5 patients you’ll meet in The Pitt Season 1

During the US run of The Pitt Season 1, the show’s lead physician-writer, Dr Joe Sachs, was approached by a colleague who warned him that the show’s use of real-life footage of medical procedures was opening him up to prosecution for HIPPA (patient confidentiality) violations. But The Pitt wasn’t using any real-life footage at all – all its convincing on-screen medical procedures were set up by Emmy-nominated head makeup artist Myriam Arougheti and her team.

Once Myriam had a list of the procedures required for the series, she studied the surgeries and other interventions on the EM:RAP database, which includes hours of videos of real-life procedures that ER physicians use to study ahead of surgeries. Myriam also studied reference photos of medical incidents before meeting with her special effects makeup team to discuss how they could make it all look real on screen without endangering the performers who’d be playing the patients. And once they knew what they wanted, they contacted special effects houses to help them to build the body parts and all the hidden mechanics that would bring them to life. 

We picked out just five patients to outline how much work went into making over the hundreds of patients passing through the Pitt’s waiting room … and there are at least 85 of them even before the 112-patient mass casualty event kicks off in episode 12!

Watch The Pitt Season 1 on Showmax. New episodes each Tuesday. 

Episode 1. 7AM – degloved foot

Minu (Arun Storrs), a Nepali woman, is brought to the ER after being pushed onto the train tracks. Her foot has been degloved (skinned) and the ankle is dislocated in an open fracture after being caught between the platform and an incoming train. 

For the scene, prosthetics artist Jason Collins and his team at Autonomous FX built an anatomically correct “dry” version of the injured leg and foot that could be re-set on screen. Sculpted by David Grasso and painted by Eric Koo, the open wound shows all the tendons on the top of the foot exposed, along with flayed skin and fascia. Painter, sculptor and makeup artist Thom Floutz then added artificial blood and wet-look gel for the on camera shoot. The Pitt’s sound effects team later added the wet, gristly sound in post production for when the joint was re-set on screen. 

Episode 3. 9AM – nail in the heart

The Pitt surgeons have to perform an emergency thoracotomy after a construction worker named Hank (Blake Shields) comes in with a drywall nail through his chest that has penetrated his heart. They can’t just yoink it out; it’s time to crack open that chest. 

And that meant Myriam Arougheti’s team needed to give the cameras a full look at the heart and lungs – which meant creating a range of prosthetics, all the way from the small penetrating wound, to a prosthesis that would allow them to slice open the chest, to a model with the chest wall retracted that included a still-beating heart and lungs, each of which was operated by their own “puppeteer”. And because they had a prosthetic chest on top of the performer’s real chest, the makeup and effects team asked production designer Nina Ruscio to help them to “cheat” the camera by building an adapted gurney that would position the real body lower than the head, so that the fake chest and actor’s real head would look as if they were on the same level.

Episode 10. 4PM – full-body burns

Photo Credit: WARRICK/MAX

This episode earned head makeup artist Myriam Arougheti and special makeup effects artists Thom Floutz, Chris Burgoyne, and Martina Sykes their Emmy nomination for Outstanding Prosthetic Makeup. 

The Pitt’s key patient is Teddy Miller (Robert Nash), a man who has third degree burns over 90% of his body following a gas tank explosion, which makes intubating him urgent. Instead of just looking blackened and cracked all over, Teddy comes in with full-thickness burns over 60-70% of his body. The look includes hyper-realistic “dead” white skin over red, raw underlayers, and wounds that show different levels of the skin that have been burned through (the makeup artists used a product called Baldiez sheets to imitate the delicate layers of skin, some as thin as a sunburn peel). Aside from the complex makeup that the skin involved – which included painting with alcohol paints then sealing with layers of pros-aid, and stippling thickened Skin-Tite using a coarse sponge in the inflamed areas to create the fine layers of cracked and sloughing skin – the makeup team also needed to show the doctors cutting open Teddy’s burn-swollen chest wall to allow it to expand, in an escharotomy procedure. So Dan Rebert created a hidden bladder rig to stretch open the prosthetic chest built by the Fractured FX artists. 

