This chapter focuses on medicine and empathy in the context of global capitalism. It argues that our affective interactions are necessarily embedded in, and inflected by, structural and material relations of power. Empathy emerges as an affect that follows existing routes of privilege. The first section, ‘Medical migrations’, analyses current debates about the relation of medical migration to inequalities in world health and traces the circuits by and through which medical resource is distributed. Turning to Aminatta Forna’s The Memory of Love, it is argued that Forna pays detailed attention to the unevenness of the global economics of medical resource, with specific reference to Sierra Leone. In the second section, Forna’s protagonist Adrian Lockheart is used to open up the question of how affect circulates, and where it sticks, in the novel and discusses Adrian’s empathetic misrecognition in the treatments of his patients in Sierra Leone. The final section asks whether change is possible in the novel, drawing out the significance of the novel’s double time frame to suggest that the unfulfilled political promise of the past can shape the future.