The Pitt and the Communization of Care

(This contains so many fuckin’ spoilers.)

I’m obsessed with The Pitt, the spiritual successor to TV show E.R., a grand piece of social realism that seems torn between the tasks of reinforcing civic morality and gesturing towards a utopian vision of healthcare. I’ve lost count of my rewatches. I learned all the characters’ names in a cast of dozens. Yes, I have shipped Collins and the HVAC Psychologist (but have you shipped Earl and the sandwich cart? no? get on my level). Obsessed. Anyway, my brain can’t help but do media criticism about it and form hard opinions about the politics of the show. I don’t write a bunch (and when I do I use an annoying amount of parentheticals) but bear with me if you would. I want to talk about some of the limits on The Pitt’s critique of the political economy and glimpses of communist, communized utopia that the show gives us.

Social Realism is a movement in art that focuses on the working class and their hardships, un- or under-represented peoples, and a critique of power. Works can vary in how radical their critique is and as one might imagine getting a show onto television tends to nerf all the radicalism out of stuff but not always. I compare The Pitt to The Wire, another sprawling social realist TV saga which offered mostly-liberal critiques of policing, the drug war, public education, print media, and addiction. The Wire soured more and more for me as my politics became more radical and I came to recognize it as copaganda which largely reinforces assumptions about policing and public safety. While David Simon is never going to be about abolishing the police, I do think the creators of The Pitt  are down with abolishing paid healthcare.

Watching The Pitt, there’s a sense that money doesn’t exist in the universe of the show. The show’s creators are (thankfully) uninterested in showing us the painstaking realism of health insurance, paperwork, means testing, collections, etc. These are all things that would confuse an international audience, too, but we get explicit reinforcement of how the show views these things.

Transgender sommelier Tasha Cordera’s (played by Eva Everett Irving, novelist John Irving’s daughter!) patient arc is unremarkable except for Student Doctor Javadi correcting the misgendering and name mismatch in Tasha’s insurance data file. Yes! This fucking paperwork IS bullshit no one should have to deal with.

(Well, I also think it’s remarkable to portray your one (1) trans character in proximity to wealth when most trans people are poor as fuck but whatever -- this show was not put together by queers or the diagnosis for a cyanotic patient wouldn’t be “popper overdose at a concert” 😆.)

Gloria, the hospital administrator (played by Wire alum Michael Hyatt) is the whipping girl for this, brought in whenever the point has to be made that the hospital is a business and has metrics and needs to make money so that Dr. Robby (played by E.R. alum Noah Wyle) can say all this is bullshit.

Actually, there’s an even better foil for this sentiment provided by the show in the grievances of Doug Driscoll, a patient perpetually exiled to the waiting room who grows increasingly frustrated at not being brought into the E.R. to see a doctor. Dana the charge nurse explains that patients are seen according to medical severity but Doug has a conflicting mental model of healthcare. Doug imagines that if someone else is getting care, it’s at his expense – literally, in that his insurance pays for the uninsured, and figuratively, in that they’ve cut the line of priority somehow. This zero-sum thinking is rejected by the show and Doug, at first a relatable character frustrated with waiting hours and hours for care, is made into a villain who suckerpunches Dana, the selfless and long-suffering nurse who enjoys “caring for people with no place left to go.”

The show can be super-preachy, too. Sometimes it seems like a 15-hour public health PSA: vaping can fuck with your heart! smoking, still bad! this motherfucker wasn’t wearing a helmet! wear masks! vaccinate! don’t let kids find your edibles! addiction affects all kinds of people!

It’s not afraid to scold you with medically-evidenced health shit and that is great for the most part (really! I miss the old PSAs) but in aggregate it also feels somewhat driven by a civic morality or syncretic religious logic. The most egregious example of this is the distasteful symmetry of Collins experiencing a misscarriage immediately after administering the first pills of a teen’s abortion. Even the limited geography of the show – almost exclusively made of the E.R. rooms and hallways – is fraught with symbolism: the roof where the faithless go, the elysian fields of the park across the street where the heroes congregate, the ironic concentration of death in “pedes” the pediatric room painted with forest animals, and the ambulance bay -> waiting room -> E.R. as reminiscent of levels of hell in Dante’s Inferno.

The show even feels conservative, at times, especially in its valorization of cops among other first responders. Collins sort-of flirts with an attractive officer; officers cheer for their fallen when an officer shot in the PittFest mass-casualty incident is finally given an airway; officers disarm a patient during a gun scare; cops guard the hospital from an active shooter; cops are shown to bend the rules for Dr. McKay when she gets cuffed for breaking her ankle monitor while saving lives; McKay herself leans on the cops to deal with a disturbed teen boy who may want to do violence to women. There’s only a mild suggestion that interaction with the police can “ruin one’s life” and zero questioned assumptions about the cops’ roles and responsibilities in mass-casualty shootings – they are assumed to be competent, tireless, etc. and not cowardly as in the Uvalde shootings or responsible for incidents of “friendly fire” and escalation as we’ve seen elsewhere. It’s not even offering the neutered critique of policing The Wire manages – it’s fully recuperative of police and state violence. Boo. Do better.

