Medicine has come a long way. Few of us realize this and we rarely think about the struggles it must have taken to get to this current point as we pop a pill for our headache or when we get (or in some cases do not get) our vaccination shots.
When it comes to surgery, the steps and strides have been even greater and filled with more risks and experimentation. We often forget or disregard the downside of experiments. We are often too focused on the end result that we do not acknowledge all the dangers and sacrifices it took to get there. Put differently, how many patients had to – and as awful as this may sound needed to - die under the scalpel to perfect that particular type of surgery.
All these thoughts have been kindled within my skull because of the wonderful turn-of-period series The Knick (2014) directed by Steven Soderbergh. Soderbergh himself is not averse to experimentation. He started off as an indie-wonder with his impressive Sex, Lies, and Videotape (1989) debut; he has made some failures both commercially and critically, Kafka (1991), Full Frontal (2002) come to mind, and some great movies, notably Traffic (2000), the experimental but outstanding The Limey (1999) and the panned but inventive biopic Che (2008), and not to forget the wildly entertaining Ocean trilogy (not to mention Magic Mike (2012)).
In his impressive repertoire, there are also a couple of movies connected to the world of medicine, such as Contagion (2011) about a deadly virus that spreads like wild fire and his what seems to be last (but hopefully he will reconsider) endeavor as a film director, the medically titled movie Side Effects (2013). But it is not only the movies that deal with medicine and experimentation: his style is also considered by many to be cerebral and clinical. So there you have it, no one better to direct a series on the gradual progress of medicine than Steven Soderbergh.
This versatile director might have gotten tired of making movies on the big screen, but looks quite comfortable and at ease with the medium of television. From the familiar cold, unsentimental and beautiful shots often hued with tones of brown and blue to the innovative and anachronistic electronic score of regular composer Cliff Martinez, this is Soderbergh at the top of his game.
The series is about the growing pains of medical science and American society set at the turn of the century in a New York hospital called the Knickerboxer. The series is based on true events and real people, but creative liberties have been taken here and there. Those are, for the most part, for dramatic effect, namely to enhance tensions, and we, for the most part, do not blame the series for this dramatic license since it makes the whole experience all the more exciting.
At the center of the series, at least in the first season, is the brilliant surgeon (and hopeless cocaine addict) Dr. Thackery played proficiently by Clive Owen and the African-American surgeon Dr. Algernon Edwards (André Holland) who is educated in Europe and in many ways an equal to his Caucasian counterpart. The issue of race is a major stumbling block between them, which is to a large degree an evident racist attitude of our protagonist Thackery, but which is also visibly propelled and encouraged by a racist society.
One thing that becomes quite clear in this series is that the United States may have been innovative in science and medicine, but that it was lagging behind Europe in terms of acceptance and tolerance of colored people. Edwards was treated as an equal in Europe, but has to fight tooth and nail for a little bit of acceptance in an openly and unabashedly racist New York (considered one of the more “open-minded” cities of the times).
Ironically, the Knick was meant to help and treat low-income people who are to a large degree immigrants, but there seems to be a clear line demarcating everyone else from the native black population. Although the black people are a part of this New York society and most of whom are suffering from poverty since they have not been given the opportunity to strive, be it in terms of education and income, they are treated as sub-human beings and are not allowed to enter the premises. In other words, the Knick is an institution for the underprivileged and downtrodden minus the black people.
This fact, evidently affects our black surgeon, so he decides to treat them by secretly setting up a practice in the dark cellars of the hospital. He trains his staff and teaches, for example, the janitor enough skills to act as a nurse by night. All of this comes from a compassionate and humanitarian heart, but it is at the same time fueled by personal ambition as he wishes not only to practice medicine, which the white staff does not let him do, but also to undertake his own little experiments to advance and improve upon the medical sciences.
That like any birth and growth, this comes with its own amount of pain and suffering is undeniable. In a proud - but by today's standard notably ironical - speech it is proclaimed that life expectancy has reached the age of 47 from previously the mid-thirties. But it is those baby steps that have given us the high ground today that we can build upon through the use of technology while projecting greater strides and achievements into the future.
The surgeries depicted in the series are messy and bloody and what we would consider barbaric. They lacked suction tubes, so the blood was cleaned and pumped out manually (a strain on the assistant surgeon's arm) and they also lacked knowledge of the best and most effective cutting procedures. At the same time, lack of medical knowledge regarding blood types, for example, had led to a number of deaths whenever blood transfusions had taken place.
