Our main man, Dr Thackeray, comes around in a red-lit basement as a woman tells him it’s half past seven. He staggers out to a hansom cab and gives directions to the Knickerbocker Hospital (the ‘Knick’ of the title—and what is it with olde tyme New York and the word Knickerbocker? It loves it some knickerbocker). The cabbie points out that he’s taking the long route, but Thack doesn’t care, because he wants the extra time to shoot up in his foot to the sound of some thumping house music. Once he’s done, he laces up his shoes and is ready to face his day.
Today, he’s joining his close friend and colleague, Dr. J Christiansen, in a fairly experimental surgery. A nurse holds up a basin and Christiansen dips his beard in what I’m assuming is some sort of antiseptic solution. Thack does not have to dip his moustache, which is probably why he keeps it so closely trimmed. The patient—a heavily pregnant woman—is rolled in. She asks Christiansen to save her baby and he smiles benevolently before she’s put under. He then turns to the crowd of observers up in the peanut gallery and explains that the woman has presented with placenta previa and is now going to have a c-section. Christiansen announces that he and Thack have practiced a lot and are sure they’ve got this down. They get started, making the first incision as Thack and Christiansen narrate. The woman starts bleeding heavily and suction begins, the blood flowing into a large jar nearby. Things quickly start going pear-shaped. The nurse announces the pulse is weakening as Thack realizes the baby’s trapped in the cord. A second jar begins to fill with blood. Thack manages to remove the baby and hands it to a nurse to be intubated while he and Christiansen try desperately to control the bleeding. A third jar swiftly begins to fill. The bleeding finally stops, probably because the woman’s basically out of blood. The mother is dead, and the baby too. Well, that’s a shitty day at the office. Christiansen looks up at the full gallery and quietly says that it seems that they’re still lacking, and he hopes this has been at least a little instructive.
The doctors withdraw to clean up. Thack reassures Christiansen that it was the procedure that failed, not him. Christiansen thanks him, then retires to his office, where he spreads a sheet over the sofa and blows his brains out.
Thack gives the eulogy at the funeral, which is attended by several employees of the hospital. He expounds on the miracles that modern medicine is creating all the time and says he plans to keep up his and Christiansen’s work.
After the funeral, one guest—Cornelia—leaves along with a very Irish nun. Cornelia compliments Thack on the eulogy but quietly says she thought it was a bit self-aggrandizing. Sister agrees that Thack was trumpeting his own war against God. A guy whose entire look screams ‘middle management bean counter’—Mr Barrow—catches up with the two ladies and makes some small talk about how nice the funeral was. Sister peels off, leaving Cornelia and Barrow to go into the hospital together. Barrow says how sad the whole affair is and Cornelia notes that Christiansen had tried the same surgery 12 times and had no survivors, so it’s no wonder he lost hope. He mentions that Christiansen did have the decency to leave his wife enough cash to attract a new husband, so there’s that. Cornelia’s clearly a little grossed out by him.
The Sister passes by the ambulance bay, where one of the drivers, Cleary, jokes about the funeral having been closed casket and that the worms will be grateful for the extra holes. Sister gives him a freezing look and he laughs and asks her not to judge him too harshly. She rolls her eyes and says the lord loves all his children equally, but she’s pretty sure that, in Cleary’s case, he’ll make an exception. The phone inside rings and Cleary picks it up, listens, and tells his partner they’ve got a pickup.
Time for a hospital board meeting, led by Cornelia on behalf of her father, one of the hospital’s biggest benefactors. When he hears that this meeting is going to be headed by a woman, one of the men suggests they adjourn, but Cornelia’s not messing around and says she’ll be happy to tell her father he wasn’t willing to attend. They all sit. Cornelia welcomes Thack, who’s now attending the board meetings in place of the late Christiansen, and then gets right down to business. The hospital’s losing money, lots of it, and they need to fix that. Cornelia invites Thack to become chief in Christiansen’s place, which Thack accepts, and then nominates Dr Gallinger as his new deputy. Cornelia has someone else in mind: Dr Algernon Edwards, who has an impressive resume and is only recently returned to New York after training in London and Paris. Barrow urges Thack to meet with the man, reminding him that Cornelia’s family pretty much owns them, so play nicely. Thack agrees, but says his mind’s made up and he wants Gallinger.
