We first meet Tom Krueger, one of four doctors featured in a gritty new documentary, amid green hills and gamboling horses on his 40-acre farm outside Nashville. Soon after that we see him in an emergency hospital in Monrovia, Liberia, where a long civil war recently has ended. He's inspecting a leg so badly infected that he decides the patient needs a "guillotine amputation" -- that is, a straight, flat slice across all skin, muscle and bone.
It's such an antiquated technique that it had already come, gone and been resurrected by 1919, to the dismay of at least one surgeon of the day
. But what else can Krueger do in a war-torn capital with limited facilities, limited tools and problems too advanced to be solved simply or over time? And so the sawing begins.
"I bet my grandfather could have done a lot better here than I'm doing here," the Tennessee surgeon remarks into the camera, referring to the relative who introduced him to surgical medicine. It's 2005, he's on his first mission for Doctors Without Borders, and he cannot imagine describing it to anyone he knows at home -- the heat, the sweat, the smells of pus and unwashed bodies, "the smell of your own panic when you're not sure what to do."
A comfort zone is a relative thing. Mine is a liberal Washington, D.C. neighborhood jammed with professionals who work in media, law, government and politics. The people on my block are black, white, young, old, straight, gay and -- in one case -- French. Yet our careers, ideologies and incomes are similar. So are our interests and wardrobes. We often wear blue jeans and black sweaters. We hang out at bookstores and coffee shops, and frequent nearby movie theaters that show arty films. We live in what amounts to a huge upper middle class comfort zone. I plead guilty to hardly ever leaving it, whether geographically, politically or psychologically, and that's something I'd like to change in 2010.
This resolution came to me after I saw three seemingly disparate movies and realized that all three were about people brave enough to abandon the familiar. In "The Blind Side
," white Southerner Leigh Anne Tuohy decides in an instant of personal reckoning to welcome a very large, cold, needy black teen-ager into her nouveau-riche mini-mansion. In "Precious
," an abused black teen-ager emerges from a prison of food, fear, shame and insecurity to take her place in the world. And in "Living in Emergency: Stories of Doctors Without Borders
," four doctors leave comfortable lives in Australia, Italy, and the United States to provide care in Africa amid war, terrorism, poverty and chaos. The film, directed by Mark Hopkins, is on a short list for an Academy Award nomination for best documentary feature; the nominees will be announced Feb. 2.
A non-governmental organization based in Paris, Doctors Without Borders
-- or Medecins Sans Frontieres (MSF) -- received the 1999 Nobel Peace Prize for its work sending doctors to areas in crisis. The U.S. recruitment page
lists travel outside the country and "flexibility and adaptability" along with more traditional school and work requirements. Only about 10 percent of Americans who apply to MSF end up in the field; the rest lack the right experience, specialties or temperament.
The MSF doctors inhabit an adrenaline-driven universe that is sometimes dangerous, sometimes isolating, and at best offers little in the way of amenities. In the Hopkins film, shot in 2005-2006, Australian Davinder Gill, then 26, is stationed alone at a remote clinic in Foya, Liberia. His anger about all that he cannot accomplish medically, all the supplies and facilities he lacks, boils over in the film and alternates with a callousness that may be superficial, but is still disquieting. It is not surprising to learn that he has not been on another MSF mission
since Foya, his first.
Another Australian, Chris Brasher, 42, went on missions for nine years starting at age 29 before taking a fellowship in neonatal and pediatric anesthesiology in Paris. Krueger, a married father of two, was 40 when he interrupted a thriving surgical practice to do missions in four countries. Italian toxicologist Chiara Lepora, 34, spent six years on three MSF missions and now is studying "the ethics of medicine in international conflicts and complex disasters" at the National Institutes of Health just outside Washington, D.C.
First missions can last from two weeks to 18 months. The intense conditions lead to hard living -- drinking, cigarettes, some drug use, a lot of sex -- possibly because there is so much death and "sex is life," Lepora says in the film. Krueger, a Bible Belt resident with a theology degree, tells the filmmakers that MSF interviewers asked if he could handle any drug use he might see. No problem, he said, and joked about the quantity of drugs on campus during his college years. Krueger waited for his children to grow up before applying to MSF. It had been his dream for years. "I really wasn't giving of myself the way I had wanted to," he said of his medical career in Tennessee.
Brasher, who was program director for eight countries at the time he was filmed at Kayna hospital in Congo, says in the film that a lot of people are running away from where they're from. "That's certainly my reason," he says lightly into the camera. "If I was looking to make myself homeless, I think I've succeeded." In an e-mail to me, written from Paris, Brasher called that a throwaway line edited from an hour-long discussion.
"I needed to get off the big isolated island that is Australia, and just going to another rich country with existentialist computer connection problems and life insurance issues did not seem to be the answer," he told me. "I hoped to learn about life from wise people, and was not disappointed. That seems in retrospect to have been my contract: I'll come and do medicine as best I can ... and I expect to be taught about life in exchange. I believe I got a better deal than the patients in the end."
Lepora, head of mission in Liberia at the time of the film, says people sign up with MSF for all kinds of reasons, but they stay for better ones. "You want to be good, or you want to run away, or you are looking for adventure, or your boyfriend is doing it. Whatever those reasons are, they are rarely precise," she said in a phone interview. "What really matters for people who continue doing it, usually the reason is not anymore about you, but understanding and getting to be aware that this (the work) needs to be done."
