No Skipping Ahead

I sit at the round bistro table alone, on the phone with Driy. He and Emily are getting married soon, in the fall, which is apparently the mildest season in eastern Washington. I tell him Roanoke’s been cold, colder than Seattle was in January, that I’ve been retreating to this coffee shop most days for a few hours to study. 

Behind me, a group of old friends is catching up. One of them tosses out “ChatGPT” as a source for whatever point they’re making, like you can cite a black box and call it scholarship. The mention lands wrong. Not surprising, not unsettling—just… irritating.

“Do you use AI a lot in your job?” I ask Driy. 

I ask in a tone that might indicate I’m broaching a secret. Like I’m denying its widespread use, even though a family member, a highly regarded economist, hires ChatGPT as one of his research assistants. Translation: someone somewhere got quietly replaced.

“Some things it does great,” he responds, “but it can’t work with design files that well yet.” 

Driy works as an industrial engineer. Ever seen one of those oversized mugs with straws? He designed those. At least, I blame him for the scourge. But he is also training to be a helicopter pilot. Apparently, it helps make his full-time job a part-time job. More time flying, which, for him, is time that actually means something.  

“I’ve been thinking a lot about how it’ll change medicine. I’m already experiencing how it is changing how we learn medicine.” 

“With AI?” he asks.

“Yeah. I remember using encyclopedias for my fourth grade science project, but really, information has become much more of a commodity since the internet came around. AI feels like a different arena: analysis at your fingertips. Part of being a doctor is gathering and interpreting data, but if AI can do that in seconds, with fewer errors, what’s left? Hell, for the first 18 months of school, I’ve been tasked to absorb an incessant array of facts and mechanisms, not to be good at a trivia category that everyone dreads, but for clinical application. I mean, in a way, making diagnoses involves training my brain to think like a computer. Gather, seek, and process information.” 

Driy coughs and I don’t even know what I feel, what I’m trying to say in this moment.  

“I know, I make it sound so sexy,” I say. “But it is fun…and satisfying. I’m starting to wonder if I’m just going to be left repeating what the algorithm suggests, akin to a tall, highly-trained Bose speaker. What’s left, the customer service part?” 

He laughs. 

“Customer service?” he says.

“I mean connection, trust, relationship building, communication, empathy. Listening to your patient and really hearing them. The humanity of medicine.” 

Driy pauses. 

“That’s all good, though,” he says. “We’ve talked about this before.” 

“Yeah, it is. It is good. But it isn’t the whole reason I wanted to be a doctor. The other part is the puzzling over, the piecing together. The kind of thinking where everything I’ve learned comes together in a moment, or forces me outside my comfort zone to explore something I don’t know. As this new resource becomes more ingrained in software, AI notetaking will evolve into AI recommendations. Lab and imaging results will come along with a flowchart analysis of next steps. All tied up with a red bow, outcome data and potential pitfalls to keep an eye out for.” 

“I mean, it sounds like it might make healthcare better,” he says.

“Ha, yeah, it probably will. Less biased decision-making. Fewer errors. But selfishly, less fun for me. This tool is creating the ultimate standardization of reality. There is a shift toward more and more people using the same source for information.” 

I let that sit for a moment. Maybe this is how older doctors feel, the ones who have seen thousands of cases, who start to lose that initial sense of mystery. Early in their careers, every patient is a challenge, a test of skill. But over time, patterns emerge. The puzzles become predictable. New treatments and technologies keep them learning, but they talk more about their patients, their lives, their stories—because that’s what remains interesting. Maybe AI is just making that shift happen sooner.  

We talk a little while longer, then I hang up. My face is warm. Not embarrassment exactly, more like exposure, the flush you get when you hear yourself say something true and petty in the same sentence. Driy’s “it might make healthcare better” hangs in the air like a verdict, and I can’t tell if I’m defending patients, myself, or the old rules of the game.

