The Hands Behind ‘The Pitt’

Photo by HBO Max/ Warrick Page

“It might be someone’s worst day of their life, and my job is to make it a little bit better.”

That’s the motto of emergency medicine physician Dr. Elizabeth “Lizzie” Ferreira as she works amid the frenzy happening in two Los Angeles county emergency rooms.

“You never know what’s going (to come) through the door,” says Ferreira, a Kalani High School graduate. “You try to make organization of the chaos that comes through.”

For six months each year, Ferreira works full-time at PIH Health hospitals located in the California communities of Whittier and Downey. But the other six months are spent on the set of the popular HBO Max medical drama series The Pitt, where she serves as one of the show’s medical consultants.

The Pitt takes place in the fictional Pittsburgh Trauma Medical Center and follows the lives of its healthcare workers and their patients. Each episode reflects what a 15-hour shift in a modern-day emergency room is like, where staffers manage unpredictable waves of patients while making rapid assessments on triage priorities. The show stars Dr. Michael “Robby” Robinavitch, who is played by Noah Wyle. Wyle is also known for his role as Dr. John Carter in the NBC medical drama ER.

Ferreira initially thought her role on The Pitt would involve sitting next to a director and advising as needed, but it turns out that the consulting gig involved weeks of commitment — and often resulted in many sleepless nights for her.

So far, she’s consulted on eight episodes for seasons 1 and 2. And her first assignment could only be described as kismet.

This fated opportunity required working with Wyle on a scene involving a grieving family and a simplified version of hoʻoponopono.

“How is it that the one girl that’s from Hawaiʻi gets the script that she’s going to choreograph on with the Hawaiian model?” notes Ferreira, adding that she remembers learning about the Hawaiian practice of forgiveness and reconcilliation while attending John A. Burns School of Medicine in Honolulu.

“(The episode introduced) the concept of how to deal with death in those of the ones that we love in a short timeframe to give some education to the public — which I thought was beautiful,” she adds.

Ferreira found out about the medical consulting job through the UCLA alumni network at Ronald Reagan UCLA Medical Center, where she completed her four-year residency in emergency medicine.

“I was the luckiest person in the world to be able to be a consultant on this specific show, and to also be able to work with individuals who are in television who also want to bring about true authenticity,” explains Ferreira, who obtained her undergraduate degree from University of California, Irvine before returning to the islands and entering JABSOM.

Ferreira is one of five medical consultants hired by the show. Each has a background in ER work.

Before the series began filming, actors had to enroll in a two-week medical camp to learn about the ER environment.

“We work through everything from suturing to intubating to how to do a normal physical exam (and) how you appropriately place your hands on a patient that’s in a respectful fashion,” she explains.

On the set, Ferreira helps with the rehearsal choreography of medical procedures, checking for any inaccuracies. She also gives feedback to the props and makeup teams to ensure visual veracity.

While actors handle a majority of the procedures, Ferreira occasionally steps in as a hand double for certain close-up shots. (Those are her hands in Season 1’s eye surgery on an injured baseball pitcher and administering sutures to a prison inmate in Season 2). She says that even the smallest mistake in a very specific procedure would be noticeable.

“The actors take it very seriously, which I think was one of the most rewarding aspects of it because they really want to bring the authenticity to the screen,” Ferreira explains. “Not to say that other shows don’t, but I do think that there is a specific determination in bringing that across and trying to get it right.”

Ferreira appreciates The Pitt because it “doesn’t shy away from discomfort” of what it’s really like to be in an emergency room.

She describes the “crash out” or mental breakdown of Dr. Robby due to his own personal crises combined with the chaos of the ER.

“I think that an emergency medicine physician — maybe all physicians … go through something similar to what Dr. Robby went through,” Ferreira adds. “It becomes overwhelming to the point where you realize you’re not caring for your own mental health, despite you trying to take care of others who may be having their own crises.”

Many of Season 1’s cases were “some of the rarest things you would see over a lifetime into one day,” yet she still finds it relatable to what she often experiences as a real-life doctor working nine- to 10-hour shifts.

