"H i, Rabbi, when do the services start?” asked a smiling, disheveled older man lying in his hospital bed.

Moments earlier, this 83-year-old former physical therapist named Abe was swinging at the staff and asking relentlessly where the biblical forefathers were hiding. As a fourth-year medical student on the psychiatric consultation-liaison service, I was asked to see this patient and provide recommendations to help manage his agitation. Needless to say, I was relieved by the patient’s current calm and jovial demeanor. He welcomed me in and motioned graciously for me to sit down by his undone bed. Though I’d never met him before, the man greeted me with a twinkle of recognition in his eyes.

I started what I guessed would be a truncated interview. After all, Abe had all the ingredients for a delirium — an underlying dementia, a bad case of pneumonia, and a resultant hospitalization that led to a major change in setting and routine. It was unlikely, I predicted, that he could give me much relevant and coherent information. I introduced myself as a medical student here to talk with him and ask him a few questions. “Rabbi Steinberger!” he replied, with a pleased look. “Where have you been?” Thrown by the completely fictional content of his discourse, I proceeded with the mental status examination.

“Do you know where you are?” I asked.

He looked at me quizzically, as though I was the one who needed some reorienting. “Why, in the synagogue, of course,” he finally answered.

“What year is it?” I continued.

He humored me: “1950.”

Disoriented to person, place, time, I jotted down, omitting any mention of the confused specifics of what he was sharing, which would surely have no impact on treatment or further care for this patient. I went straight to the essentials. He denied any physical pain, assuring me with a smile that he was comfortable. When I asked him, though, about emotional distress, his demeanor became slightly more melancholic, and he replied that he felt he was not, “Williamsburgish enough,” referring to an area of New York home to a large group of ultra-Orthodox Jews. He brought the protective glove fitted tightly onto his hand up to his ear and spoke into it as if into a telephone. “Hello, how do I get to Williamsburg? Oh, uh-huh, yes. Hello? Bye.”

Distractible, perceptual disturbance, I wrote, and ended the interview shortly thereafter, as I didn’t feel there was much use in continuing this nonsensical conversation. As I had suspected, the patient was delirious, the likely cause of his intermittent agitation. But on leaving his room, I reflected on a gnawing sense of dissonance. I was used to listening intently to patients’ fears, distresses, wishes, and losses, and trying to fill in the gap that exists between the self and the other through understanding and empathy. Here, though, this gap seemed insurmountable... (Excerpted from Mishpacha, Issue 660)