simmering too. When they were around, everyone was so excited. I saw her then both kind of joking with the cast and, you know, dancing and everything like that. I'm like, right, they clearly have a great relationship between the writers and the directors of the show and the actors.

“But I think those two specifically seem to have a really good rapport.”

I think, you know, simmer and talking on being on set with Damian, I don't know. I think that they really have a certain matter between the two of them.

We talked about San Jose Garcia and how this episode is really reaching a boiling point. And the other boiling when that's happening is with Mel and the Mel practice issue.

And again, in typical pit fashion, I love the fact that they brought in the real world experts to make sure that this was drafted in a realistic fashion. So that is why we've got medical malpractice expert Dr. Gita Pensa who consulted on the show this season to tell us more as we go outside the pit to talk about medical malpractice, which oh my god, every doctor just loves talking about so much. I feel like you're like trick like your tense. Well, a couple of months ago, I got named in a malpractice lesson. And so today is the deposition.

That's it.

“Dr. Gita Pensa, thank you so much for joining us today.”

You know, Hunter and I have talked about this before about how it's not totally uncommon for doctors to be sued or threatened with a lawsuit. Can you tell us a little bit more about that? Oh yeah, absolutely. So I and I come from this is the lenses of practicing emergency physician and also somebody who spends a lot of time in the medical malpractice world and I work with doctors who have been sued and help them kind of get acclimated to the environment and then perform in that environment. Depending on who's numbers you look at between a third and a half of all doctors and all specialties will be sued at some point during their careers. However, if you're in a higher risk specialty such as emergency medicine, some are probably like top third.

They're really, really highest risk or feels like OBGYN, neurosurgery, a lot of the procedural specialties and surgical specialties are way up there. And if you are, for instance, a practicing OBGYN 90 something percent of you are immediate sued. And even in a emergency medicine, which is, you know, what we're really focused on here in this show. If you practice for 30 years as an ER doc, you, there's a 90 percent chance that you'll be names in a lawsuit at least once. So the pit is known for highlighting issues that exist in the real medical community.

“What were your conversations like with the writers and with the executive producers about malpractice and how the pit could cover this subject?”

I was so excited when I heard that they were going to go there. And I have to say it was a virtual session over over Zoom and the whole writing room was there. And I didn't know enough about the show at the time to know that no while he was also one of the writers. And so when I got on the Zoom and I met all the writers and they tilted the camera towards him, I have to say I'm not someone who's to prone to being star struck, but I think there was perhaps a little squeal of a question. So it was really, it was very exciting. And then we really just got down to work and we had a really nuanced and to my mind, a really thorough discussion about the impact.

That medical malpractice litigation has on physicians who are named, but really the conversations were around what happens to what happens to the physician. What happens to their confidence, what happens to their sense of self, what kind of emotion they are they experiencing. And it really does tend to be this really kind of toxic stew of shame, guilt whether or not you were responsible for whatever the harm was that happened. Or whatever the adverse outcome that happened, whether or not you are responsible for that.

There's always some sort of very difficult mix of emotions to contend with because nobody wants to have anything bad happened to any of their patients.

And inevitably sometimes things do. And when you are the steward for that person's life, you take that really, you take the responsibility very, very heavily. And there's always this sort of mix between responsibility and culpability, responsibility and blame that it's a hard line to walk for a lot of us. And so we had a really wonderful conversation around all of those issues.

That's such a great question and that's so much of what I work around so historically.

“Physicians really haven't talked about this, even though I just gave you those numbers that I said that you know on a high-risk specialty like ours,”

we're practically all going to get named at some point. We don't talk about it. We don't talk about it because there's this perception that it's shameful and people don't know how to talk about it. And a lot of times you'll show up in someone's office the first day, you'll be in a claims person's office or risk manager, then maybe the attorney and the first thing they'll say to you is, I know this is hard, but you're not allowed to talk about it.

Now, I never want to talk about this without acknowledging the other side of the equation.

