Justin C. Key is joining us today to talk about his novel, The Hospital at the End of the World. Here’s the publisher’s description:
In a time not so far from our own, society is run by a global AI system controlled by an all powerful corporation. The Shepherd Organization oversees every medical school in the country save one in New Orleans, the renegade Hippocrates which still insists on human-led medicine. It is the last choice school for an ambitious young New Yorker named Pok. But after his father—himself a physician—dies under mysterious circumstance that seems connected to “the shepherds” and their megalomaniacal young CEO, Pok finds himself on a quest for answers that leads right to Hippocrates. Once enrolled, he stumbles upon a further mystery: a strange illness is plaguing newcomers to New Orleans who grew up under shepherd rule. What is causing this fatal anomaly? And how does it relate to the mystery of Pok’s father’s death and his own mysterious past?
What’s Justin’s favorite bit?
As a third-year medical student I was paired with a young, energetic attending for my anesthesiology rotation. His love for teaching was not a pre-requisite to working in a teaching hospital and being under his wing was a much-needed change. His preparation for each surgical case included extensive chart review and meeting with the patient. With his admirable bedside manner, he assured every patient he’d see them when they woke up.
An Operating Room is a place of technological magic. A patient’s brain is taken offline so that a surgeon can cut into the body and rearrange things. Situated at the patient’s head, the anesthesiology side is particularly decked out with computers, monitors, medication trays, and gadgets, all the tools needed to keep a person in limbo—and to bring them back to life.
My attending walked me through how every piece of equipment affected patient care. And then he told me it was all secondary. Our priority was to look at the patient. Examine them. Be a doctor, he said. The CO2 reading on the machine could tell us if we’d successfully intubated, yes, but first we should use our two eyes to see how the chest rises. We should watch for coloration changes to the skin to alert for perfusion issues. The technologies were tools, not replacements.
Hidden in his tone was the central conflict of The Hospital at the End of the World. There was an unspoken frustration that existed alongside his appreciation for the technology, without which he wouldn’t be able to be an anesthesiologist. His unspoken worry communicated that too many physicians were leaning on the tech at the cost of embracing the power of human doctors: the ability to touch, feel, and intuit.
I came up with The Hospital at the End of the World’s central idea of AI vs medicine early in my medical school career—about twelve years ago now. The novel naturally explore the dangers and warnings of automated healthcare. The other end, my favorite bit, is exploring what humans do well. I didn’t want solely to make a case for what to fear, but to also highlight the aspects of humanity we should be embracing. The parts of ourselves we should continue to be in awe of. With all our flaws and imperfections, what lies in the power of the human touch? In the human voice? What can be exchanged in eye contact that can’t be gained from an algorithm?
I started building the world of Hippocrates Medical Center alongside my own entry into physician hood. I was aware my perspective would be limited by the lens of Western medicine. I sought knowledge about other modalities. I read The Spark in the Machine about the history of and ideology behind acupuncture. I interviewed alternative medicine practitioners. I listened to podcasts about the history of medicine (shout-out to Sawbones: A Marital Tour of Misguided Medicine) and studied up on medicinal herbs. Whenever I learned the ‘correct’ way to medicine, I wondered what alternatives existed and sought them.Though many aspects haven’t made it formally into the book, they inform the holistic way the Hippocrates doctors approach the body, their need to see the patient, and their openness to learning new ways to heal. Medical school is hard, grueling, and unforgiving. Writing this book and researching what it means to be a healer from all different angles helped me fall in love with my profession all over again. How cool is that?
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BIO:
Justin C. Key is a practicing psychiatrist and a speculative fiction writer. He is the author of the story collection The World Wasn’t Ready for You, and his stories have appeared in the Magazine of Fantasy & Science Fiction, Strange Horizons, Escape Pod, Lightspeed, and on Tor.com. He received a BA in biology from Stanford University and completed his residency in psychiatry at UCLA. He lives in Los Angeles with his wife and three children.
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