I step outside, and the cold hits my skin. It feels coarse, textured, like the air has weight. I pause, disoriented for half a second—then focus snaps back. A head rush. My vision clears. 

There’s a hue that makes everything seem brighter, like the world has been recalibrated in my absence. A crispness to it, like biting into an apple in summer. A fleeting energy moves through me, sharp but impossible to hold onto. I try to file it under chemistry: cold-triggered adrenaline, a little cortisol, my body doing its primitive math. But it also feels like attention, plain and unprocessed. Not a chemical moment, I tell myself. Just a moment.

One that doesn’t need to be useful.

And then— 

I’m standing in line at the grocery store. The only open checkout lane. The person in front of me has a cart full of groceries—soda, frozen pizzas, mac and cheese, an absurd number of bananas. The teenager scans each item with the energy of someone who refuses to be Employee of the Month. Good for him. 

Still, I sigh. I’m tired, too. The day’s been long. I’ve been inside for most of it, breathing stale air, under the golden hue of quality lightbulbs. I shift my weight and glance behind me. I’m greeted by green eyes meeting mine.  

The person is holding a half-empty basket of random things—laundry detergent, a single bell pepper, a six-pack of beer. I imagine him pulling into his driveway as he realized what he forgot. Him smiling sadly. A deep breath and quick shift into reverse and he is driving back to the store. Grabbing those last few things in a hurry, and the beer because, hey, it’s been a day. And now we both have arrived in this moment. We don’t say anything; I feel something. A flicker of recognition. Not familiarity, just…a sense we are both here, locked into this mundane unavoidable moment of waiting.  

Time doesn’t freeze, but I feel time in that moment. Instead of feeling like I’ve suddenly jumped to the end of the day, I feel its weight. It’s like when people say, “Wow, this year has gone by so fast,” only now I’m aware of each second ticking. The squeak of the cart wheel against the smudged, waxed floor. The cashier ringing up the last 24-pack of Pepsi. “That’ll be $254.32,” he mutters.  

I throw my own items—a carton of arugula, a filet of salmon—onto the belt. I smile at the teenager. He looks at me like I’m a Bose speaker. But I don’t feel like I’m skipping a track. 

Later, I lie in bed, staring at the ceiling. Evelyn, my partner, is out of town. My hands are clasped behind my head, and my thoughts circle back, loop around that moment in the store and my conversation with Driy.  

I keep expecting fear to arrive, the cinematic kind: doom music, existential crisis. Instead it’s annoyance, threaded with something softer and harder to name: grief for the puzzling part of medicine, envy of the people who’ll train with the cheat codes already installed, and a prickly worry that my hours of practice might be depreciating in real time. 

Like getting really good at a game only for the rules to change—suddenly, all this practice might not matter as much.  

Or like discovering what I love—that something that makes me feel capable, and engaged, sharp—is quietly becoming something else.  

I pause. There is something else. I have this ambition for mastery. Maybe it’s tied to how I was raised, conditioned, or how my ego takes shape. It’s this desire to be the most capable person in the room, the one who knows. And so, now, I consider more and more medical specialties that preserve that sense of self-importance. Irreplaceable value. Roles where my thumbs, attached to this bone sack of thinking meat and highly specialized Bose speakers, can perform something no piece of machinery can—yet.  

Procedures, emergent situations, fast decisions under pressure, situations that demand real human reflex. I can’t say I like this reasoning. Still, I’m annoyed. 

That’s what AI feels like. Not really like a loss, or an existential crisis, but this shift.  

I sigh. I get up and take a Unisom. Run the mechanism of action through my head as I swallow water.  

I don’t know. But for now, that’s the thing about AI that gets to me—not that it’s coming, but that it’s here. And that it makes the future feel... flatter. 

Not worse. Just different. 

I exhale. My H1 receptors are damned well-blocked in that moment. I shut my eyes. I fall asleep with my study plan for tomorrow already set.  

But still—there is this lingering question. 

What do we do when the rules of the game change?