Karm-AI

As Alice rolled through the last stop sign on her way to the main road, she nearly hit a kid.

He was a Somali-American boy, maybe fourteen or fifteen, on one of those goddamn scooters: huge backpack dragging him down; clunky earphones covering his ears; his mind evidently wandering, oblivious to everything else in the world. 

Alice slammed on the brakes so hard that her sunglasses nearly flew off her face. Her YETI mug tumbled out of the cup holder like a drunkard somersaulting off a city bus. 

She glared at the kid as she straightened her shades. 

The kid glared back and made a point of scooting slowly around the front of her car, now idled in the crosswalk, cutting each corner with an obnoxious precision as he worked his way across the intersection.

The little shit, cursed Alice under her breath.

She felt a little hit of shame for cursing some random Somali American kid. Of course, she hadn’t cursed him for being Somali, she told herself, but for his carelessness, his refusal to look where he was going - even though technically she was the one running the stop sign. If one were trying to be technical, one might argue she was to blame - from a technical standpoint. 

She knew she wasn’t mad at him, really. But part of her was thankful for the opportunity to think about anything other than where she was going.

Generally, oncologists don’t ask for in-person meetings when it’s good news.

~*~*~

Doctor Danielsson had mustard on his oxford shirt. “I can’t believe this,” he said, his brow furrowed in disappointment - with himself, with the shirt, with the mustard? “Apparently, I can’t be trusted with a sausage. This is ridiculous. Look at this.”

He pulled back his lab coat to show Alice, who sat patiently across the desk from him.

“It’s still wet. I never know what to do for this. Should I blot it, should I let it dry and then scrape it, or… should I ask Siri? Alexa or whoever?”

Alice did a sort of half-shrug. Her mind wasn’t exactly on laundry best practices at the moment.

“It’s on the inside of my lab coat now. Goddamn it.” He let the lab coat drop back down into place. “The stupid part is that I brought a ham sandwich from home. I didn’t need to go get lunch. I could have stayed here and I wouldn’t even be in this predicament. And I knew, when I saw the guy behind the counter loading it up with mustard, that it was going to be too much mustard. How much mustard does any one man need?”

“Is there a way you can tell me the test results?” asked Alice, testily.

Doctor blinked then looked at the file on his desk, seemingly remembering where he was. “Sorry. Yes. Of course. I’ve been told my bedside manner isn’t always the best.”

He reached down to open the file folder, but before he could flip the manilla folder he raised his sleeve for Alice to see.

“Ketchup! On the cuff! This is-”

Alice remained stone faced, steeling herself for the news.

“Sorry. I don’t even need to open the file folder. I already read it - I know it’s pancreatic cancer.”

The tingling began in her shoulders and upper back, then ran up and down her spine. She felt her whole body vibrating with dread. 

Earlier that morning in the shower, as she catastrophized every possible terrible outcome of this meeting, she had wondered how she might react. Would she fall apart? Would she rage? Would she rip her eyes out from grief?

No: she sat there and said the word, “Shit.”

“I know, it’s one of the big ones. I’m, uh, obviously very sorry that this has happened. To you.”

“Is it…?” she began but could not finish. Her meaning made it to the doctor anyway.

“Likely, yes.”

“Are there…?” she started.

“Well,” said Doctor as he tugged at his collar. “That’s the rub. There are treatments. The only issue here is insurance. We could do some courses of chemo, but the cost would run many, many thousands of dollars.”

Alice frowned. “I have the Treatment Plus plan. It should be covered.”

“Well, see, but you have Treatment Plus, not Treatment Plus Plus. You need the two plusses for chemo to be covered below a certain age. It’s all very complicated. I asked our insurance guy and everything. We actually - we got hotdogs together today, although I think he got a Polish sausage. But yeah, he said no.”

“I can’t… this is, it’s unbelievable. I’m….” She exhaled. “I don’t understand how this could have happened to me.”

“Ah! That I have an answer for!” The Doctor perked up, finally flipping through the file folder. “We have this new government sponsored program - one of the few left, it seems, though Big Tech had a hand in it - but it’s a program… computer program - AI… it basically tells you the cause for these sort of catastrophic happenings. It’s called Karm-AI - isn’t that cute? Like Karma and AI? 

