One thing you don’t see a lot of in genre fiction is main characters with a serious illness. Sure, there are ill relatives and friends, but I have come across a far smaller number of stories where one of the main characters has a serious or chronic illness—especially in comparison to injured main characters or ill relatives. (I love mysteries, and in them someone is always getting hurt sticking their nose in where it doesn’t belong. (Is there a mystery book bingo card? Because that is definitely on it.))
Serious or chronic illness is something we are all likely to experience as we get older—either our own ill health or that of someone we love. Reading about these struggles can do several things: it can help us have empathy for those around us, it can prepare us for possible events, and it lets us feel seen when we might be struggling with illness or caregiving.
So I want to mention some books featuring main characters dealing with serious illness—either acute or chronic.
First is Dahlia Donovan’s story The Wanderer, which despite all the boinking (a me issue, not a story issue), was amazing. It’s a romance, and the whole thing is unflinching as we watch Graham go through cancer diagnosis and treatment. This includes not just the hair loss and weight loss, but things that are typically glossed over.
Aside from losing his hair, Graham’s body suffered from other side effects. His skin grew paler, and his nails were brittle. They’d gotten lotion to help with his dry and irritated skin.
— Dahlia Donovan, The Wanderer
The story is also blunt about the sexual side effects, and makes it clear many of the side effects of chemo and radiation can persist for a long time.
They’d all warned him about fatigue continuing to be a problem for what could be a potentially prolonged period up to several years post-surgery.
— Dahlia Donovan, The Wanderer
It also doesn’t pull punches when it comes to the strain such an illness can put on relationships.
Bad news combined with a stronger dose of chemo to make Graham both listless and depressed, and no one could blame him. A steady stream of visitors attempting to cheer him up hadn’t helped. Rupert’s last visit had ended in angry tears from both twins; the older ginger hadn’t been back since the fight.
— Dahlia Donovan, The Wanderer
We see not just the family and friends gathering together to help out, but also the bickering and misery and anger.
“I’d be ever so grateful if you’d tell my bloody brother to bugger off. How can he not see why I might need a good laugh right about now without feeling guilty? I’m taking my decreasing chances of survival as seriously as I can. What does he want me to do?”
— Dahlia Donovan, The Wanderer
Even more importantly, the story touches on caregiver burnout—how difficult it can be for those caring for an ill, elderly, or dying loved one.
Adriana Herrera’s American Dreamer (this is all SPOILERS, so skip ahead to avoid them) looks at previously fractured relationships, and how illness and impending death don’t always pull everyone together.
After everything that happened when I came out, my four siblings, using Mary as their speaker, had politely requested I never contact them again. So now I needed permission before I called to ask about my sister who was dying.
— Adriana Herrera. American Dreamer
After a moment, (the preacher) cleared his throat. “Jude, I’m here at Mary’s request to talk about your salvation, son. Your sister is dying, and she’s worried about the state of your soul as much as her own. She loves you and wants more than anything to see you turn away from the life of sin and perdition you’re living. She doesn’t want to leave this world without hearing you repent and say you accept our Lord in your heart once again.”
— Adriana Herrera. American Dreamer
This part of the story does not have a happy ending (although the romance of course does) but it does have a realistic ending, and that is incredibly important. Because stories lead us to believe that when serious illness comes, everyone will gather around and all will be good, past insults and injuries forgotten and forgiven.
END SPOILERS
Sweetest in the Gale is a collection of three novellas, and the third story has the main character discover of a lump in her breast and get a biopsy.
“I’m about to insert that titanium clip you heard about. It’ll help mark the spot for future mammograms or if you need surgery.”
— Sweetest in the Gale, Olivia Dade
And she does this while worrying about how she is going to pay for the diagnosis and treatment
Although marriage of convenience is a trope I particularly like, it is weirdly common in contemporary American romances, which is quite honestly depressing , and ’d be happier if it was relegated to historicals.
Layla Reyne’s story, Dine With Me, is a journey from diagnosis to accepting that life is worth fighting for, even if that life is irrevocably changed.
“Our lives revolve around taste— perfecting seasoning, pairings, entire menus. How much salt to add? Does it need acid? Where’s the perfect balance of sweet and savory? If I lose the ability to taste, to do those things that are essential to my daily life, both for work and my soul, which is highly likely with the course of chemo I need, not to mention radiation and possible surgery, then what the hell am I supposed to do with myself? Who the fuck am I?”
— Layla Reyne, Dine With Me
The story is his coming to accept he is more than his career, and that he has value even if he is no longer able to be a chef.
Lissa Kasey’s Haven Investigations series shows the dangers of concussion I’ve never seen in a story before.
“What happened?”
He pulled in a deep breath. “You had a stroke.”
I blinked at him in confusion. “Huh?”