Cleary and his partner arrive at their destination to find two policemen already loading the patient into the back of their wagon. One of the policemen, whom Cleary is on a first-name basis with, gets ready to engage in some fisticuffs for the privilege of taking this poor man to the hospital, but Cleary chuckles as he and his partner retrieve a pair of baseball bats and offer to bust some heads open. They get their patient. Once he’s delivered to the Knick, Cleary fills Barrow in: the guy’s rich, so he’ll be paying his bill in full and it’ll probably be a generous one. Cleary reminds Barrow to pay his commission and Barrow condescendingly reminds him it comes at the end of the month.
Up on the ward, the doctors make their rounds, checking in with some of the patients. One of the younger doctors, Chickering, stops for a moment to say hi to a new nurse, Lucy Elkins. The doctors gather around the bed of Mr Gentile, who was hit by a streetcar, fracturing his pelvis. Thack suggests the guy go up against one of those ‘horseless carriages’ next time, since he’ll have better odds. Yes, ha, ha, it’s one of those ‘they have no idea how powerful that thing will be someday’ moments. Though I think even today if one were given the choice between being hit by a streetcar or a car-car, we’d probably opt for the car. The attending doctor, Gallinger, explains that the man had a few punctures in his bowel that needed to be stitched up surgically, which was done. Thack asks if there was some consideration of removing the damaged bowel and Gallinger says the risks were too great. The only complication thus far is a small case of bronchitis, which is not uncommon after this type of procedure. Thack takes a look at the surgical incision and drains and notes that one of them is clogged. He asks which nurse changed his dressings and Lucy steps forth. Thack calls her attention to the clogged drain, which she failed to notice. He notes her southern accent and suggests she go back to Kentucky, where she can continue in the ‘fine tradition of curing people with moonshine and angleworm poultices.’ Sounds like a hell of a party. Thack, having fulfilled the ‘asshole in charge’ role, tells Gentile to rest up so he can get back to dodging trolleys before leaving. Chickering takes a moment to cutely try to cheer Lucy up by saying the joke’s on Thack, because she’s actually from West Virginia. She does not look cheered.
Cleary and his partner travel to a horrible tenement, having been summoned by Sleight, the health inspector. Speight makes his way into a really awful place crowded with people, little natural light, and finds a woman with TB coughing on a bed in one room. He informs her they’re taking her to a hospital. She doesn’t understand, so one of the children of the family, the only member who speaks English, is produced and serves as interpreter. The girl says her father doesn’t want them taking her mother away, and an accompanying policeman explains they need to take her away so she can get better, promising to bring her back fit as a fiddle.
Outside, Speight talks to the landlord, informing him that the place doesn’t pass muster. The landlord whines about how much the necessary alterations will cost and gives Sleight a payoff instead.
A well-dressed black man arrives at the hospital and finds Barrow paying for coal. The man asks where he can find Thack and Barrow looks him over and points to the basement. The man goes down and, to my surprise, actually does find Thack there, building himself some new tool. I kind of thought this was some joke Barrow was playing, especially since there’s another black man down there, shoveling the coal. The other man stops for a moment to look incredulously at the new arrival, who’s almost like an alien being. The man is Algernon Edwards and Thack looks up at him and immediately gets a look on his face that says, ‘well, someone left out some vital information here.’ Edwards quickly picks up on the weirdness and brings it up. Thack bluntly says he’s not interested in integrating the hospital staff. Edwards says his race shouldn’t matter but Thack thinks otherwise and suggests he go find work at a black hospital. Edwards says he was treated as an equal in London and Paris and Thack says this is New York, and they have racism there. ‘You can only run away and join the circus if the circus wants you. I don’t want you in my circus,’ he says.
On his way out, Edwards is intercepted by Cornelia, who asks how the meeting with Thack went. Not well. Not well at all, and now Edwards is in a right snit. Cornelia is alarmed. As he leaves, Lucy tells Cornelia that Chickering wants to see her. As she goes into his office. Speight goes to see Barrow and get the finder’s fee he’s owed for ensuring the latest TB cases come to the Knick. Barrow hands it over with a bit of an eyeroll.