“It’s a clever name,” he reassured her as he flipped through the file folder before brandishing one of the pages. “Here, I found it! Right here: cause of misfortune is… Jason Duck… er… Duque- uh… here.”

He turned the folder over. 

Alice read the name JASON DUQBEER next to a picture of the Somali kid she nearly ran over that morning.

“Wait. Uh. Is this a joke? How do you… I almost….” She faltered - how could they know about a minor traffic incident from an hour or so ago? She shook her head. “What am I looking at here?”

“According to the algorithm, this young gentleman is to blame for your illness. Jason D. Karmically speaking. So, at least you have that.”

Alice felt like her brain was missing too many important words or sentences to make sense of what he’d just said. The Doctor could see she was having trouble.

“The government created an AI algorithm to tell us who’s to blame when bad things happen to us. Karmically speaking, your cancer is the fault of this teenager right here,” he said as he set the paper out in front of her.

As he drew back his hand, Alice noticed a gloopy white liquid with little bits of caper stuck between his middle and ring fingers. 

Doctor Danielson must have noticed her stare. “Remoulade? Are you kidding me?”

“How many sauces did you put on this hotdog?” asked Alice with some amount of annoyance.

~*~*~

No wonder Alice missed the early warning signs. 

If your general mode of operation, your day-to-day experience, is to move through life with a constant sense of vague unease then how are you supposed to know when any one thing is especially wrong? Loss of appetite wasn’t entirely uncommon for Alice. Neither was itching, nor was fatigue. At what point does loss of sleep go from an existential issue to a life-threatening medical one?

It really wasn’t until the stomach pain that she felt like anything was off off.  She’d had all manner of abdominal aches before, but this one - it appeared in an unfamiliar place on her torso. It ached just a little differently.

As she sat at the stoplight on her way into work for the afternoon, she wondered: if she had never gone to the doctor, if she had just ignored the ache, would she even know the difference? Or could she have enjoyed a little bit of blithe obliviousness for a moment or two longer?

She knew letting her mind spiral wasn’t going to help. Unfortunately, she had a history of mind-spiraling anyway. One thought led to another and soon her mind started to wonder about the cancer cells themselves. How do they act? What do they look like? 

She remembered textbook illustrations of animal cells from some high school class long ago forgotten, how with their nuclei they kind of looked like eyes and if you drew a dark slash over the tops like eyebrows - a thing she occasionally did to stave off the boredom of lectures -  how the cells could be made to appear angry. 

For some reason, this is the image that stuck in her head: angry eyes with slashes above them, dividing and expanding and infecting and destroying the healthy cells and transforming them into more of their angry ilk.

She felt childish imagining it this way, but what was she supposed to do? Or to think? Or to feel?

And what did Jason Duqbeer have to do with any of this?

~*~*~

Rachel threw her left leg over her right knee and listened intently to her sister. 

The wooden park benches were uncomfortable and the weather was chilly, but Alice didn’t want to be at home and she didn’t want to go to a restaurant to watch others eat, so the park it was.

She nodded as Alice recounted her strange episode with the doctor, emitting the occasional little grunts and half-vocalizations that Alice recognized as proof of Rachel’s continued attention.

Finally, after Alice had exhausted her story, Rachel ran her fingers through her short blonde bob and asked, “So what are you going to do?”

Alice let out a heavy sigh. “I honestly have no idea. Second mortgage maybe? Depending on the cost? I don’t know, are there places that do, like, medical loans for cancer treatment?”

“No,” Rachel shook her head, “What are you going to do about that boy? Jason…””

“Duqbeer?” asked Alice. “The kid? Nothing. What are you talking about?”

“Did he not basically make it so you have cancer?” Rachel switched her legs around, right over left. “I mean, is he not to blame for this predicament? Are you not owed some sort of redress?”

Alice looked at Rachel like a second head had grown out of her cheek. “Rachel, it’s bullshit. It’s government sponsored scape-goating. The kid’s no more responsible for my cancer diagnosis than the ducks in the pond over there. How would that even work?”

