The following story contains spoilers for The Pitt season 2, episode 7, “1:00 P.M.”
IN ORDER TO sustain itself over the course of its 15 hour-long episodes, The Pitt has no choice but to understand the importance of proper pacing. Season 2’s sixth episode, titled “12:00 P.M.,” was without question the season’s most emotional and taxing episode to date, bookended by fan-favorite character Louie’s (Ernest Harden Jr.) death at the beginning, and the reveal of his tragic backstory at the very end.
For the moments like that to really hit with their intended impact, a show can’t go to that place too often. It’s smart for a show like The Pitt to then take a moment to settle back in and get things slowly moving again, building up little by little to once again in order to eventually get to the next big moment. And that’s a journey that starts in season 2, episode 7, titled “1:00 P.M.”
But because The Pitt is such a smart show, it also realized that it’s the perfect time for something new, fun, and exciting—and featuring another fan-favorite character, too. We get to see nighttime attending Dr. Abbot (Shawn Hatosy) for the first time in season 2 in “1:00 P.M.,” and he comes in a way that no one could’ve been particularly expecting—with a SWAT team, in gear, trying to save an officer named Hiro who has taken a gun shot wound (GSW) to the neck. It’s a rough, bloody subplot—anyone with a squeamish stomach should be aware.
It’s clear from the jump that we’re seeing the aftermath of a major firefight, and Abbot was there for the whole thing. It’s explained later that while Abbot was told by his therapist to get a hobby… this led him to moonlighting as a field medic with a SWAT team. We learned Abbot was a war veteran in season 1, and now we learn that for “fun” he decided he wants to help out on SWAT team missions. As Dr. Santos exclaims, “that’s badass.”
Abbot isn’t fazed. He’s locked in, immediately tapped into ER doctor mode in order to work with other doctors—including Robby, Al-Hashimi, Santos, Garcia, and more—to save Hiro, who’s got a pretty nasty wound on his neck, and has already been intubated by the time he arrives in the ER. It’s a challenge for our characters, and, for those of us watching at home, it’s an intense, jargon-heavy bit of television. To follow what’s happening, we kind of have to use our eyes and read the vibes, rather than understand much of the dialogue itself (more on that below, though).
But the challenge to save Hiro’s life also makes for a really interesting bit of The Pitt. We’ve all seen movies like Training Day, End of Watch, and Netflix’s new action movie The Rip that are filled with firefights and action—and now The Pitt is showing us what happens when someone gets hit.
We’ve seen the action movies, and now we get the aftermath, led by the great Dr. Abbot.
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An ER Doctor Reacts to Dr. Abbot’s SWAT Team Gunshot Wound Patient in The Pitt Season 2, Episode 7
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Dr. Abbot’s SWAT team emergency is one of the most compelling subplots The Pitt has done all year. That’s in part because it features the return of Dr. Abbot himself, one of our favorite characters on the show, and also because, as we mentioned above, it kind of feels like the aftermath of a major gunfight sequence in an action movie.
But the scenes themselves are quite challenging to both follow and understand, so we once again got in touch with Dr. Robert Glatter, the Assistant Professor of Emergency Medicine at Lenox Hill Hospital, an experienced ER doctor, and a member of the MH Advisory Board, and asked for his help in breaking down what, exactly, was going on in this subplot, and how the doctors managed to save Hiro’s life despite his gunshot wound.
Dr. Glatter’s take:
The reality is that a gunshot wound to the front or base of the neck (Zone 1) can cause full separation of the upper and lower ends of a person’s windpipe. It is typically lethal.
That is, unless the lower end of the windpipe is rapidly located in deep tissue planes, carefully and delicately grasped, pulled up and forward with special instruments and stabilized so that a breathing tube can be inserted. Following this, a balloon at the lower tip of the breathing tube is inflated to secure it in place. This is called a “makeshift” emergency tracheostomy.
Assurance that the procedure was performed successfully includes the absence of air leakage surrounding the breathing tube and rising oxygen levels. More importantly, doctors need to see signs of a normal gas exchange of oxygen and carbon dioxide. This would indicate the breathing tube is in the correct position.
If a breathing tube is in the proper position, the patient can be properly oxygenated and ventilated—meaning air containing oxygen can enter the lungs which is crucial for the brain, heart, and other vital organs.
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There were several clues that the original breathing tube placed by Dr. Abbot prior to arriving at the emergency department was in the esophagus and not correctly in the windpipe. First, the patient showed low oxygen levels in the mid-80s on arrival to the trauma bay. The ideal range should be above 93 to 94 percent. Second, Dr. Abbot’s statement that he saw the vocal cords but had “resistance” advancing it forward. Lastly, air “bubbling” in the open wound at the base of the neck would hint at injury to a person’s windpipe.
Working in a field with gunfire, Dr. Abbot was justified in his attempt at placing a breathing tube in the setting of a zone 1 injury, but it is critical that correct placement of the tube is confirmed upon arrival to the emergency department.
This was demonstrated when Dr. Santos first checked for a breathing tube in the windpipe using an ultrasound probe. Dr. Santos then followed by checking for “lung sliding” to rule out a collapsed lung using an ultrasound probe over the mid-chest. These are important actions to perform in any person intubated in the field, but especially among critically injured patients with a gunshot wound to zone 1 of the neck since it can be harder to surgically reach organs like the heart. Lack of oxygen, for 4 to 6 minutes from a Zone 1 gunshot injury can also lead to irreversible brain damage.
Time is of the essence, and minutes matter.
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Evan is the culture editor for Men’s Health, with bylines in The New York Times, MTV News, Brooklyn Magazine, and VICE. He loves weird movies, watches too much TV, and listens to music more often than he doesn’t.
Jocelyn Solis-Moreira, MS is the associate health & fitness for Men’s Health and has previously written for CNN, Scientific American, Popular Science, and National Geographic before joining the brand. When she’s not working, she’s doing circus arts or working towards the perfect pull-up.
