The season finale of MAX’s The Pitt premiered last month. Emergency doctors greatly appreciate the show’s attention to detail in its portrayal of the modern ER. But for a show renowned for its realism, we should expect more regarding its handling of childhood sexual abuse. After such meticulous efforts to get the details right about most aspects of emergency care, I worry that the show’s misrepresentation of how we care for families facing abuse sets unrealistic expectations for viewers who might be navigating similar circumstances in their own lives.
In Episode 7, we meet Silas Dunn after he fell from a ladder while renovating his home. An intern, Dr. Santos, notes his enlarged breasts as she places a chest tube. She explains the possible etiologies to his wife, Susan. Susan then confesses to slipping progesterone into Silas’ coffee every morning. She had been hoping to suppress his libido because she suspects he has been molesting their teenage daughter, Alana.
Dr. Santos presents Silas’ case to her supervising attending physician, Dr. Robby, and the ED social worker, Kiara. They tell her there is nothing they can do about the suspected abuse without proof, unless Alana confirms it. This is false. Mandated reporters like physicians, social workers, and nurses are obligated to report if there is a reasonable suspicion of abuse. Proof is not required.
To our further astonishment, Dr. Robby and Kiara ultimately do decide to report this case to the police—but fail to mention the sexual abuse. Instead, they report Susan for drugging Silas because the progesterone may have caused dizziness and contributed to his fall. While Susan’s actions were misguided and failed to stop the abuse, Silas should have been reported too. At the very least, his abuse could have been disclosed as part of the report.
Frustrated by the lack of resolution in protecting Alana from further abuse, Dr. Santos takes matters into her own hands. The episode concludes with Dr. Santos threatening to let Silas die unless he agrees not to molest his daughter anymore. Silas agrees. The fictionalized scene makes for great television, but it does a huge injustice to actual victims of sexual abuse. In real life, someone like Silas would almost certainly ignore Dr. Santos’ threat. He is partially sedated, so who knows whether he will even remember their conversation once the medications wear off. Most likely, the abuse will continue, albeit with a renewed sense of secrecy. Perpetrators of abuse often punish their victims if they try to seek help, so Dr. Santos’ confrontation might backfire and further endanger Alana. Given that Susan might be arrested and taken into custody for drugging Silas, she may not be home to intervene anymore.
In Pennsylvania, where The Pitt takes place, if a mandated reporter like Dr. Robby, Kiara, or Dr. Santos chooses not to make a report, they could be charged with a misdemeanor or felony and lose their license to practice. They all ought to know better. As clinicians, not investigators, it is their job to identify any possible abuse, provide the necessary medical care, and report their concern. Once the report has been made, it is up to the police to investigate so that justice can be served.
When I first saw the episode, I had hoped that Alana’s case would be revisited in a later episode, but the first season is over now. One possible solution to right this wrong is to revisit Alana in the next season. Maybe she returns to the ED months later, after the abuse escalates. The staff could then reflect on whether the abuse should have been reported.
Alternatively, since there has been so much enthusiasm for this show, I would love to see a teaser scene released before Season Two in which Dr. Santos reports the abuse herself. Choosing to report the abuse the next day would be well-aligned with her archetype as a character—Dr. Santos can be arrogant (likely a coping mechanism), but she tries to do the right thing, especially for people who have been preyed upon. Since Silas is going to be spending at least a few days in the intensive care unit, Alana is not in imminent danger. So, it would make sense for Dr. Santos to wait until the following day to file a report. When there is not a risk of imminent danger, we often wait until after our shift ends to make these reports anyway; they are time consuming and pull us away from direct patient care. If a teaser scene is not possible, the show’s writers could publish a statement to provide some additional context about the shortcomings of the episode along with resources for families struggling with how to get help. April is National Child Abuse Prevention Month, so it would be a great opportunity for the show to bring proper awareness to this topic.
In the meantime, I hope that the depiction of Alana’s case on The Pitt does not discourage anyone experiencing or aware of sexual abuse from seeking our help—especially when children or adolescents are involved. While two wrongs do not make a right, Alana’s mother should not have been reported while her abusive father is allowed to walk free. If the media continues to suggest that women will be punished while male perpetrators escape justice, women who witness or experience abuse might fear the consequences of seeking help. Just like Alana, teens facing abuse will never get the help they need if their loved ones cannot trust us to help because of inaccurate depictions in the media.
