I Am the Attending

Prologue: The Expert Patient

The first time I became the patient, I still believed expertise would protect me from the experience.

I had spent more than twenty years listening to people explain why they did not belong in the room where I was interviewing them. Some were depressed and ashamed. Some were frightened by voices. Some were furious with a spouse who had called the police. Some knew the diagnostic manual well enough to answer every question correctly while their lives burned outside the office.

I understood the structure. A clinician asks about sleep, appetite, suicide, homicide, hallucinations, medication and judgment. The patient answers. Collateral sources complicate the answer. A legal order creates the container. The chart reduces everything to language another professional can scan before lunch.

Then I entered the container.

My advantages were real. I knew psychiatry. I knew medications and the difference between an adverse effect and an allergy. I knew the legal vocabulary surrounding emergency detention. I knew how a mental-status examination was assembled from posture, volume, interruptions, eye contact, associations and whatever sentence seemed most quotable.

Those advantages became part of the illness. Knowledge supplied ammunition. Rank supplied certainty. Every question revealed its purpose before the interviewer finished asking it. I could see the machinery and therefore believed the machinery could not see me.

The month before the first hospitalization did not feel like a descent. It felt like acceleration. My younger son was in Israel during rocket attacks. Family fear crossed several time zones. I slept less and thought faster. Medication began to look like an obstacle placed between me and necessary action. Worry about kidneys and liver became a medical brief against the drugs that had helped keep me stable.

Nothing arrived wearing a label that said MANIA. The pieces arrived as concern, urgency, work, moral duty, professional confidence and the reasonable belief that other people were moving too slowly.

That is one reason this story matters to me. Illness did not erase intelligence. It recruited it.

By the time police, evaluators and hospital staff entered the story, I had already built an explanation capable of absorbing opposition. If a person agreed with me, he understood. If he disagreed, he lacked information. If he tried to stop me, he became part of the danger. The theory could not lose because every loss became proof.

I was not pretending. I was not performing madness for attention. I was using a brilliant and unreliable instrument to certify its own reliability.

The records that follow are full of humiliating detail. They include threats, sexual comments, grandiosity, bowel incidents, medication, legal protests, exhaustion and enough psychiatric jargon to tranquilize a horse without touching it. They also contain errors, copied phrases, missing context and the institutional habit of turning one person's terror into another person's documentation.

I do not accept every sentence as sacred. I accept the pattern.

The comedy begins when a psychiatrist insists he has zero mania while being transported under a magistrate's warrant. The darker truth is that he believes himself.

I believed myself.

Chapter 1: Zero Mania

The first useful fact is that I was having zero mania. I announced this with the confidence of a man giving a laboratory result. Zero. Not mild mania. Not questionable mania. Not a touch of mania around the edges. The number was clean, round and medically satisfying. I had measured the mania myself using the internationally recognized instrument known as my own opinion.

The hospital disagreed. It had police, a magistrate's warrant, nurses, a locked door and several pages of collateral information. I had a medical degree. This made the dispute more balanced than it should have been.

I arrived at Canyon Rise Behavioral Center in May 2025 after a month of acceleration. The chart called it decompensation. I called it activation. Activation was a superior word because it kept me in command of the machine. Mania happened to a patient. Activation happened to a veteran, a psychiatrist and a father responding vigorously to circumstances. A missile could be activated. A credit card could be activated. A nervous system could be activated. The word did not require a locked unit or a diagnosis. It only required energy and a reason.

I had reasons. My younger son had been in Israel during rocket attacks. My family was frightened. I was not sleeping much. I was worried about my kidneys, my liver, my practice, my wife, my sons, the war, the Jews and the general incompetence of people who insisted on asking one question at a time. The world had become a wall of switches and I was qualified to operate all of them.

The crisis evaluator asked how many hours I slept. I explained that when I was activated we should not talk about war hours. She tried again. This is a professional skill: asking the same question after the patient has answered a more interesting one. I gave her a lecture about arousal, emotion and military readiness. She wrote down reduced sleep.

