Playing Doctor

Initial Visit?

Wednesday, January 4

The Two Sides of Monsieur Valentine

When I get to the ED, I see my other intern, the bumbling one, arguing with our drunken, cocaine-induced-psychosis friend. The two of them are going back and forth about why she cannot leave. He’s trying to explain to her the rationale for her restraints and mask. He is speaking so loudly it could nearly be construed as shouting. She is repeating the word fuck, in a loud, but quieter voice, enunciating behind the mask, like a syncopated metronome: ‘Fuck. Fuck. Fuck. Fuck. Fuck. Fuck.’ Sometimes she accents the f, sometimes the u, rarely the k.

I pull my intern into our workroom.

‘What are you doing?’ I ask him.

‘She was wanting to leave,’ he says, ‘I was explaining to her why she had to stay.’

‘Were your arguments logically sound?’ I ask.

He nods.

‘I told her about cocaine induced vasospasm and how it could affect her heart.’

‘Good, good.’ I say flatly. ‘Did you use Venn diagrams or simple theorems to explain your rationale?’

He looks at me, blankly.

‘When someone is spitting at me and in four-point restraints,’ I say, ‘I find arguments using Aristotelian space to more effective than thesis/antithesis/synthesis. I think it’s because of their heightened capacity for abstract reasoning and mathematic ability.’

He continues to stare at me, but under his blankness I sense an undercurrent of something else. I cannot tell if he is simply angry or if he has actually crossed the line into hating me.

I smile.

‘Do you remember when we declared her incapacitated? That meant—specifically—that she was not able to understand or make judgments regarding her own safety: That is, that she was irrational. Explaining our rationale to someone who is irrational, is not going to be... Do you see where I am going with this?’

He stops staring at me and looks at his shoes. I cannot tell if this is because of shame or because he does not want to give me the satisfaction of answering the question.

‘Not going to be... rational.’ I say. ‘That's right. Do me a favor: let her be; Do not try to reason with her. Almost by definition, her psychosis means she can’t be reasoned with. If you expect your arguments to sway her, you’re as delusional as she is.’


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