So, why is a communist obsessed with this cop-loving show? It comes down to Dana’s statement about the E.R. operating according to medical severity and embodied by Dana herself caring for those with no other options. It reminds me of the simple distillation of communism Marx offered in Critique of the Gotha Programme: “from each according to his ability, to each according to his need." We’ve reached an interesting intersection of medical ethics and communist ideology! Medicine has incorporated this as a humanist intervention, originating with Napoleon’s Surgeon in Chief suggesting we “treat the wounded according to the observed gravity of their injuries and the urgency for medical care, regardless of their rank or nationality.” The characters of the show are not stingy in embracing this logic, either, and promote social welfare programs – embodied by another uncomplicated, angelic character in Kiara the hospital’s social worker.

How does the poor, alcoholic patient Louie afford the co-pay on his prescription for Librium? Or the Kraken’s antipsychotics? Who is ultimately paying for Myrna to charmingly terrorize the staff during her extended stay? Who’s paying for the sandwiches Earl houses? The show does not care. The show is completely uninterested in how things are paid for and totally interested in providing the highest standard of care for the most people it can. Not just medical shit! Care that is all-encompassing! Helping trafficked women! Getting an incel kid professional help! Intervening in child sexual abuse! Helping others process loss, grief, and trauma! Help for burnt-out caregivers as well! This is approaching a definition of “care” that family abolitionists talk about. M.E. O’Brien writes in Pinko article “Communizing Care:”

“In place of the coercive system of atomized family units, the abolition of the family would generalize what we now call care. Care of mutual love and support; care of the labor of raising children and caring for the ill; care of erotic connection and pleasure; care of aiding each other in fulfilling the vast possibilities of our humanity, expressed in countless ways, including forms of self-expression we now call gender. Care in our capitalist society is a commodified, subjugating, and alienated act, but in it we can see the kernel of a non-alienating interdependence.”

I think The Pitt is reaching for that kernel. It valorizes the hospital’s “Street Team” (which get cool jackets) which appears to be a totally altruistic extracurricular for the doctors and nurses to bring care to the unhoused and other vulnerable people. We are reminded of the origin of modern paramedics and the 911 system in Pittsburg’s Freedom House Ambulance Service through the exceptionally-charming character Willie Alexander, a patient with a broken pacemaker. Nick Bradley, a patient character who suffers brain death after an accidental fentanyl overdose, is righteously honored as an organ donor.

Returning to the sandwich cart, let’s watch a short clip:

In addition to seeing a white boy get humbled, there’s a blink-and-you’ll-miss-it detail here with Whittaker taking a sandwich for himself. We won’t learn that he’s unhoused himself, crushed under the repayment of student loans, for another ten episodes or something! He’s in the process of developing solidarity with the unhoused with Earl here, later with the Kraken, and in joining the street team. The sandwich cart is never depleted. No one really questions it. People are hungry and you give them sandwiches from the cart. That’s it. That’s all you really need to do communism. Provide care to those in need, free. Easy stuff. Mr. Rogers shit. The details of how the sandwiches come into being are less important and certainly doesn’t need to involve capitalism and insurance companies. Sandwiches are abundant. Earl doesn't have to eat egg salad if he doesn't want to. Our care for each other doesn't have to be stingy or spartan.

Scarcity and abundance are modeled by the show in the juxtaposition of the normal for-profit operations and in some exceptional periods of need – the mass-casualty shooting at PittFest and in flashbacks to Robby’s traumatic experiences caring for his mentor during the beginning of the ongoing COVID crisis. Robby complains to Gloria about nurse and bed shortages related to the problem of “boarding” which is the main bottleneck on the E.R.’s capacity to clear the waiting room, scarcity which the show directly ties to profitability. During the peak of COVID’s threat, with everyone in full PPE, we see Dana pleading with Robby to free up the ECMO life support machine keeping his mentor Dr. Addamson alive so that a little girl can be given a chance to recover. Both patients die and the scarcity-driven decision traumatizes Robby for years.

However, we see abundance during the PittFest mass-casualty incident. Gloria opens the vaults and pre-staged disaster supplies flow into the E.R. The bed scarcity dissolves as patients are shuffled around the different departments of the hospital to free up capacity for the emergency floor. The high-security machines that dispense medication are opened. Blood and other necessities from area hospitals are rushed to the Pitt. The night shift is called in (careful to leave a reserve for later). Abbot shows up on his day off kitted with combat medicine gadgets. Tons of wounded arrive by plumbing van, pickups, etc. People are pulling together whatever resources they have to the cause!

