Tom Skerritt moves through “East of the Mountains” like a hobbled wraith.

His character, Dr. Ben Givens, is a Seattle surgeon dying of cancer. His cheeks are sunken, his breath is punctuated by gasps and his movements … Those movements convey his suffering with every cautious, deliberate step he takes. He has to will himself to stand, to walk, to meet the day. And he’s sick and tired — literally — of doing so.

He’s a man who has given up. He’s facing the end and he wants to hasten his end. So before the movie is 10 minutes old, he’s pressing a shotgun muzzle against his forehead and struggling with the impulse to pull the trigger. The question then is where does the picture go from there. The answer is there in the title.

Loosely based on the 1999 novel of the same title by Bainbridge Island author David Guterson (Thane Swigart wrote the screenplay adaptation), the movie charts Givens’ journey from Seattle to east of the Cascades where, in the territory where he was born and grew up, he intends to do away with himself. A homecoming, and a departure.

He’s got it all planned out. He tells his daughter (played by Mira Sorvino) that he’s going on a hunting trip. He doesn’t tell her he won’t be coming back. (He hasn’t told her of his illness.)

Under the direction of S.J. Chiro, Skerritt invests his character with a profound, quiet melancholy. Silver-haired and very soft-spoken, the Seattle-based actor brings great dignity to the part.

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In addition to being terminally ill, Givens is also mourning the recent death of his wife, claimed by a wasting disease. It’s all too much.

He’s grief-stricken and without hope. But the movie itself is far from hopeless. East of the mountains, he finds a measure of redemption in the kindness of strangers. A cheerful young couple picks him up from the side of the road after his car breaks down. They’re puzzled when he asks to be dropped off a few miles away at a wide spot in the road so he can trek off into the great wide open with his beloved hunting dog, a Brittany spaniel named Rex.

Later, in a significant departure from Guterson’s book, he’s befriended by a Latina veterinarian (played engagingly by Annie Gonzalez). She treats Rex after he’s savagely mauled by another dog owned by a vicious coyote hunter (John Paulsen).

The vet, named Anita, is also a vet of another sort, a former Marine who served in Iraq and Afghanistan. That gives her a connection to Givens, a Korean War vet who was motivated to become a surgeon by his admiration for a military doctor who saved the life of a wounded buddy in a battlefront field hospital.

Anita also symbolizes the changes in the demographics of the eastern part of the state as she remarks to Givens that there probably weren’t too many brown faces around when he was a boy 50 years ago.

When he discloses his cancer prognosis, she says he doesn’t know how the end will play out. That provokes an angry response, one of only two times he allows his buried despairing rage to surface, as he describes, in an outburst lifted almost directly from the book, exactly how the end will come: with stair-steps of suffering and pain, knowledge gained through his lifetime of experience as a doctor.

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Filmed around the community of Gold Bar in Snohomish County and the grasslands of Kittitas County (as well as Seattle locations early on), “East of the Mountains” is filled by director of photography Sebastien Scandiuzzi with images of great beauty.

It’s a small-scale intimate movie solidly anchored by Skerritt’s disciplined, deeply felt work. It’s one of the best performances of his career.

‘East of the Mountains’ ★★★ (out of four)

With Tom Skerritt, Mira Sorvino, Annie Gonzalez, Wally Dalton. Directed by S.J. Chiro, from a screenplay by Thane Swigart. 84 minutes. Not rated; for mature audiences (includes theme of suicide, scenes of violence, animal harmed). Available Friday, Sept. 24, on Video on Demand; not in Seattle-area theaters at this time.

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