Talking ‘The Pitt’ With Production Designer Nina Ruscio

Coming off of Fatal Attraction (the miniseries) and No Good Deed (for Netflix), production designer Nina Ruscio‘s latest project has her bringing an emergency room to life in The Pitt, a new medical series set in real time. Each episode is meant to take place over the course of one hour in a single fifteen-hour shift. Work may never slow down for the doctors on the show, but luckily Ruscio had some time to answer a few questions:

Rachel Bellwoar: Having previously worked on Shameless (another John Wells production), how did you first learn about The Pitt and what was your initial reaction?

Nina Ruscio: When John called me to talk about The Pitt, he had this unconventional — and I think brilliant — idea to create a ground plan for the entire emergency department before the writers even started. This prescient approach would avoid the nightmare of reengineering and rewriting sequences to conform to a design, as well as the design burden of reconstructing multiple writers’ disparate imaginative geographies. Pre-creating an agreed upon blueprint freed up everyone in the writing room to populate the same playground, choreographing the placement of hundreds of characters, scene by scene, minute by minute. Because the show takes place in real time, fifteen hours in one day, this synchronized vision was key.

I met with John Wells, Scott Gemmill, Noah Wyle, and Michael Hissrich — four visionary human beings — to discuss what they were looking for and to come up with a list of ingredients, hoping I could leave that meeting and then saturate myself in information about emergency department design. Having worked with John and Mike before, and feeling everyone’s trust, I left the meeting unleashed.

Bellwoar: Shameless ran for 11 seasons. ER ran for 15. In an industry where TV shows getting to run for multiple seasons has become increasingly rare, did that track record with John Wells shows play into your decision to sign on?

Ruscio: I will turn this question upside down. I would sign on to anything John Wells does in a heartbeat. I did all 11 seasons of Shameless and all six seasons of Animal Kingdom and, yes, those long runs are increasingly rare. Sometimes I pinch myself because I have such gratitude for my fortune to work on so many John Wells productions. The JWP track record is a testament to excellent producing and the curating of extraordinary crews.

Bellwoar: Before The Pitt, had you ever filmed in a medical facility or been asked to design a hospital room?

Ruscio: I immersed myself in hospital design research, looking at, visiting, and reading books about emergency department designs. I became enamored with the designs and ideas from Huddy Healthcare Solutions, a prolific hospital design firm. I visited all kinds of different emergency departments, including exaggerating some personal injuries (like a swollen bee sting, etc.) to get myself into other types of emergency departments so I could verify and validate my research with deeper dives.

I ultimately came up with an elaborate list of ingredients of all the necessary elements for emergency departments, making sure not to include advancements post-covid (such as negative pressure rooms), as we wanted to place the most recent remodel of the “Pittsburgh Trauma Medical Center’s” main ED around 2010. I would check and cross-check that list, endlessly.

My partners in crime Josh Lusby (Art Director) and Dean Wolcott (Set Designer) and I tasked ourselves with designing set elements piece by piece from our comprehensive check list. Then we cut them all individually out of paper. That might sound arcane, but in this circumstance, it was viscerally satisfying. I stacked the units in piles, lining them up and laying them out all on a table to track all the elements, all the while shuffling and reshuffling them into innumerable different configurations. I would then nest the missing puzzle pieces, pushing and pulling them into position — always grounding them in the necessities of genuine ED ergonomics — until I could puzzle something together that I felt was really successful.

Bellwoar: How did you come up with your floor plan for the ER? Is there a standard layout most ERs follow or does it really vary by location?

Ruscio: I’ve designed many a hospital room and many an emergency department wing and I’ve shot in numerous facilities amending practical locations, but this is the most comprehensive physical emergency department that I have done from scratch. It’s over 20,000 ft².

Unexpectedly, the result of being asked to do what could be considered common institutional design was that I became deeply inspired. Within the normalcy of an emergency department there is long-developed wisdom about how space should function and much intentionality in the geometry of the layout of the various spaces. Without hesitation, we all felt compelled to be authentic and accurate with every detail large and small. A design of that scale required an extraordinary set decorator, Matt Callahan, and a wonderful prop master, Rick Ladomade, and their teams. They created a phenomenal level of verisimilitude — from mountains of correct equipment down to the P-touch-labeled content of each medical cart drawer — unimpeachably echoing a real medical facility.

