My favorite thing about season 2 is how much of the nurses we are seeing.

My least favorite thing is having to see a random dick

A very long analysis of Doctor Baran Al-Hashimi

First of all- this is not a bashing rant, this is a critical examination of Doctor Baran Al-Hashimi's first hour in the Pitt, the culture shock she experiences and the ways this shock sabotages her future work relations with Robby and the entire staff.

The main struggle Al-Hashimi faces is that she simply does not understands what it means to be an emergency department attending, and especially what it means to be the head of an emergency department of a level 1 trauma center, which I remind you, are between 220 to 255 of in the US.

Let's start with how she came in: She brought a bagel spread, which is a big win, and she showed up early to meet the night shift. But here is where she started to fail:

all this 4 minutes into the episode. Now, I hope I do not have to explain why coming in and undermining the shift's attending is bad, and why making the charge nurse hate you is a cardinal sin.

now for the next 3 points, starting with the patient passports. the patient passports, while a noble idea and a great tool in certain environments, is just not a good idea for the ED environment. First problem is that it is extra work for everyone involved, from distributing to filling when you already have an overworked staff. Second problem is the privacy issues that can arise from not being able to properly dispose from those forms that have private medical information on it. there is a risk of a passport being misplaced by a patient going into crisis or being in a rush or by a care provider who has to step away urgently because of a trauma or some commotion, leaving this form full of private medical information in plain sight. Third problem is the cost, which with quick math by myself and some friends will cost about 73000$ per year, which is also the yearly salary of a nurse.

Implementing such a radical change to the procedures and policy with so little prep-time for it, on your first day in a new place, in the hours before the person you are here to replace shows up, is a sure way to make people dislike you. now, the clear context to that it that as a Clinical Informatics Expert she led a very successful quality improvement changes in the VA, a thing that probably made her the candidate both Gloria and the board chose to bring in. This change, including all the others she wants to bring are presume included in the packet that was sent to Robby, and were probably approved by Gloria. however, Robby did not read those in the time he did not have and did not respond. Al-Hashimi ignores that, and goes forward despite not getting a conformation from Robby, leaving the entire ED to be blindsided with her showing up and immediately implementing the patient passports. This is very much a hint that management hopes to replace Robby and are using his Sabbatical to try and bring someone they thing will solve all their problems. But, Al-Hashimi is not the head of the department, Robby is, she is only covering for him, and therefore her actions are a sign of huge disrespect in the leader the ED loves, trust and listen to. Combine this with the fact that the grace period before she starts acting as chief, it can defiantly cause tension with the staff.

in most places, there will be a grace period where the new hire will shadow someone of similar or the same rank, so the fact that this is her first shift, not the first shift as substitute chief, but at all, and instead of shadowing Robby she is jumping in is unconventional. instead of taking the time to learn the lay of the land, as getting familiar with the layout and procedures of the Pitt, she came in strong in a way that feels intrusive. I do not know if we will get the backstory of why Al-Hashimi and Robby never met before the shift, but I suspect that it was an intentional play from Gloria.

for the next point- the mock trauma. it might be a great way to test the med students, in a controlled environment, without putting real patients at risk, but this kind of teaching is to be done in clinical learning sessions, not during an actual shift in an actual active ED. Her preforming this little exam pulled 4 people away from caring for patients , occupied one of the two trauma rooms that can be needed in a moment's notice and have to be ready to be used just as fast and kept it from being usable in case of a multi-victim trauma, all while the waiting room is full. A waiting room that will get more busy as the day continues due to the July the 4th celebrations. Funny enough, that little exercise just helped to lengthen the wait time, which we all know is one of the major contributors to patient dissatisfaction. taking away the med students and the intern to do this mock trauma, means that everyone else has to pick up the slack of both her and the med students, rather than being able to rely on her to lead and them to help, which means more work for everyone else. And by starting this before night shift goes home, she initiated this while taking people away from the less-staffed shift, and undermined the shift's leading attending.

this leads to the next point- which was scolding Santos for being behind on her charting. Santos was not part of that mock trauma and had to pick up the workload and gets scolded for being late on charts. Meanwhile she had Javadi, the M4, fill in a mock chart, pulling her from doing charting for actual patients and dealing with the night shift hand offs. As much we can see, only Javadi got this task, and not the M3s who would benefit more from this kind of exercise.

all of those immediately marking her as disrespectful of the ED and their work, which is not a good start. looking at that, the rest of the episode and a bit of interviews, I have come to the conclusion that Doctor Al-Hashimi's biggest blind spot, and the thing that hinders her as a leader in the ED is that she simply does not understand what it means to run an emergency department, even less a level 1 trauma center.

