Missing the Knock on the Door

barndoor

 

When a great moment knocks on the door of your life,
it is often no louder than the beating of your heart,
and it is very easy to miss it.
~Boris Pasternak

 

 

 

Years ago, a young woman I’d been treating for depression for several weeks in my clinic called unexpectedly on a Friday afternoon and canceled an upcoming appointment for the following Monday and did not reschedule. The receptionist sent me a message as is our policy for patients who “cancel and do not reschedule”. It gave me a bad feeling that she was turning her back on her treatment plan and I was uneasy about the upcoming weekend without knowing what was going on with her.

I could have just put on my coat and headed home at the end of that long Friday after a very stressful work week and even more stressful year. I was discouraged about many aspects of the clinic work load and the after-hours responsibilities only seemed to get heavier.  I was frustrated at how ineffectively I was communicating to administrative supervisors about the need for change.  I was ready to quit and walk away.

Instead I decided to call my patient to find out how she was doing.  She didn’t answer her phone. I mulled over my options, looked up her apartment address and drove the few blocks to get there. As I approached her door, I could hear someone moving around in her apartment, but she ignored my knocks and my voice and when I tried the door, it was locked.

So I stayed right there, talking to her through the door for about 15 minutes, letting her know I wasn’t leaving until she opened up the door. I finally told her she could decide to open the door or I would call 911 and ask the police to come to make sure she was okay. She then unlocked the door, tears streaming down her face. She had been drinking heavily, with liquor bottles strewn around on the floor. She admitted an intent to overdose on aspirin and vodka. The vodka was already consumed but the unopened aspirin bottle was in her hand. I was the last person she expected to see at her door.

Miraculously the mental health unit at the local hospital had an open bed. I told my patient that we could save time and hassle by heading over there together right then and there, and avoid the emergency room mess, and the possibility of an involuntary detainment.

She agreed to come with me and be admitted voluntarily for stabilization. I visited the hospital the next day and she greeted me with a hug and thanked me for not giving up on her when she had given up on herself. In sobriety, her eyes were brighter and she was more hopeful. She never expected anyone to care enough to come knock on her door when she was at her lowest point,  and she struggled to answer, as consumed as she was in her own painfully beating heart.

She was astounded and grateful and frankly, by deciding to do what I knew was necessary and right even though it disregarded every workplace policy, so was I.

Four years later, a small card arrived in my clinic mailbox on another most challenging work day from an unfamiliar address two thousand miles away. The name looked vaguely familiar to me but when I opened and read the contents, this time the knock on the door was to get my attention, to focus the beating of my heart on what was most important – not the stresses of my work place — and it was my turn to let tears flow:

 

“Dear Doctor,

I am not sure if you will remember me considering you see a number of patients daily; however, I am a patient whose life you changed in the most positive way. I never truly THANKED YOU for listening to me and hearing my silent words of grief and hearing my cries for help. If it had not been for you, had you not knocked on my door, I would not be writing this letter to you today. I don’t know exactly what to say to the person who saved me from hurting myself fatally. You were a stranger in my life, but a dear friend in my time of need. THANK YOU, for everything that you did for me. You have a permanent place in my heart, you have given my spirit hope, you have reminded me that a life is worth living. Thank you, thank you, thank you! Sincerely, L_____”

 

I’m grateful 4 years ago I had the sense to go knock on her door when all she could hear was the beating of her own painful heart. I had the stubbornness to stay put until she responded, and most of all, I’m appreciative for her gracious note letting me know it made a difference. When I needed it the most, she made a difference for me that has kept me on the job all these years later.

She knocked, oh so gently, on my door and I opened it, amazed that someone cared, and found me awash in my own tears.

 

 

Answering the Knock on the Door

tony07

From Spring 2004 with an update at the bottom:

It’s been a challenging few weeks at our farm because one of our two year old geldings, Wallenda, had an emotional crisis of sorts that I’ve been trying to understand and deal with.

Wallenda has always been on the “sensitive” side–not the most laid back of our youngsters, and far more apt than others to need to look at new things closely, stop and stare, and give a snort or two. He’s lived a trauma-free, non-demanding existence, asked only to lead and stand quietly, allow shots and worming, and get his feet trimmed. He has not been a classic Haflinger pocket pony, begging for attention, but he’s never turned away from our attention either.

One day, about a month ago, his world turned upside down. During the day while we were at work, he had managed, in an effort to reach green grass, to wiggle his way under a 12 foot pipe gate in his paddock, getting it partially off its hinges, but still barring the opening enough that his brother and sister opted not to follow him. I came home from work to find him grazing peacefully in the orchard, near the paddock, without a halter on of course. When I tried to approach him with his halter to catch him and bring him in, he reacted fearfully, running madly up and down the fence line, looking very much as if he might jump the tape and wire, just to get away from me. I solved his panic (and my concern) by bringing his brother around on a lead and Wallenda followed him back into the barn and into a stall.

