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Vikram Paralkar would appear to be a mass of contradictions: a novelist whose work confronts mortality, a cancer physician who constantly helps others deal with death, an atheist who is married to a minister. Yet his joy for life is palpable.

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Vikram Paralkar
Vikram Paralkar

Vikram Paralkar is a preeminent cancer physician and medical researcher and a celebrated novelist whose work explores mortality and the philosophy of life.

Paralkar was born and raised in Mumbai, India. Both his parents were doctors. After earning a medical degree from Seth GS Medical College in Mumbai in 2004, he relocated to Philadelphia, PA, where he is a professor of medicine and practicing oncologist at the University of Pennsylvania. His research focuses on blood cell production and leukemia.

Paralkar’s novels are deeply grounded in both medicine and philosophy. His first, The Afflictions (2014), portrays an aging librarian who discovers a centuries-old compendium of bizarre supernatural diseases. It has been translated into Spanish, Italian, and Russian. Night Fever (2017) details a disaffected Indian physician who tackles corruption while raising the dead. It was named on recommended books lists by Time magazine, The Week, and The Guardian, among other publications.


Vikram Paralkar:  We now know that we live in the universe that is 14 billion years old. Now, a galaxy has 100 billion stars, and there are probably 100 billion galaxies in the observable universe. How do we reconcile that kind of scale? Put another way, does the cosmos care about the sickness and death of a human being?

For as long as he can remember, Vikram Paralkar has been kept up at night by big questions.

Paralkar: How must a moral person exist in, and conduct himself or herself in a society in which the corrupt are rewarded and the moral are punched.

By day, Paralkar is a doctor who treats patients living and dying with cancer. After hours, he’s a novelist who explores the limits of mortality. His supernaturally tinged fiction is often grounded in medicine, but like the author himself, he’s most concerned with philosophy. His debut novel, 2014’s The Afflictions conjures up a world where illnesses infect souls as well as bodies.

Excerpt from The Afflictions:

I remember wondering how the difference between health and disease could be contained in such tiny bottles. In one state, man is free to walk and speak. In the other, he’s flat on the ground. How can the red liquid correct this difference? Even now, I marvel that two substances when mixed can lose their individual qualities and become a third substance that is entirely new. It makes me wonder what we find if we could distill a human being. How many elements mixed in what proportions? Would one of those be the element of the soul? And could you distill even that one further.

Paralkar was raised in Mumbai, India, in what is described as a marginally religious household. Hinduism was largely cultural, and when at 13, he announced he was an atheist, it wasn’t a big scandal. His parents had both rebelled against their own more orthodox upbringings, and each became the first doctor and their respective families. And while Vikram was growing up, they ran their own clinic from inside the family home.

Paralkar: As a kid, I would actually go to the operating room with them and look at surgeries. I was fascinated by biology from a very early age. Whenever we would get fish home to eat, I would dissect the fish and dissect the brain of the fish and do all these medical things. So I was just drawn to medicine from early in life.

But Paralkar could follow only so far in his parents footsteps. In 2001, after finishing medical school in Mumbai, he struggled with the idea of leaving India for the West. Yes, he would be able to become a physician scientist, someone who would get to treat patients and do research. But that was just the first of his motivations.

Paralkar: The second was my abhorrence of the casual public corruption that existed. I just realized how difficult it was to live in India without bribing someone, how difficult it was to just accept a traffic ticket and then spend hours and hours in the police station trying to just pay your fee and leave as opposed to just slipping $100 bill to the traffic cop with your ticket. And the third was the fact that I was gay—I am gay and I did not want to live a life in India where I would constantly have to either hide my sexuality or live as somewhat of a gossiped-about pariah. And those were the three decisions that led me to move to the Western world and I considered either the UK or the US, and eventually I ended up settling in the US. That said then, you’re living in a country which is a superpower, which is performing as a nation state actions around the world that now are on your shoulders, because now I’m a voter in this country, and I have to be responsible, ethically and morally for the decisions of the country,

Paralkar sees moral quandaries everywhere, and wherever he finds them, he can’t help but address them. Today, Dr. Paralkar works at the University of Pennsylvania, where he studies leukemia, a cancer of the blood and bone marrow, spending about 80% of his time in the lab, and the other 20% with patients who are often staring down death.

