Spoilers likely, dear readers!
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The best books make me both feel and think deeply. The Code of Us by Liv Evans has done so to such a degree that I will not do it justice in this post–I’m still hung over! But processing the story must start somewhere, and if I can move someone here to read or listen to it and discuss, then it will be worth the effort.

Mia, a dedicated neuropsychologist, researches artificial intelligence. Her husband, Arden, creates beautiful sculptures out of things people throw away. Their devoted love story serves as the steadfast anchor for a novel that throws into question everything we may think we know about cognition, memory, technology, relationship, and evolution–about how we think and feel about humanity itself.

Arden agrees to serve as Mia’s alpha subject for her ‘replicated intelligence’ project, meant to preserve and enhance human memory in service of improving people’s quality of life–eventually, when the product is fully developed. When a traumatic brain injury renders him essentially brain dead and on the brink of actual death, she and her two colleagues and close friends rush to implant Arden with a chip that brings him back to life, body and mind, with the still nascent but fully functional technology. Told in alternating present day and flashback, a complex journey of loving intentions, ethical dilemma, grief and loss, unintended consequences, and social implication unfolds.

While the plot engages, stimulates, and challenges me intellectually, it’s the emotional and relational evocativeness–the human(e) relatability–that makes this book an instant treasure in my library. In a mere 188 pages (5:37 hours, narrated by the multitalented Jodie Harris and Steve West), Evans examines–presciently, brilliantly–myriad potential complications and consequences of artificial intelligence–intellectual, social, legal, psychological, and corporeal, among others.

To ground the exploration in an unwavering love story, though, centers readers’ attention on the relational implications, which speak directly to my raison d’etre. Of all the questions that emerged in 10 pages of journaling on this book, the one I most wish for us all to consider is, “How does AI, in any given space, uphold and protect the humanity of all whom it touches?” I almost dismissed it as too difficult a question to attempt answering. But the more I consider the complexity, inevitability, and acceleration of this technology, the more I feel convicted that we, the human creators and consumers of AI, must step up to ask and answer exactly such challenging and overwhelming questions. We are called to be more thoughtful, considerate, inclusive, and complexity-tolerant than we have ever been, by a long shot.

Whatever we do will always be imperfect. There will always be unintended benefits and harms, and our attempts to weigh, compare, and justify it all will always leave many unsatisfied and frustrated. So how do we proceed? How do we show up to engage with the most complex adaptive problem that many of us can ever fathom? What mindset(s) will minimize the risk of nefarious, greedy, and inhumane forces overtaking the altruistic, humanitarian, and egalitarian ones?

Last fall was the first time I thought and wrote in any depth about how AI will change medical practice. Since then I open more and more to the potential benefits, led by my astute and altruistic colleagues in primary care, who model thoughtfulness, compassion, and critical (neither blind nor cynical) appraisal and application.

As my own learning progresses, some key concepts emerge that I will hold in front. They will evolve, obviously, and I ground them always in the commitment to enhancing human to human connection, no matter what tool is considered.

Acceptance with conditions

Humans innovate. We create. We aspire, imagine, and push boundaries. It is the greatest gift of our intellect, and also a potentially fatal flaw. What’s done cannot usually be undone. I accept it all in iterations, fear and trepidation giving way slowly to cautious possibility. That said, nobody should be given carte blanche to advance technology unfettered. Banning development only drives it underground, where the presence and risk of nefarious forces increases, in my estimation. Thus, we must accept and embrace our discomfort with the unknown and uncertain, ask the hard questions, and grapple with the ardent persistence of true infinite game masters.

Transparent and mindful accountability

Ethics committees are a good start. Checks and balances on the runaway flaws of primarily capitalist ventures must be established and maintained. Open source data and outcomes sharing will be key for minimizing harm, I think. That conflicts directly with the competitive financial drivers of innovation, I know. So we must, somehow, wrestle earnestly, honestly, openly, and in good faith with the novel humanitarian complexities and problems that AI creates. We must do accountability better than we ever have which, sadly, is not saying much.

Agile and adapative commitment

There are no words better than exponential acceleration to describe the march of modern technology. We have built this kite that flies ever higher and faster, and if we hope to influence its path at all, it will take more than the string and gym shoes we started with. We must invent the tethering, weighting, and conveyance materials, structures, and vehicles in real time. The faster and more fully we accept the inexorable progress of AI, the more effectively we may flow with it rather than against, to move swiftly and smoothly to manage its ethical, humanitarian, and social implications and consequences.

Critical hope and optimism

Be warned: The Code of Us is not a romance novel, despite its love story core. The book does not end happily, though the end of the book is not necessarily the end of the story. It took a few days for me to identify all of my emotions, led by sadness in depth and intensity. Liv Evans summons, with incredible economy of language, a viscerally, if not cognitively coherent (and thus quintessentially human) cacophony of feelings that at once proves the undeniable shared humanity that fiction evokes, and yet wholly defies full articulation. I don’t think I have ever journaled ten pages about any book, and I’m still intellectually, emotionally, and existentially entangled. Surprisingly, it feels light rather than heavy. This book teaches me a lesson that recurs: With every degree of acceptance, I gain a commensurate measure of liberation. Despite so many egregious examples to the contrary, I still believe humans can transcend our most self-serving, collectively self-destructive tendencies. I believe we have the capacity to collaborate for the common welfare. We just don’t readily exercise it. I have called myself a cynical optimist. Today I choose critical optimist, because we simply must proceed. We must hold onto that kite and not allow ourselves be dragged. In medicine we learn critical appraisal skills: how to evaluate data and evidence for validity and application. When the data is good, we accept it and apply, until new and better data shows us otherwise.

My opitimism is not blind. It is realistic and evidence-informed, if not fully evidence-based. I will deepen my acceptance, demand transparency and accountability, and train for adaptive cognitive and emotional agility. I intend to run with rather than get dragged or trampled.

We humans may destroy ourselves in the end, and that will be what it will be.
Until then, however, I still have hope that we may yet save ourselves.