“It’s called an Ischemic Stroke. A blood clot in the brain that deprives the brain of oxygen and nutrients. The neurosurgeon who’s treating you thinks it was caused by the multiple concussions you’ve had.”
— Lissa Kasey. Model Investigator
As a society, we’re mostly aware of the long-term dangers of repeated concussion, such early onset dementia like has been seen in those who played contact sports. But concussion can also cause blood clots and stroke, which can cause further brain damage.
“But if the clots are gone, I shouldn’t have any more seizures.”
“Baby, the seizures weren’t from the clots. They were from the damage to your brain, the swelling of blood vessels and oxygen deprivation. Those things aren’t healed yet.
— Lissa Kasey. Model Investigator
He’d had one seizure at home since having a stroke. It had been a rather mild one compared to that first terrifying moment when the stroke had hit him, but it still terrified me. Keeping him well fed and rested were keys to minimizing the seizures and allowing him time to heal. He still had small blackouts and often forgot things, which worried me a little. He might always have issues from the stroke.
— Lissa Kasey. Model Investigator
Oliver even loses his driver’s license because of the seizures.
That series tends to darkness and suspense, so the serious injuries and their repercussions (and there are a lot of both) help emphasize the danger of the situations the two characters keep ending up in.
However, illness is more than the big diseases that put you in the hospital and from which many people make a full recovery. There is also chronic illness—diseases for which there is no cure, or from which someone will never recover to who they were before.
I love stories with the day-to-day bits of living, so I particularly like ones that show living with a non-standard brain or body.
In Alissa Cole’s Can’t Escape Love, Reggie uses a wheelchair, due to her ataxia.
Gus caught a glimpse of several wheelchairs, at least one of which looked like something from a sci-fi movie. He imagined none of them had come cheaply. “You have a lot of those,” he said.
She glanced up at him, and when she spoke there was a frost in the air that didn’t come from the AC. “The device I depend on to navigate the world? Yes. I have more than one.”
— Alyssa Cole, Can’t Escape Love
Reggie knows how lucky she is to be able to afford multiple wheelchairs, but that doesn’t mean she isn’t also annoyed by people doubting her capability solely because she has mobility issues or frustrated by the weakness and lack of control she sometimes experiences.
(E)ven now, there was something in her cadence that people picked up on. She could always mark the moment when the stranger on the other end of the line began to speak to her louder and more slowly, like she needed their help to comprehend things when they were the ones with a problem.
— Alyssa Cole, Can’t Escape Love
Another story that is upfront in addressing accessibility issues is Play It Again by Aidan Wayne. Dovid and his sister review restaurants as part of their vlog.
Dovid counted to six in his head to give Rachel editing leeway, then said, “So that was a negative for The Sweet Spot. The aisle was plain too narrow for me to get through easily on my own. Which also means it’d be even harder to have someone side-by-side leading me along. And I don’t know exactly how wide the aisle was because I couldn’t see it, but it really didn’t seem like a chair would be able to maneuver comfortably either. Now, our hostess might not have been thinking and there was a wider path she could have shown us, but I can only judge what I got.”
— Aidan Wayne, Play It Again
I am aware of some of these things because I live in an area that is frequently inaccessible—which I discovered when I spent six weeks on crutches (as well as during the years my grandmother lived with us) and let me tell you it is maddening to find you can’t do simple things like open doors because a building has not been made properly accessible.
There are also “invisible” disabilities: Ones that aren’t obvious to the average bystander, but may have serious effects on someone’s daily life.
“I have POTS.”
Apparently convinced she was steady, he stepped back. She tried not to miss the feel of him, that reassuring solidness.
“What the fuck is POTS?” he demanded.
“It’s a circulation thing. Mine is fairly mild. Sometimes, when I stand up, my heart beats too fast and I get dizzy.” She usually rose slowly, so she wouldn’t drop like a sack of potatoes.
— Talia Hibbert, That Kind of Guy
“That night, I passed out on the sofa, woke up at dawn, and had this bright idea— if I cleaned up the mess before Kevin woke up, he’d be really happy. He hated untidiness, and the house was my responsibility. I suppose I got a bit nervous. So, I stood up to move all of the empty bottles… only, I’d forgotten about my heart.”
…
“I stood up too fast. My heart panicked, and I passed out and dropped everything. Then there was all this blood, shouting… It was a dramatic way to ring in the new year.”
— Talia Hibbert, That Kind of Guy
Even in stories where the characters have rare conditions, I still learn fascinating things I would not have realized otherwise.
I liked old black-and-white movies. They were easier to watch, what with never being overwhelmed by the mess of tones and colors blending into one another that represented modern cinema.
— CS Poe, The Mystery of the Curiosities
It’s one thing to know about color blindness, but it’s something else to go with someone through their day as they try to do things like getting dressed, or finding the building with “the red door.”
