Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.

Emily Silverman

Where would we be right now in the midst of COVID-19 without doctors and nurses, without bench scientists and public health workers? Could we even imagine a way out? Amidst the fear and uncertainty of the pandemic, medicine and science have helped us fight this invisible foe and shielded us from hopelessness and despair. At the same time, artists everywhere have lost their jobs, their audiences and their ways of making. This isn't new, of course, but the pandemic has rendered the plight of the arts more visible than ever before. What is lost in a world where the arts are allowed to flicker and die? Does art save lives too? We hope you'll enjoy this episode, "Night Flight to San Francisco."

Charlie Varon (as Gunther Urbach)

Hello, Nocturnists, my name is Gunther Urbach and I wanted to share a dream I had two, three days ago in which I was in the OR, preparing to do the surgery. It was a very tense situation. I was told the person whose brain I was to operate on was a very important person, a very powerful person. I was not told the name. And all I was told was to do the surgery. And in the dream, I am dripping with sweat, I am feeling palpitations in my heart. And then I look through the glass and I see somebody looking into the operating theater, who is clearly the wife of the man whose brain I am to operate on. And mind you, I have been told, get it out. That was what somebody is telling me is get it out, get out the bad part, which is what we do in surgery. But it was clear to me that they were not telling me to get out the cancer, they were getting out the evil, that it was a moral matter that there was something wrong with the brain beyond any growth. It was an evil, an immoral part of this, this brain that I had to remove. And I had to get it right. And I'm looking through the glass and I realized the wife looking through the glass is recognized to me. She is Melania Trump. And this only doubles my anxiety. And at the same time somebody is trying to operate on me. As I am trembling with my surgical instruments, there is somebody who has dropped my trousers and is trying to remove a rectal polyp. This is a problem by the way that I do have. But they're trying to, to do surgery on me as I'm trying to do surgery on this very powerful man to get out the evil. They're trying to remove my rectal polyp.And I wake up from the dream absolutely drenched. And I wake up my husband who's sleeping next to me. It is not even four in the morning. And I take him into the kitchen to tell him the dream. He pours me a scotch, and then a second scotch. And by this time after two drinks I am calm or more calm, I should say. And we together try to make sense of what all of this means because I am a physician but not a surgeon. I'm a radiologist. And so, the pressure that I felt as, as my husband and I are discussing it is the pressure of somebody unqualified to do the operation. And at the same time, why the polyp operation on me simultaneously? Do I feel, he asks me, that I'm an asshole. And yes, who doesn't? Who doesn't?

Emily Silverman

The first time I heard Gunther's dream, all I could think about was that it perfectly encapsulated 2020: the disorientation, the fear, the growing realization that this new reality was here to stay. We had put out the call for dreams to get beneath the typical linear stories that we'd heard over the past year. We wanted to get into the muddy waters of the healthcare workers' subconscious. Gunther's dream was the first that we received. And to say that we were thrilled would be an understatement. But then we got another message.

Charlie Varon (as Gunther Hess)

My name is Gunther Hess. I am radiologist. And I had a dream that I was a surgeon terrified in the operating theater. And I am also...

Emily Silverman

-wait for it-

Charlie Varon (as Gunther Hess)

...a figment of the imagination of Charlie Varon, theater artist.

Emily Silverman

So yeah, it turned out that Gunther was not a radiologist with a rectal polyp. But Charlie Varon, an actor, director, and friend, who has worked with us on a lot of our live performances in the past.

Charlie Varon (as Gunther Urbach)

"Rectal polyp, rectal polyp."

Emily Silverman

He really loves medical terminology.

Charlie Varon (as Gunther Urbach)

"Rectal polyp!"

Charlie Varon

First came the accent. Then came the character, and then the dream. And once I had thought it, it seemed a waste not to record it.

Emily Silverman

Our hopes of tapping into the subconscious of healthcare workers felt a bit dashed. But it also occurred to us that this out of work actor was finding himself so unbusy in COVID times that he was sending fake dreams to a podcast about healthcare workers. Meanwhile, actual healthcare workers were so overwhelmed and underslept and exhausted that their dreams were not exactly crowding our inbox.

Charlie Varon
There's a story there.

Emily Silverman
I'll let Charlie take it from here.

Charlie Varon

There's always a story.

Emily Silverman

Take it away, Charlie.

