SPEAKER_01 0:00

The world is a scary place by nature of where we are as a society, from healthcare to technology. And I have a book for you today called The Hospital at the End of the World, which dives into those issues head-on, tackling the intersection of AI and healthcare. Today I'm joined by Justin C. Key. We're going to talk about his debut novel, The Hospital at the End of the World. And I have to say, before we begin, I love this novel and I think it's incredibly relevant for where we are right now, today, as a species. Justin, thank you so much for joining me.

SPEAKER_00 0:33

Yes, thank you for having me. Thank you for having me. And I did not pay you to say that, but I appreciate those words.

SPEAKER_01 0:38

No, not at all. And those words are heartfelt. I um I I've talked about my background here a bit, but I have some experience in talking to clinicians and working through the human aspect in healthcare. And I think it's a really critical part of delivering care is to see your patient, to understand their emotions, where they're coming from, and to engage with that. And this book has a ton to do with the human aspect of healthcare. I wonder, could you give me a rundown of what the hospital at the end of the world is for the people who haven't read it yet?

SPEAKER_00 1:09

Yes, yes. So, you know, uh hospital at the end of the world, um, it's a sci-fi medical thriller. And on the surface, it's an AI versus medicine story. But, you know, it's uh a lot of it is my love letter to medicine and also my case for a human connection. Uh, but it's a science fiction story set about 20 years, a step in the future, where we've started to give over the keys to society over to AI. You know, like a um uh conglomerate uh global company called the Shepherds have just bought all the medical schools, and that's going to be like the next step is you know, human-led medicine is the thing of the past. And our main character has grown up, you know, drinking the Kool-Aid. He grew up in New York, which is like the hub for AI. He's a medical school hopeful, and he's really thinks the future is like AI and medicine, and he wants to be part of it any way he can. He's supposed to be a top medical school uh candidate. He applies to all the medical schools and he gets rejected by all of them, doesn't know what's going on. Um, and then he realizes that part of it is that his father, who is an old school physician and he lives with his father, um, was about to be a whistleblower for the Shepherd organization. That this is, you know, there there are uh inherently unsafe things about having AI in the driver's seat. And then there becomes a murder mystery, and Pox finds himself in the middle of it. He has to flee New York, all that he knows, and he goes to the last holdout city in the country, New Orleans, who's rejected uh the latest technology, rejected AI, and there is the last human-led hospital and human-led medical school, and Pax becomes a student there, and then he has to go through all the rigors of being a medical student, which I tapped into a lot of that directly. Um, you know, there's a medical mystery that goes on too. Um, there's this impending kind of AI company coming in because they're the last holdout. So while he's trying to deal all with this, figure out like what was going on with his father and his own past, you know, he also has to perform as a medical student. So that's that's pretty much the gist. Um, but it's really me exploring from entering the field of medicine, you know, how is this technology going to change uh my practice? What are the threats to it? What could be positive about it? And I started to think about this before kind of AI started actually going in a route that we see today.

SPEAKER_01 3:39

And you're uniquely positioned to bring this story to life because you are an author and a psychiatrist and have completed med school. Um that's uh an a feat that I can't even medical school is a feat that I can't imagine on its own, but writing a novel and continuing to put out creatively during that experience, how how did you balance that? That seems insurmountable.

SPEAKER_00 4:04

Yeah, so you know, uh luckily for me as a writer, I had spent a lot of time or many years establishing my identity as a writer in the sense of I knew it was part of me, and it wasn't something that I, you know, had just dreamed about wanting to do. There was still like the dream of being published and all those things, but actually sitting down and writing and and creating stories and having other people read it. I'd been doing that for years when I entered medical school. I'd say I started writing seriously in 2007, entered med school in 2013, have a few trunk novels that are behind me on this bookcase. So going into medical school, I knew that I wanted to continue writing in some fashion. The first couple years, well, the first year, it was easier than the ones after it. I mean, it was still very hard because you have all of these classes and like a test every other week. Um, but I could still work on short stories. Um I could still, I was part of um a writing group, Tabula Rasa, in New York. Uh, and I found that out and sought that out as soon as I got there. Um, and still, you know, there's mostly lectures in those first two years in medical school. So you manage a lot of your own time in terms of like when are you studying? And then in between, as a study break, I might uh work on writing. Um, it was really the second half of medical school when it becomes more of like an apprenticeship. The the third and fourth years of medical school, you're in the hospital at like 5 a.m. There's no more summers, there's no more breaks, there's no more like holidays, you know, like somebody's going to be working on all those days. It just, you know, it depends on like when it is that you have off. Um, and actually, one of the big things that I did is I applied to Clarion West, which is this writer's workshop for science fiction and fantasy. And it was fairly, it's it's fairly prestigious and well known and kind of a good end into for beginning writers into the writer community. And that uh overlapped with the last summer of my life. It was like the summer after second year of medical school, and it just so happened to be when I would have that break. So I actually finished the first two years of medical school, went to this workshop, and it was six weeks in Seattle with 17 other uh baby writers, and every week everyone writes a short story like new while there, and everyone critiques 17 other stories, you know. Uh so it's really like almost, you know, some people might say it's like a crash course MFA. Um and after that, like a couple weeks after that, I was on the wards, and I actually wasn't able to write that much, but I had stories that I can go back and revise here and there and submit to places. So I was still very much able to continue, I think, the identity of as a writer. And then when I went into residency and beyond, you know, it was it's kind of like a balancing um uh it's kind of like one of those scales that tip from one side to the other. In the beginning of residency, uh, particularly in psychiatry, the first two years, you're spending all the time in the hospital, sleeping overnight in the hospital. You know, that's why they call it residence, because residents used to live in the hospital. And then as I go through residency, you know, it becomes less of that and more and more outpatient. And so then there's more autonomy over the time. But, you know, I used to, there were days that I would go to uh a cafe in New York after being on overnight, and I work and I was actually working on like a version of this book. Um so what I tell people, you know, for a long time, it was really writing in the margins. You know, there was a particular, there was time where I would write in the morning at like 4 30 a.m. There was time where I would write it at night after everybody's asleep because I'm also uh a husband and a dad. Um and now, you know, uh thankfully I've been able to carve out time to actually write during the day. It's interesting, I feel like I'm definitely much more productive with the time if I have like a if it's limited and you know, a limited resource. Um, whereas now sometimes I have the whole day ahead of me and it's like, oh, what else can I do? Um but that's kind of been the journey for me from just a writing schedule standpoint.

