Welcome to It’s a Hit! In this series, IndieWire speaks to creators and showrunners behind a few of our favorite television programs about the moment they realized their show was breaking big.
Writer/producer/showrunner John Wells is a busy man. He’s produced and/or created countless hit series over the decades (“E.R.,” “China Beach,” “Southland”), many at his home at Warner Bros. since 1986, collecting six Emmy wins along the way.
More are in the cards.
His latest, Max’s new dramatic series “The Pitt,” set in a overflowing Pittsburgh emergency room, has ranked among 2024’s most popular hits (over 10 million views per episode). Easy explanations for the appeal of “The Pitt” range from its immersive, music-free “you are here now” structure — each episode of the procedural unwinds one hour of a 15-hour ER stint — to its dead-on accurate portrayal of contemporary medicine.
But mainly it’s a zeitgeist thing: the right show at the right time.
“It’s one of those beautiful and subversive works that comes together right when it’s needed,” wrote journalist Virginia Heffernan on her substack “Magic and Loss”: “It has a kind of parable structure, and offers another way of organizing society — one that is both egalitarian and then suddenly as organized and hierarchical as a ship or a commercial kitchen. It also shows, in these days of sadism, a response to pain that is neither to inflict it nor to endure it. But to treat it. To cool off the infections, open up the airways, split the bone, ease the suffering, and pitch in to heal the person right in front of you.”
For his part, series veteran Wells has learned to never expect such success. When the audience responds enthusiastically to a show like “E.R.” or “The Pitt,” which Max renewed for a second season in time for the series to return within a year, he is always surprised.
“We’re living in complicated times,” he said on Zoom as he tried to explain the series’ appeal. “The show is presenting hard-working, blue-collar people who are trying to make a difference, and are coming at their work every day in a certain way, bringing a lot of dedication in very difficult circumstances, with some integrity and a moral compass and saying, ‘Look, I can’t change the world. I can do this today. I can do this in this one-hour period or this two-hour period.’ People do find find comfort in that. They find something to admire in it, which we need.”
For older viewers, another source of the show’s allure is an old-sweater familiarity with “E.R.,” which “The Pitt” creators did consider updating at one point, but when the Michael Crichton estate refused to approve it, they moved on to something different. (The estate sued for breach of contract; a judge then refused to dismiss the case, which is ongoing.)
The two shows do share “E.R.” DNA from alumnae Wells, showrunner R. Scott Gemmill, and executive producer/star Noah Wyle, but “The Pitt” experiments with breaking new ground on how to construct a procedural medical series. Hewing close to the real world is executive producer Dr. Joe Sachs, a practicing emergency room physician trained at Stanford, who was on the faculty at UCLA, and spent 20 years as a full-time attending in emergency care.
“He’s a wonderful writer,” said Wells. “He brings us the stories, and the context with the real people. So we’re telling more stories in this 15 hours than you would normally see in a shift, but these are real stories about real people. And he does all the medicine. He and the other doctors on the show write the medicine itself.”
Verisimilitude is built into the show. “The fact that we’re showing just how difficult the emergency room situation is in the country means that people go, ‘Oh, that’s true. That’s the experience that happened for me and that I see some people who are actually trying to make a difference,’” said Wells. “They’re there. They can be doing any number of other things. All these physicians could be making two and three times more by trying to do a different specialty. And they’re actually there to care for the people who need it, usually in the most dire circumstances, or you simply have no other health care.”
So when Wyle’s attending doctor Michael “Robby” Rabinovich orders up a tracheotomy, say, Sax helps the writers decide who does what at what time, “and how, and what they would actually say to each other,” said Wells. “So you present a situation and say, ‘I want to get this character into this situation, and what’s the medicine that we could use to get them into that situation?’ He and the other physicians are involved in every step of it, from the first concept of every episode and the stories in it. They have to then meld with what you want the characters to go through. It’s a weaving process, and then they actually write the specifics to the medicine and give that to the writers to then incorporate into the scenes.”
Wells counts about nine people in the writers room, including himself, Gemmill, Wyle, Sachs, and Simran Baidwan. But the writing couldn’t get started until Nina Ruscio designed the set. “Before anything was written, we had to know where we were going to go,” said Wells. “It’s so interwoven. Nina designed a floor plan for us that we all then agreed upon, and then the writers worked seven months from around Christmas time of 2023, and then we’re in production. I directed the pilot in July. You had to know exactly what was going to happen.”
