At 7 a.m., surgical rounds were made in the ONW. Six patients were discussed during half an hour, but most of the time was given over to a fifty-four-year-old woman with a recurrence of bleeding ulcer. This was her second day in the hospital and her condition was now stable; she had received five units of blood the day before. Normally she would not be a surgical candidate, but on two previous admissions she had shown the same pattern of massive, unexpected bleeding, followed by stabilization in the hospital after transfusion. The residents were afraid that if this happened again, she might bleed to death before she got to the hospital.

The emergency-ward residents attended these rounds, for in the early morning the EW is least busy. A short distance away, however, the acute psychiatric service was in full swing. The APS always gets a group of patients in the morning; they are the people who, for one reason or another, have not been able to sleep the previous night.

In one of four interview rooms in the APS, a nineteen-year-old girl, separated from her husband, chain-smoked as she described her unsuccessful attempts to kill her three-year-old daughter: first by hanging, then by suffocation with a pillow, and finally by gas asphyxiation. She explained that she wanted to stop the child from crying; the crying was driving her crazy. She came to the APS, she said, because "I wanted to talk to somebody. I mean, it's not natural, is it? It's not natural-a kid that keeps crying that way."

In another room, a forty-year-old accountant was running down a list of eight reasons why he had to divorce his wife. He had written out the list so he would be sure to remember everything when he talked to the doctor.