Paperback $18.95

Jul 08, 2008 | 400 Pages

Ebook $13.99

Jul 08, 2008 | 400 Pages

  • Paperback $18.95

    Jul 08, 2008 | 400 Pages

  • Ebook $13.99

    Jul 08, 2008 | 400 Pages


"Gently seductive. . . . Remarkably compelling. . . . [Patterson’s] insight into the human condition pulls us to the heart of events."—The Washington Post“Utterly absorbing. . . . Engag[es] the heart as well as the mind in the service of a greater truth.” —The Times-Picayune “Patterson’s own experience . . . lends his simply told, involving novel an unmatchable authority.”—Entertainment Weekly“Patterson is a sure guide through inhospitable terrain, be it [that] of the tundra or the far recesses of the soul.”—The New Yorker

Author Q&A


You’re a prize-winning author and a practicing physician. Did you want to be a doctor or a writer growing up? How did you manage to do both careers?
I came to do both fairly accidentally. My twin brother was the one who was destined to be a physician. I was a disengaged metal-headed high school student in the power mechanics career stream, when I came home from school one day and realized that giggling, high, under a car every day was probably not a realizable life ambition. My brother had been taking pre-requisite courses for pre-medicine, and the application forms were laying about the house. I found some and filled them in and the next thing I knew I was in medicine–and broke. Which led to the next accident: I impetuously signed up with the Canadian military to pay for my tuition and books, and on graduation, found myself working in a Manitoba artillery base, taking care of 400 twenty-two year olds who had nothing other than boxer’s fractures and urethritis wrong with them. Some days, my work was done by nine in the morning. I started writing short stories, to pass the time. After a while I started selling them. Pretty quickly, those stories were most of what I thought about–besides women. I was twenty-five when I started work there. And it was an army base a hundred miles from the nearest city. The interior life became the only release. Perhaps we should say distraction?

Tell us about your stint in the Canadian army. Did that experience help to shape you as a writer?

Here’s what I think any writer trying to finish a book should do: find a job that requires you to be awake, sober and dressed at seven in the morning, under threat of a loud man or woman coming to your door. That job would require a minimum in the way of actual attention to anything, and some privacy. It should pay well enough that money isn’t so tight that it becomes a source of anxiety, but neither should it be so plentiful that people notice you. There should be an absolute absence of interesting conversation or intellectual stimulation, but books should be available and the mail should be reliable.
I’m thinking that there are a few possible jobs that meet most of these: a forest fire spotter in one of those towers in Montana (though the need to keep your eye out for smoke is problematic); parking lot attendant (though the money might be pretty tight); but a regimental doctor in a peacetime Canadian Army formation is pretty much the ideal. Also, the doctors in the army are all fairly alien to the combat arms soldiers. They have a whiff of intellectualism about them, they’re all mostly pretty clear that they’ll retire five minutes after their obligatory service is finished, and a couple of dozen push ups finishes them. Being alien is very good for getting writing done. Exiles know this. But if one needs both familiar food and sunlight–these sort of jobs are the way to go.

In what ways has practicing medicine helped you as a writer? Do you find writing and practicing medicine to be complimentary to each other?

Clinical medicine is all about eliciting and interpreting stories. It’s a nostrum of medical education that the patient’s history provides the diagnosis ninety per cent of the time, the examination nine percent of the time, and lab tests one per cent of the time. Nuance and foreshadowing and metaphor and symbolism and repetition are all pivotally important to any diagnostician.
Moreover, though doctors complain that their social position is not as exalted as it once was–the Buick has been replaced by the Beamer as the “Doctor Car,” so the decline seems to me to be mostly in their heads–their fall has nevertheless been not as precipitous as that of other "professional" classes, especially that of the clergy. The vacuum left by all those dropped collars and robes has doctors listening to the most amazing stories and confessions. I spend most of my time working in a community ICU, and the need for families to talk about their dying spouses/parents/children is almost universal. They want to be understood, as do the sick themselves. War veterans who haven’t spoken a word about their soldiering in sixty years start relaying anecdotes about the nineteen-year-old versions of themselves that leave one gobsmacked. Elderly women speak of all the children they lost to measles and polio and tuberculosis. Being in the position of proximate listener is the essential privilege of doctoring.
You travel frequently to the Arctic to practice medicine. Why are you attracted to the Arctic, and why do you continue to go back? What are the dramatic changes you’ve seen in the Arctic since you’ve been traveling there?

