Photos by Jennifer Olenik

The Nocturnists

Physicians come together to share poignant stories on death and dying as part of Re:Imagine End of Life

At night, the hospital holds its breath.

It could be the anecdotal idea patients are more likely to slip away in the midnight hours — increasingly validated by the data, at least where cardiac arrest is concerned. Or maybe the stubborn circadian rhythms of the night staff, knowing the truth of what fluorescence tries to hide, insist on evening stillness.

Whatever it is, the veil is thin at hospitals in the nighttime — and the hush is alive with stories. Physician storytelling collective The Nocturnists brought some of those tales of death and dying to vivid life onstage at Here Collective. This was one of many events hosted during San Francisco’s Re:Imagine | End of Life, a weeklong citywide festival about living and dying through art, experience, and design.

One recurring theme that evolved from OpenIDEO’s End of Life Challenge was the potential for entire communities to transform their thinking around the end of life. Cities like La Crosse, Wisconsin have done an incredible job of normalizing conversations about death and dying, and the momentum from the Challenge was the perfect spark for San Francisco to do the same. This being the Bay Area, Re:Imagine was centered around art, music, technology — and storytelling, which inspired the Nocturnists to bring stories about death and dying out of the hospital and into the light.

Created by University of California San Francisco resident Emily Silverman and produced by family medicine doctor Ali Block, the event felt both formal and intimate. Patrons milled around in beautifully shined shoes.

Combined with the dreamlike atmosphere of the rope lights and exposed beams of the Here Collective, it felt like we’d all been invited to the sweet barn wedding of old friends. That quality was amplified by mellow hill country from the band Calico, fronted by Charlotte Carlson on the fiddle, a physician at UCSF.

To kick off the event, Re:Imagine organizer Brad Wolfe called for a moment of silence. Into the stillness that fell over the audience, he invited those who had lost someone in the past year to speak their names. And with that simple invitation, the dead rose up among us.

Names fell into the silence. The murmur moved around the crowd, raising goosebumps as it passed. “Madeline.” “Peter.” “Darcy.” “Estelle.” “Zelda” — exhaled with a sigh.

As the lights fell and Calico began to play us into the first story, we held our breath.

The event featured nine storytellers, whose tales were a blend of the raucous, the haunting, and the deeply personal. Brad Hunter, an internal medicine resident, began by expressing an abiding frustration with weather forecasters. Particularly in the microclimates of the Bay Area, it’s totally possible to leave your house with the promise of 70 degrees and sun …until you’re drenched in a surprise downpour.

That anger changed, however, when he began a rotation in the ICU. Working with a patient who had been on life support for months, and whose family pushed back on every attempt to encourage them to let him go, Brad realized how much his profession had in common with meteorology.

There is no foolproof way to know when someone will die. Like a hurricane, doctors can predict the likeliest path that life and death will take. But so much exists in the shaded lines of the cone of uncertainty.

The audience chuckled ruefully, in recognition of a protocol or particularly stuffy bureaucratic hoop to jump through. There was catharsis in these physicians finally sharing their stories, which is one of Silverman and Block’s goals for the project. Doctors’ rates of burnout and depression are extremely high; storytelling builds resilience, and reclaims the humanity in medicine.

Dr. Dawn Gross, hospice and palliative care physician and co-creator of the End of Life Challenge Top Idea Death-Ed, is surrounded by death for a living. The end-of-life experience is not alien to her. But it hit too close to home when a patient came in after a life-threatening accident. A woman her age, who had seen her kids off to their first day of school just five days earlier—just as Dawn had. Their kids were the same age. Every time Dawn entered the room, she was overcome by one thought: She could be me.

It was painful to look into the woman’s husband’s eyes. He asked her how to tell the kids that their mom wasn’t coming back. “Trust them,” Dawn said. “Listen to what they’re asking you. Let them lead you.”

And then she found herself out of the room and down the hallway without knowing how she’d gotten there, hands and face pressed against the wall as if to push away her fear. She asked herself what she would need her husband to say if she were in that bed, what her family would need to hear to let her go.

“I will always love you,” she said directly to the audience, voice trembling. “And I will never be satiated. And I will always be grateful.”

Dhruv Kazi, a cardiologist, shared the story of a high-ranking North Korean party official who had a massive stroke on the train from Pyongyang to Beijing.

The neurologist traveling with him, slender and small in contrast to the official’s vast bulk, begged Dhruv and his companions to save the official, repeating, “This man is too important to die!” At first, the travelers scoffed: everybody dies.

But in time, he began to understand what that meant in a country where only the upper echelons of society have access to enough food to become fat. The death of a senior party member could also mean death for his doctor — “too important to die” meant “too important to die on my watch.”

Although there had been no pulse for the better part of an hour, Dhruv and his companions arranged for an ambulance to come directly to the next train station, where the medics met them on the platform. They continued CPR until the train stopped. The party official was loaded onto a stretcher and taken away. Only when the train began to move again did they notice the neurologist was missing.

There is a pedestrian bridge that used to run between North and South Korea. The northern side was bombed many years ago, turning the site into an observatory for South Koreans to look back at a place that has become unknowable. As the train rolled on toward Beijing, Dhruv reflected on ‘all the borders death and dying can cross, and some that they do not.’

Much of what happens in hospitals never leaves their walls. HIPAA compliance aside: for physicians to shrug off their white coats and return to the land of the living, some of what they’ve seen must stay behind.

This night of messages in a bottle, shared with colleagues and the rest of the audience, felt like a gift. The stories humanized patients and doctors in the midst of hilarious and heartwrenching experiences. They were also a deeply vulnerable way for the storytellers to claim their own humanity.

As the music faded and the Nocturnists came to a close, I was unsurprised to find that it had stolen my breath.

Read more stories about the people, ideas, and moments of OpenIDEO’s End of Life Challenge.