SPEAKER_01 8:11

It is absolutely resonant within the pages of this book how your experience had to have informed Pac's experience in medical school because uh I've never I've never read a book that was so accurate to the stress of the classroom, the stress of I would say the responsibility to the patient and delivering good care um and also balancing other conflicting interests, of which there are many for Pac. There are there are quite a few. Um I I get how you created such a realistic medical school world, but how did you find such a a realistic vision of the future? Because this world, the AI and the applications of it is so fully realized. Now, I can't tell you what it's going to look like in 20 years, but I bought into every aspect of this world from the glasses technology to the algorithmic uh diagnosing technology. How how did you come up with all of this stuff?

SPEAKER_00 9:08

Yeah, you know, um I'd say one thing that was helpful is that a lot of these ideas came out before you see the current boom. Because I had um almost like a blank slate to work with. Uh and I think that that's true to imagining what something new and kind of coming and changing and and and trickling throughout all of kind of uh society may look like. Because if we look at how AI is, you know, manifesting right now, I don't think it's something that we would have, at least the ones that aren't working on it, would have predicted like five years ago. It's like, oh, I didn't know that AI was going to come and like be threatening our books or like, you know, uh making all these weird videos, et cetera. So I think that then it's like, okay, you know, there's a mix of hope, what I want AI to maybe do, because I had for a long time been fascinated with consciousness and by proxy also fascinated by the idea of the singularity, like a super consciousness. Like, so my idea of AI for a long time was, you know, uh at one point, once general intelligence takes off, and we have something that's almost like the human brain, but is able to work at just you know magnitudes faster. So that was kind of my idea in terms of, okay, well, what could that lead to in terms of a better future? And then what could that lead to in terms of um uh things to look out for as well? And then, you know, thinking about okay, how could different aspects how thinking that there are all these different companies, you know, how would our social media change? Um and I remember actually at seeing like one of the Black Mirror episodes, I forget what, where everyone has like a social media rating. Um yeah. Yeah, yeah. And it just, you know, could completely like and I think that that could be us. I think some I think a lot of people, like who's ever over Facebook, well, you know, like we know who's over Facebook, but early on probably decided that that is a feature that we don't want to have because there's a lot of things that we rate, like we rate businesses, et cetera, et cetera. If somebody wanted to, a while ago, they could have been where we get ratings as people, like imagine on Facebook. And I think somebody just inherently knew, like, that's probably gonna be a really bad idea. Like we can separate, because that's our personhood. And now we can separate it from like the business, okay, that's their business, or them as a driver, Uber driver, for example, you know, okay, you know, they're they're they're not that good of an Uber driver. So I'm not gonna pick them for this, but to have it, you meet somebody new and it might have their rating there. So I didn't want to go that route, but then thinking about like social anxiety and thinking about, you know, us as humans are in uh inherent difficulty to read each other's mind, even though we're really social creatures, like might there be some you know, heads-up display which tells you like, hey, this person, you're losing this person as you're uh as you're conversing with them, or hey, like what you just said is probably offensive to them. Um, you know, uh having that in real time, and then how that could be like genuinely helpful for some people, and how for other people it could be blunting or it could lead to anxiety. Um and then as I went through, then it's as I'm going through different aspects of the story, you know, or uh different um plot points, might be like, oh, you know, I haven't really I haven't really added anything here. Like, you know, would this world be the same or would it be different? And having it 20 years in the future, a step in the future in New York allowed me to put a lot of the familiar things there. Like I think there still will be those hang out of the window air conditioning. I think there still will be elevators that break down. Um, because you know, if you look at the the metro on its face, you know, it probably looks very similar to when it did like 20, 30 years ago. Um, so there's going to be a lot of things, I think, a step in the future that are going to be very recognizable, even as we have like this advanced technology around us.

SPEAKER_01 13:05

That's very interesting. And I think you're right. Technology can't uh or society can't replace itself fully in 20 years. But I want to pick apart something you said uh early on in your answer, which is that you have hope for the application of AI, but there are inherent risks to it as well. Um I wonder, let's start with the risks, because I think that's the more hot button issue. What risks do you see with the application of AI in medical situations?

