The HBO Max original series “The Pitt,” which was created by “ER” alums R. Scott Gemmill, John Wells, and Noah Wyle, can be a tough watch at times, and there’s no way around that. With each episode taking place in “real time” in a busy ER led by trauma attending Dr. Michael “Robby” Robinavitch (Wyle), the audience sees a lot of terrible patient outcomes — and gets a front row seat to the reactions of their families. Be it a young college student who accidentally overdosed on fentanyl after taking a laced pill, a six-year-old girl who drowns saving her even younger sister, two adult children struggling to let go of their father, or a devastating mass shooting, Robby goes through it, and so do we … and the way that Robby and his fellow physicians handle these tragedies is very specifically written by the show’s creative team, as it turns out.

In an interview with The Hollywood Reporter, Joe Sachs, a writer and executive producer on the show who also worked in a real emergency room for three decades, opened up about how the series’ creatives portrayed some of these gut-wrenching cases. As Sachs explained, they really rely on people with firsthand knowledge. “But when I want to really make sure things are good and right, we reach for consultants,” he revealed. “The deeper you dig, the more interesting details you get that people are unaware of, and that makes for fresh storytelling.

In the case of the elderly man whose grown children aren’t ready to say goodbye to him (even after they learn from Robby that his outcome is definitively bad), Sachs said that he spoke to Ira Byock, author of the book “The Four Things That Matter Most.” In Byock’s book, he recalled that, while working as a physician, he met a patient who asked that the doctors not treat his life-threatening aneurysm, and he watched as their family said their goodbyes.

“With the man’s two daughters and wife present, I shared that other families had found value in saying four things to one another before goodbye: ‘Please forgive me. I forgive you. Thank you. I love you,'” Byock told the outlet, referencing the “four things” in his book title. “It’s the rare family that has perfect relationships. Usually, there’s some history of misunderstandings, hurt feelings, or real transgressions. Another thing to say is, ‘I’m proud to be your mom, dad, son or daughter.'”

“This is the other side of emergency medicine,” Byock shared. “It is lots of blood and guts, but I told the writers to remember there are also tender moments and opportunities to help somebody heal on a much deeper level. Apparently, Noah Wyle loved that story; he did a fabulous job making it his own.“