The Pitt Should Tackle a Heat Wave in Season 3

Like millions of other viewers, I’ve been eagerly awaiting the return of Dr. Robby to my TV this winter as HBO’s Emmy-winning medical drama The Pitt airs its second season. Lauded as the “finest example of the genre in more than a generation,” season 1 took home 5 Emmys, including Outstanding Drama Series and Outstanding Lead Actor in a Drama Series for star Noah Wyle. Season 2 is receiving rave reviews, and it has already been renewed for a season 3.

While much of the joy of The Pitt comes from its realistic depiction of the quotidian, day-to-day work of the emergency department (ED), the crown jewel of season 1 was a stunning, 3-episode-long mass casualty sequence, depicting the chaos in an ED handling the crush of victims after a shooter opens fire at a nearby music festival. While we don’t know how the rest of season 2 will go, trailers suggest the big curveball will be the failure of hospital computer systems, forcing our intrepid ED staff to do things the old-fashioned way.

Depicting the experience of doctors during mass casualty events is now a mainstay of the medical drama. Chicago Med’s pilot episode showed the aftermath of a train derailment on the Chicago El, ER forced its beleaguered doctors to handle the crush of victims from a car pileup during a blizzard, and no one can forget the myriad shootings, plane crashes, and explosions that have punctuated Grey’s Anatomy’s 22-season run.

But there is another mass-casualty hazard that deserves to be on our TV screens: a heat wave.

Heat waves are among the most dangerous environmental hazards. They can settle in place for days over a city, usually coinciding with high-pressure systems or “heat domes,” and can be accompanied by droughts, blackouts, and fires.

Our medical system is no stranger to heat waves responsible for enormous death tolls. In the sweltering summer of 1995 in Chicago, record-setting high temperatures caused approximately 700 deaths, predominantly among the isolated and elderly. In 2003, Europe’s hottest summer in 500 years lead to the deaths of 70,000 people. My colleagues and I recently showed that in August 2003 alone, more than 6,000 of these deaths were directly due to human-caused climate change.

As humans continue to add greenhouse gases to the atmosphere, these dangerous heat episodes will only become more frequent and severe. Every tenth of a degree of global warming leads to an exponential increase in the number of hot days experienced in a given location. In recent work, my colleagues and I showed that if the same weather conditions that generated past heat waves occurred at the higher global temperatures currently projected from our greenhouse gas emissions, their health consequences will be exponentially more severe.

Despite this threat, media depictions of heat waves lag behind their human impacts. Reports of heat waves online or in newspapers are often accompanied by images of sunbathers on beaches or children frolicking through city sprinklers, a narrative of “fun in the sun” that is dangerously at odds with the illness and death that can result from heat waves.

In contrast to the lighthearted nature of much of this past media coverage, season 3 of The Pitt should devote its fast-paced realism to the devastating health impacts of a record-breaking heat wave. The day would begin like any other, with Dr. Robby strolling into another shift at the fictional Pittsburgh Trauma Medical Center, but would quickly turn high-pressure as more and more heat victims turn up at the ED’s doors.

Many of the victims of this hypothetical heat wave would likely be elderly, isolated, or unhoused people, allowing the show to continue to tell the heartbreaking stories of the people who our society places on the front lines of environmental vulnerability.

But the medical challenges faced by the ED staff need not be limited to classic cases of heat illness. My colleagues and I have shown that the causes of death during extreme heat go far beyond the simple dehydration or disorientation felt during heat stroke. High temperatures increase the risk of a dizzying array of adverse medical outcomes, including preterm births, workplace accidents, renal failure, fatal car crashes, and even homicide and suicide. An elderly person suffering heat stroke in an unventilated apartment, a worker who became disoriented and fell off a ladder, a driver involved in a multi-car pileup, or a young mother about to deliver a premature child are all plausible victims who might present to the ED in the heat wave of the future.

The goal of placing extreme heat at the center of a medical drama would not be to merely scare people. The Pitt has been acclaimed by medical professionals for its realism and humanity, featuring human beings trying their best to save lives in a system that often throws up roadblocks in their way. Depicting the health threat of climate change would be a way to humanize the people on the front lines of the climate crisis, both the doctors working day-in and day-out to save lives and the vulnerable people who come to them for help.

As global warming escalates, our real-world health system will be forced to confront the climate crisis more and more frequently. The best medical show in a generation should do the same.