Over three months, the writers room planned out the entire season with the stories, some of which span two or seven episodes, or even 13, 14, or all 15 episodes. “It was all plotted out on big dry-erase boards and cards,” said Wells. “Only when that was all done did Scott start writing. He wrote the first three, and then Noah wrote the fourth one. And by that point, everybody was handing off because they knew what they were doing. And then Scott and everybody in the room, on a daily basis, was going over and making certain that all of the interweaving natures of the stories were happening and were properly addressed, so things didn’t get dropped. It was a big group activity.”
Several stories kept cropping up. “What came back from every single physician and nurse we spoke to was it’s become increasingly dangerous to work in the emergency room,” said Wells. “The hospital version of road rage has become much more prevalent as tensions within the country went up since COVID. Everybody’s on edge, and that has gone into the emergency rooms. One of the things they encounter all the time is people who have not adequately addressed the wishes of their parents as they get old, who haven’t done a living will or have done one but don’t respect it. The Fentanyl crisis and all these things came up, including the humorous ones and the crazy stuff that’s on the internet, where there’s all this stuff you can buy that has mercury in it, people getting mercury poisoning from facial products from Korea that nobody’s paying any attention to.”
The writers were mapping out the choreography of who goes where in every script. “The dialogue is written to get you from one space to the next space,” said Wells. “But you have to know where everybody is on the entire set the entire time. All of the actors are constantly doing what we would consider to be extras work, because they’re in the background. The set is big and open, so people are constantly in shots. And when you’re directing, you have to know where that person’s going.”
He continued, “We have a wonderful nurse who was at St. John’s down in Santa Monica for years as the charge nurse, and he actually gives all of the background artists working with Joe, who are patients, all have full dossiers about what’s going on with them, full treatment plans. [It’s] not just extras moving in the background. We know when the blood is supposed to be taken, when the tests are going to be back on each one of the background patients when they get served their meals. All of that’s integrated into the whole thing.”
The show used two cameras, primary and secondary. And everybody on the stage was in scrubs, including directors, assistant directors, makeup and hair, and prop people, “because there’s glass everywhere, and crew members are constantly getting caught in these shots,” said Wells, “because there’s no way to escape in time. We just say, ‘If you start to see the camera toward you, look like you’re doing something.’ And we just keep shooting.”
Even the people waiting in the emergency waiting room had to sign on for the seven months. “They didn’t bring anybody in who wouldn’t,” said Wells. “We weren’t replacing people every day. And a ton of them are actually also background medical, so they’re nurses and respiratory technicians. Everybody had to commit to be there for the whole 15-hour shift, or 13 hours to the shift.”
In fact, most people in the E.R. work a 12-hour shift. “But for the physicians and nurses, there is a tremendous amount of time it takes to hand off all your patients to the next shift that’s coming,” said Wells. “But the 15 ended up being because Max said to us, ‘Can you do 15 hours?’ And we said, ‘Sure.’ That’s big. But a lot of the shows that were on HBO, like ‘The Sopranos,’ were 12 episodes. The reduced episodes has been in large part attached to the cost of making these shows where you have these big world-building, difficult shows. There aren’t that many places that are going to spend or can afford to do 10, 12, or 15 hours of that because they’re so expensive. So when you get a ‘House of the Dragon,’ or ‘The Last of Us,’ or ‘Severance,’ shows that are so expensive to make, you’re not going to make 15 of them. It’s just not an economic reality.”
“The Pitt,” at $4-5 million per episode, is less expensive, partly because of the set built on a Warners soundstage. (Some exteriors were shot in Pittsburgh.) “We weren’t trying to create a tremendous amount of CGI or anything,” said Wells. “We had to do a certain amount of it for some of the wound work. We weren’t shooting in open spaces surrounded by 300 yards of blue screen.”
One advantage of a streaming procedural was the ability to be far more graphic than any network series. “In going back to doing a medical show, it would have only been valuable,” said Wells, “if we could do it so we’re on a ride along with emergency room physicians over their shoulder, you’re seeing what they see. And some of our admiration for what they do that the audience is taking away is seeing what they actually emotionally deal with all day long, and physically, what they deal with, how physical the job is, what they’re actually seeing, how graphic it is.”
