The Nocturnists

Today, we explore the paradox of mortality: something both certain and utterly unknowable. Through a haunting parable from Ursula K. Le Guin and stories from doctors and loved ones, we hear what happens when people try to plan for death—or avoid it. A daughter processes her mother’s calm decision to pursue assisted dying. A physician grapples with an ambiguous advance directive. A neurointensivist weighs the line between hope and false hope. What do we do when clear answers are impossible? And what happens when our attempts to control death only bring more suffering?  And in the midst of all this uncertainty, how do we find peace? Find show notes, transcripts, and more at thenocturnists.org, and subscribe to our substack. The "Uncertainty in Medicine" series is generously funded by the ABIM Foundation, by the Josiah Macy Jr. Foundation, and the Gordon & Betty Moore Foundation. The Nocturnists is supported by The California Medical Association and donations from listeners like you. Host: Emily Silverman, M

Today, we step inside the studio of visual artist Leila Simon Hayes, whose bold, shape-driven designs are born from a process rooted in imperfection, intuition, and trust. Through her story, we explore how Leila’s creative practice helped her navigate decades of chronic pain and medical dismissal, eventually leading her to healing not through certainty, but through listening—both to her art and her body. Her journey invites us to reconsider our own relationship with uncertainty, and to ask: what happens when we stop demanding answers and start embracing the unknown? Find show notes, transcripts, and more at thenocturnists.org, and subscribe to our substack. The "Uncertainty in Medicine" series is generously funded by the ABIM Foundation, by the Josiah Macy Jr. Foundation, and the Gordon & Betty Moore Foundation. The Nocturnists is supported by The California Medical Association and donations from listeners like you. Host: Emily Silverman, MD Uncertainty Correspondent: Alexa Miller Series Illustrations by 

Today, we explore the hidden layers of communication in medicine—what gets said, what doesn’t, and how uncertainty lives not just in the clinical data, but in the space between people. From a telemedicine encounter with a stubbornly independent patient in the Santa Cruz mountains, to a deeply personal story of navigating breast cancer risk, and finally to the ICU, where one physician is trying to revolutionize how teams talk about the unknown, this episode invites listeners into the gray zones of uncertainty and the doctor-patient relationship. Find show notes, transcripts, and more at thenocturnists.org, and subscribe to our substack. The "Uncertainty in Medicine" series is generously funded by the ABIM Foundation, by the Josiah Macy Jr. Foundation, and the Gordon & Betty Moore Foundation. The Nocturnists is supported by The California Medical Association and donations from listeners like you. Host: Emily Silverman, MD Uncertainty Correspondent: Alexa Miller Series Illustrations by Eleni Debo

Today, we step into the dance studio with improvisational dance artist Chris Aiken, whose work lives at the intersection of uncertainty, movement, and presence. With insights that resonate far beyond the dance studio, Chris explores how attention, poetic instinct, and even failure are essential tools for responding creatively under pressure—much like an ER doctor at a moment of crisis. Find show notes, transcripts, and more at thenocturnists.org, and subscribe to our substack. The "Uncertainty in Medicine" series is generously funded by the ABIM Foundation, by the Josiah Macy Jr. Foundation, and the Gordon & Betty Moore Foundation. The Nocturnists is supported by The California Medical Association and donations from listeners like you. Host: Emily Silverman, MD Uncertainty Correspondent: Alexa Miller Series Illustrations by Eleni Debo

This week, we explore how time and uncertainty are intertwined in the practice of medicine. A toxicologist faces a split-second decision in the ER that could mean life or death for a young patient. A woman with chronic ankle pain spends years searching for answers as dozens of doctors offer snap diagnoses and failed treatments. A rheumatologist navigates the slow, murky waters of autoimmune disease, where diagnosis and treatment often unfold over months or years. And a couple reckons with the long-term implications of a rare and unpredictable heart condition. Through these stories, we see how uncertainty can stretch time out endlessly or collapse it into a single moment and how, in medicine, working with time rather than fighting against it is often the only way forward. Find show notes, transcripts, and more at thenocturnists.org, and subscribe to our substack. The "Uncertainty in Medicine" series is generously funded by the ABIM Foundation, by the Josiah Macy Jr. Foundation, and the Gordon & Betty Moore

When a 7.6 magnitude earthquake leveled entire villages in Pakistan, retired U.S. Navy Admiral Mike LeFever was thrust into the heart of the disaster with no playbook and a simple directive: provide humanitarian aid and strengthen U.S.-Pakistan relations. In this episode, LeFever recounts what it was like to lead a massive relief effort in the chaotic aftermath—coordinating aid, rebuilding schools, and navigating diplomacy in a country where his presence was politically charged. As his mission evolved from emergency response to long-term relationship-building, including during the fallout of the Bin Laden raid, LeFever shares hard-won lessons on leadership, humility, and decision-making in extreme uncertainty. Find show notes, transcripts, and more at thenocturnists.org, and subscribe to our substack. The "Uncertainty in Medicine" series is generously funded by the ABIM Foundation, by the Josiah Macy Jr. Foundation, and the Gordon & Betty Moore Foundation. The Nocturnists is supported by The California Me

