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 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

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 Medical Association and donations from listeners like you.

Host: Emily Silverman, MD

Uncertainty Correspondent: Alexa Miller

Series Illustrations by Eleni Debo

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. Unleashed: Redesigning Health Care features clinician-innovators who have changed care on the front lines. Their stories, their voices, their ingenuity. Learn more at unleashedpodcast.org.

Host: Emily Silverman, MD

Uncertainty Correspondent: Alexa Miller

Series Illustrations by Eleni Debo

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 this episode, Dr. Wyatt mentions his time at The Joint Commission. The correct length of his tenure is 5 years.

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. Unleashed: Redesigning Health Care features clinician-innovators who have changed care on the front lines. Their stories, their voices, their ingenuity. Learn more at unleashedpodcast.org.

Host: Emily Silverman, MD

Uncertainty Correspondent: Alexa Miller

Series Illustrations by Eleni Debo

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 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. Unleashed: Redesigning Health Care features clinician-innovators who have changed care on the front lines. Their stories, their voices, their ingenuity. Learn more at unleashedpodcast.org.

Host: Emily Silverman, MD

Uncertainty Correspondent: Alexa Miller

Series Illustrations by Eleni Debo

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.

Host: Emily Silverman, MD

Uncertainty Correspondent: Alexa Miller

Series Illustrations by Eleni Debo

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 California Medical Association and donations from listeners like you.

Host: Emily Silverman, MD

Uncertainty Correspondent: Alexa Miller

Series Illustrations by Eleni Debo

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 (ArtsPractica)