The Pitt Season 2 Finale: How Dr. Al-Hashimi's Reveal Affects Robby's Future

This article contains discussions of mental health and suicidal ideation, as well as spoilers for "The Pitt" season 2 finale, "9:00 P.M."

On the penultimate episode of "The Pitt," Dr. Baran Al-Hashimi (Sepideh Moafi) told Dr. Michael "Robby" Robinavitch (Noah Wyle) something that could change the next several months of his life, so let's talk about Al-Hashimi's confession and where Robby can go from here.

At the end of that episode, "8:00 P.M.," Al-Hashimi asks Robby if they can speak privately, at which point she presents him with a chart for a patient who's 40 years old and has been suffering from intermittent seizures for over three decades. In the season 2 finale, "9:00 P.M.," Al-Hashimi opens up about precisely what's going on. 

As she confesses to Robby, she developed seizures as a child after a severe case of viral meningitis in Iran. "They tried every anti-seizure medication, but I still had episodes every few months or so," Al-Hashimi says of her seizures, which aren't typical tonic-clonic (formerly known as grand mal) seizures. "Nobody's ever noticed before. They just think I'm thoughtful." That's because Al-Hashimi's seizures are categorized as FIAS, or "focal impaired awareness seizures," which are characterized by moments of apparent distraction or lack of focus. As Al-Hashimi tells Robby, she's kept them under control with Keppra, an anti-seizure medication. Here's the problem: She had two episodes during her shift that day.

To be extremely clear, Al-Hashimi also clarifies that her neurologist — the same neurologist we saw her try and call earlier in the season — cleared her to drive and work as an attending surgeon. Still, this new development is troubling for her and Robby, as she's set to temporarily replace him as the head of the emergency department.

As Dr. Al-Hashimi tells Robby, she had not one but two seizure episodes during the 15-hour emergency department shift, which is especially stress-inducing and shocking for her because she's been able to keep the seizures under control with medication and self care. "It's been well over a year," Al-Hashimi admits. "But I had two today. I don't know why. It could be sleep deprivation, new job stress; I haven't had to deal with pedes cases since Afghanistan." (Elsewhere in season 2, Al-Hashimi chats with military veteran Dr. Jack Abbot, played by Shawn Hatosy, about her time working at the Dasht-e-Barchi Hospital in the war-torn country, which experienced a real massacre in a maternity ward in 2020, when the fictional Dr. Al-Hashimi was working there.)

That's when Dr. Al-Hashimi tells Robby, who is understandably shaken by this information, that she has a few options to try and manage her seizures. Besides increasing the dosage on her current medication or "trying one of the new anti-seizure meds," Dr. Al-Hashimi starts to tear up as she considers the alternative. "But if that doesn't work, I'm left with two choices: a temporal lobectomy, which could impair my speech, or get a neuromodulation device, which can sense and stop the seizures almost immediately." While I can't personally speak to whether or not a neuromodulation device would affect Dr. Al-Hashimi's ability to perform as a physician, a temporal lobectomy, which would remove part of her brain, almost certainly would. So how does this all affect Robby? Quite a bit, actually!

Two things I'd like to say up-front: Dr. Robby seems more devastated than anything else that Dr. Al-Hashimi is suffering, and when you see the fear and sadness in her eyes, you can see those same emotions in his as well. Still, we do have to talk about how Al-Hashimi's realization and medical emergency affects Robby, because as we all know, he was set to leave on sabbatical.

This might end up saving Robby's life in the long run, though. We've seen, throughout season 2 of "The Pitt" and especially in the penultimate episode, that Robby is struggling with his mental health ... and, more specifically, suicidal ideation, something he admits to his friend Duke Ekins (veteran TV character actor Jeff Kober). People have been theorizing for weeks now that Robby's motorcycle-centered three-month sabbatical felt like a cry for help, and considering that he likely can't leave his emergency department in Al-Hashimi's hands because she'll need further treatment, it might just keep him alive. 

At the end of the season 2 finale, Al-Hashimi starts to drive away in her car and breaks down crying, the weight of her admission finally crashing down. It's heartbreaking, poignant, and changes the course of the narrative ... for her and Robby both. You can stream both seasons of "The Pitt" on HBO Max.

If you or someone you know needs help with mental health, please contact the Crisis Text Line by texting HOME to 741741, call the National Alliance on Mental Illness helpline at 1-800-950-NAMI (6264), or visit the National Institute of Mental Health website.

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