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Payne is a Grotesque, a member of an offshoot of the human race distinguished by cranial deformities and an extra orifice in their chests. In most tesques, this orifice, the os melior, is inert, but in a small number of them it's functional, enabling them to perform wondrous healings. Tesques with healing gifts are trained, then dispatched far and wide to serve humanity (and only humanity, for tesques cannot heal other tesques; nor are tesques considered worth healing, for humans regard them as a lesser race). It's a life, as Payne is informed when his gift is discovered, "full of deeds of healing and service," but really a kind of slavery, since healers are not allowed to refuse their service. There's also a cost. Healers burn out early, a slow exhaustion of their ability known as the Drain. Most healers never see their fortieth birthday.

Payne has an extremely strong and versatile gift. He also, unusually, doesn't seem to be subject to the Drain. Unlike many healers, who resent the humans who both need and enslave them, he derives pleasure from the use of his skill, and takes pride in his ability to relieve pain and suffering. His service brings him to one strange place after another, a kind of pilgrimage through which his naïve, good-hearted idealism is repeatedly tested, but never quite shattered, by the world's cruelty and hypocrisy. But idealism is also a kind of egotism, and this leads him, early on, into catastrophic error -- a mistake that will haunt him all his life, and ultimately bring him to a point no healer has ever reached before, a place where reality and legend merge.

Through Payne and his fellows, members of a despised race who possess a power desired above all others, Michael Blumlein explores a number of powerful themes: the loneliness of the outcast, the false promise of tolerance offered by organized religion, the futile hope of change presented by ideological resistance -- and, most centrally, the healer's ambiguous position in society: supremely powerful and yet detested, urgently needed and yet feared, simultaneously master and slave, angel (when the treatment works) and demon (when it doesn't), and in his or her mastery of the mystery of disease, utterly set apart from all other beings. Payne's world is a heightened analogue of our own, in which the relationship between doctor and patient is not just symbiotic, but parasitic, with healing literally draining the life from those who practice it, and medicine is not merely difficult for the less privileged to obtain, but totally unavailable, since tesques are incapable of healing their own kind. The attitudes of healers toward their profession are as ambiguous as their patients' attitudes toward them. Some merely tolerate their work: it's a job. Some despise the sick, and their servitude to sickness. Some crave the thrill of healing; their patients, like the partners of sex addicts, are a means to an end. Only a few, like Payne, love healing for healing's sake -- though this doesn't exempt him from arrogance, and in fact is a large part of what drives him to make his terrible mistake.

The os melior, functional only in Payne and those like him, is not an organ of healing, but of excretion. Tesques don't simply cure their patients' illness, they reify it, taking it into themselves and then expelling it (or giving birth to it) through their os meliors. Like progeny, each of these concretions is unique, its form derived from the sickness, the patient who contained it, and the healer who extracted it; concretions are living things, capable of surviving outside their hosts -- just for a few seconds in the case of minor illness, but for substantial amounts of time when the disease is more complex. Beyond the city of Rampart, where the most skilled healers work, there's a grim corral called the Pen where these horrors are sequestered. This literalization of sickness, and of the many fears and taboos that surround it, is one of the book's most haunting concepts, at once fascinating and repellent. No human wants to see his or her concretion, and many healers feel a similar repulsion -- but Payne, again atypical of his kind, takes joy in the process, and finds the products of his skill strangely beautiful: "By giving form to illness, a healer could neutralize the most dreadful threats to human life, restoring health to that noble, but imperiled, organism." Surely this must embody the deepest wish of any real-world medical practitioner.

The Healer is written in a dreamy, episodic style -- a little like a series of interrelated novellas (furthering this impression, chapter numbering begins afresh in each new section). Blumlein turns a focused eye on selected portions of his world, without fitting them into any sort of overarching framework: the dusty city of Gode where Payne is born, the grim mines of Pannus where he has his first assignment, Aksagetta, the decadent gambling mecca where he's sent later on, Rampart, with its priapic Tower of healing and the terrifying Pen. Human and tesque culture is portrayed in vignettes; we learn a little and must infer a lot. This lends the narrative a surreal, somewhat disjointed quality that suits its allegorical nature -- but toward the end, when certain creation legends become important, grows problematic. Because the legends haven't entered the story before that point (and also, perhaps, because we know so little about tesque and healer culture, and thus don't have much context with which to judge the legends' weight), their just-in-time appearance seems contrived, undercutting the power of Payne's final transformative act of healing, in which he brings literal life not just to sickness, but to myth. The concluding portion of the book, and the utopian dream of healing on which it ends, feel underdeveloped, less like the culmination of Payne's long pilgrimage than a somewhat hasty added episode.

In my opinion, this is not a minor flaw. Still, it's very much outweighed by the novel's fascinating exploration of its interwoven themes, and by the resonance of Blumlein's metaphor of healing. The Healer is a strikingly original novel, whose ideas and images linger long after the final page is turned.

Victoria Strauss is a novelist, and a lifelong reader of fantasy and science fiction. Her most recent fantasy novel, The Burning Land, is available from HarperCollins Eos. For more information, visit her website.