Academic Medicine:
doi: 10.1097/01.ACM.0000413679.82632.9f
Medicine and the Arts

Commentary

Miksanek, Tony MD

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Author Information

Dr. Miksanek is a family physician, Benton, Illinois, and instructor, Department of English, John A. Logan College, Carterville, Illinois; e-mail: tmiksanek@aol.com.

Hard lives. Tough choices. Set in a 19th-century Japanese village, the film Red Beard (1965), directed by Akira Kurosawa, is a 185-minute homage to the inherent grace of both the sick and those who tirelessly tend to them. Physicians and patients alike at the Koshikawa Clinic in the film confront calamity on a daily basis. Sometimes they are endangered by a natural catastrophe—an earthquake, landslide, or storm. More often, they must cope with man-made disasters—violence, squalor, hunger, and abuse. The movie proposes that no life is merely ordinary, that empathy is communicable, and that superlative physicians do not have to be perfect human beings.

Dr. Noboru Yasumoto is a young physician assigned to work and train at the Koshikawa Clinic, a facility that provides health care to a population of underprivileged people. He has just finished three years of medical study in Nagasaki and cannot stand the thought of functioning as an intern at a health center for the poor. His sights are set on a more affluent and prestigious medical career. The haughty Yasumoto is welcomed with a warning: “It's terrible here. The patients are slum people, full of fleas and lice. They even smell bad.”

Yasumoto hopes to be dismissed by becoming a nuisance and breaking the rules at the clinic. The chief physician, Dr. Kyojo Niide, is nicknamed Red Beard. He is an experienced physician adept in the art of medicine. His practice style is holistic: “He looks into their hearts as well as their bodies.” Slowly and painfully, Yasumoto adapts to his new surroundings. In time, he fully understands the important role the clinic plays in the community. He becomes immersed in the lives of his patients. Niide teaches primarily by example, but many of Yasumoto's greatest lessons come from the patients he is assigned to care for. They teach him about courage and selflessness. Despite their poverty and thorny lives, the majority of the sick are exceptionally kind, and a few are even saintly.

By the conclusion of the film, Yasumoto's transformation is both personal and professional. He decides to stay on at the Koshikawa Clinic working with Niide rather than accept a prestigious position to become the shogun's physician. Yasumoto tells his mentor, Niide, “You taught me the road to take.” The older doctor cautions that Yasumoto will likely regret his choice—he will have little status, less money, and virtually no rest. The youthful Yasumoto remains undeterred: “I'll have to find that out myself.”

At its core, Red Beard is a “buddy” movie. The two completely opposite characters—teacher and pupil—embark on a journey that culminates not only in Yasumoto's enlightenment but also with his decision to permanently partner with Niide at the clinic. It is the dedication and resolve of Niide that keeps the struggling medical clinic afloat. Although poverty and ignorance are omnipresent in this village, human grace shines.

Niide is a paradigm of the good physician. He is a complex man who is cherished for his compassion and admired for his relentless advocacy of patients. He is gruff yet caring, stubborn and resourceful, wise but proud. He is an expert listener and a problem solver. On the other hand, Niide occasionally allows his emotions to cloud his judgment. He makes mistakes and readily admits them. He lies (albeit benevolently). He engages in a bit of extortion. Red Beard proposes that an ideal physician does not have to be a perfect human being. The film suggests that perhaps it is precisely these imperfections and past personal failings that allow doctors to be especially empathic. Physicians' own character flaws and setbacks facilitate their connection to and commiseration with patients.

Although Niide exudes empathy, his most defining attribute is his ferocity. He butts heads with the local government when budget cuts threaten patient care. He performs a grisly operation while the incompletely anesthetized patient struggles on the operating table when there is no other clinical option. At one point in the film, Niide challenges some brothel guards who attempt to prevent him from transporting a sick girl to the clinic. Single-handedly, he defeats these half-dozen men, even seriously injuring some. Viewing the casualties, he berates himself for his loss of control, then he and Yasumoto attend to the various injuries that Niide's fury has wrought.

The terrain of Red Beard is jagged and paradoxical. The movie depicts a harsh world where only the poor and those who work at the medical clinic truly seem to care about the welfare of others. It is a place where trouble is always just around the corner, yet so too is an act of kindness. The people who possess the least inevitably are those most willing to give. In this threatening environment, the Koshikawa Clinic is a sort of sanctuary.

This lengthy black-and-white film speaks volumes about service, professionalism, grace, forgiveness, attending the dying, medical education, and the doctor–patient relationship. The movie's title character embodies all those qualities that typically define a good physician, as well as a few surprises, notably his fierce nature. The film is as heartbreaking as it is heartwarming. Red Beard affirms the majesty and challenges of everyday life, the necessity of understanding one another, and the desire to promote good. At the Koshikawa Clinic, doctors are not the only heroes. Patients are too.

© 2012 Association of American Medical Colleges

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