Blood, Sweat, and Tears

Steven Soderbergh, The Knick, 2014, still from a TV show on Cinemax.

IN THE FIVE YEARS PRIOR TO 1900, average life expectancy in the US increased from thirty-nine to forty-seven years; cities were gradually wired for electricity, which replaced gas illumination; the x-ray was invented and also the motion-picture projector. This transformative moment in all the sciences is the setting for The Knick, a ten-part hospital series currently on Cinemax.

What makes The Knick (short for a fictionalized version of New York’s Knickerbocker Hospital) the latest instance of auteur TV is that it is directed, photographed, and edited in its entirety by Steven Soderbergh, a continuation of the hands-on practice that has distinguished his movie career. Not to labor the obvious, the director is as much a workaholic and control freak as is The Knick’s central character, the hospital’s audacious, driven, ruthlessly competitive chief surgeon, Dr. John Thackery (Clive Owen). Soderbergh is a chilly director—that’s a description, not a criticism—but his empathy with Thackery, whose mind is on fire even as the rest of him is a mess, turns The Knick into a hot show, or at least a constantly simmering one that boils over at least once or twice in every episode.

The writers, Jack Amiel and Michael Begler, handed Soderbergh a B-picture melodrama with familiar network TV tropes—Grey’s Anatomy, House, and ER crossed with bits from every show David Milch created. The dialogue is mostly wooden, but there are snatches of insight and wit, as when the liberal head of the hospital’s board, August Robinson, gives a lesson to its louche, bumbling financial manager Herman Barrow (Jeremy Bobb). In the nineteenth century, Robinson explains, men amassed wealth through material resources, but in the twentieth, people will get rich by controlling the immaterial, including the aforementioned electricity and X-ray technology, which he has generously provided to The Knick. Strings attached.

Thackery’s foil—first an adversary, later an uneasy ally—is a “negro” surgeon, Dr. Algernon Edwards (André Holland), son of the Robinson family’s housekeeper and childhood playmate of Cornelia Robinson (Juliet Rylance), who has assumed most of her father’s duties on the board. Edwards is as impeccably groomed and controlled in his demeanor as Thackery is disheveled, sweaty, and, by the way, drug-addicted—cocaine by day and opium by night. Thackery’s character is based on an actual surgeon, William Halsted, as famous for his cocaine and morphine habits as for the radical surgeries he performed. Having presided over the first season coked to the max, perhaps Thackery will spend the second (Soderbergh has already committed to another ten episodes for 2015) nodding out.

A graduate of Harvard Medical School who trained in Paris and London, where surgical procedures were in advance of those in the U.S., Edwards has a lot to offer the Knick, but Thackery, reflexively racist, resents being told who to hire and also doesn’t want to deal with losing patients and staff because the Robinsons want to create an integrated hospital. Edwards, however, not only digs in his heels, he creates a secret clinic and surgery in the basement where he treats the black patients the Knick turns away. It’s next to the room where they store cadavers and the pen where they keep the pigs that the surgeons practice on, when there’s no money to buy human remains. The Knick is an upstairs/downstairs series as well as an uptown/downtown one. Regardless of the hospital’s mission to treat immigrant poor of the Lower East Side, the board wants the Knick to move uptown, where “Mount Sinai Jew Hospital” is, so it can serve a more moneyed class of patients.

Steven Soderbergh, The Knick, 2014, still from a TV show on Cinemax.

The Knick doesn’t trade in nostalgia. The New York of 1900 was filthy, corrupt, and lawless; almost anyone could be bought, and money ruled. Racism, sexism, and classism were undisguised, and the gap between rich and poor was taken for granted. In a particularly telling, beautifully underplayed moment, Cornelia is at the bedside of an Eastern European woman, perhaps in her late twenties, who is dying of tuberculosis. Hearing the woman implore her twelve-year-old daughter to leave so she won’t be late for work, Cornelia arranges for her carriage to drive the girl to the sweatshop.

While Thackery and Edwards are the central characters, Cornelia and two other female characters grow in importance throughout the season, their presence having less to do with the scripts than the exceptionally strong and subtle actresses Soderbergh chose for the roles and his propensity for focusing his camera on characters when they are not speaking. (As usual, it’s the men who do most of the talking.) The great Cara Seymour plays Sister Harriet, a dark-humored, chain-smoking nun. The hospital’s resident midwife, she’s seen too many women suffer and die giving birth or from botched attempts at abortion to turn her back on desperation, even at the cost of her immortal soul. Newly come from Kentucky to the big city, the capable though inexperienced nurse Lucy Elkins (Eve Hewson, who recalls the young Andie MacDowell of sex, lies, and videotape [1989]) gradually becomes our eyes and something of the series’ moral compass. Since this is a hospital show, she and Cornelia will do their part in fulfilling the genre by being drawn into unsuitable, torrid affairs. Bodices removed from glowingly lit breasts balance operating room butchery. The Knick is nothing if not a show about the body, and Soderbergh seems to have been liberated to make both the most sensuous and erotic and also the most nauseatingly visceral images of his career.

