[SPOILERS for The Knick ahead.]

“All I know is I’m not getting what I deserve,” says Lucy Elkins (Eve Hewson) on a recent episode of The Knick, which airs the seventh episode of its second season on Cinemax tonight. Elkins, a nurse at “the Knick,” is referring to her relationships with the various men in the series. Dr. John Thackery (Clive Owen), the troubled protagonist of the series, recently spurned her after a torrid, cocaine-fuelled love affair in the first season while her father (Stephen Spinella), a fiery preacher from Texas, beat her up and hightailed it down south after she confessed her various sins to him.

This disappointment in men is registered in a speech that signals Nurse Elkins’s transition from victim of circumstance to a quasi-suffragette of the early 20th century, but the speech might as well be registering disappointment in the fate of the series, which isn’t looking particularly good at this juncture. After two critically acclaimed seasons with barely any viewers, it seems unlikely that it’ll get a third. “It doesn’t make any sense,” says Nurse Elkins “and I’m sick of it.”

An Auspicious Debut

Eve Hewson in The Knick Why You Should Be Watching The Knick

Perhaps the first harbinger of bad news for the series was the fact that the it wasn’t produced by a known quality-driven cable network, but instead by Cinemax, HBO’s less prestigious sister channel. Nevertheless, the series had a lot going for it. Steven Soderbergh is a major filmmaker and while Clive Owen might not have the same box office pull that he did in the mid-2000s, he is still a bona fide movie star. Despite a bevy of good reviews, however, the series failed to stand out from the pack, perhaps because of Soderbergh’s less-than-audience-friendly style of direction (which we’ll get into later).

Like many recent prestige cable shows, The Knick is a period piece, revolving around the staff and management of the Knickerbocker Hospital in Upper Manhattan, circa 1900. Narratively and thematically, the series follows the same formula as Mad Men, Boardwalk Empire, or even Masters of Sex. Dr. John Thackery (“Thack” for short) is at the center of the series, veritably giving birth to modern surgical practices despite a hankering for cocaine, opium and prostitutes. As Emma Nussbaum accurately stated in her initial, negative review of the series (though she later changed her mind): it’s “a Great Man tale, studded with lurid thrills.” In other words, Thackery is, perhaps, a bit too similar to the white, male antiheroes that preceded him, whether Don Draper or Nucky Thompson, who each came with their own demons and flaws but also an aura of greatness.

As with those other series, The Knick uses its setting to contextualize issues of race, class, and gender. Dr. Algernon Edwards (André Holland) is a black surgeon, begrudgingly given a position at the segregated hospital on account of his friendship with the Robertsons, a wealthy, progressive family that sits on the board of the hospital and provides it with funds. Cornelia Robertson (Juliet Rylance), who chairs the hospital board, is a strong-willed woman committed to the Knick, who spends much of her time in the first season helping to track down the origin of a typhoid breakout among New York’s bourgeoisie (which ends up being the actual Typhoid Mary).

Just as Boardwalk Empire used the character of Chalky White to explore the lives of black Americans during Jim Crow and Mad Men used Peggy Olson to explore the life of a career woman during the era of second wave feminism, The Knick uses these characters and their specific circumstances to contextualize racism, sexism and classism as accepted mores that permeate every facet of society in the early 20th century. But unlike those other series, The Knick leaves no room for nostalgic wish-fulfillment.

No Room For Nostalgia

Clive Owen as John Thackery The Knick Seaso 2 Episode 1 Why You Should Be Watching The Knick

The New York of 1900 that Soderbergh presents is a cold, dark, unrelenting place, not the kind of era one would pine for. In a series like Boardwalk Empire – which, honestly, is a bit of a bore despite its gangster movie trappings – one can easily look past the exploration of that era’s attitude toward gender and race simply to appreciate the series’ beautiful recreation of the glitzy Atlantic City boardwalk. The nostalgic appeal of Mad Men is so prevalent that it’s inspired a cottage industry of vintage “gentlemen’s” products, which celebrate the fedoras and the tailored suits of the 1960s, “minus the debauchery of it all.”

Watching The Knick, viewers should feel no desire to return to an age of pre-modern medicine. Soderbergh’s directorial style doesn’t leave a lot of room for careful compositions or golden-hued recreations of the past (although the production and costume design is exquisitely detailed). Instead, The Knick is a chance for Soderbergh, one of the first major filmmakers to really embrace digital technology, to bring the same stylistic techniques to a period piece that he brought to films like Contagion and Magic Mike: muted colors, shallow depth-of-field, and use of natural or on-screen sources of light.

