The Nocturnists

Dear Friends,What does it mean to write about illness in fragments? How can children’s questions reveal a kind of collective philosophy? On our 70th episode of Conversations, I speak with the writer Sarah Manguso, whose work moves effortlessly between memoir, aphorism, and essay.I first encountered Sarah’s writing in Two Kinds of Decay, her account of living with CIDP, a rare neurological disease. The book, composed of crystalline fragments, became a formative text for me as a young doctor-in-training. In this conversation, Sarah reflects on that early work, shares how her perspective has changed with time, and introduces her latest book Questions Without Answers, a collaboration with illustrator Liana Fink.Below you’ll find a few excerpts from our talk—on illness, writing, and the surprising wisdom of children’s voices.Warmly,Emily and The NocturnistsFavorite moments from this week’s episodeFrench Fries and Apheresis“You’re sitting there having the procedure, eating the french fries, and then you watch as the blood products actually get more greasy and fatty and filled with fat particles. They get cloudy and opaque. That always stayed with me.”Writing the First Memoir“As a younger person, writing before the memoir boom, I was asked more than once, what is a young person like you doing writing her memoirs? You’ve barely lived. And I said, it’s just a memoir of this one experience. I was only remembering one thing. In retrospect, I look at the book and think, this is just blissfully uncomplicated and clear, because that’s how my life felt at the time.”Children as Philosophy Machines“These little creatures are art machines. They’re philosophy machines. Almost supernatural, because they dwell in both worlds. My son’s mind was as interesting as the most interesting adults I knew, but with so little life experience that his questions were just bananas. When he asked, ‘When I was inside your body, did you know me? Did you want to meet me? Did I make the world?’ I thought: these are questions that deserve to be literature.”The Mystery of Necks and Chins“There were so many questions about necks and chins. One reader suggested it’s because children are always looking up at adults, so they see our necks and chins more. Or maybe it’s because a chin has a name but no obvious function. Or maybe it’s just something in the zeitgeist. One of my favorites was simply: How important are necks?”Stories of Resilience: An Evening of Live StorytellingOn October 8 & 9, the Center for Care Innovations is marking 25 years with their 2025 Safety Net Innovation Summit in Berkeley. The gathering kicks off with Wayfinders: An Evening of Live Storytelling on Resilience and Discovery — where health care workers from across the safety net will share journeys of uncertainty, renewal, and resilience, alongside live music, food, and community. Tickets are $99 for the storytelling evening, or $200 for the full two-day summit of workshops, panels, and conversations exploring how disruption can spark equity and connection.Call for Stories: Trust in Medicine SeriesWe’re excited to announce our new podcast series, Trust in Medicine.This series explores how trust in healthcare is being built, broken, and reimagined in a rapidly changing world—where shifting guidelines, systemic inequities, and new digital voices all shape how patients and clinicians experience medicine today. Submit your story today. Thank You Our SponsorsGet in touch with us.Recommend a guest, become a sponsor, or give us feedback. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thenocturnists.substack.com

Today, we're releasing a special bonus episode featuring Emily and our "uncertainty correspondent" Alexa Miller, in conversation with the ABIM Foundation. Together, they reflect on the key insights from creating the Uncertainty in Medicine series. Thank you to the ABIM Foundation for hosting and recording this webinar. To sign up for a webinar in the future, visit buildingtrust.org/webinars. 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: Pamela Browner White Uncertainty Correspondent: Alexa Miller Series Illustrations by Eleni Debo This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thenocturnists.substack.com

In the series finale, we explore a different type of uncertainty—the uncertainty that arises around the healthcare system itself. This episode follows Ed Stratton, a stage IV cancer patient who beat his cancer, only to be denied a life-saving liver transplant by his insurance provider. His daughter Erin, armed with industry knowledge and unshakable determination, teams up with a healthcare whistleblower and an AI-powered startup to wage an extraordinary battle for his life. We end with a quiet reflection on uncertainty, and what it means to keep going. 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 is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thenocturnists.substack.com

What does it mean to live well in a world where nothing is certain — not in medicine, not in life? In this episode, we follow a high school teacher who asks his students to examine “the good life” through philosophy, Buddhism, and existential inquiry. We meet two women — a Buddhist monk and a disability rights advocate — who bring spiritual wisdom to the messy realities of illness, caregiving, and embodiment. Their stories, woven with reflections on impermanence, suffering, and compassion, offer a new way of thinking about uncertainty: not as something to fix, but as something to live with. 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 is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thenocturnists.substack.com

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, MD Series Illustrations by Eleni Debo This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thenocturnists.substack.com

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 Eleni Debo This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thenocturnists.substack.com

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 This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thenocturnists.substack.com

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 is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thenocturnists.substack.com

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 This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thenocturnists.substack.com

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 This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thenocturnists.substack.com