Season two of Cinemax's The Knick ends like the opening of a risky surgical operation: You can’t be sure of the outcome, yet.
This is a dark yet oddly inspiring show. Set in a Manhattan hospital just after the year 1900, the Knick depicts life and death, doctors and nurses, executives and philanthropists, corruption and idealism, racism, love and family, surgical innovation, contraception, venereal disease, plague, mental illness, addiction, research, surgery and pain. The scene is rich, for stories and camera. And ethics: In this season, eugenics enters the picture.
What I like best about the program is its depiction of doctors. With one exception, surgeons at the Knick are brilliant, driven, caring and flawed individuals. At a time when there are few limits to what physicians might try, these guys are creative. They examine their patients constantly, and improvise. Sometimes their inventions work. To its credit, and like a good medical journal, the program presents bad outcomes too, however gruesome.
Overall, I found season two of The Knick even better, and more realistic, than season one. It’s a refreshing take on being a physician, with insight into what makes some of the best physicians tick.
The season opens with the star surgeon, Dr. John Thackery (Clive Owen) as a patient in a hospital. In modern terms, he’s in rehab. The problem is, in those pre-methadone years, his doctors prescribe heroin to wean him off cocaine. To feed his habit, right there inside of the facility where he’s been institutionalized against his will, Thackery performs covert plastic surgery on women deformed by syphilis. A colleague, Dr. Everett Gallinger (Eric Johnson), rescues him.
Thackery’s drug withdrawal is tough to watch, drawn out and ineffective. He winds up back on cocaine, snorting a heated form of it to avoid telltale marks of injection. He drinks turpentine, alcohol and does whatever he can, including rough sex in alleyways, to quell his emotional and, later, physical pain. Throughout this season, Thackery looks frazzled and unkempt. It’s borderline-implausible that he regains the trust of his colleagues and the hospital’s leadership.
Now, you might be wondering how can such a self-destructive drug addict be a good physician or surgeon? Yet several recent chapters attest to Thackery’s continued skill (though this wavers; his hand is unsteady), persistent intellect, creativity and inclination to help others.
In one episode, Thackery encounters conjoined (“Siamese”) twins in a sideshow. Within seconds of passing this attractive pair, the surgeon wonders: could he help them? He asks their pimp to bring them by the hospital. He takes an x-ray to see how they’re joined, and finds they share a liver. And then he carries out a breathtaking operation. As shown, Thackery arranged for someone to film the surgery. It’s an early–and instructive–instance of a camera’s use in an operating room.
In a daring medical escapade, Thackery saves his lover from syphilis by injecting her with malaria to cause a high fever. She’s desperate, and seizing–a sign of neurologic disease from the sexually transmitted spirochete. The patient knows the procedure could kill her, but wants him to try.
Thackery, along with one of his collaborators in experimentation, Dr. Algernon Edwards (André Holland), heats the patient’s body to crazy-high temperatures, adding to the parasite’s effect by placing her in a heating chamber, and then gives her quinine to counter the malaria. The scheme works, amazingly. But she subsequently dies in a minor, cosmetic procedure Thackery performs at her request. She’d taken a large amount of pain-relieving drug before the surgery, about which he was unaware.
Late in the season, The Knick flashes back to a younger Thackery, in 1894. He’s walking with a donkey or mule to a Nicaraguan village afflicted by smallpox. Without proper supplies, he uses plants to create salves for the patients’ wounds. He explains to the villagers who've survived smallpox that they are immune, and enlists their help in caring for those with illness. He takes smallpox pustules from the sick and recovering patients, and grinds those into an impromptu vaccine which he administers to the villagers by inhalation. In that same Nicaraguan village, Thackery rescues a fellow North American, the future Knick’s benefactor who’s been tied up (literally) for having brought the disease by carrying blankets and other infected goods.
Each of these episodes reveal the doctor’s inventiveness. A hundred years ago, most leading U.S. physicians were surgeons; there were few medicines available. They improvised devices and compounded drugs. They racked their brains for solutions, and attempted first-ever treatments. Their work is admirable, and scary.
A reader, today, might consider those fictional doctors’ experiments, however reckless, in light of oncologist Vince DeVita’s new book, The Death of Cancer, in which that author considers the downside of stifling practitioners’ creativity. Necessary regulation and, perhaps, an over-emphasis on standard practice, or guidelines, can limit individual patients’ options and – for everyone – slow progress. So this is a relevant theme in The Knick, for medicine now.
Gallinger espouses eugenics. In a chilling scene, he works – as a surgeon – in a place where boys deemed mentally unfit were left under institutional guardianship. The year 1901 would have been early in the American eugenics movement. But it’s telling, as many educated people then believed that the rooting out of individuals considered inferior, by involuntary sterilization, was a good thing for society. And it’s relevant now, as doctors and patients consider tools of genetic testing and manipulation that enable selection of offspring based on “desirable” traits.
Some of the medical ethics issues would be considered straightforward in a modern medical facility, and by law. For instance, one of the doctors performs surgery on his mother. She’s suffering from esophageal cancer, said to be inoperable. Where things get blurry is when the doctor falls for a journalist who is present in the operating theater. Today, the patient’s privacy would be an issue.
The nun’s story, and her relationship with the Irish ambulance driver, captivated me. There’s love between them, tested, through all kinds of trials after her imprisonment for performing abortions in season one. Their relationship leads to a successful and fascinating business, of selling illegal condoms made from animal intestines.
Another current, newsy theme bears on immigration and xenophobia; people arrive by ship, in New York and San Francisco, carrying the plague. However, the character who comes closest to that hot topic, Mrs. Cornelia Robertson (Juliet Rylance), digs herself further into the realm of implausibility by her grave-digging pursuit of a graft-taking officer. Near the end, she reveals her foolishness by an assumption she makes about her father, and leaps to a fatal conclusion.
Finally, I’ll mention one of my favorite scenes, in which nurse Lucy Elkins (Eve Hewson) examines and swabs the cervix of a prostitute. Elkins, who’s been reading gynecology textbooks, looks into a microscope for signs of venereal infection. She tells the woman she’s clear, and then encourages her to peer in. The prostitute puts her eyes to the microscope and shrugs. The patient has no idea what she’s seeing, much like someone today might ask to see an x-ray or genetic test result, but not know what it means.
I've read that President Obama called The Knick his favorite TV program of 2015. As of this date, the show’s future is uncertain. Director Steven Soderbergh may have planned for it lasting just two seasons. If the producers go forward with additional seasons, there’s plenty of medical, ethical and human ground to explore.
I do hope they’ll find a way for Thackery to recover, and for nurse Elkins to get back to her studies and work. With his distracting lover on a boat to Australia, Edwards might focus on his new assignment: psychiatry, or somehow apply his talents in a new direction. We could learn about the radiation machine, and what’s happening to the vile CEO’s hands and blood.
At the end of the last episode, Dr. Bertie Chickering Jr. (Michael Angaro) runs from the operating room after the patient, Thackery, has lost his pulse. Chickering grabs a vial of adrenaline, a substance he’d been assigned to study, for research before being granted operating privileges, at another (“Jewish”) hospital in Manhattan. He loads a syringe and, quickly, injects the adrenaline through skin into Thackery’s near-death heart.
Soderbergh doesn’t show what happens next.
The beauty of this ending is the plausibility that Thackery might pop back to life, like Uma Thurman in Pulp Fiction. What makes a positive outcome conceivable is the laboratory research Chickering carried out on this compound (now known as epinephrine), his knowledge, the (dangerously) unregulated hospital environment in which he and his colleagues worked and his willingness to try.
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