Kudos to THE KNICK

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Warning: Spoilers Throughout

From its opening moments, Cinemax’s new series The Knick, about the advances in surgery and medicine at a (fictional version of) the Knickerbocker Hospital in New York in 1900, has been stunning, disturbing, and realistic. It has also consistently been honest about things like racism, graft, and medical ignorance. Now the show has become downright brave, and deserves kudos for its straightforward portrayal of many historical realities.

Discrimination

Discrimination was rampant (and still is, though often less blatant) in all arenas of society: whites against blacks, whites against immigrants, immigrants against blacks, men against women, rich against poor, educated against uneducated. The Knick reveals it all without flinching.

  • When Dr. Edwards (André Holland, below) is stitching up a young girl’s arm, the mother asks a white surgeon, “Does [the black Dr] have to touch her so much?”

does he have to touch her

  • The wealthy assume that diseases like typhoid, being spread at the time by hired cook “Typhoid” Mary Mallon in their own elite homes and vacation residences, only happened to “those other kind of people,” meaning the immigrants, the poor, blacks, and Jews, who were often forced to live in crowded, unsanitary environments because of their poverty.

cornelia

  • When Cornelia (Juliet Rylance, pictured above), whose wealthy father sponsors The Knick, and who herself is actively involved in virtually all aspects of it, reveals, with appropriate pride, that the “detective work” she and the Health Inspector have been doing to track down the typhoid outbreak among the rich has led them to capture the cook who was unknowingly spreading it, Cornelia’s equally wealthy fiancé casually but dismissively says, “My wife will always have the most entertaining stories to tell at Ladies’ Luncheons.” Cornelia’s acute disappointment is obvious to everyone but the men in the scene with her.

The Knick accurately portrays the discrimination that existed (exists?) at every level of society, against every group of individuals, among genders, and among classes, making discrimination an integral examination of the show’s exploration of medical advances, and not just as random, tangential political or social statements.

Violence

Violence is a fact of life, and not just in war-zones, poor neighborhoods, or in times of natural disaster. The Knick often integrates this violence into its sub-plots, and not just by having the doctors treat its victims.

When an Irish policeman mistakes a young, well-dressed black woman for a prostitute and solicits her for a position in a gangster’s whorehouse, the policeman, who is not in uniform, is attacked and stabbed by the lady’s justifiably outraged but “trigger-happy” boyfriend. A riot ensues when the whites then randomly attack any blacks in the streets.

After the Irish policeman dies in surgery, his immigrant family stirs up more violence against the blacks. The policemen, instead of protecting the innocent victims, actively participate in the violence, aiding the mob in attacking the hospital itself.

violence in the streetsThe doctors, including Chief of Surgery Dr. Thackeray (Clive Owen, above), nurses, ambulance drivers, and other members of the hospital staff defend the hospital, try to hide the black patients to protect them, and run into the streets to try to stop the beatings and killings.

trying to protect injured blacksSr. Harriet (Cara Seymour) heads for the church — or the convent — as a place of sanctuary, holding a crucifix in one hand and an injured black man by the other. Ambulance driver Cleary (Chris Sullivan), whose horses have been stolen, pulls the ambulance himself down the street to save the black patients who must be removed from The Knick for their own security.

The Knick is dead-on in its portrayal of random racial violence quickly becoming mob violence that cannot be controlled. The medical staff is forced to deal with its genesis and evolution, not just with its aftermath.

Death

in 1900, medicine was in its infancy. Surgery was probably still in the womb. Death was a fact of daily life, and not just from racist violence, or accidents.babies died

  • Babies died. Even the babies of wealthy people, and of trained doctors and surgeons. In one of the most tragic sub-plots, Dr. Gallinger (Eric Johnson) accidentally infects his own baby daughter with lethal meningitis after unknowingly brushing against the open wound of a hospitalized man bitten by rats (for sport, in a rat-stomping contest at a bar) by not washing his hands after he comes home from the hospital and picks up his baby daughter, Lillian.

photos of dead babies

After baby Lillian dies, a photo is taken of the parents holding her, “to remember her by,” which was a common practice.

Babies die. Even educated, wealthy, trained surgeons’ babies with the best care available.

  • Patients regularly died in hospitals. In the first episode, an Eastern European immigrant with TB doesn’t want to go to the hospital because someone else in her building went there when he was sick, and he never returned. The same thing is about to happen to her.

