In a world where physical perfection has never been more important, "My Flesh and Blood" etches an unforgettable portrait of a woman with the gift of looking beyond appearances into the hearts and souls of the 11 special-needs children she has adopted. The singular achievement of Jonathan Karsh's graceful and rigorous documentary is that he enables his audiences to see his heroine's family through her very clear but always loving eyes.

And what a heroine she is: Susan Tom, a plump 53-year-old divorcée with two adult children out on their own. Tom is a veritable Mother Teresa of California suburbia, living with her kids in a spacious house in pleasantly nondescript Fairfield. When she and her ex-husband adopted two daughters with special challenges, it led to an invitation to adopt others, each with a physical or mental challenge or both. Tom's marriage waned, but her family kept on growing.

Susan Tom gave Karsh exactly one year, starting in 2001, to film her and her family with three conditions: No shots of her in the bathroom or wearing a bathing suit and, more seriously, no one could tell Karsh and his crew to stop filming except her. This provided amazingly free access for Karsh, but it also meant that when her deeply troubled son Joe became hostile toward the film crew, it became part of the record, a reminder that the crew could be an unwelcome presence.

Joe is the riveting heart of the film. At 15, handsome with a radiant smile, he is in and out of hospitals for cystic fibrosis and for psychotic episodes; he can be affectionate and amiable one moment and consumed with dangerous rage the next. The negatives in his life escalate so outrageously as to be darkly, even comically, absurd in relation to his birth mother and the latest turn of events in her life. He is one of nine siblings born to a four-times-married onetime drug addict who at age 13 started bearing children, none of whom is with her today — and that's just the beginning of Joe's story.

Now Susan is reaching a moment of truth with Joe, sensing that he's capable of doing something terrible, which as a bright and reflective youth he himself worries about.

In the meantime Susan's warmth and wisdom embrace all her other children as well. They include the remarkably upbeat and resourceful Xenia, who was born in Russia without legs, and Faith, a brilliant second-grader who was the victim of a crib fire and has endured much plastic surgery but remains so disfigured she faces much hostility at school. Then there is 19-year-old Anthony, a sweet-natured youth struck with a rare degenerative skin disease, epidermolysis bullosa, that leaves him vulnerable to cancer and in constant pain. Anthony needs intense care simply to keep him alive, yet Susan ensures that he has opportunities to participate in family and community activities.

Margaret, 18, who was born in Korea and survived a childhood epileptic attack, has become Susan's mainstay but now is starting community college classes and is feeling the strain of heavy family responsibilities.

Susan's chic blond mother admits that she herself expected a lot, perhaps too much, of Susan as the eldest of her four children. She surmises her daughter grew up feeling unloved and lonely and that this may explain why she has adopted so many children, and specially challenged ones at that.

Susan, who comes across as a loving, no-nonsense woman with strong communications skills, avoids introspection. She wouldn't mind a little romance in her life but admits she really hasn't time for the demands of a relationship. She considers taking at stab at online dating, describing herself as "fat, with lots of kids, interesting and with a sense of humor."

What this film captures so winningly is how amid so much strain and challenge, including the specter of death, the Tom household manages to be filled with much joy and laughter. The effect on her children of Susan Tom's call to serve and cherish is enthralling to behold, and "My Flesh and Blood" deeply honors her and her family.

*

`My Flesh and Blood'

MPAA rating: Unrated

Times guidelines: Some scenes may be too intense for the very young.

A Strand Releasing/HBO-Cinemax Documentary Films presentation of a Chaiken Films production. Director Jonathan Karsh. Producer Jennifer Chaiken. Cinematographer Amanda Micheli. Editor Eli Olsson. Music Hector H. Perez. Running time: 1 hour, 24 minutes.

Exclusively at the Nuart, 11272 Santa Monica Blvd., West Los Angeles, (310) 281-8223