Every so often, perhaps once in a decade, a show comes along that redefines how we view a genre.

In the 1980’s Hill Street Blues changed cop dramas forever, ushering in a new era of gritty storylines, chaotic precincts, dangerous streets, and multi-faceted characters that resonate stylistically at least, right up to this day in shows like True Detective, Fargo, Justified, Chicago P.D. and others. In the early oughts The Sopranos did the same for crime dramas. (We wouldn’t have Breaking Bad or Better Call Saul without it.) More recently Game of Thrones set the standard for what fantasy drama should look, sound, and feel like, and The Boys redefined the superhero genre by stripping it of its shiny and wholesome appeal.

Such a show is The Pitt, a new warts-and-all medical drama series which premiered Thursday, via two back to back episodes, on MAX.

The series reunites E.R. showrunner John Wells, writer R Scott Gemmill and its longtime star Noah Wyle, and sets out to offer viewers a front row seat to the real challenges facing healthcare workers across US hospitals, as seen through the lens of the frontline team working in a modern-day hospital.

Overcrowded waiting rooms where patients sit shoulder to shoulder among the blood, the vomit, and the crazy, counting down 12 hour wait times before they can be treated, doctors and nurses so deeply exhausted and traumatized by the grind that the opening scene finds one of them contemplating leaping from the hospital’s rooftop, and a relentless onslaught of new patients in distress all add to the show’s honest stab at authenticity.

Whitaker (Gerran Howell) and Dr. King (Taylor Dearden). (Warrick Page/MAX)

Starting with an episode titled “7:00 A.M.” each episode follows an hour of Dr. Michael “Robby” Robinavitch’s (Wyle) 15-hour shift as the chief attendant in “The Pitt” — or Pittsburgh Trauma Medical Hospital’s emergency room — as the docs are encouraged to call it. The hour-long format mirrors that of long running action drama 24, but it works well here too.

On The Pitt there are no shiny waiting rooms or empty corridors. There are no docs spending all of their time on a single mysterious patient of the week, and no glamorous staff in pristine scrubs, sharing their inner angst. The Pitt aims for hyperrealism over melodrama (see Doc on FOX for comparison) and the result is an exhausting, unrelenting rollercoaster ride of split-second decisions, near saves, unexpected heartbreaks, deep pressure, extreme distress, and an unvarnished dollop of social commentary about hospital funding and nurses’ pay. It also makes for compelling TV.

Fiona Dourif, Shabana Azeez, Mika Abdalla. (Warrick Page/MAX)

At the core of the chaos stands the unflappable duo of Doctors Robbie, and Tracey Ifeachor’s Dr. Collins, who steer their ship with compassion, care and conscientiousness. The pair share a history, and as we begin the day we discover Dr. Collins is pregnant, but reluctant to reveal it. Meanwhile, Dr. Robby is having some mild PTSD flashbacks to Covid, made worse by today being the anniversary of a colleague’s death.

A large ensemble cast of docs, nurses, and students somehow only makes The Pitt‘s energy even more frenetic.

Senior resident Langhorn (Patrick Ball) is skilled but uses sarcasm to cope, a trait that confuses the medical students at times. McKay (Fiona Dourif) is competent and deeply empathic, but surprises one of her students when it is discovered she wears an ankle monitor that goes off at all the wrong times. Dr. Mohan (Supriya Ganesh) is a graceful swan who doesn’t understand why everyone is in such a hurry. Dr. King (Taylor Dearden), on rotation from the VA, is a socially awkward giver of high-fives, and charge nurse Dana (Katherine LaNasa) is the calm in the center of the hourly storm.

Noah Wyle, Patrick Ball, Mark Shroeder, Taylor Dearden (Warrick Page/MAX)

The staff are joined by a trio of newbies on their very first day including sheltered child-prodigy Javadi (Shabana Azeez) who may know her medicine but who has a lot to learn about getting along with other people, the responsible and gentle Whitaker (Gerran Howell), and competitive and somewhat arrogant Santos (Isa Briones) who likes to give everyone a nickname.

And then there are the patients, the emergencies, the families, the social workers, and even a dementia-suffering janitor who turns up for work daily despite retiring over two years ago.

Overall, there’a more going on at any moment on screen than we can comfortably take in, or have been used to viewing on TV of this genre in the past. And although deliberate, the show does suffer somewhat by sacrificing time that could have been spent getting to know each character more thoroughly in favor of high fidelity realism and a slew of medical emergencies happening at once.

Is this a bad thing, or do we just need to adjust our expectations?

Watching an hour of The Pitt may make you feel like stepping out of the room for a breather afterwards but for those who want to see where it’s possible to take the medical drama genre in 2025, we feel it’s worth it. If we had to adjust our idea of how superheroes behaved on The Boys, how a show’s protagonist could also be its antagonist on The Sopranos, and how a cop show could encompass so many shades of gray way back on Hill Street Blues, we can do it again now.

When word broke that E.R. vet Noah Wyle, along with E.R.’s showrunner (Wells) and E.R. writer (Gemmill) were reuniting for this project, many critics wondered if the show was going to be an E.R. clone. It’s obvious now how wrong that notion was.

In fact, Networks, ever in search of the next big show, particularly the next big doctor drama, might want to take note. The Pitt has done that thing — made us change the way we view a genre — and there’s no going back now.

New episodes of The Pitt air on Thursdays on MAX.

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