The Hospital at the End of the World
Justin C. Key
Hardcover/Audiobook
ISBN: 978-0063290488
Harper, February 3, 2026, 400 pgs

When Pok Morning doesn’t get into the medical school of his choice—or for that matter, any of the top medical schools—he thinks his life is over.

If only he knew how true that was.

In Pok’s future, everything is digitized. Personal tech is thoroughly integrated into everyday life, and everything from meals to study to psychological analysis of your friend’s facial expression is available at the flick of an eyelid. This includes medical technology, which has integrated AI analysis of patient data so thoroughly that a doctor’s role has become much more analytical than personal or even observational. Medical facilities are owned by technocrats, and treatment is determined by the algorithm’s assessment of data, not what a patient actually agrees to.

It’s an efficient system, and one that Pok’s fast-paced lifestyle and hacker tendencies complement perfectly. But, in true SF thriller fashion, a series of sudden tragic events ejects him from his NYC home and puts him on the run to New Orleans, the last analog city in the US and home to the last hospital that relies on face-to-face patient analysis and human expertise. Pok joins Hippocrates, the medical school there, and is caught up in a race to treat a mysterious disease with even more mysterious origins.

Justin C. Key’s The Hospital at the End of the World is a SF medical thriller, which means that there is action, adventure, lots of (sometimes gross) medical moments, and some really excellent world-building. Every bit of advanced tech that the characters in this book use feels like a reasonable advancement of what we have now. Consumer applications of user data, predictive and generative AI in everything, perpetual connection to media, reliance on tech to perform basic thinking tasks while not really reducing our cognitive load—it’s all here. There’s tension between technology and humanity threaded through every page of this book.

But there are also a lot of surprisingly comfortable moments, and not all of them are tech-free. Once Pok escapes to New Orleans and takes on the stress of medical school without any computerized assistance, there are many weirdly calm stretches in the plot. Sure, medical school is stressful, new friendships can be challenging, and unexpected surprises from the past are never easy to navigate. But it’s almost as though Key wants to remind us of the relative peace of a chronically offline, tech-selective life, and how people can connect to themselves and each other without the artificially connective tissue of electronic assistance. He does this without completely maligning technology. The story in this book is much more of a call for balance and thoughtfulness than it is a Luddite manifesto. Technology is imperfect only because the people who create it are too, and the only way to get past the tyranny of institutionalized human imperfection is the vulnerability of relationships and learning from one another. At least, that seems to work in future Louisiana.

To that end, this book is seasoned thoroughly with deep, meaningful details. Clearly a lot of thought went into Pok’s New York, Hippocrates’s New Orleans, and the miles of road in between. There’s commentary on climate change, medical education, corporatization, and a dozen other very timely subjects if you know where to look. In keeping with the balancing act in the plot and themes, the characters do a lot of the heavy thematic lifting without being obtrusive. Every character in this book has a face—maybe not one you’d remember after passing them by, but they’re all distinct, useful to the story, and feel very real as they navigate the challenges of their world.

However, once you’re lulled into the rhythm of Pok’s med-student life, the plot ramps right back up into excitement. Stakes rise, characters die, and new information is revealed. Pok, his mentors, and his friends rush towards a solution that turns out to be much bigger than anyone in the story thought, it but won’t be a surprise to serious SF readers. It’s a well-executed and satisfying ending to a complex, detailed story that doesn’t take the easy route of making technology a simple, faceless villain. If you enjoyed Ken Liu’s All That We See or Seem or qntm’s There Is No Antimemetics Division, you’ll probably like this too.