I also felt inspired — not restrained — by the idea that we would need to put this all on one stage. Though we ended up using a stage-and-a-half, imposing that level of critical focus on the design from the get-go required an economy of detail and ergonomic efficiency that utilized every square inch of our physical space, distilling functions down to their essence.

There’s an old expression “you make a few decisions and then suddenly you’re fifty years old.” On this project I felt of the two million decisions that go into any design, we would make five foundational commitments: the layout, the palette, the floor, the lighting and the ceiling. After that there would be no turning back.

After studying all kinds of hospital art direction traps that I wanted to avoid (too much use of blue, frequent over-art-direction, etc.), we gave birth to the exact opposite of what you commonly see on medical dramas, leaning into the harsh desaturated space that actually is everyone’s triggering hospital experience. Johanna Coehlo the cinematographer and everyone else bravely embraced this blanched palette.

Because the show is set in real time and we shoot primarily handheld in continuity (i.e., every hour-long episode is shot in scenes sequentially from scene number one), I wanted the design to make for seamless photography, to flow contiguously. We subtly lead your eye from space to space by the curvature in the floor, paralleled by the curvature in the soffits, and the graphical way the ceiling tile patterns make your eye move energetically forward from space to space, so that filming never faces a stasis or a blockade. Because the set extends fire-lane to fire-lane continuing on to another stage, everywhere you keep moving and turning you can keep shooting.

The fully immersive experience of The Pitt, both emotionally and physically — for the actors and crew — supports the intent of The Pitt to be closer to documentary than narrative. And from a production standpoint, the lighting is practical, built into the ceiling and carefully integrated into the design. It’s baked in. So, though this is an over-simplification, you can go on set in the morning, flip a switch, and shoot handheld continuously through the entire space all day long.

Bellwoar: On ER, the L train acted as a regular reminder that the show was set in Chicago. Given that The Pitt was mostly filmed in LA and takes place in real time, so there aren’t that many scenes outside, was it difficult making sure the show still felt grounded in Pittsburgh?

Ruscio: I had one shot at it. We selected the exterior of Allegheny General Hospital to be the exterior of “Pittsburgh Trauma Medical Center,” where Dr. Robby works. I adored certain aesthetics of the building and wanted to incorporate those elements throughout, like little architectural kisses, so that you could feel the authenticity of the exterior of the space bleeding into the interior of the space. The marble columns, the brick, the capitals, and the marble floor in the waiting room and the tangential public spaces that lead off from the main emergency department are both purposeful and a link to the heritage architectural spaces that define the city of Pittsburgh. I wanted our set to reveal the years of remodeling, but also have spaces left in their original textures to express the century-old reality of this hospital. The double meaning of the title “the Pitt” is of course Pittsburgh, but also the idea that the emergency department is in the basement of the hospital. I added supporting columns inside the space to make you feel like the emergency department is foundationally holding up the building. The height of the building is above you and the weight of it all is, metaphorically, on top of you.

During the entire season, we filmed only three days in Pittsburgh, and certainly I would love to have shot there more. Still, I hope we used those three days well to create a parenthetical experience of being outside in Pittsburgh at the beginning and the end of Dr. Robby’s shift.

Bellwoar: Continuity would also seem like a major concern with a series like this, where the entire season is meant to take place over the course of a fifteen hour shift. Did that timeline ever feel constrictive?

Ruscio: Since the entire season takes place in the course of one fifteen hour shift, the continuity requirements didn’t feel constrictive, but more like a call to action. The intensity of watching The Pitt is part and parcel of the immersive experience of being fifteen hours inside of one intense space. I felt a responsibility to assure we made that space as authentic and as detailed as possible, so that you were never taken out of the realism. I also wanted to create a space that had enough possible motion designed into it so that it felt architecturally limitless — that it had no beginning and no end. I naturally also felt the responsibility to create a space that could provide for any story line (all of which had yet to be written when we designed the set!) and avoid the doldrums for everyone involved. I wanted to insure there would be numerous ways to shoot every scene, providing unending visual depths and possibilities for engaging the foreground story in the frame, and simultaneously all of the stories in the deep background and the viewers’ peripheral vision. My hope is the audience stays continually interested and has enough engagement with the space that it takes time to really feel like you can hold it all — the whole PTMC Emergency Department — in your mind at once.

Bellwoar: Thanks for agreeing to this interview, Nina!

New episodes of The Pitt air Thursdays on HBO and are available to stream on Max.