Enrique García Merino
Asesoría técnica de la Revista de Medicina y Cine. University of Salamanca (Spain)
Correspondence: Enrique García Merino. Alvaro Gil, 27-1ºB, 37006 Salamanca (Spain).
Received 10 June 2007; accepted 10 September 2007-10-18
Keywords: Prostate cancer, Rectal examination, Prostatectomy.
To Editors: Venus (2006), by Roger Mitchell, is a film about old age as seen from the perspective of three elderly gentlemen in physical decline. Maurice (Peter O’Toole) is one of the main characters and for some years he has engaged in daily meetings at the Cabin Café in London, his home city, with Ian (Leslie Phillips) and Donald (Richard Griffiths). Maurice and Ian are good friends and both are actors. Maurice is still working and Ian is between jobs. Maurice is involved in a TV series in which he represents an old man who in one of the scenes appears dying in a hospital.
The arrival of the daughter of one of Ian’s nieces, Jessie (Jodie Whittaker), to look after him completely disrupts their lives. On one hand, Ian sees how his expectations about being attended to vanish in smoke, since Jessie is neither pleasant to him nor knows how to cook, and she begins interfere with his (very, almost meticulously) ordered life. In turn, Maurice –trying to help his friend- decides to take Jessie out to see the town and what it has to offer. He is very attentive towards her and becomes caught in a tangle of love and impossible desire. Jessie is the counterpoint to ageing offered by the film, since she is a clear example of today’s youth, or at least part of it.
Maurice is a friendly sort, who tries to put a brave face on the potentially fatal nature of his disease. He is a drinker and a smoker who continues to have good relations with fellow workers; he has been a bit dissolute in his day, but he is on good terms with his ex-wife Jillian (Cathryn Bradshaw), who he abandoned, together with their children, for other paramours. Peter O’Toole’s acting, at his 73-74 years of age, is nothing short of magnificent. In contrast, Maurice’s “shadow” is Ian, who is cautious, methodical and somewhat depressive.
The title of the film derives from a picture by Diego Rodríguez de Silva and Velázquez -Venus at her Mirror- in the holdings of the National Gallery in London. Jessie wants to be a model, a fashion model, and Maurice manages to find her a job, although it is as a model at a painting school, where in the end -as a counterpart to her initial reluctance- she almost triumphantly poses naked, following the composition of Velazquez’s famous picture. Jessie is a modern girl, whose only “sin” has been an abortion in the past) and -as we anticipate- she inevitably feels drawn to Maurice.
As could only be the case, the film reflects some of the personal and social aspects typical of ageing. Thus, we see the relations between people of different ages, between ex-couples, the sexuality of the elderly, forgetfulness [*You’ve got my glasses (Ian). No, You’ve got them (Maurice). How am I going to have them, I’m not wearing them. Oh God, I’ve lost them, that’s the worst thing that could happen to me (Ian). You have them in your right hand (Maurice)], loneliness, the need of assistance of both healthy (Ian) and sick (Maurice) elderly people, the joy of having pets (Jillian), the lack of financial resources, the loss of old friends through demise, the awareness of the closeness of death, etc.
The film also explores certain characteristic medical problems, such as eye strain (presbiopia) and being prone to depression. The film begins with a meeting in the café where we see how the elderly seem to be condemned to a life revolving around prescription drugs. On choosing the pill with the nicest colour, Ian opts for the blue ones (I recommend any of the blue ones); a clear nod to Viagra. The avid “popping” of pills and capsules and tablets underscores the trust in drugs by the elderly for them to remain alive. At this moment, the film also drops a hint about the importance of reading the drug prospectus and studying the contraindications of each (Do not handle heavy machinery. Keep out of the reach of children). The plethora of prescription of drugs taken by some elderly people means that it is necessary not only to know the contraindications and side effects but also drug interactions. The physical deterioration of the three old gentlemen and of Maurice’s wife, who has to walk with the aid of a crutch and finds it difficult to get around, is clear, but the most impacting aspect is Maurice’s prostate cancer, which he refuses to divulge to his friends and acquaintances (I hate compassion). After an apparently routine check-up, Maurice’s doctor performs a rectal examination, where he finds a prostate tumour (The prostate should be like a peach with a groove in the centre; yours has a few lumps. It’s possible that it’s just a small nodule but it may be nothing so I’m sending you to a specialist), and he makes the typical comment: Many men have this but it doesn’t usually kill them. Maurice replies, Yeah, you die of something else before, and the doctor retorts Exactly! It’s something to worry about but not too much. The exploration is done laterally with the help, as usual, of gloves and lubricant, accompanied by gentle banal reassurances from the doctor (Going anywhere exciting on holiday?), asking him to breathe deeply when doing the examination and mentioning that he himself does not relish his own rectal examinations. Maurice finds this disagreeable and painful. With the results of his blood analysis, which is carried out by nurses who are seemingly unaware of his presence and chatter away in his presence, Maurice is admitted for a prostatectomy. A nurse begins to prep him and shave him, and is probably going to give him an enema. Before the operation, the surgeon who is going to perform the procedure tells him, giving him the impression that he has never seen him before, that he has done this hundreds of times and that there is a high probability of Maurice becoming impotent and incontinent, although he will not die. After the operation, Maurice insists on leaving the hospital before he is officially discharged. He is weak and in an acting scene he actually has a dizzy spell. He has been fitted with a urethral cannula with its corresponding bag and confesses his impotence to Jessie. He also says that he is going to die, suggesting that his cancer is very advanced and was already terminal.
The film highlights the practice of prostate cancer screening in older men, whose actual value has not been clearly established1,2, and the importance of rectal examinations for elderly men. It does not portray any symptoms or signs of the disease except for the deterioration of Maurice’s state of health. Neither are we told of any additional diagnostic tests, such as the determination of prostate-specific antigen (PSA). One would imagine that the determination of this parameter would have been included in the blood analysis that Maurice underwent prior to his operation, or that an echograph or an ultrasound-directed biopsy would have been performed. And there is no mention of a CAT scan or the use of NMR to determine the extent of the lesion. Another feature absent is any reference to hormone treatment, radiation therapy, brachitherapy, chemotherapy…. And, as viewers, we are offered little in the way of being able to know whether the script writer was thinking of any specific surgical technique for Maurice’s operation.
Prostate pathology does not appear very often in the cinema and Venus is a good example of a film showing what happens in prostate cancer. Wild hogsdoes place viewers in a situation related to another pathology of the prostate -benign hypertrophy- but only in a couple of brief comments, which are easily missed.
Director: Roger Mitchell
Music: David Arnold and Corinee Bailey Rae.
Screenwriter: Hanif Kureishi
Cast: Peter O’Toole, Jodie Whittaker, Leslie Phillips, Richard Griffiths, Cathryn Bradshaw, Vanessa Redgrave, Beatrice Savoretti, Philip Fox, Ony Uhiara, Ashley Madekwe and Kellie Shirley.
Runtime: 95 minutes
Genre: Comedy, Drama, Romance
Production Companies:Free Range Films, Film Tour, Mira-max Films and UK Film Council.
* Translations of actual dialogue are approximate