by RON PAUL KLEIN
This current century has seen an exponential proliferation of medical-centric programming on American television – both cable and terrestrial.
There have been 49 medical series, either drama or an occasionally comedy, which have aired sometime during the 21st century (so far…).
To help gauge the rate of acceleration the first medical drama, City Hospital (1951 – 1953), was introduced to American terrestrial television audiences on CBS in the early 1950s.
In its original run, beginning in the fall of 1982, St. Elsewhere (1982 – 1988), the then-groundbreaking contemporary medical drama, set in a fictitious, structurally deteriorating, but underrated South End Boston teaching hospital, St. Eligius, was only the twentieth medical series to have been shown on American television.
The next medical juggernaut to dominate American TV was ER (1994 – 2009), if we excluded the fictitious quirky small-town Cicely, Alaska drama, Northern Exposure (1990 – 1995), with its protagonist Dr. Joel Fleishman (Rob Morrow), a recently transplanted New Yorker fresh out of medical school – the series was only tangentially involved with medical issues, focusing more on Fleishman’s big city ways, and his ‘fish out of water’ social interactions with the local eccentric town folk.
And also the exclusion of the sitcom, Frasier (1993 – 2004), which was a spinoff of another sitcom classic, Cheers (1982 – 1993). In the latter, the main character was psychiatrist Dr. Frasier Crane (Kelsey Grammer), who after eleven seasons finally left the tavern, Cheers, a local watering hole for many where “everybody knows your name”, and relocated to his hometown Seattle, where he became host of a mental health show at a radio talk show station. During his 22 years portraying a psychiatrist on television – a record for a primetime role – Crane never came close to setting foot in either a hospital or a doctor’s office.
And with this most recent proliferation of television medical series this century, yet another prognostication of 1960s and 1970s Canadian media guru Marshall McLuhan has come true. McLuhan postulated that the genre of medical drama is highly compatible with the medium of television. In his 1964 cutting-edge examination of media theory, Understanding Media: The Extension of Man, he postulates: “One of the most vivid examples of the tactile quality of the TV image occurs in medical experience…. Thus the TV image, in fostering a passion for depth involvement in every aspect of experience, creates an obsession with bodily welfare.”
Incidentally, at the time of the original publication of his study only seven medical dramas had ever aired on American television, and it was experiencing a bit of a proliferation of its own, with four of them then-currently airing, which included two daytime soap operas, The Doctors (1963 – 1982), and General Hospital (1963 – present). (It is not clear how many people working in network and cable television (including medical series) have ever read McLuhan.)
The first medical series to venture into comedy, and the fifteenth in total, on television was, Temperatures Rising which débuted on 12 September 1972. It only lasted for two seasons.
Still remaining the greatest example of a medical sitcom, M*A*S*H*, based on the 1968 novel and 1970 movie débuted five days later, lasting 256 episodes over 11 seasons. (Lasting almost four times longer that the actually Korea War, the period in which it was set in.) The first season’s viewer ratings were lackluster, and the series was in serious jeopardy of being cancelled after only one season. This Korean War-era comedy, frequently offered poignant reminders of the tragedies and sober and somber events caused by war.
Despite its various genres – daytime soap operas, comedy, drama, or a hybrid of the two, a dramedy, or the time of its airing in the afternoon or primetime evening slot, the current critical acclaimed medical series, The Knick has a unique twist that differentiates it from it estimated 88 predecessors, and the one medical drama series that débuted a mere five weeks after it (and has since been cancelled.) This uniqueness is that The Knick is a historical medical series – a period piece set at a turn-of-last-century New York City hospital. All previous medical shows presented then-state-of-art medical technology and hospital equipment. In this series the X-ray machine is just being introduced.
The Knick’s distinctiveness is derived mostly from the use of now-retrograde hospital equipment, and now-archaic, then-groundbreaking experimental medical procedures of the day. As a tagline in one of the show’s promotional poster proclaims: “Modern medicine had to start somewhere.”
Steven Soderbergh, acts as one of the show’s numerous executive producers, along with directing all ten of the first season’s episodes. He is also the director of photography, being credited under his regular alias, Peter Andrews.
Its namesake, the Knickerbocker is the real-life hospital that the series is inspired by, affectionately nicknamed ‘The Knick’, from where the series derives its title. The historical Knickerbocker Hospital was established in 1862 as the Manhattan Dispensary. It was re-named the J. Hood Wright Memorial Hospital in 1892. It was first named the Knickerbocker Hospital in 1913, the name it retained until they shuttered their doors in 1979. This historical inaccuracy, with the show’s creators taking some creative license with renaming the hospital prior to its actual name change does not diminish the show’s realistic portrayals and accurate depictions within the hospital, including the surgical procedures performed in the operating theater.
