Sea Trial

by Brian Harvey

  In the 1950s, John Holter, an engineer and father of a hydrocephalic child, worked with surgeons to develop a shunt with a valve. There are now hundreds of valves, catheters, and antisiphons for surgeons to choose from, including programmable valves that let you fine-tune your own CSF flow. Survival of shunted children has reached 95 percent, although 30 percent end up intellectually impaired.

  Shunt insertion is still the most common neurosurgical procedure; for pediatric neurosurgeons, shunting is a large part of their business. I found a 2004 paper that provided a step-by-step method for inserting a shunt, and it made me marvel at the trust we put in surgeons, especially when we hand over a months-old infant with an inflated head and say, “Fix this, please.”

  In one picture, the tiny child is arched backward over a rolled towel, the gourd-like head lolling to one side; the marking of the two incisions, in scalp and abdomen, demonstrates how thoroughly the child will be plumbed. Of course, the article doesn’t say plumbed. It refers instead to “tunnelling,” the gentle passing of the tube under the skin, mindful of wrong turns, all the way from the abdomen to the valve waiting under the scalp.

  Many things can go wrong. Sometimes the tube gets plugged. Some shunts overdrain and collapse the ventricle. In the old days of spring-loaded tubing coiled in the peritoneal cavity, other weird things could happen — the tubing eroding into the intestine, bladder, vagina, even out the anus. If you combine complications mechanical and infectious, the numbers aren’t great: even now, 30 to 40 percent of all shunts will have problems in the first year.

  Infection is the second most common problem (after obstruction), and it happens in 5 to 15 percent of cases, usually within six months of surgery. The younger the child, the higher the risk. Often there’s no option but to take out the hardware. But the safest time to reinsert a new shunt is still a big judgment call for the surgeon. The infection has to clear up before the shunt is replaced — or you’re back where you started. The big question is how to deal with increasing pressure in the meantime because once you remove the drain, the clock starts ticking. The lawsuit against my father was all about that ticking clock.

  Within the fifty-odd years of shunting, my father’s surgical experience of hydrocephalic patients fell into the early stages; he was already in mid-career by the time the kinks were being worked out (this was in the mid-’60s). In 1976, when he operated on an eight-month-old premie called Billy, it was a straightforward business of “shunt first and be prepared to remove the shunt if it gets infected.” If it did, you pulled the damn shunt out and hoped for the best, which is what he did for Billy. It was a bit like the decision many a sailor would make when faced with a sudden and savagely rising wind: shorten sail and keep slogging toward your destination. It’s going to be nasty for a while, but sooner or later the wind has to ease up.

  But what if it doesn’t?

  Herring Town

  But we weren’t trapped in a rising gale, we were comfortably anchored in Clam Bay, where it had turned into a lovely evening. The cannon-balling teenagers had worn themselves out, and I heard a new, more welcome sound, the rhythmic chanting of the coxswain in an eight-person canoe.

  The long cedar dugout emerged out of the setting sun behind The Cut, making straight for us across the darkening water. I shaded my eyes; there were eight paddlers, and the man urging them on from the raised stern seat wore a traditional woven cedar hat. Hatsumi and Charley joined me, and we all watched the canoe sweep past a boat’s length away, paddles glinting in the fierce late-afternoon sun. Charley growled softly, way back in his throat, like a distant Harley-Davidson. Incongruously, all the First Nations paddlers wore bright yellow life jackets, and I wondered, is that what it’s come to? Do they have to carry flares and plastic emergency whistles too? On a trip like the one we were starting out on, there would be a strong Indigenous presence, and the absurdity I sensed at seeing those paddlers cutting a hard and fast line through the anchored yachts would be repeated time and again over the next two months. From masters of their own land to families blown to dust by nearly a century of residential schools, and now to paddlers in Transport Canada–approved life jackets — whose idea of progress was this?

