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The following story contains light spoilers for The Pitt season 2, episode 1, “8:00 AM.”
THERE ARE A lot of things that make The Pitt a fun show. Its fast-paced nature keeps us at full attention, its commitment to detail makes each case feel more realistic than just about anything else on TV, and the characters are both well-written and well-performed, making them feel not only like entertaining people to spend an hour per week with on our screens, but almost like real people who we kind of sort of know.
Another important ingredient in The Pitt‘s recipe for success, though, is the way its constant revolving door of patients and medical cases allows for new information, subplots, and mystery with each passing week. Last week, one of the most compelling storylines we got introduced to centered on a man named Mr. Williams who seemingly had something cognitively wrong, and Dr. McKay’s desire to help him figure out the issue, while subtly protecting herself along the way as well.
It also allows for medical situations that may not be as much of a mystery, but are quite interesting and compelling nonetheless. Episode 2 introduced a subplot for several of our doctors with Mr. Randall, who came into The Pitt and quickly explained to Dr. Langdon (Patrick Ball) that he’s had an erection for eight hours and counting. Yeah, safe to say that sounds like something that needs pretty immediate attention.
Dr. Langdon questions Mr. Randall a little bit, uncovering some important information (he gave himself two ED medication injections, which marks twice the recommended dosage), along with some not-quite-as-pertinent information (it was Mr. Randall’s 20th wedding anniversary, and he wanted it to be special).
Eventually, we transition to Mr. Randall being under the care of Dr. Santos (Isa Briones), Dr. Mel King (Taylor Dearden), and Dr. Al-Hashimi (Sepideh Moafi). In layman’s terms, they’re draining the blood from Mr. Randalls 8+ hour erection—and Dr. King is simultaneously discussing the fact that she’s been stressing out over being named in a malpractice lawsuit.
It makes for some pretty compelling TV to see how our team of Pitt doctors deal with a medical issue that’s probably a lot of men’s worst nightmare, and Drs. Langdon, Santos, King, and Al-Hashimi seem to have seen such a case before; none of them seem overly stressed or worried as they help get Mr. Randall all fixed up.
But what did an ER Doctor think?
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An ER Doctor’s Opinion on Mr. Randall’s ED situation in The Pitt
For an expert’s opinion on Mr. Randall’s case and how Dr. Langdon, Dr. King, Dr. Santos, and Dr. Al-Hashimi handled it, we once again reached out to Dr. Robert Glatter, the Assistant Professor of Emergency Medicine at Lenox Hill Hospital, an experienced ER doctor, and a member of the MH Advisory Board.
About That Medical Emergency…
To start, Dr. Glatter agreed with The Pitt‘s depiction of Mr. Randall’s situation as a genuine medical emergency. He noted that it’s not uncommon to see things like this, especially in people who didn’t see results after their initial injection (the injectible medication most commonly used for ED is called Alprostadil). He also said that this sometimes also occurs with younger patients who were acting under the influence of alcohol or other mind-altering drugs.
He commended the show for drawing attention to the legitimate danger involved with such a situation.
“The public needs to understand that this is quite risky, and could lead to permanent damage to tissues in the penis, the surrounding blood vessels and permanent ED,” he said. “While the patient wanted the moment to be special, the consequences could be life altering and disastrous.”
About That 8-Hour Erection…
Mr. Randall’s erection lasting 8 hours is a particularly long period of time—a length that Dr. Glatter says is a true medical emergency, and one where speed is critical. “Typically, an erection lasting longer than 4-6 hrs is itself a marker for death of penile tissue, injury to penile blood vessels and the risk of permanent ED,” he says.
Dr. Glatter noted Dr. Langdon’s appropriate upgrading of Mr. Randall to have him seen immediately, given the true nature of his situation. However, the doctor was critical of Dr. Langdon’s questioning with Mr. Randall. He found the doctor should have done a thorough medical history, not asking what number anniversary they were celebrating. This would include asking about high blood pressure, heart disease, or a history of aneurysms.
Also of note: Mr. Randall’s treatment later in the episode. While he was appropriately given a local anesthetic, Dr. Glatter notes that he would almost certainly be in far more visible pain, and that a cardiac monitor with continuous blood pressure monitoring would be necessary and vital in the case of any potential issues with elevated blood pressure or heart rate.
There’s also the procedure of removing blood depicted in the episode, which is known as intracavernosal injection of agents such as phenylephrine and aspiration of blood from the penis. While it was the correct technique, Dr. Glatter says it was not the most accurate. “It can take up to 1-2 hours depending on duration and extent of priapism, but often is accomplished in 30 to one hour in my experience.”
He also notes that Dr. Al-Hashimi’s idea of “performing penile massage to facilitate detumesce (or reduce the erection of the penis) is not recommended in the care of patients with priapism lasting 8 hours” is not recommended in cases like these, adding that if it is “done improperly or with excessive force, it could lead to a penile fracture.”
About The Pitt Doctors’s Professionalism…
Finally, Dr. Glatter said that the banter from the doctors around Mr. Randall—particularly about Dr. King’s malpractice suit—was unwarranted and unprofessional.
“The doctors need to focus and comfort the patient, not discuss personal issues related to malpractice cases in their past,” he says. “The attending, Dr Al-Hashimi, does not set a good example for her residents and medical professionals, to say the very least.”
Evan is the culture editor for Men’s Health, with bylines in The New York Times, MTV News, Brooklyn Magazine, and VICE. He loves weird movies, watches too much TV, and listens to music more often than he doesn’t.
