The Empty Corner

What a leadership exercise revealed about uncertainty, expertise, and the capacity we were never taught to build.

There were about fifty of us in the room.

Clinicians, administrators, healthcare leaders with decades of experience between them. People who had spent their careers making decisions under pressure, communicating difficult information, guiding organizations and patients through conditions of radical uncertainty. We had gathered for a leadership development day, and we had just completed an exercise: a series of questions about our habits of mind, our instinctive responses to challenge, our personal strengths.

The strengths were things you'd expect in a room like that. Optimism. Resilience. Creativity. Adventurousness. And one more: Tolerance for Ambiguity.

When the scoring was complete, we were each asked to move to the area of the room that corresponded with our primary strength.

Not one person stood in the corner designated for tolerance for ambiguity.

Not one.

I remember the pull of it — a quiet, energetic whisper that I have learned to trust enough to investigate. And when I took a moment to look around the room, I wondered whether I was the only one standing somewhere safe while some part of me had already decided that it was time to move towards uncertainty.

I have thought about that room many times since. Fifty people who had chosen careers in healing — in the careful, skilled, daily work of accompanying other human beings through their most uncertain and frightening moments — and not one of us had identified our own tolerance for not-knowing as a strength. Not one of us had named ambiguity as something we do well, something we lean into, something we might even lead from.

That empty corner is what I want to talk about.

The medical system — and by extension the broader institutional cultures that medicine has shaped — is built on an architecture of certainty. Diagnosis. Protocol. Evidence-based intervention. The language of clinical life is the language of knowing: assessment, findings, conclusions, recommendations. The clinician who projects confidence is trusted. The one who expresses uncertainty makes patients anxious. And so, early and thoroughly, clinicians learn to perform certainty — even when the clinical reality can be far more probabilistic than the performance suggests.

Diagnosis is rarely as clean as a name implies. Treatment response can be individual and unpredictable. The body, and the mind, resist the precision that the system promises. And yet the performance continues, because the patient in the room needs to believe that someone knows. And so someone performs knowing.

This is not unique to medicine. It is the logic of most institutions that carry high stakes and hierarchical trust. The attorney, the executive, the senior partner — each operates within a culture that has quietly agreed: certainty is what authority looks like. To say I don't know is to risk the room. And so not-knowing becomes something to be managed, minimized, concealed.

But there is a cost to this. And it runs deeper than we usually acknowledge.

The data from that leadership day suggested something uncomfortable: that the path toward a career in medicine may carry a selection bias against people who are comfortable with uncertainty. That the very qualities that draw someone toward clinical work — the drive to understand, to diagnose, to help, to fix — may be, simultaneously, a drive away from ambiguity. We are drawn to medicine, at least in part, because we want to know.

Because not-knowing is uncomfortable, and we have found a vocation that promises, if we study hard enough and think clearly enough, to give us answers.

And then we stand in that room together, and see it reflected back at us all at once.

The research contributes to some concern about the findings in that room. Low tolerance for ambiguity is associated with higher rates of physician burnout, increased anxiety, higher rates of diagnostic testing, and reduced satisfaction. [1] It predicts discomfort with dying patients, greater rigidity in clinical reasoning, and reduced empathy. [2] These are not trivial stakes.

But here is where I want to complicate the story — because the reflex to simply increase uncertainty tolerance, as though more is always better, misses something important. Philosophers and medical ethicists have arrived at a more nuanced position: neither high nor low tolerance for uncertainty is inherently good or bad. A clinician who is too comfortable with not-knowing may delay necessary action, miss the moment when ambiguity has resolved into something that requires a clear and urgent response. The capacity to sit with uncertainty is not the same as the capacity to recognize when it's time to move.