Paralkar: Every patient that you see with acute leukemia has a seven in 10 chance of not making it the next three years. And there are these conversations we as leukemia specialists have to have with patients who have just learned a day ago that they have leukemia cells in their blood. And then we have to be the ones to go into the room and explain to them what they have, why they have it, and what the implications of this disease is. And I’ve seen different doctors approach this challenge in different ways. One kind of way is to cloak everything in jargon. And that is a defense mechanism for doctors where they feel as though if they can throw out some buzzwords, then they have done their job and conveyed information to the patient. And then the patient can just stick with the plan and keep moving along. I try my best to explain in as clear and simple language as possible, understanding fully well that the patient is not going to be able to retain everything that I’m saying, is not going to be able to process everything that I’m saying and this will be something that will have to be reinforced again and again. My approach has been that I’m treating not just the patient but also their family. I’m trying to do my best to save the patient’s life or prolong the patient’s life. But there will be patients who will not make it. And then the family has to move on with memories of what that treatment experience was like.

After a full day at the hospital and before sitting down for a night of writing, Paralkar can often be found unwinding at home with his husband, Nate, a Unitarian minister. When they met in 2009, the two immediately connected despite their apparent differences.

Paralkar: It was really interesting when I first met Nate, and it became clear that this was becoming a serious relationship. I would often find myself, talking to myself, “am I really dating a minister?”

Vikram married Nate in 2020 in a nondenominational ceremony that reflected the couple’s shared and diverse interests, including an Einstein quote, custom vows, a Hindu prayer. And though he doesn’t personally follow any religion Paralkar does hold dear the questions that live at the heart of all faiths.

Paralkar: Questions about morality, about meaning, about purpose, about value. These are the questions that religions try to answer, but I just don’t find the solutions that religions come up with particularly satisfying. And that was what led me to become interested in philosophy. Because I did feel that science and scientists often tend to be somewhat scornful about these questions and the rejection of religion sometimes leads to a wholesale rejection of the questions that drive it. That is not a position that I hold.

These questions and more drive his 2017 novel, Night Theater. The story of a disillusioned surgeon working at an isolated rural clinic in India, as he battles government corruption, and ultimately is tasked with resurrecting the dead.

Excerpt from Night Theater:

“It couldn’t be, it just couldn’t. Why have you come to me?,” said the surgeon. “Go find a priest, a sorcerer, leave me alone.”

“We need you to fix our wounds, Dr. Sahib. At sunrise, our bodies will fill with blood again, and we will no longer be walking corpses.”

“How? Why? How is that possible?”

“The answer is long and complicated, Sahib, and I don’t understand everything myself. I can only tell you now that an angel took mercy on us. I’ll explain everything else later. We have so little time, I know nothing about surgeries, but I’m sure that injuries as severe as ours will take you all night to stitch up.”

On the page, Vikram Paralkar processes the kind of existential anxieties that he faces in his day job. He imagines life, interrogates death and ultimately finds a way to embrace mortality.

Paralkar: All of us know that we are going to die. And the fact that we do is in some ways, both the tragedy as well as the beauty of the human condition that we know that we have transient lives, that we are flecks of dust in the amber of deep space and deep time and accepting…

AJC: But we feel so important to ourselves.

Paralkar: Yes, we do. And we feel important, and we are important to ourselves. And if you think about it, imagine the coincidences that went into creating us, imagine the number of chance encounters and DNA divisions and sperm and egg fusions that had to happen since the beginning of time for us to exist, And the geological changes and social changes and population shifts that had to happen to create us. And so that’s an immensely privileged position to be in. Now, of course, I could be ungrateful and say that, “Well, this is not enough. I exist and I have my 80 or 90 years of existence, but actually what I want is immortality.” And I don’t think the universe owes that to us. And so what we can, we can mourn the fact that we don’t have immortality or we can celebrate the fact that we exist at all.