The Knick is not an easy show to watch. The hospital drama centres on a group of brilliant  medics working in New York’s Knickerbocker Hospital in the early 1900s,  performing a series of sometimes gruesome and often fatal operations in a bid to progress  surgical techniques.

In preparation  for the second season (which in Hong Kong premieres on Cinemax on October 17)  the  actors are talking to the press in parent channel HBO’s offices in midtown Manhattan.   When they  describe the show, the words  “grim”, “bleak” and “exhausting” crop up time and time again. Everyone is in agreement that the writers,  Jack Amiel and  Michael Begler, and the director, the legendary  Steven Soderbergh,  excel in rendering difficult situations and introducing intractable problems.

“It wasn’t easy,” says British actor  Clive Owen, of  playing   chief surgeon   John Thackery, who is pioneering C-sections and skin grafts while battling  cocaine addiction; the character is partly based on real-life  surgeon  William Stewart Halsted.

“It wasn’t straightforward  but I loved the challenge of it,” says Owen.

“Loved the challenge” could also describe the experience of watching the show.  The Knick takes up so many television tropes that it can be hard, at first, to take seriously. It is a hospital drama, a period  drama, a troubled genius story and another example of what American writer  Brett Martin calls “the genre of difficult men”. The issues it deals with are so fundamental as to seem  obvious: racism, sexism, science versus religion  and the savage reality (or unreality) of the American dream.

 Then there’s the way the show deals with its themes.  The Knick can seem profoundly unsubtle. The dialogue  comes in quickly spoken exposition, the acting is often framed in close-ups, all bulging, bloodshot eyes and sweating brows, and the operations are full of oozing blood and theatrical gore (they are  performed in an auditorium, before a student audience, for the most part).

Yet the show is like a whirlpool; its riveting account of medical history, of a hospital treating the city’s poorest citizens and of a prodigious black doctor’s struggle to be recognised, keeps pulling you in.  

It is a modern televisual convention that a show’s second season  embodies a radical change: a new setting, new characters, a massive plot twist.  For The Knick,  it’s the  location that has shifted. The hospital is being moved uptown  and if physically this means only a handful of city blocks, in reality it is like moving to a different country: from the impoverished, polyglot immigrant part of the American experience to a richer, whiter, more establishment  neighbourhood.

Soderbergh’s camera work, always dynamic, now seems literally unhinged, jogging and swooping, peeking around corners and  chasing characters from behind like it’s  trying to keep up.

Fans of the well-lit and artfully filmed surgery scenes, however, will not be disappointed.  

 “Last year the surgeries were really intense but this year makes  them look like a romantic comedy,” says  Andre Holland, who plays Thackery’s foil,   Algernon Edwards, a Harvard-educated, European-trained black surgeon.  “When you get to episode 10, believe me, it’s going to blow your mind.”

The surgical procedures in The Knick are gory. Blood gushes and sprays, pus oozes, bones snap. But rather than being gratuitous, in many ways the  operations are the point of the show. The Knick, at its core, is  giving a historical  account of medical progress, and that progress is played out on the operating table. The thrilling realism  elevates  the work: you   are seeing how surgery was  performed in 1900.  

Ensuring  historical accuracy took an enormous amount of work, especially since Soderbergh insisted on doing the operations "for real”   (the bodies are fake, of course, but the techniques and equipment are genuine).   

“They’re tricky because it’s like performing a stunt,” says  Michael Angarano, who plays surgeon Bertie, “in the sense that so many things have to go right for the surgery scenes to be good.”

“You’re saying these words that you’ve never heard before and add to that you’re actually suturing,” says Holland. “You’re not fake suturing. You’re actually doing it with the real instruments, the real cat gut – the wire, which is like a live organism, it’s bouncing around like crazy – and they put the blood on top of that so everything is all slippery and there’s   100 background actors [in the auditorium] and you’re addressing them. Your back hurts and your feet hurt from being hunched over all day.”

The actors spent weeks conducting research   at the Burns Archive, in New York, which houses a vast collection of early medical photography. The archive’s   Dr Stanley Burns  put Owen and Holland through a two-week version of early  1900s medical school and was on set for the shooting of each surgery scene.  

Owen says he still hears the doctor’s mantra in his head, “More clamps! More blood!”

Although The Knick takes place more than a century ago, its subject matter remains relevant, and often forces the question: have we come as far as we think we have? Nowhere is this more evident than in the show’s handling of race.

The story of   Edwards, played with a taught smoulder by Holland – and based, at least partially, on the surgeon  Daniel Hale Williams – is one that manages to be both clichéd and woefully under-told: a person of colour and  great talent finds their potential  thwarted at every turn because of their race.

In  today’s America, hot-button issues, most of all race,  seem to be treated with kid gloves in the entertainment world. This can be seen, for example, in the relatively light-hearted sitcom treatment of recent television comedies Fresh off the Boat and Black-ish.   But  due in part to The Knick’s historical setting, the daily difficulties  of being black in America are not  subtly hinted at but  laid  bare through a series of shouted slurs.

In The Knick’s world, racism is a billy club wielded by a white man and aimed at a black man  – bringing to mind recent episodes of police brutality in the United States.  