What we are really talking about is not a dial to turn in one direction. It is a form of discernment — the ability to read a situation accurately, to distinguish between uncertainty that calls for patience and uncertainty that calls for decision. The virtues that support this kind of clinical judgment are not tolerance per se, but courage, diligence, and curiosity: the willingness to stay present with complexity, keep investigating, and act decisively when the moment demands it. [3]

The goal is to become calibrated — accurate in your assessment of what you know, what you don't, and what the situation actually requires.

Medicine itself offers a natural experiment here, because not all specialties are built the same way. The classic research on this divided clinical practice along a fault line: surgery and its subspecialties scored lowest on tolerance for ambiguity, while psychiatry, radiology, and anesthesiology scored highest. [4] Family medicine has long been associated with greater comfort in unstructured, undifferentiated presentations — patients who walk in without a clear diagnosis already attached, problems that resolve slowly or not at all, plans that have to flex as new information arrives. The reasoning was straightforward: a field structured around ambiguity will, over time, either select for people who tolerate it or train that tolerance into the people who stay.

It is a tidy story, and like most tidy stories, the evidence is now more complicated than it first appeared. A 2025 reexamination, using the same instruments as the original studies, found that specialty choice explained less than two percent of the variance in uncertainty tolerance — and concluded that the link between the two may be more myth than established fact. [5] Other findings cut in both directions: residency training itself seems to build tolerance over time regardless of specialty, with family practice residents becoming measurably more comfortable with ambiguity between their first and third years. [6]

What this tells us is more useful than a clean correlation would have been. Tolerance for ambiguity is not simply a trait that sorts people into the right specialty before they ever begin. It is something that training — the right kind of training, sustained over years — appears able to build, in people who did not start out with it. The surgeon and the psychiatrist may begin in different places, but both are shaped by what their work asks of them, repeatedly, over time.

Research shows that clinicians with higher tolerance for ambiguity experience significantly lower rates of burnout. The capacity to remain present in uncertainty is not only intellectually generous. It is protective. And leaders who cannot tolerate ambiguity tend to make two characteristic errors: they decide too quickly, collapsing complexity into premature certainty — or they freeze, unable to act without the certainty they were trained to expect. Neither serves the people they lead.

What the research also makes clear is that this capacity is not fixed. It can be taught. Studies across medical schools have found that humanities-based curricula — narrative medicine, art-based observation, literature, ethics — significantly build tolerance for ambiguity. [7] Simulation programs that deliberately introduce irresolution have produced deeper clinical reflection. These are increasingly recognized as core competencies in medical education: the kind of training that produces not just technically capable clinicians, but clinicians who can remain present in the places where technical capability runs out.

The key is not teaching tolerance of uncertainty as passive endurance. It is teaching it as active engagement — the skilled, courageous practice of staying in contact with complexity long enough for something true to become visible. Not-knowing, held with integrity and skill, is itself a form of leadership. The leader who can say I am working with incomplete information — I will stay, pay attention, and revise my understanding as new things become visible is not demonstrating weakness. They are demonstrating something rarer, and more trustworthy, than performed confidence.

But most of us in that room did not receive formal training in any of this. The humanities curricula, the reflective simulations — they weren't there when we trained. We were handed the architecture of certainty and told to inhabit it. And now, decades in, we are being asked to renovate from the inside.

So what, practically, can a seasoned clinician actually do?

Mindfulness-based practice. Mindfulness-based interventions for healthcare professionals have shown consistent effects: reduced emotional reactivity, greater capacity to remain present under pressure, and increased tolerance for uncertainty in both personal and professional contexts. This is not about meditation as a wellness add-on — it is neurological change over time. [8] Uncertainty, after all, is not only a cognitive state. The body holds it first — in held breath, in tightened shoulders — long before the mind finds language for what it's already sensing. A growing number of mindfulness programs are now designed specifically for clinicians, many offering CME credit, and are worth seeking out as continuing education that addresses not just knowledge, but the practitioner behind the knowledge.

A coaching approach — for yourself and your team. Coaching may be one of the most underutilized tools for building uncertainty tolerance in clinical and leadership contexts — precisely because it is designed, at its core, to work in unresolved space.