SPEAKER_00 13:33

I can imagine with these large language models where it may not even be um a specific this is what you should do, right? But how it's supposed to be so conversational and how it's you know designed, I think you to keep you engaged, I definitely could see it being one of those things where you go back and you read it. It's like, oh, well, it didn't, there's not a liability here because it's not saying like explicitly you should do this or do that, but it didn't say against it. Or it was the things that it said just kind of reinforce what the person may have already wanted to hear coming to it, you know. Um, so I think that you can just seeing that example on a small scale, you know, um think of it just uh um just blown up, you know, in terms of if everybody's consulting their artificial intelligence and in place of their doctors. And I think that one of the problems with healthcare is that there is such a gap that AI is ripe to fill, you know, for better or for worse. And I think a lot of it'd be for worse. You know, how do you chastise somebody for going to an AI therapist if, you know, their insurance won't cover therapy, or if they're uninsured, or if they can't find a therapist who has openings or things like that? Um I think that there's a lot of nuance in being a doctor and uh alignment with like patients, like in terms of choosing the right care for them. And I'm the type of psychiatrist or doctor who will very much try to align with my patients, right? Like, for example, if somebody comes to me with depression, you know, there's a lot of different medications that we could try, right? And let's say if it's run-of-the-mill depression, I might have like things that I go to uh that I start first. But if somebody comes and is like, hey, my friend was on this and it really helped them or what have you, it might not be my first go-to, but as long as it's not dangerous, and you know, uh I will align with them because a lot of it is that alignment out of the gate. But let's say if somebody comes in, for example, and they have like a history of like bipolar, I might say, actually, you know, this medication for somebody who has a history of bipolar actually could be harmful, you know. Um, and that's why I recommend this. So there's and there's that nuance of seeing who's in front of you. And then a third patient that might come in and has a history of bipolar, but it's like, hey, I've been on this medication before and it worked well for me and I didn't have any problems, et cetera, then that's even different because I also know that nobody's body or brain reads the textbook. So, you know, uh so one of the I tell patients like one of the uh best pieces of information I have can be what has worked for you in the past, right? You know, like some patients they'll be they'll have been on this medication before and they come back and try it again, and they're like, you know, what are the side effects? Like these are the side effects that I would expect for somebody to start a new, but I actually think the experience that you had before, that's most of what I would expect now, you know. Um, so I think that there's that human connection, and then I can recognize like if somebody's like hesitant when I'm talking to them about like medications and if or treatments or interventions, and I might have to kind of, okay, let me redirect, or if I need to spend the whole first meeting really like kind of breaking down like some of the barriers that may be there, whether they're you know coming to it from uh some distrust or if they're uncomfortable. You know, I think there's all of that nuance, I think, of the human interaction that can be lost um in AI.

SPEAKER_01 17:06

There's some good themes that pop up in your book from distrust of medical providers to being physically and emotionally present with the patient. And I can't wait to unpack those later in this conversation. But before we jump in there, I don't want to I don't want to leave this on a negative note. What hope do you have for the application of AI in medicine? How can it assist you as a provider, uh, either personally or the industry as a whole, to service the patient better?

SPEAKER_00 17:32

Yeah, so um I think a technology for whatever it is, I think it should be a tool, a tool in like human hands, right? Um and when I think about what AI could help me with, really thinking about this kind of this system that has this large, this access to a large amount of data, whether it's studies, whether it's you know a patient's complete history, whether it's all of the different uh interactions with, you know, doctors to say psychiatrists in this standpoint, um, with other patients and making these types of decisions or what have you, to be able to bring all that together and give me insights that I may have not even considered. So, for example, you know, my thought would be that a powerful system in the future may be able to see that, okay, if somebody's rate of blinking changes uh by this certain percentage point, that might be an indicator for uh, you know, first break psychosis or being at risk for that. Or it could be something totally different. It could be like brain cancer or something. Something that we are not as humans like wouldn't really be able, excuse me, to pick up on and maybe not even have the insight to study, right? Like I feel like if that was the question, it's like, oh, you know, uh I want to do research on, you know, rates of eye blinking and how it relates to this different these different diseases. It'd be like, okay, what are you uh that feels like that might be a reach, or what are you trying to find out? But I think these models or things that I was that excited me about it before was the fact that they can have this large amount of data and then pick out these associations that me, we may not excuse me, even know what the middle is, right? There's probably a lot that would happen in between increased eye blinking and something like psychosis that you know, then some very smart scientists can figure out. So, like those type of things in terms of preventative care. Or let's say if I'm talking with a patient and I've been with them for a while, or maybe they have been, you know, uh with somebody else's care for a while, like having like real time, like maybe suggestions. It's like, hey, you know, one thing to consider is that, you know, this same time of year they have this likely pattern, right? So maybe before before you think about making this this change right now, consider that this usually happens around this time, you know. Uh so I think that all those could be like really powerful versus it being more prescriptive, right? Because I think, you know, excuse me, not going back to fear, but one of the issues with being a doctor and taking recommendations and having something that that that recommends is that we as doctors, like every doctor has, you know, spends a lot on malpractice insurance. And what I fear is how much the recommendations from AI or whatever system is going to influence care because it's then it's like, oh, this now it's in the record that this AI has suggested uh a route that I don't feel uh feel like would be harmful. But if I go against it and something goes wrong, then this could be pulled up like in uh in a lawsuit. Um and even if it don't dis if even if it doesn't make sense or what have you, then I think that that really could influence like a doctor's care against their better judgment, right? It's almost unfortunately like a cover your ass um uh uh type situation. So I fear that too, and just how insurance may, you know, um how that might play into how insurance, you know, um covers like different aspects of patient care as well.

