It's 1901, and Clive Owen's brilliant but tormented surgeon has a new pet project: conquering his addiction.
Credit: Mary Cybulski/HBO

At both the start and the close of tonight’s second-season premiere of Steven Soderbergh’s gruesomely gripping drama The Knick, we find ourselves asking the same question: Who’s that girl?

Sadly, Madonna and her 1987 song won’t be much use in figuring out this mystery, but, considering this apparition of a pale-faced child in a hospital gown and Dr. John Thackery’s crippling drug addiction are undeniably intertwined, I have a theory: She’s the young girl the brilliant but tormented surgeon accidentally killed during a botched blood transfusion last season, which resulted in Thack being placed in an institution for his cocaine dependency.

It is now several months after the events of last year’s season finale. We’ve moved from 1900 into the winter of 1901, and everyone affiliated with New York’s Knickerbocker Hospital, not just Thack, is downright miserable. Not that “upbeat” and “happy” are words usually associated with a show like The Knick, but “Ten Knots” is a real bummer of an episode. Speaking of the title, the only real glimmer of hope arrives when Clive Owen’s Thackery completes his 10 knots task (more on that in a bit). Nurse Lucy Elkins’s voice-over brings us up to date on a few important details via a letter to Thackery, her former lover — still undergoing a steady treatment of heroin at Cromartie Hospital. But the only real information the letter conveys is that the Lucy-Thackery relationship has remained one-sided since the surgeon was admitted to Cromartie. One reason being that Thackery checked in under an assumed name, “Crutchfield,” which would explain why Lucy isn’t able to visit or get a letter in return. Then again, Thackery, heroin addiction or not, doesn’t seem the type to write mushy notes addressed to “my love.”

Thackery has been keeping busy by performing that nose-reconstruction surgery he pioneered on his old flame, Abigail — this time on syphilitic patients at Cromartie — in exchange for extra heroin (he’ll even tattoo lips to “make them appear more plump” for additional vials). I tell you, nothing gives you a good shiver like seeing flesh pulled away from the nasal cavity. So forget any sort of recovery at this rehab center, but hey, at least he’s keeping his surgical skills in practice!

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But a visit from Thackery’s colleague, Dr. Everett Gallinger, allows us to see exactly how counterproductive the hospital’s treatment regimen is. Gallinger is horrified to discover that a stay at Cromartie has only resulted in a new addiction for his incredibly fidgety colleague, who watches the clock religiously so he won’t miss his next heroin dose. What Gallinger does next, however, is ultimately for the good of Thackery’s health, but it begs the reminder that it’s for selfish reasons too. He is demanding the surgeon’s return to the Knick due to his unrelenting, yet commonplace for the time, prejudices: Gallinger staunchly refuses to serve as subordinate to Dr. Algernon Edwards, the acting chief of surgery who just happens to be an African-American.

While Thackery undergoes a more brutal drug-treatment program courtesy of Gallinger and the Atlantic Ocean, the 20th century continues to march on without him. Just as his grisly work in the surgical theater will some day elicit less-gory advances in modern medicine — word of warning, we get a season’s worth of pus in the span of a single scene — so will the actions of the other brave souls who are trudging through a society determined to keep them subjugated. Emphasis on “some day.”

At a board meeting, Edwards proudly announces that since assuming the acting chief of surgery position there has been an increase in weekly surgeries and new procedures, as well as a drop in mortality rates. The board members — with the exception of Henry Robertson, whose wealthy family paid for Edwards’s Harvard education — could not have been less interested in the doctor’s findings, judging them entirely on the color of his skin.

NEXT: Cleary & Harry, together again

Edwards is humiliated as the board ignores his suggestion that he replace Thackery as chief of surgery and watches with dismay as they toss around potential candidates with him still in the room.

Things aren’t going much better for Edwards in his personal life either: His sight has been significantly affected since getting into a couple of brawls last season, which necessitates turning over important surgeries to less-qualified, less-experienced doctors like Dr. Bertram “Bertie” Chickering Jr. Also, after engaging in a dangerous affair with Henry’s sister, Cornelia, which resulted in a pregnancy she was forced to terminate, Edwards no longer has the safety of 3,000 miles separating him and his now-married beloved. Mrs. Phillip Showalter, a.k.a. Cornelia, has returned to New York after a brief sojourn in San Francisco (where she couldn’t help but continue her social crusading, this time with the bubonic plague sufferers of Chinatown). And there is bound to be more than just that one awkward run-in with Edwards at the groundbreaking for the Knick’s new, uptown location.