Television has always been more an aural than a visual medium. But as movie directors have turned to making series TV, the priorities have occasionally been reversed. Jane Campion’s Top of the Lake (2013) was thrilling for its images of primeval New Zealand. Cary Fukunaga’s True Detective (2014) and some episodes of Breaking Bad (depending on who was directing) were great rural landscape movies. There are gorgeous images in The Knick, but more exciting, they are composed and edited to keep the mind as well as the senses alive. Shot on multiple locations in New York, the period detail is not simply decorative but speaks to basic issues of power, money, science, the body and its mortality. Soderbergh shot almost the entire series hand-holding the RED Dragon, currently the most low-light-sensitive high-end digital movie camera. (The military has cameras that can see in so-called total darkness.) The handheld camerawork is almost never obvious, but it keeps the image alive and contingent; darkness and shadows are everywhere—even in the bleached-out winter exteriors, the notable exception being on the stage of the operating theater where the whiteness is blinding until the blood pours.

Most TV dramas, even those that are photographed in so-called film style, light the actors’ faces so intensely that they seem to exist in a separate dimension from the background. Soderbergh favors natural light for exteriors and a minimum of practical lights for interiors, which allows him to play with focus as well as shadowing for expressive purposes. But what makes Soderbergh a great filmmaker (albeit one who seldom has had scripts commensurate with his talent, The Knick not excepted) is his juxtaposing of image and sound (words, effects, and music). There is a sequence late in the series where Thackery, in the throes of cocaine withdrawal, is forced to sit through a hospital board meeting. The camera holds tight on his face, as sweat drips from his forehead and the muscles around his eyes and mouth twitch and contort. Throughout the shot, we hear the voices of the board members but the sound—if one can say this about sound—is out of focus, the words hardly intelligible. It’s a common enough device (sweaty face, distorted sound), used to indicate that someone is about to pass out, but it’s the length of time that Soderbergh holds the shot—minutes rather than seconds—that causes us to experience it kinetically, as a sensory experience in our own body.

Or take the sensational ten-minute opening of the first episode: sex, drugs, and The Knick’s equivalent of rock ’n’ roll—graphically depicted high-risk surgery. In the red-gold haze of an opium den, a young Asian woman, naked except for a thin robe that floats behind her, gives a wakeup call to a client named Johnny. The client, Dr. John Thackery, now dressed for work, climbs into a carriage for hire, where he prepares for the morning by shooting up with liquid opium, readily available from the hospital dispensary. As the carriage drives through the muck-covered streets and Thackery readies his morning pick-me-up, we are introduced to The Knick’s signature musical score—repetitively looped, throbbing, skidding, minimalist electronica by Soderbergh’s frequent collaborator, Cliff Martinez. Here, the quickening pulse and screeching upward glissando is precisely synced to the seconds before the needle finds the vein, evoking the anticipation of the orgasmic rush of the drug itself. As a cocaine-saturated movie experience, The Knick has the edge on Goodfellas (1990).

The longest scene in this ten-minute introduction is a surgery so bloody that even this hardened viewer turned away the first time she saw it. Never mind, you can do what you want without embarrassment in your living room, and if you rewatch the episode, you probably won’t be as nauseated. A woman is being given a Caesarean section. From the first incision, made with the equivalent of a box cutter, it’s clear that her uterus has ruptured and she’s going to bleed out. Nevertheless, the surgeons and nurses give it their all, turning the handle of the primitive siphoning apparatus (it’s the only sound we hear), filling bottle after bottle with gushing blood, trying to get the baby out and the artery sewed shut. But to no avail. Soderbergh moves his camera in, its lens as close as the surgeons’ eyes and hands. The gory spectacle is not gratuitous; this is where the series lives and its reason for being—to depict the dark ages of medicine and what it took to bring it into modern times.

The remainder of the first episode is overly cluttered with the introduction of characters and setups for various plot strands. And the second episode suffers in the same way. Don’t give up. By the time you are midway through Episode 3, I suspect you’ll be addicted.

The Knick plays Fridays at 10 PM on Cinemax with repeats during the week. Episode One is currently available for free on YouTube.