The patient needed to undergo a closed reduction of a dislocated shoulder in the emergency department where I was training. And, because the patient had been “fall-down drunk” at the time, the orthopedic surgeon decided to forego analgesia. This vignette took place fully 40 years ago, near the beginning of my training, but I still recall quite vividly how I reacted. I was horrified, initially believing that the decision to withhold anesthesia was designed as a punitive measure. Perhaps you, dear reader, can remember the first time you were involved in a situation such as this. Eventually, however, I came to appreciate the wisdom of this approach. Although analgesia would have undoubtedly secured the short-term advantage of pain relief, it would have done so at the expense of altering the patient’s sensorium. To be sure, a patient’s comfort is important, but his/her safety must necessarily take priority. Skilled practitioners administer drugs sparingly, or even not at all, in certain clinical situations, lest we incur the risk of masking a patient’s symptoms.