An excerpt from The Algorithm Will See You Now.

Jacie shoved her glasses up her nose. “For those not selected, when PRIMA gives its report, or whatever… and if it says the treatment won’t work, how do you tell the patient?”

“We don’t.” Hope paused. “That’s the nurse’s job, of course.”

Cecilia gave her a reproachful glance.

Hope backpedaled. “I mean, PRIMA has proven that training the nurses in the triage and delivery of test results allows the physicians to be more efficient. Physicians only meet the patients who’ve been properly identified as responders. Patrons, I guess we’re calling them now. That allows us to focus all of our medical skills on the people we can truly help. PRIMA trains the nurses to inform those we can’t help.” She tilted her head at Jacie. “You should understand this.”

“Oh, I understand.” Jacie’s voice was soft, but her jaw remained set. “So PRIMA doesn’t have to pay for the cost of their care, you mean.”

Hope couldn’t believe her ears. “What? That’s not the driving force. Not at all.”

Jacie shrugged a shoulder. “Don’t you worry even a little about their motivations? To make a profit?”

Hope’s head went hot, and she spoke in a carefully controlled voice. “Doctors gave my mom chemo—before they had the tech to know she’d be a non-responder. Do you know what happened? All she did was suffer. That’s the driving force. PRIMA helps us prevent unnecessary suffering.”

Jacie didn’t meet her eyes. “I guess—”

“No, there’s no guessing about it. That’s the entire point of what we’re doing here.”

Cecilia cleared her throat, and Hope dialed back down her voice. “Besides, if someone doesn’t want treatment at PRIMA, they can go elsewhere.”

Jacie raised her eyebrows. “Do you really think that? Do you know how hard it is for the uninsured?”

“They have the market exchanges.”

Jacie mumbled something that sounded like, “Yeah, right.”

Hope looked at Cecilia to interject, but her mentor was studying Jacie, a curious expression on her face. Hope shook her head in frustration.

“The reality is someone has to pay for healthcare. You don’t know what it’s like, outside of PRIMA.” Hope thought back to her first year of residency before she’d transferred to PRIMA. “All those prior authorizations and denials. The insurance companies impede doctors at every step. But here, the algorithm guides our treatment decisions. PRIMA’s going to improve the system for everyone.”

“But…” Jacie trailed off.

Hope raised her hands in frustration. “But what?”

Then she recalled Jacie’s words on the unit yesterday—my sister. Hope was truly sorry if Jacie had lost a sister, but Jacie didn’t understand the suffering doctors caused by treating non-responders.

An unbidden image flashed through her mind of the first time she had seen her mom’s bald head—the unexpected smallness. She’d wanted to cup her hands around it and feel the fascinating smooth beauty of it, but she’d been afraid, her mom’s head so fragile, and her eyes so large without her hair to frame her face. So instead, she’d shoved her hands in her pockets and stared at the floor.

Hope forced those thoughts back into the compartment where they belonged. Jacie was making this unnecessarily difficult. All they had to do was perfect their medical skill-sets, and the algorithm would guide them. Yesterday had been an exception. That’s all.

But another part of her mind whispered that she had administered treatments to a non-responder without knowing it. The algorithm had caused her to do what she most dreaded—the thing it was supposed to protect her from.

Maddox’s voice echoed in Hope’s head. The AI doesn’t make mistakes. People are a different story.

Had it somehow been Hope’s fault?

“I almost forgot.” Cecilia interrupted her thoughts, holding out an envelope. “This came for you. I meant to give it to you at our last Saturday breakfast.”

Hope took the letter, palms damp with sweat, her dad’s handwriting visible on the outside. He’d long ago figured out mail had a better chance to get to her here, where Cecilia periodically rounded it up for her, than at her apartment.

It was the last thing she needed right now, and she shoved the letter into her bag without opening it. Cecilia was right. The best thing Hope could do was rededicate herself to her purpose.

An alert popped up on her tablet, drawing her attention, and she forgot all about the letter. She sucked in a sharp breath, not believing her eyes.

Her ranking.

It had dropped, and she no longer held the top position. It now belonged to Leach. But the only person who could dock points was…

Maddox.

It wasn’t fair. The non-responder had been nothing under her control. She wanted to say something to Cecilia—to explain the unsettling interaction with Maddox.

The post-residency position. It should belong to you. I see it in you.

“Hope, if you could stick around, there’s something else I need to talk to you about—”

Cecilia broke off as, behind Hope, a change in air pressure rustled the papers on the floor, signaling the door opening.

Hope rotated halfway in her chair and froze.

Silver hair. A sweater, red as arterial blood. Maddox strode through the doorway, her gaze sweeping the room as if she owned the place.

Jennifer Lycette is a novelist, award-winning essayist, rural hematology-oncology physician, wife, and mom. Mid-career, Dr. Lycette discovered the power of narrative medicine on her path back from physician burnout and has been writing ever since. Her essays can be found in The Intima, NEJM, JAMA, and other journals. She can be reached on Instagram, LinkedIn, Facebook, and Mastodon.

Her books explore the overarching theme of humanism in medicine. Her first novel, The Algorithm Will See You Now (Black Rose Writing Press), a near-future medical thriller, is available now. Her second novel, The Committee Will Kill You Now, a prequel in the form of a near-historical medical suspense, is out 11/9/23 and available for preorder now in paperback and on Kindle.