The Noonday Demon

by Andrew Solomon

I repeated my requests for a psychiatric consult, but no such thing was offered. Psychiatric records are not available in emergency rooms, and so there was no way to check on my complaints, though the hospital where I found myself is the one with which all my primary-care physicians and my psychiatrist are associated. I believe that the emergency room policy in which saying “I have had severe psychotic depression exacerbated by extreme pain” is treated much the same as saying “I have to have a woolly teddy bear with me before you can use sutures” is unacceptable. The standard textbook on emergency room practice in the United States does not deal with the psychiatric aspects of somatic illness. No one in the emergency room was remotely equipped to deal with psychiatric complications. I was asking for steak at the fishmonger’s.