Between his time in the operating room, teaching, and raising his three sons, Atherton resident Dr. Rick Novak has found time to write two novels.

Novak, 65, an anesthesiologist at the Waverley Surgery Center in Palo Alto, recently published his latest, "Doctor Vita," a story about an artificial intelligence (AI) physician module that goes awry.

It's a science fiction novel that explores how technological breakthroughs like artificial intelligence and robots will affect medical care -- and already have.

One might wonder how an anesthesiologist, who also serves as an adjunct clinical associate professor of anesthesia at Stanford University and is Stanford's deputy chief of the Anesthesia Department, segued into the world of writing. It began, he explains, with writing a monthly column in the Stanford Anesthesia Department newsletter, and this grew into writing essays on his website, The Anesthesia Consultant, in 2010.

"I just love it," he says of writing novels. He finds it more emotionally gratifying to write fiction than to spend nine months on a three-page medical journal article that few people read, he adds.

Novak, who has a medical degree from the University of Chicago Pritzker School of Medicine and a 30-plus year career in medicine, has worked in clinics, intensive care units and medical helicopters in addition to operating rooms, and brought first-hand experience to his novelistic brand of storytelling. AI, he says, is coming to the medical field faster than people might expect.

He recently shared with The Almanac his insights into technology's effects on medical treatment.

The future of medicine

Both of Novak's published novels integrate medicine into the plot. "Doctor Vita" specifically focuses on how technology affects medicine.

AI is already playing a part in our everyday lives -- from Alexa following our verbal commands in our homes to smartphones verbally directing us to our destinations as we drive. Robots will become increasingly more common in surgeries in the next 20 years, Novak says.

"I started seeing things like ATMs replacing bank tellers, automatic checkout at stores, and thought 'someday we will do this to doctors,'" he says. "Over the last 15 years AI has grown and become common. We now have Siri and Alexa. It's coming on pretty strong in medicine."

In the last few years, a slew of artificial intelligence devices have been tested in operating rooms. For example, McGill University researchers tested the "McSleepy" sedation machine to administer anesthetics and muscle relaxants to patients. The iControl-RP machine goes a step farther, making its own decisions about administering medications through an IV, according to a paper Novak published in May called "Artificial Intelligence in Anesthesia and Perioperative Medicine is Coming."

The five-armed da Vinci robot enables the surgeon to see inside the body in 3D and to perform fine motor procedures at a higher level, according to Novak's paper. The da Vinci can currently perform robot-assisted prostatectomy and administer anesthetics to a patient, according to the device's website.

IBM has begun programming its Watson computer to ingest and analyze medical data. Watson for Drug Discovery analyzes millions of articles and other data in minutes to help find insights about ailments like Parkinson's disease, according to IBM.

A 2019 review of applications of machine learning in health care published by doctors in The American Journal of Medicine, "Artificial Intelligence Transforms the Future of Health Care," states that machine learning has its highest potential, and implications, in disease prediction and diagnosis; drug discovery and repurposing; and epidemic outbreak prediction.

There will be not only robo-surgeons in the future, but AI will also play a part in more routine visits to the doctor, Novak says. In "Doctor Vita," a robot examines a patient, taking his vital signs and collecting his health history. Novak foresees machines recording a patient's medical history, blood pressure and temperature.

But AI isn't quite ready to replace the roles of doctors yet, one study found. Physicians significantly outperformed computer algorithms in correctly diagnosing an ailment (84.3% versus 51.2%), according to a 2016 study called "Adverse Events in Robotic Surgery: A Retrospective Study of 14 Years of FDA Data."

There were over 1.75 million robotic procedures performed in the U.S. between 2000 to 2013, according to the study. The number of adverse events per procedure was less than 0.6%. There were more complications in complex surgical areas, such as cardiothoracic and head and neck surgery, than gynecology, urology and general surgeries.

Doctor vs. machine

A central theme of "Doctor Vita" is the potential dangers of machines replacing human doctors. Human errors happen during surgery (medical errors are the third-leading cause of death in the U.S., according to a 2016 study by Johns Hopkins University), but there's also the fear of operating system crashes or hacking of robots that are at the helm of life-or-death situations. There's also the question of how hospitals would handle malpractice lawsuits if a robot is at fault for an error.

"People who have read the book ("Doctor Vita") so far are shocked," he says, adding that they say they don't want robots providing their medical care. But it's expensive to train and employ doctors, and it will take some automation to ensure that more people have access to medical care, he says.

"The greatest challenge (in medicine) isn't cures but how to make the tough decisions on who gets the high-level care," he states.

Novak says that he wouldn't want a computer between himself and the patient if he's trying to save a patient's life.

"Most physicians are reluctant and very suspicious (of AI), but there's so much money to be made that entire companies are going to try to make machines useful," he notes. "If they start replacing people -- that's worrisome. ... It is easier to build a computer than to train a physician for seven years, but you need to have a human doctor there supervising machines."

The writing process

Novak spent three years working on his first book, "The Doctor and Mr. Dylan," which he published in 2014.

But he began writing "Doctor Vita" in 2004, before starting to write the other book. He says he was inspired to write about AI by watching technology change the world around him. After putting the draft down for a while, he says, he picked it back up in 2015.

Novak, who grew up in Hibbing, Minnesota, a mining town, has enjoyed writing for years, but didn't think he could make a living as a writer. He says that a well-written story he substituted for an undergraduate college admissions essay helped him get accepted at Harvard University, but he chose to stay in Minnesota, graduating from Carleton College with a bachelor's degree in chemistry. He always knew, though, that he had the capacity to write at a "high level," he says.

Because of his small-town upbringing, Novak likes that Stanford is one of the only world-class medical centers not located in an urban area.

"The first week I moved here from medical school at the University of Chicago, I looked around and said to myself, 'If things work out, I'd just as soon stay here for the rest of my life.' ... Atherton is an oasis in the Silicon Valley maze, to mix a metaphor," he says. "I feel like I'm in a bucolic Minnesota village when I'm at home."

Novak's lifelong love of reading also spurred his decision to start writing fiction. In his Atherton home, where he writes, you'll find books by Stephen King, John Grisham, Ayn Rand and Hemingway on his bookshelf. He has read "The Great Gatsby" about five times. Most of his writing process takes place in his head before he writes it down on a page, he says.

Novak has two more unfinished novels that he hasn't found time to complete because of his busy schedule. One is set in Woodside and follows an anesthesiologist who stands trial for murder by lethal injection when her husband's lover dies, he says. The other, he adds, stars a physician Special Forces officer who is sent to the Middle East to kill a terrorist leader.

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