Originally from Manitoba, Kevin Patterson put himself through medical school by joining the Canadian army. A specialist in internal medicine, he divides his practice between the Arctic and the coast of British Columbia. As was made clear by The Water in Between, his sailing memoir, and Country of Gold, his debut story collection, Patterson has seen and done much where two or more world views intersect. It make him a peculiarly well-informed and insightful guide to the conflicts within the coastal Inuit community of Rankin Inlet in the Canadian Arctic, the primary setting of Consumption, a tale that also carries its readers to Winnipeg, New York, New Jersey, the South Seas and several points in between.

On the surface, Consumption is deceptively simple and gripping. It's the story of one woman and her family. But what a woman -- and what a family! Victoria is the Inuit daughter of Emo and Winnie, and sister of Tagak. Born in 1952, she's raised in the nomadic hunter ways of her forefathers until her parents are first driven from the tundra to the largest of the hamlets on the west coast of Hudson Bay by the failure of the caribou hunt, then kept there by government policy and easier living conditions. At 10, Victoria develops tuberculosis and is sent south to a Manitoba sanatorium; for the treatment of so severe a case, she requires both disfiguring surgery and six years extensive therapy.

Educated by Kablunauks (southerners) and semi-adopted by a Cree family, the teenager masters both their languages and becomes acclimatized to books, radio and store-bought food, and living with emotional intensity. When she returns to her parents' home, she's an unusually marginalized young woman who drifts further from the traditions of her people by marrying Robertson, the British manager of the Hudson Bay Company store, who becomes the father of her daughters, Marie and Justine, and Pauloosie, her son, the eldest and most Inuit of her children.

Victoria's marriage and family ties are pulled this way and that, not only by the common stresses and strains that beset any late-20th-century North American relationship -- a son who disdains the trappings of middle-class life and strives to be a man of the land like his grandfather, daughters who embrace pop culture and dream of living in Toronto, working at MuchMusic and partying on Queen Street West, a husband who is distracted by amazingly lucrative economic opportunities falling into his lap, and a lover who wants to draw her back to their shared childhood -- but also by the diseases and social disorders endemic to the North as well as the epidemic of greed unleashed by the development of diamond mining in Canada's Arctic.

What makes Consumption so much more than yet another middlebrow account of a highly sensitive wife and mother's struggle to heal herself while nurturing her family through violent and terrible upheavals is Patterson's ability to track Victoria's life from many angles. The eyes of every member of her family are on her, but she and they are also observed by several Kablunauk outsiders: Pauloosie's lover, a schoolteacher, the resident Oblate priest and the local doctor, Keith Balthazar. Multiple points of view and shifting perspectives turn the storyline on its head several times in ways that reveal the moral perplexities of fundamentally decent people trying to do the right things when they are living among what U.S. poet Wendell Berry calls "punishments and ruins" in his essay A Few Words in Favour of Edward Abbey.

Like Abbey's, Patterson's work is written in defence of the natural order and human nature. He is a traditionalist, a conservative advocate of aesthetic realism, for whom character is still the defining quality. "Such writers," Berry notes, "submit to standards raised, though not necessarily made, by themselves" -- Dickens, Conrad, D. H. Lawrence and their moral successors.

Like many of the medically trained, Kevin Patterson has better eyes than ears. He writes clean, serviceable prose that is cinematically accurate, digitally precise. When you close the book, you feel you've been watching a movie, albeit one without much of a soundtrack. With the major exception of Dr. Balthazar and the minor one of Father Bernard, most of the characters are more or less inarticulate, but even so, the dialogue is more stilted than seems necessary. And anachronistic, especially in the case of Victoria's daughters.

Balthazar has so much to say throughout the novel that he can never find enough listeners, and so saves many of his sharpest insights for The Diseases of Affluence, a 50-page unpublished manuscript that forms an epilogue to the novel. It is, in itself, reason enough to buy a book that can be argued with on several levels, but is far too good for much of what ails us to be ignored.

Storms are sex. They exist alongside and are indifferent to words and description and dissection. It had been blizzarding for five days and Victoria had no words to describe her restlessness. Motion everywhere, even the floors vibrated, and such motion as was impossible to ignore, just as it was impossible not to notice the squeaking walls, the relentless shuddering of the wind. Robertson was in Yellowknife, and she and the kids had been stuck in this rattling house for almost a week, the tundra trying to get inside, snow drifting higher than the windows, and everyone in the house longing to be outside.

It was morning, again, and she was awake and so were the kids, but they had all stayed in bed and listened to the walls shake. Nine, or something like that, and still perfectly black. She had been dreaming that she had been having sex with Robertson. She was glad she had woken up. Even the unreal picture of it had left her feeling alarmed -- thought that eased as the image of the two of them, entwined, had faded. In another conscious moment she was able to blink the topic away and out of her thoughts. As it had been.

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