I’ve never gotten over my incredulity that anyone has ever actually managed to live there at all, and the idea that people did that without diesel generators and fuel oil staggers me. There’s no wood up there, nothing to make a house or a campfire with. The kind of resilience necessary to do that doesn’t just dissipate immediately after the physical demands of living there lessen. I think there was a kind of taciturn and absolute resolution necessary to survive there that is actually a pretty heavy burden. And that sternness endures in many of the older people.
Nevertheless, the place is changing, and the magnitude and pace of that change exceeds anything any other part of the world has seen. Until the late 1960s there were still people living on the land, following the caribou around, living mostly as they had for twenty thousand years. And now the problem is internet porn. Try to get grandpa and junior to talk about that.
Can you talk about the modern contradictions of the Arctic, how tradition battles with modernity? How are these contradictions reflected in Consumption?
People can adapt to anything, I think, and this is demonstrated by the success of the Inuit in the treeless Arctic itself. Nothing about the way we live at the moment is less strange than that. But what does disorient people is very rapid change.  And what’s unprecedented about the way everyone lives, from the Inuit to Brooklyn art students, is the rapidity of that change. We all just got e-mail about twelve years ago. Cellphones were the size of toasters just before that. You had to go to an Italian cafe to get a cup of coffee that wasn’t light brown. Beer was all variations of pilsner.
Compare these changes, which seem striking enough, to coming to the same place from a hunting-gathering existence at the same time Jim Morrison was breaking on through to the other side–which is only a more compressed version of the same transition the entire world has gone through over the last few lifetimes. It has a comparable effect on everyone. The experienced are rendered obsolete, and grandparents are devalued; we all keep struggling to find the easiest way to do things, long after unnecessary expenditures of effort stop being life threatening–and so we engorge. As it becomes less possible to know what to expect we become skeptical to the point of cynicism. From cynicism flows materialism and consumerism. Our garages become stuffed and everyone aspires to–and increasingly becomes–rich. Men stopped wearing hats overnight, and churches may empty in a heartbeat, but a yacht is forever. The rich don’t have babies, partly in order to preserve their riches. And so their possessions are even more heavily freighted. This is Western Europe, America and the Arctic.  

Why did you choose the title Consumption for your novel?

Consumption is an old word for tuberculosis, especially the chronic wasting illness it caused, and TB is important both to the book’s plot and to the history of the Inuit. It also alludes to the idea of affluence, and the disordering effect of affluence is one of the ideas of the book, too.

One of the larger themes of the novel is dislocation and shifts in identity. This is reflected mostly through the character of Victoria, who moves to the south at a very early age, and when she comes back to the Arctic, it’s changed drastically. Can you talk more about this dislocation, particularly as it relates to what the Inuit went through over the last half century?
The Inuit moved from the most traditional hunter-gatherer lifestyle to the Facebook era in about fifteen minutes. Until the late sixties, there were still Inuit living on the land, hunting caribou and seal–even today, when one is talking to someone fifty or older, the chances are good that their childhood was spent in migration, watching the geese and the weather and arctic char, just as their ancestors did for thousands, even millions of years. That kind access to our origins is enviable, but the subsequent pace of change has been violently fast. And because it has been so compressed, this transition reveals things about the way we live now. It demonstrates that lots of phenomena that dominate our lives are not inevitabilities of being human, but rather, mostly a product of how we have constructed our lives. Disaffected teenagers, heart disease, and depression are examples of this.
The Inuit are becoming more and more indistinguishable from southerners, and as tax woes and job stress progressively replace all the more primal threats, they exhibit responses to them that are the same as any people that face them. But in the meantime, I think they are caught in a strange transition phase that is disorienting and hard on everyone. It is interesting, too, to see which elements of the old life are mourned and which elements of the new are welcome. There are surprises in there.
 One of the characters, Keith Balthazar, is a doctor practicing in the Arctic town of Rankin Inlet. How much of you is in the character of Keith Balthazar?

