At the end of all my digging into the medical mess that resulted in The Game, I was left with the most unexalted of conclusions: of course things went wrong. They always do, always will. Most catastrophes are crudely engendered and obvious. A bus driver fails to do a shoulder check and wipes out a cyclist. A weekend sailor mis-times a squall, takes a flogging jib sheet across the face, and finds himself spitting teeth onto the cockpit floor. Simple systems, misjudged for an instant, the squibs popping away in the background of our lives. On the face of it, my father’s experience was meaningless: a lawsuit was launched, he got caught in the headlights for a medical procedure he didn’t even do himself, and he couldn’t answer the complaint about “failure to attend” because he didn’t remember. The plaintiffs and their lawyers walked off well satisfied. Without the chance to defend himself, he just limped home to brood.
As to why he could never get over it, the best answer I’d come up with in two months of digging was the public damage to his good name. “Get over it,” was easy to say, and maybe he should have. But when I asked myself how I might react if I were publicly shamed, I realized I had no idea. We’re exhorted to empathize with others, and that’s what I’d been trying to do for my father, but how good could I be at empathizing when I was unable even to predict my own reactions to something as calamitous as what he went through?
After spending a year on just one medical condition, and how its “going wrong” caused so much pain and suffering to such a large cast of characters, I decided that the amazing thing about modern medicine, even in my father’s time thirty years ago, was that things went so well. Especially with the brain — no, not just the brain, the developing infant brain, bathed in its cushion of fluid, consolidating its spectacular inner architecture for monitoring, processing, controlling, executing all the conscious and unconscious commands the organism needs to move, to see, to eat, to communicate, to live independently of the mother ship. That such complexity even exists, and works as well as it does, is a potent reminder of why Charles Darwin kept his theory of evolution so close to the vest for so many years. Something so complex as the human nervous system flew in the face of reason. It was just too much to expect. Divine direction was so much simpler.
But the developing infant brain does exist, and we understand it pretty well, and most of the time, it does what it seems built to do. Babies get born, they cry, they suckle and grow. When something goes a little off the rails — a touch of jaundice, an ear infection, croup — medicine steps smoothly in and puts it right. But what happened when many things went wrong? Like an insidious, undetected ventricular bleed long before birth, followed by an untimely early appearance and a struggle to get the oxygen so desperately needed before all those developing systems begin to falter and reorganize themselves into worrisome variants of the normal? That, I decided, was when our expectations of medical knowledge and the ability of its practitioners might be a little over-optimistic. Maybe the doctors could fix a “bad baby.” But maybe they couldn’t.
And if they couldn’t, society felt compelled to award a consolation prize: the malpractice settlement. The better medicine got, the more people expected from it, and the more severe their displeasure when things went wrong. Try as I might to be fair to Billy’s parents and lawyers, I couldn’t shake the conviction that he’d been born into a perfect storm of neurological disasters that, doctors or no doctors, shunt or no shunt, would inevitably have compromised his life and the lives of the people who would care for him. My father sailed into that perfect storm, and when he had done his best to keep the ship afloat and come out the other side, the legal system was waiting for him.
That’s how I felt when I finally reread The Game. It was never published, although he had a publisher interested. The problem was he couldn’t finish it. The pain was still there, but the fire to get it on paper had finally flickered out. I’d been through it years before, when many of its chapters had been parts of a larger memoir that I’d nagged him for years to complete. The entire manuscript was on now-unreadable floppy disks, and I’d had it all laboriously retyped so that he could refine and rearrange without the frustration of computers. And he did it, spreading the chapters out on the kitchen table and annotating in an increasingly wavering hand. But whenever he came to the material on the trial, the whole process ground to a halt.
“I can’t face it,” he would say.
“Okay, let’s put it together some other way. Defer the trial stuff until later.” The result was a slim and entertaining memoir and the manuscript for The Game. The memoir got printed and distributed to friends and family, but The Game died with him. Now that I’d finished with every scrap of evidence, the trial itself and its aftermath, I was finally ready for it. In Bamfield, to the accompaniment of a bad pub band, I read it.
It was so much better than the memoir. He’d taken chapters about his youth, his training, his experience as a doctor, and alternated them with the story of Billy, from the summons at the door to the stories in the newspaper. Told this way, the malpractice case ran as a malevolent countercurrent to his career, and the back and forth pacing worked just as it should in the telling of any good story. It was good writing, and not just in the architecture but the details too. In a chapter called “Water on the Brain,” his description of the cerebrospinal circulation made my own efforts seem ponderously journalistic. He compared the ventricles to “a chain of lakes,” and the choroid plexus, where cerebrospinal fluid is produced, to “frilly curtains” projecting into the ventricles. His primer on shunting managed to be breezy and authoritative at the same time. “Infants outgrow their shunts,” he wrote, “just as they outgrow their shoes.”