More than a decade ago I was in a class where one of my classmates blithely said that if he was no longer able to drive, he wouldn’t want to live anymore.
I was taken aback, to say the least.
Yes, different people have difference standards of quality of life, but to see a life restricted by something as small as no longer being able to drive as a life not worth living any longer… That’s a pretty harsh take.
It’s another reason I think stories are so important—because they allow you to see the value in other lives—even ones we might think we would find restricted and unhappy.
Historicals can sometimes be problematic for me, because they often to gloss over the lack of medicine and treatment available. The likelihood of a woman dying at any point in any of her pregnancies is a subject I’ll skip for now, except to say there are books that do an amazing job of addressing the subject, and I wish there were more.
Aside from pregnancy, there were many serious illness—easily treated now—that were common and devastating.
It had taken him years to accept that he couldn’t properly run a business when he might be taken ill at any time. There were men whose livelihoods depended on Medlock Shipping remaining a going concern, and he couldn’t properly ensure that when he was delirious and feverish. The realization that his bouts of illness were going to continue forever, bringing his life to a grinding halt with no warning, had finally dawned on him this past year. There would always be relapses and recurrences; he might not die, but he wouldn’t get better. Regardless of how well he felt when he was healthy, there would always be another attack waiting for him around the corner. Eleanor’s tinctures only did so much. Bloodletting and special teas did nothing at all. He would spend the rest of his life trying to cram his living into the space between illnesses, his life a sentence with the ugliest punctuation.
— Cat Sebastian, The Ruin of a Rake
Despite the many different miracles of technology we use on a daily basis, it’s how we are able to heal and control so many once common illnesses that I think would impress travelers from the past.
I initially had difficulty accepting the HEA of the following story, because the main character had tuberculous, which is uncurable and would have severely shortened his life.
“The doctor said you broke a rib coughing. He said not to try binding it up because then you’d risk injuring your lungs. So I’m afraid it may have healed badly.”
— Cat Sebastian, Two Rogues Make a Right
Then I realized I was being obnoxiously selfish and abelist, because everyone deserves love and happiness. None of us know how long our lives, and the lives of those we love will be, so we should grab love and happiness when we have the chance.
As much as I adore properly researched historicals (and I do love them) one of the more terrifying things about them is treatments of that time which make an appearance.
“My sister,” Chant began, “was… odd. That’s what my parents called it at least. She would have fits where her body would jerk and she would lash out. She might shout obscenities or nonsense. But, Gale, she was sweetness itself when you knew her, you must believe me. My parents called it an affliction. Her doctors too. And I suppose it was. But I also think that, were the world more receptive to the idea that we are all made differently— that it is not really for any of us to say what is normal or right— perhaps her character would not have seemed such a burden to my mother. My father loved her so very dearly. My mother too, in her way. But my father was especially bonded to her. He was a busy man, and I don’t think he fully understood the toll it took on my mother to care for Jenny in a society that thinks those with ‘afflictions’ ought to be locked away and only spoken of in whispers. Jenny’s prospects lay in marriage. But my mother took her to a rout one Season, and it was such a disaster that we attended no more events. Gradually I noticed my parents were keeping Jenny inside more and more. Not even trips to the pie shop or the bookstore were permitted. Jenny became all but a captive within those walls.
— J.A. Rock and, Lisa Henry, A Case for Christmas
“Why didn’t you tell me?”
He clenches his hands into fists around the blankets, face set, then says, “Fine, you want to know why? Because at the end of this year, I’m not going to law school, I’m going into an asylum.”
We stare at each other. It takes a long moment for me to grasp what he’s said— it’s so horrid and utterly unbelievable that I’m certain I must have heard wrong. “You’re . . . what?”
“There’s a place in Holland. A sanatorium. For the . . .” He squeezes his eyes tight and finishes very carefully. “For the insane.”
— Mackenzi Lee, The Gentleman’s Guide to Vice and Virtue
“My aunt thinks that this is God’s way of punishing me. The family’s bastard Negro boy has convulsive fits— it’s appropriate. She still won’t be disabused of the notion that I’m possessed by the devil, and my uncle keeps telling me that I need to stop being hysterical and overcome it.”
— Mackenzi Lee, The Gentleman’s Guide to Vice and Virtue
“Have you ever taken the water cure?”
“No, but I understand that if it’s properly done, it can alleviate a great many ills.”
“Is there a proper way to douse a terrified child with ice water? Or wrap her in freezing, wet sheets and tie her to a bed, or—”
“No,” he said quickly. “None.”
— Alissa Johnson, A Dangerous Deceit
“Some doctors call it epilepsy,” she said cautiously. “But she has seen so many of them. The only thing they can agree on is that they don’t know how to cure her fits.”
