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It was a summer Saturday night, an all-hands-on-deck kind of shift. The rooms were filled, spilling patients and families into the hallways. Another ambulance was unloading in the bay, the fourth in 20 minutes. Vera was in Room 5, fuming over the wait. Her chart, listing the usual complaints, was stacked behind 12 others. I was well into the ninth hour of my shift, working at a pace that I would describe as focused mania. I was tired and anxious about the possibility of missing something vital in the crush.

On my knees in the hallway outside her room, I was splinting an obscenely swollen ankle belonging to a man addled with Percocet. Vera, believing herself unobserved, crawled off her stretcher, walked to the center of the room and slowly arranged herself into a pile on the floor.

"Vera, get back on that stretcher. Now!" I shouted.

Shamelessly, Vera replied that she had been thrown from the stretcher. "And I'm going to sue."

Hurriedly smoothing out the top of Mr. Percocet's splint, assured that it and he were securely in place, I spun around and tore into Vera's room, grabbed her by the knotted belt of her chenille bathrobe and yanked her to a standing position. Stunned, Vera stood unaided and unbelieving.

"That's it. You're outta here!" My professional empathy -- already stretched -- had snapped.

Thwack!

I was down, much to my surprise and that of the aide who had come to help. Vera, aspiring paraplegic, had sucker-kicked me in my solar plexus. She then pounced on me and began pinching and twisting my ears. My thoughts flashed back -- I imagined I was being attacked by the Three Stooges' grandmother.

Then she spit in my face.

For the first time in my life, I hit a patient: I smacked her open-handed right on her malevolent mandibular angle, toppling her onto her galled gluteus maximus. With that swing, my pristine armor shattered.

Rattled, my dignity and self-assurance badly bruised, I completed the required physical examination, careful to document her remarkable strength and agility. Unhurt and unrepentant, refusing to depart under her own power, Vera was carried firefighter style out to the waiting room. Patients and their families shifted nervously as they watched two strapping adults deposit this seemingly ailing elderly woman -- bellowing, "They're trying to kill me" -- in their midst. "Boy, how sick do you gotta be to get help in this E.R.?" I heard someone whisper from the crowd.

The police were called when she wouldn't leave the waiting room. A shiny new 24-year-old officer, displaying more swagger than experience, asked me what I wanted to do with her.

"She is evil and should be destroyed, but filing charges will do." I reached for another patient's chart. Officer Swagger was last seen trying to roll Vera, wedged tightly in a hospital wheelchair, into a small family consultation room. Vera, a leg braced against each side of the door frame, was doing a fairly decent job of defeating his intentions.

Having worked several thousand shifts in emergency rooms, both urban and rural, I've interacted with the drunk, the dying, the insane and the average Joe who is having the worst day of his life. Sometimes their fear and pain make them strike out violently. I have ducked punches, avoided kicks. I have been bitten and spit at and called every name in the book. This is just part of the job, which I rarely take personally. But with Vera, my professional veneer cracked and I did take it personally. In slapping her, I broke my Hippocratic oath, thereby eviscerating my hubris. Not only had I lost control, I didn't even feel sorry about it. I regretted my actions, sure, but sorry? Never.

Now the prodigal patient, Vera still comes to our E.R. Having voluntarily elected to reside in a full-care nursing home, she has finally found her haven. She has moved up in weight class, tipping the scales at 140 pounds, but her attitude and attire have changed little. As for me, I still say my prayer, but I make no assumptions that the gods can protect me from myself.