The patient, newly arrived on the unit, is sitting in a chair in the middle of her room. Her hands are clenched in her hair, one on each side of her head. Her eyes are screwed shut, and she is kicking her legs and yelling at the top of her lungs.

“AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAHHHH!!!!!!!”

I knock, then walk into the room with a tray. “Here, I brought your dinner,” I say through the din.

The patient stops yelling, opens her eyes, and takes the tray. “Thank you,” she says calmly, smiling up at me. “May I have an extra creamer, please?”

“Sure, I’ll go get you one,” I say. As I turn toward the door, her expression returns to one of anger and agitation and she resumes pulling at her hair and yelling.

“AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAHHHH!!!!!!!!”