History & Film

Blood, Cocaine & Hubris: The Knick

Doubtless much to our readership’s relief, it’s been awhile since I’ve penned a History & Film column. When I came to write this one, I found myself in some difficulty. Lately it’s proved challenging to find something with enough appeal to watch, much less try to blather on about with nominal coherence in written form. I considered Mank, the recent Netflix film about screenwriter Herman Mankiewicz; its plot ostensibly concerns the tribulations that birthed Citizen Kane. Press was positive, with critics calling it a “love letter” to the Golden Age of Hollywood. I dutifully sat through it. Two things: 1. It’s tragic, really, that so many critics have never been the recipient of a love letter; this is the only logical conclusion to draw from their hailing Mank as one. 2. Gary Oldman is exceptional in whatever role he takes on, including this one — a feat near Herculean in a film that requires its 63-year-old British star to convince viewers he’s an alcohol-soaked American screenwriter in his early 30s. I won’t go into what this film actually is, since about halfway through, I realized I had little desire to write a column about it (or even finish watching it, if I’m honest). I switched gears, really switched them, and settled on The Knick, one of the “best and most influential shows of the prestige TV era…that almost nobody saw.”1 Well, I saw it.

The Knick (two seasons, 2014-2015) is set in New York City in 1900. It stars Clive Owen, was produced and directed by Steven Soderbergh, so there are some heavy hitters here. The Knick of the title is the Knickerbocker Hospital, the name of a real hospital which operated in NYC. Yet it shouldn’t be taken as too literal a model. The real Knickerbocker got its start as the Manhattan Dispensary in the 1860s; it was located on 131st Street and Covent Avenue (presentday Harlem). This is an important distinction from the Knick of the series, because Soderbergh’s hospital is located on the Lower East Side, and there is the constant question of “moving uptown.” The Knick suffers from the location, location, location problem of its real estate — it struggles financially because, though there are notable exceptions, the population it primarily serves is the working poor of the Lower East Side tenements.

The Knick is the domain of Dr. John Thackery (Owen), a volatile and brilliant surgeon whose dapper white shoes are counterbalanced by his unfortunate choice of mustache. He’s also less than judicious in the medication he selects for himself: cocaine, with the occasional opium aperitif. While there’s plenty of relationship drama, one of the show’s more gripping aspects is its portrayal of progress in the medical profession. This time period saw exponential acceleration of medical practice and constant innovation. Watching The Knick feels, at times, like the Eakins comparison put into motion. If you’re unfamiliar with Thomas Eakins, he was an American realist painter. Amongst other things, he treated two subjects (Dr. Samuel D. Gross and Dr. David H. Agnew) hard at work in their operating theatres. Historians have long compared the two paintings to show exactly how far medicine had come in such a short period of time. The paintings were executed less than 15 years apart (1875 and 1889), and they offer a visual representation of how significantly things had changed, not least of which was the adoption of sterile practice and pervasive use of anesthesia. Thackery personifies this shift in The Knick. He and his small team of doctors race to create new treatments and perfect their understanding of the human body. Often patients benefit, but the word experimental doesn’t even begin to describe Thackery’s approach, and there are plenty of dark inside jokes at ignorance’s expense. As just one example, the sleazeball hospital administrator (Jeremy Bobb), excited to try out the Knick’s first x-ray machine, has its radioactive material trained three inches from his skull…for over an hour.

Thackery seems loosely based on William Stewart Halstead, a pioneering surgeon who focused on aseptic surgery practices and use of anesthesia. Halstead also had a serious drug dependency which included morphine and cocaine, legal and entirely unregulated at the time. Some of Halstead’s innovations, such as inguinal hernia treatment, see screen time through Thackery and his colleagues. Yet Thackery is, like much in the series, a conglomeration, conflation, and vehicle of sorts; he evokes other medical men such as Thomas Dent Mütter, an even earlier 19th century medical pioneer, when he pursues skin grafting for a syphilitic patient, and gets pitted against a colleague of Karl Landsteiner’s in an important plot point regarding the race to demystify blood groups. Thackery’s zeal to find a viable treatment for patients suffering placenta praevia is near obsessive, and there’s also a significant focus on abortion (secretly performed by one of the hospital’s affiliated nuns, no less). These are interesting foci given the fact that, according to the Directory of Social and Health Agencies of New York City for 1914, one of the categories of patients denied admittance to the real Knickerbocker were maternity cases.

Maternity patients weren’t the only ones barred — the show takes pains to highlight the Knickerbocker’s refusal to treat black patients through the character of Dr. Algernon Edwards (André Holland). Edwards is black, and as a “colored” physician, faces discrimination at most, though not every, turn. There were “colored” physicians in New York City long before 1900; James McCune Smith, who was educated in England and Scotland, is often credited as the first, beginning his US practice in the 1830s. Edwards shares some similarities with this historical man (like Smith, he spends time interning in Paris), but despite sterling competence and a keen mind, he owes his position at the Knick solely to his benefactor, August Robertson (Grainger Hines), a shipping magnate and donor who keeps the Knick financially afloat. Robertson forces Thackery to take Edwards on, and the road to his acceptance by Thackery as a talented physician allowed to preside in the operating theatre takes half the first season. The change of location affects this aspect as well — the real Knick’s stance on not treating “colored people” was even more problematic than that portrayed in the series, especially as time went on, because it was located in the heart of Harlem.