The rules are relaxed. Langdon, effectively fired by Robby for stealing benzos, shows up to provide free labor because saving lives is what animates him. McKay drills a hole in her loud, malfunctioning ankle monitor. Mel and others provide unscreened blood when the supply runs out since people are dying and slavish commitment to rules shouldn’t be the reason why. Javadi and Matteo are repurposing mismatching medical equipment when airway and chest tubes become scarce. More hunches are acted-upon without regard to legal/financial liability. 

The patients are even anonymized as the burdens of paperwork are lifted and care notes are reduced to an index card strapped to their wrists (or sharpie on the forehead). Patients become a sea of blanket-covered lumps with simple but critical needs: airways, tourniquets, saline, IV fluids, blood.

The mass-casualty mode of the E.R. is communized care. Let’s go to O’Brien again for a working definition of communization:

“Though we can’t know the conditions of future insurrections, a few features characterize communist measures: a critical mass of proletarians rapidly seizing, transforming and putting into use the infrastructure and land, to enable non-market human survival and human flourishing.”

That’s our team of doctors and nurses – proles all! The MCI protocols which the owners/admin of the hospital have sanctioned give up all this material without conflict for various reasons: being stingy during a crisis would be bad optics; a combination of state-mandated emergency preparedness and medical ethics that sometimes nudge healthcare in utopian directions; but mostly I think it’s because it’s temporary. In nearly the same breath that Gloria praises the “miracle” the “Pitt crew” achieved with communized medicine, she insists they reopen the hospital to normal (profitable) operations.

The show is uninterested in obscenity and doesn't point out that mass-shooting victims typically have to pay for their own care.

M.E. O’Brien and Eman Abdelhadi were considering the communization of hospitals when they wrote their utopian masterpiece Everything for Everyone: An Oral History of the New York Commune 2052-2072. We hear the story of Belquees Chowdhury, an adult in the future relating their family’s experiences during student and hospital occupations in our (2025) near future. Download the PDF and read the entirety of chapter 4 – it’s short (14 pages) and pretty self-contained (or read the entire book! it’s right there!) – or at least take a look at this excerpt:

Chowdhury: So, the workers kept going on strike over pay and patient care. The hospital was turning away patients who couldn’t pay or provide insurance. That was pretty much everyone at this point, because the depression was so bad. People could hardly afford food, let alone these insane fucking hospital bills! And we never had huge public investment in hospitals—the system relied on the idea that people or their employers could pay. And when gradually everyone was pretty much out of work, the system had nothing to sustain itself. So yeah, it was definitely an incubator for struggle.

One of my favorite direct actions was when workers started sabotaging the billing. [Laughs.] Bills would mysteriously disappear from people’s accounts. But of course, that didn’t last long. The workers weren’t being paid consistently and supplies were running low. The first couple of strikes helped a bit, but then they started closing hospitals. When they went on strike in ’45, the hospital just shut down. It was fucked up. They started just shutting down the hospitals, because nobody was funding any of it and the government couldn’t keep up with running anything at that point. My mom and a lot of her coworkers ended up moving over to Elmhurst Hospital. But the City was in the middle of abandoning that hospital too. They wanted to close it and were reducing resources to it every day. The writing was on the wall—this hospital would close too. Until LARS-47 hit.

Abdelhadi: What happened then?

Chowdhury: LARS was nuts, because it made people hallucinate. And people were already stretched so thin, taking care of their loved ones and neighbors while they were in full-blown psychosis was really impossible. So, everyone rallied around the hospital once the pandemic started—workers, patients, everyone in _ the neighborhood. The City and the feds were useless, of course. What do you do with mass support but a city government that doesn’t care? At that point, “city government” was basically just the police and skeletons of previous infrastructure that had been gutted by budget crisis. Everyone was demanding more, and finally, in early 48 I think, the City announced they were officially closing the hospital. The response was huge. The nurses started a full occupation of the building. About five hundred people from the area joined in. They had these huge assemblies every day, and they made the decision to keep the hospital open. The [US] Army was everywhere at this point, they had tanks and gunboats lined up at LaGuardia. The political situation in Queens was a mess. Extremely fragmented, very chaotic. Every neighborhood had a totally different thing going on, and it was all rumors and confusion.

Abdelhadi: How did they keep the hospital running in the middle of all that? 

