by Brian Harvey
Clam Bay is on Penelakut territory, so most people who anchor there don’t go ashore. The bay is guarded by a sandy spit and a marked shoal, between which you have to insert yourself, and I cut it too close. Eight feet, the sounder suddenly read (eight feet! Only three feet of water under the keel!), and I had to crank an embarrassing hard right to clear the unseen mound of sand. But there was plenty of room to anchor, and I curled up for an hour inside the mind of Nabokov’s monstrous anti-hero. Teenagers cannon-balled off a power cruiser across the bay, whooping and hollering, while Humbert Humbert quietly plotted his campaign for literature’s most famous bobbysoxer. The constriction of the channel we would need to negotiate our way through tomorrow, the unforgiving headlong rush of water from one basin to another, faded from my mind. But constrictions of another sort were at the heart of all those medical and legal records I was ignoring in favour of a novel I’d already read.
The Sea Inside Us
By the time we had set out in Vera, I already knew at least as much medicine as the lawyers who had made the deal my father had had to live with for twenty years. I had to: if I was really going to read his detective story, one document at a time, at anchor somewhere, or sitting on a log in some remote cove, I needed to understand the technical basics. If I did, the two months our trip would take might be enough time to get to the bottom of the person who’d been a puzzle to me for fifty years.
I hadn’t brought any medical textbooks though. Vera had bookshelves, but those were needed for all the tables and guides and how-to books that made up our floating library. In a choice between Principles of Neurological Surgery and the shop manual for the Yanmar diesel engine, engine maintenance won out. What I didn’t know yet was how close engine maintenance was to surgery. And I would never have guessed how the currents and constrictions we would navigate in Vera were mirrored, in miniature, by an aquatic labyrinth inside the brain, where my father did so much of his travelling.
He got his first look at the human brain when he was eleven. An “unknown man” (as his hometown Killam News put it) had fallen asleep across the railroad tracks that led to the swimming hole. “Not a little excitement” ensued when the poor man was discovered decapitated. In his memoir written seventy-five years later, my father picked up the story:
“The men who were responsible for overseeing the remains informed me that they were going home to lunch, and it would be my job to watch over the deceased. I remember my feeling of pride; I had been given a very important assignment! It was a hot day; flies covered the stump of the neck and the smashed-in head, and the man’s brain was scattered about like spilled porridge.”
I’ve always wondered how it fell to him to guard the corpse and whether his sang-froid in the presence of all that grey matter was real or just a convenient memory. Either way, twenty-five years later he was struggling to become a brain surgeon. That brain surgeon’s nemesis was a disease called hydrocephalus, “water on the brain.” If I could get my own head around hydrocephalus, its treatment, maybe even something of its history, then I could make sense of the rest of the stuff I had squirrelled aboard Vera — and of him. Without putting in the time to learn about this disease, whatever I wrote about my father would be as worthless as those newspaper articles from twenty years before. And if I could figure out what made my father tick, it wasn’t too late for me to learn a few lessons myself. Never a bad thing at a time when people start commenting on your resemblance to your parents.
Conveniently, there was a medical library right across the street from my house. A few months before leaving on our trip, I had given the librarian a short list of topics I was interested in. A week later, I walked down the street and across the road to the Royal Jubilee Hospital to pick up the results. The last time I’d been there was to take my father to Emergency after finding him on the kitchen floor next to a puddle of melting chocolate ice cream. His bewilderment and rage at having to spend the night on a gurney in the hallway, for lack of bed space, had been hard to watch. Thirty years before, he could make beds materialize with a snap of his fingers.
The Victoria Medical Society maintained a brave little museum of old textbooks and instruments in a corner of the psychiatric ward. I passed the loading bay with its smell of soiled sheets. A scarecrow figure with exploding hair stared wordlessly at me as I struggled with the heavy door. He was wrapped head to toe in a blue hospital blanket. One side of his face seemed lower than the other, like a comic-book villain’s. Whatever his condition, it was entirely possible that somewhere in the materials I’d requested there was an article that described it. We could sit down together, the sagging man and I, on one of the green vinyl sofas and pass an instructive hour looking for similar cases. An attendant took his elbow, and I escaped to the medical library.
To get around the cost of purchasing scientific articles online, I had used a subterfuge when filling out the request that would put the librarian to work downloading and printing out the twenty or so I’d asked for. Where it said, “Requesting Physician,” I wrote “Dr. Harvey.” It was true, in a way, and it worked, although the librarian gave me a searching look when I picked up the fat envelope.
“This will mean a lot to him,” I said, taking a surreptitious peek at the contents. The papers I’d requested were all here, even the ones on the historical treatment of hydrocephalus, going back to the Middle Ages. But before I did any reading on history or treatment, I needed a road map. If I was to understand the disease, I had to know the terrain, and that meant textbooks. I extracted an up-to-date Clinical Neuroanatomy for Medical Students and the latest edition (the thirty-eighth) of Gray’s Anatomy, a good fifteen pounds between them. Then I lugged my treasures to a table, along with a book I’d brought from home, my father’s own copy of Gray’s.
