What does a doctor say when words don’t come? Such was my dilemma several years ago on an inpatient psychiatric service when I responded to an emergency alarm activated by staff in a patient’s room. A young female patient—call her Lisa—had just knotted some latex gloves around her neck, and her face was still plethoric as I entered her room. Staff restrained her while a nurse carefully cut off the gloves. This allowed Lisa to begin taunting me. Fixing me with a malignant stare and a gleefully sadistic grin, she exulted that “you stopped me this time, but I know exactly what to say to get out of here, and when I do I’ll kill myself, and there’s nothing you can do about it!”