“Don’t worry, sir, there will be no more pain!” This promise, awkwardly yet chipperly delivered by Dr. King in the beginning of episode 13, is a much-needed yet fleeting moment of levity in an hour marked by devastation. It’s fitting, then, that she says it to a man in a clown costume after poor Whitaker takes Dr. Robby’s directive to give every patient an IO a bit too literally and drills into the man’s arm. The man is smeared in makeup and blood, and he regards King with an expression of brittle weariness that gives the episode its last real moment of humor—barring Dr. McKay’s drilling into her ankle monitor after it goes off—before The Pitt delves into some of its most deeply tragic scenes to date. 

Just a few beats after this moment, social worker Kiara and her colleague, the ward clerk, do the quiet and brutal work of photographing the dead. The tension of knowing that soon they’ll have to show these photographs to agonized family members hangs over every other moment on the floor as the medical team works to keep the wounded out of the makeshift morgue—even as it highlights how the living will be forever altered.

McKay, Javadi, and Perlah attend to a young woman who can’t feel her legs and tearfully asks if she’ll be paralyzed, which McKay can only answer with the notion that recovery is possible. Mr. Grayson, the “old hippie” with the head wound, tells Whitaker that he’ll never get the images of the day out of his mind. After attending to Mr. Grayson, Whitaker helps Carmen, a young woman whose leg injury won’t stop bleeding, as she trembles and sobs, at first barely choking out answers to the questions he asks to distract her—as best he can—from her agony. 

For a show that, by virtue of its setting alone, is suffused with maximalist drama, The Pitt manages to show its characters’ evolutions, or de-evolutions, with effortless subtlety. Whitaker, the death-haunted aspiring doctor who came to be almost frightened of his patients, chats with Carmen about how he likes coconuts. (Has the farm boy ever even had one? Likely not.) Mohan, the queen of patient-centered care, whose dedication earned her the nickname “Slow Mo,” finds the reserves to act with a life-saving swiftness on her feet. Dana is back in boss mode, ushering the police who’ve hovered over their fallen colleague into a waiting area. Meanwhile, Robby and Langdon are ready for battle on the floor, but currents of anger, betrayal, anxiety, and reverence flow between the two men. Because even when the immediate blitz of terror is done, what has gone on between them is far from over. 

The episode builds on smaller beats of dread, like Kiara and the ward clerk saying “I’m sorry” in unison to a woman in teddy-bear-covered scrubs who’s just learned that her husband is dead and her brother is unaccounted for. Or Langdon finding an ankle holster on a jewelry-shop owner hauled in with a massive gut wound, compounding the amorphous, free-floating anxiety that the shooter will bring his carnage directly to the hospital. Or the image of a shell-shocked woman with her arm in a cast wandering out of her wheelchair, gazing out at the rows of broken bodies with a glazed, dead-eye slur of a stare. 

These smaller beats culminate in the absolute tragedy of the hour, one that starts to unfurl when a pickup truck with Jake and his girlfriend Leah pulls up to the hospital. Jake has taken shrapnel to the leg, but Leah has been shot through the heart and is unresponsive. Taj Speights, who’s only had a minimal role, gets to absolutely shine in this hour, starting with his panicked yet blindly optimistic delivery of the line “I kept pressure on the wound”—as if this little bit of knowledge picked up in the ER could possibly save his love. 

Robby’s attempts to revive Leah will become the axis of the episode, the spoke around the wheel of all other tragedies will grind. These scenes are unflinchingly brutal, starting with the image of Leah’s bloodied, bare-chested body being moved onto the gurney as Robby does hard compressions on her slim chest. With Leah unconscious and slipping away, it falls to the other characters to express just how dire her situation is. Katherine LaNasa deftly vacillates between sorrow for Jake, for Robby, and for the young girl on the table and a professional determination to do the best she can. But the best everyone can do here is not enough—nothing would be, except for divine intervention. 

That doesn’t stop Robby from trying. Noah Wyle conveys Robby’s resolve and fatigue, the sense that, even beyond being Jake’s girlfriend, Leah is not just an ordinary patient. She’s an avatar for all the people he hasn’t been able to save, including the Mr. Spencer, Nick, Amber, and, of course, Dr. Adamson. To further emphasize just how above-and-beyond Robby is going, how he’s past the point of hope, writers Joe Sachs and R. Scott Gemmill have Dr. Abbott repeatedly challenge Robby about how much blood he’s using for Leah, telling him that they’ll lose 10 patients in the time he’s spending on this girl who’s already gone. 

While The Pitt has been an actor’s showcase for its talented cast, it is fundamentally Wyle’s show, and this episode gives him his most powerful scene to date. Watching his careworn face crumple soundlessly, telling Jake that Leah has died before he even opens his mouth, is devastating. Wyle seems aware of the potency of his warm, gravely voice, how his tone can sound both knowledgeable and assuring. So as he allows it to rise and start to crack, slowly, as he recounts all the deaths of the day to Jake, the effect is unsettling.

Leah’s death prompts one of the more detailed flashbacks to Dr. Adamson’s, with Robby, still in PPE, slumped over his mentor’s bedrail, sobbing. And it’s a scene that’s made all the more eerie for being in total silence. That silence transitions over to Robby’s breakdown in the here and now, as he slumps down to the floor, weeping without end. It’s been a long time coming, but it’s coming at the worst time possible.  

Stray observations 

• • I understand that Jake is heartsick and traumatized, but him blaming Leah’s death on Robby was so unfair. 
• • In other news, Dr. Santos does a seemingly reckless maneuver on Carmen but ends up saving her life. If the show has one flaw so far, it’s that a lot of her more off-the-cuff actions don’t seem to have consequences. It doesn’t feel realistic for every risky move to be rewarded with success. 
• • David, the boy with the hit list, has returned to the hospital to pick up his mother. He’s immediately tackled and detained as the suspected shooter. But the show is too smart to have it be this obvious.