It’s 4:30 a.m. in the emergency department, and the relentless hum of the central air conditioning is the only thing keeping you awake. You are standing at the workstation, finishing up documentation for a complicated laceration repair, when your intern approaches, looking slightly harried.

“Doctor, I need you to see the patient in Room 4,” he says, glancing at the chart. “He came in via triage a few minutes ago looking distressed.”