Excerpts Science Fiction Read an Excerpt From The Hospital At The End of This World by Justin C. Key In a near future where artificial intelligence runs the world, a medical student must unravel family secrets to investigate his father’s death. By Justin C. Key | Published on January 15, 2026 Comment 0 Share New Share We’re thrilled to share an excerpt from The Hospital At The End of This World, a near-future science fiction thriller by Justin C. Key, out from Harper on February 3. In a time not so far from our own, society is run by a global AI system controlled by an all powerful corporation. The Shepherd Organization oversees every medical school in the country save one in New Orleans, the renegade Hippocrates which still insists on human-led medicine. It is the last choice school for an ambitious young New Yorker named Pok. But after his father—himself a physician—dies under mysterious circumstance that seems connected to “the shepherds” and their megalomaniacal young CEO, Pok finds himself on a quest for answers that leads right to Hippocrates. Once enrolled, he stumbles upon a further mystery: a strange illness is plaguing newcomers to New Orleans who grew up under shepherd rule. What is causing this fatal anomaly? And how does it relate to the mystery of Pok’s father’s death and his own mysterious past? One Decision Day The narrow overhang jutting out from the New York City apartment building did little to protect from the downpour. Pok’s back pressed against hard brick as he scanned the gray skies, his augmented reality glasses made pedestrian by the weather. The whir of an ambulance rose and dissipated, leaving behind the hum of rolling traffic. Directly above him, solid lines of rain ran from the air-conditioning unit hanging from their third-story window and cascaded off the fire escape. Where is it? The decision drone should have arrived ten minutes ago. After acquiring twelve of the country’s top medical institutions, the Shepherd Organization made clear their confidence in their state-of-the-art AI-centered medical curriculum by waiting until all other schools had sent out decisions before deploying theirs. It was a ballsy move. The stunt had paid off. According to the message boards, hardly anyone had accepted offers from non-shepherd schools even though most semesters started within the next month. Everyone was waiting on “The Prestigious Twelve.” “Decision day?” Skip James called above the rain and traffic as he stepped out of the small shop directly under Pok’s apartment. The longtime owner of Park Avenue Market, one of the last human-staffed brick-and-mortar stores in Manhattan, chucked two black bags into the garbage. Rainwater fell in sheets from the lid. “It’s all over my feed!” “They’re late,” Pok said. “Don’t catch a cold, kid.” You can’t catch a cold from the rain, Pok thought. He was about to check the message boards when a soft, persistent buzzing drew his attention. He stepped out from under the ledge, instantly drenched, a touch of metal on his tongue. The buzzing grew, steady and direct, and the drone emerged from between city buildings, cut through the rain, and stopped inches from Pok. The drone’s indicator blinked red; Pok raised his AR glasses and readily offered his irises for scanning. Verification done, its hatch opened and a silver case dropped on a string. Pok examined his delivery. The metal was warm. The Shepherd Organization’s insignia—a shepherd holding a stiffened snake as a staff—was engraved above the fresh stamp: Applicant Pok Morning. Verified at 12:14 p.m. Inside, his unique quick-response code. Kris Boles popped onto Pok’s glass display right as the decision page loaded. His friend’s temperament was spirited. His environment was dry. Yellow bordered his display. “Where’d you get in?” he said. “I haven’t checked. You got in?” “What do you mean you haven’t checked? How could you not check?” “It’s still loading.” Come on, come on. Every mentor and counselor had assured he’d have beautifully tough decisions to make at the end of this application cycle. Pok, who had applied to all twelve, had his heart set on the Shepherd School of Medicine at MacArthur Hospital, just up the street from his and his father’s apartment, where East Harlem met the Upper East Side. Outwardly unimpressive, the interior was intricately designed. The medical school was built atop the busy, three-tier hospital that served all five boroughs. Its website proudly proclaimed its future doctors sat upon the figurative shoulders of the medicine they studied. That was his dream school. Buy the Book The Hospital At The End of This World Justin C. Key Buy Book The Hospital