The Pitt Episode 10 “4 PM” has perhaps the most devastating shocker of an ending yet, and this is a MAX show that’s already left poor charge nurse Dana Evans (Katherine LaNasa) bleeding on the concrete outside the hospital! Dr. Robby (Noah Wyle) decides to take Dr. Santos’s (Isa Briones) concerns about Dr. Langdon (Patrick Ball) seriously. When Dr. Robby gets to the heartbreaking truth about Langdon, it feels like a stunning blow of betrayal.

**Spoilers for The Pitt Episode 10 “4 PM,” now streaming on MAX**

The end of The Pitt Episode 10 “4 PM” confirms that Santos’s suspicions are correct: Dr. Langdon has been stealing prescription painkillers from his own patients.

So what exactly comes next? Does this mean that Dr. Langdon is gone from PTMH for good? How long did actors Noah Wyle, Patrick Ball, and Isa Briones know that this twist was coming? And does this mean that everyone should be nicer to Santos now?

Here’s everything DECIDER learned about the explosive end to The Pitt Episode 10 “4 PM” on MAX…

The Pitt Episode 10 Ending Explained: Is Dr. Langdon a Drug Addict? Is Langdon Fired?

Yes, Dr. Langdon has a dependency on prescription painkillers. More damning, however, is the fact that he’s been stealing drugs from his own patients. This double whammy prompts a massive argument between Robby and Langdon, culminating in Langdon’s firing.

When DECIDER caught up with Pitt star Patrick Ball recently, he revealed that he was clued into Langdon’s secret struggle as early as his first screen test. He was given the scene between Dr. Robby and Dr. Langdon by the lockers as part of his audition.

“So I knew it was coming all along and they were clear that it was going to sort of come to a head in [Episode] 10, but I had no idea what was going to happen between [Episodes] 1 and 10,” he said, before going on to praise series creator and showrunner R. Scott Gemmill.

“Figuring out how to how to thread that needle was really cool and really a testament to Scott Gemmill, the showrunner, because I think he did a really amazing job of not making it overwrought or sending up a bunch of signals or circling everything with a big marker,” Ball told DECIDER. “He allowed it to sort of come out subtly, which was cool.”

Langdon continues to argue, deflect, beg, and plead with a devastated Dr. Robby, pointing out he was given a prescription by their “own Dr. Hagan” and that he’s been “weaning” himself off. It’s a scenario that TV nerds might recognize from another Noah Wyle medical drama, only with the roles reversed. In the ER Season 6 finale, “May Day,” it’s discovered that Wyle’s Dr. Carter has been secretly and illegally injecting pain meds and an emotional intervention is staged.

“You know, it’s so crazy. We watched two shows in my house growing up. We watched The West Wing and we watched ER. We put it in the schedule every week. And now I get to work with those guys, which is crazy,” Ball said. “But in getting ready to do this show, I was really intentional. I was like, ‘I don’t want to go back and watch ER.’”

Ball didn’t want John Wells, Noah Wyle, and Scott Gemmill’s last gritty medical drama influencing him “either consciously or subconsciously.” But before his second audition, he acquiesced and watched “one random episode.” It turned out to be “May Day.”

“Which was crazy because at that point, I did not even know that this was going to be part of my story,” Ball said. “Then we then we got to actually doing the scene. It was amazing.”

“Noah is an incredible actor and he’s an incredible scene partner. He’s a really amazing mentor and has become a really good friend. You know, this is my first TV show, this was my first time doing this, and he’s like really sort of taken me under his wing. And so when we got to have that big blow out scene, it was… God, it was my dream come true.”

Another reason why this reveal is upsetting is The Pitt‘s made Langdon by and large a likable, upstanding character. Santos, on the other hand, has been ruffling feathers on The Pitt. Her investigation into Langdon seems at first to be simply sour grapes, since the older resident refuses to let Santos have her way.

“I think it’s funny because there are a lot of similarities. He’s a very cocky doctor himself and so is she,” Isa Briones said. “So I think from the beginning, it’s like there’s animosity there and it’s always him kind of being like,’ You’re being too bold,’ and Santos being like, ‘He’s always shutting me down.’ And there’s validity to both of those things.”

Ball said, “I think maybe on some level he sees her as a threat. Like, you know, she is sort of sniffing around and he does have skeletons in the closet. And so that could be a scary thing.”

“I also think he sees himself in her, whether consciously or unconsciously,” he said. “She comes into this space very much confident, sort of out over her skis and being like, ‘I’m going to be the star.’ And I think Langdon probably came in in a similar way.”

Briones also warned that she didn’t think that Santos “being right” would be “the win for her maybe she wants.”

“Because at the end of the day, someone’s getting fired who is beloved in the ED,” Briones said. “I think there is, in the world, a tendency to believe a man who’s being really nice, who is maybe doing the wrong thing, and not believe a woman who has evidence.”

“She’s not going to feel like, ‘Wow, I win!’ It’s like, ‘Okay, and what now?’ Like, people are going to blame me?”

Langdon’s officially out of the ER on The Pitt, but is Briones right? Will things continue to be difficult for Santos?

We’ll just have to keep watching The Pitt on MAX to find out…