What happens when doctors have to make life-or-death decisions in an evidence-free zone — and patients are left to navigate the unknown? In episode 5 of “Uncertainty in Medicine", we bring you three gripping, real-life stories: a neurosurgeon weighing impossible risks in the operating room, a palliative care doctor facing a young man’s quiet resolve to die, and a patient whose long-awaited kidney transplant vanishes in a single phone call. These are high-stakes moments where instinct takes over, control slips away, and the only way forward is a leap of faith. Find show notes, transcripts, and more at thenocturnists.org, and subscribe to our substack. The "Uncertainty in Medicine" series is generously funded by the ABIM Foundation, by the Josiah Macy Jr. Foundation, and the Gordon & Betty Moore Foundation. The Nocturnists is supported by The California Medical Association and donations from listeners like you. This episode is sponsored by a new podcast that fans of the Nocturnists are sure to love. Unle

What does uncertainty in medicine have to do with Chernobyl? According to patient safety officer Dr. Ron Wyatt, more than we might think. In the fourth episode of our "Uncertainty in Medicine" series, he draws a chilling connection between one of history’s worst nuclear disasters and the quiet, preventable tragedies that unfold in hospitals every day. In both cases, the warning signs were there. People sensed something was wrong. But no one spoke up—or if they did, no one listened. Through his work at the Joint Commission, Dr. Wyatt has spent decades investigating sentinel events, the most serious and avoidable medical errors. What he’s found is deeply unsettling: the root causes rarely come down to lack of knowledge. They come from cultures where fear, hierarchy, and silence override curiosity and caution. And time and again, he’s seen how racism and bias magnify that silence. Here, Dr. Wyatt reveals what truly makes healthcare safe—and what has to change to protect every patient, equally. Quick note: In thi

In episode 3 of the "Uncertainty in Medicine" series, patient Dana undergoes a routine knee replacement and expects a straightforward recovery. Instead, she’s plunged into a baffling and relentless illness—one that defies diagnosis and leaves her life in limbo. As her symptoms intensify and specialists write her off, Dana finds an unwavering ally in her primary care doctor, the one person who refuses to let her fall through the cracks. This episode traces their year-long search for answers, revealing the emotional cost of medical uncertainty and the rare power of a clinician who stays the course. Along the way, we visit Lewiston, Maine, where a small, intentional change to residents’ schedules is making the uncertainty of primary care more manageable and helping keep young doctors in the field. Find show notes, transcripts, and more at thenocturnists.org, and subscribe to our substack. The "Uncertainty in Medicine" series is generously funded by the ABIM Foundation, by the Josiah Macy Jr. Foundation, and the 

On this episode of Conversations, Emily sits down with the creative team behind The Pitt—a gripping new medical drama on HBO Max that’s making waves in the healthcare world and beyond. Joining her are showrunner R. Scott Gemmill (ER, NCIS: LA), physician-writer Dr. Joe Sachs (ER), and emergency medicine educator and EM:RAP founder Dr. Mel Herbert. Together, they go behind the scenes of the show, discussing characters, medical cases, set design, and the creative team’s relentless pursuit of medical authenticity. Find show notes, transcript, and more at thenocturnists.org. The Nocturnists is made possible by the California Medical Association and donations from listeners like you.

Step inside Alexa Miller’s classroom, where paintings become portals and doctors learn to see like patients. In this episode, Alexa leads a powerful exercise called the “image circle,” where clinicians reflect on their own experiences of medical uncertainty and choose artworks that speak to those moments. What follows is anything but abstract—through close looking and deep conversation, participants begin to feel what it’s like to sit on the other side of the exam table. Alexa, a trailblazer at the crossroads of art and medicine, shares  frameworks for understanding uncertainty and introduces her BOLD framework for navigating uncertainty in healthcare. Find show notes, transcripts, and more at thenocturnists.org, and subscribe to our substack. The "Uncertainty in Medicine" series is generously funded by the ABIM Foundation, by the Josiah Macy Jr. Foundation, and the Gordon & Betty Moore Foundation. The Nocturnists is supported by The California Medical Association and donations from listeners like you. Ho

In the premiere of the "Uncertainty in Medicine" series, The Nocturnists explore medicine’s uneasy relationship with not knowing. From the clean resolutions of medical dramas to the structured rituals of case conferences, the culture of medicine often treats uncertainty as something to be avoided, resolved, or explained away. But what happens when uncertainty is not just a temporary gap in knowledge—but a constant, lived reality? Through story and reflection, this episode invites listeners to reconsider the role of uncertainty in clinical care. What if the goal isn’t to eliminate it, but to navigate it skillfully? And what if doing so makes us not only better clinicians, but better collaborators, listeners, and humans? Find show notes, transcripts, and more at thenocturnists.org, and subscribe to our substack. The "Uncertainty in Medicine" series is generously funded by the ABIM Foundation, by the Josiah Macy Jr. Foundation, and the Gordon & Betty Moore Foundation. The Nocturnists is supported by The Cali

Our Uncertainty in Medicine series launches next week, and to set the stage, we’re sharing one of our favorite episodes from the archives - a heartfelt conversation with New York Times columnist Ross Douthat about his journey through the healthcare system while living with chronic Lyme disease. Medicine likes certainty - diseases we can see and test for and treat. But what do we do when we can't see? When we can't help? Do we keep searching? Or do we look away? In this episode, Emily speaks with New York Times columnist Ross Douthat about his book The Deep Places, which tells the harrowing story of his experience with Lyme disease, and what it's like to navigate a chronic illness that mainstream medicine hasn’t yet fully explained. Find show notes, transcript, and more at thenocturnists.org. The Nocturnists is made possible by the California Medical Association and donations from listeners like you.