Cornelia (Juliet Rylance) breaks the bad news to the patient — through her daughter since the TB-infected woman cannot speak English — informing her that she will not get better or leave the hospital alive, but that they will do their best to make her comfortable.

The immigrant unemotionally and matter-of-factly then asks the time, and instructs her young (12-year-old?) daughter that she must leave the hospital immediately or she will be late for her shift at the factory.

People in the hospital die, and it’s a well-known fact, even to immigrants who cannot understand or speak a word of English.

  • Patients died more often in surgery than they survived. Thinking that placenta praevia — an obstetric abnormality in which the placenta displaces, preventing the baby from passing through the birth canal and sometimes rupturing the uterus during labor, causing the woman to hemorrhage, killing both mother and child — could be “fixed” by performing a caesarean section delivery faster than 100 seconds, Dr. Christiansen (Matt Frewer) committed suicide in episode 1 after his 12th failed attempt at the procedure, in which both mother and child perished.

patients dieLater in the series, Dr. Thackeray (Clive Owen) attempts to perform the caesarean even faster. Next, he is shown sitting abjectly in the surgical theater with bloodied hands and forearms, asking an equally despondent Dr. Chickering (Michael Angarano), who had assisted him, how long the mother & child had lasted before death (I believe the answer was 72 seconds).

People rarely survive major surgical procedures.

Gruesome and depressing as it may seem, The Knick honestly deals with early medicine’s inability to heal many patients, with the lack of surgical knowledge, and with the high incidence of mortality, despite medical intervention.

Sometimes, because of it.

Segregation

segregation was the normSegregation was the legally enforced norm. After Dr. Edwards (André Holland) sets up a black clinic, surgery, and infirmary in the basement of The Knick to treat the black patients who will not be admitted to the main hospital, he successfully operates on and otherwise treats many of them.

After the “black hospital wing” is accidentally discovered by Dr. Thackeray (Clive Owen), however, he orders it to immediately be shut down. The sick patients are seen forlornly trailing down the street, away from their only hope at medical treatment.

Because Dr. Edwards is black, he has no power to insist that the black patients be treated in the hospital proper, alongside the white patients — though virtually all are poor at The Knick. And he has no power to retain his “black clinic” in the basement.

Dr. Thackeray is not only his superior in the hospital, Thack is white, and in America in 1900, white trumped any other race every time in every arena, including the medical one. Racism and its accompanying legal segregation is an intimate theme in The Knick, and it is handled deftly.

Drug Abuse by Professionals

cocaine between toesOne of the scariest things in the show is the doctors and surgeons using cocaine and opium — both legal — and huge amounts of it, in order to stay awake and alert to do their surgeries. Dr. Thackeray keeps a regular supply at home and in his desk drawer: he injects it between his toes because his veins have collapsed. He offers it to Dr. Chickering when he can’t stay awake and keep up with Thack, as it was offered to Thack by his mentor, Dr. Christiansen, in episode 1.

I noted in an earlier post about The Knick that Dr. Thackeray had too much weight on him to be using as many drugs as was being portrayed, and that he was too functional. In fact, the only time he wasn’t functional, was the time he “quit his post, again,” because the “Negro doctor” had been hired, and Thackeray had gone the night without the cocaine.

professionals and drug useThough he’s still too highly functional, i.e., he’s made no medical or surgical mistakes due to his high drug consumption, the show did finally show him obviously “flying high” on cocaine, calling Dr. Chickering’s home in the middle of the night or extremely early in the morning, and asking him to come down to the hospital to help with some of his placenta praevia research (on two naked Thai prostitutes, who were not pregnant).

When questioned about how long he’d been working without a break, Thack replied, with a sly gin at the nude girls, “Two days, but we’ve had a few breaks.” The prostitutes giggled. Thackery’s rapid speech and quick, jerky movements, along with his lack of sleep for a sustained period, finally accurately portrayed what such high drug use would be doing to him. (And the previews of subsequent shows indicate that the hospital has “run out of cocaine” due to a war, giving hints that when Dr. Thackeray is withdrawing from the drug, he cannot perform as well.)

And he’s the Chief of Surgery at The Knick.

New Medical Equipment
as “Toys”

xrayAs many of the “new” medical advances were made, especially those in  equipment, their dangers were completely unknown. The Knick treats these as commonplace “toys,” with everyone wanting to try them out. Especially the X-ray machine.

