Then again, maybe you don't :
And because the Ukrainians (U-craniums?) are "very tough," the doc foregoes a general anesthetic, leaving the patient wide awake through the procedure.
In fairness, when the doc's back home, he uses a $60,000 pneumatic number, and (presumably), an anesthetic.
Or so we're told.
UPDATE: It appears that Dr Marsh may simply be reviving an ancient medical practice:
We certainly hope that Dr Marsh's patients enjoy better outcomes.