Pitt's lead makeup artist, Miriam Arughetti, knew that after the success of the first season, she would have to raise the bar for the second season.
The first season featured heart attacks, third-degree burns, and emergency thoracotomies. The second season sought to push the boundaries and heighten the drama for the doctors at Pittsburgh Trauma Center.
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Arugheti worked on another thoracotomy, a laceration to the head from a firework, margarita burns, and more. In the second episode, a patient's cast is opened, revealing a cluster of maggots. "The maggots were disgusting," she laughs.
Arugheti told Variety "It's always interesting to surprise people with something unusual." Here, she reveals the makeup secrets behind some of the season's bloodiest moments.
Clamshell Thoracotomy – Episode 1
When the new shift began, no one held back. A patient was rushed to the trauma center after being stabbed in the chest with a kitchen knife. When his heart stops, it fell to Dr. Garcia (Alexandra Metz) to perform a thoracotomy.
«"We open everything up," says Arughetti. However, the challenge was achieving a realistic look in terms of skin quality. "There's a lot of fine-tuning in the design, and we have to make sure the silicone has the necessary flexibility," she explains. Arughetti notes that the torso is artificial, but where possible, she wanted to use as many real body parts as possible. "We have a head and arms. But they're all at different angles. The actor is hidden in this artificial gurney.".
Margarita is Burning – Episode 8
In episode 8, a patient is brought in with "margarita burns." "I didn't know this could happen, and it's scary," Arugheti jokes.
But it's entirely possible. Citrus burns occur when areas of skin exposed to citrus fruits and sunlight become severely sunburned.
Arugheti admits that this particular design disgusted her, as she spent a long time looking at photos, pondering what the design would look like. "There was nothing practical about it. It was just makeup, and it takes hours to apply," she says.
The blisters were made of silicone by Autonomous Effects. "We needed different sizes and opacity levels, and then we painted them. We used airbrushing and hand painting. We added products like Vaseline or KY gel to add shine, volume, and texture," she says.
The challenge was finding the fine line between realism and comedy. "We do a lot of testing. In this particular case, we added something at the end, a small element that the doctor wanted to see, and when the makeup dried, I thought, 'No, it's not working. It doesn't look right.' I said I need 10 minutes, and we were able to make the adjustment, and everything turned out great.".
Head Flap - Episode 12
Arugheti asks, "Remember how we slapped ourselves on the head? That was pretty cool.".
She's right. In Episode 12, Dante (Shane Nelson) suffers a traumatic brain injury after a botched fireworks explosion in a warehouse. "He has a full-blown laceration, and we see a large, flap-shaped wound on his head," Arughetti says.
The makeup required simulating bleeding arteries on the doctor's face, shaving his hair, and stitching. Arughetti says it was quite challenging. "We had this [flap] on the actor. We wanted to stitch it up on camera, so we had to ensure it was protected enough to avoid injuring him. Again, it took a lot of testing and discussion to create this look and pull off this stunt on camera.".
How long did it take to build something like this? A full six weeks.
«"They take a mold of his head, and it has to fit perfectly. Then they have to make holes so that the hair in certain places matches his real hair. It's a long and labor-intensive process. There's nothing to hide.".
Brandon's Knee – Episode 6
In Episode 6, Brandon (John Squires) is brought in with a laceration to his knee. The idea was to create a seamless transition from wound to wound on the actor's knee.
«"It was a procedure where they checked for nerve damage and injected him with a glow-in-the-dark fluid. If it came out of the wound, it meant he was in trouble and needed surgery; if not, he was fine. We just stitched it up, and he was fine.".
Arugheti explains that the most frightening thing people experience is when a needle pierces the skin. But Noah Wyle decided to change things up a bit. "He wanted to see how this huge syringe was inserted. Well, obviously that's impossible, so we had to quickly fabricate a prosthetic leg, reinstall it, and attach it to the artificial leg.".
The challenge, however, was that since the artificial leg was made of foam, Arughetti had to "create a channel inside that would follow the injection point where the liquid would flow, otherwise the real fluorescent liquid would spread throughout the entire foam leg, causing the entire leg to glow in the dark." She continues, "We created this channel, and the actor had to press precisely in that spot to get the liquid inside.".
Suturing also presented a challenge, as a figure-eight shape was required. The silicone had to be firm enough to hold all the open wounds in place, yet "soft enough to compress the middle and create that figure-eight shape." She adds, "It's all about the flexibility of the silicone.".
Tongue Laceration - Episode 8
A key element of this makeup was the retainer. "We made tongues of different sizes and sewed them to the retainer," she says. Because the tongue was attached to the retainer, it allowed the actress to move and react. When the doctor made her incision, it turned out the tongue was longer. "They managed to sew it back up," Arughetti says confidently. "She doesn't feel any pain.".
Bloody Birth – Episode 15
What better way to end the season than with a whirlwind pregnancy? Nicole is rushed to the hospital with swollen ankles and high blood pressure. When she begins having seizures, doctors decide to perform an emergency C-section.
The makeup required a variety of elements. "We had a prosthetic belly that was glued to every scene until editing." But because the patient was constantly rolling onto her side, says Arughetti, "we had to strategically position the edges so it wouldn't be too obvious.".
In addition to her stomach, her ankles were also swollen. "She spent several days in the makeup chair; five hours each for her stomach and swollen ankles.".
When it came to the abdominal incision and the leaking fluid, Arugheti said it took numerous tests to figure out what to do. They also had to coat the baby with a sticky white substance known as vernix caseosa—cream cheese was the perfect substitute. But the challenge was that with each take, the entire pregnancy had to be restarted. "There were six or seven of us, and each had one specific task: fill the uterus, fill the baby with the sticky fluid, close the uterus," she adds. "It was crazy.".
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