 “I know it’s a period piece but I think it speaks to America today,” says Holland. “I grew up in Alabama in a very small town. Racism and bigotry are something  I’ve seen. I’ve seen the effects of them first-hand in my parents’ generation and also in my own life.

“In so many aspects of the show, race relations just being one of them, there are direct parallels to what’s going on today,” says Holland, refererring to a powerful episode from the first season, chillingly entitled "Get the Rope", in which a race riot erupts. “Last season we had a man on the street having a misunderstanding with a police officer  that turned into a riot on the streets of New York … cut to  six months ago.”

In season one, it took more than six hours of television before the drug-addled  Thackery  condescended to perform an operation with Edwards. And in season two there is still little  love lost between the pair;  Thackery’s views on race don’t seem to have evolved.   

“In the first season, race was one of the most provocative elements and some people were actually shocked,” recalls Owen. “I had people saying to me, ‘How could you say those lines?’ But it would have been a complete disservice if I was the one liberal guy that said, ‘Hey, you’re talented so come in.’ Life wasn’t like that. It wouldn’t be authentic.”

The show’s treatment of  Asian-Americans  is similarly brutal.  All of the Asian characters   are pimps, prostitutes  or opium addicts; Asian women almost always appear naked, even at the hospital. In one particularly odious scene Thackery uses his favourite prostitutes as guinea pigs to test a new vaginal insertion device he is developing. They lounge naked and dull-eyed in the lab, smiling while the doctors discuss, in a language the women show no sign of understanding,  what to put inside them. It comes as no surprise when the show’s one male Chinese character is revealed to be a martial arts expert.  

The show’s lead female character,  nurse Lucy Elkins, is played by  Eve Hewson, daughter of U2 frontman Bono.

 Elkins’  faith takes centre stage in the second season when  a reunion with her  ultra-religious father prompts a wavering of her own belief.   That loss of faith is   exacerbated by her growing understanding of science,     heartbreak and frustration with her place in   the world.

For Hewson,   landing the role as  Elkins was a career milestone.  As a rock star’s  daughter,   she is no stranger to celebrity but her appearance in The Knick marked the first time the spotlight  had fallen so brightly upon her.  Slated to appear in this year’s Steven Spielberg film Bridge of Spies,  as the daughter of Tom Hanks’ character, it seems her  star is only set to rise.  Her jokes that she’ll need to start “caring what she looks like before she leaves the house” and “washing her hair” don’t go far in masking her apprehension at the prospect.  

At 24, Hewson is just beginning to experience the sexism prevalent in “the industry”, and  is  the first to admit that her role as  Elkins may have set her expectations unreasonably high.

“The amount of scripts and auditions I’ve done where you’re just ‘the girl’  can get really tedious,” she says.  “That’s why I’m so lucky to be in this part. There’s a lot of integrity to the women’s roles in The Knick. They’re not just there to be fallen in love with.”

 The  show is populated with smart,  strong women, whose strength is only emphasised in the face of visceral sexism.   

“She’s really not like me at all,” Hewson says of  Elkins. “She’s very quiet and she’s an introvert. I’m definitely more of an extrovert so she wouldn’t be a character I would normally gravitate towards, but I ended up kind of falling in love with her.”

Elkins is presented as a cerebral presence, making her actions, no matter how extreme, seem reasoned.

“She is quiet and she does seem like this naive little precious thing,” says Hewson. “But she’s made the decision to come to New York. She’s made the decision to work in this hospital.”  

When the nurse begins an affair with Thackery and becomes an eager and erotic co-conspirator in his drug use, the potentially facile old story of naive nurse falls for brilliant doctor is skewed.

“She’s completely put herself into the relationship with Thackery; he’s not holding her down,”  says Hewson. “She’s sort of attracted to danger and she’s looking for this excitement.”

 In fact, it is Thackery’s vulnerability – when she discovers him in the whimpering depths of a drug withdrawal – not hers, that sparks the relationship.

Which brings us to the drugs. If questions of race and gender dominated season one, early signs point to this season’s main  theme being addiction.

 The first series ended ominously, with Thackery  being treated for cocaine addiction with a new miracle drug – heroin. As season two opens,  the surgeon is still a full-blown junkie. Over the course of the first episode we see him get clean and return to The Knickerbocker, where he announces he will now dedicate his medical training to,  as he puts it, “treating addiction like a disease”.

New to the behaviour patterns of an addict, Elkins is shocked to find Thackery’s affection for her  has not outlasted his drug dependency.    

Of portraying  Thackery, Owen says, “It was an exhausting character to play in lots of ways because he is so volatile and fuelled  by his drug intake.  It’s never just the scene going on, it’s how high is he? You have to be very focused, very on your game.”

In talking about the second season, Owen makes it clear that Thackery’s recovery will be fraught.  

“It would be wrong for him to come back a changed man,” he says. “Addiction is long, hard, difficult. I felt it was really important that we didn’t take that lightly … the things that fuel his brilliance in the medical world are the same things that make him take drugs and be a crazy man.”

And so it would seem that, as with the last series, season two of The Knick will again confront us  with a host of intractable problems and a cadre of characters whose better natures seem doomed by their circumstances.

More Clamps! More Blood!

The premiere of season two of The Knick will be repeated on Sunday at 11.55pm on Cinemax, with a new episode aired every Saturday at 10pm


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