Creating a Realistic Emergency Department for The Pitt

From creator R. Scott Gemmill, The Pitt highlights the challenges U.S. frontline healthcare professionals face through the lens of the fictional Pittsburgh Trauma Medical Center’s emergency department. In a real-time, hour-by-hour format, audiences see the medical cases and the personal turmoil (and occasional life-saving joys) that physicians and nurses must navigate as they reckon with an overabundance of patients and a lack of resources.

For production designer Nina Ruscio, creating that world meant building an emergency department capable of sustaining the series’ relentless pace without ever feeling repetitive. The Season 2 expansion completes more of the 360-degree set, giving the camera and performers even more room to move through the hospital’s maze-like environment. But much of Ruscio’s most meticulous work is designed to go unnoticed, from embedding lighting into the set itself to camera-testing every material and paint color. Even seemingly small details, like an owl carved into the hospital’s columns, carry deeper meaning.

Designing the Pediatric Room

Ruscio’s conversation with Noah centered on the idea of a space where there would be a discordance between what the physical space looked like and what was happening emotionally in that room. He had this idea of a single animal, and Ruscio suggested it could be a menagerie of animals. And this space, this ironic room of cartoon animals and colors, would be the place of such extreme trauma.

When designing the pediatric room, Ruscio wanted to create a space that would be both visually appealing and emotionally resonant. ‘Peds was born out of my very first meeting,’ Ruscio explained. ‘I met with John [Wells] and Noah [Wyle] and Scott [Gemmill] and Michael Hissrich when they talked to me about doing the project. They approached me to design an emergency department before they wrote anything.’

Ruscio’s goal was to create a space that would reflect the emotional intensity of the characters, while also being visually striking. ‘In speaking with them, we tossed around a lot of ideas, and whether it was an institutional design, it still has the essence of what should be an emotional reflection of the people that are in it,’ Ruscio said.

Lighting the Set

One of the most impressive aspects of the set is the lighting. Ruscio’s team embedded lighting into the set itself, allowing for a more immersive and realistic environment. ‘Because the environment is 360 degrees, everything has to be capable of being looked at in detail, whether it’s the foreground, the mid-ground or the background, and all of it has to be accurate,’ Ruscio explained.

Ruscio’s team also used practical lighting to create a more realistic environment. ‘We don’t use traditional lighting,’ Ruscio said. ‘We don’t use ground-based lighting, and there’s not a lot of grip equipment. But we do not light from the ground because, as a director or as an actor, you can walk from one end of this set without any equipment in your way, as if it is a real emergency department.’

The Owl Symbolism

Ruscio also wanted to incorporate symbolism into the design of the set. ‘There’s an owl carved into the columns,’ Ruscio explained. ‘They are as if they’re painted terracotta tile, essentially. And I love this owl detail. Owls are a symbol of the transition between life and death and wisdom and knowledge.’

Ruscio’s use of symbolism adds depth and complexity to the set, making it feel more immersive and realistic. ‘For me, it represents metaphorically what happens here every day,’ Ruscio said. ‘The stakes are very high. You’re dealing with this intersection of where life might meet death and death might meet life. And all of that is the subtextual intensity of working in this environment because the stakes are really high.’

Expanding the Set

For Season 2, Ruscio’s team expanded the set to include more of the hospital’s maze-like environment. ‘We actually made a big addition to the second stage,’ Ruscio explained. ‘Essentially, the set is on two different stages. On the first stage, we went fire lane to fire lane and completed every single inch of that thing. There’s not a single spot on that stage that’s not well used for full-on immersive scenery.’

Ruscio’s team also wanted to create a more immersive environment for the actors. ‘We gave that up,’ Ruscio said. ‘We wanted to make the set on the second stage—the triage and the waiting room—as immersive and 360-degree photographic as possible.’

The expanded set allows for more complex and nuanced storytelling, making the show feel more realistic and immersive. ‘It has sustained this much storytelling is very satisfying for everybody because it was a daunting task to be asked to do something without written words, and for it to have had all the life that it’s had,’ Ruscio said.

The set’s design also allows for a more dynamic and engaging environment, making it feel more like a real emergency department. ‘You’re never really sure where the beginning and the end of something is,’ Ruscio explained. ‘So if you’re wondering what parts of the hospital we’d want to explore, we’re so dominantly the emergency department that the need in the story would have to be born out of a need in the story to tell of another department in the hospital.’