When I started as a senior house officer on the unit she was practically mute: the effort of speaking was immense, she could give none of the usual conversational cues, and it was difficult to maintain such a one sided encounter for long. She sat on the ward throughout the day, eschewing the group activities, her face conveying silent despair. “I just can't do anything,” she would manage. Later she recalled how she had felt the predicament of others trying to draw her out, but when I asked what she felt her attendants should do in that situation, she replied, “You can't, there's nothing anyone can do. When someone's like that you just have to leave them.” None the less, I went every day to see her, asking her how she was and taking blood to check …