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.

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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