All of these deaths and the evident helplessness on the side of the surgeons coupled with the continued seemingly interminable quest to find the missing block or obstacle must have been a strain on their well-being and psychology. In fact, the series starts with the suicide of one of those eminent surgeons who cannot bear the repeated failure of his medical strategy regarding cases of placenta previa that have led to deaths of mothers and their babies. His promising student, Thackery, must now shoulder the burden and he deals with his own demons by injecting cocaine between his toes at work and by smoking opium at night in a Chinese brothel.
Algernon Edwards, who apart from his medical stress has to deal with constant and daily racism, has found another way to release his pain and frustration at work; he gets into random and pointless brawls to vent off all this negative energy, which may be, all things considered, a slightly better but more painful vice than abusing drugs.
I have always considered the job of surgeons to be a stressful choice. In many cases, it may pay well, but the amount of responsibility attached to it outweighs in my mind any potential financial benefits. Even a simple and straightforward surgery can go horribly wrong and become fatal. Nor do we know everything regarding procedures, consequences, and side effects. It is a common fallacy that one assumes that the knowledge one has at any given time is mostly correct, if not infallible, but then new findings arise and turn the previous knowledge on its head.
A minor such example may be the recurring belief that coffee is bad for your health, only to find out its many benefits according to recent research. But more importantly, there are the issues of anesthesia, for instance, where constant revisions and adjustments are necessary due to its effects on the body, especially the brain. In the series, they use cocaine to anesthetize since at the time it was not officially outlawed. Morphine often used as a painkiller is highly addictive and at times can create more problems than good.
The series gives us running gags of dramatic irony where we the modern viewer know more (thanks to the clear focus of hindsight) than the protagonists. For example, when they experiment with an X-ray machine, the characters are amazed that one can see beyond the flesh and take pictures of the bone structure. In one scene, the doctor wants to try it out for a “head-shot.” The operator turns on the X-ray machine and tells him to stand still - for an hour!
There are also parts that may shock and bewilder us, again easy to say in perfect hindsight. That same operator of the X-ray claims that he and his children have been toying around with this machine taking a number of pictures. Oh the horror, by today's standard knowledge of the carcinogenic nature of X-rays.
The very last shot of the series finale for Season 1 is also priceless. As the surgeon is admitted for his cocaine dependency, they are using a new experimental medication certified by the well-known and respectable pharmaceutical company Bayer. We see the patient falling asleep in the background and the close-up gives us the ironical shot (sorry, you need to watch it since I won't spoil this one but perhaps you can already guess what that medication contains).
The series also slightly but aggressively alludes to the field of psychiatry. It is still in its infancy and the series portrays a very negative picture of it or perhaps it was isolating that specific ward from general practice. But since there were still unconfirmed and wildly speculative theories abounding in that field of study (i.e. phrenology), the treatment that the wife of one of the most reprehensible characters in the series gets is shocking and harrowing. The psychologist believes that the germ of madness resides in the teeth and has hence extracted them all!
The Knick takes its time to give us characterizations and a portrait of the era. One can argue that it could have dug deeper into the psyche of its main characters, but without getting confused or bored, we are given the essential and vital information of each character as well as vivid and broad strokes of the city. The Knick's strongest moment must be in Episode 7 provocatively titled “Get the Rope” where a race riot is breathtakingly choreographed and rendered with chilling scenes that it might equal, in terms of film-making and suspense, the impressive edge-on-the-seat raid in True Detective (Season 1 of course)!
Yet there are also a few weaknesses. The surgery scenes were good but they became repetitive after a while, especially with the recurrent graphic images. But more importantly, it portrayed that all those relevant medical inventions can be traced back to Americans. For instance, X-rays are shown as if they had just been invented in the States and that is misleading since Wilhelm Röntgen should get a mention, if not some credit.
The reason for this might be to make up for the barbaric aspects of the American society when it comes to not only class divisions but also cruel and unbridled racism towards its African population (and I have not even touched upon its anti-Catholic aspects). Yet I believe it would have been better to scale down the embellished and exaggerated achievements of the American doctors to a more realistic level since the series could be possibly misconstrued and distorted as an American propaganda piece for medical sciences instead of a historical account of its veritable successes and advances.
Moreover, both main characters are based on real people, but they are at times treated as if they were supermen. They are not invincible and they are flawed in their own ways, but they surely are brave and have given a lot to the medical community. Their unwavering dedication and thirst for knowledge and experimentation have saved lives both in the past and the future.
For instance, it was a surgeon who saved my life decades ago after a burst appendix (which would have definitely killed me in the 1900s and may be life-threatening even today) and an experienced gynecologist who saved my son's life during a complicated and difficult pregnancy. And for all this and more, doctors and all the others who have made contributions, and who, of course, continue to contribute to the medical field I would like to give my heartfelt acknowledgement, appreciation and thanks!