“It’s about the right thing to do, it’s about conscience, and Prof. Zaizen lacks conscience” according to a star witness at the conclusion of a medical malpractice trial in Satsuo Yamamoto’s adaptation of the novel by Toyoko Yamasaki, The Great White Tower (白い巨塔, Shiroi Kyoto). One of a series of films heavily critical of the medical system in the midst of rising economic prosperity, Yamamoto’s tense political drama presents the succession intrigue at a university hospital as an allegory for the nation as a whole implying that lingering feudalistic and authoritarian thinking has poisoned the contemporary society.
This is in part reflected in the way in which major hospitals are often run as large family businesses where succession is a dynastic matter. In this case, however, the scene is a prominent university hospital in Osaka at which the head of the surgical department, Azuma (Eijiro Tono), is about to retire. Generally, one of his assistant professors would simply move up after being approved by a board comprised of other department heads but the problem is no one, and especially not Azuma, is particularly happy with the most likely candidate, Zaizen (Jiro Tamiya). The issue between them seems to be one of ambition and authority. Zaizen is regarded by all as an excellent doctor with a stellar track record but he is also cold and arrogant with no regard for departmental protocol all of which of course offends Azuma as does his background and person. The son of a country teacher, Zaizen prospered through the dedicated labour of his widowed mother along with family connections before marrying into the extraordinarily wealthy and influential Zaizen family who run a large obstetrics clinic. Consequently, he is free to pursue his interests and lacks the economic anxiety that might make another employee wary of pushing his luck.
His humble background might have placed a chip on Zaizen’s shoulder but it’s also clear he’s part of a new generation that does things differently from the last, apparently keen to build a public media brand appearing in a glossy magazine which brands him “the magic scalpel” thanks to his success in treating pancreatic cancer. While they might not be able to argue with his track record, other doctors worry that Zaizen has developed a god complex and is slapdash with his practice often timing his operations and smugly pleased with himself when hitting a new record. Azuma first picks him up on this in the case of elderly patient, questioning his treatment decisions in accusing him of neglecting to fully consider the patient’s post-op wellbeing. This then becomes something of a recurring theme as good doctor Satomi (Takahiro Tamura) is minded to bring Zaizen in on the tricky case of a man, Sasaki (Nobuo Minamikata), he suspects may have pancreatic cancer but has been repeatedly diagnosed with chronic gastritis.
Though it’s political intrigue that in some senses leads him to Zaizen, Satomi is otherwise depicted as the responsible physician who deeply cares for his patients’ wellbeing and not much at all for interoffice politics. Thus he continues to investigate Sasaki’s case even when other doctors tell him he’s wasting too much time on one patient and should just leave it at gastritis. Zaizen, meanwhile, is the exact opposite taking one look at the X-rays and deciding it is pancreatic cancer after all but thereafter ignoring Satomi’s advice after taking over the case refusing to run a CT scan to verify that the cancer hasn’t spread to the lungs as Satomi fears it might have.
For Zaizen Sasaki ceases to matter, to him the human body is no different to a machine and he perhaps more engineer than doctor even as he proclaims medicine more art than science in insisting that he just knows the early signs of pancreatic cancer while others are unable to detect them. After the first operation we see him perform, a grateful wife stops to thank him profusely for saving her husband’s life though he treats her coldly and implies it’s all part of the job before going outside to celebrate his private glory in his record-breaking feat. It’s then a minor irony that he finds himself later slapped with a malpractice suit by Sasaki’s wife upset that he was unavailable as her husband was dying because he was preoccupied with the ongoing elections for Azuma’s successor.
The implication is that the dehumanisation of the health industry has reduced it to the status of any other company, the head doctors no better than ambitious salarymen whose lives are defined by their job titles. The various department heads eventually descend into factions with Azuma plumping for an external candidate, Kikukawa (Eiji Funakoshi), while others line up behind Zaizen or his internal rival Kasai (Koichi Ito). Influence is brokered largely by outright bribery or industry manipulation by external influential players including Zaizen’s wealthy father-in-law and a professor in Tokyo who can offer monetary perks, access to funding, and potential promotions to those willing to vote for their chosen candidate. The main argument against Zaizen is his bad character, yet the fact he has been carrying on an affair with a bar hostess is never used against him even as they prepare to smear a rival candidate with his mistress even suggesting they hire a hitman to take him out completely. Zaizen’s minions meanwhile make an ill-advised visit to Kikukawa to ask him to withdraw bizarrely stating the importance of maintaining “democracy” even as they themselves deliberately undermine it for their own gain.
It’s this sense of feudalistic, fascistic authoritarian chumminess that Azuma’s daughter Saeko (Shiho Fujimura) later decries in asking her father why he did nothing to change such a destructive system while he himself had the power to do so the implication being that he saw no need because he continued benefit from it. Only she and Satomi present any kind of challenge to the hypocrisy that pervades the medical system but eventually discover that there is no place for integrity in the contemporary society. Zaizen miraculously falls upwards every time because his success is more expedient that his failure. Even the Tokyo professor brought in as an expert witness during the malpractice suit declares that Zaizen is unfit to be a physician because of his arrogance and total lack of human feeling but pulls back from testifying that he caused the death of his patient through negligence later explaining to a colleague that if a university professor were to be found guilty of malpractice it would undermine public faith in the medical system.
If can’t they can’t have faith in the medical system, the very people who are supposed to care for them when they are most in need, how can they have faith in anything else? As the rather bleak conclusion makes clear, the entire system is rotten to the core and no longer has any place for idealists like Satomi who are continually pushed to the margins by those jockeying for power in this infinitely corrupt society defined by hierarchy and cronyism while ordinary people, like Sasaki, continue to pay the price. Just as in his opening sequence, Yamamoto takes a scalpel to the operations of the medical industry to expose the messy viscera below but ultimately can offer no real cure in the face of such an overwhelming systemic failure.
Original trailer (no subtitles)