Failure to Treat with Peter Kowey, MD

Drawing on a lifetime in medicine and the stories behind his new book Failure to Treat, cardiologist Dr. Peter Kowey explores how profit, bureaucracy, and the corporatization of healthcare have transformed the practice of medicine. We discuss what has been lost, what can still be reclaimed, and why he remains hopeful that technology may ultimately give physicians back their most precious resource: time with patients. Looking for more from The Nocturnists? Explore The Nocturnists+, our subscriber-only feed featuring The Nocturnists After Hours—a monthly series where host Emily Silverman is joined by executive producer Dr. Ali Block for more informal, open conversations about medicine, culture, and their own lived experiences. Subscriptions start at just $10/mo and include exclusive discounts on our new merch. Learn more or subscribe at thenocturnists.org/plus.

Dr. Giulia Enders—physician, gastroenterologist, and bestselling author of Gut—joins us to discuss her new book, Organ Speak. She invites us to see the body not as a machine in need of repair, but as a living source of intelligence, metaphor, and meaning. Reflecting on her early fascination with the gut and her years treating patients with complex gastrointestinal conditions, Giulia explores how language shapes our experience of illness. The conversation ranges across the skin, grief, immunity, and sleep, revealing how a sense of wonder can emerge when we stop viewing the body solely as a problem to be solved. Looking for more from The Nocturnists? Explore The Nocturnists+, our subscriber-only feed featuring The Nocturnists After Hours—a monthly series where host Emily Silverman is joined by executive producer Dr. Ali Block for more informal, open conversations about medicine, culture, and their own lived experiences. Subscriptions start at just $10/mo and include exclusive discounts on our new merch. Learn more or subscribe at thenocturnists.org/plus.

Cardiologist Dr. Lisa Rosenbaum tells the story of how her grandfather—a physician-writer whose experience as a patient transformed his view of medicine—influenced her sense of purpose, storytelling, and care. As she navigated her own path through medicine and writing, she became increasingly interested in the cultural narratives shaping physicians' experiences, particularly during the COVID-19 era. Drawing on a viral "Milk Duds" story and broader shifts in burnout discourse, she explores the tension between systemic failures and individual agency, arguing that meaning in medicine can sometimes come not from stepping back, but from choosing deeper engagement with patients.  Looking for more from The Nocturnists? Explore The Nocturnists+, our subscriber-only feed featuring The Nocturnists After Hours—a monthly series where host Emily Silverman is joined by executive producer Dr. Ali Block for more informal, open conversations about medicine, culture, and their own lived experiences. Subscriptions start at just $10/mo and include exclusive discounts on our new merch. Learn more or subscribe at thenocturnists.org/plus.

In this crossover episode with Remo Health, Kaylee Glenn of the Day By Day Project shares how a childhood moment playing violin in a memory care facility inspired her to create a music-focused nonprofit for people living with dementia. This episode was originally produced by Remo Health as a part of their "Talking Dementia" podcast. Remo Health is an innovative telehealth company providing whole-person care to people living with dementia and their caregivers. To learn more about Remo, visit remo.health. This episode of The Nocturnists is sponsored by Claimable. Every year, insurers deny over 850 million claims in the United States. Fewer than one percent are ever appealed. Claimable exists to change that, with an online platform that helps patients overturn unjust denials and restore access to the care they need. With Claimable's easy to use appeal builder, patients create and submit personalized, expert-backed appeals combining clinical, policy, and legal evidence into powerful coverage arguments. If you or someone you know has ever lost access to a medication because of an insurance denial, Claimable was built for that moment. To learn more, and explore how Claimable works with partners in healthcare to expand access, visit www.getclaimable.com Looking for more from The Nocturnists? Explore The Nocturnists+, our subscriber-only feed featuring The Nocturnists After Hours—a monthly series where host Emily Silverman is joined by executive producer Dr. Ali Block for more informal, open conversations about medicine, culture, and their own lived experiences. Subscriptions start at just $10/mo and include exclusive discounts on our new merch. Learn more or subscribe at thenocturnists.org/plus.

Historian Susan Wise Bauer tells the story of how, across centuries—from ancient civilizations to modern medicine—humans have tried to make sense of illness through evolving frameworks, from divine punishment to bodily imbalance to germs. Drawing on historical accounts and cultural analysis, she explores how fear, suffering, and uncertainty shape not only medical knowledge but also trust in authority and social behaviors—and ultimately shows that our present-day struggles with medicine and trust are not new, but part of a long, repeating human story. This episode of The Nocturnists is sponsored by Claimable. Every year, insurers deny over 850 million claims in the United States. Fewer than one percent are ever appealed. Claimable exists to change that, with an online platform that helps patients overturn unjust denials and restore access to the care they need. With Claimable's easy to use appeal builder, patients create and submit personalized, expert-backed appeals combining clinical, policy, and legal evidence into powerful coverage arguments. If you or someone you know has ever lost access to a medication because of an insurance denial, Claimable was built for that moment. To learn more, and explore how Claimable works with partners in healthcare to expand access, visit www.getclaimable.com Looking for more from The Nocturnists? Explore The Nocturnists+, our subscriber-only feed featuring The Nocturnists After Hours—a monthly series where host Emily Silverman is joined by executive producer Dr. Ali Block for more informal, open conversations about medicine, culture, and their own lived experiences. Subscriptions start at just $10/mo and include exclusive discounts on our new merch. Learn more or subscribe at thenocturnists.org/plus.