Charlie Varon

My name is Charlie Varon. I'm a theatre artist, writer, performer, director, teacher. For close to 30 years, I've worked at a little theatre in San Francisco called The Marsh. And, and I've had the amazing chance to have an audience that has followed my work here in San Francisco over time. I think I was talking to Emily Silverman, the founder and director of The Nocturnists, and she was saying we're going to do this thing on dreams. I said, "that's great." And I can remember that I was on one of my daily walks around Dolores Park in San Francisco, and I just started thinking dreams, dreams, hmm, wonder what kind of dreams they'll get from physicians. Then I thought, what, what if I made one up? I wonder if I could fool them. I wonder if I could make them believe that this was an actual dream. This is the prankster in me. You know, for me, the creative work of making any kind of anything for the stage always begins with a voice. And I love doing voices and characters. And so I started playing. I was on my walk. And I started talking to myself in character. And I started playing around with different voices. And, uh, once the voice emerges:

Charlie Varon (as Gunther Hess)

"My name is Gunter Hess,"

Charlie Varon

It is almost effortless that the content follows.

Charlie Varon (as Gunther Hess)

"The rectal polyp is a problem I do not wish on anyone."

Charlie Varon

I'm fascinated by form, and fascinated by stretching the bounds of form. And I think that's part of what the dream stuff was for me is here's a form. It's you know, you have this box: physician, dream, what? It's sort of that's what, that's, that's the question my intuition was answering. And half a dozen voices immediately presented themselves as possibilities. The delight in invention, and the slight guilt of, is this ethical? I've always loved radio. I'm an audio person, and the intimacy of the human voice and, and the lived experience as expressed through the voice. I think there may have been a little bit of envy as well. Listening to these incredible voices and thinking hmm, what, you know, I have a voice. I'm not, I'm not a doctor. But the thing about being an actor and a theater person is you can be a doctor. It's a strange combination for me, the work of escape into other worlds, other characters, other realities, kind of probing reality through these fictional constructs. The rehearsal room is a very, it's like a little protected sanctuary.

Lauren Klingman

I'm a second year emergency medicine resident in the Bay Area. I was a theater performance person before I switched to medicine, and landed on emergency medicine. So my life in theater, I think it really started when I was young. I was eight years old when I did my first play. And once that happened, I got sort of hooked into the theater world. I was convinced that that was what I was going to do with my life. And I went and I got a BFA in theater performance. And I still loved it at that point, and was, was pretty determined that I was going to either do some combination of acting and directing or I really wanted to be an artistic director and run a theater. That was my ultimate goal. And then I pursued an MFA. Again, in theater performance and dramatic arts, where I did do a lot of directing and acting and production work.There were a lot of factors that kind of went into my decision to leave the theater world and head into the healthcare world. I remember there was a day we were doing like something in stage combat, and we were doing these repetitive roles on a mat. That day, we were doing it again, and again, and again. And once you've done it enough, and once you've done it for weeks, you're kind of black and blue all over from flipping yourself or doing these various moves. As you got better you would, you would take a running start and you'd flip yourself into this roll. And all around me, people are doing the same thing. So you would just hear "thud" and "thud" and "thud" and "thud" again, from all around you and there are body parts flying everywhere. And I landed on my back. And I just remember laying there, these rehearsal rooms had these giant windows that opened up onto trees. Light was just streaming in through these windows, and I was laying on this blue mat that was sticky and smelled like my colleagues. I was bruised all over and I just was lying there. And I just remember looking up at kind of the leaves that were rustling right outside of the tree above as the sunlight was pouring in, thinking, I have now spent over an hour this morning doing this and I'm just not sure why. There are people dying out there. What am I doing with my life?

Sarah Dulaney

I'm a geriatric clinical nurse specialist. I discovered modern dance in middle school, my best friend and I went to a modern dance performance in like a town - I grew up in a kind of a small town. And then I was like, wow, that's the coolest thing ever. So I did modern dance at University of Washington in Seattle. And when I graduated, I moved to Portland. And I danced with Oslund and Company, Mary Oslund. One of my friends who's an artist, she's actually considering going back to school to be a nurse. It's just funny to me, um, a little bit that, that she's considering that now. But I think for me, you know, part of me was questioning myself. Like if I lived in a country with like, universal healthcare. You know, in my world as an artist, being an artist was a sacrifice. People had to work two jobs. You know, you're not contributing to retirement. That was pre- Obamacare, and even with Obamacare, like paying for insurance, as an individual is very expensive. I remember having coffee with the choreographer that I was working with at the time in Portland and, and I would have been lucky to have been as successful as her like she had her own company. And she was saying, like, you know, she was 64 at the time and she didn't have health insurance and didn't have a retirement and I guess it was sort of like it was like, kind of a turning point for me in terms of by that point I was already kind of deciding, like, okay, I'm not making enough money with the things that I'm doing on the side. But I also really loved it. I just wasn't sure that dancing, for me was worth that level of sacrifice.