Chowdhury: The nurses, well, the Assembly they ran, but the nurses were the heart of it, decided they would keep Elmhurst open, and not charge any money for anything. It was still a totally wild idea. I gather people were trying something like this in other uprisings years before, but we didn’t know anything about that. It felt like we were just making it up as we went along. Hundreds of people would turn out to the Hospital Assembly every night to try to figure out how to keep the hospital running. Maybe a million people came to Elmhurst during the occupation for care. The Jackson Heights Commune had just started, and they initially kept everyone fed. Then the problem was how to get drugs. There was this big drug plant in the liberated zone in the Mississippi Delta, just outside the Jackson Fallout Zone—this was Jackson, Mississippi, not Jackson Heights. It was modeled after liberated pharmaceutical operations in Lima. They were shipping up drugs and medical supplies—so we had connections all over. I lived at the hospital for two months. I was coordinating teen volunteers. There were maybe a hundred kids who would come every day and help out with whatever needed doing. I think a lot of them became nurses and doctors later. Elmhurst was one of the first places in the US, to my knowledge, where a workers’ occupation just started providing free services permanently. 

Abdelhadi: Amazing!

Chowdhury: It really was. I think Elmhurst was really a turning point for the whole movement in North America. It became a really important model of communization struggles all over the city. The riots, the communes, the worker occupations—they were all patchwork before that. And Elmhurst was one of the moments where they could come together into a full break from the money economy. It was like: “Oh. We can meet our own needs.” The elders in movement circles would always say, “We keep us safe.” And at that point, it was like right, we keep us safe. We also keep us fed. We keep us healthy. We keep us alive. 

It was honestly so exhilarating for me to be a part of. I formed all of these really strong relationships there, like it felt like I was falling in love with everybody. I feel like I kind of discovered the kind of person I could be through being in struggle with other people. Like, mostly I am thinking of the teen volunteers I coordinated, but I also formed all these really strong friendships with doctors and the cleaning staff I had been working with and long-term patients.

Abdelhadi: That’s beautiful. The hospital ... it’s not still there right? It was ... it was destroyed? 

Chowdhury: [Pause.] Yes. Queens ... we were militant, you know. This neighborhood did not take kindly to military occupation, and they punished us for it. They had instituted these checkpoints and a curfew in ’49 or ’50. And people weren’t having it. After the military shot up a bunch of people after curfew, a squad from this area blew up a checkpoint. The military bombed the hospital the next day. Leveled it. There were over six hundred patients, maybe half that many workers. My mother was one of them. 

Lots of familiar stuff, right? We hear our nurses from the Pitt discussing strike actions they’ve had over the safety and other issues to Gloria’s face. The very first conversation Robby has after taking his earbuds out in episode #1 was rumors nurses had of the hospital closing (divestment).

The hospital becomes a locus of support and provisioning in times of acute crisis. We see how the doctors and nurses are animated by values and politics personal to them, yes, but also the utopian ethics doctors learn in school (put into praxis in residencies) and the development of empathy required of caregiving of all sorts. They are not animated by communist theory like I am, but arrive at the same sentiment of “to each according to their need” and it needn’t be more complicated than that.

So, like, how could a season of The Pitt handle an anti-fascist uprising if their writers were able to stop jacking off to cops and commit to the care communization they hint at? Well, I have some ideas bordering on fanfic so let’s get dangerous.

Maybe we start a usual day at the E.R. and once lulled into some complacency and minimal heat to demonstrate the show has absorbed the current moment – maybe a patient is abducted by ICE? or a nurse? – we see the unsuccessful but valiant life-saving efforts on someone murdered by a cop. There’s nothing resolved about the underlying conditions that drove the Floyd uprisings (the conditions are so much worse!), so why not just portray this in a social realist style mapped onto Pittsburgh?

Pittsburgh reacts with community grief, and a vigil forms outside the Pitt. Cops riot, as they invariably do. “Less lethal” munitions result in tons of life-threatening injuries pouring in (PSA the shit the media doesn’t report about “riots” please..) That night, a police precinct burns. Protesters occupy the E.R., overwhelming security and capturing several injured police – including the racist piece of shit cop (I repeat myself) who did the murder. Langdon, divorced, having made some recovery from rock bottom of an addiction with the help of people with good politics (why not several trans women?), is now a badass street medic and among the occupiers having himself an incredible redemption arc. Late into the night, cops attack and partially destroy the E.R. The lifesaving can’t stop, won’t stop!

Does the Pitt crew pick a side? Do they reject the cops and state violence and continue communization of the hospital or do they reproduce the unbearable “normal” we all suffer under? Do they put Gloria in soft restraints? Who is hungry and who eats from the sandwich cart? Everyone.

Myrna

She destroyed her cage

Yes

YES

Myrna is out

<3

Further Reading:

"Junkie Communism" by M.E. O'Brien, published in Commune

Health Communism by Artie Vierkant and Beatrice Adler-Bolton