  It was high tide when we left the next morning, so there was only a sliver of pebble beach for Charley to defecate on, crouched like a sumo wrestler beneath overhanging cedars. We left in time to catch the eleven o’clock slack current at Dodd Narrows, raising the sails once we were past the shoals and tacking into a freshening northwest wind. We fell into the routine of upwind sailing: maintain a course roughly forty-five degrees off your intended destination until you run out of sea room; spin the boat ninety degrees by steering through the eye of the wind; sail the new leg of the zigzag until you run out of sea room; repeat. It can get boring.

  “I had a weird dream last night,” said Hatsumi after an hour or so of this. “A dead person on the floor of the cabin.”

  “Man or woman?”

  “Man. I had to step around him.”

  “Were you frightened?”

  “No. But when I woke up this morning, I thought somebody will die.”

  We turned Vera again. Convulsing sails, whiplashing ropes, immovable winch handles.

  “Well, somebody did die, you know,” I said. “Maybe it was just him.”

  “Maybe.”

  I said what I generally say. “Let me know if it happens again.”

  Even with the wind on the nose, we made decent progress, and by ten we were only a half mile south of the narrows. We dropped the sails and started the engine.

  “You’re always too early,” said Hatsumi, as I put Vera in a holding pattern of slow circles. To the south, boats began to appear behind us. On every one of them, the same conversation was probably happening.

  “I’m too early? I thought there were two of us making these decisions.”

  “Let’s just go.”

  “An hour before slack? Come on, we only make six knots, the current’ll still be running at, what, four?”

  “You worry too much.”

  In the end, we went through thirty minutes early, merging into a parade of hell-bent pleasure boats like a squabbling family entering an on-ramp. Dodd Narrows seems to bring out the worst in boaters, some of whom will churn past you in their rush to be through it, even though, at its narrowest, there’s barely room for two vessels. The waning current spat us into Northumberland Channel, a five-mile industrialized stretch that leads to the port city of Nanaimo. Northumberland Channel is a wind funnel, gathering the prevailing northwesterly and stuffing it into the hourglass that ends at Dodd Narrows. We abandoned the idea of sailing, hunkered down, and pounded into it under power, an hour and a half of substantial seas on the nose, sheeting the windows, coursing down the decks.

  It seemed to take forever to crawl past the log booms and the red-and-white barges of wood chips tethered along Gabriola Island. I kept the binoculars on the huge ferry docked at Duke Point and breathed a sigh of relief when it separated from the land and, accelerating smoothly, plowed across our bows and into the Strait of Georgia. One more obstacle avoided.

  And a good thing, because Charley was letting us know what he thought of his first taste of rough weather. He cowered on a cockpit seat, shivering rhythmically, as though some fiend were zapping him with electricity. Hatsumi wrapped him in blankets and winced along with him as Vera punched through the whitecaps.

  “Should I take him down below?” she said.

  “Don’t even think about it. You’ll both get sick.” As dogs, I might have added. “Tough it out, we’re almost there.” She and Charley stayed in the cockpit that time; two days later we would find out what happened when they didn’t.

  Finally, we rounded Protection Island and followed the channel markers into the relative calm of Mark Bay, on Newcastle Island. Everybody stops in Mark Bay; it’s across the harbour from the best provisioning city on the coast
and minutes from the extraordinary marine park at Saysutshun, the Indigenous name for Newcastle Island. It’s usually jammed with boats of every size and description, from derelict local liveaboards to gleaming sixty-footers. And the skill level of the boaters in Mark Bay is similarly all over the chart. Part of the evening entertainment is watching boats back slowly through the anchorage, husbands at the wheel and wives standing forlornly on the foredeck, towing a too-shallow anchor along the bottom and wondering why it won’t dig in.

  We found a spot at the head of the bay, near the public wharf, and launched Charley into the dinghy. He was vibrating with anticipation, and he urinated ecstatically as soon as his feet touched the dock. We hurried along the wharves and up the trembling ramp to Newcastle Island. Charley broke free, grabbed a four-foot branch better suited to an Afghan, and began to cut delirious circles in the grassy meadow that looks east across Georgia Strait to Vancouver. He even ignored the goose droppings that speckled the grass like thousands of thick green worms. If ever there were such a thing as pure joy, here it was doing rings around me.

