The Power of Pausing in Uncertainty with Maggie Jackson
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You're listening to The Nocturnist Conversations. I'm Emily Silverman. In an era where certainty is often prized above all else, embracing the unknown can be a revolutionary act. Today's guest, Maggie Jackson, an award-winning author and journalist, invites us to rethink our relationship with uncertainty through her new book, Uncertain, The Wisdom and Wonder of Being Unsure. Nominated for a National Book Award and celebrated on numerous Best Books of 2023 lists, Uncertain has captured the attention of people everywhere, although I was especially interested in the sections that address uncertainty in medicine. As you may know, The Nocturnist is currently working on an entire series on the topic of uncertainty in medicine.
So I was really grateful to have the opportunity to chat with Maggie about her experience interviewing surgeons about uncertainty, the way that we handle uncertainty in diagnosis, and the value of slowing down and even daydreaming in facing down the unknown. Maggie did such an amazing job bringing together science, psychology, and even poetry in this book. So before we dive into the conversation, let's hear a passage from Uncertain.
Here's the last big thing that needs to be divided, Molten whispers to me as the surgeon exposes his final target. The crucial bile duct nestling in the organs recesses. The cancerous half liver is nearing removal, the five-hour operation approaching completion. The senior surgeon keeps urging the junior doctor to hasten. He makes a move, a stapler bites down on flesh, It was a critical moment, Caroline Moulton explains later, and he divided it like it was all routine. And then he halts, saying, hold it. The small talk ceases as sweat darkens his cap and a ringing phone goes unanswered. Don't cut, he orders. Stumbling on an unexpected glimpse of bile duct, he suspects that a minute earlier he may have done the unthinkable and severed the duct's main stem.
In medicine, such incidents are called never events, errors that shouldn't ever be made. Has he ridden blindly into danger, mistaking the irreplaceable for the expendable? This time, it was just a frighteningly close call. Failing to clean off enough of the surrounding tissue, he was working a few millimeters off target and sliced through an innocuous blood vessel, mistaking it for his true mark. That wasn't the bile duct, that thing before, he murmurs, swiftly recovering his pace. This is the bile duct. Actually, yeah, the mistake we made was we were too far into the right side. Over a lunch of chowder and chili in the cafeteria, he and Moulton unsparingly probe the incident. I clearly cleaned off the wrong structure, he admits.
That could have been a landmine, she accuses. You didn't check it. I didn't feel comfortable. I have to admit that, he says. He had barreled into the crux of the operation, assuming success was a given. He had clung to his certainty, the badge of the old school expert. Shifting uneasily in the lunchroom, he admits a sense of shame while repeatedly defending his commitment to the fluency he believes is his due. You take pride in being quick, she says. Yes, a lot of people do, I think. She looks down, pensive. That's the system we make, she says.
I am here with the wonderful Maggie Jackson. Maggie, thank you so much for being here today.
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Chapters
6 chapters
1
What is the main topic discussed in this episode?
0:00–5:57
2
What is the central premise of Maggie Jackson’s book *Uncertain*?
5:57–14:44
3
How does Maggie define the two main types of uncertainty – aleatory vs. epistemic?
14:44–20:45
4
What did surgeons reveal about uncertainty during high‑stakes operations?
20:45–29:07
5
How does the brain react physiologically to moments of uncertainty?
29:07–36:31
6
Why is pausing or slowing down beneficial for clinicians facing uncertainty?
36:31–38:26