Vera is not her real name, but anyone who has ever worked at our E.R. will instantly know who I'm talking about. For years she has been a regular. Always arriving via ambulance, swathed like a babe in blankets, the 67-year-old seems frail (at one time she weighed just 97 pounds). She wears a stained flannel nightgown, a purple chenille robe, pink house slippers with exhausted stockings collapsed at her ankles. Her white, wispy hair looks like the spun glass strung on Christmas trees; waxy gray skin shrouds her tiny torso. In short, Vera appears to be just the sort of needy, fragile creature that people like me went into medicine to help.

But as soon as Vera opens her mouth, this picture of vulnerability shatters. "Get me into a room now," Vera barks. "NO, I won't go into a wheelchair. Where's the doctor? Don't take my purse."

"What seems to be the problem?" asks the triage nurse.

"Just get me a bed, bitch -- you're my problem."

By all counts, Vera is a troubled soul. Though she waxes venomous whenever she gets a chance, it's obvious she's a lonely, powerless person. Why else would she spend all of her time trying to get a bunch of strangers to take care of her? But such psychological explanations don't really help those of us who have to work under the shower of her bile.

Over the years, a mythology has grown up around her; only evil gossip can soothe our frayed nerves after a night in her charming presence. Some say that Vera slept with her parents until she was 18, and that after she married, she pretended to be "sickly," demanding that her husband return home immediately to tend to her. He apparently lost his job at the local battery plant as a result of missed work. Some say that he divorced her years ago, but Vera hisses that he died a slow, horrible death.

Although she spends all her time trying to get our attention, she pretends to abhor companionship. Vera will do anything for a private room in the hospital. She once told another patient, installed in the bed next to hers, that she had overheard us talking about his medical condition and that he was going to die -- a painful, protracted, agonizing death, not unlike her late husband's. This patient had merely been constipated, but it took us hours to convince him that some milk of magnesia and a switch to more water and fiber in his diet were really all he needed.

Over the years Vera has complained of many ailments and pains. At first, when test results came back negative and it appeared that nothing was wrong with her, I assumed that her symptoms were psychosomatic. Now I'm more inclined to assume they're consciously fabricated. Her favorite? Paralysis. Her error is that she can't tolerate having the door closed on her room. One day I developed the Vera Walk Test: Shut the door to her room and wait 10 seconds. Slowly the door opened, and Vera could be seen nimbly climbing back onto her stretcher, her paralysis "healed."

"Vera, this is wonderful; you can walk."

Nonplused, her reply was almost Nixonian: "I am not and never have been able to walk."

Realizing that it wasn't medicine so much as a life that she needed, we tried to help her. She refused therapy, home visits, Meals on Wheels or suggestions to volunteer, adopt a pet or get a hobby. Since her main desire -- admission to the hospital for total and complete care -- is rarely satisfied, bitterness has become her favorite bone. She has fired every doctor who ever cared for her, and sent a complaint to the state attorney general renouncing us as heartless, greedy doctors who abandon the sickly and the old. Our reply to her complaint consisted of two large boxes filled with medical records, X-ray reports, psychiatric evaluations, dietary notes, social service consultations and a 200-page book detailing her medical bills for the previous year, mostly unpaid because the state thought the care was unnecessary.