SPEAKER_01 21:13

I had never considered intuition versus liability uh and risk exposure would play into this. That's really insightful and honestly scary. I I choose my provider because of a uh because of a connection, because of a trust that they have built with me, and I wouldn't want them to go against that uh or their instincts. That's wild. I know that I I want to get into uh a little bit of uh some uh a topic that I might not be fully the right person to unpack. But since I have the author here, I thought it's a topic worth approaching. And that's some of the disparity of outcomes in medicine today and how that's reflected in your book, specifically with people of color, um, reinforced by themes of even AI not being able to recommend hair. Treatment for Pac, the main character. And also talking a little bit about biases that exist today in large language models, which it there are already biases built into the code, which we don't even know what's going on under the hood half the time. Who knows how they got there other than scraping biases that exist in what we've already written? But are are there fears of that amplifying or fears that we can't mitigate that, even knowing that it's there? And I'm thinking of things like the percentage of black women who die in childbirth versus the percentage of white women who die in childbirth, and things that I'd been aware of for years just with my exposure to the medical industry. Is there concern around that with AI being rolled out in diagnostic or prescriptive ways?

SPEAKER_00 22:49

Yeah, you know, um, and I'd say like what my personal confr concerns are, like I don't know the exact details of like what studies may show, like what is the current, like actual tangible fears, right? You know, I know, but I know for example, there are have been case studies of um psychosis-induced, well, how how do I say no no no not psychosis induced, like let's say chatbot induced psychosis. Um so and with people who hadn't had a history of psychosis before, there has been some people who have like a propensity, like a it it's already been established, they have that ability, um, or in them. Um, but it's just in terms of some way how it uh interacts with people, bringing out this disconnect with reality, right? And I feel like that's something that I guess if you thought about it hard enough, you'd be able to predict it. But I'm sure like when um you know, open AI or anthropic or have you are putting these things together, they aren't thinking like these are the things that we need to that we need to look out for, or even like that you'd be able to, you know, hack it kind of by talking to it to where it will then um uh be on board with you, you know, dying by suicide or something like that. Um I do think one of the fears that I have is that over time the biases that either we miss or that we don't work out enough could be then baked in. Um I was having this conversation with one of my friends who works in tech back like you know 14 years ago now. And I think that you know, once alg once algorithms are really used heavily to let's say go through resumes or decide jobs, you think about it, like over time that's gonna trickle down, right? Like you're gonna have the applying for the job, it's gonna be sorting through people that went to these different colleges, and that colleges chose who was gonna go there by an algorithm that sorted through the different high schools or what have you. And then that high school, the let's say the top high schools are gonna be, you know, their cohort is gonna be decided by you know uh where they went to medical uh middle middle school, and then that's also gonna be so when if there's a long enough time, then almost somebody's path to a certain degree can be determined almost just from like from birth or where they're born or what have you, you know, because from the very beginning, you know, it's gonna be like, okay, you live here, your your uh parents had this, or this is what we suspect your IQ may be just based on like your you know environmental risk or your gestational age or how you're walking and talking or what have you. We wanna suggest that you go here. And we want to suggest that you, you know, focus on these lines of studies, or et cetera, et cetera. So if you imagine like it becomes more pervasive, and we are having these computer systems that are recommending every part of our lives or influencing, informing every part of our lives, like what it is that we're going to what we should do or what decisions we can make, you can see really then you're gonna have these rigid lines that I think are gonna be very hard to break out of. Um I think breaking out of it's gonna be much more the uh the um not the norm, but the um uh uh on the fringe, right? And even then I think that those breakouts are gonna be something that an algorithm is gonna be like. Our algorithm shows that this person, they're gonna be set aside, you know, set apart from the rest.

SPEAKER_01 26:30

It's scary because uh we we don't talk about our kids much on the channel, but but my wife and I were even considering AI when we were naming our kids. We're like, what name wouldn't trigger to, you know, we gave them weird middle names because we wanted their first name to be something that could in 20 years be selected for a job if it came to that. And that's it's weird when you when you have these like pre-fears where you can't say I mean you sound ridiculous whenever you're talking about being afraid of something that might happen, but it it's it's we're in the Wild West in some ways. And uh I think it's important to talk about that. Because I uh like in your novel, they they get dangerously close to eugenics and uh recommending pregnancy termination within the bounds of what is legal in the in the future world. Um all things that are weighing heavily on my mind when we when we start talking about predictive uh AI and prescriptive AI as well. Changing gears just a bit. I know we talked about AI a lot in healthcare, but I wonder if you could share your insights into the human aspect of healthcare, because while this is speculative fiction and science fiction, and I would argue horror adjacent, uh at least body horror adjacent with some of the detailed medical sequences. I think it's an incredibly human story from the first chapter, Pax's relationship with his father, Pax's relationship with his best friend, Pax's relationship with a few people he meets along the way, and I don't want to spoil any of that because there are some really beautiful and gut-punchy twists along the way from chapter three or so on. I was like, oh, we're we're here already in the story. Okay. Whoo, catch my breath. But I wonder if we could talk about the human aspect of of medicine and maybe if you if you feel like going off the human aspect of medicine in the book as well.