Max was supportive on showing the doctors cutting into people and showing their bloody insides. The writers brought the audience in gradually. “We were going to escalate it a little bit so that the audience becomes slowly able to tolerate more of what they see,” said Wells, “because it’s becoming more normalized. It’s much more graphic in the latter episodes. I’ve been in the shoes of these emergency room physicians and nurses long enough that we’re trying to get people to look at it in the same way that they look at it. You become technicians in the sense that you’re repairing something, and the body in that situation is not the individual. You don’t get much chance to interact with your patient. You’re not taking them through a cancer treatment or anything else. You’re just dealing with an emergency that has to be fixed. The average emergency room physician sees a new patient every three to four minutes. It’s on speed, but it’s actually the speed of an emergency room because they are under a tremendous amount of pressure, particularly in urban medicine, given how many people there are who need the help.”
Each episode takes nine days to shoot, with no days off. You finish one on a Thursday, start the next on Friday. If you finish on Tuesday, you start the next one on Wednesday. “We just keep going,” said Wells, who directed the pilot and the finale.
Casting was a long pursuit with endless auditions for the new residents who start in the E.R. on day one. Gemmill, Wells and their team wound up casting three so-called nepo babies, the talented children of Brad Dourif (Fiona Dourif), Bryan Cranston (Taylor Dearden), and Isa Briones (Jon Briones). “I actually didn’t know who anybody was until after we’d cast them,” said Wells. “Everybody auditioned multiple times to get the parts, and I had no clue who anybody was until later, when we were on set and they would sheepishly mention who they are or whatever. They’re theater kids, because this is a live performance when we’re on stage, it’s very technical in that sense, there’s a lot of choreography, there’s a lot of movement, you’re not standing in a room and throwing lines back and forth. You’re walking, chewing gum, and tapping the top of your head the whole time.”
Presiding over the sprawling cast was Wyle, who took on writing and directing as well as acting and leading the team on set. “He’s matured from when I first worked with him, when he was 23 years old,” said Wells, “into an extraordinarily talented actor who holds this show together. What you see on screen of him being the central nucleus of this is exactly what happens on the set. Everybody depends upon him. The other actors depend upon him, and he sets a tone for what what they’re going to do and how they should act, and what being a professional is.”
In Episode 1, we get hints of Dr. Robby’s lingering post-pandemic PTSD. “One of the other major reasons that we all wanted to do another medical show,” said Wells, “was to talk about the trauma that our first responders went through. We are in a stage in which everyone’s trying to forget the pandemic, because it was a strange, surreal, horrible experience for everybody, with tremendous ramifications on the economy and other things, but for the people who were there, who were having patients die on the left and right, who are taking the risk of their lives, who had their co-workers dying, that trauma and PTSD from that has not left. There are lots of reasons for the nursing shortage, which is severe, but the biggest reason for it is that so many people left. They were just exhausted, burned out, had PTSD, died, had illnesses from dealing with this tragedy that we had for months and months and months. And the look that Robby has in the show, when he’s fully covered in PPE and going in to help, that’s modeled on a photograph of Dr. Joe Sachs at Northridge, who looked exactly like that every day going to work.”
The last three episodes of the series dramatically up the ante as the E.R. copes with hundreds of grisly victims of a mass shooter. Sachs and some of the writers reached some people who were involved in the tragic Las Vegas shooting to share their experiences. “A lot of those details are based on those conversations,” said Wells. “Like, several of the doctors slipped on all the blood that was on the floor and were hurt. It’s that kind of detail that you have to go out and do the research for.”
The first two of the mass shooter episodes were directed by producing directors Amanda Marsalis and Damian Marcano, who had already done a number of episodes. “We have a large model of the set in the offices,” said Wells. “Every single bit of it was planned out in advance with diagrams and where the cameras and gurneys are going to be, and that was the only way to do it. And then extra medical personnel on set to help us with making certain that we were being accurate in what we’re doing.”
Next Up: Not only is Season 2 already set to shoot in June and premiere in January — as Dr. Robby keeps improving his mental health, Day One will bring back from rehab Dr. Frank Langdon (Patrick Ball), who rejoins his cohorts — but HBO/Max CEO Casey Bloys plans to adopt the immersive one hour per show model for other venues like a police station. Stay tuned.
All episodes of Season 1 of “The Pitt” are now streaming on Max.
