• Alex Borstein and Laurie Metcalf run a dead-end (literally) hospital unit.

There’s not a whole lot that isn’t depressing about nearing the end of life. It’s lonely. Your daily routine is whittled down to the point that it consists almost exclusively of the execution of basic bodily functions—eating, sleeping, bowel movements—unassisted, if everyone’s lucky. Dying’s probably the least depressing part of the whole affair.

HBO’s new series Getting On—an adaptation of a BBC sitcom by the creators of Big Love—makes no effort to portray being old and infirm, and being surrounded by the old and infirm, as anything less than grim as fuck. Naturally, it’s a comedy.

The show is set in the women’s extended-care unit of a California hospital that’s on the verge of losing its Medicare reimbursement. This funding concern is brought up at least twice in the premiere episode, but within the context of what you’d think would be a less pressing situation: a piece of human shit was discovered in the lounge.

The feces—”a feces,” according to one nurse, because “it wasn’t a gang of them, it was just one piece”—becomes the narrative device through which we learn about the hospital’s female staff and their hierarchy. Brand-new Nurse Ortley (Reno 911‘s Niecy Nash) finds the poop and just wants to clean it up. Those efforts are stymied by her immediate supervisor, Nurse Dawn Forchette (Alex Borstein of Family Guy and MADtv), who insists they identify its origins and file an incident report. Dawn’s supervisor, Dr. Jenna James (Roseanne‘s—and Steppenwolf Theatre Company’s—Laurie Metcalf), wants the poop to be preserved for a “fecal study” she’s working on. See, the unit isn’t just a dead end for patients, it’s a career dead end for its staff, and James isn’t about to get stuck (although that’s exactly what happens by episode’s end).

This isn’t just scatology for yuks—to an extent, the characters’ work lives do revolve around shit. It’s healthcare depicted at its least glamorous. (Though the juxtaposition of the scene where Ortley finally cleans up the poop and one where Dawn is sucking chocolate cake from her fingers just feels a little excessive.) Later in the episode, we see the theme dealt with more tenderly as Ortley helps a patient use the restroom and clean up.

The show isn’t exactly hilariously funny (yet), but Laurie Metcalf’s return to a leading sitcom role is enough to get excited about; she plays Dr. James with the same sort of barely restrained mania she brought to the character Jackie on Roseanne. (Full disclosure: I own every single season of Roseanne on DVD and I think Metcalf is one of the greatest things that ever happened to sitcoms.)

Eventually, we all have to accept to the reality of aging. I have a feeling that the sooner I do, the better I’ll enjoy Getting On.