There is reason to pause at the beginning of Kevin Patterson's new novel. The epigraph, "For the sick, the poor, and the ashamed" makes one wonder what one is in for. Indeed, the story, which takes place over a 40-year period, deals with these conditions and more. And though the narrative swings gently back and forth between two main characters, Victoria and Dr. Balthazar, it is also the story of community, of cultures clashing in Canada's far north -- specifically, the small town of Rankin Inlet, close to the Arctic Ocean and on the western edge of Hudson Bay.
Victoria, a 10-year-old Inuit child, is diagnosed with tuberculosis and sent to a southern sanatorium, where she lives for many years. Treatment at the time consists of weekly injections of streptomycin and high doses of oral medication. The more radical treatment, thoracoplasty, is eventually performed and several of her ribs excised in order to collapse cavities of infection within her lungs. This is later described by Balthazar, her northern doctor, as "savage deforming surgery."
When Victoria finally returns to the north, an intelligent young woman with an "incandescent energy," she has become an outsider. The Inuit community has changed during her absence. Her parents, who had lived out on the land, fishing and hunting, are now in town, where her father has a job at a recently opened diamond mine. They worry that their daughter may be better suited to marry a white man than an Inuk, but "this was too painful an idea for either of them to utter aloud." Just as they fear, Victoria meets Robertson, a white man from the south, a Kablunauk, who manages the town store and eventually works for the owners of the new mine. He and Victoria will have several children together.
Balthazar, the town doctor, has been coming to the Arctic since his 20s, but he maintains a life in his old world and keeps an apartment in New York to which he returns every summer. His lack of confidence about his own skill as a physician is well-based, but he is a sympathetic character, beautifully drawn. He also loves from afar the unattainable Victoria. He delivers her children, albeit in a bungling manner, and their lives go on to intertwine in other ways.
One of Patterson's strengths as a writer is that he creates a wide cast of characters. Some never get to meet or interact with others, and yet each contributes to the overall complexity of this novel's theme. One of Victoria's daughters muses, a generation later and while watching Axl Rose in a Guns n' Roses performance, "As he put it, the choice becomes whether to consume oneself along with everything else." This is meant in the widest possible sense. A book that seems to be about tuberculosis (once known as consumption) becomes a book about isolation in its extremes -- whether in the south or north, about hardship and greed and secrecy and longing and love.
The pace of the storytelling is gently seductive and always informative. And woven into this are tantalizing chapters about different facets of medicine -- changing epidemiology that includes Type II diabetes, drug-resistant tuberculosis, obesity -- all told through the voice and writings of the isolated physician with too much time on his hands. He is lonely and often sad, but he is curious and astonished by discovery. He is also punishingly realistic, as revealed in his journals. "All my life I have equivocated, puzzled most of all about what it was I wanted," he writes. "I came to the Arctic for a summer. . . . But this is where I ended up spending my professional life. . . . I didn't actually choose the place until I had spent half my life there."
The spell of the novel is broken only when the outside narrator intrudes, stopping the story to explain what tundra is, or the igloo, or what it is like for the tuktu (caribou). These small bits of information could easily have been filtered through the eyes and minds of Balthazar and other characters. Even so, when he is in his stride, Patterson is capable of creating sentences such as these: "In hollows, the grasses rise to midankle and the tuktu proceed through it like mowers lined abreast. . . . By August, their bellies bulge and their necks appear like swollen wineskins appended to their trunks."
Because of his unique experience in the north, where he practiced as a physician, because of his elegant style and compassionate vision, Patterson has created a remarkably compelling novel. His insight into the human condition pulls us to the heart of events, even when the idea of these is "too painful . . . to utter aloud."