Behind the Sharp Sound of ‘The Surgeon’s Cut’

Netflix's The Surgeon's Cut — created by BBC Studios Productions — takes viewers into the operating rooms and minds of four leading surgeons specializing in fetal medicine, neurosurgery, transplant surgery and cardiology. Here, Halo Post's re-recording mixer Sam Castleton discusses the role of sound in the docu-series.

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Story by Sam Castleton, photos courtesy of Netflix/BBC Studios Productions

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Dubbing mixer Sam Castleton — at Halo Post located in central London — is well-versed in the sound for docu-series, having mixed a wide variety of non-fiction shows like Reported Missing, Jamie’s Quick & Easy Food, America in Color, and The World According to Jeff Goldblum. During the pandemic, Castleton and sound editor Tom Foster teamed up with some familiar faces: BBC Studios executive producer James Van der Pool, Netflix Post Manager Richard Hobbs, and directors Sophie Robinson, Lucy Blackstad, James Newton and Stephen Cooter (who he’s worked with on several previous projects) to tackle the Netflix/BBC Studios Productions docu-series The Surgeon’s Cut. Here, he shares an inside look at their approach to the show.

The Surgeon’s Cut | Official Trailer | Netflix

Early Involvement

Dubbing Mixer Sam Castleton at Halo Post

Getting involved early was key to the success of the sound on The Surgeon’s Cut. In our first meeting, James Van der Pool (exec. producer) talked us through his vision for the series and the important role sound could play. He wanted to bring a sense of beauty to surgery and have the surgeon’s life inside and outside of the operating theatre link and overlap in interesting ways. We discussed mixing in Dolby Atmos and how it would allow us to experiment more and push these ideas. When we contacted Netflix, they responded enthusiastically and gave us the green light.

Each episode of The Surgeon’s Cut follows a different surgeon and is directed and cut independently. So we had a meeting with some of the directors between shoots to understand more about their films and to get them thinking about sound more while shooting. When the films were closer to picture lock, we watched through rough cuts and met to discuss themes and specific points.

An excerpt from `The Surgeon`s Cut` Ep02/Dr. Q Rough Cut Notes

We then had ‘pre-lock’ sound design days to go through the amazing wild recordings and construct our sound design ideas as a proof of concept. This also allowed us to be far more efficient with our sound edit time.

Wild Recordings

Production hired some of the best sound recordists out there (Andy Paddon, Steve Hopkins, and Lucy Pickering) and their wild recordings proved vital. They recorded the unique sounds of specialized surgical tools, instruments, machinery, and location atmos, as well as specific recordings depending on the shoot — for example, Dr. Q’s skipping rope and heavy breathing from his workout.

Creating sound this way…makes it authentic and true to the story being told.

These recordings formed the foundation of our sound design. We processed and treated them with sound design techniques in order to fit the theme or aim of a scene. Creating sound this way not only makes our sound design unique; it makes it authentic and true to the story being told.

“Heart & Soul” – Dr. Shetty

For this film, Stephen Cooter (director) often portrayed Dr. Shetty in a spiritual light. We are in India and because he saves lives he is revered as a god-like figure there. We could have used any old stock sound effect to convey this spiritual theme, but in order to make our sound design unique and true to Dr. Shetty’s story, we used the recordings of bells from his local temple in India. We reversed, reverbed, and pitch-shifted them to create some beautiful ethereal sounds, often sliding the pitch up then down and panning them up in Dolby Atmos. This pitch and pan combination makes them feel like they are transcending the room into the heavens.

The Surgeon’s Cut – sound design sequence for Dr. Shetty

The Surgeon’s Cut – the processing on Dr. Shetty’s spiritual light

One of the best wild recordings from Andy Paddon (sound recordist) was of the heart-lung machine, which bypasses the blood circulation so they can operate on the heart. It makes a whirring sound, punctuated periodically by a plastic valve, but rather ingeniously. Andy also recorded it with a contact mic. These recordings were perfect for the points in the film during surgery where everything slows down and we transition ‘inside Dr. Shetty’s head.’ For these transitions, we used EQ sweeps and pitch sliding to scoop from the whirring sound into the treated contact mic. The contact recording had a deep pumping sound; it’s exactly how you’d imagine a mechanical heart to sound but we also slowed the rhythm of it down and up as we transition in and out of the sequences. The experience really makes you feel like you’re plunging into Dr. Shetty’s mind at these tense moments — exactly what Stephen wanted to achieve.

The Surgeon’s Cut – sound design sequence for ‘inside Dr. Shetty’s head’

In the final scene, Dr. Shetty reads a letter he wrote to the 4,000 children he operated on in Kolkata. Stephen wanted to differentiate the dialogue and give it more gravitas to distinguish it. We had a lot of fun with Dolby Atmos here, running some awesome Atmos reverbs into the ceiling, but my favorite was pinging delays upwards and backwards. The result is spectacular and uniquely achievable in Atmos; it’s a great example of the immersive format working to accentuate the aim of a scene.