“How am I supposed to know? I’m not a doctor. But the system works for a reason. Did you hear about this, uh, the airbag recall? Basically, these airbags were going off without a collision - just while people were out driving around - and it was causing massive issues, car crashes and chemical burns. Well, Karm-AI figured out that the whole thing was the fault of this trans man named Sid Messner. You must have heard this story?”

Alice had not heard, although that didn’t surprise her. She was often the last to hear about current events, and airbag malfunctions were low on her rapidly growing list of concerns.

“Well, they got rid of Sid and did a recall on the cars, and now there are no airbag issues. So. There’s your answer.”

“I don’t get it. Did Sid work for the airbag company or something? Did the airbag company compensate people for the damages?” asked Alice, but Rachel only shrugged. “You can’t really think some random trans person…”

“I don’t have to think. That’s the point. And it’s not ‘random.’ I feel like you’re not really listening to me. This is an established fact. The algorithm figured out who was to blame and then boom: problem solved.”

Alice frowned but bit her tongue. Rachel’s propensity for certainty always irked her a little bit. 

To Alice, life was a collection of random events to be sifted through and sorted, like a jigsaw puzzle of rancid garbage that when properly assembled made a makeshift working radio or something. 

But for Rachel life always seemed to present itself as a simple path for her to follow. 

This vision, or maybe lack of it, made Alice irritated and jealous in equal measure.

“So what, then? What does it mean ‘they got rid of Sid?’”

Rachel shrugged, as though the answer were self explanatory.

“You can’t be suggesting I kill this child?”

“Oh Christ, Alice, what do you want from me?” said Rachel. “I’m not suggesting you do anything. Don’t get pissed off at me - I’m not the one who selected the Treatment Plus plan.” 

“Treatment is in the name of the plan! How was I supposed to know the Treatment Plus plan wouldn’t cover treatment?” shouted Alice.

“You always take the most pluses you can afford. This is why Doug and I have Treatment Plus Plus Plus. Listen: you drag me out here to this cold-ass park in the middle of the day. You tell me who’s to blame and then you get mad at me for repeating it back to you. You’re my sister. I love you and I feel for you and I’m there for you. You do whatever you want and I’ll support you. But if the algorithm provides you with an answer and you turn it down, that’s on you. 

“And by the way, nobody said ‘kill.’ Alright? I’m sure there are options. You could negotiate some sort of deal where he moves to Canada. I bet he’d really like Canada. You could…” Rachel leaned in and lowered her voice, “you could call ICE. I know that’s not the most popular option right now but it is an option. I’m sure they could set him up in a very nice warehouse somewhere in Texas. I really don’t know. It’s up to you.

“But I do know this: if it came down to my life or someone else’s life, I know which life I’d pick.”

~*~*~

Alice wished she’d asked more questions of the doctor while she had the chance. The diagnosis and explanation shocked and appalled her so much that she neglected to push back, and now she had the moral conundrum of this nonsensical algorithm distracting her from forming an attack plan for the actual cancer.

Driving home from the park, she couldn’t help but run the numbers - how much would another consultation cost? How much for a second opinion? Would single Plus coverage pay for any of this at all? Would the countless hours on the phone with the insurers to find out be a wise use of time?

She guided her car through a gentle right turn at a red light. 

Logic told her that Karm-AI made no sense, that there was no rationale for believing that some random kid could ever possibly be responsible for what went on inside her own body.

But like most people she also did not understand algorithms. Hell, it seemed like the programmers didn’t understand half the time. She had not even the slightest clue how Karm-AI worked, which meant she didn’t know what she didn’t know.

Obviously, this Jason kid could not have physically caused Alice’s body to spawn cancer cells.

Unless there was some karmic connection of which she was unaware - if karma even worked that way. Or if there was such a thing as a quantum connection between Jason and her. Quantum physics was way out of her comfort zone. 

Or even if there was some spiritual link. Alice was not spiritually inclined - her divine utterances were limited only to times when she’d left her phone at a restaurant - but if anything her ignorance made things worse. There existed a whole subject full of explanations for the nuances of life and death and she knew nothing about it.

This teenaged kid with the oversized backpack and the headphones - surely he had nothing to do with Alice’s misfortune. Logically speaking. But, if Alice were religious or spiritual in any way, she may have confessed that a part of her doubted logic - that a part of her wanted to believe it was so simple as the wrong person in the wrong place.