SPEAKER_00 28:18

Yeah, you know, so um human aspect of medicine, I mean, you know, why I went to medical school, and I think why a lot of people, like my classmates, why go into medical school. Um, you know, you uh it's that connection with another person, I think that the the the magic I think that comes from and the responsibility and all this stuff that comes from you know being an intimate part of these people's lives. And what I mean by intimate is that, you know, in some way, whatever field you go into, you know, they're gonna share with you things that that usually they wouldn't share with any other human being. Like as a psychiatrist and also as a therapist, it's just about their their thoughts and their experiences. I hear a lot, like dude, the first person I told this, right? If it's a surgeon, like no one else is gonna be like inside their body, right? You know, um, and uh so there, I think that it's very important to I think it's very important to be seen by another person. Um so I even think, for example, with therapy, uh you hear a lot about like the the large language models, like becoming a therapist, right? And a lot of times people, especially if they haven't experienced therapy before, from what I've seen, you know, will come away with, I think, very important insights. But I think that one of the important aspects that I've seen in being a therapist is like over time being seen by another person, another human. Um, and I think that there's something innate there that's going to, you know, it's going to be lacking over long term, like in terms of like being with somebody two or three years or talking to a chat bot for like two or three years. Um I I've I've compared it recently to also like, you know, would we go to a basketball game to see like robots compete with each other, you know? But a robot could sh do what Steph Curry does perfectly, but it's not it's not uh it's not impressive or engaging or what have you, unless it's someone that we know that this is like a person that's made of the same stuff as we are. Um so I think that that's an aspect from a therapy standpoint. Um I do think that that alignment with someone, knowing someone who's also mortal and is going through this life almost in the same way that you are in a lot of ways, I think is important. Um and that connection can be a lot of different levels. You'll see a lot where, you know, um, for example, a lot of my black and brown patients, they may just from the very beginning express that they, you know, naturally feel more comfortable with somebody who comes from like a similar background to them, that they might assume comes from a similar background to them, or they feel like may relate on some level. And I think that there's, you know, when we're thinking about like humans versus AI, AI really can't, you know, uh can't relate at all to being in the flesh and going through, right? And making this decision because, you know, uh a classic question that you'll hear patients, you know, ask doctors, like, what would you do? Or this is your family member, like what would you do if you were needed to make this choice? You know, it's interesting because it's a hard question for us as doctors to answer because we want to stay objective or what have you. But I think it also can be a very powerful uh answer to give. Just like, okay, like is also someone who is going to have to face mortality one day, maybe already has, maybe has already, you know, survived uh medical issues or had like a family member that this went through, experienced a loss, like being able to talk from that. And even if you haven't, I do think it's powerful to be able to tell patients, like, hey, I, you know, I haven't experienced this, right? You know, but from other people that uh that I've worked with who have, or you know, knowing this or that, et cetera, right? I think that there is that still that innate commonality of being human that's important. So there, and then we as social creatures, I think we're really just in tune to a lot of the nuance um of each other, you know. And I was talking about before how AI might be able to bring out like the eye blinks, but we have a lot of that innately. Like I think I read or heard maybe like a year ago that the the dilation can influence attraction. I think they did this uh eye dilation. They did this study where they show like people um uh different pictures of um you know the the sex that they were attracted to, and the difference was how dilated their eyes were, and they found them significantly statistically significantly more attractive for those who had like either it was more dilated or less. But what it is is that on the receiving end, those the the dilation is an indicator of a level of attraction on the other end, so we are in innately able to recognize like when there is an increased attraction with someone else for reasons that we don't know. There's parts of our brain that's able to see, like, oh, you know, we've evolved together, we've evolved as social creatures, I recognize this. And I think that's very important, I think that's very powerful. And since we still don't understand how all of this came about to be in us, I think the idea of replicating that or passing that on to AI is I think that's going to be, I think that's going to be a mistake. Um I I would say I think we need to fully understand how our consciousness works before we do that. And I think that safely is going to push it well down the road because you know the brain is one of the final frontiers of medicine. I mean, of um science.

SPEAKER_01 33:55

Absolutely it is. As somebody who's fascinated with consciousness, I thought it was interesting in the book that Pac had a trouble adjusting because his glass wasn't telling him what the social cues he was receiving were. I thought that was just such a and it got it's it'll it's a blink and you'll miss it kind of moment in his adjustment period, but it was so relevant in how we rely on technology to engage with people and maybe a future state metaphor for how sometimes kids who grow up only on social media engage with one another. It was really, really nice. And I think that was a really well-said statement about human connection. When I was working with medical professionals, the things that we would encourage them to do is lead with empathy, read the social cues of your patient, name the emotion that they're feeling to help them process it, align with their values, and most critically to make a recommendation. Because a lot of the times folks will talk around it, especially if it's a recommendation that is difficult. And so I I think you really nailed it. Uh a lot of the time when we would be role-playing, the the the patient would ask, what would you do if you were in my situation? It was I mean, it was absolutely exactly what I experienced as a as a uh a trainer, but also with my mom being sick recently. It's exactly what I experienced as a family member. Um so really well said with that. I wanna I want to shift gears away from AI and away from the book itself and ask a little bit about you so our audience can get to know you a bit more. And my first question is I know that you've written horror in the past, and I know that we've talked a little bit offline about your love of horror. So I wonder what draws you to, and us being a horror first channel, what draws you to horror, what draws you to sci-fi, or broadly speaking, if you want to just answer this question, both fall under speculative fiction. What draws you to speculative fiction?