Doctor Al-Hashimi ran a VA, which serves a very specific group- veterans and their families and works in a completely different way. A VA is a clinic, and while they do get walk in emergencies, as stated in episode, they do not get medic runs. While walk in trauma's are a thing and can be complex in their own right, Medic runs can and will be far more severe as the patients often cannot get anywhere by themselves. another major difference is that a VA is built for long tern care, that means patients that will return multiple times for regular care and only come in for a single, specific emergency. Therefore, cultivating a positive relationship that builds enduring trust encourages that patient to both keep returning and rate you well as a physician and medical center, is an important part of the service being offered.

while a long tern or a returning patient is part of the proper routine of the VA, an emergency room is a completely different beast. outside of the outlier of frequent flyers, Emergency rooms rarely see the same patient twice and ideally, EDs take care of the emergency so that the long term care could be moved to the proper specialties for the long time care. this makes patient ratings less critical for the ED, as recommendion from a former patient to someone else needing the ED's services can bring new patients, they are not as important as they are in the VA setting or clinic settings in general. Often an ED is not picked out due to recommendations online but to factors like proximity and availability on relative short notice.

While the VA do have a residency program, PTMC is a teaching hospital, which is a different kind of team management and teaching methods. The VA is much more controlled environment than the ED. They are more likely to have rooms to practice clinical learning on dummies with simulated demos. The VA still handles traumas, but this is still worlds apart Lvl 1 Trauma Center.

The final difference I want to point is the culture. Emergency medicine is full of dark humor, banter and a type of flexibility around the rules, a culture that developed both as a cooping mechanism and as a clash between the pristine protocols and the messiness of life. while this kind of humor is welcomed as a healthy cooping mechanism in the ED, for a VA doctor this kind of attitude is reasonable from the patients, but showing this can be a sign of a bad or negative mentality which would negatively influence the emotional state of the patient and the staff.

this gap in understanding can be shown in the trauma scene. First I will offer you a breakdown of all the moments Dr. Al was out of sync of visibly out of place, with a more complete analyses afterwards.

now, what does all of that shows us? basically, that Al-Hashimi is not in sync with the rest of the ED. Robby has a very specific leadership and teaching style that focuses on guidance, while Al-Hashimi is very much a hands on teacher- she rather show people and be a part then stand back and let someone inexperienced call the shots. Both are valid educational approaches, defined by the environments they developed their teaching styles.

Robby is very much still responsible, but he is a guide from the sideline, which clashes with Al-Hashimi's instinct to join in and teach by doing. From the dialogue and the acting we know that this whole situation is not new to Robby, he is familiar with the outcome enough to stand back comfortably, intervening only when he feels that there is a need. Al-Hashimi very visibly lacks this pattern (and the specific experience), for her this trauma is an edge case that requires her to join and lead by doing. in season 1 we see Robby lead by doing, but he does so rarely, only when he feels that his active participation is needed, if because he cannot guide others from the side or that they need the extra set of hands.

this class is frustrating to doctor Al-Hashimi, who Robby talks to as if she was his resident and not an equal attending, and holding her back, in a way that can be interrupted as a lack of trust.

from the rest of the episode we can see that this leadership difference continues, Al-Hashimi continues to be a very active and involved teacher, providing answers, while Robby is very much a guide from the side line that prefers to let others reach the answer themselves.

another small example is the exchange with Santos- Robby stays mostly quiet, letting Santos give him the information and her suspicions, asking her for a plan and not giving it to her. Al-Hashimi came in with a question, ready to offer an answer. looking at Trinity we can see the way she defers to Robby, comfortable with his more hands off leadership approach, unsure of what to do with Al-Hashimi more involved approach.

I am not calling Baran Al-Hashimi a bad doctor or a bad teacher, this is a valid approach that can serve her well, but it is out of sync with the rhythm of the Pitt, and her insistence to stick to her own methods and not play by that tune imminently marks her as an outsider, for better or worse.

We do know from interviews that Al-Hashimi did some humanitarian work, and I am curious to what type, but even the most intense stint is a temporary one, in contrast to the never ending high and lows of an emergency department.

Now, the next part is almost entirely speculations based on interviews, the one episode we have and my own experience as a project manager and a regulator among other stuff.

I believe That Gloria and the board brought Al-Hashimi in hopes to use the sabbatical as a trial run so they could justify replacing Robby with Al-Hashimi. We know that the Pitt has under average satisfaction scores and is considered inefficient, with the board considering a management company, so it is not outside of reason that Gloria wanted Al-Hashimi to appease the board. Al-Hashimi showing up on Robby's last day is sketchy but we don't know enough at this moment.

