This post contains some spoilers for The Knick’s first season.

Cinemax isn’t the first place you think of when you want to watch a premiere drama. You probably call it “Skinemax” or think of it as faux-HBO. It’s certainly not the type of place you expect to find a show like The Knick.

The Knick is Jack Amiel, Michael Begler, and Steven Soderbergh’s gritty look at the medical field in turn of the century New York. It’s a grimy place full of prejudice, drugs, and danger. Dr. John Thackery (Clive Owen) is a brilliant, intense, drug-addicted man. Yes, I know this sounds like House 1900, but it most definitely is not. The Knick is not a formulaic case of the week show. It’s about innovation. It’s about race and pride and every social issue you can think of.

New York has never felt so big and so small. It truly is a city of neighborhoods here. Much like Mad MenThe Knick uses the shock of segregation and racial attitudes of old to its advantage. It goes even deeper into these issues. Dr. Algernon Edwards (Andre Holland) would be a top surgeon anywhere today. In 1900, just 35 years after the end of the Civil War, this is not the case. It’s not easy being a black doctor when most people still think of you as subhuman. Doctors don’t want to work with him, patients don’t want him even touching them. Edwards tries his best to handle everything with grace, but that isn’t always possible.

Thackery and Edwards are both compelling figures with very different demons. Clive Owen gives Edwards the desperate look of the world’s first notable cocaine fiend. You see him slowly succumb further and further into the stimulant’s grasp until he needs it just to get through the day. Edwards takes out his frustrations with his fists in back alleys. He has to claw for every inch of respect that he can get. Even that’s not enough. When these two men work together, they are the best of the best.

When they’re at the top of their game, Thackery and Edwards are on the cutting edge of innovation. It’s thrilling to watch them advance medical science in The Knick’s gory surgical scenes. Procedures and devices that seem commonplace today are crazy, wild ideas to the people of New York 115 years ago.

Social class is a prominent issue on The Knick. The Knickerbocker Hospital is the last good hospital available downtown where it is accessible to everyone. The board of directors wants to move it uptown, to cater to the wealthy. You know, the type of crowd that looks like the New Yorker logo.

Dr. Edwards is the one member of the staff that has to deal with poverty on a daily basis. The only housing he can get is in a tenement. Have you ever had to stand in line to use the shower? It ain’t fun. Edwards has to set up his own secret clinic just to help black patients on the hush-hush. His life is poverty, which will certainly be upended if the Knickerbocker moves to the monocle-wearing side of town.

I’m shocked The Knick isn’t on HBO. It feels like it should be on HBO. HBO has even been offering it On Demand. I’m waiting for them to steal it away from Cinemax. Until then, Cinemax has their hands on an outstanding drama and perhaps the current best on TV.

The Knick’s second season premieres on 10/16 and airs Fridays at 10pm eastern on Cinemax.