Lauren Klingman

Why is medicine valued more than the arts? I think value is in some ways tied to money, certainly. I mean, we live in the United States where everything is tied to money. I truly, fundamentally believe that they are both important. I think during COVID, healthcare workers were somewhat more appreciated than sometimes we are. A light was shown on the fact that if you don't have healthcare workers, society literally can't exist, because there's no way to take care of the people who, who need to be taken care of. And I think, unfortunately, art because it, it got closed down to a degree, theaters got closed down, concert venues got closed down, museums got closed down. So all these venues in which we, we see art were not accessible to us. And I think there was somewhat of a mentality that many people had is was that, oh, well then, this is not necessary. And I kind of approached it going through this year being like, but how much worse does your life feel. And it's not only because we can't hug our friends and because we can't go to restaurants. And because we can't play in whatever sports, I don't know, whatever people do as hobbies. But part of it is nobody got art experiences. You know, even, even people I am friends with who, who are more medically driven, more scientifically driven, most of them at least like, you know, music and are like I would just do anything to go to a concert venue and hear live music. And the first time that I heard live music, they had kind of quasi opened an area outdoor, of course, and you could sit at your own table away from everybody else and listen to live music. And it wasn't a very good band, but part of your soul is just like screaming for these like human events to occur for, for art to happen. Certainly I was. And I think this is what art is. This is why art is important. Because you're missing out on things that feed your soul. I certainly wish that art was valued as much as medicine, the epitome of society is not healthcare worker, it's so much more nuanced than that. We need both.

Sarah Dulaney

You know, there's so many ways that our culture severs us from our bodies. You know, like diet culture, and it's not about like, knowing what your body feels like and knowing like being in your body in space with time and energy, like just those, like, really honing in on those elements. And a lot of other things that require practice and discipline are about, you know, ignoring your hunger, ignoring your pain, pushing through things, and not that dance doesn't do that. But I guess I felt like it was like exploring my body as an instrument. You know, everybody has different possibilities and, and limitations. I think I also found a lot of freedom, like, my, my body became like this, like, this way to freedom. Like, freedom from what other people expect of you, freedom from any kind of worldly pressure. Dancing was where I've found that sense of freedom and ease and belonging. It helped me avoid self destruction at a really important transition in my life. You know, my aunt, I think always wanted me to be a nurse. My aunt didn't have children. And she, you know, took a lot of interest in her nieces and nephews, I guess, trying to influence them. So I guess I thought healthcare in general is like, oh, steady job, like doing something helpful. And the people who are there all the time are the nurses. I liked building relationships with the people I cared for. And I, I liked knowing people's stories.

Charlie Varon (as Martin Morgenstern)

Before anything else, I would like to congratulate you on asking for dreams and nightmares of physicians. The unconscious of our profession is rarely delved into and it's very important and neglected area. I should say my name is Martin Morgenstern. I am a psychiatrist here in New York City. I've been a psychiatrist for 45 years. I do psychoanalysis primarily. And the dream, actually dreams, plural, that I would like to tell you about, the first of these dreams, a particular patient of mine, who I've been seeing for some 25 years is in my office. And we are conversing. But at some point, she stops looking at me, and she begins looking at my computer. And this is very strange, because my computer, I look and it's turned off. I don't know what she's looking at and why she is neglecting me. It's a very disquieting dream. And, and I talk to her. I say, "Is there something that's distracting you or some, something from your past a memory or a dream that you like?" And she says, "No, no, no, you're very, very opaque." So the following night, I had a different dream. And in this dream, I was addressing an auditorium of four or five hunded people, which is something I do from time to time. And these people in this auditorium at a particular moment, very early on, in my address, they all pivot. Their seats are apparently swivel chairs, and these four or five hundred people are now turned away from me. And they are ignoring me completely. All right.So I, not knowing exactly what to make of these two dreams, I took them to my own psychoanalysis. And I said, "Yeah, do you have any idea what these dreams? I mean, I've looked into them, I've inquired into them, and I got nothing." And so my psychiatrist said to me, said, "Martin," he said, "You're not gonna believe this. But I have had dreams that are eerily similar. Patients ignoring me, looking at computers. Patients, just not having any, any attention for me at all." I say, "Well, do you have any, any insight or any, any advice, or any, anyway of penetrating the mystery of these, these dreams that you and I seem to be having? Because I'm getting nowhere." And he, he pauses and he leans into me, he says, "Martin, did you, did you actually look at what that computer was doing in your dream?" And I say, "How do you mean?" He says, he puts me in regression and I go back into the dream. And I see that the computer in that first dream is speaking to my patient. And she's hearing it but it's completely inaudible to me. And he says, "Do you understand what I'm getting at?" And I said, "I think I do." And we both had this, this terrifying moment in silence. If you can picture, you know, two esteemed New York psychiatrists in a very well appointed office. Lots of beautiful artwork on the walls and so forth. We're not, you know, we're not newbies, we're not novices. We've been at this a long time. And he and I look at each other and we, we realize our days are numbered, and that the computers and the lack of attention to us is the harbinger of the era of the AI psychiatrist. In my dream, I was able to go back and listen to the advice that the computer, the AI psychiatrist, was giving to my patient. And I have to tell you, it was more perceptive, more insightful, and more brilliant than anything I had to say. We really are finished.

