9 things ‘The Pitt’ gets right, according to North Carolina ER workers

A version of the following article appeared in the April 13, 2026, edition of The Charlotte Ledger, an e-newsletter with local business-y news and insights for Charlotte, N.C.

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by Michelle Crouch
Co-published with N.C. Health News

When Dr. Jennifer Casaletto’s kids started watching “The Pitt” last year, her 14-year-old son had a question: Which one are you?

“I’m Doctor Robby,” she told him, referencing the attending physician played by Noah Wyle who oversees the chaotic emergency room in the hit HBO TV drama.

She said his jaw dropped: “That’s what you do??”

Casaletto, who has worked as an emergency medicine physician in Charlotte for 15 years, said it was the first time her kids really understood what she does. They are now more mindful when she’s sleeping after a night shift and less likely to complain when she’s at work, she said.

“It has made a huge difference in our house,” she said. “I’ve been doing this for 25 years, and I’ve never really been able to explain to people what I do. This show has made us feel seen and made us feel heard.”

Matt Trifan, an emergency medicine physician at Cone Health, said the show is helping humanize the profession at a time when trust in medicine has eroded in the wake of the pandemic that upended health care workers’ lives.

“I’ve had more than a few patients say, ‘I watch ‘The Pitt.’ I know how busy you guys are,’” Trifan said. “Hopefully, it will help build back a little trust.”

Now in its second season, “The Pitt” unfolds in real time, with each episode following a single hour of a shift in a hectic Pittsburgh emergency room. The show’s creators consulted closely with real emergency department workers. Doctors and nurses from across North Carolina told The Charlotte Ledger/NC Health News the result is unnervingly accurate.

“It gives me flashbacks,” said one Charlotte doctor who asked not to be named. She added that some of her colleagues stopped watching the show because it was too much like being back on shift.

What makes “The Pitt” stand out isn’t just its medical accuracy, doctors and nurses said. It’s how well it captures the challenges they face: overcrowded waiting rooms, violence against staff, staffing shortages and more, along with the emotional whiplash of the job. But “The Pitt” also highlights the teamwork and connections that keep them going.

“One thing that really hits home for me is how well the show communicates that we work really hard not just with our brains, but with our hearts,” said Casaletto, a member of the American College of Emergency Physician’s board of directors. “Our hearts are tied to each and every patient. It’s a job, but it’s so much more than that.”

Here are nine aspects of emergency room work that North Carolina ER workers say “The Pitt” gets right:

On “The Pitt,” the packed, noisy waiting room is a constant backdrop, with frustrated patients waiting for hours, and a long line just to check in. In North Carolina, which has the ninth-worst emergency department wait times nationwide, ER staff said their waiting rooms often look similar, especially in winter when respiratory viruses peak.

Trifan said the waiting room scenes made him “squirm a little bit” because they’re so accurate. “It’s like a pressure cooker in there, with sick people, frustrated people,” he said.  

A Charlotte doctor said she covers her badge when walking past the waiting room, because if patients see it, they ask for help. Like the physicians on the show, she feels guilty telling them they have to wait their turn.

At UNC Health Rex Hospital in Raleigh, the backlog was once so bad that a young boy with abdominal pain waited nine hours only to be sent home, said medical director Ryan Lamb. He said that case prompted him to make changes.

Now, Lamb said, some patients are evaluated right in the waiting room. Others wait there for test results instead of taking up a bed.  “We see more people in chairs,” he said. “It’s not ideal, but if we didn’t, we would have 6-, 8- or 10-hour waits.”

On “The Pitt,” Dr. Robby tells the medical trainees the emergency department is “clogged up with boarders” — patients who have been admitted to the hospital but are waiting for a room, sometimes for days.

North Carolina staffers said boarding here can be worse than the show depicts, with beds lining hallways and filling every corner. At times, as many as a third or half of ER beds are filled by people waiting to be transferred to another facility or to a bed in another part of the hospital, doctors and nurses said.

Boarders include not just admitted patients, but psychiatric patients, older adults waiting to move to a rehab facility and children in state custody with nowhere to go, said Tim Lietz, an emergency medicine physician who recently switched roles after 30 years in Charlotte area hospitals.

