Filmmaker Interview

POV: How did you meet neurosurgeon Henry Marsh? And how did you begin to make a film about him?

Geoffrey Smith: Five years ago, the BBC asked me to make a film about surgeons. I asked the boss there, who had met a lot of different surgeons around the country, "Who's the most interesting one? Who's the most human one?" And he said, "Without a doubt, Henry Marsh." I rang Henry up, and the next day, I was with him.

It was a remarkable meeting. What struck me first and foremost about Henry was that, in a sense, he's more of an artist first and a surgeon second. Because of that sensibility, he's aware of his own doubts and dilemmas, and he allowed me into his world. And that's what really drew me in — his ability and willingness to be vulnerable. That same night, we also discovered over some vodka that both of us had a love affair with Ukraine. Not many people in the U.K. had been there, and each of us had been going to Ukraine for over a decade.

Our meeting was like a fated event. We genuinely felt that we had to make this film together. He felt what he was doing was special. I'd always wanted to make a film about Ukraine but never had a way in. So when Henry came along, we realized that in each other, we had each found the perfect platform. Since then, we've spent a lot of time together and shared a lot of interesting experiences. Unashamedly, I will say that Henry really is my best friend and a soul mate. In a sense, while you're watching the documentary, you're watching Henry let me into his world, you're watching my relationship with him.

POV: Tell us a little bit more about why Henry Marsh went to Ukraine in the first place and about the characters we encounter in the film.

Smith: In 1992, Henry went to Ukraine for the first time to give some lectures. Henry was always very interested in the Soviet bloc, and so when he went there, he was keen to see some of the hospital facilities in Kyiv. When he finally got to walk around the hospital corridors, he could see that there was no electricity, there was no equipment, patients were left to die and no one affiliated with the hospital was being honest with him. The last day that Henry was in Ukraine, he met Igor, who was then a very young doctor. Igor told him, in a sort of broken English, "Dr. Marsh, we need you. We need change."

So Henry said to himself, "Here's someone who I can work with, someone who is honest enough to admit that things have to change radically." It's a long story, but Henry got Igor over to London, and then Igor returned to Ukraine and publicly said, "We have to embrace new ways, new equipment and the new world." That was an extremely politically sensitive thing for him to say, and by aligning himself with Henry he incurred the wrath of the people in positions of power, who still had the old Soviet mindset. Igor made a vast number of enemies and even received death threats. The people in power closed him down, took his equipment away and got rid of his staff. He was going to lose everything he'd ever stood for.

Henry decided that what was happening to Igor wasn't fair and he wanted to help him. So Henry drove equipment in to Igor, and the two of them started to operate. They had great results, and the burgeoning free press in Kyiv got behind the two of them and turned them into local heroes, which made it very difficult for the authorities to stifle them. Igor and Henry survived and continued their work, and they've developed a profound friendship over 15 years. That's part of the reason that Henry continues to go to Ukraine, despite that fact that it can be frustrating: He goes because of his profound friendship with Igor and his profound commitment to those patients.

POV: In the film, we're presented with a series of cases that Henry is working on, and each patient has a different diagnosis and the patients have different prospects, some of them very tragic. Henry is faced with ethical dilemmas on a daily basis as a doctor, and he seems very open and honest in front of the camera about his patients. Can you talk more about Henry as a character?

Smith: Henry and I have discussed the ethics of being a doctor a lot, and he feels very strongly about educating the public to be better informed about their surgeons. When patients are sick, they want some superman or superwoman to come and cure them, but doctors are flesh and blood people. They have limitations and they worry about their moral responsibility, particularly in Henry's case, because, as he says, operating on your brain is really operating on your thoughts and feelings.

Henry says that you could lose an arm or a leg, but you'd still be the same person. But with the kinds of operations he is performing, you could come out of the operating room a completely different person. That's a shocking and ever-present moral responsibility that he takes on. So the more understanding there is between patient and doctor, the more dialogue there is, the better it is. The difficulty, Henry says, is in working with the patient to find out what's best for the patient. The difficulty is in deciding what to do, not in operating itself.

POV: There's one scene with a woman who has a non-operable tumor. Her diagnosis is grim, and yet Henry chooses not to tell her the truth, which is that she's going to die. Can you talk about your decision to include that scene?

English Surgeon - Ulyana


Smith: That scene is reasonably close to real time. This beautiful girl walks in, and Henry told me that when he looked at the scans, and then looked up at her, he thought they were someone else's scans. He couldn't equate her with the scans, because the scans were an absolute death sentence, not just in Ukraine, but in any country. There was nothing that could be done. She didn't speak English, so Henry couldn't communicate with her. She was also on her own, and there is an understandable moral principle — as well as medical guidelines — that says you can't impart that type of information to a person who is alone. It's too traumatic. The point of the scene is to confront the viewer and ask, "What would you do in that situation? Would you deprive somebody of hope? Or would you lie?"

Henry is caught in this difficult position, and the beautiful thing in that scene is that both Henry and Igor have to confront their own impotence. They are great men, men we look up to, and each says, "I don't know what to do." They are reduced to men who have lost their certainty. So they chose, at the time, not to tell her. And viewers can think that's either right or wrong, but the real question is "What would we all do?"

I should add that in November of the same year, seven months after we filmed, that woman came back to the hospital. She was already blind. She understood what was happening to her and had accepted the situation. Her mother had not and thought that she could still be cured. Henry and Igor gently broached the subject of her being in the film, and she very gracefully and simply said, "Anything that can help you carry on with the work you're doing is fine." Unfortunately, her blindness was the first indication of the terrible things that were going to happen to her in the future.

POV: Another remarkable scene in the film shows Henry shopping for a standard electric drill in Kyiv. He will then use that drill to open up someone's skull! It's such a shocking scene for a Western audience. Can you talk about the dichotomy, in terms of tools, between Western medicine and medicine in Ukraine?

Smith: There is quite a theme in the film about saving these bits at the end of the drill, and just to clarify things, I should say that as long as that bit is a sterile piece of metal, the drill itself is immaterial. Henry is quick to point out that the vast amount of expense that we indulge in for this sort of equipment in the West is, to a large extent, unnecessary and wasteful. It's just lining the pockets of medical equipment manufacturers. So he tries to save that equipment as much as is possible and recycle it in the Ukraine.

POV: So in the United Sates or the U.K., the drill bit is disposed of immediately?

Smith: Exactly. It's a one-off event. But the equipment is very well-made, because it's medical grade, and Igor's been using the same drill bit and having it re-sharpened for 10 years. So it really puts the whole question of waste of resources into perspective. And, yes, as for the drill itself, Henry's drill in England costs about 30,000 pounds under the N.H.S. system, and Igor's costs about 50 dollars, but as long as the battery on Igor's holds out, it will effectively do the same thing as Henry's drill. So the two of them are both very keen on equipment and making do with limited resources.

POV: What do you want viewers to take away from the film?

Smith: For me, the film is a moral fable. It's not just a document about what happens, or a medical film, or about surgery, or about one man's journey to Ukraine. It's really about one man's struggle to do good things, and that is a universal struggle that confronts all of us. All of us have choices every day about whether to do something good, and Henry's choices are much bigger than ours, generally speaking, because we are not usually saving lives. Therefore, Henry is the perfect vehicle for thinking about that struggle — he struggles deeply with the ability to do good things, but also with the human cost that goes along with it.

In some ways, Henry is no different from us, and that's why we love him. He's vulnerable; he struggles; he lets us in; he doesn't pretend to be a superman. He lets us know that it's the struggle that defines us, that gives us our humanity and that makes us who we are.