Along with the first season of True Detective (directed by Cary Fukunaga), The Knick was touted as an example of director-driven television, in contrast to most prestige series, which are run by their creators and head writers (Breaking Bad and Vince Gilligan, Mad Men and Matthew Weiner, etc.). But that explanation downplays just how strange of a beast Soderbergh is, and how that’s affected the particular style of The Knick.

In an interview about his film Side Effects, from 2013, Soderbergh (who also acts as director of photography and editor on the series, under pseudonyms) stated that he’s “constantly trying to figure to not have to take a light off of the truck… which I like because I want the world to look the way it looks. I don’t have a desire to have the light be where I want it to be—I want the light to be where it is (emphasis by interviewer). This sentiment might give any fledgling film student an aneurysm, but the mentality gives Soderbergh the chance to do some virtuosic things with the camera – such as the ability to shoot long, handheld 360 degree takes of the hospital’s period perfect infirmary room without having a film crew’s duffel bags, apple boxes, or light stands get in the way of the shot.

A Visual Nightmare

the knick bloody Why You Should Be Watching The Knick

On the other hand, this distinctive style gives the series a nightmarish quality, often enhanced by the excessive shadows created by lack of key lighting. The Chinatown brothel that Thackery often visits in season 1, for example, is cast in a harsh red glow, accentuated by Cliff Martinez’s pulsating, synthesized score. Outdoor scenes, meanwhile, are cold and blue because of the natural light. There is very little warmth in the world of The Knick, which makes sense, given that New York winters would have been very cold for residents in 1900.

Granted, series creators (and writers) Jack Amiel and Michael Begler probably try a little too hard to make The Knick a dark and gritty evocation of the period. Beyond Thack’s frequent trips to the brothel, there’s Herman Barrow (Jeremy Bobb), the hospital manager who spends a great deal of time in the company of loan sharks in an attempt to keep the cash-strapped institution afloat. Meanwhile, Sister Harriet (Cara Seymour), a nun in the infirmary, provides clandestine abortions to women in need with the help of Tom Cleary (Chris Sullivan), an Irish bruiser who drives an ambulance for the hospital. And then there’s the cocaine-fuelled love affair I mentioned previously.

But the real horror resides in the harrowing scenes of early modern surgery. The series begins with, probably, the most visceral surgical scene ever filmed, as Thackery and his mentor (Matt Frewer) attempt to perform a caesarean section on a woman with a complicated pregnancy. In an operating room full of spectators, the surgery is meant to showcase a new surgical method, but we watch the procedure go to hell in more-or-less real time, with the surgeons scrambling to patch up her bleeding belly while rookie surgeon Bertrand Chickering, Jr. (Michael Anganaro) hand-cranks a pump to get rid of the excessive blood. In a particularly haunting detail, the doctors don’t even wear sterilized gloves, but perform the operation with their exposed skin.

The Horrors of Early Surgery

The cast of The Knick in The Knick season 1 Episode 1 Why You Should Be Watching The Knick

The second season has, if anything, upped the ante on surgical verisimilitude. Thackeray (who was sent against his will to a rehabilitation clinic at the end of the first season) is first seen giving a young socialite an under-the-table nose job, despite the fact that he can barely stand. In a more recent episode, after Thack cleans up his act and returns to the Knickerbocker (read: he stopped injecting cocaine and started snorting it), he performs a lobotomy on a patient in an attempt to cure his morphine addiction. It doesn’t work, and he turns the patient into a vegetable, but the brain surgery itself feels incredibly, grotesquely real.

Soderbergh never shies from showing the blood or body parts in a way that dwarfs the gore of the gangland violence in Boardwalk, or even the excessive brutality of something like Game of Thrones. As makeup designer Justin Raleigh puts it in a featurette on the series, Soderbergh “really wanted to make something that was just as graphic and as visceral as possible.”

Currently, The Knick is averaging a little over 200,000 viewers per episode, suggesting that most people probably aren’t interested in being horrified by early 20th century surgery. In comparison, Boardwalk Empire had over 2.5 million viewers in its second season. Nevertheless, The Knick will probably be remembered as a grand experiment in the history of television – and if you want to be a part of it, you’ve still got four whole weeks to jump on the bandwagon.

The Knick returns tonight at 10pm.

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