So at three in the morning, because it's always three in the morning, and because somehow the clientele know it wouldn't really work so well presenting to casualty suicidal on the bus at three in the afternoon on a sunny day, I am called from the sparking acrylic sheets of the on-call room by some grumpy A&E doctor.

"This is it. I've had enough. I'm going to kill myself. I've planned it all out. You've got to admit me." It's one of the peculiarities of modern life and the far-sightedness of the human psyche that this is the patient speaking, rather than the overworked overstressed and underpaid SHO in A&E. Suicide rates fall in wartime.

Right. Now there are a few things you should know about how hard-hearted I'm about to be. First, everyone is suicidal these days, and not all of them can come into my hospital because there's no room at the inn. This is a decision you all made collectively in the 1980s when I was about 12 years old so it's no good moaning to me about it now. Secondly, feelings are my business these days, and however cuddly I might appear on the outside, I'm paddling away frantically like a scheming little duck underneath the tranquil waters of my heart-warming smile. Just dig it.

Suicide is the big concrete negative outcome in psychiatry, not to mention a king-size tragedy. It's up there with murder, and it makes us all shit our pants, or at least it does me because I'm only a baby psychiatrist. So let's tighten our sphincters, loosen our ties, polish our smiles and knock up a quick crystal ball to predict whether or not she really is going to kill herself if we boot her out on to the streets for financial reasons.

Risk assessment is all in the demographics, the previous, and the mental state. Young women with friends, in general, don't kill themselves; they just pretend. Grumpy old bachelors, they really go for it. The closest they get to seeing a psychiatrist is when they're sloshing around in a big dish on a slab in the mortuary underneath the on-call bedrooms. Which makes a bit of a mockery of my job. Think how we feel about it.

I ask how she has been feeling recently. "Awful. I'm crying all day. And I can't sleep, I'm tired all day, I've lost my appetite and I can't concentrate on anything."

Amazing. So matter of fact. And a full set of biological symptoms of depression in the first paragraph. I focus on being relaxed and understanding. Even if it's a put-up job, she has still got to be pretty unhappy, and it's not her fault I've got to work all day tomorrow. Every contact should be therapeutic. Grit your teeth.

How's your self-esteem? "Low. I just feel so helpless and hopeless. And worthless." This girl knows Beck's triad of depressive cognitions better than I do. "And guilty." Bingo. Full house. "And I live alone." She reads my mind. Or she reads psychiatry textbooks. No one to keep an eye on. Very bad sign. She so knows it. The gun is in my chest. My hands are above my head. The only question is: what's the ransom? A fistful of benzos? A week on the inside?

I look up her previous on the computer, and she has 56 presentations to this A&E alone, all either teeny overdoses or threats. It's a blatant personality disorder, a world of frustration, untreatable, incessant, lifelong maladaptive manipulative anxiety-inducing nightmare punters from hell. I just don't get them. I think that's because nobody does. I think you're supposed to have firm boundaries. I think that means not admitting them. I think that means having balls 10 times the size of mine.

I call the registrar. "Sweet thing. First night on call? Much love." When did an orthopaedic registrar ever talk to me like this? I present my tiny balls. "Oh, honey. This will grumble on for years. She might kill herself one day, but you have to send her home, or ask, what will you achieve with this admission?"

She's so sane. And the answer is, rather obviously, that I don't want someone to go home and kill themselves on my first night on call. At any cost. I'm so lame. She coos. "Oh, such a dearest thing. Have a bed. For both of you. Good night. Oh. Bless. Sweet thing. Goodnight." And I'm in love.