Nurse Jackie: Another Hit for Showtime?

It's not TV or HBO. It's Showtime.

The battle between HBO and Showtime seemed like a David vs. Goliath affair for years, with the latter's slingshot perpetually empty.

Now, it is Showtime's turn to capture the zeitgeist with original offerings like Weeds, Dexter, and The Tudors. All the while HBO trots out noble attempts like The Comeback and John From Cincinnati, two shows which couldn't hold a candle to the pay channel's iconic hits like Sex and the City and The Sopranos.

Showtime's latest salvo hits HBO where it hurts, since it stars Carmela Soprano herself, Emmy winner Edie Falco.

Nurse Jackie, which debuts tonight at 10:30 on Showtime, follows a no-nonsense nurse trying to heal the sick, right the wrongs, and pull off any other noble gesture she can during her endless stream of double shifts. Yes, the world hardly needs another medical drama, but casting someone like Falco as a complicated nurse is enough to chase away most cynical thoughts.

Falco is an unconventional beauty, the kind of actress whose talent somehow can't transition to the big screen. Or maybe it's that few screenwriters write the kind of rewarding roles for which she's uniquely qualified. Like Holly Hunter and Kyra Sedgwick, Falco has decided to make her way via small screen projects. It's the film industry's loss, but today's studios too often look askance at actresses over 40 who aren't named Streep or Sarandon.

Falco sports a boy-like hairdo in Nurse Jackie, a style completely removed from the New Jersey coif we've come to know and love. The series opens with Jackie rationalizing her need to pop pills to make it through another day. From there she correctly diagnoses a patient who comes into the ER with a seemingly minor leg injury. Naturally, the doctor on call (Peter Facinelli of Twilight fame) is too arrogant to consider her opinion, setting the stage for the first episode's big moral crisis.

Meanwhile, Jackie must train a chirpy rookie nurse and find time for a quickie with one of the hospital's doctors. No wonder she needs a little medicinal pick-me-up to make it through her shift. She's like the cop who bends the rules to bring justice, total justice, to the streets. But in Nurse Jackie's case, justice means forging an organ donor card signature or dressing down a doctor who refuses to heed her advice.

There's immediate potential there, much like the tension which charged FX's The Shield for seven seasons. Lives are at stake, and one suspects so is Jackie's troubled heart. And that heart sure does beat loudly.

"Quiet and mean, those are my people," she tells a young nurse to stop her from chatting endlessly. Naturally, it's a front, but Falco is just the actress to pull off such posturing.

Black humor is such a natural in hospital settings, even though ER rode the earnest express for umpteen seasons.

The show's best bits are droll little moments, like when Jackie mechanically performs the Heimlich maneuver on a fellow restaurant diner, annoyed that she has to use her life-saving skills off duty. The scene is played with the kind of precision that tells the audience the show isn't interested in broad humor -- thank goodness.

It's every medical show's sworn duty to come up with the most imaginative, funny, or downright gross malady that needs fixing. Here, a stoner shoots a Roman candle out of his rectal aperture and suffers severe burns down yonder.

It's too early for any cast member save Falco to shine, but it's worth noting that Haaz Sleiman, who proved so charming in the 2007 sleeper The Visitor, plays Jackie's nursing confidante.

The show's big visual flourish comes from the cascading pills that Jackie takes to keep on top of her insane work schedule. Or is it to stop her from caring too much? She seems to care less about herself and some of the relationships in her life, something which becomes clear in the final moments of the first episode. It's the kind of sucker punch meant to make you tune in for episode two, but here it comes off as one gimmick too many.

Nurse Jackie still holds promise, both for its uncompromising attitude and the talent of its lead actress. But a few more big twists so early and the show could quickly be put on life support, something a network on a creative roll can ill afford.