I started with that one. The leather-bound Gray’s Anatomy had been my great-grandfather’s, and it looked its age, stained and beaten. When I opened it, some dried petals drifted out, brown, veined, and paper-thin, like the wings of a moth. They fell apart in my fingers. Leander Harvey’s signature on the inside cover was dated 1862; he must have bought the book the year it came out. The oval business stamp next to his signature proclaimed him “Surgeon, Accoucheur and Coroner, Watford, Ontario.” “Charges Moderate,” it said too, and “Attendance on the Destitute Free of Charge.” An accoucheur was an obstetrician, so my great-grandfather must have done a bit of everything.
My father’s signature, dated ninety years later, was the latest in a list of four medical Harveys, a streak that ended when none of his children offered to pick up the scalpel. His own father, in fact, had been a druggist and optician, and the closest my father got to a “medical upbringing” was the hours he spent hand-filling gelatin capsules with the concoctions his father had mixed. Still, some cabal of genes must have called to him across the generations; if anybody had asked me, right then, why my father had quit his job as a high school teacher and enrolled in medical school, I would simply have pointed to all those signatures in Gray’s Anatomy. For him, the years as a medical student were years of hope and discovery — the best years of his life.
Gray’s Anatomy, like all early anatomies, was the product of innumerable dissections of cadavers, accompanied by meticulous note-taking. This battered original was his ancestors’ working manual: parts of the text were heavily marked up with pencil or green crayon. What I needed to know — the basic architecture of the brain and spinal cord, and especially the system of channels and ducts and reservoirs for the fluid that was at the core of hydrocephalus — was all there.
Modern editions are still called Gray’s Anatomy but are the product of a committee. Comparing the two as I sat in the medical library, I saw that the modern version wasn’t all new; a few of the original diagrams lingered on, a testament to how good those early anatomists had been. But the progress in imaging techniques was extraordinary. Now, the anatomist’s eyes and simple light microscope were augmented by electron micrographs and magneti
c resonance imaging (MRI) scans that allowed anatomists finally to observe and take measurements from a living subject. The MRI pictures of the brain in the new Gray’s were so clear they could have been, well, diagrams.
***
It only took me an afternoon to get my bearings. The new anatomies were that good, allowing me to leapfrog a thousand years of medical observation and trial and error. I learned that our central nervous system contained an aquatic labyrinth and that I was going to have to navigate it. Like a nautical chart, the map of the cerebrospinal system was three-dimensional, and it depicted a tiny ocean within the globe of the skull. And, as I soon learned, these waters of the brain ebbed and flowed just like the waters of the ocean.
For the mariner, the greatest problems usually occur at constrictions, where water squeezes through narrow openings and the resulting buildup in pressure creates rapids as fast-running and dangerous as any river. It was the same in the sinuous channels of the brain; there were constrictions everywhere. To me, the generations of anatomists and physicians who had charted this inner ocean seemed to have something in common with their seafaring contemporaries. The great anatomist Giovanni Battista Morgagni opening the brain of a cadaver in Padua, the mapmaker George Vancouver creeping farther and farther up the forbidding fjords of Desolation Sound: both were explorers.
But there was too much terminology for me. I needed a way of seeing the cerebrospinal system in a practical light. I decided to think of it as the solution to a problem in engineering design and add the fancy names later. Here is what I came up with.
The brain and spinal cord comprise a single mass of neural tissue (imagine a pudding with a long tail). If you had to design a way to nourish and protect this delicate system, you might bathe it in fluid because fluids absorb shock and transport nutrients and wastes. Why not give the brain its own fluid-creating engine? Set it for continuous operation and attach a system of reservoirs and you’ve made a good start.
But you need to get that fluid outside the brain and spinal cord if it’s going to act as a shock absorber. You also have to find a way to return the overflow to general circulation. So you do two things: perforate the inner network near the base of the brain, allowing fluid to leak out, and capture what comes out by wrapping the whole brain and cord in a membrane. Most importantly, you make that outer membrane a leaky one: tight enough to cushion the brain, but porous enough for the overflow to seep into the blood circulation.
Problem solved, in a way that’s beautiful and mind-boggling. You now have two fluid spaces, two seas, one inside the brain and cord and another bathing them. Fluid is produced in the inner system, enters the outer system through a few critical one-way drains, and escapes through selective pores through the membrane that wraps everything together.
Here are a few critical names.
The fluid is called cerebrospinal fluid. All the authorities abbreviate to CSF, and so will I. There are about 130 millilitres of it — a cappuccino’s worth — filling the spaces in and around the brain and spinal cord. The whole system is renewed four to five times a day. It’s made in four cavities in the brain that look like a three-dimensional version of the Great Lakes. Those cavities, which will appear again and again in my story about hydrocephalus, are called ventricles (think “vent” and “trickle”), and they form a cascading system that’s a prime candidate for blockages and obstructions. Eventually, the CSF escapes out the fourth ventricle to collect in that cushioning outer sea which encapsulates the brain and spinal cord. Things are crammed in here: that envelope also surrounds the optic nerve, an arrangement that can have unpleasant consequences if CSF pressure increases. Pressure on the optic nerve was at the heart of the plaintiff’s case against my father.