As Alice steered her car into her subdivision, she saw him again: Jason Duqbeer - the same backpack and headphones and scooter - flying down the sidewalk.

She slammed on her brake in the middle of the intersection.

As he came to the crosswalk, the kid gave her the same irritated glare, but then his facial expression softened. Maybe he saw something in the desperate way that she looked at him.

He mouthed something at her. She put down her driver’s side window. “Heh?” she grunted.

“Are you okay?” he asked.

Alice thought for a second.

“Can I talk to you?” she asked.

Jason looked around. “Here? I’m, uh. I’m on my way somewhere.”

“I’m not trying to kidnap you, if that’s what you’re worried about.”

“That’s not what I was worried about.”

“There’s a Taco John up the street. Can I meet you there? Buy you a taco?”

~*~*~

Jason had a $7 meal steal. Alice bought an order of Potato Oles but she barely picked at them. Mostly she just watched Jason eat, which he did with the abandon of a teenager. As he tucked into his Taco Bravo, his pace slowed. She could almost sense his unease, the realization that this was weird. She hadn’t even asked him any questions yet.

“Big Somali community around here, huh?” she asked, and then immediately wished she hadn’t.

He grunted, then replied, “Big white people community too, though.”

Alice nodded. Fair enough. “Were you born here?”

“Aw, for real?” he asked. “That’s what this is?”

“I’m just curious is all.”

“Yeah, I was born here. My parents were born here. What is this? Are you going to ask for my papers?”

“I’m not - calm down - I just…” Alice floundered. Why hadn’t she thought this through first before enticing this kid to some random Taco John’s for an interrogation? Usually she would run every conceivable version of this conversation that she could imagine first before even considering approaching someone, but the opportunity presented itself so quickly - opportunity for what exactly she wasn’t even sure, but it seemed to her like they needed to talk. “It’s not like that. I wanted to know. I’m curious. That’s all. I mean, I nearly hit you the other day and I wanted to make it up to you.

“I’m not the type of person who likes to run over teenagers, you know. I felt bad.”

Jason still regarded her with suspicion, but he did pop a Potato Ole into his mouth.

“Where do you go when I see you?” she asked. “You’re always on the scooter and you have the backpack.”

“School,” said Jason.

“It’s the weekend,” noted Alice.

“Not today. I’m on my way to the library. Mom and Dad work, so I head over there sometimes.”

“They have a reading program or something?”

“I mostly just play video games. Hey so,” began Jason. “I appreciate the tacos and the Mountain Dew, but this has all been super weird. I’ve been nearly run over by tons of people in their cars and nobody’s ever bought me food before. What is this really about?”

Alice thought about trying for some other explanation so that she could plumb him for more information, but in truth her interrogation skills left much to be desired. She took a deep breath.

“The day I nearly hit you, I was on my way to the doctor. I have cancer.”

Jason regarded her. His shoulders slumped. “I’m sorry,” he said. “That sucks. Is it bad cancer?”

Alice’s brow furrowed. “Is there good cancer?”

“Some cancers are better than others, I think. Right?”

“This one is a very bad one. Pancreatic.”

Jason looked down at the table and, for a little bit, neither of them said anything.

“My uncle had… I’m not sure what kind of cancer - I’d have to ask my Dad - but it was also very bad. He wasn’t really my uncle - he was just an old friend of Dad’s that used to hang out at the back of the shop with him and smoke cigars and make fun of the customers behind their backs. Uncle Hamoudi,” Jason said, a smile crossing his lips. “He was a lot of fun. A good guy. He always had a crisp dollar bill for me. Which, you can’t really buy anything for one dollar but it was a nice thought.”

“What happened to him?” Alice asked.

“What do you mean? He had very bad cancer. There was nothing to do.”

Alice was quiet for a moment. “Do you know what type of healthcare he had? Was it Treatment Plus or Treatment Plus Plus?”

Jason shrugged. “It was rough on us all, particularly my Dad. They’d known each other for a long time. Like I said, not my real uncle but it really hits you. To watch someone suffer like that? With nothing to do but wait? I wouldn’t wish it on anyone.”