It would be less than accurate to describe this as an ensemble drama. Though there are strong supporting cast members with their

own troubles and backstories, this is essentially a vehicle for Owen, with Holland running a close second. Owen was approached for the role because the show needed “a movie star” with “that kind of watchability and gravitas.”2 Owen is certainly watchable, though it’s often painful, between general jerkiosity and shooting up so much he’s blown even the veins between his toes. It comes as a relief in the second season when, in response to daily needle mark checks required by the hospital, he takes to snorting rather than injecting. The show doesn’t “pussyfoot around about the prototypical surgeon’s personality,”3 and you aren’t meant to like Thackery. You’re meant to be riveted by his medical innovations while relieved you don’t have to work with him or, heaven forfend, for him. This offers a sort of juxtaposition: medicine moves forward while Thackery devolves into a pitiable (?) mess. Even in his reduced state, his mind clings to medicine – he begins working to try to find the “seat” of addiction, and the series has him advancing the unheard-of theory to a shocked hospital board that addiction is a “disease” that can be treated, rather than a moral failing.

The aforementioned elements are well done, but admittedly less than original. (The arrogant surgeon with a substance abuse problem is practically a television staple at this point.) What sets The Knick apart is the sense of motion and immersion Soderbergh manages to offer the viewer. He describes the visual style as visceral, and that’s entirely apt. This show is not for the faint of heart or light of stomach. Soderbergh stated in an interview, “There’s gotta be at least one moment, if not more, in every episode where somebody has to cover their face, because they just can’t watch.”4 This viewer will vouch that it’s mission accomplished for The Knick on that score. The gore isn’t so much gratuitous as it is unavoidable; there’s the feeling that if one wants a sense of realism in a series with this time period and subject matter, blood is inescapable. With very few exceptions, the special effects are practical (as opposed to computergenerated), and they impact the viewer in way that CGI (at least, as the technology currently stands) is simply incapable of doing. It can be stomach-churning. But it also offers historical atmosphere. As a counterpoint to historical, to give it a sense of immediacy — of now — camera work is usually handheld, and natural lighting is used whenever possible. The angles often put the viewer inside the scene, which is another way this resembles Eakins’ paintings, since the artist inserted himself into them. The entire effect is finished off with an unexpected score which, if I had to describe it, puts me in mind of the tinny electronica produced when my phone’s timer notification goes off. It sounds strange, but the entire combination conveys energy, an energy of which the viewer is a part. It’s far from the clumsy efforts to “modernize” historical drama one often sees, and somehow, when all elements are melded together, it works.

Critics were generally effusive, and if I have a complaint worth sharing about the show, it’s that it occasionally seems as if it’s trying to shoehorn every notable element of the period into the relatively small confines of the Knick’s wards. The sleazeball administrator brings in gangster elements and Tammany Hall corruption through his shady dealings. Robertson’s daughter (Juliet Rylance) offers the above-stairs fight for gilded cage feminine independence while Dr. Edwards’ parents provide the below-stairs dynamic as her cook and carriage driver. Thomas Edison and his wax cylinders and Mary Mallon (aka Typhoid Mary) and her filthy hands both make an appearance. One critic noted that it all adds up “to a crammed feeling of tremendously high ambition and not a little potential hubris.”5

If you take a look at the date on some of the references for this piece, you’ll notice that The Knick is seeing a lot of 2021 play for a 2015 show that no one saw. I suspect most didn’t see it because it aired on Cinemax, an experiment meant to break a channel known for… well, BEWBS (ie, soft-core pornography) into the prestige television game. That experiment failed. As Soderbergh put it, the show “got subsumed by the never-ending tsunami of new content that shows up on these platforms almost every day.”6 But The Knick has survived its first brush with obscurity; it’s now available for streaming on HBO Max, and interest in it has revived. The series was intended to run for six seasons rather than the two it originally got before its untimely death, and those seasons were meant to occur in varying time periods. The rumor is that HBO is slated to resurrect it, though Soderbergh is no longer at the helm. Instead, with Soderbergh’s blessing, André Holland and Barry Jenkins are developing material for a third season. Given that the real Knickerbocker survived as a working hospital well into the 1970s, the possibilities seem vast. If the plans for a new season come to fruition, I’ll certainly tune in.

REFERENCES

1. Adam Chitwood

“Why ‘The Knick’ Was Cancelled, According to Steven Soderbergh.” Collider, 20 March 2021. https://collider.com/whythe-knick-was-cancelled-steven-soderbergh-comments/

2. Alan Sepinwall

Alan Sepinwall. “Steven Soderbergh on the Gore, the Grind, and the Glory of Making ‘The Knick’.” Rolling Stone, 25 February 2021. https://www.rollingstone.com/tv/tv-features/steven-soderberghinterview-knick-hbo-max-1131019/

3. Emily Nussbaum

"I Changed My Mind About ‘The Knick’”. The New Yorker. 2 October 2014. https://www.newyorker.com/culture/culturalcomment/changed-mind-knick

4. Alan Sepinwall

Alan Sepinwall. “Steven Soderbergh on the Gore, the Grind, and the Glory of Making ‘The Knick’.” Rolling Stone, 25 February 2021. https://www.rollingstone.com/tv/tv-features/steven-soderberghinterview-knick-hbo-max-1131019/

5. Nick James

“Further Notes on The Knick.” British Film Institute, 29 January 2015. https://www2.bfi.org.uk/news-opinion/sight-soundmagazine/reviews-recommendations/further-notes-knick

6. Alan Sepinwall

Alan Sepinwall. “Steven Soderbergh on the Gore, the Grind, and the Glory of Making ‘The Knick’.” Rolling Stone, 25 February 2021. https://www.rollingstone.com/tv/tv-features/steven-soderberghinterview-knick-hbo-max-1131019/

WRITTEN BY BETHANY LATHAM

Bethany Latham is a professor, librarian, and HNR's Managing Editor. She is a regular contributor to NoveList and a regular reviewer for Booklist.