The Night Shift” returns for its second season on Feb. 23, and Variety has an exclusive behind-the-scenes look at what goes into creating the medical drama’s visceral visual effects and makeup.

The footage reveals techniques from three-time Emmy-winning makeup department head Cheri Montasanto, showing a cast that is quick to react to gory injuries that are so intricately designed that the cast and crew sometimes forget they’re not real.

“It makes everything much easier when you’re looking at stuff that looks real,” says Eoin Macken, who plays doctor T.C. Callahan.

Actress Jeananne Goossen, who plays Krista, describes having her arms fully submerged in someone’s torso for an episode where a pregnant victim of a car crash has a head wound and needs a C-section. She reveals that there are actors puppeteering underneath the procedure tables, so it gives the illusion that the heart and lungs are moving.

“It looks like a living, breathing thing,” she said.

Director Eriq La Salle, who worked on “ER” for 15 years, noted that a key to the success of medical dramas is a sense of non-stop energy.

“The more realistic it feels to the actors, the more engaged they can become, and the more engaged the actors are, the more engaged the audience is,” La Salle said.

The medical drama will return on Feb. 23 at 10 p.m on NBC.