MARSH READY TO REPORT SOME BAD NEWS

Self-effacing hero

The English Surgeon is a documentary that's a little vague on some details, but the material -- an extraordinary operation, life and death decisions, hope brought to desperate people, the moral dilemmas of medicine, a study of the inequities in health care, and a look at a profoundly decent and generous man -- is far too good for a few small gaps to matter. The title refers to a London brain surgeon called Henry Marsh, who began making regular trips to Ukraine in 1992 when he arrived to give a talk and saw how dreadful the conditions in his field were there. His collaborator is a Ukrainian brain surgeon, Igor Kurilets, whom he trains and gives equipment to and whose most serious cases he operates on himself when he's there. The film focuses on one of Marsh's trips in the dead of winter when he sees the lowest temperatures he's experienced of his fifteen years of this one-person mission.

A main focus is Marian, a young man with a brain tumor giving him epileptic seizures that must be removed with him awake because Marsh must monitor whether motor function is retained on his right side, and because special drugs aren't available. (Brain surgery under only local anesthetic is a Marsh specialty: Wikipedia article.) We see this, and it's astonishing and not a little disturbing for the lay person to watch. But it's also uplifting to observe the optimism and bravery of the patient, who's committed to the operation and has faith in God and Marsh, and Marsh's sangfroid under the stress of a difficult case, the trickiest operation, he says, he and Kurilets have seen together. It wouldn't have happened without him, because Ukrainian doctors who fail are sacked, so they refuse to do anything tricky. Kurilets has struggled with periods of expulsion from his own profession; he also struggles to raise the funds to build his own clinic -- whose site he shows Marsh (and us), and must rent his current space from the Ukrainian equivalent of the KGB. Marsh at this point expresses his "particular interest in the influence of hospital buildings and design on patient outcomes and staff morale" (Wikipedia article). The fact that Marsh's labor is donated, so the surgery itself is free, helps this poor, small town patient to be able to afford to have his life given back to him. Some of the images of this sequence of the operation are gruesome to look at, but the event is so uplifting one doesn't ultimately experience them that way.

The doctor is haunted by one failure, a seven-year-old girl called Tanya. He shouldn't have operated. Her tumor was too big, and the operation, a failure, only made her two remaining years more miserable. He feels with some reason that he has violated the "do no harm" clause of the Hippocratic Oath. He was trying to do too much. It was wishful thinking. He and Igor travel to visit the family for a ritual meal, a moving event and a search for closure for all concerned. Marsh, who often addresses the camera, turning this into a transcendent and powerful instructional film for aspiring doctors, says brain surgery is easy. It's the decision when to do it that's difficult, because it's so dangerous it must only be done when the risks of not doing it are greater.

Also memorable though brief is the visit to Kurilets and Marsh of a very beautiful 23-year-old woman who has invasive brain cancer. She does not know this yet, but it is inoperable and she will go blind and live only five years, but Marsh explains to his colleague right in front of her -- as he can, since he and Kurilets communicate in English, which she doesn't understand -- that in cases such as this, informing the patient is a too tricky a business to do with only her alone present. So Kurilets arranges for her to come back with her mother. And they don't remove the hope she still has, even though it's illusory, of an alternative diagnosis.

A brief office scene in London before the trip shows Marsh struggling with the electronic system of the National Health's automated records, whose computerized and mindless forms don't allow him to get proper credit for what he actually does. This man of great calm under pressure actually gives up and walks out of the room. While he admits that every time he comes back to the long, dark corridor of Kurilets' clinic with the crowd of patients waiting it's extremely daunting, the independent act of donating work in Ukraine may offset his discomfort with the English medical bureaucracy.

The cinematography here is handsome, the filmmaking unobtrusive, the editing skillfully interweaving the various themes. The understated musical background for this BBC-sponsored film is a collaboration of Nick Cave and Warren Ellis.

As the film begins we see Marsh doing carpentry, making up himself the wood boxes he ships equipment he's salvaged to send to his Ukrainian collaborator. This is another way to deal with the bureaucracy: the healing process of doing things with one's hands. It also links with the improvised tools he and Kurilets find in a market and turn to use in the Ukrainian clinic.

Here is someone who can serve as a role model for any of us. We don't get to see every aspect of his life, but we surely get to see one of the parts that matters most and can take the measure of this rare man.

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©Chris Knipp. Blog: http://chrisknipp.blogspot.com/.