Gloria probably gave Al-Hashimi an introduction to Robby, and a very biased one. I suspect that Al-Hashimi got the impression that Robby is a dinosaur, probably a misogynistic, apathetic asshole that will refuse any improvements to the department or technological advances due to his ego. She came in guns blazing, ready to fight the good fight for the sake of the emergency department, uniting the department with her innovations and technologies that improved the VA and earned her the favor of the board.

instead she got the sassy, petty cowboy, that is respected and loved by his department. She came in expecting to have him try and walk all over her, and she is struggling when the most he does is sass. she came in ready for a fight and does not know how to react when she those not get that fight, instead Robby treats her in a slightly amused unbothered resignation. not only that, the entirety of the staff is not immediately enthusiastic about her reforms, treating her with suspicions and even anger when she expected the open arms she got from Gloria.

My main takeaway from 2x02 is that the hospital board should actually let Dr. Shen run this Emergency Department, because the two day shift attendings are currently both on extremely thin ice. Al-Hashimi is not endearing herself with her AI enthusiasm, and she seems more focused on pushing Robby's buttons than on treating anyone. Also please someone teach her about the concept of personal space, it's stressing me out. Meanwhile, Robby is allowing her to push his buttons, and more disconscertingly is suddenly happily agreeing with insurance bullshit instead of advocating for his patient because the chick he's banging wants him to, and that may be the biggest disappointment yet of all. Listen. John Shen is not even going to ask for a raise, just give him another latte and Thanksgiving off this year, and he's your man.

oh dennis baby

The moment this happened I knew Tumblr was gonna have a field day

@man1cpixiedreamcowboy got me thinking about autistic jack abbot.

jack abbot who never understood why sudden loud noises were so harsh to him, even before the PTSD.

jack abbot who takes things apart and puts them back together.

jack abbot who eats the same breakfast everyday, the same flavor of protein bar as close to 12 AM as he can get it, and drinks a sunny d around 5 to push him through the last of the night shift (a comforting drink from childhood).

jack abbot who buys the same shoes every three months and has no desire to try onclouds or hokas or whatever the fuck everyone else insists is better.

jack abbot who kinda hates being sweaty. he can compartmentalize that well enough at work but he will be damned if he’s not bone dry at home.

jack abbot who just wants to talk about napoleon with anybody who will listen. he really likes talking about pollinators too.

jack abbot who goes up to the roof so no one sees him meltdown and hit his head and yank his hair.

jack abbot who has had the same phone since 2017 and dreads the day it stops working.

jack abbot who didn’t even get diagnosed until his 40’s and then everything just kinda made sense.

jack abbot who lost his wife, the one person who understood all of this intuitively without the label or the explanation and had to establish a whole new routine without her.

THIS IS... THE MIGHTY NEIN (plus Essek) ⤷ template

i think my big hangup with melangdon as a ship is that, as an autistic lesbian, having a platonic friend like langdon would be life changing for me. like someone (a man???!!!) who gets me who i also get, someone who sees me in a way other people don’t and is in a position to protect/advocate for me, and it doesn’t come out of a place of wanting anything in return but friendship. like to me that is such a beautiful relationship that i personally find more appealing and fascinating and unique than a romantic one.

(and i say this at someone who rolls their eyes when ppl say that characters i ship have familial relationships or “why can’t relationships just be platonic” etc etc so this is not an attack on melangdon as a romantic ship i just feel so much excitement for this kind of platonic relationship between a man and a woman)

autistic mel king [insp]

dr mel king is perhaps the most violently autistic coded character I've ever seen and I've spent the last five months murderbotspiralling. she just got knocked right out of an emotional breakdown by someone telling her he needs her to very slowly and methodically pick one thousand pieces of gravel out of a wound. her face lit up like a firework mid-bloom.

something something dennis whitaker having an autistic meltdown in the pitt and running to the roof to have it in private.

something robby seeing him run towards the roof and panics bc he’s too young to be having the pitt driven suicidal tendencies and follows him up only to find him hyperventilating and hitting himself in the head.

he runs over and hears him humming but through the tears it sounds more of a pained gurgle and tries to talk to him only for him not to respond and won’t stop hurting himself. he has to restrain dennis to get him to stop, puts the thought of how much smaller he is and how easy he is to manhandle to the back of his mind, and calls in reinforcements-aka jack abbot his sleep deprived husband.

comes in early to find robby still holding dennis and whispering sweet nothings to him about how to breathe and that everything will be ok. his breathing finally calms but he still isn’t completely present, going into verbal shutdown from exhaustion.

maybe they give him the choice to go home early with santos or go to their home- they can’t leave the poor boy alone after this come on!- and he has enough awareness to think that he hasn’t told santos that he’s autistic yet and he’d rather not have that conversation right now so he ends up going home with jack.

