Transference by Ian Patterson

A Rusalka Books Review

IMPORTANT - Please read the sentence below in the overly dramatic American movie trailer man voice:

In a world where disease is transferable and health can be bought, can one man change the very fabric of society and topple the social hierarchy?

(Okay, voice off.)

From the first page of Transference, I was hooked. I feel guilty about this, because I know authors spend months, even years, writing books, but I got through Transference in 2 days. And those 2 days were awesome! Patterson’s world is immersive and unsettling — a place where class is physically hierarchical and health is transactional. I couldn’t put it down.

The story follows Nick — or Allen (trust me, it’ll make sense) — a “sicko” who earns a living by absorbing the diseases of the wealthy. He’s a likeable lead, and thanks to the gripping first-person, present-tense narration, I felt like I was right there beside him: his confidante, his accomplice. Every one of his victories and failures felt like my own.

For me, the true magic of Transference lies in Patterson’s world-building. From the different echelons of society to the disturbing meetings and deals between sickos and their clients, each detail is extremely evocative. There’s always a new layer to peel back — both figuratively and literally.

You discover the disease transfer machine pretty early on through Nick/Allen’s work as a “sicko,” but what’s truly brilliant is how Patterson doesn’t just present it as sci-fi tech — he weaves it seamlessly into the novel’s entire economic and political framework, and even into the personal identities of the lower classes who rely on it for their income. It becomes a symbol of power, a tool of oppression, and the backbone of a grotesque class system. The machine isn’t just part of the plot — it made this world the way it is.

As a dystopian devotee, I thought I had the ending pegged. Would it be the genre-typical fall-of-the-regime, where hope wins? Or maybe the classic cycle-repeat scenario, where one regime is simply replaced with another?

But no.

The ending blindsided me — in the best way. It spiralled into existential territory (complete with mandatory nervous break-down): Does anything really matter? What’s the point in life? If there is no point, is that terrifying... or freeing? As cliche as it sounds, this story didn’t just make me think, it made me reevaluate what is important to me. (It even nudged me toward law school — but that’s another story.)

If you’re into speculative fiction that blends thrilling action with uncomfortable truths, Transference belongs on your TBR.

If it sounds like your cup of tea, you can get the book here. (If you buy it from this affiliate link, I may earn a tuppence.)