It started with a faint. Javier Miranda, a generally healthy 69-year-old man living in Venezuela, attributes his episode of dizziness to the summer heat and humidity. His only child, Andres Miranda, is a physician whose intuition tells him something is seriously wrong with his father. The doctor obtains blood work and schedules a CT scan and MRI of the brain for Javier. The medical work-up reveals rapidly progressing lung cancer with metastases to the brain. Violating his credo of complete honesty with patients, Dr. Miranda lies to his father and reassures him instead. Dr. Miranda's mother died when he was just 10 years old. Now his father's remaining lifespan has dwindled to a couple of months. The doctor must find a way to break the bad news to his dad.

Meanwhile, Dr. Miranda receives multiple messages - phone calls, e-mails, and letters - from a difficult and persistent patient. Ernesto Duran suffers from dizzy spells and multiple other symptoms. It could be panic disorder or maybe Ernesto is a hypochondriac. Dr. Miranda instructs his office secretary, Karina, to deal with these communications and remind the patient that there is nothing more that can be done for him. When Ernesto admits he is stalking the doctor, Karina worries. Pretending to be Dr. Miranda, she begins corresponding with Ernesto via e-mail. Before long, Karina develops symptoms similar to Ernesto's and experiences empathy for him.

When his physician-son finally summons the courage to announce the terminal diagnosis, everything changes for Javier - his mood, personal relationships, and awareness of his body's metamorphosis. He perceives the smell of rot associated with his physical deterioration. Dr. Miranda's frame of mind also changes as he copes with his father's impending death. Javier's deathbed request is simply for his son to shatter the terrible silence by talking about the two of them.


There are good reasons why physicians should refrain from diagnosing and treating family members. This novel illustrates the emotional and ethical predicaments that arise when a physician informs a parent that they have a terminal disease. Truth and trust give way to deception and procrastination.

Fear and fragility are major themes. Dr. Miranda acknowledges "the limits of medicine in the face of illness's infinite power" [18]. A surgical colleague wonders why people "find it so hard to accept that life is pure chance" [18]. As proof, the author offers up a character, Javier, who develops metastatic lung cancer even though he never smoked, walked everyday, and followed a healthy diet.

The two patients in the story - Javier and Ernesto - both experience attacks of dizziness. It is no coincidence. Dysequilibrium is an important symbol. Loss of psychological, spiritual, professional, and familial balance is a constant threat. Risk management (and even a remedy) for life's emptiness appears to involve heartfelt communication and empathy.


This edition of the novel is translated from the Spanish by Margaret Jull Costa.
The novel was first published in Spanish as La Enfermedad in 2006.
It is the winner of The Herralde Prize.


Tin House Books

Place Published

Portland, Oregon & New York, NY



Page Count