The doctor saves the day

Henry Marsh is biking to work in London on a misty morning in 2007, looking more the part of a country doctor in a perfectly aged trench coat than one of Britain’s leading neurosurgeons. We soon find that he’s also got the wisdom of Solomon, a love of power tools and a wit drier than sherry, all of which serve him well on his yearly sojourns to Ukraine, where Marsh takes on the country’s crumbling infrastructure, failing medical system and desperate patients with a gale force of brilliance, efficiency and charm.

Documentarians are forever in search of a compelling story, which the good doctor is. But in Marsh, the subject of Geoffrey Smith’s latest documentary, “The English Surgeon,” the director is also blessed with a true leading man; a 60-ish sage in scrubs whom you hope you will never have need of but would top your list if you did.

Ukraine first came into Marsh’s life in 1992, when a few days spent as a guest lecturer turned into a private obsession once he saw the primitive medical conditions. Though he was told the problems were too significant and too entrenched to overcome, Marsh decided he had to try.

Despite an extensive London-based practice and a clinical professorship at the University of Washington here in the States, he has come back to Ukraine on his own every year since, diagnosing patients, training doctors, performing high-risk surgeries -- all of which become the focus of Smith’s documentary.

The brain business is unique; as Marsh puts it, you can lose an arm or a leg and survive essentially intact, but diseases of the brain can change the essence of who you are. And that is something that Marsh has spent a good deal of time thinking about, particularly with his work in Ukraine, where he operates out of a former KGB hospital that looks almost medieval, the lack of resources ratcheting up the risk factors.

Tragedy is not hard to come by here, and in the wrong hands, these bare facts and harsh realities could have overwhelmed the film with waves of raw emotion. Instead, like Marsh, the filmmaker has taken a sort of triage approach to telling the tale, with near-perfect pacing as he moves between Marsh, the patients, and Marsh’s wonderful Ukrainian colleague, neurosurgeon Igor Kurilets, whose sense of irony and efficiency are a good match for these dire situations.

As much as medicine, “The English Surgeon” is a story of relationships -- the close bond that has developed between Kurilets and Marsh, the ties between doctor and patients -- creating an emotional narrative made all the more moving for the filmmaker’s restraint.

When it comes to the surgery itself, though, the camera is in the middle of it. The Australian director has long been drawn to the human condition in crisis and is unsparing in detailing the overwhelming medical difficulties that patients and doctors face.

Watching one particular scene in a Ukraine operating room reminded me of a museum diorama of brain surgery during the Colonial period. The patient, eyes open, sizable hole in his head, is being examined by a Sir Walter Raleigh look-alike, drill in hand, bloody bits at his feet.

It turns out that it doesn’t look all that different today, as Marsh and his cordless power drill take on the particularly difficult case of Marian Dolishny and his dicey brain tumor. To minimize the risk of paralysis and worse, he will have to be awake during the procedure, which Marsh promises will have virtually no pain but “can get a little noisy.”

What is noisy for Dolishny is noisy and graphic for us. The lens gets within splatter distance as bone is cut, the brain exposed and Marsh goes about the meticulous yet messy work of removing the tumor. There were groans as drill hit skull -- not in the operating room, where Dolishny holds up remarkably well, but from those of us watching.

Though Marsh has had much success in his Ukraine efforts, there are failures too. Tanya particularly haunts him, a beautiful little girl with big eyes and a tumor pulling down one side of her face.

Marsh has decided to visit the family, whom he’s grown close to over the years of her treatment. It is a modest house in a tiny village. Everyone has gathered for lunch. When Tanya’s mother notices his plate untouched, she worries, “You don’t like the food?” It’s not that, he explains, but the emotion of being here. Marsh raises a glass to the family, then, just for a moment, the doctor gives himself over to their healing embrace.

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betsy.sharkey@latimes.com

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‘The English Surgeon’

MPAA rating: This film is not rated.

Running time: 1 hour, 33 minutes

Playing: In limited release, locally at Laemmle’s Music Hall 3. A Q&A; with director Geoffrey Smith follows the 5 p.m. and 7:20 p.m. screenings this Friday and Saturday.