Pressure is normally kept constant, however, and we know the entire fluid volume turns over every five hours, but how? The heart doesn’t push it around. How does it get from the ventricles, down around the spinal cord, around the brain and out?
This is the part that made me sit back in my chair in the medical library, look up from the shiny colour diagrams, and shake my head. Because circulation of the CSF is passive. Fluid moves because of the beating of a million hair-like cilia that line the ventricles like microscopic oars, because of the flexing of the spine, because of respirations, coughs, and changing body position. Even the far-off beating of the heart is tapped. It was like my father’s self-winding LeCoultre wristwatch that fascinated me as a child; I would pick it up from his bedside table and tilt it back and forth in my palm just to feel the mysterious internal clunk of the tiny weight inside, rolling around and somehow keeping the watch ticking.
And I had all this in my brain! No wonder he’d had such a horror of the head injuries we might suffer if we swung from a tree, played football, rode a motorcycle. This microcosm of pulsations and membranes and imperceptible internal tides had been his universe, and he knew from daily experience that a blow to the head could easily overwhelm the shock-absorbing capacity of the CSF. His warnings to us were fifty years ahead of today’s vigilance about concussions. What I was finding in my reading was mechanisms upon mechanisms, checks and balances, an exquisite homeostasis of the kind that nature is so profligate with, from the microscopic world to the planet we live on. I gave my head an experimental little shake, in case my own cerebrospinal fluid needed a nudge, like my father’s ancient watch.
Unfortunately, a tiny failure somewhere in the chain can crash the whole system, as surely as a single submerged rock can hole a ship and sink it. In the human brain, the consequences of failure in the CSF circulatory system can be spectacular. The best known is hydrocephalus. The name means, roughly, “water on the brain,” although really that should be “too much water on the brain.” Hydrocephalus is a nightmare, and for over a thousand years, physicians stood and watched while children died from it. Hydrocephalus had been the gremlin riding on my father’s shoulder in 1976, looking down while he performed the simple operation all neurosurgeons did to put the brain’s plumbing back in order.
Relearning is a second chance. What I learned about the workings of the CSF system in an afternoon at the library was wondrous and felt new, but it wasn’t really. I had studied these things before, as an undergraduate in biology, but the learning then had been unengaged and impermanent. I had no reason to care about the human brain, not then. This time around, though, the cerebrospinal system went from being just a diagram to be memorized to a small universe populated with the ghosts of ancient anatomists and my own family’s skeletons. The novelty, the complexity, the history — it was irresistible.
Learning to Sail (Again)
I also had to relearn how to sail. I had learned the hard way, my father lowering me into an eight-foot sailing dinghy and pushing me away from the dock to fend for myself while he tried to get some varnishing done. I wound up jammed against the side of a tug anchored in the bay. Most horrifying were the white roman numerals painted on the stem, like a ladder into the depths.
The last sailboat I had owned was a twenty-foot daysailer that was little more than a big dinghy. Vera was almost twice as long, and a sailboat’s volume and complexity don’t increase with length in a linear way; they metastasize. Here was novelty, here was an embarrassment of complexity, and mastering it would all be very public.
Sailing would be relearning for me, and my wife’s maritime experience with the pedal-driven swans in Inokashira Park wasn’t going to be much use in Haro Strait. From the moment we took possession of Vera, Hatsumi and I would be partners in a three-legged race with plenty of spectators. For the first few years, it felt as though we had opened the wrong door and stumbled into the Olympics.
The first lesson we learned about sailing was that it’s ruinously expensive. I already expected this, although I soon realized it was mostly non-boaters who, when I told them what we’d just done, brightened and said, “A boat! You know what a boat is, right?”
“No. What is it?”
&
nbsp; “A hole in the water into which you throw money. Har! Har!”
I’ve always thought this a feeble image; in my imagination, the bills simply float around until you reach in and retrieve them. I prefer “Boating is like standing in the shower and tearing up dollar bills,” because it better captures the masochism of it all. But both adages claim the same thing: boating is a waste of money.
This tearing up and flushing of currency refers mostly to parts and maintenance. When you buy a boat, you meet a lot of men in coveralls (and a few women). The silver lining of inflated marine prices is that they establish a dividing line between two kinds of boater: those who pay the professionals and those who are prepared to put themselves through all manner of contortions in order to avoid shelling out. If you pay, boating really is ludicrously expensive. If you don’t, and you learn how to fix things yourself, it’s almost affordable.
The water pump on Vera’s Yanmar diesel engine, for example, would cost me nearly a thousand dollars to buy new and another couple of hundred to have installed. It’s a critical component, even though all it’s asked to do is sit on the end of the engine and be spun by the alternator belt so that it sucks in seawater to cool the engine. Is that so hard? There’s nothing to the thing: a cast-metal body the size of a baseball, a pulley, a shaft that spins a rubber impeller inside like a miniature water wheel. It only costs a thousand dollars because people are willing to pay that much for it.