Imagine a kind of amnesia wherein everybody forgets about you (Amnesia inversa). Imagine a disease that causes you to contract the infirmity of your neighbor, as your neighbor assumes yours (Renascentia). Imagine becoming so comfortable with the sensation of death that ultimately your spirits gently leave your body (Mors inevitabilis).
These are imagined diseases compiled in "The Afflictions," a work of fiction based on a 16th century medical encyclopedia – the 375-volume Encyclopedia Medininae – housed in an medieval library in Portugal.
That, too, is made up.
"The Afflictions" is the first published work by Vikram Paralkar, an oncologist at the University of Pennsylvania specializing in cancer of the blood. In whatever spare time he has when not researching cancer and treating patients, he likes to write fiction.
"I've always been passionately interested in reading fiction. I discovered Calvino, Borges, and Gabriel Garcia Marquez at 18," said Paralkar, referencing his magical realism influences. "I wanted to capture ideas in beautiful language."
The ideas he is closest to are medical. The 50 diseases described in "The Afflictions" – some complete with cures and case studies – can be read as bizarre, gruesome fables that hint at medical issues.
Take the aforementioned Renascentia, wherein neighbors meet in their village church once a year to find out where the "divine dice" rolls, taking away pre-existing maladies from some and assigning them randomly to others.
Some leave with freshly pockmarked faces, others with new obstructions in their bowels. Some receive dementias or epilepsies of fulminant afflictions that wrack them with agony even as they rise from the pews. And others are cured of consumption, their amputated limbs grow back, or their pustules vanish.
"One of the ideas this disease tries to explore is the arbitrariness by which diseases are given out to people," said Paralkar. "If this were to happen, on a single day of the year, you were to get a completely new set of diseases, you would consider it an awfully unjust system. But is it any more unjust than what exists now? People are allotted their own random set of diseases."
The imagined text on which "The Afflictions" is based – the Encyclopedia Medicinae – is written as though it were lifted directly out of the Age of Enlightenment, when science and religion were still easy bedfellows.
The disorder known as Persona fracta, or Fractured Person, is a psychosis wherein the invalid believes every body function is controlled by a separate person. Paralkar created a case study of a suffering seamstress who understands that walking is done by the walking seamstress, breathing by a breathing seamstress. Her body houses the talking self, the eating self, the looking self, an infinite number of persons each of whom step forward when needed.
The seamstress is not actually suffering. She functions perfectly normally, if a bit crowded. The problem is theological: if she believes her body functions are a collection of dissociated pieces, it stands to reason her soul is the same. When the body falls apart, the soul follows. That notion goes against the church's insistence on the perseverance of the soul in heaven.
"In the 16th century, any explanation you proposed, you had to grapple with ideas of god, heaven and hell," said Paralkar. "I decided to utilize that to the fullest. Anytime a disease that veered into theological implications, I dived into that area."
The world that Paralkar created, based in part on the history of medicine and in part by imagination, is one that makes sense. He wrote brief summaries of 50 diseases, all of which describe a single malady. The meta-affliction in "The Afflictions" has something to do with being fractured and displaced, with the center not holding.
In his day job as an oncologist, Paralkar, the scientist, realizes that disease does not make ethical sense, nor theological, nor moral sense.
"Its intrinsic to people that we find a moral purpose to things," said Paralkar. "Especially with cancer, people ask - why did this happen to me? The answer is because cells divide and sometimes they make mistakes. That answer is immensely unsatisfying. It's just the way we are programmed, we try to find reasons and patterns." -

Disease is made into something new and strange through the eyes of writer-scientist Vikram Paralkar. In his debut book The Afflictions, Paralkar takes advantage of long held associations of medicine with magic to literalize our most darkly-held superstitions about illness.
The book claims to be a collection of entries from the fictional Encyclopedia of Medicine, a compendium of surreal and arcane materia medica. But behind the pseudo-medieval setting and the Calvino-style diction is a meditation on the symbolic resonances of the word “affliction.”
In one of the entries, a man afflicted with Corpus ambiguum can no longer understand the boundary between his body and the rest of the world. “On being asked to sketch pictures of themselves, invalids with this condition often draw incomplete versions of their own bodies, surrounded by amorphous auras and clouds of disjointed appendages.” A woman diagnosed with Persona fracta, on the other hand, is “unable to think of the ‘she’ who walked and the ‘she’ who spoke as the same individual.”