The International Coaching Federation's core competency model describes the coaching relationship in terms that map directly onto what the research says builds uncertainty tolerance. A coach is required to embody a coaching mindset — remaining open, curious, flexible, and client-centered, with an ongoing reflective practice and the ability to regulate one's own emotional responses. A coach maintains presence in a way that explicitly includes being comfortable working in a space of not-knowing, and creating space for silence, pause, and reflection rather than rushing toward resolution. Curiosity is not a personality trait you either have or don't — it is a practice, and the coaching relationship makes it a discipline. These are not incidental features of good coaching. They are the thing itself.

For leaders, individual coaching builds this capacity in two directions simultaneously. The coaching relationship becomes a practice environment — a place where uncertainty can be named, examined, and held without the pressure to perform certainty, and where saying I don't know becomes available in high-stakes moments because it has been practiced in lower-stakes ones. The skills the coach models become available to the leader: powerful questioning that opens rather than closes thinking; active listening that attends to what is not being said as much as what is.

For teams, a leader who brings a coaching approach to their work creates psychological safety around not-knowing. When a leader asks what are we not seeing here? rather than projecting certainty they don't feel, they signal that uncertainty is a shared condition to be navigated together — not a failure to be concealed. This is, in the language of the ICF competency model, cultivating trust and safety. The research on uncertainty tolerance consistently points to normalization as one of the most powerful interventions available: when not-knowing is treated as a legitimate part of clinical and organizational life rather than a deviation from competence, its grip loosens. A coaching approach — whether received individually or practiced within a team culture — creates exactly this environment. It does not eliminate uncertainty. It changes our relationship with it.

Deliberate engagement with the arts and humanities. The evidence is specific: engagement with narrative, visual art, literature, and music builds the cognitive flexibility that underlies uncertainty tolerance. It is not the content that matters so much as the practice of staying with something open-ended — resisting the pull toward resolution, holding multiple interpretations without collapsing them into one. Narrative medicine has been shown to build exactly this capacity in clinicians at any career stage. Reading fiction. Looking carefully at a painting. These are not recreation. They are training.

None of these eliminate the discomfort of not-knowing. That is not the goal. The goal is calibration — an accurate, honest relationship with the limits of your own knowledge, and the confidence to act wisely within those limits rather than performing certainty you don't feel.

I want to return to that room one final time.

What struck me most was not the absence — not one person — but what the absence revealed. Not a failure of character. A failure of formation. We had been trained, selected, and socialized into a professional culture that made uncertainty something to overcome rather than something to develop a relationship with. The corner was empty not because we lacked the capacity, but because no one had ever told us that capacity was worth building.

That is changing. Slowly, unevenly, and not fast enough — but it is changing. The question for those of us already deep in our careers is whether we wait for the system to catch up, or whether we begin, now, the work of growing something that was never formally cultivated in us.

Tolerance for ambiguity is not a fixed trait. It is a capacity. And like all capacities, it responds to attention.

The clinician who can do this is a better clinician. The leader who can do this is not a more uncertain leader. They are a more present one.

What if it's not certainty that heals — but presence?

References

1. Hillen, M. A., Gutheil, C. M., Strout, T. D., Smets, E. M. A., & Han, P. K. J. (2017). Tolerance of uncertainty: Conceptual analysis, integrative model, and implications for healthcare. Social Science & Medicine, 180, 62–75. https://doi.org/10.1016/j.socscimed.2017.03.024

2. Kvale, J., Berg, L., Groff, J. Y., & Lange, G. (1999). Factors associated with residents' attitudes toward dying patients. Family Medicine, 31(10), 691–696.

