An Englishman abroad

Abstract

A fly on the wall film about an English surgeon has been a surprise hit on the festival circuit—largely because it shows doctors as fallible humans and not just slick professionals, says Khalid Ali

Rarely has a documentary film about doctors and patients been such a hit with audiences. The English Surgeon, which follows Henry Marsh, the neurosurgeon of the title, from St George’s Hospital in London to the Ukraine, enjoyed standing ovations at its screening at last year’s London Film Festival. The film is compelling viewing—not least because the central character is so likeable and engaging, like an older George Clooney. The film follows a three stranded narrative: that involving Marsh, another about Ukrainian neurosurgeon Igor Petrovich, and the story of a patient waiting for brain surgery to remove a large tumour. The action flits between Britain and the Ukraine, which Marsh visits regularly. When Marsh first visited Kiev in the early 1990s he was shocked by the inefficient and bankrupt medical system. Meeting the enthusiastic young surgeon, Petrovich, Marsh took it upon himself to lend support to the Ukrainian system through regular visits, performing difficult operations, training young surgeons, and donating surgical equipment.

The film tackles some complex clinical dilemmas. Deciding when to operate to remove a large brain tumour is always going to be a risky undertaking. We see the patient, a young man, agonising over the decision to have only a local anaesthetic while his tumour is removed, to ensure that the removal of brain tissue does not result in limb paralysis. In spite of his fears the patient totally trusts his doctors. How much information a doctor should tell a patient can be a difficult dilemma. To be totally honest without giving false hope, while also not being swayed by emotions, is a daily challenge for the two surgeons. “Making these decisions will always be a difficult task that needs compassion, time, and training,” Marsh says.

Doctors tread a fine line between being brave and reckless or between being wise and timid. The film compares neurosurgeons to mavericks playing Russian roulette (the film is also known by the title Russian Roulette). This well illustrates the difficulty of the decision making process—is it justified to undertake a risky brain operation knowing that the patient might lose his personality, intellect, or ability to walk? Alternatively, is it humane or professional to leave a patient suffering with epilepsy, allowing him to die slowly from a growing brain tumour? In the current media climate in which doctors are often accused of being little more than income obsessed business people, it is refreshing to see a portrayal of doctors as human beings, agonising over clinical decisions as much as their patients do.

This warts and all documentary does not suggest that doctors always make the right decision. The doctors’ fallibility is poignantly portrayed in the case of a young girl who dies from complications of brain surgery. The two neurosurgeons travel to a distant village to visit her family and share a meal with them, and in the process they share their sadness, suffering, and loss. Despite the sad ending to their daughter’s life, the family are still grateful for the hope of cure the surgeons gave them.

Confrontation over medicolegal issues and disqualification are serious threats for doctors who practise in such a difficult specialty. The surgeons are totally aware of the high risk of complications and death in such operations: “We may and probably will kill patients.” However, their determination to continue operating and their plan to build a big neurosurgical centre in Kiev, calling it their “field of dreams,” can only be admired.

Exploring the fundamental theme of the ethos of medicine as a profession, the two surgeons argue whether successful doctors are those who dedicate their life to saving patients or those high flying academics who accumulate letters after their name and a long publication list. The question is left unanswered, something for the audience to think about. The film does not shy away from exposing the frustration that doctors experience when they are faced with bureaucracy, professional rivalry, and financial restraints in the face of ever expanding waiting lists. It makes pertinent comments on commercialising medical practice and considers both sides of this argument.

The English Surgeon ends on an optimistic note with the surgeons’ insistence that they will never stop trying to make things better. The question “What are we if we don’t try to help others?” may come across as a bit sentimental but fits nicely with the film’s theme of doctors as revolutionaries fighting for a better future for patients.

In the current media climate in which doctors are often accused of being little more than income obsessed business people, it is refreshing to see a portrayal of doctors as human beings