At The End of This World Justin C. Key Buy this book from: AmazonBarnes and NobleiBooksIndieBoundTarget Pok swiped clear his glass; new drops immediately streaked across the silicon display. Logos for twelve of the country’s top medical schools—all now rebranded with the Shepherd Organization’s crest—popped onto the page. Adrenaline navigated open veins. Red Xs lined the margins. Beside all twelve schools. Every single one. “I didn’t get in.” Speaking the words made them real. “What?” Kris said. “I didn’t get in. Anywhere. This is bullshit.” They were both speechless. A digital delivery scooter honked for Pok to move. It knocked the back of his knee. He could have fallen face down onto the flooding sidewalk, mouth filling with gritty rainwater, and he wouldn’t have cared. This was bullshit. “What about that one school?” Kris said. “Gaylen or something? Down south?” “Hippocrates.” Under his father’s insistence, he’d applied to the Louisiana-based anti-AI school as a “safety,” one he’d never expected to consider. They had fallen far off of TIME magazine’s yearly top medical school rankings after essentially eliminating the latest technology from their curriculum. Just the thought of moving to Louisiana—the most backward state in the country—twisted Pok’s gut. “I don’t understand. How many did you get into?” “I don’t think—” “How many?” “Eight.” Eight? The New York air somehow grew hotter; Pok could visualize the rain sizzling off his skin. He’d received perfect marks. He’d checked all the boxes. His own father was a physician who’d given fifteen years of his life to MacArthur Hospital. And eight of the Prestigious Twelve wanted Kris and none wanted Pok? He knew Kris’s application. Hell, he’d helped with the essays. There was no way Kris would be picked over him. No way. And eight times? No fucking way. Pok rounded his building’s corner, head down, embarrassment pounding at his ears and rain pelting the nape of his neck. He unlocked his apartment door remotely as he took the stairs two at a time—the elevator was broken again—and resented the smell of the city’s concrete summer. “It’s got to be a glitch or something,” Kris said. “Somebody messed up. You’re the smartest kid I know.” The Shepherd Organization’s algorithms didn’t make mistakes. Not like this. But Kris inadvertently sparked an idea that bloomed into an insatiable urge. Pok squinted against his bedroom’s harsh, swinging light. The building—which housed MacArthur’s many medical trainees, physicians, and personnel—offered to install ones that adjusted to pupil dilation. His father, old-fashioned but well-meaning, had refused. Pok cleared a spot on his bed, found his virtual reality gaming headset, and booted up Impact, an open-world, massively online multiplayer game about teamwork and survival. “I’m coming over,” Kris said. “Don’t.” Pok took a moment to finger-comb out his shoulder-length locs; water dripped onto his thighs and the edge of his bed. “What are you up to?” “Troubleshooting,” Pok said. “Don’t do anything stupid.” “You know me. I’ll catch you later. And congratulations.” Pok took off his glass and replaced it with his gaming set. His New York apartment fell away and Impact took hold. His temples hummed with adrenaline as he created a new profile and avatar and started anew as a lone nomad. He summoned a hovercraft and directed it away from active play, full speed. Impact advertised an endless world. It generated new maps—including towns, resources, and histories—whenever a player ventured into an uncharted area. When Pok was confident about the distance between him and any other online players, he ejected himself from the hovercraft, ran into the closest house—still rendering itself in real time—opened the first closet, and jumped inside. His avatar fell into darkness. Pok counted to three and activated his jet pack. Below him, disc-shaped platforms popped up in domino effect, one under the next, like giant floating stairs leading down an endless abyss. Each had its own unique landscape, from lush countryside to suburban neighborhoods to downtown districts replete with skyscrapers. He descended to a metropolis platform several levels down, landed on the tallest building, and found its control room. He went straight to the central kiosk, brought up its command line interface, and inserted his custom string of code. A door appeared and slid open. The bright room contrasted with the building’s otherwise dim, dark interior. Rows and rows of stacked computer screens aspired toward infinity. The Underground Web. A hacker’s portal to wherever they dared venture. Years ago, during AI’s great technological boom, a