Haltingly, slowly, another story emerges from these encyclopedia entries. The framing narrative and the heart of The Afflictions is the story of Máximo, a young apothecary who wants to become a librarian. As he is guided through the workings of the vast “Central Library” by an elderly librarian, more and more bizarre medical entries are presented to the reader. In one of the more masterful narrative strokes in the book, the nature of Máximo’s own affliction is never fully explained but merely hinted at, mirroring how the encyclopedia itself only hints at the full scope of maladies that can potentially afflict us. As the elderly librarian warns Máximo, “If you read the Encyclopaedia from beginning to end, you get the feeling that every affliction known to man is part of a single, infinite progression. Or that every disease is a different facet of one great and terrible malady.” 
If all this reminds you of a certain Argentinian short story writer, it should—Paralkar cites Jorge Luis Borges as his literary idol. The prose of The Afflictions at times can read like an imitation of Borges’, and Paralkar shares with Borges a collector’s delight in details. One can practically feel Paralkar luxuriating in the task of describing some of the three thousand essences of sounds distilled for the treatment of Agricola’s disease, “some that restore the invalid’s ability to hear the wings of sparrows, others that cover the lower sonorities of dulcimers, yet others that are concerned with the sounds of raindrops.”
But Paralkar’s obsession with minutiae and the archaic are more than just literary mimicry. The medieval world of The Afflictions is a vast, senseless universe that can only be ameliorated by fleeting beauty and small joys. For example, in the unlucky towns afflicted by Auditio cruciablis epidemics, every sound inflicts the most excruciating pain. Though the inhabitants are trapped in the desolation of silence without end, they respond not scientifically, by searching for a cure, but aesthetically, through dance. The medical scholars “write with wonder of the elaborate ballet of the people, the slow, viscous movements they conduct with wary grace, the extraordinary steps they take to preserve the silence.”
In The Afflictions, disease is an organizing metaphor through which Paralkar explores the unfairness of “affliction.” Why, he seems to ask, does one man wake able to prophesy in tongues, while another is fated to constantly regress to a state of infanthood? And if pure randomness is the only reliable authority in the universe, is there a way in which we can “cure” the affliction of chance? The Encyclopedia is one such attempt at a cure, where scholars try, impotently, to rationalize the irrational. As the elderly librarian warns Máximo: “One day, I fear, the separate strands will refuse to twist together anymore. The golden thread will unravel. The stacks out in the corridor will overflow the Library and become impossible to curate. The Encyclopaedia will lose its authority, and all our knowledge will disperse into fragments.”
The most poignant responses to the afflictions of chance are the moments of futile defiance. The entry on Lanfranco’s Disease tells of a village whose inhabitants became deaf to all except fragments of music only they could hear. Musical experts quickly realized that the afflicted were hearing, “A vast and magnificent expanse [which] could now be glimpsed, one without beginning or end” and yet the nature of the disease meant that it would be impossible to ever fully capture the music in its entirety. They try anyway, even though the passing of the years means that “The possibility of access to the music has dwindled to a handful of threads. Soon it will diminish to a trio, a duet, a solo.” The act of attempting to grasp what one can from inevitable loss, Paralkar seems to express, is the only human course of action, and the principle has no small resonance for the field of science as well.
The Afflictions returns us to the idea of the essential interconnectedness of mind and body, that our faculties of memory, of language, of morality, of love, are no less real and necessary to survival than the organs of the heart or kidney or lungs. Paralkar suspends, for a brief moment, the enmity between life and sickness in order to imagine how affliction can be a kind of sea-change, a shift in our being or impetus for a new mode of consciousness. A number of the diseases in the book ultimately result in victims having to become traveling minstrels or drifters. Their estrangement from any community transforms them into living ghosts, an analog to the death that is the consequence of many real-life diseases.
One such invalid, afflicted by Morbus geographicus, is forced to wander the earth endlessly,  “becom[ing] a palimpsest, his life etched with layer upon layer of new scenery, until he wonders if there is anything beneath it all.” The hulking Encyclopedia of Medicine is similarly “over-written,” and threatens to lose all sense. But if we are meant to take any consolation from The Afflictions, we can take it from this, that just as the “trajectory” of the man suffering from Morbus geographicus inevitably “folds in on itself and leads him back to the land of his birth” so will our knowledge return to purer incarnations as it unravels. - Brenda Wang