She flushed again.

“What about nonpharmaceutical-based interventions? Have you tried talking to Melvin?”

“I’ve cursed him out a few times. Does that count as conversation?”

“I don’t know. Does it?”

The detective smiled wryly. “My husband would probably say that for me, the answer is yes.”

I put down my pen, regarded my patient steadily. “To recap, you’re in extreme discomfort. You’ve said no to ice, anti-inflammatories, pain pills, topical ointments and meaningful conversation. So. How is that working for you?”

D.D.’s chin came up, eyes finally sparking to life as she replied in a heated voice: “And there it is: the ultimate shrink speak. ‘How is that working for you?’ It hasn’t worked for me, obviously, or I wouldn’t be right here, right now, feeling like my arm was on fire and my life is over and I’m never going to return to my career, let alone carry my kid or hug my husband. This sucks. Melvin . . . sucks.”

“Which is why you came here. Because your life sucks, and frankly, you need someone to share that pain. How am I doing, Detective Warren? Why look in when you can lash out?”

“Don’t fucking crawl inside my head!”

“With all due respect, I’m a psychiatrist; climbing inside heads is what I fucking do best. Now, would you like to continue yelling, or would you like your discomfort to dial down a notch?”

D.D. stared at me. She was breathing hard. Agitated. Enraged. But also distressed. Genuinely physically distressed. I leaned forward, stating more kindly:

“D.D., you have suffered one of the most painful injuries there is. Your own tendon ripped away a chunk of bone. And instead of being allowed to rest your arm to heal the break, you’re being forced to move it every single day, because as I’m sure the doctors explained, immobilization could lead to a frozen shoulder and long-term physical disability. You’re subjecting your broken humerus to daily physical therapy exercises, not to mention wrenching it through shirtsleeves and wrestling with car doors and doing dozens of other small, unconscious movements all day long that lead to instantaneous, teeth-grinding, mind-screaming pain. Welcome to a day in the life of Sergeant Detective D. D. Warren. You hurt, and you hate hurting. Worse, you feel helpless, which in turn makes you feel hopeless, and you are not a woman accustomed to either emotion.”

D.D. didn’t say anything, just continued to regard me stony faced.

“You don’t trust shrinks,” I continued briskly. “You’re not even sure you like me. And yet, of all the interventions you could’ve done for your pain today, the only one you managed was to show up at my door. Surely that must mean something to you.”

She offered a small nod of acknowledgment.

“All right, let’s build on that. Have you done your physical therapy exercises today?”

“Not yet.”