Touma (Shinichi Tsutsumi) is a doctor who has abandoned a promising career in the medical elite, left a top-flight university hospital, and gone on a quest to hone his skills. He is an eccentric who has studied organ transplants in the U.S.A., but has not followed this path on his return to Japan, preferring instead to practice 'regional medicine’ outside of the major urban areas. He has chosen this path because of his mother, who died because a specialist, could not be found in time. 

A melancholy surgical drama with a hard-boiled feel.

JAPANESE FILM FESTIVAL: According to aficionados, Japanese cinema has a fondness for hospital melodramas; one wag in The Japan Times wrote that what westerns were once to Hollywood, medico dramas are to the contemporary movie-makers of Japan – a reliable genre, with ready-made plots, scope, promising plenty of narrative excitement.

Whatever the case, at this year’s JFF there are two 'white-coat and stethoscope’ melodramas: Miwa Nishikawa's sweet and funny Dear Doctor and Izuru Narushima's melancholy and moody, The Lone Scalpel. Both films offer up a mediation on duty and identity; both use their narratives to make some telling observations about the way the Japanese bureaucracy deal with medical service and the political, social and culture issues that come with it (particularly in the provinces; both movies are set in small towns).

Still, far from being austere social critiques, both pictures are warm and human and perhaps even mythical; both movies concern mysterious strangers whose powerful personalities embolden those around them into action. Perhaps The Lone Scalpel is the finest of the two; but such claims and comparisons, especially when movies are this good, are odious.

Told in flashback, the film begins as a story about a disillusioned and disgruntled nurse, Ryoko Nakamura (Yui Natsukawa in a superbly modulated performance). A single mother, with a young son, she finds the atmosphere in the small hospital where she works grim, and sad; here, doctors pass the buck, in order to save face, meanwhile, patients suffer or die.

Then everything changes when Dr. Toma (Shinichi Tsutsumi) arrives; he’s tough, he lacks social skills, but he’s good with patients and he’s a genius in the OR. Pretty soon Toma soon changes the culture of complacency in the hospital; the staff are split between supporting Toma and resenting the changes his influence will bring (which amounts to having all staff take on their civic and moral duty and treating it with the sincerity such a commitment deserves).

Based on a novel by Toshihiko Ogane, the plot derives, in part, from a true story about Japan’s first liver transplant, and it has a no-nonsense, hard-boiled feel. This is a movie about work; thus Narushima takes us into the operating theatre and guides us through the intricate life and death medical procedures. It’s not pretty; there’s frank and disturbing images here of patients with their insides exposed and huge close-ups of pulsing organs. At first, all this stuff is very upsetting. But as Toma’s quiet, assured style takes hold, the OR scenes become less traumatic in their effect, but no less graphic.

Still, for all of its seriousness, The Lone Scalpel has an edge that’s sweet; the translated Japanese dialogue has a lovely poetic sweep that’s deeply moving. (At one moment Nakamura writes in her diary that every day in the OR starts with hope but ends in a 'sea of blood.") Given the predictable sounding set-up, The Lone Scalpel evolves and developments in a surprising way that’s deeply satisfying; Nakamura falls in love with Toma, but the expected full blown romance never really arrives. Even the book-end structure – where Nakamura’s grown up son, played by Hiroki Narimiya, now a doctor, reads his mother’s diary – has a beautiful pay-off.