Lauren Klingman

Every day I feel like I am at some point during the day performing. I think it is less than I felt previously. Certainly, as a medical student, you literally put a costume on to go into the wards. You put a white coat on, which is to me the equivalent of a costume. You walk in and you are, you are a persona, you are a character, you are a version of someone that you think deserves to be there. In every field, you know, there's some imposter syndrome. And I think there is a significant amount of imposter syndrome in medicine. There are still times almost daily where I catch myself doing something, or responding to a patient in a specific way, or trying to, you know, run a trauma and I feel like I'm playing a character. It makes me think back to this one time, I think I was a third year medical student. And I was doing a rotation in the emergency department. We had this person come in, and she was coding. And EMS is doing chest compressions on her. And I had never done chest compressions on somebody before, because I was a third year medical student, and they pulled me over, and they said, you're going to do chest compressions for two minutes. I remember doing chest compressions. And chest compressions if you've never done them before, feel very different than they, than they look on TV. You can feel bones cracking, and there's somebody under you. Around me, there's just noise, there is noise everywhere. And there are lights shining on you literally. And there is just colors and smells everywhere. And it felt like a performance. It felt like I had removed myself and was suddenly in this bizarre. I mean, I know that they used to call them operating theaters. But it felt like I was in this bizarre medical theater. And I was acting this part of saving this person's life. While you're grinding through it, you don't feel like what you're doing is heroic. At no point did I feel like what I was doing was heroic. I felt like I was going to work every day like I was told to go to work every day. And I was doing the small thing that I could do to try to, to take care of patients, which is no different than I had done previous except the workload just got heavier, and the patients got sicker.I remember seeing signs, you know bright color letters that said, "Thank you healthcare workers." And I know in other states or other cities, there was kind of a, there was a seven o'clock applause or something that happened. And, you know, throughout it all, I was like it's nice, but I still don't feel like a hero. I think we read books, we see plays, we see movies, and there is always a hero in there. And the more I think about it, and the more I've taken time to sort of step back and kind of delve into that, I think even in literature and in art, heroes are often, don't realize that that's what they are, don't, don't, don't see that don't, don't, don't use that as part of their identity. And I think a lot of us in healthcare, if you took a step back and really thought about what you were doing, you would go running the opposite direction.

Sarah Dulaney

My boyfriend and I went out to eat once recently. It was like eating outdoors, you know. But just hearing little snippets of other people's conversations and interacting with the waiter like, I, we were both like, wow, like we've forgot what it's like to be around people you don't know. Like you, you're in such like an intimate circle, that the only people that you really interact with are people that you either know really well or you have like this professional relationship with them. Just being in this like casual or like random people, you know, it's just funny how that felt so weird and enjoyable, you know. There was an article that Mark Morris wrote once about the magic of live performance, how it's, I think it was around, like how people were just listening to streaming music and thinking that performance was gonna go away. And he was saying that, you know, just that sharing a live performance together is so magical. And for me, I feel like in some ways, it's like, this is really out there but, it's sort of like, dealing with mortality, you know, like you have this like, shared experience that's, you know, can be transformational. It's like, it's just this like, I feel like live performance is so much more intense than seeing a movie or like something else, you know, and you're all like sharing this moment and breathing the same air, and then it ends and you, you leave and like it's gone. And I kinda feel like that's what life is like. Practicing, getting okay with death, you know. You enjoy something and then it's gone. And even if you record it like it's not the same, you know.