Dr. Stanley Burns, CEO of Burns Archives, which boasts of over one million photographs of early medical photography, including post-mortem, and other relevant historical photos, was hired as on-set medical advisor to ensure historical authenticity of the medical procedures of the era. The archives have published over 40 books in the last 40 years. Dr. Burns has also contributed to various television and film projects, by offering consulting and advisory services including using some of his still photos in their productions. Projects he has worked on include Ken Burns’ (no relations) documentary film series, The Civil War (1990), The Silence of the Lambs (1991), and The Gangs of New York (1992), among many others. He is also a regular contributor to History, the cable television channel. In mid-2014, Dr. Burns opened the Morbid Anatomy Museum in Brooklyn, which he described in a The New York Times article as displaying “the darker side of life.”
For his role as medical advisor for The Knick, Burns conducted highly involved tutorials for the cast, including extensive on-hands practice of the prevailing medical procedures of the day with the silicon limbs that he self-manufactured.
It gives little comfort that the surgical procedures of the era were performed without rubber gloves or surgical masks – not fully understanding yet, the detrimental consequences of spreading air-borne germs and disease had on the already high mortality rate. (And this mortality rate was excessively high). One can say, at least they washed their hands thoroughly before they performed an operation.
And the show’s lack of sanitization extends beyond the dubious hygienic conditions (by modern standards) of the hospital’s operating theater. The hospital’s ambulance driver, boorish and foul-mouthed Tom Cleary (Chris Sullivan) supplements his legitimate salary by relieving the ambulance’s occupants of their valuables, along with receiving a ‘commission’ from the hospital’s administrator Herman Barrow (Jeremy Bobb) for bringing in patients capable of paying the hospital fees. Barrow has mismanaged the hospital’s funds, and is severely in hock to ruthless loan shark Bunky Collier, which makes for an interesting side story.
In the series’ second episode, ‘Mr. Paris Shoes’, Drs. Galliger and Chickering, two doctors at the hospital, along with Cleary break into a library to examine some of Dr. Edwards’ French medical journals, The Knick’s newly appointed deputy chief of surgery. The purpose of this invasion, was trying to remove Edwards from the equation by not having to ask for his assistance, but needing to acquire knowledge of the medical procedure. While the doctors were diligently rifling through the journals in search for the one they were looking for, Cleary was more interesting at perusing the available daguerreotype photographs of medical oddities.
Cleary first gets his hands on a photo of a man with a grossly enlarged left foot, which Chickering explains is elephantiasis. Cleary remarks that a local football club “… could use him as a punter, wouldn’t even have to use a f**king cleat.” Next he shows Chickering another case of elephantiasis, this time a man with excessively enlarged testicles (in reality from Dr. Burns’ personal collection). He accompanies this photo with another snide and crude comment: “This guy’s nutsack is the size of a sailor’s duffle” and “I bit he can squirt.”
Portrayed by Cara Seymour, Sister Harriet, a Catholic nun and midwife, who manages the orphanage under the auspice of The Knick, surreptitiously performs abortions in her off-hours.
Sister Harriet, and especially Cleary portray, vital but, peripheral roles in this medical drama. And though the hospital is affiliated with the Catholic Church, there are few choir boys – proverbially speaking – in this series. It takes a candid, uncompromising look at the urban realities routinely experienced among the turn-of-last-century working class, particularly of the recently-arrived immigrants, and rural Southern migrants to the city.
The Knick, has a large ensemble cast, but the plot tends to center around the protagonist, Dr. John W. ‘Thack’ Thackery, (Clive Owen) the chief surgeon at the Knickerbocker Hospital, after his predecessor, Dr. J. M. Christiansen (Matt Frewer) committed suicide by a single self-inflected gunshot wound to the head after a fatal placenta previa operation, which he considered botched. His suicide occurred early in the pilot episode, so during the season he has appeared in Thackery’s visions. Thackery, although well-respected among his colleague and a skillful surgeon, often injects cocaine during his working hours, and is known to frequent a Chinatown opium den/brothel in his off-hours in the evening.
His deputy is a European-trained African-American physician, Dr. Algernon Edwards (Andre Holland) who operated a clandestine clinic after-hours in the hospital’s basement for the African-American patients who were denied admission to the hospital. He is shut-down by Thackery once he became aware of what is happening. Dr. Edwards is supremely talented, and more up-to-date on the development of pioneering medical techniques and procedures, than the other doctors, including Thackery.