~*~*~

Alice walked to her car. She gave Jason one last wave, got in and pressed the ignition button on her dashboard. Jason boarded his scooter, then took out his phone - maybe he was picking a song to accompany him on his ride to the library.

She took out her sunglasses and placed them on her face. As she did, she thought about Jason and his dad and his not-real uncle. Then she checked her mirrors and adjusted the volume on her music. As she did, she imagined Hamoudi laying in his hospital bed, nothing to do but wait. No recourse. No options. Only certainty.

She put the car in reverse and lined up. She put the car in gear. She stomped on the gas.

~*~*~

In the end, the court did not find Alice liable for the death of Jason Duqbeer, even if technically - technically - her car was the car that hit him in that Taco John’s parking lot.

Karm-AI analysis determined that the actual cause for the “accident” was a fellow by the name of Henry Valdez, who had been born in Bethesda, Maryland but was none-the-less sent to serve out his life sentence in CECOT.

Though she tried her best to live her life normally, occasionally Alice found herself getting cold sweats. Her skin would become prickly. Her hair would become so sensitive that laying her head against a pillow felt unbearable. Whenever she thought of Jason and her mind started to spiral, she felt as though her stomach would tighten up into a knot of guilt.

And she did feel guilt. 

She felt this even though technically the court had already decided the guilt belonged elsewhere. What was she expected to do? If there was even a sliver of a possibility that she could save her own life, shouldn’t she take that? Was she supposed to just sit there and wait for death? If her sister was right - if it really was her life or his - could anyone really blame her?

She liked to think of Jason as some sort of a sin eater, a fellow villager willing to take on the faults of the rest - the worry, the fear, the blind anger and resentment. And though ’willing’ wasn’t quite the right word for how Jason and the rest of those condemned by Karm-AI were treated, she nonetheless imagined him taking her weakness with him when he passed.

Regardless of how she felt or whether she slept or didn’t, Alice was free - her movements unencumbered by the constraints of a CECOT prison sentence - and so she was able to attend another in-person meeting with Doctor Danielsson.

“Amazing,” he said as he perused her file folder. Alice couldn’t help but let out a relieved sigh.

“Oh thank God,” she said.

“You must feel a ton better.”

“I think so, yeah. I think I do.”

“Good. Certainty will do that for you,” he said. “The body and the brain - there’s a direct connection between the two. And I’m not just talking about the neck here. I mean, holistically. A good mental attitude means a good life. I read that somewhere.”

“Hopefully in a medical text book, right?” quipped Alice.

The Doctor shook his finger at her, as if to say ‘good one,’ and then closed the file folder. “Anyway, I’m glad you can rest in peace knowing that the guy responsible was punished.”

Alice nodded, grateful to have everything behind her, although something about the Doctor’s phrasing bothered her. “Right. Also, I can rest in peace because the cancer’s gone, right?”

The Doctor grimaced.

“What’s that mean?” asked Alice. “Why did you do that with your face just now? I am cured, right? You opened my file folder and you said, ‘Amazing.’”

“I surprised myself. I had a whole double chili cheeseburger while I was reviewing the file. It got so out of hand that I had to change my whole outfit this afternoon, but somehow not a single drop made it onto the paper. It’s a minor miracle.”

“I’m still sick,” she said - or asked - her voice hollow.

“But don’t you feel better?”

Alice hopped up from her chair. “I’m cured. I have to be. You wouldn’t make me do… you couldn’t… that poor kid….”

“Hey,” said the Doctor rather sternly, “I didn’t make you do anything. Besides, that ‘kid’ had a whole lifetime of causing severe medical emergencies ahead of him. Maybe. If the algorithm is to be believed. And right now, we have no reason to believe otherwise - it was a very expensive algorithm. You - and by ‘you’ I mean Henry Valdez - did us all a great service, for which Henry will forever be punished.

“Sometimes there’s nothing to be done. But at least you weren’t the only one to suffer, right?”

Alice sat back down, the wind completely knocked out of her. She cast her eyes around the room and suddenly a vision of cancer cells popped into her head - the same illustrations with the slanty eyebrows - the ones that had been growing and killing and pillaging their way through her body. 

In that moment she knew in her heart that she herself had been transformed, that she herself had become some other type of cell. And that, algorithm or no, there was nobody else to blame.

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