I'm seventy years old, building a medical technology company that might ultimately become nothing more than firewood.
And strangely enough, Marcus Aurelius is helping me make peace with that possibility.
I've been listening to his Meditations lately. Not just once. Over and over again. I find myself returning to the same passages, hearing something new each time. It's a peculiar experience to have a Roman emperor, dead for nearly eighteen centuries, helping you think through the challenges of building a company in the age of artificial intelligence.
But here we are.
What strikes me most about Marcus Aurelius isn't his position as emperor or even his remarkable self-discipline. It's his insistence that we confront the temporary nature of everything around us.
He reflects on generations of families, famous men, powerful rulers, and entire civilizations. They lived, worked, argued, achieved, worried, and eventually disappeared. Their descendants did the same. The world went on.
It's a sobering perspective, particularly when you're seventy.
But I don't find it depressing.
I find it strangely liberating.
The freedom of knowing that nothing lasts
At this point in my life, I have a fairly intimate understanding of impermanence.
I spent roughly thirty years practicing family medicine and forty years working in medicine more broadly. I've witnessed extraordinary recoveries, devastating losses, and countless moments when life reminded me how little control we actually possess.
Medicine teaches humility, although not every physician learns the lesson.
You can understand the physiology, study the literature, make a careful diagnosis, and recommend the most appropriate treatment. You can do everything right.
And the patient may still do poorly.
Conversely, you can make a decision under considerable uncertainty and watch someone recover beyond all reasonable expectations.
A good physician learns that sound judgment and favorable outcomes are not synonymous.
That distinction has stayed with me.
Now, instead of seeing patients every day, I'm helping build ClearVeillance, a company devoted to improving the safety, reliability, and accountability of artificial intelligence in healthcare.
It's an ambitious undertaking. Some days, perhaps an absurdly ambitious one.
We're developing systems that evaluate clinical AI, examining how machines interpret medical information, and trying to establish boundaries around what those systems should—and should not—tell patients.
There's no guarantee that our company will succeed commercially.
We may attract collaborators, influence standards, and build a sustainable business.
Or we may spend years creating something that never gains traction.
Firewood.
And I'm increasingly comfortable with that.
Medicine was always a philosophical undertaking
Long before I began listening to Marcus Aurelius, I think I was practicing philosophy without recognizing it.
Good medicine requires more than remembering facts or recognizing patterns.
It requires listening when you're tempted to interrupt.
It requires considering explanations that contradict your first impression.
It requires admitting uncertainty when a patient desperately wants certainty.
And sometimes it requires the courage to say, "I don't know."
Those are not merely clinical skills. They're expressions of character.
The ancient Stoics described four cardinal virtues: wisdom, justice, courage, and temperance.
I've been thinking about how naturally those ideas fit the practice of medicine.
Wisdom is knowing the difference between evidence and assumption.
Justice is remembering that the person sitting across from you deserves honesty, compassion, and fair treatment.
Courage is being willing to reconsider a diagnosis, acknowledge an error, or deliver news neither you nor the patient wants to hear.
Temperance is resisting the temptation to do more simply because you can.
A physician who orders another test without a sound reason is not necessarily practicing better medicine. Neither is one who offers reassurance without adequate evidence.
Sometimes restraint is the most responsible clinical decision.
And that brings me back to artificial intelligence.
A machine can generate an answer. Should it?
We've entered an extraordinary period in medical technology.
A patient can type a question into an AI system and receive a fluent, confident, often impressive explanation within seconds.
The answer may be correct.
It may be partially correct.
Or it may sound reassuring while omitting the one piece of information that matters most.
Fluency is not wisdom. Confidence is not evidence. And an answer that sounds compassionate is not necessarily safe.
When we began developing what eventually became ClearVeillance, we focused heavily on clinical rules, physiology, and the need to distinguish justified conclusions from unsupported assertions.
Our work has evolved into two complementary efforts.
Atlas is our rules-based laboratory interpretation system, designed around explicit clinical boundaries and limitations.
Yardstick is our framework for evaluating the quality and safety of clinical AI responses.
Neither is a substitute for clinical judgment. Both are attempts to make claims about health more accountable.
As we build them, I keep encountering questions that feel less like software engineering and more like moral philosophy.
What should a system do when the evidence is incomplete?
