Interview: The Knick Creators Amiel and Begler

Jack Amiel and Michael Begler co-created The Knick, a medical drama starring Clive Owen and directed by Steven Soderbergh. Set in 1900, the show follows life and death in a New York hospital. Oh yeah, and the main character is a surgeon who happens to be addicted to cocaine.

First up, here's a brief preview to give you a taste of what the show is like (note, some surgical gore and mild early-episode spoilers are here):

Where to watch The Knick: Fridays at 10pm on Cinemax. You can catch up on clips on The Knick's website.

If you're into medical history, check out our interview with Dr. Stanley Burns, medical advisor to The Knick.

A Gut Feeling

Chris Higgins: Where did the idea for The Knick come from?

Michael Begler: The idea stems from health issues I was going through at the time. I was having some issues with my gut, and I was going down the roads of traditional medicine and alternative treatments. There were points where I was really amazed at what medical science had figured out, and other points I was really frustrated about what they still didn't know. Jack was privy to all of my health issues, and I wasn't shy—

Jack Amiel: We were like two old Jewish men, "Let me tell you, I tried this, I tried that! You know the doctor said I have to bring a stool sample in?!" Literally we're like two old Jews in Palm Beach.

Jack Amiel (left) and Michael Begler (right) on set. in the operating theater / Mary Cybulski/Cinemax

Begler: Yeah. But that also got us asking questions like, "Why do you know anything at any given point? What is the trajectory of knowledge in general?" And so purely out of curiosity we went onto eBay, we found a couple of medical textbooks from 1900, because I was also asking the question, "Well, what would I have done a hundred years ago?" What would my options have been? Because everything is at my fingertips now. [...]

So we bought these books and the minute we opened them, it was a treasure chest. It was so endlessly fascinating to us, and we were emailing and texting each other like, "I can't believe this fact I found." And so we knew that there was something special here in an era that hadn't been explored in television.

[... That] was the jumping-off point, and then we [started] to look at, "Well what was the world like in 1900?" And from that we learned so much more, and saw, again, an endless wealth of fascinating stories in a time of enormous change, and not only in medicine but in the country.

Amiel: I think for us the era is also fascinating because you're coming out of the Victorian era, you're coming to modern America. America is emerging as the world power. You know, it is in this era that we first project our military power across the world, we are suddenly at the forefront of invention, whether it's the phonograph, or the wax recorder, perfecting the light bulb, electrifying the telephone, we're working on the automobile.

So it is a time of amazing technological advancements, and you also have a country that is looking towards medicine for the same advancements. Suddenly you have X-rays. Suddenly you have electricity that can be used within medicine. Suddenly you have ether that can safely put someone under, and safely wake them up. You understand germ theory now, so you can at least try to mitigate infections. All of these modern advances were allowing doctors to try new things and experiment—new understanding of drugs, of chemistry, and pharmacology were allowing you to have new treatments as well. So we thought, "Wow, what an amazing confluence of events that were all coming together at this exact time."

On Medical History

Higgins: So I'm wondering how the research process works, and to what extent the Burns Archive fits into that? Do you start with an invention? Do you start with a story? Both?

Amiel: We went through a lot of procedures. You know, there are some wonderful medical archives online that we were able to go through surgical procedures and to go, "Oh, okay. This is kind of interesting." And [...] they give you the history of the patient—the prognosis, the outcome, how they performed it. So that was really helpful for us because we wanted to be truthful about what the procedure was.

We were very careful to make sure that it was within a year of 1900 on either side. So if it was a procedure that was from 1899 or 1901 we could place it 1900, but other than that we really wouldn't mess around with too much, because we wanted to make sure we were truthful to the era.

So in the pilot episode you saw there was a spinal procedure where someone did a spinal block. [Ed. note: this is a spinal injection of cocaine to numb the lower body, first published in 1899.] [...] Michael found that, and he was like, "You're not going to believe what they did!" We loved the confluence of cocaine being used for its intended purpose as a numbing agent as opposed to Thackery's purpose, which is to embolden him and allow him the stamina to continue on in a life like his. [...]

The Burns Archive was helpful to us because there are some things [later in the season] that we saw and that are directly from things that [Dr. Burns] talked about. And what Dr. Burns does sometimes is he'll be telling one story and then he'll throw out a piece of information that's tangential to that first story, and you'll go, "No, no, no, go back to the tangent! Go back to the tangent. Wait a second. What?" And then you go, "Okay. We need that. We're going to use that. I don't know where, I don't know when, but we're going to use that." And then you say, "Oh, do you have a picture of this?" And he goes, "Do I have a picture of it?" He'll go to a file and there will be 150 different pictures of that particular malady, or problem, or surgery.