But nothing seemed the same for him. This young horse who formerly would always come up to us in the stall when we opened the door to feed him or put on his halter would bolt for a corner if we approached, literally climbing the walls to get away from us. He wouldn’t take food offered from our hands, and wouldn’t even approach his grain until we moved away from the stall. He was petrified, eyes wide and white, muscles trembling and tense.

We were completely baffled. No one else works or handles the horses here except my husband and I, and no one was at home when Wallenda got out. We wondered if he had, in fact, somehow gotten out to the road
and been frightened there by someone trying to shoo him home, but it seemed so unlikely that he would leave lots of grass and his buddies to venture out that far. Clearly there had been a major emotional trauma over the course of the day, as he didn’t have a mark on him anywhere to indicate he’d been harmed or hurt.

If both of us went into his stall together, we could approach him slowly from either side and he would stand for haltering, but if only one of us went in the stall, he’d immediately turn his butt to us, and swing his front end away, very effectively keeping out of reach, and threatening us with his hind legs and once, when Dan was trying to halter him alone, landed a painful kick on Dan’s ribs. It was clear to us that he was reacting out of fear, not aggression, but that realization didn’t make him any safer to interact with.

We tried to keep his routine the same as best we could. He was haltered, with us approaching him in the stall together, and he would lead fine out to his paddock. However, once in the paddock, there was no way he’d allow himself to be caught to come in at night and the paddock was too large for us to be able to position him to be caught. When we tried once, he ran for the 5 foot board fence, jumped, landed on this belly on the top cracking the top rail and landing in the paddock unhurt on the other side. We were incredulous.

He spent several lonely nights alone in the outdoor paddock because he absolutely would not be caught–not with grass, not with grain, nothing. He would snort and toss his head repeatedly, telling us emphatically not to touch him. I even delayed his meals, thinking a hungry stomach would bring him close as I held out hay to him, but it did not help. It was so un-Haflinger-like that I started to wonder if he had some brain injury causing this aberrant behavior–could he have had a concussion? a tumor? or do horses sometimes go psychotic?

We’ve had a breakthrough over the past week. We started to allow the horses some pasture time, building it up gradually, and he has been out with his siblings in a big field, free to run and eat. At night, they come to the gate to be led in one at a time, and though he would hang back, he would follow the others in to the barn. Each day, I could tell he knew the destination was the pasture and that was where he wanted to be. So it took less and less time to position him for safe haltering in the morning in the stall. He accepted grain from my hand. Two mornings ago, I walked into the stall, he turned and faced me, and ate grain from my hand and then allowed me to halter him, without ever turning his butt to me once. This morning, he came right to the stall door, just like old times, and dove his nose right into the halter without hesitation. I feel like my horse has come back from whatever hell he was in for 4 weeks. His eyes are softer again, and he doesn’t toss his head at me when I look him in the eye and talk to him.

Whatever happened? All I know is that he lost all trust for us, through no action of ours that we can define, and we had to slowly patiently gain it back. It was tempting to get angry with him and his behavior, and react with punishment, but clearly that would be exactly the wrong thing to do as it would only affirm his fear. What he needed was consistency, reassurance, predictability and calmness. And it has worked. I certainly won’t assume that his fear is gone forever but I have a relationship to build from again.

Addendum:  Wallenda went on to become a star student for his trainer, learned dressage, jumping and is now a successful eventing sport horse in Wyoming.
Fear is a powerful emotion that we all know well. It is disabling to the point of causing us to harm others and ourselves in our effort to flee.

I thought about Wallenda when a young depressed college student I’ve been working with for several weeks in my clinic suddenly canceled an upcoming follow up appointment and did not reschedule.  It gave me a bad feeling that she was “turning her back” and not wanting to be approached, just as Wallenda had done. I could have just put on my coat and headed home at the end of a long Friday but decided to call my patient and see what was going on with her. She didn’t answer her phone. I looked up her apartment address and headed over there. I could hear her moving around in her apartment, but she didn’t respond to my knocks or my voice. I decided to stay right there, talking to her through the door, letting her know I wasn’t leaving until she opened up the door, and eventually, tears streaming down her face, she did. She had been drinking heavily, with the intent to overdose herself on aspirin and vodka, and I was the last person she expected to see at her door. Her fear of life was such that she wanted to “flee” so badly that it didn’t matter to her if she died in the process.

She agreed to come with me to the hospital and be admitted for stabilization and when I went this morning to visit her, her eyes were brighter and more hopeful and she greeted me with a hug and thanked me for not giving up on her when she had given up on herself. She never expected anyone to care enough to come looking for her, and to stand firm when she was rejecting all approaches. She was astounded and grateful, and frankly, so was I.

