Sean McCourt: Geoffrey Smith on The English Surgeon

The 51st San Francisco International Film Festival wrapped on May 8th, but I'm still finding people interested in talking about favorite films from the two-week festival. I'll be writing more on some of them soon, but in the meantime here's a piece on a documentary I missed called the English Surgeon. Luckily, able correspondent Sean McCourt caught the film and spoke with its director, Geoffrey Smith:

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In the medical world, there are serious risks associated with any kind of surgery. If a mistake is made during a procedure on a leg or arm, there might be some loss of movement or ease of mobility, but the patient can still generally go about their lives, perhaps with a slight physical handicap. If something goes wrong during a brain surgery, however, a person can lose their memory, their control of motor skills, even the ability to think.

This is the challenge that faces British neurosurgeon Dr. Henry Marsh every time he operates on somebody, and is one of the personal revelations about his work that he shares in the film The English Surgeon, which screened at the San Francisco International Film Festival on May 1 and 2.


Marsh has been traveling to the former Soviet republic of Ukraine since 1992, volunteering on his own time to help in a region of the world that has a medical system that lags many decades behind those in the industrialized West -- and where many cases of brain tumors and other illnesses go undiagnosed or misdiagnosed for so long that what would have been easily taken care of with a routine operation or procedure at Marsh's hospital in London have now progressed to the point that there is little doctors can do to save the patient's life.

During the screenings at the Sundance Kabuki theatre, audience members alternated between quietly sniffling and dabbing their eyes during the more heart-wrenching scenes, and then bursting out in collective laughter (and relief) during some of the film's more light-hearted moments.

That emotional dynamic and natural flow to the piece was of significant importance to director Geoffrey Smith, who discussed his film along with Dr. Marsh the day after the first screening of the festival.

"The only model one has [when making a film like this] is what you see out there. When I first went out with Henry, that's really what happened, it was funny, farcical, surreal, tragic, moving, and then it would just start over again. Life in many ways is like that in the Ukraine, so it gave me a model to structure the film, and also to pace it emotionally, because just when you think you're safe, you get another wake up call, and then you have another piece of humor. It feels good though, it feels real, because that's how reality is there."

"I think the thing about these situations is that people in extremes, people in difficulty, of course it's dramatic, but it also allows us in to see how people cope, and how other people treat them, what those dynamics are. Ultimately it's a great metaphor, a barometer, for how good or otherwise, society is. It challenges all of us to do something. So, if you can encapsulate those forces into a human story, and medicine is very useful for that, I mean, it also has a beginning, a middle and an end, it's a useful technique."

"I love sort of the difficult stuff; the ethics and the dilemmas, because, life, it seems to me, is more about that, it's not simplistic and clear cut. You and I can't save lives with our hands, we can do all sorts of small things, and it's the choice we make or don't make, and it's the decisions about those things, that's where it resonates with each audience member, as it gets closer towards the end, it starts to grab you by the throat and ask the same questions."

Both Smith and Marsh have long been interested in Ukraine, each having their own reasons for initially making their visits.

"The first thing about the Ukraine for me was meeting people on the Trans-Siberian Express back in '83. I corresponded with people, and I had a chance to go after the wall went down properly—I fell in love with the city and those people, I really, really did," says Smith.

"There's something that you can't put into words -- back in the early '90s, the place was absolutely dire, the whole bottom had fallen out of it, and we have seen, literally, this country transform in some ways, and not all of them good, but it's intoxicating to be there because of the rate of change, and amount of possibility is like you could never have in the West."

Marsh had been interested in Russia and Russian cultures since he read Tolstoy at the age of 16; he later attended Oxford University, studying politics and economics, with a specialization on the Soviet Union.

As he puts it, he then "strayed into brain surgery, in that way one does, and I never thought I'd be able to combine Kremlinology and brain surgery. By chance in 1992, a local businessman in my part of London was looking for some neurosurgeons to take out to Ukraine, which had just become independent, to give sort of good will lectures—to maybe help him sell British medical equipment—it was rather naïve in retrospect, because the Ukraine was totally bankrupt at the time."

Marsh says that his initial introduction and first visit to a place he had learned so much about from afar was a jarring one, but he found himself thoroughly intrigued.
"It was a totally extraordinary, intoxicating, terrifying time—if you had a hundred dollars in your pocket you were a millionaire, it was like sort of being in a dream world. It was horrifying actually, it was very deeply depressing. I remember getting back to my hotel room with one of my colleagues and opening a bottle of duty-free whiskey and drinking most of it in a state of sheer shock at seeing such rough medical conditions."

After returning to London, Marsh heard nothing for a year, but then got a Christmas card from one of the doctors he had met on the visit, Igor Kurilets, who had gotten approval to ask about coming to London to work with the esteemed surgeon, and learn from him. Marsh accepted, and during the three months that the two worked together, they developed a strong bond, and once Igor went back to the Ukraine, Marsh began taking trips to visit him, bringing him used medical equipment from London so that the poorly provided for clinic in Kiev where he practiced could have a better chance of helping people.