  The history of Newcastle Island, however, was more complicated. Joy there must have been, but hard work and sorrow were here too. Newcastle sat upon a fortune in coal (the name given it by British colonists was no accident), and you had only to walk ten minutes from where Charley was now savaging his stick, and scuff the trail with your shoe, to uncover the black grit of Nanaimo’s past. A trail ran all the way around the island, and at one point, fenced-off concrete platforms, moss-covered and crumbling at the edges, marked the walled-off openings to the ventilation shafts that kept the miners alive.

  Beginning with the ubiquitous Hudson’s Bay Company and continuing at the hands of a succession of coal barons, companies pulled coal out of a half-dozen mines around Nanaimo into the 1950s. In coal’s heyday, shafts criss-crossed beneath the city, even across the harbour to Protection Island. Today, home buyers in some parts of the city are still advised to check with city hall before plunking down their money.

  There were quarries here too, where the unique sandstone of the island was sawn out in disks by huge rotating cookie cutters that now sat rusting in the pit beside a monolithic jumble of rejects. The discs became millstones for grinding wood in pulp mills. Other chunks of Newcastle sandstone were shipped as far afield as San Francisco as building material.

  Beyond the quarries, along the narrow passage that separates Newcastle Island from the City of Nanaimo, the Japanese families who were so much a part of the commercial fishing industry in B.C. before the Second World War built salteries for the salmon and herring that they shipped back to Japan and the Far East. By the 1920s, Nanaimo, which had been known as “Coal Town,” had forty-three Japanese salteries and was now known as “Herring Town.” The Japanese lost it all, along with their boats and everything else they owned, when the xenophobic wartime government banished them to internment camps.

  Of the Indigenous people who were there first, there are few artifacts beyond the mounds of shells in Midden Bay, a seasonal encampment for harvesting the herring that used to mass near Protection Island. They got their first taste of the white man’s progress by digging coal shoulder to shoulder with Chinese miners, for half the wage of the whites. Now the Snuneymuxw First Nation manages the park, which is part of their traditional territory, offering cultural tours and interpretation on Saysutshun. Every evening we watched their aluminum scow depart for Nanaimo, piled high with the white man’s garbage.

  Nanaimo is a good place to contemplate human nature; like every place we stopped in the two months it took to go around Vancouver Island, the sense of past lives was overwhelming. You never had to look far — there was usually an abandoned log skid or a drunken length of cedar fence to remind you that families had been here. Sometimes you even brought up the evidence on your anchor. The bottoms of many bays were criss-crossed with old tackle, and remote beaches were often littered with what, at first sight, looked like sizeable brown turds. They turned out to be fragments of two-inch cable so rusted you could shatter them against a rock.

  The hot wind blew all night, carrying snatches of music from a wedding being celebrated in the nineteenth-century pavilion on the island. Hatsumi steamed the two barely legal crabs I had managed to entice into our trap, and we ate them in the cockpit while Vera swung uneasily on her chain. I wondered if we’d make it through the night without bumping into our next-door neighbour, the James Island Belle, an ancient liveaboard with a dinghy whose sails hung, algae-slimed, in the water. A young guy and a mutt came and left in a decrepit runabout, and the whistle of his windmill generator rose and fell in the gusts fanning across Mark Bay. A dirty rope at the bow led to something on the bottom; I hoped it was an anchor.

  Winnowing

  When I’d confessed to my father that I’d kept all his papers, I hadn’t gone into detail. But before we actually detached Vera from the dock and pointed her north, there was one last thing I’d had to check off my list: “sort F’s records.” The cardboard box marked The Trial was too big to stow on Vera. We needed every available nook and cranny for legitimate provisions.

