He greeted me when I walked into the elevator.

“Hi, doc,” he said, smiling at me.

“Hi,” I replied. I’m getting used to strangers greeting and starting conversations with me. This practice, which occurs frequently in New York, rarely happened while I was in Seattle.

“How you doin’?” he continued.

“Well; how are you?”

“I’m good, I’m good,” he said. Still smiling, he said, “I know you. You work on That Floor, don’t you?”

“Uh, well, I actually run all over the hospital,” I explained. “I don’t stay on any one floor.”

“Yeah, but you work on That Floor, right? You’re the one asking that man, ‘Where are you? Where are you?’, right?”

Realizing what he was referring to, I sheepishly smiled.

“Yeah, that’s me,” I said.

Great, I thought.

So there’s this man who may be demented and is likely delirious and is also hard of hearing.

This is not an ideal triumvirate.

Because I want him to hear me, I shout at him. And, for a variety of reasons, I cannot close the door to his room.

Thus, everyone in that section of the ward can hear me.

(This is why I hold the strong belief that all hospital wards should have some sort of microphone-and-headset device. The hard-of-hearing patient wears the headset, the interviewer uses the microphone for volume amplification, and patient privacy is preserved as much as possible. No one else needs to know what the interviewer is asking. Particularly the questions I ask.)

This man provides different answers every single time I speak with him. He’s confused. When patients are confused, a non-pharmacological intervention includes accurately reorienting them.

Example:

“WHERE ARE WE RIGHT NOW?”

“What?”

“WHERE ARE WE RIGHT NOW?”

“Right now?”

“YES. WHERE ARE WE RIGHT NOW?”

“59th Street and Amsterdam. If you hurry up, you’ll be able to catch that taxi over there.”

“WAIT—A TAXI?”

“You should take the train, but if you don’t to walk, take the taxi.”

“WAIT—WHERE AM I GOING?”

“Hoboken!”

After soliciting more details about his perspective, I then offer “gentle correction” (key in any sort of feedback):

“RIGHT NOW, YOU’RE ON THIS FLOOR OF THIS HOSPITAL. YOU ARE NOT OUTSIDE ON 59TH STREET. YOU’RE ON THIS FLOOR OF THIS HOSPITAL.”

“Yeah, I know. I’ve been going to This Hospital for years! You think I don’t know that I’m at This Hospital?”

Sometimes, we appreciate recognition for our work. I apparently am now recognized as The Doctor Who Shouts at Patients. Yay.