But most of The Game wasn’t breezy. It was sad, angry, defiant. When he wrote about waiting for the trial so he could rid himself of his “secret monster,” it wasn’t funny. His feelings about lawyers and the operation of the legal system were there, and strong, but he didn’t entirely lose his sense of humour. When his own lawyer remarked it had been a tiring day, he said, “It has. But you can send in your bill for it, and I can’t.”
Everything he’d concluded about medicine and the law was contained in a fine chapter called “Two Solitudes.” In medicine, he said, truth has “few absolutes and many exceptions.” Yet, “the doctor in court encounters an inquisitor who insists on yes or no answers, who urges him to turn biological grey into legal black and white while at the same time telling the truth, the whole truth, and nothing but the truth.” But despite the pain, there was an undisguised love for medicine, even if it didn’t turn out the way he’d hoped. He loved teaching and, at least at the beginning, even the surgery. His whole professional life was in The Game, good and bad, including the drop-out periods when he tried to escape the grind. He called his brief sojourn at the University of British Columbia, “The Easiest Full Professorship in History,” and reprinted all of Robert Frost’s famous “The Road Not Taken.”
There was a high point, when he had a Chicago-trained partner and got the respites he desperately needed, allowing him to join the violin section of the Victoria Symphony after “seven years of being the neurosurgical Lone Ranger.” But his partner didn’t stay long in Victoria, and my father went back to his escape attempts. Eventually, he got another partner, but by then he was winding down. Finally, in his mid-sixties, he packed it in. The telephone stopped being an enemy. “I would look at it when I climbed into bed and say you’re not going to ring tonight. It was a good feeling.” He was just getting used to that, eight years later, when the summons came.
The rest of The Game is a diary of the case. It takes over his life, infiltrates sleep: “It is always the same dream. I am in the operating room, in the middle of a craniotomy, when I suddenly ask myself, why am I doing this? I’m retired. I have no malpractice insurance. The operation is never finished; it goes on and on. And then I wake up in a sweat.” To get ready for his appearance in court, he quotes Polonius:
This above all, to thine own self be true
And it must follow, as the night the day
Thou canst not then be false to any man.
It’s easy to belittle the use of a famous literary quotation to justify one’s own actions, but he really believed in truth. Reality, though, was his lawyer entering court dragging “a little two-wheeled cart like the ones you see in airports, and on it was his own giant briefcase beneath a stack of loose-leaf folders three feet high.” Reality was the freezing cold inside the glass-walled atrium of the Vancouver Courtroom, where lawyers gathered in whispering clusters during recess.
“Always remember,” his lawyer told him, “you’re in enemy territory here.”
Above all, reality was the abortive trial itself, which turned out to be a game, a contest between lawyers with the judge as referee.
Finally, near the end of The Game, I found the thing that was as close as I would get to a bombshell. It was this: for him, the real story of the trial wasn’t the defeat and the shame. It was “how a gifted individual managed to make such a mess of things.” Everything in his life — from the tiny prairie town to violin trophies and top of the line professional training at the University of Chicago, then the sputtering practice in Victoria, the isolation, the conflicts and defections, the escapes and the restarts — everything was connected. It was a process, and it led to the final straw that broke his back. The trial confirmed what he already believed: he’d made a mess of his life.
Of all the surprises I’d encountered in nearly two years of invading his past, that admission was the biggest. Thinking back over the man I had known, it wouldn’t surprise me if his disappointment in himself had driven him through his entire career. The conclusion I’d come to the day before — that public humiliation had been the thing that broke him — wasn’t wrong, but it wasn’t everything. Now I knew: the trial was the last nail in a coffin he’d been building all his life. I’d thought I was finally getting to know him and now this.
It explained what he said to me between the stroke that eventually killed him and his final day, when the nursing staff tucked him into bed with his bloodstream full of tranquilizers, stage one in the death routine such places can practically set their watches to. And not just what he said, but how he said it. He was still in his ratty velour recliner, cardigan cross-buttoned and slipping off one chicken-shoulder, white hair flying as though we were braced against a gale rather than sweltering in the hothouse of a care home. Two days before, we’d arrived for a visit and found him on his face on the hallway carpet, his legs still in the bathroom where he’d fallen. He couldn’t move, and he’d given up calling for help. Now he was only a few days from the end. He leaned forward, or tried to, and looked me in the eye.
“I was a very good doctor,” he said.