The Hospital at the End of the World by Justin C. Key

 "Not for the faint."

Speculative fiction looks at the possible direction of medical care.

In a near-future America, the Shepherd Organization has turned healthcare in to a cold, algorithmic commodity. AI dictates every diagnosis and treatment, leaving no room for human intervention or error. Pok, an aspiring medical student living in New York, has spent his life preparing to join this system alongside his father. When his applications to medical school are rejected, his world falls apart coinciding with his own father's sudden death.

Following a path his father had secretly set in motion, Pok flees the high tech surveillance of the North for New Orleans. The city, guarded by electromagnetic spires that block the Shepherd's reach,  is home to Hippocrates, the last medical school on earth that still practices human led medicine. But that special place and sanctuary comes with a price. As Pok struggles through the grueling medical school training, he discovers a terrifying new plague -- the Grips -- that specifically targets those who have spent their lives under AI. As more become infected and die, Pok must accept his own purpose and realize all that he is capable of when the truth about his origin and past are revealed. 

This plausible scenario was haunting and scary and I really enjoyed it. I love medical fiction, and this plunged deep into the big questions about what AI will do as it is increasingly integrated, or mandated, into our lives. Will human empathy and all the skills of a human physician be traded for an algorithm and efficiency. Who lives, who dies just a calculation. There is so much to think about within these pages and so it took me a lot longer to read this than a typical thriller of this type. It made me even more certain that restrictions and restraints need to be in place to prevent machine driven medical practice and care. 

A huge question raised by the author deals with the ethical questions. Definitely a must read for fans of speculative fiction who want a story that feels both like a warning and a tribute to the people who still believe in the human side of healing. 

I was able to listen to the audio book while also following along in the e-book ARC, both provided by the publishers. The narrator, James Fouhey, did a decent job, but it was a bit of a let down because he just didn't do women's voices well. As a result, the characters basically sounded the same without much differentiation. This production would definitely have benefited from a full cast, or at least a female voice. I always enjoy the immersive experience of listening and reading, and this would have been such a huge hit had the characters sounded more distinctly male or female.

This is a debut novel and I plan to read more from this author.

Genre - speculative fiction, medical care, AI, coming of age