WhenERaired from 1994 to 2009 on NBC, it was one of the most dramatic andengrossing portrayals of a hospital emergency roomthat television viewers had ever seen. There were shocking plot points, fascinating medical mysteries, and plenty of romance between the characters. Now, withthe premiere of Max’s new medical drama,The Pitt, audiences are being treated toan even more accurate and honest depiction of what actually takes place in an emergency room. BecauseThe Pittis able to head into more gruesome territory, the series is already earning praise forsurpassingERin its authenticity.

As cutting-edge asERappeared when it first aired,there were actually a lot of restrictions on what the series could portray. Becauseit was a network television show, the series was required to abide by broadcast standards and practices. These rules can limit the amount of violence or graphic images that are displayed during a show (given that there are moral, ethical, and legal challenges to every piece of content). Even though it was assumed that this wasn’t exactly family-friendly entertainment, there was more of a tendency to play it safe to avoid offensive or harmful images being shown. Networks were (and still are) leery of losing advertisers, so they would have been limited by what the network deemed appropriate.

Noah Wyle looks off to the side while wearing a hoodie and stethoscope in The Pitt.

ERstill hasplenty of heart-pumping moments, including at least two doctors who needed limbs amputated and crises ranging from collapsed buildings,exploding ambulances, and stabbings. But looking back, even with the bloodiness inherent in an emergency room,the show would not be remembered as being particularly overt in its carnage.

Noah Wyle Explains How ‘The Pitt’ Is “Different by Design” from ‘ER’

Noah Wyle stars as Dr. Michael Robinavitch in ‘The Pitt’ and played John Carter in ‘ER.’

‘The Pitt’ Has Surpassed ‘ER’ in Its Realism and Gore

There are many reasons whyThe Pittseems to have moved beyondER, in terms of what they can depict on the show. The biggest explanation is thatThe Pittairs on a streaming channelversus a regular network. Because of this,the series is permitted to depict much more graphic content, violence, and language.The Pittcan portray something like a woman’s foot hanging off after it was run over by a train (in Episode 1) and the entire degloving process to mend the damage in all its gruesomeness. This scene is hard to stomach because it looks so real (the injury reveals open muscle, bone, tissue, and a whole lot of blood), and it’s something you would never have seen back in the day onER. There’s also the fact that audiences have grown to be able to accept much more explicit and intense scenes than in the past (like in the ’90s whenERaired). Viewers have become more immune to graphic elements (especially when it comes to things that have already been shown in other television shows over the years), so shows likeThe Pitthave also had to raise their game when it comes to shock value.

The Pitthas also improved uponER’sability to depict medical scenesbecause of improvements in makeup and special effects. All the medical cases (from a patient who has a nail lodged in his heart to the sound of ribs cracking from CPR being performed), all work to make these stories feel organically real. Even though some of the scenes are difficult to watch (the show is definitely not for the squeamish),the series is somehow both disturbing and oddly captivating. BecauseThe Pittis capable of recreating some of the most horrific things that can happen to the human body, the gravity of these high-stakes life-saving actions becomes even more gripping.

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The graphic quality ofThe Pittmakes it so that we’re reminded of how fragile we all are. Somehow,watchingERdidn’t create the same effect, because it always felt easy to remember that these were just actors on the screen.The Pittshowing what a gunshot or drug overdose (or even old age) can do to the body, helps to drive the point home that we’re all just one step away from a serious illness or injury. By creating a documentary-type series about what it’s really like in a high-pressured emergency room,The Pitthas proven that it’s an updated, even more realistic showfor modern audiences who can handle a little bit more grisly gore.

The Pittis available to stream on Max in the U.S. New episodes drop every Thursday.

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The Pitt is a medical drama developed by veterans of the television series ER. The series will follow healthcare workers set in Pittsburgh, showing he challenges faced in the modern-day United States by nurses, doctors, and other medical professionals.

Watch on Max

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The Pitt