Charlie Varon

Live performance, which was, of course, until a couple hundred, a hundred, two hundred years ago, whatever it was, was the only performance. There's no film, there's no TV, there's no radio there's. And so it was there and it was gone, it was evanescent. One of the writers who's had a big impact on me is named Walter Ong. And he wrote a book called Orality and Literacy, and he's contrasting societies that existed before there was written language, or any technology of the word. And for oral cultures, the way Ong puts it, words were forever going out of existence. They only existed in the moment. And that's a description of live performance, which for most people, has been supplanted by things that do seem to exist beyond a single moment. You can stream movies and watch them again and again, so forth. So there's there's that, there's this seeming permanence, but I think it is a reminder of mortality. I think art does save lives. I think art is a portal through which people can walk into new possibilities. There is risk when we come together in real space, in real time. But there's the possibility that some, some collective truth can be spoken.

Lauren Klingman

To me, the goal of theater is taking the works of poets, artists, who can, who can look at society and the world in which we live, and create scenes and characters experiencing the best and the worst of what we as, as humanity experience. And as an actor or as an as a director, your job is to create the world in which what we're all experiencing is true and feels true. And the end goal is to have an audience come and, and see what you're doing. And then at the end of that play, take, have something changed in them. That's where the power of theater lies. And I think all good theater strives to make someone feel something. And in so feeling potentially change their thoughts, their minds, their ways, at least make them think about some kind of aspect of, of our all shared collective humanity.I think Angels in America is an extremely well written play and I think kind of stands the test of time. The play itself is a whole day experience, I think it's almost eight hours in its entirety. There's a monologue by one of the female characters that at the end, she's kind of escaping the life that she had lived and for the first time setting off on her own. And the line from that that's what was jumping into my head. But the line from that is "Night flight to San Francisco, chase the moon, across the sky. God it's been years since I've been on a flight", and it keeps going from that. And I just think that that's such a it's such a beautiful image. You have this just single character sitting on stage, becoming herself for the first time.

Adelaide Papazoglou (as Harper Pitt)

"Night Flight to San Francisco; chase the moon across America. God, it's been years since I've been on a plane. When we hit 35,000 feet, we'll have reached the tropopause, the great belt of calm air, as close as I'll ever get to the ozone. I dreamed we were there. The plane leapt the tropopause, the safe air, and attained the outer rim, the ozone which was ragged and torn, patches of it threadbare as old cheesecloth, and that was frightening. But I saw something that only I could see because of my astonishing ability to see such things: Souls were rising, from the earth far below, souls of the dead, people had perished from famine, from war, from the plague, and they floated up, like skydivers in reverse, limbs all akimbo, wheeling and spinning. And the souls of these departed joined hands, clasped ankles, and formed a web, a great net of souls, and the souls were three-atom oxygen molecules of the stuff of ozone, and the outer rim absorbed them and was repaired. Nothing's lost forever."

Emily Silverman

That's our show. Our deepest thanks to playwright Tony Kushner for granting us permission to use his monologue "Night Flight to San Francisco" from Angels in America: A Gay Fantasia on National Themes. The Nocturnists is produced by Director of Story Development Adelaide Papazoglou, Associate Producers Molly Rose-Williams and Isabel Ostrer and me. Our Student Production Assistants are Hannah Yemane, Ricky Paez and Siyou Song. Original theme was composed by Yosef Munro. Our Audio Engineer is Jon Oliver. And our illustrations are by Nazila Jamalifard. Thanks to The Nocturnists' own Adelaide Papazoglou for voicing the role of Harper Pitt. Our Executive Producer is Ali Block, our Chief Operating Officer is Rebecca Groves, our Admin Assistant is Suparno Jasuja, and our Social Media Intern is Yuki Schwab. The Nocturnists is made possible by the California Medical Association, a physician led organization that works tirelessly to make sure that the doctor patient relationship remains at the center of medicine. To learn more about the CMA, visit cmadocs.org. Support for The Nocturnists also comes from the Patrick J. McGovern Foundation, the California Health Care Foundation and people like you, who have contributed through our website and Patreon page. Thank you for supporting our work in storytelling. I'm your host, Emily Silverman. Join us next week for an all new episode exploring how COVID changed the way we relate to our patients. See you then.