Come On,
Marky

In 1967 an eleven-year-old boy in Montréal was handed insulin, a glass syringe and a notebook, and told to write down his blood sugar. Within days he was writing down more than that: what he had eaten, what he had predicted beforehand, whether the prediction held.

This is his sixtieth year with Type 1 diabetes, and the notebook habit never stopped. Come On, Marky is the story of that record and of what turned out to be in it.

A chart holds outcomes — the glucose value, the dose, the lab result. It does not hold the thinking that produced them. Every patient generates that layer every day, and nearly all of it is thrown away. The datasets now being used to train clinical artificial intelligence have the same hole in them. The machines are learning from what was left over.

That is the argument. The book makes it in scenes, because scenes are the only place it exists. A boy admitted at 425 mg/dL. A men's room in Montréal a year later, where a stranger walks in mid-injection and turns out to have been taking the same shot since 1928. A misjudged meal in Chinatown that produces a number telling the truth and explaining nothing. Decades of margin notes no clinician ever asked to see. And the death of a son, where the book stops being about data.

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