Dr. Erika MacIntyre reflects on her path into critical care and chronic ventilation medicine, as well as the mounting pressures she faced during COVID-19—including professional strain, loss of personal outlets, and family challenges. Seeking change, she and her family embarked on an ambitious sailing journey across the Atlantic, navigating both physical and emotional challenges while living simply and disconnected from modern conveniences. Looking for more from The Nocturnists? Explore The Nocturnists+, our subscriber-only feed featuring The Nocturnists After Hours—a monthly series where host Emily Silverman is joined by executive producer Dr. Ali Block for more informal, open conversations about medicine, culture, and their own lived experiences. Subscriptions start at just $10/mo and include exclusive discounts on our new merch. Learn more or subscribe at thenocturnists.org/plus.

Pediatric intensivist Dr. Chris Carroll tells the story of an unexpected consult: a young gorilla named Kevin, critically ill with Shigella sepsis during an outbreak at the Jacksonville Zoo. What begins as a strange crossover between human and veterinary medicine becomes something deeper as Chris works alongside veterinarians trying to save Kevin's life. In the process, he is struck not only by the similarities between caring for sick children and sick animals, but by the reverence and tenderness the veterinary team brings to their work. We talk about pediatric ICU medicine, the human-animal boundary, grief across species, and what doctors might learn from veterinarians about compassion. Chris originally performed this story at a live storytelling event produced CHEST as a part of our Satellites Storytelling program. Looking for more from The Nocturnists? Explore The Nocturnists+, our subscriber-only feed featuring The Nocturnists After Hours—a monthly series where host Emily Silverman is joined by executive producer Dr. Ali Block for more informal, open conversations about medicine, culture, and their own lived experiences. Subscriptions start at just $10/mo and include exclusive discounts on our new merch. Learn more or subscribe at thenocturnists.org/plus.

Solange Madriz, a public health professional at UCSF, reflects on her work training birth attendants and clinicians in rural Guatemala to respond to maternal emergencies through low-cost simulation. For years, she helped others prepare for postpartum hemorrhage, preeclampsia, and other life-threatening complications of childbirth. Then, after the birth of her own first child during the pandemic, she developed severe postpartum preeclampsia and found herself on the other side of the hospital bed. In our conversation, Solange talks about public health, maternal health, the limits of knowledge when your own body is in crisis, and how her own medical experience changed the way she thinks about her work. Solange originally performed this story at a live storytelling event produced UCSF Institute of Global Health Sciences as a part of our Satellites Storytelling program. Looking for more from The Nocturnists? Explore The Nocturnists+, our subscriber-only feed featuring The Nocturnists After Hours—a monthly series where host Emily Silverman is joined by executive producer Dr. Ali Block for more informal, open conversations about medicine, culture, and their own lived experiences. Subscriptions start at just $10/mo and include exclusive discounts on our new merch. Learn more or subscribe at thenocturnists.org/plus.

In this episode, infectious disease physician and global health leader Dr. mike Reid reflects on a moment early in his career working in Botswana, when a young patient died in front of him despite his efforts to help. The experience brought back a memory from childhood, when he first heard his father quietly describe himself as a failure. In a field where the needs often far exceed the available resources, mike explores how physicians learn to live with doubt, responsibility, and the persistent feeling of not doing enough. Together we talk about the emotional landscape of global health, the role of failure in medicine, and what it means to keep trying anyway. mike originally performed this story at a live storytelling event produced UCSF Institute of Global Health Sciences as a part of our Satellites Storytelling program. Looking for more from The Nocturnists? Explore The Nocturnists+, our subscriber-only feed featuring The Nocturnists After Hours—a monthly series where host Emily Silverman is joined by executive producer Dr. Ali Block for more informal, open conversations about medicine, culture, and their own lived experiences. Subscriptions start at just $10/mo and include exclusive discounts on our new merch. Learn more or subscribe at thenocturnists.org/plus.

While navigating a painful period in her personal life, ICU physician Nikki Mittal cares for a patient with severe brain injury whose family is preparing to withdraw life support. After a difficult earlier interaction that leaves her questioning herself, the family gathers on the day of withdrawal and unexpectedly asks to pray for her. In that moment, the usual direction of care shifts—the doctor who came to support the family finds herself receiving comfort and reassurance from them instead. Nikki originally performed this story at a live Satellites Storytelling event produced by Dr. Shayne Poulin and the Riverside-San Bernardino Chapter of CAFP in 2025. This event was generously funded by the California Health Care Foundation, as a part of our Satellites Program.   Looking for more from The Nocturnists? Explore The Nocturnists+, our subscriber-only feed featuring The Nocturnists After Hours—a monthly series where host Emily Silverman is joined by executive producer Dr. Ali Block for more informal, open conversations about medicine, culture, and their own lived experiences. Subscriptions start at just $10/mo and include exclusive discounts on our new merch. Learn more or subscribe at thenocturnists.org/plus.