Medicine is full of uncertainty—from ambiguous diagnoses to unpredictable outcomes and the complex emotions of not knowing. Uncertainty in Medicine is a new documentary podcast series, created in collaboration with Alexa Miller of ArtsPractica, that examines how both healthcare workers and patients navigate the unknown. Through powerful personal stories and in-depth conversations with professionals whose work depends on making decisions amid uncertainty, the series explores what it means to embrace the gray areas of medicine—and life. The first episode of Uncertainty in Medicine drops Thursday, April 3. Find show notes, transcripts, and more at thenocturnists.org The Uncertainty in Medicine series is supported by the ABIM Foundation, by the Josiah Macy Jr. Foundation, and the Gordon & Betty Moore Foundation. The Nocturnists is supported by The California Medical Association and donations from listeners like you. Series Host & Co-Creator: Emily Silverman, MD Series Correspondent: Alexa Miller (ArtsPrac

Dr. Allan Detsky, a Canadian physician, health economist, and Broadway producer, examines the contrasts between Canadian and American healthcare. He then delves into his passion for musical theater, recounting his unexpected journey into Broadway production and how he integrates musical theater into hospital wards as a means of decompression and connection in medical education. Find show notes, transcript, and more at thenocturnists.org. The Nocturnists is made possible by the California Medical Association and donations from listeners like you.

Kali Dayton, critical care nurse practitioner, ICU outcomes consultant, and host of the Walking Home from the ICU podcast, joins pioneering ICU physical therapist Heidi Engel to discuss long-standing ICU practices rooted in sedation and immobility. Together, they make a powerful case for a transformative model that keeps patients awake, engaged, and walking—even while on ventilators. Find show notes, transcript, and more at thenocturnists.org. The Nocturnists is made possible by the California Medical Association and donations from listeners like you.

Dr. Marcy Bolster, Dr. Jason Liebowitz, and Dr. Philip Seo join us to discuss their newly published anthology, A Masterclass in Medicine: Lessons from the Experts. They created this compelling essay series to explore what it means to be a master clinician, featuring lessons from their own clinical heroes as well as other renowned physicians. Through these essays, they highlight the essential qualities of exceptional doctoring—empathy, clinical reasoning, and lifelong learning. In this conversation, they share the insights that shaped their careers, reflect on the impact of mentorship, and examine the enduring art of patient-centered care. Find show notes, transcript, and more at thenocturnists.org. The Nocturnists is made possible by the California Medical Association and donations from listeners like you.

Physician and New Yorker writer Dhruv Khullar argues that modern medicine is in a Gilded Age—one where groundbreaking innovations mask deep systemic issues, including misaligned incentives, escalating costs, and growing dissatisfaction. From the influence of private equity on healthcare to the flaws of Medicare Advantage and the crucial role of data as the ‘oil’ of the healthcare system, this conversation explores the challenges of contemporary medicine while underscoring the importance of frontline clinicians actively engaging in health policy debates. Find show notes, transcript, and more at thenocturnists.org. The Nocturnists is made possible by the California Medical Association and donations from listeners like you.

Susannah Fox discusses her book Rebel Health: A Field Guide to the Patient-Led Revolution in Medical Care. Drawing from decades of research, Susannah shares stories of patients and caregivers who, when faced with challenges mainstream medicine couldn't solve, stepped up as innovators. From parents hacking their own medical devices to build DIY artificial pancreases to communities collecting critical data for rare diseases, Susannah highlights the power of grassroots healthcare innovation. Find show notes, transcript, and more at thenocturnists.org. The Nocturnists is made possible by the California Medical Association and donations from listeners like you.

Jamie Metzl, author of Superconvergence, explores the convergence of technologies shaping humanity’s future. From the genetics revolution to artificial intelligence, he unpacks how these technologies intersect, the ethical dilemmas they pose, and their potential to reshape life, work, and health. With insight and optimism, Jamie challenges us to harness humanity’s newfound powers wisely to create a better world for all. Find show notes, transcript, and more at thenocturnists.org. The Nocturnists is made possible by the California Medical Association and donations from listeners like you. This episode of The Nocturnists is sponsored by the Bucksbaum-Siegler Institute for Clinical Excellence at The University of Chicago. The Institute is dedicated to fostering compassionate doctor-patient relationships and advancing clinical care. Each year, the Bucksbaum-Siegler Institute recognizes extraordinary healthcare professionals through The National Clinical Excellence Award. To learn more about the award and to nomin