If there are patients who have been harmed, sometimes it is because of error, many times it's not, many times it's sort of systemic problem or it's as we've seen on the show. You can get stuck between a rock and a hard place and one doc can say we're going rock and the other one says we're going hard place. And one of those choices in retrospect may not have been the right choice and we face these choices all the time in medicine. But then you have this outcome that none of us ever wanted and we have our own feelings around that and then you are blamed in a way.

I mean, the process is really highly adversarial and they'll come at you with all sorts of really really harsh language and using words like, you know, now practice in negligence in malfeasance and just making you feel like just the worst possible human being. So this is actually a real threat to identity for us. But when you take a person who's dealing with all of that and you tell them now you're not allowed to talk to anybody. I mean, and we tend to be except for Robbie like a lot of us are real followers. You tell us not to talk about it. We're not going to talk about it, but it really does something to us and I don't know really any other scenario and which you take an individual any really truly traumatize them like this and then the party line is you're not allowed to talk to anybody.

And so part of what the work that we did together in the writer's room was getting I was so excited to see Robbie say this to Mel.

“To be able to draw that line between talking about and revealing important details of your case versus talking about the process is happening. This is how I feel about it. This is the ways in which this is like really stressing me out.”

And this is what I wish I could do like these things are not your case details and we need just as human beings doing really difficult work and being caught in a really tough position. Many of us we need to be able to talk to somebody who can receive it empathetically from us. But as you also keep that it's about any potential trends in an in Malpractice cases that you may have seen over the years. I bring this up. It's like I had a family threatened to send me once because the MRI machine was down.

This was not my fault. I did not break the MRI machine, but they were so frustrated with this delay and care because of that machine. And what scares me is I can see some law firm being like, yeah, let's do it. Let's sue everyone about hospital for millions of dollars. And so I'm curious if you've seen in your consulting work and your personal experience a trend.

You mentioned some of the specialties who are more likely to be named in lawsuits is there is it always error is it.

“You know, something you mentioned with systemic issues are more cases being dismissed. Is there anything that light you can shed about the direction we're going?”

Sure. So there's a couple of the trends that are that are interesting that we probably should unpack, but just sort of overall. Probably half of them don't go anywhere. Like half of them just eventually go away. There's really no fault that can be found. They can't really leave a story around it. They can't find it expert to support it. So there are a lot of medical malpractice suits that are initiated. Because something bad has happened or because a family is frustrated or sometimes they can't get answers. They can't get answers from a hospital system that's very opaque.

More and more corporate. It's really tough to get to get help or answers when something has gone wrong and that frustration. Where does it go? If you can't get help from this side of things, right? Someone will tell you go talk about attorney and the attorney is often more than happy to figure out like, oh, is there a case here? Is there an expert who will support it? And I don't really fault anybody in this situation. I mean, like patients, it's very frustrating to be a patient these days. So the more frustrated the public gets at the fragmentation of care, at the inaccessibility of care.

And the heart of it truly is to access care. The sicker people are when they get to care. They're more likely there is going to be some outcome that nobody want it, right? And then when the system, if they are being obstructionist, if it is a circle of wagon kind of mentality, which is not what I advocate for at all.

And the worst, this is terrible, but the worst, the outcome and the younger, the patient, the more likely it is that they're going to try to, to pursue an action.

“Again, very complicated, very nuanced, there's pain on all sides. And the other trend that we're seeing is the rising these so-called nuclear verdicts, you'll see these like millions and millions and millions of dollars.”

One point I want to make is that if a doctor is going to try it, unlike other things, if a doctor is going to try to defend themselves, they usually believe that they did a good job. That's like true malpractice is settled, not all settlements are malpractice, but usually forget trying to settle that out of court. The doctors that go to trial and I as a doctor who spent 12 years in one malpractice and went to trial twice defending it. Again, for, I mean, a huge part of my career, I will tell you, it's this extraordinarily difficult, it's just a long and very, very arduous path. But we're seeing now, perhaps if the doctor usually will win in those times like 80 to 90 percent of the time.