Meanwhile, Chickering informs Cornelia that this TB case (the woman from the tenement) is terminal, but they can’t communicate with the woman to tell her. They need the daughter to interpret for them, which Chickering is uncomfortable with. Cornelia takes charge, sits down with the little girl, introduces herself nicely, and gently asks her to interpret for her mother. The little girl does, and seems creepily unconcerned by the fact that she’s informing her mother she’s about to die. The mother also doesn’t seem to care, she just asks what time it is and then reminds the girl she’ll be late for her shift if she doesn’t leave soon. Cornelia seems a tiny bit disturbed and gives the little girl a lift in her own carriage before going inside to yell at Thack for being a dick to Edwards. Thack reminds her that the hospital’s running a major deficit which will be difficult to fix if they have a doctor on staff that no patient will agree to have operating on them. I hate to admit it, but he does have a point. Cornelia thinks patients just need to be educated on his abilities, which really just shows how much of a bubble she’s living in. Thack says things don’t work that way. She leaves in a snit.
At the end of the day, Barrow catches Thack on his way out and announces Cornelia’s family is pulling their money, which was paying for the hospital to get electricity. Thack sniffs over how childish that is, which it totally is, and Barrow tells him that, childish or not, it’s happening, so Thack needs to hire Edwards, no matter how much they all hate it. Thack threatens to resign (not for the first time, apparently) if Edwards is hired.
Sister prepares a basin of ice water for a pregnant woman to hold her belly in in the hope her breech baby will turn around. Once that’s done, Sister heads out for a smoke and is spotted by Cleary, who jokes that he envies that cigarette and asks if the ‘penguins’ ever want to have a good poke. She wearily says they get curious, but then take a look at a photograph of him and run right back to God. ‘Your ugly mug’s been responsible for more girls staying virgins than a chastity belt,’ she informs him. Heh. I like her.
Thack works late into the night and flashes back to another late night, with Christiansen. Thack asks his friend how he manages to keep going at all hours and Christiansen introduces him to his good friend, Uncle Parker. He even provides the needle. What a pal! And that’s how Thack started taking coke.
The next day, Lucy tells Gallinger and Chickering that Gentile’s much worse. Gallinger recognizes the symptoms of septicemia and figures the bowel repairs didn’t hold. Just then, Barrow shows Edwards into the ward and introduces him to the other two doctors. Gallinger looks fairly alarmed but Chickering, being our designated ‘nice guy’ shakes Edwards’s hand and gives him leave to call him ‘Bertie.’ Gallinger shakes his hand and welcomes him to ‘their circus’. Edwards checks Gentile, hears he’s got blood poisoning, and says they need to go back in and repair the man’s bowel. Gallinger immediately pisses on his territory while Chickering points out that the man can’t have ether because of his bronchitis, so there will be no surgery. Gallinger asks for Thackeray, who isn’t in yet, so Lucy is dispatched to fetch him. Chickering gives her the directions to Thack’s house she completely failed to ask for.
Lucy rushes through the streets to Thack’s palatial brownstone, but he doesn’t answer her knock. She finds an open window and manages to climb in, finding him upstairs, in bed, shaking and apparently going through withdrawal. She tells him he’s urgently needed, so he tells her he needs her to shoot him up with some coke. She can’t find a useful vein in his arm and is afraid to try for the tiny ones in his feet, so he whips it out and tells her to just go for the urethral vein. Jesus. She prays for forgiveness and does it.
Now pulled together, Thack arrives in the operating theatre, where he notes Edwards and immediately relegates him to the role of observer. Gallinger reminds Thack that the man has bronchitis and can’t, therefore, be knocked out, but Thack is a miracle worker and decides to basically invent the epidural. While Lucy prepares the solution, Thack tells Gallinger that he was forced to hire Edwards, which is news to Edwards, who gets ready to leave, but then decides to remain in the theatre, as the Hippocratic Oath directs. He’ll resign right after. Once again, the gallery is filled with other doctors and Barrow. Thack tells them what he plans to do before finding his spot and telling his assistants (and the patient, who’s still awake, of course) that he’s tried this—unsuccessfully—once before, on a Labrador retriever. Oh, well, then. He inserts the needle and injects the solution, then tests to see if Gentile is feeling anything below the waist. He is not. Surgery can begin. Edwards still thinks Thack is a madman, even though he’s just seen the madman’s method work. The man’s incision is reopened and the bowel pulled up so they can see where the stitches failed. Edwards is sent to retrieve a tool from the sterilizer while Thack prepares to remove several inches of the man’s intestine. The tool from the sterilizer helps hold the bowel together so it can be stitched. Edwards is so impressed he decides not to resign after all.
That night, Thack heads out, pausing by Christiansen’s old office. He hails a cab and asks to go to Chinatown. Inside the Knick, the new electric lights are turned on for the first time. 1900, folks. It was a helluva year.