‘The Last of Us’ Made One Significant Change to the Big Hospital Scene

13 March 2023

[Editor’s Note: The following review contains spoilers for “The Last of Us,” including the season finale.]

Ask most fans of “The Last of Us” to describe what makes the game a standout achievement and you’ll probably get an explanation of the hospital scene. It’s not a coincidence that in the post-premiere trailer that gave viewers a peek at everything to come in “The Weeks Ahead,” Joel (Pedro Pascal) walking through the hospital was the last image teased.

In Sunday night’s season finale, Joel’s tragic choices play out once again. Faced with the option of leaving Ellie (Bella Ramsey) to die and offering the world a chance at a cure, Joel goes the opposite route. In a cloud of bullets and bodies, Joel swipes Ellie from the Fireflies’ makeshift hospital and takes her away. Marlene (Merle Dandridge) is left dead, along with a number of surgeons and nurses who thought they were fulfilling humanity’s last best hope.

Aside from transposing most of the details from a first-person gaming experience to a TV viewing one, the HBO version of “The Last of Us” ending gets one big change, courtesy of a familiar source. In addition to series co-creator Neil Druckmann, Dandridge, and assorted cast members who were involved in the original game over a decade ago, the TV incarnation of “The Last of Us” also brought back composer Gustavo Santaolalla. Along with fellow composer David Fleming, the music of the series is that same mix of familiar and new that has powered the best parts of the show.

Speaking at a virtual press conference last week, series co-creators Druckmann and Craig Mazin spoke about this final episode, including the music-based shift to the season’s emotional climax.

“There was one option that we had that we employed, I think, to great effect during Joel’s attack sequence in the hospital,” Mazin said. “And that was to take a very different piece of music that was meant for what happens right after in the game — which is his picking Ellie up and walking out with her  — and taking that and putting that under that sequence. In the game, that sequence is largely gameplay. But here, it is this beautiful, sad, mournful cello-based piece. It allowed us to feel almost heartbroken by what Joel was doing and what he was breaking inside of himself and how he was betraying something that he probably knows Ellie wouldn’t want him to do. You’re both rooting for him and you’re also so sad for him. That’s the brilliance of Gustavo is that sometimes just taking a piece from over here and putting it under this makes magic.”

“The Last of Us”

Courtesy of Liane Hentscher / HBO

As for the content of the ending itself, that was one element of the finale that stayed untouched throughout the process. Mazin emphasized that, as a fan of the original game, the ending was one of the main engines for wanting to make a show in the first place. Discussing how exactly to shape Joel’s decision within the context of an episode of TV became a helpful case study in how the two went about working together.

“Neil, in the smartest, most generous, and flexible way, was always open to the process of adaptation. He understood what adaptation meant,” Mazin said. “But the ending, there was never a question. As a player, I got to the end. Why would I ever want to change that? It’s awesome.”

“Had Craig come and said, ‘Hey, I’ve been thinking about this other ending,’ I’m sure at first I’d tense up a little bit and just hear the pitch. But our process would be like, ‘OK, let’s talk it through,’” Druckmann said. “We would go back through the whole season and say, ‘Have we worked up towards this other ending, potentially?’ And we’d consider it and often the answer would be, ‘Yeah, it doesn’t quite work’ or ‘It changes too many things’ or ‘Now it’s shifted too much.’ And then we’d go backwards and undo, Ctrl+Z, Ctrl+Z, until we got back to where we were and then keep going.”

The interior of the hospital is lit and laid out similar to the game, which makes sense for a controlled, indoor environment. “The Last of Us” also features a lot of treacherous outdoor terrain, particularly as Joel and Ellie make their way through the Rockies. The production filmed in locations all over Alberta, as Jasmila Žbanić described after directing Episode 6, “Kin.” Mazin gave credit to visual effects supervisor Alex Wang and his team, as well as VFX house DNEG, for transforming some of those locations into places that felt plucked out of the middle of the United States.

As the series turns its attention to Season 2, the show’s creative team is mindful of the change in scale that these upcoming episodes are sure to have.

“It was massive. I’m trying to stop saying it’s massive to myself because I know that next season is going to be more massive, and I don’t wanna freak out. Man, it wasn’t easy,” Mazin said. “I will give us honestly a solid B+. But my goal is to do better next season, now that we’ve learned some lessons. Every now and then you get a little bit of a ‘Oh, it’s Canada’ when we don’t want it to be Canada. That said, it’s an awesome place to shoot. I loved it. I love being there.”

Bella Ramsey in “The Last of Us”

Liane Hentscher/HBO

That increase in scale might come with a change in how the show sees its cordyceps antagonists. Though the Infected have certainly been a threat throughout the season, the show has defaulted to focusing on human resilience and despair rather than a growing parade of action sequences. (Mazin also dispelled the rumor that he didn’t want people to use a certain word to refer to the Infected: “I don’t know what everyone was talking about. We call them ‘zombies’ all the time, because it’s funny.”) Part of that came from a long-range vision for how each season could feel different from each other.

“We did at times have choices to make about how we wanted to present the Infected. Even though we were greenlit for a season of television, Neil and I felt like we can’t just make a season of television without considering what would come after. There is more ‘The Last of Us’ to come. And I think the balance is not always just about within an episode or even episode to episode but season a season,” Mazin said. “It’s quite possible that there will be a lot more Infected later, and perhaps different kinds. But within the episodes that we were concentrating on, I think ultimately we generally stressed the power of relationships and trying to find significance within moments of action. So there may be less action than some people wanted, because we couldn’t necessarily find significance for quite a bit of it. After all, you’re not playing it, you’re watching it. And although a lot of people do like to watch gameplay, it needs to be a little bit more focused and purposeful when we’re putting it on TV.”

With an entire season now under their belt, Druckmann and Mazin expressed a level of confidence in approaching the next season. Whatever changes are still to come from what fans of the game have already experienced in “The Last of Us, Part II,” the two insist that those adaptation choices for Season 2 will come from a now-familiar, unified place.

“One of the things Neil and I have been talking about over and over is to not change our process. Our process works. Our process of kicking the tires on everything, our process of agreeing that no matter how much we disagree, we will find a way to agree. There’s no veto power here, just: We will figure it out,” Mazin said. “To keep the writing process roughly what it was, which is pretty solitary and monk-like, these things are important to us. Production-wise, I learned so much.”

“I knew 0% about making TV shows. Now I know 5%,” Druckmann said.

“He’s 5%. I’m up to 12. So we’re doing great,” Mazin said. “What I’m really excited about is the fact that for so many of us, whether it’s crew or cast, we will be returning sophomores. We know where everything is, we don’t get lost figuring out how to get to math class anymore. And that’s a comfort level that you have to earn. And so I’m excited to feel that.”

“The Last of Us” Season 1 is available to stream on HBO Max.

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