The other night I had an 18 year-old whose family had brought him in to the ER.

Reason for visit, and I quote: “psych consult.”

He had not been himself for a year, but for the preceding two days he had been out of control, telling the family they must go to church, talking about fleeing the liberals, trying to kill evil spirits with knives. He lay quietly on his bed and I came in the room. Every now and then his hands would start to shake, and the shaking would work its way up his arms, and he’d have to hold his arms up in the air and they’d just shake and shake. Then he’d settle.

“Tell me what brought you in here today,” I said.

I waited, very quiet, very still, for a minute (“a minute” being actually sixty seconds, which in medical time is a small eternity) or so. Finally he said, “I’m feeling sick. I’m a little bit shaky.”

Open‐ended questions when nowhere with this young man—many long periods of silence during which he forgot what I’d asked him—and I eventually told him I was going to ask him yes/no questions. He agreed.

Yes, he was hearing voices.

Yes, he was seeing things that frightened him.

Yes, these voices were telling him what to do; they were telling him he had to be good—he had to go to church.

“To church, yes, of course,” he said.

No, they weren’t telling him to hurt anyone. No, they weren’t telling him to hurt himself. Then he looked at me and said, “Do you know who you’re talking to?”

I said, “Tell me who I’m talking to.”

He said, “You’re talking to God. It’s God in here. I’m down here and people are going to be punished for what they’ve done.”

I said, “Wow, that must be really frightening for Peter to have God inside him.”

Peter nodded, “Yes, he’s very scared.”

“Are you being good to Peter?” I asked.

“Yes. Peter is going to come back to heaven with me. He will be my servant, my son, like Jesus.”

The room was small and close. The patient was so scared. His sister sat in a chair against the wall, wide‐eyed and nodding. “you see what I mean?” her eyes said. I called psychiatry, of course. In some faint hope that maybe this guy might have a brain tumor (*how telling is that—that a brain tumor is less frightening than a psychotic break?) We had scanned his head—nothing there that shouldn’t be, at least not that we could see. I pray that everything goes well for this poor young man and his frightened family. Does his mother creep into the room where he sleeps? Does she look down at him in broken‐ hearted confusion? Does she gather him up in her arms, he twice her size, and hold him while he sleeps? I bet she does.