Consumption: A medical redemption wrapped in the epic tale of TB in the North

“One of the great calamities for all mankind, tuberculosis was simply the worst thing that ever happened to the traditional Inuit,” writes Kevin Patterson. 

The statement appears in an appendix in Patterson’s novel, Consumption, disguised as an unpublished manuscript written by one of the characters. That character, Dr. Keith Balthazar, also explains the astonishing death toll of the disease (a number one killer for most of history), its role in medical history (primary), and the fact that Canada’s push to move Inuit into settlements was partly driven by the need to control its spread.


These are the animating principles behind Consumption, a novel based on Patterson’s experience as a doctor working in Rankin Inlet over about ten years.

The book did not make a strong impression on my when I first read it shortly after it was published in 2006. It just didn’t strike me as exciting or new. Reading it again in 2019, I was surprised by its scale and scope, and then completely drawn into the hopes and fates of its many characters and the preoccupations of its author (illness, the North, failure).

In fiction, it really doesn’t get any better than that.

The story revolves around Victoria who, at age 10, is taken south to be treated for TB. She returns six years later, a changed person in a community that has itself been completely altered while she’s away. Gradually, we meet Victoria’s future husband, then her children, the man who will become her lover, a priest and, crucially, a doctor, whose love for her is the key to the book (this was published thirteen years ago so there will be spoilers).

We also follow the fates of her parents, her brother, a schoolteacher and a handful of townspeople. The plot revolves around a new diamond mine, which is proposed and built, partly thanks to the work of Victoria’s kablunauk (I presume this is Kivalliq spelling c. 2006) husband.

In the end, we get love, betrayal, death, murder and many characters seeking their rightful way in the world (and in this case, a world few Canadian readers are likely to know much about).

The book takes a while to come together. The writing, at times, is painfully didactic, breaking into long paragraphs explaining various aspects of the region. This is dated, obviously written in the time before people read alongside mobile phones.

But the storytelling!

For me, it took off around page 175, when a minor character, who’s so far been described only as an inept hunter, gets hired at a mine, where he surprises everyone with his ability as a bookkeeper. It’s an unexpected transformation, the first of many. 

It’s hard to quote from this book. It’s workmanlike with action and movement. Few of the characters articulate their thoughts in any kind of detail (the bookkeeper is a neat exception). 

So I’m going to offer some more spoilers instead.

TB. Victoria’s daughter Marie becomes dangerously thin and is thought to be infected. It’s a terrifying prospect, and she’s sent south (echo of Victoria’s own youth) to see a psychiatrist, who is about to diagnose anorexia. But before they meet, Marie escapes the hospital and accidentally drowns in a river in what is believed to be suicide.

Marie’s story is heartbreaking, tender, nuanced and painful to read. And written ten years before most people had heard of the student deaths in Thunder Bay.

The doctor who writes the manuscript at first seems like an outdated authority figure, but he has his own journey, involving drug abuse and a niece he fails to protect. His professional life fluctuates. When Marie dies, another doctor calls him with the news. On the phone, he can tell she is horrified by his jaded reaction: he can tell how warped and gross he seems to someone unused to the life he’s living and the rampant illness and death he sees every day. It’s a troubling but great moment in the book.

I’ve described the beginning of this book as feeling dated, but as I read on, it felt less dated and more like a timepiece. It covers the Rankin of the 1960s, ‘70s and ‘80s, when people had newly come off the land. When a murder takes place, it’s described as the first in the community. There is little sign of the cultural revival that is taking place now.

I think I better mention the ending, which involves several of the characters starting over on a Pacific island. Several people have noted the similarities between the Canadian Arctic and the South Pacific: great distances, complicated logistics (the Northwest Company operates in both areas), limited agriculture, massive cultural change. It’s also true that northerners travel a great deal; bumping into some on the tiny island of Nuku Hiva in French Polynesia is quite plausible.

Still. The whole things feels a little strange. 

However, the real ending has to do with the doctor, whose love for Victoria is revealed when he reconciles her to the son who has run away. This after he (the doctor) has somehow taken the blame for a stillborn child he helped deliver, and of course, Marie. It was this doctor who sent her on that fatal trip south.

The doctor’s redemption (and unrequited love; he dies alone) makes this book read as a kind of medical apology, a lament for the harm and failure disease and its cure (among other things) has inflicted on Victoria and many others. If this isn’t made clear in the resolution of the plot, it certainly is in the appendix, which includes several other essayistic digressions on medical history.

This is a book that clearly started as an idea. What Patterson has done is take a professional preoccupation — and a timely one; TB is still killing and upending the lives of Nunavummiut; drug-resistant strains are an urgent threat — and weave it into a nuanced, gripping tale.

Now that’s a great premise. 

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