When the Director Barrow (Jeremy Bobb) is negotiating for a used X-ray machine after Cornelia’s father Captain August Robertson (Grainger Hines) has agreed to purchase a new one for The Knick — because another, rival hospital has more than one — the salesman tells Barrow how his own children were playing with it all weekend, so it works just fine.

Barrow then asks if he can try it out himself. He is instructed to hold a photographic X-ray plate in front of his face, which he does, and the salesman turns on the machine — without leaving the room himself. Barrow is instructed to stay in front of the machine, which can be heard humming in the background, until the X-ray of his head is done.

Which will take an hour.

head xrayAfterward, a couple of excited, giggling nurses come into Barrow’s office and ask if they can have a turn with the X-ray machine. Barrow, who likes plenty of women other than his own wife, joyfully obliges them in playing with the newest “toy.”

The danger of the situation isn’t slammed into the viewers’ faces as if we’re stupid. In fact, it’s never even alluded to, in keeping with the knowledge available to the medical establishment at the time period in which the show takes place. The writers and actors all act like the wondrous new X-ray machine, as well as electricity (for surgical cauterization, which catches a patient on fire and electrocutes a nurse the first time it’s used in surgery) are the magical innovations they were considered to be.

They don’t know the dangers of radiation exposure.

We do.

That’s sophisticated writing, and the writers of The Knick — Jack Amiel and Michael Begler, the director — Steven Soderbergh, and all the actors deserve credit for pulling it off so subtly, while not letting it escape the viewers’ horrified notice. That’s dramatic irony at its finest.

Bi-Racial Intimacy

cornelia and edwardsI saw hints of it in early episodes, and was hoping The Knick would be brave enough to enter the territory that Cornelia (Juliet Rylance) and Dr. Algernon Edwards (André Holland), who were childhood playmates, friends, and confidants, have finally entered. Bi-racial intimacy.

Though Cornelia is engaged to the son of another wealthy family (whose father — Hobart Showalter [Gary Simpson]  said and did some creepy, weird stuff to Cornelia in one episode), her fiancé Phillip treats her almost as if she’s his property.

At their own engagement party, Phillip (Tom Lipinski) informs Dr. Edwards that Cornelia and Phillip will be moving to San Francisco — away from her belovèd Knick — after the two of them are married “because Cornelia’s father wants the future son-in-law watching his business interests out there.” It’s the first Cornelia has learned of it, but the only person who notices her dismay, and sympathizes with her about it, is Dr. Edwards.

Later, Edwards teases Cornelia about her new “love interest” — the overweight, crudely mannered Health Inspector (David Fierro) — and she playfully kicks at his foot. In the most recent episode, after Cornelia has saved Edwards from the mob violence  by wheeling him, hidden under a gurney, to the Negro Infirmary, which will take in the black patients, Cornelia and Algernon end up in the basement clinic of The Knick.

There, as they say, one thing leads to another and before the viewer realizes what’s happening (though I was rooting for it), the two were passionately kissing each other and getting intimate on the operating table.

Despite their obvious affection for each other, their shared sympathies, and this recent intimate physical encounter, I doubt that the families — Cornelia’s and her fiancé Phillip’s  — will allow her to break her engagement. Especially not to become openly involved in a love relationship with a “Negro,” even if, according to Cornelia’s father, Edwards is the “finest Negro surgeon” in New York.

Still, it was tremendously brave for the writers to take us to another dangerous reality of the time period: forbidden interracial relationships. And they’re dangerous even if one of the people in the relationship is immensely wealthy and the other is a skilled, highly educated, accomplished surgeon.

images-9The ubiquity of discrimination, violence, and death; legally enforced segregation, legal drug abuse by professionals (even surgeons), ignorance of the dangers of new medical technology, and the taboo of bi-racial relationships and intimacy. These themes and sub-plots are integrally interwoven with the major story of The Knick: the advancement of medical and surgical knowledge and procedures at the turn of the century.

The writers and director treat its viewers as if we are intelligent and sophisticated. The actors treat us that way, too. It makes The Knick more than interesting: it makes it fascinating and compelling.

Kudos to all involved. You are greatly appreciated.

(Airs Fridays at 10pm ET, with repeats throughout week)

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