“Sacred Brain” – Dr. Q

There is a myriad of themes in Dr. Q’s film and many sound themes to go with them. A lot of Dr. Q’s story is about his childhood in Mexico and his journey to becoming a surgeon. This is set up in the opening scene at a playground by a railway in Mexico. We hear the recordings of children playing, metal clangs from the playground, sound effects of distant trains, and the children playing marbles. We decided to draw upon the soundscape of this scene whenever the film refers back to Dr. Q’s past. We treated the sounds and used them in imaginative ways. The marbles were used as crackles for the fire at his grandfather’s funeral, as sparkles when he and his brother are looking at the night stars and as water drips as we transition from a shot of hands washing in Mexico to hands washing in surgery. We processed the metal clangs from the playground with a number of sound design techniques, in one instance creating a whoosh-like sound for us to use on transitions. This sound association is a perfect example of using sound as a storytelling tool.

The Surgeon’s Cut – sound design sequence for Dr. Q

The film focuses on one operation, the patient Robert. We’re told early on that he’s a surfer and they’ve used some nice shots of waves which help us form this link to him. However, the film focuses on Dr. Q’s story for long periods before we come back to Robert. We had some meetings pre-lock about this and came up with the idea of using processed wave sounds as we transition back into surgery. The idea is to help remind the audience of Robert and his story. This theme is established early on and it’s a good example of using sound to help guide the audience.

The Surgeon’s Cut – sound design sequence for Dr. Q

“Saving Life Before Birth” – Dr. Nicolaides

In the Dr. Kypros Nicolaides’s film, one of the themes is being ‘lost in the forest,’ which is explained at the start and develops later in the film as he reflects on his own mortality. James Newton (director) cut in some eerie shots of a foggy forest for these moments in the film and we had some really nice gentle rustles of the tree branches as they pass over and past you. These rustling sounds provided a nice sound theme for us. A good example is when he talks about his father in Cyprus, we use the sound as a segue tool as we transition from the Cypriot countryside to shots of him in London brushing his hand over foliage. We also use it very lightly when he is on his office balcony where he has a symbolic olive tree.

The Surgeon’s Cut – sound design sequence for Dr. Nicolaides

In the final scene, Dr. Nicolaides dramatically fights to save the life of a baby in the womb. The ultrasound of the baby’s heartbeat is crucial to the scene. Dr. Nicolaides uses it to navigate the evolving situation and at one point refers to it as ‘sounding normal.’ We were able to greatly improve the audience’s understanding of this scene by taking this ‘normal’ sounding heartbeat and working backwards through the film, applying it to previous scenes of unborn babies with healthy hearts. This allows the audience to subconsciously register the sound and then instantly recognize the difference in the final scene and it’s intrinsic danger. This practice is a great play on the way humans react to changes of established sounds.

This film was also one of the toughest for dialogue. As with all the films in the series, there is a lot of noisy equipment and machinery. But much of the machinery in this film was mostly loud white noise from computers. The pitch and character of these sounds would vary, giving us a moving target, which results in a lot of manual removal in iZotope RX. Add Dr. Nicolaides’s hairy chest and starched shirt combination on the lav mics and we had a real RX workout.

“Living Donor” – Dr. Ascher

Sophie Robinson (director) jokingly referred to her film about Dr. Ascher as the black sheep in the series and whilst I wouldn’t go that far, we certainly lean on the gory side of surgery more. This is inherent in a few ways: Dr. Ascher is a liver surgeon and we learn how unusual and vascular the organ is. She tells us about her early career when surgeons were portrayed as Frankenstein. She recalls childhood nightmares and tells us about her love for horror movies. So we always created our sound with a scary and eerie style in mind.

The film focuses on one operation, a liver transplant between a mother and her daughter. When we transition from Dr. Ascher’s backstory to the hospital, Sophie used very gloomy exterior shots in keeping with the eerie theme. Without overdoing it, we made these shots sound very ominous, developing the sounds as we cut inside the hospital to the patients. The aim is to make the audience feel uneasy and to remind them of the impending operation.

The Surgeon’s Cut – sound design sequence for Dr. Ascher

Dotted throughout the film, we see Dr. Ascher watching old horror movies in a cinema where a film projector is heavily featured. We came up with the idea of using the sound of the projector as a way to interconnect the different scenes throughout the film. We used it over the cinema shots, over the horror film archive, and over old photos and archive footage when Dr. Ascher talks about her past. We also used the projector more creatively when possible, for example over the crosscuts of Dr. Ascher on an exercise bike.

The Surgeon’s Cut – sound design sequence Dr. Ascher, PT 2

This sound linking helps thread the story arc, coming full circle and concluding very neatly in the final scene with Dr. Ascher in the cinema.

Conclusion

The series demonstrates the combined power of using the best sound recordists, giving them time to record wild tracks, and getting the post sound team involved early.

It’s also a testament to mixing in Dolby Atmos and how we can immerse the audience more in the themes and stories unraveling on-screen.

Most importantly, the series is a fantastic example of how we can steer the narrative in documentaries and tell a story through sound.

A big thanks to Sam Castleton for giving us a behind-the-scenes look at the sound of The Surgeon’s Cut!

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