There is no way to prepare yourself for that first mission, Lepora told me. Before hers to Angola and Congo, she was assured that "of course" there were showers -- "what do you think, people don't wash themselves?" When she arrived, "the field coordinator took me to this little room and showed me a bucket and showed me a cup and said 'here's the shower.'" What did she do? "I took a shower. You have no choice at that point. You realize very quickly that the things you value are not that important. You have to take a shower with a bucket and a cup, that's perfectly fine."
On a far more profound level, Lepora told me that you can never prepare yourself for so much death. On the second day of her first mission, there were six deaths in one day -- more than she'd experienced in her entire career to that point. "I don't think you get used to it," she said. "It hurts more and more, the more you see it. You adjust your mental expectations so you know it happens. You know you have to work knowing it happens ... The moment where you internalize that knowledge, you get to be really aware of it, it's not about accepting it. It's about doing more."
That's the ideal. For some, such as Gill, it doesn't happen like that. The film paints a complex picture of the young Australian as he lashes out about communications and supply problems ("Go do your inadequate job somewhere else!" he fumes to an MSF employee) and seems to become more detached from his patients. It's fine to say, as he does in the film, that the first couple of deaths are terrible but then "it just becomes part of the work and you just try your best." But the filmmakers also capture a disturbing fatalism.
When a toddler is brought in, his stomach distended and his body swollen from head to toe, Gill decides it is kidney disease brought on by E. coli and says he is glad. "I'm glad because it gives me a cause and there's nothing I can do," he says. When he is awakened with the news that the mother and child have left the hospital, he makes no move to try to bring them back. "Let them go. I'm not offering them a lot," he says. Lepora, who is there visiting him, is so upset at his attitude that she walks out of the house. Later she remarks wryly that he is getting into Heart of Darkness
territory, all alone in his kingdom.
Contrast that with the team that treats a Liberian man brought to the Kayna hospital on Brasher's watch. He has been shot at point blank range and there is blood dribbling from his head. There is no equipment to figure out what kind of brain damage he has and the hospital has run out of the drilling screws that are needed. The team is flying blind with little hope, but they go ahead and drill into his skull with the wrong type of screw in order to drain liquid. He eventually opens his eyes and is asked to identify a man standing at his bedside. "My son," he says, and the doctors rejoice right along with the relatives.
Later the medical team celebrates with cigarettes, beer and a hilarious self-congratulatory monologue from Brasher about MSF's swashbuckling brand of activism. He boils it down to we're here, this is what we do, we're going to do it. Then he parodies "touchy-feely" relief groups and a possibly fictional "guy from UNICEF" who's been to "seven meetings in the last 24 hours about all the different sort of theoretical programs that might happen in the next, like, three years." By the end, everyone is laughing. (Full disclosure: I have donated to both of these organizations on occasion).
Brasher says in the movie that "apocalyptic" conditions in Liberia in 2003 during its civil war -- no water, civilians randomly wounded and killed, buildings peppered with mortars -- made him decide he "didn't have the stomach" for much more. He took one more assignment, the one in the film, then returned to what he calls "sedentary life." In some ways, he told me, that's harder than being in the field because "we are distracted from real meaning." But he does not expect at this point to return to MSF.
After Liberia, Lepora became emergency coordinator for Somalia, Chad, Cameroon, Sudan and Kenya. It was her last stop before she accepted the NIH fellowship, part of her attempt to pace herself and recover from burnout. "Taking these two years doing something that is totally intellectual in a very excellent environment is a way for myself to be recharged," Lepora told me.
Still, her studies are directly related to her MSF work -- analyzing moral conundrums such as whether terrorists have the right to health care. MSF doctors often face the question of whether they are fueling a conflict by treating people who are part of it, she said. Her research led her to a clarifying conclusion: "It doesn't really matter whether there is any sort of extreme or horrendous action that somebody does. As a doctor I still hold the duty to treat people independently of who they are, where they come from. It's not their right, it's my duty." Lepora plans to take her new insights into the field on her next MSF assignment. In fact, she joked to me, "coming to D.C. really put me outside of my comfort zone."
Okay, that makes me feel slightly less cowardly and routine-bound. Here's one more narrative. In Washington, a print newspaper reporter becomes an online columnist and goes to see films she would have avoided in the past as too disturbing -- films like "Precious" and "Living in Emergency."
It's a start that I intend to build on. I don't anticipate making choices nearly as dramatic as those made by Chris Brasher, Chiara Lepora and their MSF colleagues. Nor can I expect to match the fictional Precious, so courageous in her transition from an unloved, withdrawn, emotionally crippled victim to a loving mother with responsibilities, ambitions, an education and a future. It is the true story of Leigh Anne Tuohy that seems closest to home and most feasible to emulate, even with the upfront decision that unlike her, I won't be adopting anyone.
"The Blind Side," though fact-based, unfolds like a Hollywood fairy tale. It doesn't have the edge or depth or tragic ambivalence of "Precious" and "Living in Emergency." But there is a scene I did find breathtaking. It's when Tuohy, having told her husband to turn the car around, gets out, faces the chilled, homeless teen-ager, and decides in that moment to take the biggest risk of her life.
It's a get-out-your-handkerchiefs movie moment, I know. But it can be an inspirational movie moment, if we make it so.