Kill or Cure: Medicine and Healing in SFF

Humans are fragile creatures. Flesh breaks easily and even the most healthy, brawny and athletic of us fall prey to sickness from time to time. Depending on the severity of whatever ailment or injury befalls us, it can have a significant impact on the way we live the rest of our lives.

Most fantasy stories include a certain level of action in them somewhere – be it a full on battle of five armies or a Quidditch match – and in extreme physical situations injuries and fatalities are inevitable, even for characters who are well suited to, and trained for, the task. Authors address this in various ways throughout the genre, using methods of healing to advance their plots and add an important layer to the worlds they create.

As with any aspect of worldbuilding, the healing options characters have at their disposal can make a huge difference to the way a story can go. Staying alive is a pretty important goal for everyone, so much so that it’s an instinct ingrained into us from before birth, and while dangerous situations and bloody battles might be both exciting to read and necessary to the plot, injuries can have certain consequences. A character can only be pushed so far before they simply end up dead or maimed beyond repair.

Bran from A Song of Ice and Fire is an obvious example of this. Pushed out of a window at the beginning of the series he is broken for life, which affects both his physical limitations, as he is unable to do many daily activities the able-bodied might take for granted, and his psychological well-being. These limitations change the person Bran would have become if the accident hadn’t occurred and therefore the plot follows as George R.R. Martin intended, but permanent injury might not be the plan for some characters and so different methods of healing become necessary.

The huge advantage to fantasy is that if no method exists in reality, or wouldn’t have existed in the historical setting of the fictional world, then a writer can just invent one – probably a more exciting and magical one – to get the job done and the character back in action. Harry Potter would have been extraordinarily dead, or at least disabled, a number of times if there weren’t magical remedies to everything he happened to face. In The Chamber of Secrets a spell gone awry causes him to lose all the bones in one arm. Had this been permanent he may not have fared so well against Voldemort in the next five books and so J.K. Rowling has some Skele-gro on hand to ensure that he is completely healed the next day, while demonstrating the sort of powerful potions available to her wizards and witches. The properties of this medicine also mean that Harry has to stay in the hospital wing overnight, where he learns some valuable information that advances the plot.

Medicine, drugs and poison are useful tools for plot development because of their life-changing nature. When used unethically or irresponsibly they can easily manipulate and destroy, and because they are built on scientific principles (even magic-based remedies and tonics usually require specialist knowledge), most characters can’t do much about it without the help of an expert. In Scott Lynch’s Red Seas Under Red Skies the book’s entire plot is hinged on the fact that Locke and Jean have been poisoned to ensure their cooperation.

From this we can see that the medical status of a character can prompt motivations that may never have occurred otherwise (consider how careful Kvothe from Patrick Rothfuss’ Kingkiller Chronicles is with his hands for fear of damaging them and losing the ability to play the lute) while allowing the author to share some of the capabilities of their world without any of the dreaded info-dumping.

Medical practice is just one of many parts that make up a well-built world but it’s one that affects every character at some point. This may be as minimal as how they are hatched and dispatched but in some cases it can shape an entire society.

This is more obvious in science fiction, which is rife with medicine. It’s been used for plot, setting, exposition, character motivation, themes and metaphor ever since Mary Shelley began it all with Frankenstein in 1818. As a fundamental area of societal development it is a key element in Utopian and Dystopian futures, ethical debates and a huge focus of potential scientific breakthroughs.

We can see from the news the effect that healing opportunities and the lack thereof have on societies – every day children in third world countries die of diseases that first world countries can cure with a quick injection – but sci-fi shows the extremes that are possible with further development. Never Let Me Go by Kazuo Ishiguro explores the ethics of cloning humans to increase life expectancy, while Richard Matheson’s I Am Legend shows the post-apocalyptic results of the Krippin Virus which, originally intended as a cure for cancer, mutates into a disease that kills 90% of people that aren’t immune and turns the others into rabid vampiric creatures that plague the Earth.

Stories that focus on all the possible outcomes of advanced development in medicine, healing and different kinds of drugs do more for our understanding of the world than simply outline (admittedly sometimes through rather unrealistic metaphors) the various worst-case scenarios and extreme benefits. They depict the realities of cause and effect in any area of mass societal change, usually emphasising the point of view of the person who suffers from the outcome because it’s better for the story but also because it teaches an essential life lesson: we can’t play god and fix everything. We are only human and part of being human is that we have to die. In Middle Earth this mortal lesson is considered a gift from the creator but refusal of the fact seems just as implanted in human nature.

In the process of prolonging the inevitable, the use of drugs (medicinal, physiological and recreational included) and healing techniques in fiction reflect the real world in the same way as any aspect of storytelling. Lives can be ruined or saved depending on their use, and their prominence and reputation in a society or world say a lot about that society’s level of civilisation. A valuable commodity, good healing facilities promote economic growth – not least because less people are dying and reducing the population of workers – and so the hamlet of Cutters Hollow in Peter V. Brett’s Demon Cycle flourishes due to Leesha’s medical discoveries and in The Lord of the Rings the elven kingdoms that focus on rest and recuperation are depicted as heaven on (Middle) Earth, reminding us that health equals happy and prosperous.

Healthcare for some is an everyday thing that becomes almost invisible with familiarity. For others it’s a profession, a lifelong skill to be honed or an addiction-supporting career in drug dealing. However it features, as well as detailing an important aspect of the world to readers, a key function of medical opportunities within a fictional realm is to act as a threat to our favourite characters’ success. Although rarely mentioned in such terms, without the potential for terminal injury or the possibilities of bringing people back from the brink of death, characters would have nothing to lose (apart from readers’ interest), which makes this area of worldbuilding an essential part of any story.

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