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The regular presence of the unorthodox – brilliant, self-medicating doctors, one of whom Clive Owen, right, portrays in HBO’s The Knick – is now completely orthodox on cable TV.Mary Cybulski

The heroic-but-flawed doctor has been a television staple ever since ER conquered Thursday nights for 15 seasons straight. On The Knick, the Cinemax original series now airing Fridays on HBO Canada, that anti-hero is the arrogant, brilliant John Thackery (Clive Owen), newly appointed chief of surgery at New York City's Knickerbocker Hospital in the year 1900.

When we meet Thackery, a prostitute is rousing him from his sleep in a Chinese brothel; on his way to the hospital to perform a potentially groundbreaking surgical procedure, he injects cocaine into a vein between his toes. In short, he's unorthodox in a way that, for cable TV, is now completely orthodox.

We've seen eccentric, self-medicating doctors before. In its sixth season, ER saddled Noah Wyle's John Carter with an addiction to painkillers. On Grey's Anatomy, Seattle Grace's chief of surgery is a recovering alcoholic. House and Nurse Jackie are basically predicated on their title characters' drug addictions.

The Knick is more similar to A Young Doctor's Notebook, which stars Jon Hamm and Daniel Radcliffe. Based on the short stories of Mikhail Bulgakov, the British series follows a doctor fresh out of med school (Radcliffe) working at a clinic in a tiny village during the Russian Revolution. Hamm plays an older version of the doctor, who watches as his young self becomes addicted to morphine.

The two series share an early-20th-century setting that promises lots of gore. The Knick's pilot episode opened with a horrifically botched C-section. The only sounds are the doctor narrating the procedure for watching colleagues, and the squeak of a hand-cranked blood pump, which increases as the situation worsens. The scene quickly devolves into a nightmare; by its end, the pristine white surfaces of the operating room are stained a deep red.

The surgical set pieces are thrilling beyond their shock value: Here's a rare medical drama where the medicine is the drama. Like police procedurals, shows such as ER and Grey's Anatomy offer plenty of case-of-the-week intrigue – most episodes feature a guest star with some exotic disease or another. But The Knick needn't contort itself to make its medical plots interesting. The time and place provide enough fodder. New York's hospitals compete for corpses on which their doctors can practise; in the meantime, Thackery hacks away at a dead pig, a close second to a human cadaver. The steady influx of immigrants and the cramped quarters they share forebode a health crisis. And in these early days of modern surgery, patients suffer terribly, if they make it out of the operating room alive.

In the midst of such chaos, it's not hard to make a hero out of Thackery. Only one thing threatens his snarling charm: When the daughter of the Knick's benefactor insists on hiring Algernon Edwards (Andre Holland), an experienced black surgeon, as Thackery's new deputy, the chief rejects him. In a bracing bit of period accuracy, he insists, "I am certainly not interested in an integrated hospital staff." A maverick to rival Thackery, Edwards is shunted to a dungeon-like basement suite and almost ignored by the hospital staff.

That is, until the chief realizes Edwards's true genius and swivels his heels, which allows Thackery to be an all-around awesome guy instead of an awesome guy who's also racist. To an extent, his bad-boy arrogance evades the conventions of the tired anti-hero who mopes at the centre of so many TV dramas; the seven episodes I watched persuaded me that any surgeon in 1900 had to be inherently badass. Here, mentors pass on both knowledge and cocaine habits to their protégés.

My problem with Thackery is that the character works. Clive Owen is terrific, sporting a low, impatient growl and a thick, black moustache that somehow looks cool. But The Knick's writers/executive producers, Jack Amiel and Michael Begler, seem to have engineered the character to make him a modern hero. This undermines the show's refusal to present a rosy image of life at the start of the 20th century. Here, the past feels immediate and alive.

So it's a shame that Thackery turns out to be one more period grouch, another sour, prickly, but undeniably sexy product of a bygone era. Still, I'd be lying if I said I didn't enjoy watching him plunge his bare hands into people's guts.