“There was one kid who lived in the emergency department for three months — through Thanksgiving, Christmas and New Year’s,” Lietz said. “This poor kid, they couldn’t get him placed. He had nobody to talk to because we were all busy doing our work. He was just eating junk food. I think he gained 50 pounds.”  

While they wait, those patients still need medications, meals and basic care — work that falls to already stretched staff.  

“It pulls us away from patients who are acute and sick,” Casaletto said.

On “The Pitt,” patients lash out at doctors and nurses. In one episode, a nurse was punched by a disgruntled patient. In another, a nurse was choked.  

ER workers said those episodes hit close to home, mirroring a real-world increase in violence. Verbal abuse and threats happen every day, they said, and they’ve seen colleagues punched, kicked, spit on and threatened with knives and guns.

“Patients swing at us, people get hit all the time,” said Gia Bonis, a registered nurse at Cone Health. “It has just become something that we have to — I hate to say accept, because it's not okay — but unfortunately, we do accept it.”

Lietz said he once saw a patient head-butt an attending physician, knocking out several teeth. He also saw a nurse “grabbed by the hair and held down.”

Even routine interactions can turn ugly, especially when patients are in pain or frustrated by long waits, said Alycia Beverly-McCown, a registered nurse at Cone Health.

“Patients will cuss you out in a heartbeat,” she said. “It can be over a turkey sandwich, over some water, a blanket.”

The staffers said hospitals now provide training to help them spot warning signs and de-escalate tense situations, and some have issued panic buttons staff can press if they feel unsafe. In 2023, North Carolina also passed a law championed by Rep. Tim Reeder (R-Ayden), an ER physician, requiring emergency departments to have a law enforcement officer on site.  

Those changes have helped, workers said, but the risk hasn’t gone away. 

“Violence is still a very real reality” in the ER, Trifan said.

Watching “The Pitt” can be exhausting. The camera moves from one crisis to the next without a break, giving viewers a taste of the ER’s nonstop demands. In one episode, Dr. Robby repeatedly tries — and fails — to take a bathroom break.

Local doctors said that pace is very real. Interruptions are constant: test results dropped on their desks, calls from paramedics, questions from family members and one crisis after another.

It’s not just the number of interruptions; it’s the constant switching between cases, Lietz said.

“Doing one at a time isn’t so bad,” he said. “But when you have five complicated cases, then a trauma comes in, then a sore throat, an ankle sprain and a mental health issue — all at the same time — that’s when you get cognitive overload.”

Lamb said he once counted nine interruptions while he was trying to answer a father’s questions about why his son’s care was taking so long.

Eventually, “he looked at me like, ‘Never mind, I understand,’” Lamb said. “It helped him realize I wasn’t just out here eating bonbons.”

“There’s not a moment in time that something is not interrupting me,” he added. “The only time I don’t get interrupted is if they know I’m telling a family member that someone is very sick or died.”

The nonstop pace and emotional swings take a toll. On “The Pitt,” it shows up in small moments — a doctor breaking down in the morgue, a nurse in tears after conducting a sexual assault exam — and then, always, they move on to the next patient.

Those moments resonate with North Carolina providers.

Burnout rates in emergency medicine are higher than in any other medical specialty, Trifan said, “because we carry so much home with us.”  

“There are moments in the show where you see Dr. Robby in the bathroom trying to catch his breath,” he said. “On harder shifts, you really do need to step away like that. Then you get back up on the horse. You have to keep going. People still need help.”

The emotional whiplash can be especially challenging, Lamb said:

“You have to tell a family member that somebody is dead, and then you go into another room to see a cute baby, and you’re acting cheerful. Then on to someone else who is really mad,” Lamb explained. “That bouncing back-and-forth … can be really hard.

“What you want to say is, ‘I just told someone that their family member died. Can we just take the stress level down a bit?’ You want to say that, but of course you can’t.”

Casaletto said clinicians are expected to switch gears instantly, even after a devastating loss.

“You walk out of a room of a child you’ve been [trying to resuscitate] for an hour and a half who dies, and you’re immediately accosted by someone two doors down who is angry and wants to know why they haven’t been seen,” Casaletto said. “I don’t know that it’s human to be able to compartmentalize a death that fast and be able to put on a smile, but it’s what we’re trained to do.”