they get back to their house and jack keeps all the main lights off, only turing on the fairy lights in their living room, makes dennis drink a glass of water before taking him to their bedroom and finding him some clothes to change into. before dennis can even think about it he starts to get changed before jack leaves and realises only once he’s taken his shirt off that he’s standing in his bosses bedroom with nothing but his binder on.

jack sees and just tells him to take it off- he turns around to face the wall trying to preserve his dignity as much as he can- and to just get comfortable. the smell of their clothes is so calming to dennis that he just stands there smelling the shirt he just put on when jack turns around again. he smiles at him and puts him in their bed and tells him to sleep, they’ll talk later.

dennis curls into a ball in the bed and relaxes into the smell of them, sleep finding him easily.

when he wakes up robby is home on the couch and jack has taken the night off, cooking soup for them all to enjoy.

idk what happens next but the night deffo ends in the start of hucklerabbot but im too dyslexic and lazy to write this properly.

Feeling very jolly waiting for season 2 on Jan 8th

Asexual!Mohan who rolls her eyes annoyed at McKay for lamenting to her about needing to get laid. It’s not that she’s unwilling to talk about sex, she just has a lower tolerance for it with coworkers she’s only kind of acquainted with.

Enter actually perpetually horny!Mel King. She’s always had a kind of autistic fascination with sex and besides that masturbation has always been a quick self soothing measure. She doesn’t want to make Samira feel like she has to do anything for her, she’s gotten this far without needing it after all.

But Samira finds she doesn’t mind dirty talking her girlfriend one bit. It’s a nice form of intimacy actually, petting Mel’s hair while she desperately humps the pillow between her legs, biting her lip to muffle her pitiful moans as Samira tells her how pretty she is like this and that she’s doing so good, being so good for her. That she loves seeing how pink her face gets as she gets close. Encouraging her to make noise for her and tell her how good it feels.

One of the things I love about The Pitt's portryal of an autistic character, is that there's a girl-genius medical student (not the autistic character) and there is a doctor who has no social life outside of their work (also not the autistic character) and then, there's a skilled, cool under pressure, very professional and also crying sometimes, when she gets emotional, and self-regulating when she gets overwhelmed (sometimes at a suggestion of others, but that was only once) doctor, who actually is autistic (coded). Oh, btw, that doctor has a sister, also autistic (confirmed), and the two of them are best friends. :D

High functioning autism Jack Abbot anyone? Based off this post. Jack Abbot who went undiagnosed until he met a therapist who specialized in dsm-5. Who went most of his life just masking and experiencing brutal burn out. The army paid for his med school but now he's trying to unlearn years dadt. Finding out he was bisexual and had a burning love for his best friend Robby. Finding about he was autistic and all those years finally being explained.

Jack Abbot who eventually gets diagnosed with ADHD, the inattentive type. Who better understands why he's so calm and controlled in chaos. Why he keeps pushing till he's burnt out beyond repair. Who sees the similarities in Robby and his constant flirting with passive suicide idealization into active. Who finally convinced the man to get therapy and seek help.

Now Jack has an explanation for the scrubs he wears out to death because he loves how they feel. How he's cut out every shirts tag. Why some days he feels like nothing is correct despite the whole system he has being just fine. His intense schedules and heavy masking in public. Where he lays alone at home and lets it all out the idle fidgeting and faint vocal stims sitting at the back of his throat. Where he rewatches the same movies from when he was in the army.

idk where I was going with this I'm at work and my brain fried.

dennis farmboy whitaker who believes firmly in only having real trees at Christmas. No artificial nonsense or prelit bullshit. His personal issues with christmas aside, he insists on doing it the old fashioned way, finding a tree farm and forcing his city boys to go with him to cut one down. They don't complain about the time off, but they do complain about the cold, the snow, the fact that dennis had to pick the farm that doesn't do any precut ones.

Until Dennis has a saw in hand and is the one moving his arms back and forth and he gets a little sweaty and suddenly Jack and Robby feel like they're the city girl victims of a hallmark movie. And when he goes to move the tree and tosses it into the back of Jack's truck do they decide that every single room in their home needs a real tree in it, cut by Dennis of course.

PLEASEEEE dennis so makes them watch hallmark movies and points at the high-powered-city-girl who discovers The Meaning Of Christmas in a rural little town and goes "that's you guys"

Okay here's my take: yes, Mel is very obviously intentionally autistic coded, but I'd argue that Santos is almost as autistic coded as Mel is, just in a completely different way.

She's blunt. She's repeatedly shown to have a strong sense of justice, and is somewhat rigid in her ways. She's bad at social cues and has a strange sense of humor. She's recognizes Langdon's addiction when no one else does, which reads as pattern recognition to me. She behaves in a way that's deemed as socially inappropriate, and seems to have a difficult time dropping it.

Her undiagnosed poorly masked autistic swag....