3. Reis-Dennis, S., Gerrity, M. S., & Geller, G. (2021). Tolerance for uncertainty and professional development: A normative analysis. Journal of General Internal Medicine, 36(8), 2408–2413. https://doi.org/10.1007/s11606-020-06538-y

4. Geller, G., Faden, R. R., & Levine, D. M. (1990). Tolerance for ambiguity among medical students: Implications for their selection, training and practice. Social Science & Medicine, 31(5), 619–624. https://doi.org/10.1016/0277-9536(90)90098-D

5. Wegwarth, O., Pfoch, M., Spies, C., Möckel, M., Schaller, S. J., Wehler, M., & Giese, H. (2025). Tolerance for uncertainty and medical students' specialty choices: A myth revisited. Medical Education, 59(8), 833–841. https://doi.org/10.1111/medu.15610

6. DeForge, B. R., & Sobal, J. (1991). Intolerance of ambiguity among family practice residents. Family Medicine, 23(6), 466–468.

7. Mangione, S., Chakraborti, C., Staltari, G., Harrison, R., Tunkel, A. R., Liou, K. T., Cerceo, E., Voeller, M., Bedwell, W. L., Fletcher, K., & Kahn, M. J. (2018). Medical students' exposure to the humanities correlates with positive personal qualities and reduced burnout: A multi-institutional U.S. survey. Journal of General Internal Medicine, 33(5), 628–634. https://doi.org/10.1007/s11606-017-4275-8

8. Epstein, R. M. (2017). Attending: Medicine, mindfulness, and humanity. Scribner.

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Interterrestrial: On Athletics, the Body, and the Return to Earth

What if your greatest performance isn’t a rising — but a returning?

The story we tell about athletic greatness is almost always a story of ascent. We speak of transcendence, of breaking limits, of surpassing what the human body was thought capable of. We build stadiums like temples, plant synthetic turf, engineer tracks that return energy to the foot, develop altitude tents and lactate monitors and GPS-enabled everything. The arc of modern sport bends steadily upward — faster, higher, stronger, as the Olympic motto has it — and we understand this as progress. The great athlete, in this telling, is someone who has exceeded the merely human. A cyborg. An optimized system. A being who has bent nature to their will.

This is a coherent story. It is also, I want to suggest, the wrong one. Or at least, it is half the story — the visible half, the half that makes sense from the outside looking in. The other half, the half that athletes themselves most often reach for when they try to describe what their greatest moments actually felt like, points in precisely the opposite direction. Not up, but down. Not beyond the body, but deeper into it. Not past nature, but into communion with it.

What if the greatest athletic performances are not acts of transcendence at all, but acts of return? What if we have been measuring the wrong axis entirely?

The Superhuman Fantasy

To understand what is wrong with the ascent story, it helps first to take it seriously. The desire to become superhuman through athletic effort is not trivial or vain. It carries within it something genuinely profound: the refusal to accept limitation, the insistence that the body is not a ceiling but a threshold. Every runner who has ever tried to chase down a personal record, every swimmer who has squeezed another tenth of a second from a turn, has felt the electric pull of that refusal. There is real dignity in it.

And the results speak. Human beings run faster today than they did a century ago. We swim farther and climb higher and endure longer. Some of this is nutrition, some is coaching science, some is the expansion of who gets to compete at all. The superhuman project has delivered. We are, by the numbers, better athletes than our ancestors.

But something curious happens when you ask the athletes who achieve these superhuman results to describe them. The language shifts. The metrics dissolve. Roger Bannister, after breaking the four-minute mile, described feeling “a moment of mixed joy and anguish” before seeming to lose consciousness of the external world entirely. Eliud Kipchoge, the greatest marathon runner in history, speaks not of optimization but of simplicity — of becoming, in his word, “like a child.” Free. Unthinking. Returned to something before strategy and effort and self-consciousness existed. The ultra-endurance athletes who push deepest into human limits consistently report that the late miles are not experienced as a triumph of the superhuman will over the merely human body, but as the dissolution of that distinction entirely. The self that was trying to achieve something falls away. What remains is older, quieter, and far less interested in the clock.

