Science fiction allows readers and writers to experience an array of possible futures. In novels and short stories, authors have explored advances in topics as vast as technology, transportation, space exploration, and politics. Want to know what the existence of teleportation technology might do to questions of ethics and identity? Check out James Patrick Kelly’s “Think Like a Dinosaur.” Utopias and dystopias, for good and for ill of the people living under them, have been explored in countless works. But speculation about the future of medicine and disease enters into a trickier realm.

If you’re a writer exploring the nature of illness and healing in the future, from what angle can you best approach it? Some might choose to explore a world in which all disease is curable—and, perhaps, to focus in on an exception to that, and its effects on both the person afflicted and the wider society. Another might opt to focus on a specific treatment of a specific malady. And still others can use settings commonly associated with medicine for explorations of other science fictional themes.

D.G. Compton’s 1974 novel The Continuous Katherine Mortenhoe balances a near-future take on illness and death with an equally resonant riff on an omnipresent media that seems deeply prescient, from a present-day perspective. The novel’s opening introduces its cynical narrator Roddie, equipped with camera eyes, and instantly establishes that the title character is the object of his interest. “Suddenly, out of the blue, the Medical Center had rung her,” Compton writes; Katherine soon learns that, in a society that had largely cured illnesses, she has been stricken with a brain condition affecting the connections between cells in her brain.

“Nobody of my age dies very much,” Katherine tells the doctor informing her of the news. And this, then, is what’s drawn the media’s attention to her—in a world where few people die young, her mortality makes her a kind of celebrity. Thematically, there are a host of intriguing juxtapositions here, largely between the information intake that was once believed to be the cause of the brain condition affecting Katherine and the information intake that Roddie’s new eyes force him into. And Katherine herself is a reluctant protagonist, a deeply normal individual who chafes at the idea of being turned into a symbol or the object of unwanted attention. Early on, she refers to people as “[e]ach one simply chemistry, simply a bundle of neurones.” For a novel focusing on death (and how we examine it), this is a deeply unsentimental look at life, which makes the emotional sting that its ending contains that much more powerful.

Science Fiction about medicine is represented in the stories collected in the Ann and Jeff VanderMeer-edited anthology The Big Book of Science Fiction by James White’s 1957 “Sector General.” In their introduction, they speak of the setting of this story and many others by White—a hospital whose patients and staff hail from a variety of alien species. Specifically, they laud this approach for the empathy that it can create, pointing out the setting’s “strong undercurrent of pacifism” and the use of tapes that overlay information about the anatomy of other species into the minds of doctors. Conway, the story’s protagonist, has his first experience with one such tape early in the story. Afterwards, “he felt himself to be two people—an Earth-human named Conway and the great, five-hundred-unit Telfi gestalt which had been formed to prepare a mental record of all that was known regarding the physiology of the race.”

In other words, the process of being a doctor in White’s fictional world is one that already comes with narrative devices that deal with the essential stuff of science fiction. The novella has an episodic quality to it, following Conway as he moves from patient to patient, covering a wide range of species that might be strange to human eyes.

Geoff Ryman’s 1989 novel The Child Garden, or, A Low Comedy offers perhaps the most radical take on the future of medicine and disease. Its first two sentences describe its main character engaged in a seemingly everyday practice: “Milena boiled things. She was frightened of disease.” To those of us reading this in the here and now, that seems like an understandable sentiment. Milena, however, lives in a future society in which viruses impart knowledge and skills, and are an innate part of civilization. In this future, cancer has been cured, but with the side effect of shortening human lifespans to around 40. Milena is an outlier in this world, in that she is largely immune to the effects of viruses.

Ryman’s novel memorably depicts Milena’s alienation from this world of genetically-altered humans. In a society in which tremendous technological advances have occurred, Milena’s chosen occupation hearkens back hundreds of years: she works in the theater. And as a relative outsider, she makes for an excellent guide to a world in which nearly everything a contemporary reader might understand about health, sickness, and disease are fundamentally altered.

The novel blends a number of disparate threads: the evolution of Milena’s grandiose storytelling project; her relationship with Rolfa, a woman genetically engineered to live in polar environments; and the way that her resistance to viruses takes on a greater significance, as it ultimately places her in a harrowing position regarding mortality and immunity. In her introduction to Small Beer Press’s 2011 edition of the novel, Wendy Pearson noted that the novel “is also about the dual meaning of the word ‘pharmakon,’ which denotes both cure and poison.” That sense of knowing contradiction runs throughout the novel, up to and including its subtitle’s invocation of comedy even as it delves into gut-wrenching questions of mortality.

Whether tinged with a sense of adventure or tapping into our anxieties about our own health, science fictional explorations of medicine have an added layer of complexity in their very structure. But simultaneously, they also add a layer of grounding to even the most fantastical of settings. To use Ryman’s novel as an example, the setting may seem almost alien to us—but the concerns about disease, death, and not having enough time to accomplish all that one desires are close to universal. And while science fiction about medicine and disease is hard to do well, it has a substantial and empathic impact when it lands.

Top image: Firefly “Ariel” (2002)

Tobias Carroll is the managing editor of Vol.1 Brooklyn. He is the author of the short story collection Transitory (Civil Coping Mechanisms) and the novel Reel (Rare Bird Books).