The Nocturnists

This week on The Nocturnists, we hear from Alicia Ashorn and Anthony Thigpen, two community health workers with the Transitions Clinic Network who are redefining what care looks like beyond the hospital walls.Alicia and Anthony share their personal stories—Alicia’s journey through addiction and recovery, and Anthony’s path through grief, transformation, and reentry work—and how these experiences shape their care for people returning from incarceration. In our conversation, they explore the power of storytelling, the emotional complexity of supporting clients in crisis, and the wisdom required to balance compassion with boundaries. Through vivid anecdotes from the field, they illuminate the essential yet often unseen role of community health workers as bridges between the clinic and the community, offering trust, dignity, and hope to people navigating systems that routinely fail them.Alicia and Anthony originally told their stories at “Journeys of Healing: Stories of Resilience and Transformation,” a Nocturnists Satellites event hosted by Transitions Clinic Network in Los Angeles in 2025, made possible by a generous grant from the California Health Care Foundation.Enjoy,Emily and The Nocturnists TeamFavorite moments from this week’s episodeThe Chaos and the Calling“There’s no two days the same. I might be helping someone who’s hungry, someone who can’t get their medication, someone going to court, someone sleeping in their car. From the moment I open my eyes, my phone’s ringing. It’s busy—but this is what I’m called to do.” — AnthonySpeaking from the Heart“I had practiced my story for weeks, but when it came time to perform, I froze. Everything I’d written went out the window. So I just spoke from my heart. I still don’t remember everything I said, but I know it was real. And when people told me afterward they could relate—that’s when I understood the power of it.” — AliciaThe Gift and the Curse“Sometimes our clients look up to us so much they’re afraid to disappoint us. That’s the gift and the curse. They see us thriving, and they don’t want to let us down. But I tell them, I’m safe—come to me with the truth. We’ll get through it together.” — AnthonyFreedom in the Truth“This was the first job interview where I was proud to say I’d been to jail. For the first time, my past wasn’t something to hide—it was something that made me right for the job. It felt freeing.” — AliciaWe Are All We’ve Got“The resources are scarce, but we’ve learned to come together. The nonprofits, the community orgs—we’ve realized no one’s coming to save us but us. So we share what we have, we show up for each other, and somehow, we make it work.” — AnthonyEnjoying The Nocturnists? Check out a new podcast from our friends at Unleashed: Redesigning Health CareUnleashed: Redesigning Health Care is a new podcast features guests are clinician-innovators who have changed care on the front lines. Their stories, their voices, their ingenuity. Learn more at unleashedpodcast.org. Thank you to our sponsorsGet in touch with usRecommend 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

Dear friends,Nurse practitioner Linda Wick has spent more than four decades in medicine, beginning her journey as a six-year-old watching nurses care for her injured brother. In today’s story, she recalls the early lessons that shaped her career—from the strict nuns who taught her at the College of St. Scholastica to the life-and-death responsibilities of the ICU and dialysis unit. When a medical emergency reunites her with one of her toughest teachers, Sister Helen, Linda is forced to confront the words that haunted her for years.We first heard Linda’s story on stage at Intersections, a live storytelling event produced by the Center for the Art of Medicine in Minneapolis in 2024 through our program, The Nocturnists Satellites. Below are a few excerpts from Linda’s story—on mentorship, mistakes, and the heart of nursing.Enjoy,Emily and The Nocturnists TeamFavorite moments from this week’s episodeA Six-Year-Old’s Awakening “I was six years old when my brother was in a terrible car accident. His legs were crushed between two cars, and he lay in traction for weeks. I remember the nurses—the ones who kept him from getting bedsores, who joked with him when he got cocky, and who comforted my mom. I watched them and thought, this is what I want to do. My nursing career started when I was six years old.”The Nuns of St. Scholastica “The College of St. Scholastica was run by Benedictine nuns—some like mothers, some like tyrants. Sister Agatha made us memorize the periodic table by heart. Sister Helen Claire taught skills and had no sense of humor. She once told me, ‘One day, you’re going to kill someone.’ I was twenty and thought she was just mean. I had no idea how long I’d remember those words.”Integrity When No One’s Watching “Sister Helen also said, ‘Integrity is what you do when nobody’s watching.’ Nursing gives you a thousand chances a day to prove that. You can make a mistake and hide it—and no one would ever know. I remember my first drug error. It wasn’t catastrophic, but I still called the physician. All I could think was: she was right. Integrity is what you do when nobody’s watching.”A Reunion in the Dialysis Unit “When I walked into the dialysis suite, there was blood everywhere. A patient’s fistula had ruptured. And then I saw her face. Sister Helen. My first thought was: Why does it have to be her? I went into ICU mode—calm, steady, focused. I told her she’d be okay, that the surgeon was good, that we’d take care of her. But inside I was thinking: Please don’t die on my watch.”Minneapolis: Upcoming call for storiesThe Center for the Art of Medicine will host their next live storytelling show, For the Moment, at the Parkway Theater on April 30, 2026. Their call for stories opens in early December, so if you or someone you know wants to share a story, reach out to cfam@umn.edu to join the email list and learn more.EXTENDED: Call for stories for 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. Thank you to our sponsorsGet in touch with usRecommend 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

