Twenty years ago I was a resident in psychiatry and was called down to the emergency room one night to see a patient. Richard, 40, was wearing jeans, a button-down shirt and exceptionally clean white sneakers. He had neatly folded his unused patient gown and placed it at the foot of the bed. He was calm and didn't appear to be physically injured. His pulse-oximeter, clipped around his right index finger, displayed normal vital signs on the bedside monitor. I glanced back over my shoulder to the senior emergency room physician sitting at the desk, nodded toward the patient and gave him a quizzical look. The other doctor raised an index finger and circled it around his right ear - the universal "crazy" gesture. I walked over to Richard and introduced myself. "What brings you here tonight?"
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