Television is full of medical dramas. “ER” and “House” recently dominated the airwaves, but it was also true as far back as “Ben Casey” and “Marcus Welby, M.D.”
“The Knick” takes medical drama back a century, to the fictional Knickerbocker Hospital in 1900 New York. Dr. John W. Thackery (Clive Owen) is on the forefront of surgery after his mentor Dr. Christenson (Matt Frewer)’s suicide. He is also on cocaine. We spoke writer/producers Jack Amiel and Michael Begler before they presented “The Knick” to the Television Critics Association. “The Knick” premieres tonight at 10pm on Cinemax.
CraveOnline: I always love the inherent drama of medical situations. Is medical drama even juicier before there was even the technology we had on “ER?”
Jack Amiel: I would say, yeah. You look at modern shows, even shows from the last 50 years and they’re always saying, “Well, get him some antibiotics” or “Let’s get a CAT Scan” or “Let’s get a PET Scan” and they have a massive book of all the diseases and what to do, hundreds and thousands of surgeries. What you get is increasingly stranger and stranger situations, medical mysteries because everything else has been done.
The amazing thing is that we have an open playing field because they just invented the appendectomy. So what we’re getting is the invention of all the medicine we think we’re so smart because we know.These guys were just as smart as we were. These guys were brilliant and hard working and gutsy. They put people under the knife knowing that they were going to kill them and having to deal with that reality of it.
There were surgeries with 100% failure rate. If you went to the hospital, you had no expectation you were going to come out alive and there was no liability. If you killed someone on the table, there was no fear that someone’s going to sue you. It was expected. So for us, doing a drama in that era is fascinating because you’re watching the invention of what we all think we know, but it had to start somewhere.
It’s incredibly juicy because something that a doctor would look at today and go, “Oh, I know how to solve that.” You went to medical school and in medical school they taught you what these guys figured out, so now you think you’re really smart.
This is before they had X-Rays and CAT Scans to even identify what was wrong.
Michael Begler: X-ray was brand new and it took about an hour to have something X-rayed.
Jack Amiel: And it was incredibly dangerous and it literally shot you with 1000s times more radiation.
Michael Begler: 1500 times more radiation than you would get in an X-ray today, but they were, again, doing it on the fly. They were figuring it out. The breakthroughs that they thought they had medically, like for example they thought that it was okay to infuse mercury that you breathe into steam to help with certain ailments. That was just standard practice. They didn’t realize that will end up making you insane and killing you. Back then, it was considered revolutionary.
Jack Amiel: A new technique.
Because this was also before health insurance, was cost not as much of a factor?
Jack Amiel: Interestingly, Germany under the Kaiser had the first national health insurance. Teddy Roosevelt even suggested a few years later national health insurance, but medicine wasn’t nearly as expected and the indigent were taken in. They were. Often they worked in the hospital to pay off their bill. As soon as you could get up, you would sweep a floor, you would wash a bedpan or you would do other things.
But people weren’t turned away. So without insurance, what did you have? You had money out of pocket. Well, when you have 500,000 poor immigrants coming into New York in 1900, these are not people who have the wherewithal to pay.
I read one patient’s chart. He broke his leg, he was brought into the hospital, he was kept there for 58 days, with a broken leg. If you broke your leg today, if it was really severe and maybe had to have surgery, you’d be in the hospital two days, three days. If you broke your leg normally, you’d be out in a few hours. Back then it was 58 days so you had to pay for that kind of stay.
When we created a hospital where they are dying for funds because the wealthy have moved uptown and left, the poor are coming in and expecting treatment and nobody can pay, we’re talking about a recipe for a hospital to go under. Now they’re trying to figure out how to survive in this new paradigm.
Michael Begler: And one thing about hospitals back then too is the middle class didn’t go to the hospital back then. They didn’t want to pay out of pocket. The poor went because they had no other place to go, and there were public hospitals that had to just accept them. And the wealthy had the private rooms, but the middle class didn’t want to be on the wards with the poor, but they couldn’t afford the private rooms so they stayed away.
So this giant population just veered away from the hospital as much as they could. It’s very similar to today. You have people just pouring into emergency rooms because they don’t have insurance and they figure this is the only place that they’re going to get any sort of [help].
Jack Amiel: And it’s gotten to that point. The other piece of it I think for us is this idea that the hospital is now becoming a place where miracles happen. Doctors really became rock stars of the era. Technology was everywhere. It was taking over. In 1895, no one had ever heard a recorded voice. Now suddenly you had recordings and record players. Nobody had ever seen a moving picture.
Now you had these Vitascope halls and the Edison moving picture camera and people were starting to see that. Telephone, they were suddenly hearing voices. It was an extraordinary time and architects were building incredible things now that they had steel to build it and technology to build it.
So you had electric lightbulbs lighting these buildings. You had elevators going up and down, so architects and scientists and inventors and doctors were becoming the famous rock stars of the era. So a new procedure, a new medical breakthrough would make it into the papers. The press would come and they would really come to these galleries and they would report on this new technique, this new thing. So patients were suddenly saying, “Wait, there’s something going on here.”
Doctors now knew about germ theory so they were cutting down on infections. The rate of success was going up slowly and they had ether which could knock you out safely and wake you up somewhat safely. And so you were getting an era where medicine was progressing. They could do things with a degree of success so people were now being drawn into the hospitals slightly more.