Viewing a stereoscopic photograph / Mary Cybulski/Cinemax

He also showed us these—you'll see them in the later episodes—the doctors used stereoscopic cameras, and they basically used them in conjunction with a surgery-by-numbers triptych kind of notebook. We use that as well, and Dr. Burns has an amazing collection that a surgeon made who wanted to chronicle every one of his surgeries, or at least every type of procedure. [...]

Begler: [...] We loved the idea of marrying what was going on technologically with the procedure. So for example, at the end of the pilot they get electricity in the hospital, and we said, "It would be great to use this new technology in a surgical procedure." So we would then research and try and find, well, how did [doctors] use electricity? And that's how we came across the aortic aneurysm using the galvanic procedure, and you know sometimes it works really well, as you see in the episode, and sometimes it doesn't work at all and it's quite tragic, as you also see.

The first time we went to see Dr. Burns...his brownstone is covered from the basement to the roof with photographs. He has something like a million photographs from this era. I mean, he's the world's most specific hoarder. He showed us a photograph from the turn of the century of a black surgeon in Paris, who was the lead surgeon in a surgical theater, and he's surrounded by an entire white staff of doctors and nurses. This is basically the only photograph in existence of this, but it affirmed what we had created. Now granted, Jack and I had done our research, and we knew that African Americans would go over to Europe, and they could study, and they could work alongside these [white] doctors, but here was the proof, and so that really felt like we were on to something.

Cross-Boarding

Higgins: I'm wondering what it's like to run a show with a single director for the whole season, and I gather that you have a second season coming. But I'm wondering, when you start shooting, how many scripts are complete? And what's it like having a single director, a single shooter, a single editor, and that person being Steven Soderbergh?

Amiel: Let me try to answer those in pieces. [...] The easy answer is, we had all ten [scripts] done early. We basically got the green light in mid-June [2013] that we were going to do this, and Steven said, "Okay, We're shooting in late August, early September." [...] At that point we only had really one or two scripts, but we knew where we wanted to take it. So we sat down with Steven in New York and we plotted out what we wanted to do in terms of the ten episodes, in a very sketchy way, but we understood what the arc was, and we broke it down in a way that each story flowed like a movie. So everyone gets an arc, everyone gets to start in one place and end in another.

So it really did break out like a ten-hour movie broken into hour-long segments. Then we had to go off and write an outline, as quickly as we could, to get to the network because we wanted their [go-ahead] as quickly as possible. So within four or five days we had about a 65-70 page outline. Every scene, every character, every location all figured out. [We] got that to the network, and then we started writing, and Michael and I blasted through.

Steven Soderbergh on set / Mary Cybulski/Cinemax

We have a supervising producer, Steven Katz, who was a friend of Steven Soderbergh and Greg Jacobs, our executive producer, who had a really good knowledge of this era, because we didn't have time to catch anybody up. You know, we didn't have time to take somebody from 2013 and say, "Here. Catch up. Learn everything that we've learned over the last six months, now." We just didn't have time. Luckily Steven Katz knew all of that, really knew a tremendous amount about the era because he had written other things in this era, so we blasted through. We wrote ten episodes and they were written and rewritten. We never had a table read. We had to trust that 20-something years of us doing this, and Steven's ear, and Greg Jacobs's ear, and the actors—[we had to trust] that we were getting it right on the page. [...]

We cross-boarded it, which means instead of shooting episode one, then episode two, then episode three—which isn't terribly efficient—you could shoot scenes from four different episodes in a day if they all happen to be in one location. [It's] much harder on the actors, but it's a very efficient way of shooting, and so that was how we shot.

[...]

In terms of having Steven Soderbergh, it's like winning the Powerball ten times. I mean the fact that he would do the pilot would have made us jump for joy. The fact that he did all ten, and that you're getting this extraordinary signature filmmaker's vision was absolutely extraordinary. I don't think we could have been more thrilled in our lives, and to feel that lucky, and to feel like all we had to worry about was the words, and the stories, and the characters, and Steven was going to put his spin on it, his take on it, put his brilliance on it, and elevate it. Everything he does elevates the piece. [...]