This is strange, if the ascent story is correct. Why would the pinnacle of human athletic achievement feel, from the inside, like losing the human self? Why would the body at its greatest feel, to the person inside it, like an erasure rather than an expansion?

The Animal Underneath

There is another way to read the evidence. What if the body, under sufficient duress and sufficient devotion, is not transcending its nature but excavating it? What if what gets stripped away in those moments of peak performance is not limitation, but the accumulated noise of civilization — the social self, the anxious ego, the calculating mind — and what is revealed beneath is something older and truer: the animal, the ancestor, the body that evolved not for stadiums but for landscapes?

Athletic culture already knows this, even if it rarely says it directly. We name our teams after apex predators and birds of prey. We study the biomechanics of cheetahs and the endurance of wolves. We speak admiringly of athletes who play on instinct, who move before they think, whose bodies seem to know things their conscious minds do not. We idealize, in other words, not the rational human but the pre-rational animal. The greatest compliment we can pay a dancer, a wide receiver, a sprinter, is that they are impossible to predict — that their movement is not calculated but felt, not planned but lived.

The barefoot running movement made this argument in its most literal form. Strip away the cushioned shoe, the motion-control technology, the engineered insole, and what you recover is not a deficit but a capacity — the foot’s ancient intelligence, its ability to read the ground through thousands of nerve endings, to adjust and respond in real time to the surface beneath it. The technology was not making the runner better. It was insulating the runner from the earth. And in that insulation, something was being lost.

What was being lost, I want to suggest, is contact. The live exchange between a body and the ground it moves across. The conversation, conducted in vibration and pressure and heat, between an animal and the planet that made it.

Interterrestrial

We have a word for looking outward and upward: extraterrestrial. Beyond the earth. It is the word of rockets and satellites and the dream of leaving this planet behind. Much of modern sport, with its synthetic surfaces and climate-controlled arenas and algorithmic optimization, is extraterrestrial in its deepest impulse — an attempt to lift the athlete off the earth, to eliminate the wild variable of nature, to control all conditions and therefore all outcomes.

I want to propose a different word, and a different direction: interterrestrial. Between the earth and the body. A relationship, a dialogue, a live and mutual exchange. Not the athlete performing upon the earth, but the athlete in conversation with it. Not the earth as surface but the earth as participant.

The prefix matters. Intra would suggest going within — solitary, self-contained, a depth that belongs only to the individual. But inter — like interpersonal, like interspecies — implies two parties. It implies that the earth has something to offer and something to demand. That the ground pushes back. That the altitude asks something of you. That the trail is not passive. This is not mysticism. It is phenomenology. It is what athletes actually report when they are honest about what the best moments feel like.

The interterrestrial athlete is not trying to overcome the earth. They are trying to enter into more intimate relationship with it. Every step on a trail is a negotiation. Every stroke through open water is a response. The mountain does not yield because you are strong enough; it yields because you have learned, at some deep level below language, how to listen to it.

Interment: The Body’s Return

There is a word that rhymes with this idea in an almost uncomfortable way: interment. The burial of the dead. The returning of what was borrowed from the earth back to the earth. We tend to keep this word at a safe distance from athletic achievement, because athletics is supposed to be about life, about vitality, about the body at its most exuberantly alive. Death belongs elsewhere.

But I think the connection is worth sitting with. Because what the greatest athletes describe in their peak moments is something very close to a rehearsal of that return. The ego that dissolves, the self that falls away, the thinking mind that goes quiet — these are, in miniature, a practice of dying to the constructed self. The human being who is a social role, a set of opinions, a history, a future — that person temporarily ceases. What remains is the body, and the body’s ancient knowledge of where it belongs.

Sweat returning to soil. Breath becoming atmosphere. The body’s heat dissipating into the air around it. Even the physiology of exertion is a kind of return — a reminder that the boundary between self and world is thinner than we usually allow ourselves to believe. The athlete in extremis feels this. They are not a self moving through an environment. They are temporarily the environment, the ground, the air, the light — all of it continuous, all of it alive, all of it participating.