This week, I’m joined by Dr. Meghan Rothenberger, an infectious disease doctor whose story we first heard live on stage at Intersections, a live storytelling event produced by the Center for the Art of Medicine in Minneapolis in 2024 through our program, The Nocturnists Satellites.Meghan grew up feeling uncertain and disconnected from her body. As a teenager, she struggled with an eating disorder, trying to make sense of the changes of adolescence and the cultural messages around her. Years later, as a medical student studying anatomy, she began to see the body not as something to control, but as something wondrous and worthy of care. In this conversation, Meghan talks with me about growing up, navigating an eating disorder, and finding healing through science, pregnancy, and the everyday miracle of being alive. Together, they explore how understanding the body can open the door to compassion, connection, and belonging within oneself.Enjoy,Emily and The Nocturnists TeamFavorite moments from this week’s episodeThe Poem That Stayed“The boy on the ski lift yelled, ‘Roses are red, violets are black—why is your chest as flat as your back?’ I laughed like it didn’t matter, but it did. That poem took root. It became a script I recited to myself for years—that my body was a problem to solve.”Control and Disappearing“When I started restricting food, it didn’t feel like punishment—it felt like control. I was good at disappearing. Praise poured in. I didn’t know then that disappearing was the thing I’d have to unlearn for the rest of my life.”The Body as Miracle“In anatomy lab, I looked down at this incredible architecture—nerves like threads of gold, arteries like rivers. I realized my body was doing all of this too. The sheer precision of it was awe-inspiring. It was the first time I thought: maybe my body isn’t ugly—it’s miraculous.”Motherhood as Reclamation“Pregnancy forced me to surrender control. My body was suddenly huge and capable and unapologetic. It was the first time I felt powerful in it, not despite it. I thought, this is what it means to inhabit a body instead of fight it.”The Miracle of Normal“Every day, I open a lab result and look straight at the red numbers—the ones that are off. But what about the ones in range? The ones that mean thousands of things went right today? We overlook the miracle of normal all the time.”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. Submissions close Oct 31 at 11:59pm Pacific.Upcoming Satellites Live Storytelling EventsLost and Found: A Night of Physician StorytellingSunday, Nov 9 | The Box Riverside, Riverside CA | FreeHosted by the Riverside–San Bernardino Chapter of the California Academy of Family Physicians, this Nocturnists Satellites event brings together five local physicians to share stories of loss, discovery, and what it means to find one’s way in medicine.Free admission — RSVP required.A Night of StorytellingWed Nov 12 | UCSF Institute of Global Health Sciences, San Francisco CA | FreeAs part of the UCSF Institute for Global Health Sciences’ 25th anniversary celebration, IGHS is hosting a special evening of live storytelling. Five members of the IGHS community will share personal narratives of challenge, connection, and humor, inviting us to reflect on the past and envision a more compassionate and inclusive future for global health. Free admission — RSVP required.Thank you to our sponsorsGet in touch with usRecommend 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

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

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

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 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

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

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 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 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 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

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 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

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. 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