Steven's thing is that he trusts everyone to do their job. He does four jobs—at least four jobs—on the set, so if you only have one job, you are trying your level best to make sure you do it really well. So everybody brings their A game. [...] So it frees us up to only worry about the things that we want to focus on: the writing, and the story, and the characters, and the words, and the settings, and everyone else comes in and makes us look really, really good.

A Medical Drama on Cable TV

Higgins: When I think about putting a medical drama on cable TV, that opens some doors. You have the latitude on cable to show gore, but you also have the latitude to show sex, and at least in the seven episodes I've seen there's a lot of gore, in the context of operations, and it seems realistic. There is a little bit of violence, and there's very little sexuality, I mean relative to any typical cable TV drama, and I'm curious if you want to talk a little bit about that choice? Like, was that a hard sale to say, "This is a medical drama where we're going to show the medical stuff, and that's going to be gritty, and no, we're not going to have a lot of sexposition."

Begler: We just wanted to tell the stories that we wanted to tell. [...] Yes, you're given freedom on cable, but we interpreted that freedom for the stories we wanted to tell. We didn't feel like we needed to add anything just because we were allowed to. If the stories involved any sort of sexuality, or sex, then we'll throw it in there. But we felt that this is about a hospital, first and foremost, and this is about medicine, and it's about the progression of medicine, and it's about racism, and it's about sexism, and those social issues were more important to us than just having a bunch of naked bodies. And again if it lends itself to the story, we put it in. But I don't think that we felt like, okay, we need to check this off our list, and make sure in each episode we're showing breasts, or genitalia. You know? Now granted, with the opening shot, two seconds in, here comes a naked woman, but I think that it was just the way we broke out the story. We figured, this stuff is so entirely interesting on its own that we don't need to spice it up.

Clive Owen, in surgery / Mary Cybulski/Cinemax

Amiel: [...] If you want to separate it out to something like cursing, some characters will curse. The ambulance driver, Cleary, curses every third word. Even our rough-and-tumble nun, when she's alone with Cleary, might curse, but she's not going to curse around children. She's not going to curse in her capacity as a nun. [Dr.] Algernon [Edwards] is not going to curse around white people because he wants to be seen a certain way, and he's not going to act in any way that compromises the idea of his propriety, and his...I suppose elegance would be the word because when I think of Andre [Holland], I think of elegance. And perhaps if that character, Dr. Edwards, was sitting around with black people, when he was comfortable, and he wasn't feeling judged, he might curse.

So you have to decide when and where you're going to use the things you can use, and does it fit the character. Does it fit what's going on? We didn't want to be gratuitous about it because, just because you can do it, sometimes you lose what the scene's is about if there's a boob hanging out there. You know? You do. Now you're just going, "Hey, look. I'm looking at a boob." [...] So for us...it would have been easy just to throw in sex but that's just not the story we wanted to tell.

Andre Holland, reviewing surgery / Mary Cybulski/Cinemax

An Era of Power Differences

Higgins: To me, all good period pieces deal with the racial, the sexual, and the economic situation of the leads situated in their time. And that situation is often very grim, right? So in this series you've got leads who are black, you've got various women, you've got people who are in challenging positions. Now knowing that it's set in or around 1900, I don't know a lot of watershed moments that are about to come up that are going to make the lives of these people substantially easier. Is there anything I should be watching for, as we head into a second season, or the last three of this season, to see major moments when any of these issues get a lot better?

Amiel: First of all, this is an era about power differences, and about entitlement, and if these people's lives are difficult—if you're an African American who's done everything you can to educate yourself as a surgeon, and you are mightily deserving of a chance to practice your trade in the highest echelons of society, and you're being denied that chance because of race? Well, that's the truth of this era. We are 47 years from somebody allowing Jackie Robinson to throw a baseball with white people. So the idea of a black man with a scalpel coming towards someone and saying, "I'm going to heal you," we're not going to pretend that that wasn't an extraordinarily new and difficult situation. You have all of these poor immigrants pouring into America. There's a massive gap between rich and poor.

The rich are the old, moneyed, entitled white protestant males, and they're watching their country slip away from them because suddenly you've got Catholics, and Irish Catholics and Italian Catholics, coming into the country and changing the demographics of the nation. You've got Jews coming in, and you've got people from all over the world saying, "Oh there's that beacon on the hill." So into this mix pours all of these people who just want a shot at this American dream that they've heard so much about. You've got blacks coming from the south saying, "We're not going to be treated poorly anymore." The Irish coming from Ireland saying, "We're not going to be treated poorly by the British anymore." You've got Jews saying, "We're not going to be treated poorly in Eastern Europe anymore." You've got rural whites saying, "I want a shot at economic prosperity in the big city."

