There are MASSIVE spoilers ahead for The Pitt Season 1!
1. First, Noah Wyle was inspired to star in a new medical drama 16 years after the conclusion of ER — which he starred in for 254 episodes from 1994 to 2009 — during the COVID-19 pandemic. He told Variety that he was getting messages from first responders that read, "Carter, where are you?" and "It's really hard out here." After an ER reboot failed to get off the ground, Wyle teamed up with ER producers John Wells and R. Scott Gemmill to create The Pitt.
2. While auditioning for the show, actors were also given a "mission statement" written by Noah Wyle, which detailed the dedication he was expecting from the ensemble that would ultimately be cast. Isa Briones, who plays Dr. Santos, recalled the statement, saying something along the lines of, "This is a very specific type of show. It's intense. It's fast-paced. It's like theater. We are a group of players. If you can be a team player who is ready to lock in with a family, then this is the place for you."

3. Before production began, The Pitt cast was trained by real doctors for two weeks so they could learn how to perform emergency medical techniques that would look as realistic as possible on camera. A lot of physicians are also involved in the creation of each episode, which is why a lot of real-life doctors have praised how realistic the series is. Dr. Joe Sachs, who was the technical advisor on ER, also works on The Pitt.

4. During their medical boot camp, aka doctor school, the cast learned how to do tracheotomies, intubation, drawing blood, ultrasounds, and more from visiting medical professionals who helped train them. One thing the doctors were very particular about was the actors getting the CPR correct.

5. Since we don't see the characters' lives outside of the hospital, the actors were given their backstories by the creators. Isa Briones told TVLine, "We would get pulled for individual meetings with John Wells and R. Scott Gemmill, and they wrote out a whole page of what they think your backstory is. They said, 'Obviously, there's room to play here. Share with us any ideas you have, but this is what we have in mind.'"

6. The Pitt is filmed almost like a play, with the cast staying on set throughout filming for the day, even if they are only in the background of a scene. The episodes are also shot in continuity and they filmed Episode 1 to Episode 15 in order. The actors were also given the scripts one at a time. Patrick Ball told Variety, "You might be the star of the show, but you’re going to spend three hours being a fuzzy blob in the background of somebody else's scene."

7. Also, because of how the series is filmed, background actors are also on set all the time in the same hair, makeup, and costumes for the duration of filming the season. Executive producer John Wells told Variety, "People come in, and they’re in the emergency room waiting room for seven, eight episodes, with a line or not a line at all. And then we see them come back and they might have two or three lines. And then an episode later, they have a huge scene. So we had to have buy-in from everyone."

8. One way The Pitt makes the ER setting seem as authentic as possible is you'll notice there is virtually no music. Unlike other medical dramas, like Grey's Anatomy, the series doesn't use popular songs to score scenes. Instead, there are a few instrumental moments here and there, but not many.

9. In order to foster a family-like environment on set with all the actors, cellphones were banned from the set. Instead, Noah Wyle encouraged reading and chatting, which was likely an environment that existed during his pre-cellphone ER days. The cast even started a little library near craft services so people could grab books to read, with Noah donating a bunch of books. The books ranged from classics to modern releases, with one extra even keeping Harry Potter inside her fake pregnancy belly to read between takes.
10. The sets for The Pitt were designed before writing began on the series so that it would feel like a real ER, with people waiting in a waiting room, patients waiting to be seen again by doctors, and the monotony that can happen in an ER. The real-time aspect of each episode being an hour of a shift also allowed the show to track all the background characters and share their journeys. Executive producer and creator R. Scott Gemmill told Variety, "I've spent many times in the ER with loved ones, and it's hard to capture what that feels like."

11. For the PittFest mass shooting episodes, all of the blood on the floors had to be tracked by production designer Nina Ruscio, who needed to keep tabs on how the blood got from "space to space." She had to figure out how to "manage the blood," which was essential to depicting the reality of what happens in an ER during a situation like this. She told Variety, "A rule for myself was how blood is tracked from space to space: on the gurneys or off the gurneys onto the floor. It had to be ergonomically connected to where the wound was."

12. One of Patrick Ball's audition scenes for The Pitt was the moment when Robby confronts Langdon about the pills. So, while some viewers might've been caught off guard by Langdon's secret, Ball knew from the very beginning. This is Ball's first major TV role after having only guest-starred on Law & Order. In real life, his dad is a paramedic, and his mom is an ER nurse.

13. In order to make the birth scene in Episode 11, aka "5:00 p.m.," as realistic as possible, a "birth rig" was used to make it look like Enuka Okuma, who played Natalie, was actually giving birth. The rig consists of a gurney with a prosthetic of a pregnant belly, legs, and a vaginal canal anchored on top. Okuma was able to sit in a kneeling chair behind it and align her body with the rig. Then, her real legs and two puppeteers — who were controlling the silicone baby and tubing that added blood and other fluids — were hidden by the gurney and medical drapings.

14. Also, the moment when Mel holds the newborn baby in Episode 11 wasn't scripted but something the cast came up with while filming the episode. The baby was animatronic, but Dearden said you could feel it moving with a puppeteer controlling it off-camera. Taylor Dearden told Vulture, "Dr. Collins was the only one supposed to be handling the baby, but I remember Tracy Ifeachor saying, having lost a baby, it would be really hard to cradle a healthy baby right now."

15. Katherine LaNasa shadowed a nurse named Kathy Garvin, who works at LA General and who the character of Dana Evans is loosely based on. She said while shadowing Garvin, she learned about the "care of [the ER] regulars." LaNasa told Vulture, "She told me about a guy there and what his journey had been like. I really got to see her relationship to him. But it was very matter-of-fact because there’s emotional, mental, and physical trauma going through there all day, every day. For them to be able to serve everyone, they have to have this kind of emotional efficiency."

16. In Episode 14, aka "8:00 p.m.," McKay's father is played by actor Fiona Dourif's real-life dad, Brad Dourif, who has been playing Chucky since Child's Play in 1988. Speaking to Variety about how her dad wound up in The Pitt, Dourif said, "My suspicion is that it was Noah Wyle's idea. He has talked to me about my dad’s career in great detail before, so I know there needed to be a device to get Harrison home, and it was probably thrown out in the writers’ room as a very cool idea."
17. And finally, since the big trauma scenes are incredibly complex, the actors rehearse everything before filming begins. "The lines come rapid fire. The procedure comes rapid fire. There's so many moving pieces," Fiona Dourif told HBO. Gerran Howell, who plays Whitaker, also related the big trauma scenes to a "dance" where it's almost like "everyone has their own choreography."