I am neither a morphine addict, nor American, and I am a way, way better doctor than Balthazar is. But I like 30s jazz and possess some of Balthazar’s social awkwardness.
Throughout the novel, there are bits of Dr. Keith Balthazar’s journal, and some of these entries read almost like nonfiction. How did this "nonfiction" find its way into the novel?

Originally the book was going to be a collection of nonfiction essays about cultural change in the arctic, and in medicine. I was working away at this when it became clear that I was talking around what I was interested in, that the kind of inner turmoil that drew my eye couldn’t really be referred to in discussions of the pathophysiology of obesity and diabetes and heart disease. I went for a long sailboat ride down to French Polynesia, and took my laptop with me. By the time I got there, six weeks later, the essays had become the work of a figure about whom I was writing a novel.
Why did you include a storyline set in the United States? Were you trying to show or address anything in particular with this storyline?
Amanda’s story echoes the story of Victoria’s daughters; I wanted it to be clear that this is not a book about the trouble of the Inuit, but rather it’s about the trouble we all face. The same ideas of dislocation and generational alienation and confusion affect southerners and more traditional peoples. We are to some degree inured to our experience of these, which is why it might be interesting to examine these things through the lens of the Inuit, but the same factors are at play in all societies because, increasingly, we all belong to the same society.

What are you working on now?
I’m working on the second volume of a travel trilogy about the Pacific Ocean. (The first was The Water In Between, which Nan A Talese/Doubleday published in 2000.) It’s called Becalm and is about a sailing voyage I made around the North Pacific Subtropical Gyre, a weather/ocean current system which dominates the North Pacific Ocean. I’m also co-editing an anthology of first person narrative writing about the war in Afghanistan, called Outside the Wire. It will come out this winter.

From the Hardcover edition.


What inspired you to write Consumption? How do you see the novel relating to the themes you have explored in your previous work?

I’ve always been interested in the tension between the individual and his/her community, the lives we all lead interiorly and the lives we lead among our people. Consumption is about rapid social change and the way that affects people, what it means when people lose their ability anticipate the expectations and nourishments of their world.

In your acknowledgments, you describe transforming a collection of essays about cultural change and epidemiology into this novel. What were the challenges and pleasures of this process?

It was like looking at the same landscape through two different lenses. In my work as an internist in the Arctic, the change in the nature of the illnesses I treat–the rise of the diseases of affluence–as been as striking as the change in the disposition of the people, toward a very recognizable combination of suburban ennui and striking worldliness. Twisting these different aspects of the same essential process together was illuminating for me–at bottom, the fictional and non-fictional elements of the book are both trying to get at the same truths. They are less opposites than they are complementary.

How did you go about the extensive historical, medical, cultural and other research for this book?

I’ve worked in the Arctic, first as a family physician and then as an internist, since 1994. The amount of time I’ve spent up there in the course of a year has varied widely, and I wasn’t up there when I was in my internal medicine residency, but over the years, there has been an accumulation of anecdotes and stories I’ve heard that ended up informing the book more thoroughly than a conventional library assisted research effort would have.

Which authors have been most influential to your own writing?

Annie Dillard. Annie Proulx. Barry Lopez. Bruce Chatwin. Mark Helprin. Lawrence Durrell. Patrick Leigh Fermor.

As someone who practices medicine in the north, how did you find writing about the struggles and failings of Keith Balthazar?

Medicine involves constantly coming up against anxiety about the shortcomings of one’s own skill set and knowledge. Certainly in the north, where colleagues, let alone consultants are uncommon, this is just about constant. On has the sense sometimes that any minute one will be revealed for the charlatan quack one is. That’s Balthazar’s circumstance, certainly. And although he is tentative, and has bad luck, he is not as inept as he thinks he is. But he does think he is inept, and so do many of the people around him. He’s sort of the doctor version of the dream where you have the examination tomorrow but you’ve forgotten to go to class all year. The worst case scenario.

Are there any tips you would give a book club to enhance their discussion of Consumption?

Pay attention to Penny. Why is she so desperate to find Pauloosie?

From the Trade Paperback edition.

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