As its real-time clock continues to tick, The Pitt has reached its most emotional episode yet. Dr. Collins is still consumed with pain and despair. But she composes herself and gets back out on the trauma floor – not to immediately see a patient, but to self-administer an ultrasound examination. While Dr. Robby, with Dana, engages in some levity over the nearly constant anxiety-inducing crush of their workplace – “Another 24 hours of bright lights, screaming trauma patients, hard gurneys and sleep deprivation, all while you wait!” – he also notes Collins’ discomfort, and tries to offer his senior resident the usual Pitt platitude. “Are you OK?” But she ignores him, or at least doesn’t answer, because right now anyway, there’s just no time. A six-year-old drowning victim is arriving in the emergency department.

Within seconds, the team’s in action. Whitaker is on chest compressions. Mel notes the little girl’s symptoms of hypothermia. And Collins calls out what they need. “250 cc’s heated saline, set up the Arctic Sun, continuous core temperature monitoring…”

As that course of treatment continues with heightened urgency, the Pitt’s trauma floor also contains the honor walk that’s forming around Nick, the college-age victim of a fentanyl overdose, whose parents have ultimately agreed to donate his vital organs after consulting with their parish priest. Family friends and hospital staff alike line the hallway as Nick is wheeled to the ambulance waiting to take him to the donation site, and as the parents hug Robby, he asks if he and his colleagues can attend their son’s funeral.

The Pitt’s churn of population and newly-arriving problems seems to pause in this moment, and it’s a quiet heartbreaker. But this week’s Pitt won’t stop. Amber, the little girl who drowned in a backyard pool while saving her even littler sister, has died. As he did with Nick’s parents, Robby was right there with Amber’s, first to calmly explain the steps of treatment, and then to tell them why he called it. (“No one has ever survived a cardiac arrest with potassium over 11. There is absolutely no chance of recovery.”) A pediatric drowning spreads a pall across the trauma floor. Everyone’s feeling it. Collins is feeling it hit her particularly powerfully. We’re all feeling it. There’s nothing quiet about this show’s latest heartbreak.

Whitaker asks Dana Evans how she does it. She’s worked the ER for 33 years, while the amount of death – and fluids – he’s experienced in just one day feels overwhelming. (We hear you, dude!) Dana tosses a comforting arm over his shoulder. “I take care of everyone, especially the ones who fall through the cracks, and got nowhere else to go.”

Dana Evans, you truly are the charge nurse for our souls.

Another person Dana seeks to protect is Piper (Courtney Grosbeck), a new patient she joins Dr. McKay to treat with a little bit of perceptive, above-and-beyond care. When Laura (Shani Atias), Piper’s hovering “boss,” keeps answering sensitive medical questions for her, McKay and Dana suspect it might be a human trafficking situation. They separate Piper from Laura under the auspices of a radiation-restrictive CT exam and press her gently about the relationship. If only Gloria the bottom line-obsessed hospital administrator could see the Pitt’s staff in these moments. They’re investigators for dignity and human rights as much as they are quick and efficient providers of critical medical care.

Langdon: “The average emergency doctor gets pulled from task A to task B every 3 to 5 minutes.” 

Mohan: “Remind me again why we picked this specialty?”

Langdon: “Because we all have ADHD and anything else would be boring as hell.” 

This exchange, conducted as doctors Langdon and Mohan are part of the team to stabilize Willie (Harold Sylvester), an elderly man with a bum pacemaker, isn’t as heartbreaking as it is exhilarating. It’s inhabited with the same rush Dr. Santos gets when she assists on a tricky procedure. And in a different kind of emotional note for this week’s Pitt, it turns out that when he was a young man, Willie served as a field-trained first responder with the Freedom House Ambulance Service of 1960s Pittsburgh. Dr. Robby, Javadi, and other members of the Pittsburgh Trauma staff gather around his bed as Willie describes his experience, complete with a recollection of Dr. Adamson, Robby’s late mentor, as a young med student who worked with the program. “They were the heroes of Hill District,” Willie’s son adds about his father and the Freedom House medics. “A bunch of young Black dudes saving lives.”

Doesn’t it make your heart beat faster? The way this show refuses to pause between its multiple emotional triggers? There used to be a joke about ER, how patients were always crashing through the doors. That occurs regularly on The Pitt, too. But without fail, as each arriving trauma is recognized and the resulting treatment begins, an intimacy is formed that feels wholly new to each particular case. These doctors are fiends for action. Metaphorically, they live and die with each patient. And despite the facts of heartbreak, we wouldn’t have it any other way.

Johnny Loftus (@glennganges) is an independent writer and editor living at large in Chicagoland. His work has appeared in The Village Voice, All Music Guide, Pitchfork Media, and Nicki Swift.