And the pit is, you know, to my mind, one of the greatest things that happened to healthcare in years because it tells the story of our competence. And that's a story that I want to see every single day is a story about our competence because by and large we are very competent and we want to do the right thing. But shows like this where you get to start a conversation even about it to me are just, they're just beginning and I hope we can keep the ball rolling. This is great. This is great life of ice.

I'm really glad I'm really glad to have been here. I'm so excited and grateful to the writers that they're moving with the story line. I can't wait to see it comes next and thank you. Awesome. Well, thank you so much. This was wonderful. I learned so much. I think the most interesting thing about talking to Dr. Kita Penso was that there's not a lot of ways for like patients to feel heard. And so sometimes like taking it directly to a lawsuit, very extreme is the way to like feel like you've accomplished something or that you've like recoup something in some way, which is like actually quite sad.

“It's it's awful and you have to feel for patients like we have a very very frustrating broken fragment of healthcare system and if something goes wrong, if there's an error like patients don't always know the culprit is but they're angry.”

And inevitably there are law firms will say like hey, like let's go see this hospital and then like I mentioned earlier, there's situations where yes, there should be an investigation and I'm glad yeah I'm glad you brought that up and glad you brought the emotions and also the fact that some physicians feel truly scared and lost. Hello, let's go back into the comment section. I'm feeling brave today. I'm feeling brave and curious. Let's see what people have to say again. I want to read this comment as it deserves like a slow clap around the world.

I love the pit in your podcast. I wanted to be involved in the medical role, but because of my mild C.P. Superpozy, I was limited to what I could do and I just learned so much from watching you all. Plus your heart. I'm 70 now, but things like volunteering in food pantries working on a suicide helpline. Bringing Belle to the Salvation Army and working at a preschool for handicapped kids for 23 years. Who is this Nobel Laureate? I love it.

Like amazing. What a well-hearted, amazing individual.

Yeah. That deserved its shadow. I do kind of want to see more like volunteers on the pit. That's like a role that I want to see.

“They have them. They have them show up in the club black, remember? Volunteers. So they go to be runners.”

Yeah. But you're right. They should have like more volunteers playing a pivotal role in patient care. Singing to women's stuff. Yeah. I want to see like a volunteer like Czech Ovovi. Like, can volunteer really school like one of the med students I could be cute.

Ovovi's not going to let it fall. You always use to be a volunteer or I've an ego.

Yeah. He's too busy reading James Baldwin. To put people in his act full life. Actually, we made a joke about. I made a joke about multi-singing. Music therapy would be a fun one to see. We have music therapists. Okay.

That'd be good one. We're like one of the ERs I work at has a dog. Like a service dog. Pull like rolls around. Service dog's name is Barker Posey. And like rolls around and like keeps patients calm. Like that would be give me a service dog.

My dog grandma is auditioning. Not a service dog, but she's a service to humanity. That's it for today's episode of the pit podcast. I cannot wait to talk about episode 11. Hope you'll join us. We'll be right here every Thursday after each new episode. You can watch us on HBO Max or listen wherever you get your podcasts.

The pit podcast is a production of HBO Max in collaboration with PRX.

“The executive producer of PRX is Jostlyn Gonzalez.”

Our managing producer is Courtney Florentine. Our editor is Lucy Perkins.

Our production managers are Ebuda Choa and Tony Carlson.

“Our video producer and editor is Anthony Q. Artis with assistant editor Damon Dirral Henson.”

This shows engineering by Tommy Bazarian, special thanks to Joe Carlito.

The executive producer of HBO podcast is Michael Gluckstatt.

“The senior producer is Allison Cohen Cerrocatch and the associate producer is Aaron Kelly.”

Technical director is Insang Huang. I'm a local Patel. And I'm Hunter Harris. We'll see you next week in the pit. [Music]