You might bristle at in the opening moments of The Knick, as our salty protagonist Dr. John Thackery (Clive Owen) is awoken by a prostitute at an opium den. This is airing on Cinemax, after all; perhaps it will be thickly slathered with nudity and splattery violence, trying to catch our eye with extreme content while remaining as highbrow as it can. Make no mistake, The Knick has a lurid edge to it, but a considered one, too. Steven Soderbergh has a deserved reputation as a director who churns out incredibly eclectic content at a super-fast pace, but he's incredibly considered and patient behind the camera, and it's in The Knick's quietest moments when it wields the most heft.

Writers Jack Amiel, Michael Begler, and Steven Katz are working from some very familiar tropes. Thackery is a brilliant, pioneering surgeon, experimenting with cocaine as an anesthetic so that he can work on even more daring procedures. Inside the operating room, he's a maestro, methodically explaining his work to a gathered audience in a booming quasi-British accent. Outside, he's a mess, injecting coke between his toes and angrily dismissing an eminently qualified black doctor (Andre Holland) forced upon him by his hospital's progressive benefactors because he doesn't want the trouble that comes with being socially pioneering.

Everyone's been rolling their eyes at the posters for the new USA show Rush, with the tagline "Good Doctor, Bad Habits," since that's pretty much been the show for every doctor show since time immemorial. Oh, the dramatic irony of a man who can play God in the operating theater but barely knows how to run his life outside of it! But it's a trope that works for a reason. Thackery's tortured attitude gives the surgery the tension it requires. One can make a show about a medical grandmaster who's always right (look at Masters of Sex) but there has to be some personality trade-off to generate conflict.

Of course, there's plenty more beautiful conflict generated by the 1900s New York setting of this medical drama. Every breakthrough, medical and personal, takes that much more struggle and grit to achieve, and Thackery's renegade nature feels that much more congruous. He'll need elbow grease and innovative thinking to get through even the most standard medical procedure, given that surgeons were seen as creepy butchers within his lifetime. The "first black surgeon" plotline is twenty years too early, according to Slate, but its inclusion makes sense since The Knick sees its characters madly struggling to achieve breakthroughs as the new electric lights flicker around them. It's about America's gross and bloody history, and New York's transformation into a metropolis—and it's about how building over the mud-caked streets hardly did away with its underbelly.

Owen, who has been sorely lacking in interesting leading-man roles for years, is perfect casting (he's always erred on the side of growly and mean, and Thackery is the right kind of meat for him to sink his teeth into). Holland and Chris Sullivan as a bat-wielding ambulance man, who scares off other vultures to secure patients for Thackery's hospital (all healthcare was private back then, remember) are the other characters who stick out memorably early on, but the entire ensemble hangs together nicely. It's easy to poke at The Knick for copying all the tropes of a hospital show, just with bloody 1900s flavor, but it's a formula that works for a reason.

The other reason that this show (which was written for HBO but dumped into Cinemax's lap) works is, of course, Soderbergh, who directed, shot and edited every episode and gives it the kind of unified, cinematic feel that is becoming more and more common on premium cable (hello, True Detective). He brings in composer Cliff Martinez to provide a hypnotic electronic score and moves his camera in a way that immediately has you realizing you're watching something special.

This is the true advantage of premium cable, of course, not the ability to ladle in scenes of unnecessary nudity and spilling intestines. I have no qualms with Cinemax's programming approach up to now (wildly fun and silly pulp dramas like Banshee and Strike Back) but the biggest compliment I'll give them to date is that they realized Soderbergh had a specific vision for how to make this show and just gave him free rein to do it. Television has long been the most fertile ground for creative and expansive writing, but that's more and more becoming true for directors too.