Episode 11. 5PM – childbirth

After surviving a traumatic birthing experience, director Quyen Tran wanted to take the audience into the reality of the experience. The patient, Natalie (Enuka Okuma), comes in with her baby already crowning, which Dr Collins (Tracy Ifeachor) confirms – with a flip of the modesty blanket that shows the audience literally everything … and nothing. From the pregnancy belly, to the birth canal and surrounding area, to the emerging baby, this entire scene was set up by the makeup department. 

Autonomous FX’s Mike McCarty already had experience with creating mechanical babies and prosthetics that could mimic a birth thanks to his work on SMILF and Dead Ringers. He and his team constructed a rig consisting of a gurney with a silicone prosthetic of a belly, legs, and birth canal anchored on top, which were coloured to match actress Enuka Okuma’s skin tone. Enuka knelt on a chair directly behind the rig, which allowed her to lean over the belly and legs to simulate labour. Hidden by the gurney and medical draping, a puppeteer had their arm inside the hollow pregnancy belly, and synchronised their movements with Enuka’s to squeeze the silicone baby out of the birth canal (with the silicon baby immediately being swapped for a mechanical one that could make subtle arm, chest and head movements). PS: if you think you’re seeing too much blood when Natalie starts haemorrhaging after delivering the placenta, The Pitt’s consulting doctor for that scene confirmed that it really is that much, that fast.

Episode 12. 6PM – bullet exit wound

Twelve hours into the shift, 112 new patients pour into The Pitt following a mass shooting at an outdoor festival. Head makeup artist Myriam Arougheti and background supervisor Lisa Simone attacked the shoot with near medical precision, performing their own version of triage as they set up charts showing every extra playing a patient, where they were shot or injured, pictures of the prosthetics that would be used to create the effect, and a detailed step-through of how the ER staff were going to handle the patient’s treatment. 

Amid all the chaos, one makeup look that comes in right at the end of the episode is really worth pausing for. Officer Rich Stefano (Telvin Griffin – check out his Instagram page for a short video of the prosthetic-making process) comes in with a gunshot wound with an entrance in his neck, and exit wound via his cheek on the opposite side. Christien Tinsley and his team at Tinsley Studio sculpted the super-detailed cheek prosthetic, which included blown out teeth (complete with fillings) and multiple pulped skin, muscle and fat layers in the cheek wound. The prosthetic, which was sculpted over the lower half of the actor’s face, was hand-painted by Thom Floutz. 

Also watch out for…

Episode 15: fork in the nose

After a gruelling day dealing with a mass shooting, the ER staff get a moment of comic relief when an unnamed 14-year-old patient comes in with the tines of a fork stuck through the tip of her nose following an accident at home. The case was inspired by a real-life image of a toddler with a similar injury. To build the effect, Justin Raleigh at Fractured FX created a prosthetic nose tip with a fork handle and tines that were made in two parts, so they could snap together magnetically to make it look as if the fork had gone through the nose. 

Episode 13: poke the clown

Dr Whitaker (Gerran Howell) misunderstands an instruction and uses a procedure that is normally only done on unconscious patients, drilling into circus clown Buster Pirelli’s (Skylet Stone) arm bone with an EZIO medical device so that an intra-bone IV can be placed. It’s Buster’s reaction to seeing Dr McKay (Fiona Douriff) pick up the EZIO later that really sells this, especially when he refers to The Pitt as a circus. 

Episode 6: BBL trouble

Twenty-two-year-old Channel Sutton (Megan Barkley) turns up at the ER shame-faced after getting a back-street Brazilian butt lift by having someone she found on TikTok inject silicon caulking into her rear. The lumpy, fake butt was sculpted by Eric Koo, made into a mould by the Autonomous FX team and painted by Thom Floutz before being placed over Megan’s real behind.

Fun Fact

With the camera flying all over the ER capturing the action from different viewpoints, director of photography Johanna Coelho had the show’s crew dress in scrubs so that they’d just look like medical staff if they accidentally wound up in shot. 

Read more about medical drama series on Showmax.