The next day I reported four hours, which I described as perfectly acceptable for somebody of my level. The phrase somebody of my level did not help my case. It was, however, a precise summary of my thinking. I was not an average sleeper. I was not an average psychiatrist. I was not an average prisoner. I was operating at a level for which the standard sleep recommendations were merely suggestions prepared for civilians.

The staff documented pressured speech, flight of ideas, grandiosity, irritability and poor judgment. I documented errors in the staff. They asked whether I was suicidal. Never. Homicidal. Obviously not. Hearing voices. Never in my entire life. They kept asking because those were the doors on their diagnostic hallway. I kept answering because I knew the hallway and believed I could walk out through the right combination of negatives.

The problem was that danger does not require a wish to die. A man can deny suicide with complete honesty and still drive as if the highway has appointed him. A psychiatrist can recognize every question and still fail the examination. Intelligence is not insight with a better vocabulary. Sometimes it is denial with footnotes.

I was a local psychiatrist with patients waiting, charts unsigned and a city allegedly suffering in my absence. The chart quotes me estimating two thousand charts, or perhaps six thousand. Numbers were flexible in the activated economy. The important point was that civilization depended on my discharge before lunch.

The staff thought this was grandiosity. I thought it was continuity of care.

Both sides wrote notes. Only one side controlled the door.

The acceleration had a moral quality. I was not merely awake; I was vigilant. I was not merely worried; I was responding to history. When a son is in a country under attack, ordinary sleep can feel like negligence. The nervous system mistakes helplessness for a request to produce more electricity.

People around me saw the tempo before I did. Messages multiplied. Subjects changed without warning because they were connected in my mind by highways nobody else could see. I could begin with Israel, turn toward renal function, pass through my practice and arrive at constitutional law without taking an exit.

The connections were not random. They were too abundant. Mania did not remove logic so much as abolish the admission price. Every thought entered.

I had treated patients who described this state and later apologized for it. I had explained reduced need for sleep to families. I knew that a person may feel rested after two hours and still be impaired. Yet when the same pattern occupied my own body, knowledge became defense counsel.

The most dangerous sentence was not I am invincible. It was I know what this is, and this is not that.

Chapter 11: I Am the Attending

On June 10 I entered the treatment-team room and noticed a serious administrative defect: no attending physician was physically present.

There were residents, students and staff. There was expertise, but in my estimation it lacked rank. I solved the problem.

There is no attending in the room, I said. Then I am the attending. Go ahead, son.

The sentence deserves preservation. It is a joke, a symptom and a complete theory of authority. I had spent a career in rooms where the attending's judgment organized everyone else's work. When stripped of my role, I recreated the hierarchy and placed myself at the top.

The young physician across from me did not accept the promotion. Hospitals are conservative about freelance appointments.

I interrupted the interview with concerns about electrolytes, kidneys and medical mistreatment. When asked why I was not in a medical hospital if electrolyte imbalance caused the behavior, I escalated the image. The chart quotes me saying I could put my hands into a person's chest and rip the heart out, but would not do it.

The second half was meant to reassure.

It did not.

I denied suicidal and homicidal intent. I denied hallucinations with the firmness of a man offended by the question. The team heard denial alongside violent imagery, pressured speech, agitation and severe disorganization. They did not grade the reassurance separately.

Nursing reports said I followed other patients, told them I was a psychiatrist and harassed them. I saw myself restoring clinical services. The unit had patients and no visible attending. Nature hates a vacuum.

The reversal was irresistible. Residents who might once have rotated under me now interviewed me. Medical students watched. I evaluated their questions, corrected their premises and tried to teach. The chart described intrusion and grandiosity. I described standards.

I did not merely claim authority. I performed it. I asked other patients about symptoms. I discussed diagnoses. I addressed residents as residents and students as students. I treated the day room as a badly managed teaching service.

The problem was not that I knew more psychiatry than some people in the room. I probably did. The problem was that knowledge had detached from role, consent and judgment. A scalpel remains sharp in the wrong hands.

The quote eventually became the title of this book because it contains the entire event. The doctor and patient occupied one body. The doctor refused to surrender the podium. The patient had no vote.

I was the attending in memory, training, ego and grammar.

I was not the attending in the room.