He nodded thoughtfully. “What I overheard the other day, that’s the nature of the typical experiment, then? The doctors want to send an electric shock through her?”
“Among so many other things.” Too many treatments to list. Too many for Jane to think about without feeling sick to her stomach. “They’ve tried bloodletting and leeches and potions that make her vomit. Those are the easy ones to talk about. The rest…” If she closed her eyes, she could still smell the poker burning into her sister’s arm. She could still hear her scream. “You don’t want to hear about the rest.”
— Courtney Milan, The Heiress Effect
Never mind the cocaine pills and mummy powder and laudanum and trepanning and Mercury elixir and snake oil.
My favorite thing about historicals is that I am only visiting the past—I don’t have to live there. I only wish the future where all things are better, was already here.
Books with Illness Representation
Main Characters
~Romance~
Not So Cookie Cutter (2019) Aidan Wayne, osteoarthritis
Play It Again (2019) Aidan Wayne, cancer
Can’t Escape Love (2019) Alissa Cole, ataxia
Destined To Last (2010) Alissa Johnson (Providence Series) unknown
Arctic Heat (2019) Annabeth Albert (Frozen Hearts) cancer
Status Update (2015) Annabeth Albert (#gaymers) Celiac disease
A Duke in Disguise (2019) Cat Sebastian (Regency Imposter) epilepsy
The Ruin of a Rake (2017) Cat Sebastian (The Turner Series) Malaria
Two Rogues Make a Right (2020) Cat Sebastian (Seducing the Sedgwicks) tuberculosis
Lucky Charm (2019) Chace Verity, deaf
A Kiss for Midwinter (2012) Courtney Milan (The Brothers Sinister) miscarriage
The Countess Conspiracy (2013) Courtney Milan (The Brothers Sinister) miscarriage
The Color of You (2017) CS Poe, asthma
The Wanderer (2014) Dahlia Donovan (Sin Bin series) cancer
Sweetest in the Gale (2020) Olivia Dade, cancer
Get a Life, Chloe Brown (2019) Talia Hibbert (Brown Sisters) fibromyalgia
That Kind of Guy (2019) Talia Hibbert (Ravenswood) POTS
Blind Faith (2018) N.R. Walker, blindness
~Mystery~
Blind Justice (1994) Bruce Alexander (Sir John Fielding) blindness
CS Poe‘s Snow & Winter series, achromatopsia : The Mystery of Nevermore (2016), The Mystery of the Curiosities (2017), The Mystery of the Moving Image (2018), The Mystery of the Bones (2019), The Mystery of the Spirits (2021)
Southernmost Murder (2018) CS Poe, narcolepsy
Fatal Shadows (2000) Josh Lanyon (Adrien English) heart
Dine with Me (2019) Layla Reyne, cancer
Lissa Kasey‘s Haven Investigations series, concussion, seizures (attack)
Model Exposure (2017), Model Investigator (2017)
~Fantasy~
The Gentleman’s Guide to Vice and Virtue (2017) Mackenzi Lee, epilepsy
The Nobleman’s Guide to Scandal and Shipwrecks (2021) Mackenzi Lee, epilepsy
A Natural History of Dragons (2013) Marie Brennan (Lady Trent) miscarriage
Secondary Characters
~Romance~
Life’s Too Short (2021) Abby Jimenez, parent, sibling, ALS
American Dreamer (2019) Adriana Herrera, family, cancer
Knit Tight (2015) Annabeth Albert (Portland Heat) family, cancer
The Heiress Effect (2013) Courtney Milan (The Brothers Sinister) sibling, epilepsy
The Luckiest Lady in London (2013) Sherry Thomas, sibling, epilepsy
~Mystery~
A Case for Christmas (2021) J.A. Rock & Lisa Henry (The Lords of Bucknall Club) sibling, epilepsy
Why Representation in Books Is Important
Mental Health Representation in Books: Depression
Mental Health Representation in Books: Anxiety
Mental Health Representation in Books: Grief
Mental Health Representation in Books: PTSD
Mental Health Representation in Books: Addiction and Eating Disorders
Representation in Books: Injury
Agents of Winter (2022) Ada Maria Soto (The Agency)
Always Only You (2020) Chloe Liese (Bergman Brothers)
An Agreement with the Soldier (2021) Sadie Bosque (Necessary Arrangements)
Husband Material (2022) Alexis Hall (London Calling)
Delilah Green Doesn’t Care (2022) Ashley Herring Blake (Bright Falls)
A Marriage of Equals (2021) Elizabeth Rolls
Dearest Milton James (2021) N.R. Walker
Paris Daillencourt Is About to Crumble (2022) Alexis Hall (Winner Bakes All)
The Love Hypothesis (2021) Ali Hazelwood
Although it wasn’t a new release, I was delighted by Kathryn Harkup’s 