Smith, who has made a variety of documentaries over the past 20 years, first heard about Marsh while making a BBC program about surgeons, and was immediately drawn to him as a subject.

"What I like about him is that he's able to articulate these things, he's able to let you in, to be vulnerable, and fragile maybe, even to be flawed, and ultimately wrong, perhaps, or at least admit the possibility of that. But within all of that there's this wonderful 'Nobility of Failure,' as he calls it, which immediately makes us feel like we can relate to him. He's not putting on a show, he's not perfect, he's not contrived, he's not pretentious nor arrogant; he's one of us at that level. Mixed in with great humor and compassion, he's a hero, and that world loves a good hero."

During his visits to Ukraine and Kurilets' office, Marsh learns of the case of a young man named Marian from a small village who has a brain tumor that has been deemed inoperable or too tricky for native Ukrainian surgeons to deal with. The film features the parallel journeys of the patient and the doctor to the city, with the final outcome being that Marsh decides that the procedure is possible to do in the Ukraine—but in a manner different than what would be done in the West. Due to a lack of needed equipment and properly trained staff, Marian will have to be awake during the operation—a local anesthetic will be used as opposed to a general one, so he will have to hear and somewhat feel what is going on.

Intermingled with this part of the narrative are scenes of Marsh helping Igor with consultations of other prospective patients, sifting through lines of people that stretch down entire hospital hallways, some people being told what they should do for their treatment, others being told that nothing can be done.

Also mixed into the film is the story of a young patient named Tanya that Marsh tried to help several years ago, bringing her to London for a surgery that ended up not going as planned, resulting in the girl's eventual death a couple of years later. During his visit to the Ukraine when accompanied by the filmmakers, Marsh decides to visit Tanya's mother, Katya, enveloping viewers into an even more personal emotional journey.

"It was the first time I had seen her since she and Tanya had left London. [She lives in] a very remote part of the Ukraine, and I didn't really have any reason to visit her before. I'm very busy when I'm there, and Igor would see no point to it, 'what's the point, it's sentimental.' But he could see the film was a good idea, it wasn't going to do him harm, it was easier to say, 'let's go and see Katya.' Igor is a nice guy, but he's not sentimental," says Marsh.

"Going to see Katya was nice for me, not that I felt guilty or bad about what I did—I tried, and I failed. When I was walking in the cemetery, I felt all the dead faces on the tombstones saying, 'well, you tried, that's something, at least you tried.' But it was nice to see Katya, because although we don't have a common language, we were very close; she had been to my home [in London] many times, and it was good to see her again."

The English Surgeon features a soundtrack composed by Nick Cave and Warren Ellis, which adds to film's tone, but never attempts to take it over; it us is used very sparingly, which Smith says worked perfectly in the end result.

"I think the thing that's important to realize about Nick is that he is enormously cine-literate; he watches more films than anyone I know. He's a softie, but in a way that he responded exactly to Henry, because what he saw in the paper proposal and in the rushes, is someone who is utterly unsentimental, and yet through the almost melancholic idea of the failure of things, in the failure, there's all the love and goodness and trying and the redemption that Nick writes about."

During many of the most dramatic scenes, such as when Marsh and Kurilets have to tell a grandmother that there is nothing they can do for her grandchild, there is no music—the enormity of the real-life situation is enough on its own, which Smith says that they were all very conscious of during the making of the film.

"Nick is very strong on the complete idiocy of using music to manipulate the story, and so am I. It's the power of what's going on, and there's no music under any of those emotional scenes, because that would be really silly."

The English Surgeon presents a very moving and powerful story about what a couple of strong-willed individuals are attempting to do to help their fellow man—but both the director and subject want to steer clear of any perceptions that this could be a 'feel good' or 'self-congratulating pat on the back' type of project—and they know that the film wouldn't be as effective without the contributions of Kurilets.

"My very close friendship with Igor is an incredibly critical element. I really like seeing him, he really likes seeing me. Our idea of socializing is work, you know, my idea of a holiday is to go and operate in the Ukraine—I'm not interested in beaches and things like that," says Marsh. "[But we] have to be very wary of ethnic voyeurism, you know, these wealthy, comfortable, well-fed Westerners nip into a bit of hardship overseas, and then say, 'Gosh, wow, this is reality,' and then nip back home again. I hate that. But there is a certain nobility—with suffering and poverty people have to surmount problems we don't. They are in some ways finer people than we are, because they've been tried. If they survive, if they transcend their terrible difficulties, as Katya in a sense has, maintaining her dignity, I'm filled with awe, and God knows how would cope if I had to cope with what they cope with."

"There's a great quote by the Hungarian poet Faludy, who said that Soviet communism is like acid poured over metal—people made of base metals were destroyed, but people made of gold shone all the brighter. When I see people like Igor or Katya, that's what I feel. But how I would be if I had the acid poured over me? None of us knows until it happens; all one can do is see that some people have come through that, and it's very humbling."

--Sean McCourt