Cornelia, despite her wealth and closets full of finery, is also trapped by the restrictions of her status and her gender. Last season, her then-fiancé’s father, Hobart Showalter, demonstrated his powerful, invasive nature by coming on to her while she was in a state of dishabille. In “Ten Knots,” we see that absolutely nothing has changed, with Hobart barging into the marital bedroom as a skirt-less Cornelia is talking with Phillip, who’s chastising her for neglecting her wifely duties in favor of helping the poor. She may not be able to do much in retaliation, but selling Hobart’s mother’s earrings to pay for the food and supplies she brought to the needy Chinatown residents must’ve given her at least a hint of satisfaction. When Hobart moves the newlyweds back to New York — naturally, Cornelia had no say in the matter — he also drops the bomb via his son that the apartment he’s building for the couple isn’t ready yet. This means Cornelia will be stuck living in Hobart’s house for the next few months. A dreadful prospect, to be sure, but at least the health department inspector, Jacob Speight, has stumbled upon a mysterious new outbreak plaguing immigrants over at her family’s steamship docks. I smell this season’s Typhoid Mary subplot!

But of the main characters, Sister Harriet is the one who’s been punished the hardest by the strictures and moral codes of the time. Sometime between last season and the events of “Ten Knots,” the tough-as-nails Irish nun was arrested on account of her secretive night job: performing compassionate abortions. In Sister Harriet’s line of work, unlike at the Knick, where the wealthy patients are given preferential treatment, there is no discrimination. “Harry” serves the destitute and the affluent (she handled Cornelia’s predicament), for an unwanted/unacceptable pregnancy was a desperate situation no matter the woman’s financial status in 1900. After Lucy makes a vague reference to Sister Harriet’s trial in her letter to Thackery, we see the disgraced nun in prison being visited by her Mother Superior, who effectively excommunicates her from the church and hurls vicious insults in her wake (“I should’ve let you die”). The scene becomes only more painful to watch depending on how much you read the news in 2015 about women’s reproductive rights.

The only real friend Harriet has right now is an unlikely one — but fans of the show will be tickled to see who has the potential to be the fallen nun’s savior: Boorish ambulance driver and partner-in-crime, Tom Cleary. It’s during Cleary’s visit to the prison that we learn how exactly Harry landed in the clink: She took a job without him (after he discovered her side gig last season, he insisted on teaming up with Harriet and splitting the money, lest he tell the wrong people what she was up to), and the “coppers” picked her up. Lucky for Cleary, he was off getting drunk somewhere and avoided detection.

NEXT: I’m sailing away…

Cleary may be a crass brute, but he’s got a soft spot for the old girl, and he’s going to get her the best lawyer money can buy, even if it means lying to her about it. He tells Harry he’s got cash socked away, which we know isn’t true because he just blew it all to replace the Knick’s antiquated horse-drawn ambulance with a shiny new motorcar. So, it’s back to the wrestling underworld for this fellow. These two have always been one of the more entertaining duos on The Knick, so even though it was under dreary circumstances, their scene together was one of the strongest in “Ten Knots.”

Anyway, back to Thackery: Gallinger kidnaps him, ties him up, and brings him out to sea on his sailboat, the Amorita. With chemical drug rehab still in its infancy and the heroin regimen having proved a failure, the only option is to keep Thackery offshore in a forced cold-turkey environment. Just like in the operating room, Soderbergh doesn’t hold back on the graphic nature of drug withdrawal, with Owen spending all of his boat scenes in vomit-encrusted clothing. Gallinger is now crucial to Thackery’s survival, because he’s the only one who knows how to sail — if Thackery, in his anger, follows through on his threat to kill him, then Thack dies as well. So when Thack is saddled with the assignment of learning the first 10 knots on the chart below decks, he has no choice but to obey, or else he’ll never see land again. That and the whole knot task will help Thack combat the overwhelming urge for self-medication, which the surgeon has already surrendered to: “You don’t understand; the need will never go away,” he pleads to his friend. But Gallinger mandates that Thack must “fight the need,” and learning how to make knots in a length of rope is a great way to start. (Plus Gallinger neglected to bring along any art-therapy supplies.)

Maybe it was the intricacy of the rope work, maybe it was having a clear mind for the first time in months, but as soon as Thack completes his 10th knot, he reveals his epiphany — and what will undoubtedly be his primary project for this season: Inventing modern drug rehabilitation.

Well, at least comes close to it. As he admits to Gallinger, he’s been approaching this all wrong. Thack realizes he has to attack his addiction like he would any other medical problem: “If I treat my desire for drugs not as a craving but as a sickness, that means there must be a cure. And if there is, I’m gonna find it.”

History has shown that the answer to drug addiction is not so much a cure, but treatment and management. So while it will be fascinating to see how Thack’s work will contribute to what we now know as recovery therapies, we must also be prepared to watch him die a slow death trying to find the right answer to this medical conundrum. If he becomes the guinea pig in his own research, Thack could be setting himself up for a tragic ending identical to the one that befell the little girl of his visions.

Which, of course, would be fitting.

Stray observation:

  • Anyone else find it odd that Gallinger had the time to abandon his full plate of a life in order to devote himself to Thack’s cold-turkey cruise? His now-toothless wife, Eleanor, is still recovering from her ghastly ordeal at the sanitarium after she drowned their adopted baby daughter.

Episode Recaps

The Knick
Clive Owen and Steven Soderbergh team up for this 1900s medical drama.
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