Addendum:  Four years later, a small card arrived this week in my clinic mailbox on a most challenging work day, from an unfamiliar address two thousand miles away. The name looked vaguely familiar to me but when I opened and read the contents, this time it was my turn to let tears flow:

“Dear Doctor,
I am not sure if you will remember me considering you see a number of patients daily; however, I am a patient whose life you changed in the most positive way. I never truly THANKED YOU for listening to me and hearing my silent words of grief and hearing my cries for help when all I could feel was anger and hopelessness. If it had not been for you, had you not knocked on my door, I would not be writing this letter to you today. I don’t know exactly what to say to the person who saved me from hurting myself fatally. You were a stranger in my life, but a dear friend in my time of need. THANK YOU, for everything that you did for me. You have a permanent place in my heart, you have given my spirit hope, you have reminded me that a life is worth living. Thank you, thank you, thank you! Sincerely, ______”

I’m grateful 4 years ago I had the sense to go knock on her door, the stubbornness to stay put until she responded, and most of all, I’m appreciative for her gracious gesture in letting me know it made a difference. Instead of being consumed by her anger to the point of harming herself, she was now reaching out in gratitude.

On a most difficult day this week, this student made a difference for ME. She knocked on my door and I opened it, awash in my own tears of relief at the healing that had taken place.

A Church Potluck of Comfort Food

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Perhaps it was celebration of the end of a long cold winter month
Possibly a need of respite from a month of dieting
Likely a response to economic bad news day after day:
A potlatch, a potluck, a communion of comfort food.

What to bring? What soothes stomach and heart?

Macaroni and cheese, with drizzled bread cubes on top
Beef stew chuck-a-block with vegetables and potatoes
Teriyaki chicken
Meat loaf topped with catsup
Spaghetti and pizza

Home made bread, steaming, soft
Whole chocolate milk
And ice cream sundaes

Nothing expensive
Or extravagant
Or requiring debt to pay.

It was the beginning
Of an evening of games and laughter;
When times get tough
And jobs are lost, savings dwindling

It is time for reconnecting community,
For huddling against the storm
Forgetting worry for a night
And sharing comfort, all together, smiling.

A Knock on the Door

knockFour years ago, a young woman I’d been seeing for several weeks in my clinic called unexpectedly Friday afternoon and canceled an upcoming appointment for the following Monday and did not reschedule. The receptionist sent me a message as is our policy for patients who “cancel and do not reschedule”. It gave me a bad feeling that she was turning her back on her treatment plan and I was uneasy about the upcoming weekend without knowing what was going on with her.

I could have just put on my coat and headed home at the end of that long Friday but decided to call my patient. She didn’t answer her phone. I mulled over my options, looked up her apartment address and drove there. As I approached her door, I could hear someone moving around in her apartment, but she didn’t respond to my knocks or my voice.

I decided to stay right there, talking to her through the door for about 15 minutes, letting her know I wasn’t leaving until she opened up the door. I finally told her she could decide to open the door or I would call 911 and ask the police to come to make sure she was okay. She then opened the door, tears streaming down her face. She had been drinking heavily, with liquor bottles strewn around on the floor. She admitted an intent to overdose on aspirin and vodka. The vodka was already consumed but the unopened aspirin bottle was in her hand. I was the last person she expected to see at her door.

I called the mental health unit at the local hospital and they had an open bed. I told my patient that we could save time and hassle by heading over right then and there, and avoid the emergency room mess, and the possibility of an involuntary detainment.

She agreed to come with me and be admitted voluntarily for stabilization. I went the following day to visit her and she greeted me with a hug and thanked me for not giving up on her when she had given up on herself. In sobriety, her eyes were brighter and she was more hopeful. She never expected anyone to care enough to come looking for her, and to stand firm when she was rejecting all approaches. She was astounded and grateful, and frankly, so was I.

Four years later, a small card arrived this week in my clinic mailbox on a most challenging work day, from an unfamiliar address two thousand miles away. The name looked vaguely familiar to me but when I opened and read the contents, this time it was my turn to let tears flow:

“Dear Doctor,

I am not sure if you will remember me considering you see a number of patients daily; however, I am a patient whose life you changed in the most positive way. I never truly THANKED YOU for listening to me and hearing my silent words of grief and hearing my cries for help. If it had not been for you, had you not knocked on my door, I would not be writing this letter to you today. I don’t know exactly what to say to the person who saved me from hurting myself fatally. You were a stranger in my life, but a dear friend in my time of need. THANK YOU, for everything that you did for me. You have a permanent place in my heart, you have given my spirit hope, you have reminded me that a life is worth living. Thank you, thank you, thank you! Sincerely, L_____”

I’m grateful 4 years ago I had the sense to go knock on her door, the stubbornness to stay put until she responded, and most of all, I’m appreciative for her gracious note letting me know it made a difference. Now, on a most difficult day this week, she made a difference for me.

She has knocked on my door and I have opened it, awash in my own tears.