  Whoa. I finished Barry Malzberg's The Men Inside last night. The tech-spec it builds from is one I've come across before - human miniaturisation for the purpose of entering a livng human body to perform surgery.
Fantastic Voyage, anyone? But Malzberg's vision of the future is drastically different from nearly anything Asimov ever thought up. It's a bleak world where most of humanity subsists in grim, violence-ridden cities Downside and only the elite few can live a better life. One of the few ways out from Downside is to become a Messenger, people who are miniaturised to excise cancers from patients wealthy enough to pay for the procedure.
There is a downside to becoming a Messenger - the process renders them impotent. But this hardly matters to Leslie Blount, who has never had much room for emotion. Although he does seem capable of a fair amount of hate, specifically towards his father, an incessant gambler who keeps thinking up new ways to blow all his money on horse races. Also, as Blount realises, there is nothing particualrly grand or noble about the Messengers' Institute. By maintaining a stranglehold on the patents for the miniaturisation process, Hulm, the inventor of the Projector, has created an artificial scarcity, ensuring his own wealth and denying treatment to scores of cancer sufferers who are too poor to afford the treatment.
Blount decides to declare his contempt for this and walk out on the day of his graduation, but is ultimately carried away by the grandeur of the ceremony and takes his oaths. Then, when he is a fully-fledged Messenger on his 16th patient, he suddenly discovers the urge to kill his patient. Messengers who kill are a part of Institute folklore - the proximity to the inner workings of a living being, the ease with which that being can then be made to cease living - surely this is a temptation some would have succumbed to?
The folklore has it that such Messengers were not betrayed to the outside world but shuffled off into assignments where they would not directly treat patients. After a variety of painful flashbacks, awkward fantasies and even more awkward real-life encounters, Blount does the deed. And is caught and executed. A fairly simple story, in that sense, and written in a sort of breathless, knowing style that manages to be both funny and terribly sad. But what exactly is it all about? I think, at some level, it is a refutation of the cozy SF notion that the advance of science and technology will give us all better lives.
To continue with the SF-deconstruction, Malzberg posits a negative equivalent of the bold explorer of final frontiers, an internal astronaut whose feelings about his vocation are as different from that of the typical SF Spacer as is his destination in the tissues of a living human being. Blount seems to be a fairly pathetic person - but not, Malzberg reassures us, particularly malicious. Finally, his act of murder seems less a retaliation against rich, greedy patients selfishly extending their worthless lives, or a retribution against the venal Institute or perhaps even some long-delayed revenge on his father, as it is an expression of his need to obliterate his own pointless existence.
Early on, Blount realises that he cannot really imagine his life as a retired Messenger. As a kid Downside he had no real prospects, as a Messenger, he realises that there are no real prospects. In the end, he attains the only real 'way out' left to him - his own dissolution. A terribly negative book then, but not an unenjoyable read at all.
I don't know if Malzberg always writes like this - but its an interesting style. A little too intrusive at times, but perhaps more effective in the service of a stronger plot? 