revolutionary driverless car company ventured into neuro-enhancing brain implants. Through the Underground, a hacker caused a violent psychosis in dozens of early adopters and triggered multiple concurrent killing sprees that left more than a hundred dead across five states. And because many of the neuro-hacked were social media influencers, the world watched much of it live. All tech companies subsequently banned the Underground, sucking it dry. Until the Shepherd Organization. It embraced and revitalized it, boldly proclaiming their system open to anyone with altruistic intentions. Any nefarious acts, however, would be immediately thwarted by powerful algorithms, leaving the perpetrator technologically exposed to TSO and buried in litigation. None of which Pok had an appetite for. He stayed pedestrian with his hacking, mainly using it to access betas of in-production games. Venturing into the Prestigious Twelve’s applicant database would be closer to the shepherd sun than he had ever dared to fly. Find the application, see what in the hell went wrong, and get out. Pok stepped inside and picked a random aisle. Identical screens ran various lines of code. One unit stood separate from the rest. An old-school computer connected to a physical keyboard sat atop a table. Pok paused the scrolling code with the tap of a key. A new line with a blinking cursor appeared. He typed: The Shepherd Schools of Medicine, Admissions. The screen flickered, scrolled more code, and soon his own face smiled out at him. Unease touched his belly. Exploring the Underground was like peeling back human flesh to see the inner biology at work. Only a skilled surgeon could hope to tamper without disastrous results. This was reckless; he should have stopped there. But every single medical school? Pok had to know why. He opened his file. “What the hell?” The application had his name, date of birth, and unique applicant ID. Beyond that, nothing else was his. While his transcript was perfect, the one submitted had a subpar GPA with multiple withdrawn classes. The extracurriculars were without theme or merit. Pok had numerous peer-reviewed, first-author publications; here, the “Research” section was blank. This wasn’t the application he’d turned in. Not at all. Why? How? Important questions, but secondary. He had to fix it. From his personal files, Pok queued for upload his true application, complete with his encrypted genome, and hesitated. Months ago, when initially submitting, he’d grappled with the same ingrained apprehension. His father had diligently waived genome analysis at every turn of Pok’s childhood and adolescence. Antidiscrimination laws made it illegal to require DNA in applications—except in select fields like medicine. Once TSO had his genome, there was no reversing it. Pok completed the transfer. This done, he brought up the activity log, scrolled past the various review stages, and found his initial submission time stamp. Shit. “Upload Incomplete.” He’d never received that error. He quickly saw why: only minutes later was another, completed transfer, initiated by user CryingRabbits218. Not an error: a fake. Pok combed his memory for past rivals he’d hacked, gaming foes he’d humiliated. This could be the perfect revenge prank. The handle, however, didn’t ring a bell. The screen flashed red. The hue leaked out to the surrounding room. Pok groaned. He’d programmed a warning system into his hacking interface. The shepherds were investigating his activity; he needed to abort before he had deeper problems than an anonymous online enemy. Pok moved quickly but meticulously. Source or not, he’d just hacked into a subset of TSO. He needed to cover his tracks. Pok backed out of the Underground and spent the next hour scouring the newly rendered area to seek out and kill any rogue NPCs. Each represented an errant line of code that, if left unneutralized, could infect his entire system. He then deployed a kill code to eradicate this particular door to the Underground and turned off his console. His senses came back to the real world. The patter of rain on his window. The whir of the hallway air conditioner. The lingering hint of metal on his tongue. Beside him, his glass still showed the decision page. He put it on and refreshed. As if the algorithms would magically reprocess, see what an exceptional candidate he was, and immediately offer a spot. Still rejected. Still unanimous. Red marks, all the way down. Excerpted from The Hospital At The End of This World, copyright © 2025 by Justin C. Key. The post Read an Excerpt From <i>The Hospital At The End of This World</i> by Justin C. Key appeared first on Reactor.