  So I had to winnow. I was interested in the effect the experience had had on my father — on all of his family — not in establishing right or wrong, fairness or injustice. That would be the criterion. I decided to begin at the end. After all, that’s why the story was in a box: it had ended badly. This wasn’t a whodunit. I already knew how the story ended; what I desperately wanted to find out was why it had ended that way, and why my father had never recovered.

  A single photocopy said it all: the order in the Supreme Court of British Columbia, dated 1987, for a settlement of $1.5 million. Liability was not admitted by any of the defendants, who were never heard in court. Attached to the order with a rusted paper clip was a nice letter from the Canadian Medical Protective Association — my father’s insurers — wishing him “many pleasant retirement years.” End of story . . . except that it wasn’t.

  I spent a few minutes with the clutch of newspaper stories that came out during the trial itself, but the idea of my father not responding to phone calls about a patient, of offering to “find another baby” for the distraught mother seemed as ridiculous as it had in 1987. Facts were what I needed, not newspaper stories. Having reasoned my way soberly to this point, I took the media stuff on the trip anyway; those articles were like the gory illustrations in a book that you just couldn’t help looking at.

  Next came the “patient records.” There were several slim folders, one to a patient, and then Billy’s gargantuan file. I knew why Billy’s file was there, but who were those others? So many people had passed through my father’s hands, but for some reason, I had seven of them in front of me — a curious little collection of hangers-on. I had no idea who most of these people were, but I figured they might tell me something about Dr. Harvey. Welcome aboard.

  That left Billy. What I did with his file was up to me, but I knew I had to watch myself. Condemnation or vindication were not only irrelevant, they were probably risky as well; if I wasn’t careful, I’d be looking at a lawsuit of my own.

  Billy’s file could be subdivided into categories, which I arranged more or less on a scale of believability. If one assumed that things written on a form were believable, then the six inches of “hospital records” had to come first. Here was the official record of every encounter between Billy and the medical system in British Columbia, from the moment of his birth to the trial almost ten years later. Of those hospital records, nursing records took up the most space. Each day of Billy’s life presented a cluster of boxes to be filled in, for intake and output, temperature, blood pressure, medications. Many had sections for the nurse’s comments, and these were often filled in by two or three different people. This child passed through many hands. The doctors themselves contributed history sheets, consultation records, and progress notes. Laboratory reports summarized tests on blood, urine, and cerebrospinal fluid. Actua
l operations were described in consent to operation forms, the doctor’s own report of operation, and anaesthesia records. Much of the doctors’ reports was narrative, and they ran to several pages, often in the dry, laconic style of an airline pilot. Most were in the first person, perhaps because they were dictated into a machine. “I presume this is a hydrocephalus,” said my father to his Dictaphone, right at the start.

  Once out of the hospital, Billy moved to a special-needs clinic, yielding five years’ worth of psychological evaluations, physiotherapy, and social work notes. The sense of urgency running through the hospital records was gone now; instead, it looked like a methodical charting of one boy’s progress through a smoothly running system.

  All in all, the official records comprised a formidable brick of paper. Some poor soul had spent hours over a photocopying machine, dizzy with ozone, hand-feeding flimsy pink carbons. Without knowing anything about the case, you could start at one end and emerge, days later, at the other, cross-eyed but theoretically knowing as much as anybody about what happened to Billy. You could also come to about a hundred different conclusions as to why, and I imagined the legal staff for the plaintiff and for my father doing just that, forcing themselves through the smudgy, often illegible pages, staggering out for coffee breaks, then diving back in to look for weaknesses. Bulky or not, the records had to come along on Vera.

  Next, and decidedly lower on the believability scale, were the expert opinions. The opinions were also written by doctors, but they were based not on their own actions, but on the pile of photocopied hospital records I’d just gone through. The doctors who wrote these opinions had read exactly the same material I would read on Vera, except that they had been paid for it. Some, it turned out, had been selective; one hadn’t bothered with the nurses’ records at all. All the opinions were written long after the events took place. I decided, after a quick look, that the six expert opinions about Billy (three on each side of the case) would be an interesting read, like one of those novels where the events are retold through several points of view.