SPEAKER_00 35:52

Yeah, you know, great question. Um so I think very early on, uh, you know, uh reading Goosebumps, and then I graduated to, well, Animars was in the middle of uh Animals was great, and then um Stephen King and Michael Crichton. Uh, you know, what I loved about reading was just being able to go anywhere, to live all these different lives, you know, be an astronaut, you know, survive dinosaurs, etc. Um uh so from very early on, like that aspect took me. And I think the thing about horror is you know similar to what uh the thrills that people get from an amusement park, right? Like, you know, you're able to experience these um supposed to be unsafe like feelings and emotions in a safe uh in safety, right? Like people wouldn't get on a roller coaster if there's like, oh, there's 10% chance that you're gonna die on this. Like the the expectation is that like this is gonna be like really scary, but I'm gonna come out on the other end and then be able to, you know, kind of process what it is that I felt and maybe like really enjoy it in the moment, right? So I think that that's what uh uh that brought me to horror. Um and then you know, Stephen King, just as a horror writer, uh, he just you know he really does like great character work. Uh his his um his stories and settings feel like really lived in. I think uh sometimes when I go back and read and and I'm writing, I'm like, man, are my people not messed up enough? My characters, because because I read you know, I'll read his books and like his characters could be like really dark, like everybody in the story will will be dark on some level. Um but then one of the things that drew me to science fiction, like particularly uh Michael Creighton, is I remember learning like so much um from reading. I remember reading Jurassic Park, uh, I think when I was in like third or fourth grade, um uh I got the after seeing the movie, I then read the novel. And there are still like some aspects about the Animal Kingdom, some some facts that I learned from that novel, you know, like three years ago now. Um uh so that that was I used to, and I still do, but it's hard to say because I'm one of them now, but I used to think of authors as like the most brilliant people on the planet, you know, because reading these books, and it's like you uh you inform me and you make me feel these ano these emotions, and then you like, you know, and then there's these twists, and how was it, how did I not see it coming? I just thought that it was like you have to be a genius to be able to put these things on the page. So I really looked up to to authors. Um, I would say that I gravitated more towards writing science fiction naturally from going through medical school. Um, because just because of the things that I'm learning and my brain being a very like, you know, what if, you know, what if brain. So um, like if I'm going in and you know, I'm seeing a surgery for for example, and it's like, okay, like what if this technology makes this difference? Or, you know, what if this goes wrong, et cetera? Uh, versus like before in the same way, like my what if brain, it'll be looking at things like, you know, what if goes surreal, or you know, what if, you know, uh, or you know, what if et cetera, et cetera, et cetera. But but my what-ifs became naturally more like science fiction. Um, so leaning into that, um, but still very much at the end of the day, like some stories that I sit down to write, like one story I wrote recently, it was like, you know, what if, you know, there's this ditch in the back in the backyard that usually toys go down and they never come back. Um I was thinking of my grandma's backyard. Well, what if things came back changed? Right? Like what if there, and then what if a person falls in there? So then there's no science about it at all. Like I can make it scientific if I wanted to, but it's then really that kind of tapping into that childhood fear. Because I remember I used to think, like, you know, what if one of us fall into that ditch that looks like it has no bottom, right? Um, that's just this unknown. Uh, and then, you know, the imagination goes, wow.

SPEAKER_01 40:08

I love, I would read that story for sure. And I look forward to the day, because I read Jurassic Park about the same time as you did. And my daughter is in a giant dinosaur phase right now. And what I took away from that book, I'm having to re-remember to tell her about dinosaurs, and I look forward to the day where she's old enough that we can read that book together because uh I think it'd be a really lovely moment. I actually, and I I should also mention I was wearing a goosebumps hoodie before this call started. I took it off to like look look a little bit more sleek on camera here. I don't know how I don't know if that worked, but uh I I'm a goosebumps fan here too.

SPEAKER_00 40:42

Um that's my original like that's how I came to to to love reading. Um somebody introduced me, gave me a goosebumps book, and then it was yeah, devoured them. Same.

SPEAKER_01 40:54

Again, again, uh th something I'm really looking forward to sharing with both of my kids. We we've we've bought a couple and stored them away. Uh I think I have one vintage one back in uh on camera somewhere back there that uh that we're saving for, but obviously two and a half, she's just gonna rip the pages out. So looking at the story, it is uh it's a human story. The the hospital at the end of the world. It's it's extremely human and it's uh it deals with responsibility to your family, to those you meet along the way, to your patients. And I I think that it it raises interesting questions, of course, about AI and what it's like to be uh a medical professional. I wonder if there's something that you're hoping the audience, uh your readers will leave thinking about, or that that will make what what will you want to make them feel over the course of this journey? And I know that sometimes authors really hate when I ask this question. So you can feel free to punt it, but um I wonder if there's something you want the audience to leave thinking about or feeling.

