We recently launched our Uncertainty series here at The Nocturnists, and those episodes will continue to drop on Thursdays as planned.
But today, we’re bringing you a special bonus episode, because this conversation was just too fun to postpone.
In this episode, I sit down with the creative minds behind the HBO Max television show The Pitt—a new medical drama that has captivated so many of us in healthcare. At the time of this interview, the first eleven episodes had aired, and the stakes only grew higher from there. The characters on the Pitt feel incredibly real (my personal favorite is the charge nurse, Dana) and the cases hit close to home, which shows how much this creative team understands what it’s really like to work in the ED.
Which brings me to today’s extraordinary guests: R. Scott Gemmill, longtime television writer and producer, known for his work on ER, NCIS: Los Angeles, and now the creator and showrunner of The Pitt; Joe Sachs, an emergency physician turned TV writer, who worked on ER for years and now brings his clinical expertise to The Pitt; and Dr. Mel Herbert, a beloved educator in emergency medicine and the founder of EM:RAP podcast, who served as a consultant on the show and recently joined the writer’s room.
As someone who works at the intersection of medicine and storytelling, I was honestly a little starstruck to be in conversation with these legends. We talked about everything from:
How they set out to make a medical show unlike anything we’ve seen before
How they write to the historical moment, bringing in real-world crises like burnout, boarding, and even Press Ganey scores
Why they chose to tell the story in real time, one intense hour at a time, across a single 12-hour shift
How they nailed the realism of the show, from a hand-designed airway to a fake toilet that was a little too convincing
What they hope The Pitt will mean to clinicians and the culture at large
All episodes of The Pitt season one are now streaming on MAX. I hope you enjoy this conversation as much as I did!
Warmly,
Emily and The Nocturnists Team
This transcript has been condensed, visit our website for the full episode.
Emily Silverman
I have the pleasure of sitting here with Scott Gemmilll, Joe Sachs ,and Mel Herbert. Thank you so much for being here today.
R. Scott Gemmill
Thank you for having us
Joe Sachs
Our pleasure.
Mel Herbert
You're welcome.
Emily Silverman
I've watched all 11 episodes of the pit that are out thus far. I think we have a few more. And I have to say that never before when watching a medical show have I turned so many times to my husband on the couch and said, Oh my God. That is so real. That is so realistic. That's exactly what happens. That's exactly what that looks like. That's exactly the words that I would say if I were in that situation. Everyone is talking about the authenticity of this show. I think for me and my doctor friends and the physician community, something that we're feeling a lot with this show is just feeling really seen in a way that maybe we haven't with other medical shows in the past, there's just something in the water at the show that just feels like it really represents our experience. So to begin, I just wanted to ask if that was a conscious goal from the start, as you brought this show into existence,
Mel Herbert
Joe?
Joe Sachs
Well, I'm gonna let Scott talk, because he has the created by credit.
R. Scott Gemmill
Yeah, absolutely. If we're going to do something, we want to do it well, and we want to do it with respectfully to the community and physicians and nurses and everyone else that's involved in healthcare. And trust me, it's not always easy, as Joe and I went through this morning as we were trying to agree on how to tell a story about a sim lab and what was real and what wasn't. So, yes, we do strive to be as authentic and honest as possible.
Joe Sachs
I think it came from Scott it came from John Wells. And when I was brought into the project, I just wanted it to be as real and authentic as possible. And John, I remember, in the early moments of this show's conception, said, "I want a medical show the way no one has seen a medical show before" so I knew what had to be done.
Emily Silverman
And just to be clear, we have some physicians in the room. We have some writers in the room who have written medical drama but aren't physicians, and then we have some who are both. So maybe, can you just walk me through, who here has the physician hat? Who here has the writer hat, and who here has both?
R. Scott Gemmill
Well, I'm a shaman and a writer. No, I'm just a writer. I've written a bunch of medical shows, but I am just a writer. I'm a one trick pony. These other guys have multiple skill sets.
Joe Sachs
I'm a writer and an emergency physician with 33 years in the pit, as they say. The short answer to how I came down this path is while I was in medical school, I also went to film school because I had an interest in public health education, and as I was learning how to evaluate and plan public health campaigns, I became more interested in the creative side of things, and made the decision to go to film school. And that served me well, because as I finished my residency in emergency medicine, a show called ER came along, and about halfway through the first season, they were in need of some help, and they reached out to me.
Emily Silverman
do you still practice, Joe, or are you full time writing?
Joe Sachs
I do, I do. I've worked in a Los Angeles County Trauma Center for 33 years, including at the peak of the COVID epidemic, including intubating the sickest patients in full PPE. As the show began to have its conception, I made a decision to cut back to urgent care, just because the amount of time that I need to spend with every aspect of the show is monumental, and I just couldn't afford the time constraints of working an overnight or working till three in the morning, because I really am working seven days a week on the show when we're in production.
Emily Silverman
And Mel, how did you get involved with this?
Mel Herbert
So, I'm an ER doc, and I retired from clinical work, actually to run my education company full time because it had gotten too big and busy. I still work clinically in other countries, but I don't really practice in the US anymore, but I got involved back in the day. Joe was my attending when I first got off the boat from Australia in 1991.
Emily Silverman
Wow.
Joe Sachs
And I like to say I taught Mel everything he does.
Mel Herbert
And I don't know anything, so I don't know what that means. So Joe got me involved in ER years ago, basically as a medical consultant. So he'd run cases by me. And what do you think of you think about this? What do you think about that? And our education program is, is all about emergency medicine. And so a lot of the cases would come from there. And then when The Pitt started, he's like, do you want to play that game again? And so for season one, like that, sounds like a fun game. Let's do that again.
Joe Sachs
I think one of the things at the beginning of season one, I wanted to bring Scott and Noah, Noah Wiley, who's both an actor and a writer, and some of the other writers, to meet all of the key physicians at EMRAP. So we would attend the live Grand Rounds session, just because I wanted to give everyone a sense of the complexity of academic Emergency Medicine, of the teaching, and to meet giants in the field, like Mel, Stuart Schwadron, Sean Nort, and we would watch and listen to Grand Rounds and then have dinner. And those were very enlightening and successful for some of the other writers to get a sense. And then Mel's relationship to the creation of stories would be very informal, like once or twice a week, I'd be driving home from Warner Brothers, and I would say, "Hey, Mel, I'm thinking about doing this story, and it's going to be a seven year old drowning victim, and I needed to go on for this and this and this, and I know she's going to be hypothermic, and I know we're going to warm her And this or that, but I need a really good way to finish it." And Mel goes, "make her potassium 12, because nobody ever comes back with potassium 12." So Mel was kind of the spice and seasoning that would often put the finishing touches on the cases that we were creating.
Join Emily and Alexa in exploring Uncertainty
Each month, the ABIM Foundation’s Trust Conversations explore both the challenges and opportunities inherent in establishing trust within health care settings. Join us for their next live event "Managing Uncertainty: A Path to Better Patient Care” on Monday, May 5, 2025 from 1:30-2:30PM ET.
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