400 pages, Hardcover
Published February 3, 2026 by Harper
Hospital At the End of the World by Justin C. Key
Medical dramas are having a moment thanks to The Pitt, but let's be real every medical story is in a sense, Science Fiction. Medicine is a science, but Key’s novel is a medical thriller set in the near future, and in my opinion works even better as a work of SF than purely medical. This is a stunningly good debut, from a writer who clearly is more experienced than your average first timer.
This novel was on my radar ever since I first became aware of the author. Key was on a panel at the first SFAM in Los Angeles, and when I attended that panel, I did a very modern thing. I followed him on all socials as I was sitting there. It was soon after that he announced this novel. So when I was offered a chance to review this novel, I jumped at the chance. This was one of my anticipated novels of the year.
This near-future thriller is about a medical student and the changing technology, and speaking of the Pitt, that technology is at the heart of the second season of the Pitt. Not only are the doctors on the show rejecting AI, and having issues with how it interfaces with their jobs but the season involves technology failing. Just like every sector, the ripples of AI technology make sense to be in the air with medical stories. Hospital at the End of the World, with the near future setting, is even better at examining the ins and outs of this changing political dynamic.
Justin Key may be new to the novel format, but he has released plenty of stories a collection and a novella. This novel doesn’t have some weaknesses of a first novel, in fact I suspect that even though it is his first, he cut his teeth on some rougher yet unpublished novels. Maybe he is just that good.
The story is about Pok, a medical student who is turned down for placement in one of many medical schools in the unified AI-operated Shepard corporate system. Shepard is the most powerful AI in the world, running nearly everything, So it was crushing for Pok, whose only option is natural medicine and medical school (Hippocrates) in New Orleans, the city that has set-up a firewall to resist Shepard's control.
Once in New Orleans, he is brought in to the research looking for a solution for a mystery illness that looks like withdrawal from tech. ¨The scrollers¨ who are moving to NOLA and suddenly are cut off from technology. There are reasons why Pok was put into the position...
"I saw the beginning of their plan for you and for the New Orleans. They want to show the world that being separate is unsafe." The Emergency room went cold. "How are they going to do that?"Pok said.
"By making it unsafe. I don't know exactly how but this place, this city, it's their target. and once your TSO's target..."
The paranoid, future tech-driven dystopia elements make for a strong SF reading experience. I loved this novel, the medical stuff was as subtle as the world-building. I could follow it easily, the characters were well drawn, and the narrative was well paced. Most importantly for this novel, the themes and issues it addresses are timely and important. Not preachy, but woven perfectly into the mysteries.
What is chilling about the story is it how vulnerable our entire species feels during this story. A good medical drama will make you feel vulnerable, but the trick here is that this medical story is about an illness that can sweep humanity as fast as an actual disease.
Does AI inherently make for better medicine? The argument is that there is a lack of human mistakes, but of course, just like anything else, the human touch is important. This novel never takes such things lightly.
The SF elements are strongest in the way the technology and culture clash, when characters withdraw from tech, they use drugs like synth…
"Synth has been around a lot longer than Agrypria. And withdrawal symptoms are well defined and usually self-limiting. This isn't simple withdrawal."
A medical thriller writer might miss these types of speculative ideas, and this novel overflows with them.
Hospital at the End of The World is among the best new releases in genre fiction; the fact that it comes from a new voice might be the most exciting part. It is an excellent cross between a medical thriller and a paranoid techno-dystopia. Like many books in the genre, it could easily spin off into other stories set in this universe. It is ripe for sure. I suspect this will be on my best of at the end of the year, so yeah read this book...Doctor's orders.
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