SPEAKER_00 41:58

Yeah, you know, what one of the the great things about having like a novel out there, which I'm experiencing now in real time, is how it can mean like different things to different people and some aspects that I didn't even that uh or I temporarily forgot that I put in. Like, oh, that part really like resonated. I was like, oh, I forgot I did that, right? Um, you know, it's like so for example, I think there's a there's a a small portion, it's only dealt with a little bit, but you know, it it deals with you know performance enhancers or addiction and kind of and there and I can you know imagine somebody that that really might you know stick out to them where it's like you know, and if they to hear someone say like, oh I felt I felt seen or felt heard, which I've heard from like a past story that had to do with an allegory to addiction. So so that's been really great to see that it can mean like different things, but if I had to choose, um it's really that that human connection and that power of and the privilege of being like a healer or doctor or physician. Um I really wanted that to come through because writing it was kind of my way in a lot of ways for me to rediscover the love for not necessarily the process, but the process, not the process in med school, but the process of what changes in you because going through med school, I hated it, you know. Um it's just you know, I I uh my first son was born like halfway through the the the first year of med school when I was married, you know, I also was writing. So I already in my head, I was a little bit older, was like, you know, I am not just this isn't I can't let this be completely defining like who I am. Like I am a person who's coming and I'm becoming a doctor, as opposed to like, you know, taking on this thought of like, you know, I am. special because I'm physician, right? So, and I do think that the the the process, even from just getting into medical school, I think it's like really way too selective. You know, a lot of people say like, oh, you gotta be special, be a doctor. I was like I actually wish more people like that we would open the doors to to more people who have, I think, the attributes to come and do good medicine. So but going through it is really hard, uh at least for me. Some people really enjoyed it. To enjoy it in the moment because of all the anxiety about doing well, all of the you know anxiety about you know impressing like your um uh your your superiors, you know, and trying to balance that with like actually doing good patient care. Being able to write this book over the years is actually me being able to be removed from it and then focusing more and looking back and like, oh yeah, you know that that that interaction that I had with that patient or, you know, that powerful moment or how does this failure, how did it shape like who I am now for better or for worse? You know, what are the the good attributes I got from it? What are like some of the ways that it added to my anxiety um and I think it always it comes back to the importance of that physician patient interaction and also a recognition that, you know, us being us being doctors like you know stressed and burned out, how that can fall short. You know, and knowing that there's a lot of people, a lot of colleagues, a lot of like more senior doctors know I know I know them and knowing that they went in with you know wanting to kind of be the best physician they can be and still falling into that maybe trap of you know um putting a patient in a box right or thinking that like a patient's like frustrations is more like dis disrespectful towards them or not grateful towards them versus like thinking about okay what are they bringing to the table? What are some of the historic things that um would actually make sense that this person is going to come and like have this kind of attitude with us or or be less trusting or you know this is going to be the future or is going to challenge your credentials uh against like what their chatbot told them. So we're so to tell you I really would like that power of that human-human connection to come out. Really quick recently I was doing something and somebody I was talking about this and in the chat I saw somebody says like okay AI versus uh versus humans for doctors like AI is going to to win you know like uh 99.999% of the time like I don't even understand how this is like a conversation it's gonna be perfect and that's what I I would want that person to read this book right because yes like if I'm asking an AI to do something like what's the hundredth decimal place of pie and there's gonna be a lot of things in medicine that is going to need that computational power and it's gonna be very beneficial yes they are going to be be able to beat me out. But what are all these other aspects that go into it as well that I think that we still very innately need to be in the driver's seat for as humans.

SPEAKER_01 47:11

Yeah I I mean not to make it not to put too fine a point on it but the the you have to craft the perfect prompt to get what you need from that AI. The AI right now can't deliver you have to you still have to be the eyes and the ears to develop the question that you need answers for. And it just at a right now state, at a present state, yeah it's it's still an incredibly human game. I just want to call something out that you did so beautifully in the in the novel talking about the privilege of being a doctor and talking about the things about not disclosing things that we were talking about earlier. Is you started each of the major sections with the traditional Hippocratic oath. And uh I think that is one of those brilliant genius writer things you were talking about. So please do feel free at least I give you permission for whatever that's worth to consider yourself among those genius writers because I thought that was so wise. I had to actually check myself I'm like is this is this the traditional Hippocratic oath? Okay. And I like Googled it and I was like idiot oh my god I see what he's doing. This is so good. This is so good. So yeah very very clever um very very and and the sections that you chose of it to represent the four seasons of his year were just yeah it was well done. So this is these are some questions we ask everybody who comes on the show. And knowing that this is I would say horror adjacent I'm going to tailor the first question for you and then I'm gonna ask a standard question. First would be what is your favorite sci-fi or horror novel, movie or TV show? You can give me one of each any of each there's no rules here. I just want to know what kind of horror or sci-fi gets you excited.