When should it decline to interpret a result?
Is a reassuring statement acceptable if it is technically true but potentially misleading?
If an AI system makes an error, who is responsible for recognizing and correcting it?
And perhaps most importantly: Are we willing to discover that something we've built is wrong?
These are questions about truth, responsibility, judgment, and restraint.
They are also questions about virtue.
Of course, I don't believe software possesses moral character. A machine isn't virtuous because its programmers give it a set of ethical-sounding instructions.
But the people who design, evaluate, deploy, and govern these systems can act virtuously—or fail to.
Our choices become part of the technology.
Ambition without attachment
One of the ideas I find most challenging in Stoicism is the distinction between what lies within our control and what does not.
I can control how carefully I approach our work.
I can insist that clinical claims be supported by evidence. I can question our assumptions. I can acknowledge errors. I can treat collaborators with respect. I can refuse to trade patient safety for a more impressive demonstration.
But I cannot guarantee that customers will appear, that investors will be interested, or that the healthcare industry will embrace what we're building.
That's an uncomfortable distinction for an entrepreneur.
Entrepreneurs are supposed to be relentlessly optimistic. We're supposed to believe that our products will transform industries, attract millions of users, and perhaps make us wealthy.
I wouldn't object to any of those outcomes.
But I don't want my satisfaction with the work—or my sense of self-worth—to depend on them.
This is where Marcus Aurelius has been particularly helpful.
Acceptance of fate doesn't mean abandoning ambition. It doesn't mean refusing to make plans or surrendering to circumstances.
It means doing the work wholeheartedly while recognizing that the outcome is never entirely ours to command.
There's an enormous difference between indifference to the work and acceptance of its eventual fate.
I care deeply about ClearVeillance.
I want it to succeed.
But I'm learning that I don't need to demand success in order to justify the effort.
The firewood test
I sometimes imagine that, years from now, someone will look at everything we've built and decide it wasn't worth preserving.
Perhaps our technology will become obsolete.
Perhaps another organization will develop a better approach.
Perhaps we'll run out of money, enthusiasm, or time.
Perhaps the whole enterprise will become a collection of old documents, unused software, and interesting memories.
Metaphorical firewood.
Would that make the work meaningless?
I don't think so.
If we've approached the work with intellectual honesty, if we've challenged unsupported medical claims, if we've helped even a few people think more carefully about the safety of clinical AI, then something worthwhile will have happened.
And even if our influence proves modest, the undertaking itself can still be an opportunity to practice wisdom, courage, justice, and restraint.
That doesn't excuse poor execution. Stoicism is not permission to be careless, complacent, or indifferent to results.
We still have an obligation to build thoughtfully, evaluate rigorously, and improve when the evidence demands it.
We owe that to the people who may ultimately rely on the systems we're developing.
But we can fulfill that obligation without pretending to control the future.
What I hope to leave behind
I don't know how many productive years I have ahead of me.
Nobody does, of course, although the arithmetic becomes a little more conspicuous at seventy.
I still have ambitions. I still love learning. I still enjoy solving problems, building things, and occasionally entertaining ideas that are probably too big for my own good.
I'm not interested in spending the rest of my life simply waiting for it to end.
I'd rather spend it doing something I believe matters.
Marcus Aurelius reminds me that permanence is not the measure of a meaningful life.
Character matters. Conduct matters. The way we treat other people matters. The effort we make to distinguish what is true from what we merely wish were true matters.
And perhaps the same principles should guide the technologies we leave behind.
I want ClearVeillance to become a successful, enduring organization.
But more than that, I want us to build it in a way that we can respect, regardless of what eventually happens to it.
If it succeeds, I'll be grateful.
If it becomes firewood, I'll still be grateful for the opportunity to have built it.
I don't know whether what we're building will succeed. I do know why we're building it.
And increasingly, I'm learning that those are two very different kinds of certainty.
Edward Rose, M.D., is a physician, medical writer, and clinical co-founder of ClearVeillance. After decades in medicine, he is exploring the intersection of clinical judgment, artificial intelligence, ethics, and Stoic philosophy.
This is the first essay in Medicine, Machines, and Marcus Aurelius, an occasional series within ClearVeillance Reflections.
The views expressed here are personal reflections, not clinical guidance or statements of company policy.