Interview: Damian Marcano on Trusting His Heart While Directing ‘The Pitt’

Damian Marcano never gravitated toward medical dramas. Then again, The Pitt is not your typical medical drama.

“Besides all the medicine and everything that was going on, I was reading the pages for the human story,” Marcano explains. “So I was wondering moreso not about the supraclavicular subclavian, but I was more interested in like how does Langdon and Robby really feel about each other at this very moment? I think that is the joy of our show because it’s less focused on the patients and more on the actual medical professionals. That’s what really piqued my interest.”

Marcano’s direction specifically stands out because they hold space for the humanity of the characters to come to the forefront. Whether they are being pushed to their breaking point or to the point of vulnerability, Marcano allows the characters to guide.

“I remember doing a set up in Season 1 and just kind of stopping and saying, ‘Guys I really just realized that this is the one place in America you can show up, no matter who you are, no matter what you’ve done,'” he recalls. “Your race, your class, your sexual identity, it does not matter…. No one says, ‘Ah, not me, I can’t right now.’ And to me, that became the emotional core of the show and that was everything I really aimed for as part of my storytelling for season 1. The joke of Season 2…I remember talking to John Wells and Mike Hissrich…and I said, ‘Guys, what are we gonna do differently in Season 2’ and they said, ‘The very same thing we did in Season 1.’ That’s what we aimed to do in Season 2 for sure.”

This season, Marcano directs four episodes spread out over the course of the fifteen hour shift. But, despite the varying degrees of chaos and energy, Marcano approaches each episode the same because “[t]hey have to be on in hour one and they have to be on in hour 12…. I think it’s amazing the fact that we explore, with all of the micro aggressions, patients cussing you out, your body being fatigued… how do you be at that 100% you’re expected to be at that 7:00 AM shift at 7:00 PM?”

This dilemma is where a lot of the characters’ conflicts are allowed to thrive. For example, in Season 2 Episode 10, “4:00 PM,” we witness Langdon (Patrick Ball) and Santos’ (Isa Briones) conflict unfold amid an intense procedure. The encounter expertly highlights personal conflict trickling into professional dilemmas and what happens when that “100%” begins to falter.

“That’s the joy of it,” says Marcano. “I like to think of scenes like that on our show of not ‘we talk and then.’ I like ‘let’s talk while.’ There’s so much that’s happening and…then there’s so much emotion that’s earned in this moment….”

This simple mentality folds myriad layers into what could’ve simply been another operation. He deftly allows both conflicts to unfold simultaneously in a single scene without ever allowing one to swallow the other whole. Marcano’s intent to “talk while” allows various emotional arcs to compound upon one another, culminating in impeccable tension for the audience. 

That expertise in building tension also comes out in a dizzying sequence where Dr. Mohan (Supriya Ganesh) suffers a panic attack in the middle of the ED.

“It’s such a long sequence that just builds,” he says when asked about that moment. “We explore medicine but we are really exploring almost in real time…what an anxiety attack would be like on an actual doctor in an ER. And that’s something I haven’t seen. But there is a feeling. We shoot this show between Stages 22 and 21. 21 holds the lobby. 22 is nice and air conditioned, even the other side of 21 is nice and air conditioned. But, when we put all of those background extras into that lobby, you literally feel the humidity once you get through those doors. I remember rehearsing that and saying, ‘This is how we have to shoot it, I have to make this wall, I have to make sure that we feel her temperature’s going to rise even more in here’ because the minute you break through those lobby doors…it hits you, you feel it and you’re like ‘there’s no way she’s getting out of here.'”

Marcano focused on immersing the audience in Samira’s experience. He continues, “A lot of our show is in that handheld space, but we control it…. This was a moment that the camera could have some fun. The camera was not going to leave this POV…. She’s a really great performer. Having Supriya be the one to do this as well was pretty epic.”

The signature of a Marcano-directed episode, though, isn’t solely these heightened sequences dripping with chaos. Marcano masterfully balances that chaos with moments of stillness that leave the audience to sit with profound moments of emotion. In Episode 13, “7:00 PM,” Marcano crafts one of the episode’s most memorable sequences out of a small moment with unhoused patient Digby (Charles Baker).

“We shot that scene way before the episode was written,” he admits when asked about Digby’s big scene. “We had just a little crew and for once it was kinda quiet and very intimate on that set. There was just a little handful of us, we had Digby, we had Emma, we had Dana. Doing that scene and discovering that moment in the episode… I wanted the world to see Digby’s reflection at the same time that he saw it. So we’d see it through the mirror but we’d also see Dana and Emma looking at him…. We all take for granted the last time someone told us we look nice today…. [I]t was such a gut punch for me to say, ‘Man I take that for granted.’ And most of us that were there also realized that we all take that for granted and the fact that we could maybe learn something from a character like Digby who’s just been kind of hanging out since he showed up in the hospital this morning…. These human beings that we are able to explore in this show are I think a good therapy for some of us as well. You just learn some things and hopefully you keep it stored up here and say ‘I’m not gonna take that for granted again.'”

Marcano elevates so many of these memorable emotional beats with striking and intentional imagery without ever allowing the dueling tones to overwhelm the other. So what’s the secret to holding all of this and nailing the moment?

“I just trust this little thing that ticks right here,” he says, pointing to his heart. “I like to think of the ten possible ways I could attack this and then usually by the time I get to work the pessimist inside of me has said, ‘Oh no no no that is so pretentious, are you really doing that?’ And what it always falls back to…do you remember the first time you watched something, something that made you move? Well guess what? You’re the person now on the other side that’s responsible for that…. We sit, we listen to the lyrics as I like to call it before we rehearse, and then I say, here’s what the true POV is. We’re really trying to give you moments and I think we’re trying to capture them in a way that moment should honestly be captured. Any shot list, any cool blocking, all of that, all falls prey to whatever your heart feels that day.”

His heart-first approach is what makes Marcano one of the most exciting directors in television today. It’s not shocking that he’s directed some of the most talked about episodes of The Pitt. Whether it’s shot composition or the characters’ own journeys, he’s consistently crafting a story that is both visually dynamic and grounded in the human condition.

You can check out all of Damian Marcano‘s work on Season 2 of The Pitt, streaming on HBO Max. New episodes of The Pitt air Thursday at 9:00 PM ET on HBO Max. Be sure to check out our full conversation with Damian below.