Health care systems are starting to acknowledge the toll, she said, offering counseling and debriefs to help staff cope.

Humor is part of how ER workers get through the stress, doctors and nurses said. On “The Pitt,” staff trade sarcastic comments and tension-relieving jokes — and even have betting pools, such as on how many patients they will get from a closed nearby hospital.

Physicians said that type of gallows humor is common. Clinicians often place bets on a patient’s blood alcohol level, Casaletto said. Or they compete to see who’s had the patient with the highest blood pressure or lowest platelet count.

“It's the way we survive,” Casaletto explained. “It's probably not appropriate outside the ER, but if you can't joke and laugh about it, you would cry. … Those laughs are actually tears disguised.”

For all the chaos, emergency department workers said one of the most accurate parts of “The Pitt” is the teamwork and camaraderie.

“A lot of times we’re like one big family all hanging out together taking care of patients,” Beverly-McCown said.

Unlike many medical dramas that focus on physicians, the show depicts roles often overlooked — nurses, med techs, social workers, even those who clean the rooms — and how they work together to keep the department running, she said.

That includes strong charge nurses like the character Dana, who helps orchestrate the entire department.

“Any physician who has been practicing for a while has had a charge nurse like Dana, who is a force to be reckoned with. Those charge nurses absolutely run the emergency department,” said emergency medicine physician Stephen Small, president and CEO of Mid-Atlantic Emergency Medical Associates, which staffs emergency rooms across Charlotte.

“When you can take someone on death’s doorstep, and everyone acts in a coordinated manner, and you find out a day later the patient made it, and they walked out of the hospital, that is very, very rewarding,” he said. 

As “The Pitt” depicts, the emergency department is a catch-all for broader social problems, including mental illness, substance abuse and homelessness, workers said. In one episode, a homeless man is so unclean that he can’t stay in the waiting room; when staff remove his months-old cast, they find maggots.

“There are patients that utilize the ER on a daily or near-daily basis,” Trifan said. “Often, when bystanders call police because they see someone wandering in traffic or doing something unsafe, they’re brought into the ER.”

Staff are required to medically evaluate them, he said. Nurses and social workers offer showers, clean clothes and a safe place to get warm or sober up.  But ERs aren’t designed for that, Trifan said, and it adds to the strain.  

Over time, staff get to know the repeat patients and their stories, just like the characters on “The Pitt.”

“There are repeat patients who are very entertaining that you look forward to seeing,” Beverly-McCown said. “Then, when they don’t come in or they pass away, it hits home. They were part of your emergency department family.”

The workers said one thing “The Pitt" gets especially right is how they connect with patients; they said it's what motivates them to stay despite the challenges. 

Casaletto recalls saving the baby of a pregnant woman who had died in a car crash. The woman’s husband sent her a note she still thinks about. He wrote, “I miss my wife every day, but thank you for saving my daughter. She is why I’m alive and why I live every day.”

Lamb remembers a man he convinced to stay in the hospital who went into cardiac arrest shortly after — a decision that likely saved his life.

For others, it’s the smaller moments that stick.

“My pediatric patients have a special place in my heart,” Bonis said. “Those little arms around your neck, the hugs, the kisses — you never forget those. It reminds you why you do what you do.”

North Carolina ER workers shared many other issues “The Pitt" gets right, from vaccine hesitancy and racial discrimination to the challenges of navigating family conflicts.

Where the show isn’t accurate, they said, is in the number of extreme cases it compresses into one shift.

“I’ve seen every single thing in a patient that they have put out there,” Lamb said. “The only difference is that on the show, they’re seeing way more severe cases in a day than you would at any hospital. On a typical shift, you might have one of those dramatic cases. Most of what we see is chest pain, headaches, abdominal pain.”

The show also glosses over the less exciting parts of the job, like doctors spending a third of their shifts typing information into a computer and how long it actually takes for scans and lab results to come back.

“I wish I could get a trauma patient a CT scan in three minutes or lab results in 15 seconds,” Beverly-McCown said.

Michelle Crouch covers health care. If you have tips or ideas for her, please shoot her an email at [email protected].

This article is part of a partnership between The Charlotte Ledger and North Carolina Health News to produce original health care reporting focused on the Charlotte area.

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