Every major spiritual tradition has a version of this. The vision quest. The pilgrimage. The sweat lodge. Ritual exhaustion as a technology for shedding the social self and recovering contact with something older. Athletics, at its most serious, has always brushed against these practices. The marathon is a pilgrimage. The long training run is a meditation. The race is a ceremony. We pretend otherwise — we measure it, we commodify it, we put advertisements on the jerseys — but the body knows what it is doing.

The Pine Forest

I ran my first trail race through a pine forest. Single track, winding through trees, the canopy filtering the light into something quiet and ancient. I was not fast. I was not optimized. I had no GPS data and no race strategy beyond don’t fall. And somewhere in the middle miles, something happened that I have been trying to find words for ever since.

The sound narrowed to two things: the fall of my footsteps and my breath. The visual world narrowed to filtered light through pine, tree trunks repeating, the trail unwinding. And in that narrowing, something opened. I had felt this before, but I hadn’t. I had been there before, but I hadn’t. My body remembered what my mind could not recall.

That is the only honest description I have. The memory was not biographical. It was not mine, in the usual sense. It was older than me, and it was also completely, undeniably me — the most me I had felt in years. I was not achieving anything. I was recovering something. Not a skill or a performance level. A relationship. A knowledge of where I belong when the noise falls away.

This is what I mean by interterrestrial. Not a philosophy. Not a metaphor. A felt exchange, conducted in the body, between a human animal and the ground it evolved to move across. The pine needles under my feet. The filtered light. The breath. These were not the backdrop to an athletic experience. They were the athletic experience. The earth was not a surface I was performing upon. It was a presence I was in conversation with.

Subhuman, Superhuman, or Something Older?

The question I began with was whether athletics asks us to become superhuman or subhuman. I want to revise the terms. Both words accept the same assumption: that the ordinary human is the baseline, and that athletic greatness moves away from it in one direction or another. Superhuman: beyond the human, above it, transcending its limits. Subhuman: below the human, before it, more animal than civilized.

But what if the dichotomy is wrong? What if the human being, at its deepest, is not something separate from the earth that can either transcend it or descend into it, but is already and always a creature of the earth — temporarily confused about this by language and cities and schedules and shoes, and occasionally, in moments of great physical effort and great simplicity, reminded?

The athlete in the pine forest, the runner dissolved into the late miles of an ultra, the climber whose hands read rock before the mind processes anything — these are not subhuman. They have not descended. They have arrived. They have recovered a fluency that was always theirs, that civilization had temporarily covered over. The body remembering what the mind cannot recall.

Training, reframed through this lens, is not construction. It is not the building of a performance machine. It is excavation. The uncovering of a body that already knew how to do this, that carries the knowledge of ten thousand generations of human movement in its muscles and bones and nerve endings. You are not becoming something new. You are becoming, more fully, what you have always been.

The Deepest Direction

The extraterrestrial dream is real and it is human. The desire to go beyond, to exceed, to transcend — this is not nothing. It has produced genuine beauty and genuine achievement. But it is incomplete as a description of what athletics, at its best, actually is.

The greatest moments in sport — the ones athletes struggle most to describe, the ones that feel most unlike the rest of experience, the ones that leave people changed in ways that have nothing to do with the medal or the time — these moments are interterrestrial. They are exchanges. The body and the earth in live conversation, the self temporarily dissolved into something older and larger, the human animal recovering its ancient knowledge of where it belongs.

We train upward, but we arrive downward. We prepare to transcend, but the gift, when it comes, is a return. Not a return to weakness or to primitiveness or to anything we should be embarrassed by. A return to membership. To the felt knowledge that we are made of this earth, moving across this earth, and will one day be returned to it — and that in the meantime, in the miles between, the most profound thing we can do is to remember that.

What if your greatest performance isn’t a rising — but a returning?