SPEAKER_00 48:50

I think so I think my favorite horror novel um and it's a complicated novel uh and I think my picking it as a favorite is actually complicated as you you can see me saying it is it by Stephen King. And I've read it a few times which isn't a you know small feat. You gotta commit to it. It's like I can read 10 other books in a time read this. And you know it's just the the ha almost like the whole city or town like being like a character. And it just fell it feels like his like him getting to a place where he's like I'm just gonna put it all out there. I'm gonna you know take what I am a Stephen King or have he and he's done so much since then but he had done a lot leading up to that. And I've always seen is like one day I want to write my it whatever it is that it may be. Let's see movie I really love Inception. I love you know I think the the types of movies like Inception where it takes like aspects of consciousness and really kind of delves into how weird consciousness is. Let's see a TV show has a lot of one thing that's really and I don't know if it's favorite but it's been on my mind lately it's like Pluribus and just the it being very smart I think science fiction um and what I think really resonated with me from the very beginning and spoilers for just for the first episode of anybody who hasn't seen Pluribus is that it makes sense that a virus a virus its MO is going to be to spread and it makes sense that if a virus has taken over all of an intelligent uh being on a planet that the next step will be how do we spread across the universe so I thought that that was so that was like a kind of like mind blown moment where I was like oh I wish I had thought of this. And then you know how you kind of implement it or what have you becomes very specific. But yeah those are some of the things and then just oh oh gee for me like Jurassic Park by Michael Crichton uh so either that or it's my favorite horror book Jurassic Park's my favorite science fiction book um I've gone back and read it like several times I went back and you know um uh read it again as I was like editing this novel to kind of like tap into Michael Crichton's spirit um so yeah so those would be my answers I think those are really solid answers first of all when people tell me they've read a certain number of books in a year and I'm like yeah but what books?

SPEAKER_01 51:31

Because yeah yeah yeah it's gonna take you a couple weeks there I it definitely was a commitment for me. And I have to say that we've never heard anything like Inception on this podcast. Oftentimes we get the shining or the exorcist those are like the two or the thing like the three most common answers. So I'm really I'm fascinated by Inception and I love that as a selection because I think the psychology of first of all an unreliable narrator yeah that's that's the kind of stuff that scares me is not knowing what is objectively real. And based on our knowledge of consciousness and our limited senses I'm not sure we ever know as people what's objectively real. So ah that just those kind of movies chill me. And uh I always love this question because I always get something to add to my watch list and Pluribus has been so highly recommended to me and I've not made time for it yet this might be the thing that pushes me over the edge and gets me to start watching. So thank you for that. So where can people find the book? I I know that I got a a galley of it but I also listened to it on Audible as well in preparation for this. So I know that it's available in ebook but where can people find the book if they want to read it?

SPEAKER_00 52:42

Yeah and um James Holey did a great job uh on the audio nice but yeah uh you know wherever you get wherever you get your books um you know bookshop.org is always like a good place to to to try it out um like if you're unsure like supporting indie books booksellers uh but you know it's on the barns and almost on the Amazons. Um I think there are still if you're so inclined like signed copies at Reparations Club in LA um Mysterious Bookshop in New York and Brookline Books Booksmith in Boston those are where I did events so they should have some signed copies left over uh and if they don't that that that that then clap for me that means I'm I'm selling books in stores uh and then you can find me on um justinckey.com and I'm very active on social media right now if if you message me I'm in that stage that I will respond so you know uh if you read it and like it or what have you tag me and I'll probably respond to you. Are you on Instagram or TikTok or where yes so Instagram definitely on Instagram so I'm on TikTok don't judge me for my TikTok you know it's definitely like you know I'm a I'm a I'm a psychiatrist and a dad and an author and I'm trying to figure out what I am as a TikToker. Um so you know a work of progress my my my Instagram is a much more like you know suit and tie like I'm kind of know kind of what I'm doing. But the TikTok is it's like the wild wild rest wild wild west but I'm justin' key on both of those.

SPEAKER_01 54:14

We'll have all of that in the episode description either in on YouTube or on the podcast that you're listening to.

SPEAKER_00 54:20

And I have to ask if you can share it what are you working on next yeah so um I'm working on what you know in an ideal world would be my next novel. I you know I don't have you know I'm at the end of the contract with this book out so you know no one's waiting for it or what have you though my agent knows about it. I'm working on a horror uh novel it's like a horror uh um sci-fi mashup it's basically body horror with quantum mechanics uh and you know the idea is just main characters flipping between two universes or one think of like the um uh Schroeder's cat the one universe dead other one alive body horror ensues and it also explores uh psychopathy um so um so I'm having a lot of fun with that and you know before jumping on here and after coming off I'm uh finishing up this draft that I hope to get well actually I will get to my uh writing friends my first readers on April 1st so I put that little fire under myself um so I'm almost there.

SPEAKER_01 55:24

Well you have one person waiting for it and that's me because psychopathy from a clinical psychiatrist point of view is something I'm absolutely interested to read. So I wish you the best of luck with that. Justin this has been an enlightening and uh rejuvenating conversation for me because it brought me in back in touch with some things that I cared deeply about in terms of patient care and communication and it gave me a little bit of hope for how we will responsibly use the tools at our disposal in providing that patient care. So thank you for joining me today. I loved the book. I highly recommend all of you go out and check out the hospital at the end of the world. Again, Justin thank you so much. Yeah thank you this was great thanks so much for having me and stay spooky my friends