This is a recap of the 12th episode of the Max medical drama The Pitt. Spoilers for that episode obviously abound. For a more general look at the series, check out this review from mid-season. 

There is a moment late in the 12th episode of The Pitt in which Dr. Trinity Santos, who has spent all day cycling back and forth between swagger and fear, leans down to speak to a woman who’s sitting in a wheelchair with a gunshot wound in her arm. Santos checks her dressing, and it looks good. Can she wiggle her fingers? How’s the pain? The patient mostly cries. Santos stammers out some reassurance that the bullet probably broke her bones but hasn’t hurt the nerves or the arteries, which is a good sign. There is no answer. Eventually, a flummoxed Santos pats her knee briskly and says, “You’re going to be okay.” She leaves to find the next patient. Nurse Donnie, who’s been sitting in on this conversation, quietly says to the woman, “I’ll find you some tissues.”

There are more dramatic moments in this episode. But this short scene, in which a young doctor on her first day realizes she has no idea what to say to a woman who just survived a mass shooting — realizes there is nothing to say — is one of the most effective.

The Pitt has hinted all season that an act of mass violence might be coming. Robby, played so beautifully by Noah Wyle as a man inching ever closer to his breaking point, has been scrapping with McKay over whether to call the police about Theresa’s son David after he ran off. Robby didn’t want to, but McKay eventually did it anyway, and Robby made it clear he didn’t approve. And so, over the course of the very long day that makes up this season, the spectre of horrifying violence has never entirely disappeared, and now, the results of that violence have arrived at the emergency department, although we don’t know yet whether there’s any connection to David.

(Neither does Robby, although note that he goes out of his way to tell the first police officer he sees that he thinks David had something to do with the shooting. So despite Robby’s earlier reluctance, he’s the one who steps in and tells the police specifically that David might be responsible for this particular shooting and gets the police looking for him.)

The shooting took place at PittFest, the music festival where Jake took his girlfriend. As soon as Robby hears what’s happened, he’s terrified for Jake, who’s not answering his phone. But at the same time, he’s the boss, and he has to prepare.

It’s sobering to see just how ready the hospital is for this, how unsurprised. Robby quickly assigns teams to zones, to treat injuries of differing severity. Patients will be triaged and tagged with slap bands out in the ambulance bay. There is an impromptu morgue. Huge plastic bins of extra supplies arrive, but Robby knows they won’t be enough. He sends Santos, Whitaker and Javadi to raid central supply for more of everything, continuing The Pitt‘s running theme of competition for resources even within the hospital. Dana is the lead person for all the nurses, and she is everywhere: getting supplies from other hospitals, trying to find more blood and helping Robby try to track down Jake.

Over and over, we get details of what happens when so many people are hurt so quickly. With no time for regular charts, patients will get wrist charts tied on, little more than cards to scribble on with a Sharpie. People will die identified by a little card on a string, with a number and a bar code. Robby has a box of 300 of these wrist charts out in triage. He hopes not to need all of them.

One of the ways The Pitt has leveraged its one hour/one episode format is that people come and go, which helps mix up the energy in a series that’s now mostly about doctors and nurses who are already exhausted. The show, like the emergency department, gets some fresh legs, and their personalities come through right away.

Dr. Shen (Ken Kirby), the night shift attending, shows up sipping an iced coffee and seems like he might not even be paying attention. But when Robby presses him, it’s clear that Shen is plenty sharp; he just manages a crisis in his own way. And when Dr. Ellis (Ayesha Harris) arrives, Robby tells her to ask for help if she needs it. She walks off, looks around, and mutters to herself, “Help.”

Perhaps most important, this episode re-introduces Jack Abbot, another attending we met just briefly in the first episode as Robby talked him down from the roof after a rough night. Shawn Hatosy as Abbot is so, so good here, joining the ensemble seamlessly, which isn’t easy in the 12th episode of a 15-episode season. He has an easy authority and confidence, and the fact that he’s Robby’s closest ally comes through loud and clear. Robby is also relying on Mohan, whose reputation for taking her time doesn’t mean she can’t act quickly and decisively, which everybody learns right away.

Less welcome for Robby is the return of Langdon, who Robby sent home a couple of hours earlier after discovering that he’d been stealing benzodiazepines from patients. (Not just from the hospital — from patients who needed them to whom they’d been prescribed, which just seems so much worse.) Hoping Robby will be desperate enough not to dismiss him again, Langdon sneaks in like nothing happened and then refuses to leave when Robby spots him. Robby doesn’t have time to argue when Langdon won’t go. So this move, which is less good-doing than an awful exploitation of tragedy on Langdon’s part to get around his suspension, is successful for now.

McKay has her son stashed in the staff lounge when all this starts, because her rotten ex is upstairs having surgery after his goofy skateboarding accident (sigh). But Chad’s surgery is canceled on account of the mass casualty protocols, and he ends up wandering downstairs to the emergency department in his hospital gown to look for the kid. When he gets there, he spots McKay working to save a patient, surrounded by all this blood and awfulness, and you get the sense it’s maybe the first time he’s ever understood what she actually does.

To say this is a hard first day for the newbies — Mel, Whitaker, Santos and Javadi — is an understatement, but they all find their feet. Mel becomes a good leader in her zone, juggling direct patient care but also literally running to follow a mother’s request to note on her son’s wrist chart that he’s deaf, so that they’ll know when he wakes up from surgery. Mel also begs to donate blood to her desperate patient — which is very much not protocol, since there’s not time to screen for disease. But Robby goes along under the circumstances, and Dana promptly starts a blood donation center for staff who are type O. Desperate times and all.

Whitaker excels, too, grabbing the portable ultrasound to figure out that a sneaky liver laceration is why his patient is more unwell than they expected based on her broken leg. And Javadi manages not only to handle her patients and MacGyver a solution to some supply shortages, but also to get her mother out of her hair with a sharp “Read the f****** room, Mom!” After her mother walks away, Javadi looks over to McKay for reassurance that this was the right thing to do, and she gets the sly smile she needs.

As for Santos, she does good work, but maybe her best moment is catching the creep who faked an injury to get into the emergency department to film. When he (poetically enough) slips on the bloody floor while running from her and briefly knocks himself out, she grabs his phone and “accidentally” throws it into a mop bucket. Say this for Santos: Likely from sad experience, she can spot somebody who’s up to no good.

But that moment late in the episode – when Santos takes a moment with the woman with the wounded arm, who doesn’t speak — is so very important. Doctors are running around, nurses are running around, patients are coding and bleeding and being saved from death. And then here is this moment where Santos realizes she’s talking to someone who, at the very least, has just watched a lot of people die. The weight of the trauma, which is not just physical but psychological and emotional, is not forgotten. These doctors and nurses, in fact, as hard as they are working, are treating only the first part of what these patients are facing.

This series has been exceptional, perhaps the best new show of the last few years, and even though this tragedy was hinted at from the first episode, it’s treated with gravity and presented in agonizing detail. The episode ends with no word yet about Jake, and no word about David or anyone else being the shooter or not. There is much work left to do. People are still being driven up to the ambulance bay in the backs of cars and the beds of trucks. There is no word yet on how many more are coming. The day shift was supposed to end at 7:00, but as it turns out, nobody is anywhere near getting to go home.