“You see the nudity, you see the profanity, you see the violence, the aggression, the suicidality. Everything is on the table, and the ER is exactly that,” Ferreira explains. “There’s nothing that is off limits.”

The show also touches on current issues happening in the political landscape, and it isn’t uncommon to see patients violently lashing out on healthcare workers. In one episode, for example, a frustrated patient punches the charge nurse.

And yet, the show still presents a dose of hope for viewers.

“It’s been extremely refreshing to see people trying their best to make situations better, especially in such technical fields like medicine, where the stakes are so high,” Ferreira says. “The show does a good job of balancing the bleakness with seeing people trying to work in a system that is, unfortunately, so broken in the United States, but being so competent at their jobs, despite their own human errors.”

One of the most accurate moments from the show for Ferreira wasn’t a procedure or diagnosis. She describes an episode where an intern reaches a decision without running it past a superior and winds up making the situation worse for the patient.

“I just remember thinking, there is not one resident or now-attending doctor that has never made a mistake,” Ferreira reflects. “I thought it was so well done in regards to showing how serious a mistake could have been, and how having seniors and those with more experience teaching you and being available to correct the mistakes was appropriate and authentic.”

Working as an attending solo practitioner for four years has been both highly rewarding and stressful for Ferreira. But for those not in the medical field, the everyday pressures may not seem as obvious.

To help viewers better understand what ER life is like, The Pitt aims to be what Wyle calls an “empathy generator.” In fact, the show is already making headway with most viewers, 90% of whom indicated they’re now more aware about understaffing issues in ERs since the series aired, according to a study conducted by University of Southern California’s Norman Lear Center.

These impacts have also filtered down to Ferreira’s job as an actual ER physician. She says she’s seen greater appreciation for her nursing staff. Additionally, people appear to be more patient and understanding than before — something she never takes for granted because “the ER is only becoming more of an overwhelming place.”

“As a physician, it makes me feel honored and privileged to be able to be part of something so impactful and somewhat having a phenomena type effect on our nation’s audience,” Ferreira says.

Before she ever put on a white coat and beginning at age 8, Ferreira helped sell trinkets at her family’s shop near the old International Marketplace.

“The only time I ever got off was for junior and senior prom,” she says, “because I’d be working every weekend from elementary through high school.”

When she was in her teens, her father developed Parkinson’s disease. She remembers placing her feet under his and helping him walk at home. She also recalls feeling frustrated with not understanding the disease.

It was while Ferreira attended UC Irvine that she received a call from The Queen’s Medical Center’s ER that her father had passed away from subdural hemorrhages after falling twice. The ER staffer’s kindness while delivering the devastating news, however, was something Ferreira never forgot. The moment convinced her that she, too, could be someone who helped get others through difficult times.

“If I can help one person every single day, I’ve left the world a better place within my capabilities,” says Ferreira, adding that on film sets, her motto often becomes, “We’re going to make someone’s life better today because they saw something on the show.”

She believes The Pitt will be able to educate more people with its reach — and that’s an average of more than 15 million viewers per episode from season 2 alone, according to Warner Bros. Discovery.

“Whether it’s the mental health crisis, nurse staffing shortage, why vaccines are important, how to treat stitches, how to clean a wound — it’s such basic things that people may not get education on that can be done through the screen,” she says.

Ferreira hopes to eventually return to Hawaiʻi and serve her island community. She says that despite living in LA, she’s still very much attached to home and visits her family on Oʻahu at least four times a year.

“I go home as much as I can to try to keep myself grounded and understand the purposes for why I do things, which is to improve the communities that I’m in, particularly with emergency medicine,” Ferreira says. “The goal (is) always making (patients) better … just so that they can get through their day and if a life-saving event occurs, (that’s a) huge win.”

Ferreira is looking forward to the release of Season 3 of The Pitt when it releases in January 2027.

“I’m glad that there’s a show like The Pitt that’s able to let me bring the art to medicine in my own way and in my own life,” she says.