Cara Seymour (Sister Harriet) and Chris Sullivan (Cleary) / Mary Cybulski/Cinemax

So I don't think you should be looking for it to get better. I think you should be looking for how this pot gets stirred. Because you've got these women [...]—we're talking about women who don't have a lot of options. They can work as a seamstress at a sweatshop. They can work as a nurse, if they're lucky, or a nanny, if they're lucky, but for the most part there are very few options available to women, which is why prostitution was a giant business in New York City. It was estimated that there were between 30 and 40 thousand prostitutes in New York. There were brothels all over the Tenderloin and all over the city because that was one of the only ways for women to make a living. So we're not going to solve the ills of society. I think what we're going to do is we're going to see people trying to survive in spite of them and try to get an incremental step forward in their own situation.

[Pauses] That was long, wasn't it?

Clive Owen displays an X-ray / Mary Cybulski/Cinemax

Higgins: No, it's good. This is a quickie, but my family, for a few generations, is from West Virginia. I notice you have Nurse Elkins who's also from West Virginia. Any chance you're going to explore West Virginia stuff in the future?

Michael Belger: I don't think we're going to go there. I'm sure we will look more into Lucy, Lucy's life, in particular. Well start to learn more about who she is and where she's from, and that's all I can really say about that.

Amiel: And I think she's representative of rural whites coming to the big city for the adventure and the excitement. They may have one idea of what the city is, and they might have one idea of who they are when they get there, but there is such adventure in Manhattan at this point in time. As much as they don't want to admit it, they're there to ride that rollercoaster. Sometimes it's "be careful what you wish for," because the ride gets pretty exciting.

No One Forgot Hammerstein

Higgins: How do you guys decide whose name goes first when you're credited as, you know, Amiel and Begler?

Amiel: It's done by weight. I'm much heavier than Michael.

Amiel: It's just alphabetical.

Begler: It's just alphabetical.

Higgins: Well, yeah, obviously it's alphabetical, but I mean did you have to fight this out amongst you, or you just decided that's how it was going to be?

Begler: No. It's never been an issue. I've never felt like my name has to come before his, never.

Amiel: He should have gone for someone whose last name was Charles, or Dandy, or something. Unfortunately he partnered with someone whose last name just happened to begin with an A. But it's not like anyone forgot Hammerstein because Rodgers came first.

Higgins: Is there anything you can or want to say about the remainder of this season, or the next season?

Amiel: Well, a nuclear bomb hits, and it's really weird because we're about 40 years before they were invented. So that's about it. Did I give away too much?

Begler: I think the ride just continues to get crazier, and you've seen through [episode] seven, I think the speed picks up in eight, nine, and ten. I really like the way it arcs. And then we kind of take off to a whole new place in season two, but we want to keep all of the details to ourselves.

Higgins: All right.

Amiel: I think there has been a lot of focus in the first episode about the gore and I think that going forward there's less gore. I think it's less about the visual craziness in the procedure, there are moments, but—

Begler: I don't know. There's stuff coming up—

Amiel: There is stuff, but I think initially it's shocking, but I think it will normalize for people and that they'll go, "Oh, it's just part of the show." You know? I think people become much more used to the blood and the guts.

Operating equipment / Mary Cybulski/Cinemax

Higgins: Yeah. It normalized for me, for what it's worth. Initially I thought, "Wow," and then within 45 minutes I thought, "Okay. I get what's going on here." And it really doesn't seem gory or violent, especially in the context of cable television.

Begler: No. Because, again, we don't feel as gratuitous, we just feel it's authentic, and I think maybe that's the difference, you know we're not slashing people open, we're just showing the reality. Sometimes the reality is actually harder to take than somebody taking an axe and chopping somebody in half.

Amiel: Yeah. There's nothing cartoony about our blood or our guts, so perhaps you can watch Freddy Krueger do something and go, "Oh yeah, whatever. That's phony." But ours feels very, very real, and maybe that's why it's so visceral.

Where to watch The Knick: Fridays at 10pm on Cinemax. You can catch up on clips on The Knick's website. If you're into The Knick or medical history, check out our interview with Dr. Stanley Burns, medical advisor to the show.