First Night on Duty as a Medical Resident

It is 1959; it’s my first night on duty as a medical resident at a VA hospital. I am called to the ER.

I enter the ER where the nurse, appearing frightened and perplexed, is talking on the phone. She places her tremulous hand over the receiver and says to me, “It’s a Korean war veteran. He thinks he’s in action and is speaking to his command installation and is screaming for more back-up, more shelling. We are trying to trace the call.”

She hands me the phone.

I assume the stance of the psychiatric interview. “What’s bothering you?” “Are you are on medication?” “Where are you?”  “Are you going to harm yourself?”

My futile attempts to break through to him are met with a soliloquy of obscenities that concentrate on my incompetence and failure to respond to his needs. We talk past each other.

Suddenly the nurse whispers that the police have traced the call and are at the door, but the patient has barricaded himself the room.

When it comes to aggressive delusional material, there are two principles in psychiatry. One, don’t enter into the patient’s psychotic world. Two, never let the patient think that one is not in control.

Despite these “first principles,” I say in a commanding voice: ”Sergeant, this is your commanding officer! I order you to open the door! We will help you!

Suddenly and calmly the veteran says “Yes sir” and goes peacefully and opens the door.

Joseph Fennelly
Madison, New Jersey

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