Edwards was promoted to deputy chief surgeon, on the behest of Cornelia Robertson (Juliet Rylance), who is chief of the hospital’s social welfare department, and a representative of her father Captain August Robertson, a wealthy industrialist and a powerful member of the hospital’s Board of Directors. The Robertsons, have been long-time friends of the Edwards family, and a decades-long employer of the doctor’s parents. Captain Robertson, has underwritten Edwards’ medical education, and continues to be a staunch supporter of his professional advancement. In the pilot, Robertson, the hospital’s most generous benefactor, withholds funding to the hospital’s electrification project until Edwards de facto occupies this new position as deputy. Edwards is routinely disrespected by the hospital staff and most of its patients, due to the color of his skin.
Dr. Thackery opposes Dr. Edwards’ appointment to this post, on the grounds that hiring a Black would deter admittance to the financially struggling hospital. Not to mention, having already promised this position to Dr. Everett Gallinger (Eric Johnson). Gallinger is competent, yet not as talented a doctor as Edwards. He is resentful towards Dr. Edwards for this promotion, partially due to his attitudes about white entitlement.
The other pivot hospital personnel includes Lucy Elkins, a nurse who is a rural West Virginia native, portrayed by Eve Hewson, the youngest daughter of iconic U2 frontman and social activist, Bono (né Paul Hewson). In the show she has grown close to Drs. Thackery and Chickering.
Dr. Bertram ‘Bertie’ Chickering, Jr. (Micheal Angarno) idolizes Dr. Thackery, who he considers his mentor. Bertie’s father, a distinguished doctor in the city is displeased with his son’s near-worshipping of Dr. Thackery, and his choice of hospitals to work at, rather that selecting a more elite, privileged class of patients than The Knick customarily admits.
Also, to add some authentic ambience of the era, the ambulances were horse-drawn enclosed cart, with a manually operated siren, as were most of the vehicles operating on the city streets of turn-of-last-century NYC. Mechanized vehicles were exclusively owned and operated by members of the city’s elite.
In the pilot episode, ‘Method and Madness’ The Knick is fitted with electrical wiring, being one of the first of New York City’s hospitals modernized by this pioneering electrification project. With the installation of this technological advancement the medical staff was no longer required to manually operate the pumps to effectively run the equipment.
In the closing scene of the first season’s finale episode, ‘Crutchfield’ Dr. Thackery, has been admitted to a rehab clinic, and is seen visibly suffering from withdrawal symptoms from his drug dependencies, primarily cocaine addict. He is counseled by a doctor ensuring him that the medicine just administered to him is completely harmless. The camera then pans away to his night table, which show’s a vial that is clearly labeled “heroin”. The scene fades to black and a cliffhanger ensues until the opening scene of next season’s premiere.
It is difficult to imagine that the protagonist of previous medical dramas in the 1960s and 1970s, like Dr. Kildare, Dr. Ben Casey, or for that matter Dr. Welby would have ever got caught raiding the medicine cabinet in order to obtain their daily ‘fix’.
This supremely talented cast is clearly in the foreground, but ominously hovering in the background is the series’ haunting instrumental music occasionally played to significantly enhance the dramatic effect, and intensity of suspense. Cliff Martinez, composer of the series’ score, and regular collaborator with Soderbergh’s on ten previous theatrical projects; including Soderbergh’s, now-classic, début 1989 film, sex, lies and videotape. Incidentally, in April 2012, Martinez was inducted into the Rock and Roll Hall of Fame as a past drummer of the eclectic funk-punk band, The Red Hot Chili Peppers. Martinez jammed with the band during their induction ceremony after a 26-year hiatus with them.
The viewer ratings for the show have remained relatively static premièring at 350, 000 for the pilot and ending the series at 410, 000 – dipping as low as 320, 000 twice, and hitting its peak at 420, 000 for the two consecutive episodes after the pilot. According to Rotten Tomatoes, the review aggregate website, The Knick’s first season achieved a rating of 89% “certified fresh” with the general view that: “The Knick is sincere, emotional period television that takes a down-to-earth, no-holds-barred approach to vital topics.”
Its universal critical acclaim from its inaugural season is well-deserved, with its drama often riveting. With the character development of members of its ensemble cast, and the social interactions between them maturing, this series has much to offer. It is time for the viewing public to respond.
The Knick, will never be able to compete with General Hospital in the longevity department (nor was it ever their intent to), with 13, 234 episodes aired as of 30 January 2015. Or for that matter, The Doctors, which ran concurrently with its soap opera brethren until it threw in the towel at the very end of 1982 after airing 5280 episodes.
But with ten episodes now under their belt, and the series renewed for another ten-episode season by the premier cable channel, Cinemax, a subsidiary of HBO, and somewhat lackluster numbers in the ratings, momentously incommensurate to the quality of this landmark medical drama, one can only hope that both numbers will increase considerably.