Encountering the Wardrobe


(A visit to C.S. Lewis’ childhood wardrobe at the Wade Center at Wheaton College)
The black oak wardrobe with
Intricate wood carving by his grandfather
Bears a sign which reads:
“We do not take responsibility for people disappearing.”

This is no mere piece of furniture;
Enchantment hangs within
Among the furs and cloaks
Smelling faintly of mothballs.

Touch the smooth wood,
Open the doors barely
To be met with a faint cool breeze~
Hints of snowy woods and adventure.

Reach inside to feel smooth soft furs
Move aside to allow dark passage
Through to another world, a pathway to
Cherished imagination of the soul.

Follow the path to feel the mists of the moors,
Hear honks of cabbies in Piccadilly,
Taste the gardens of Beatrix Potter,
And swim the icy lochs of Scotland.

Here are tall white cliffs
And there are stern henges of stone
Echoing within expansive cathedrals and Roman ruins,
All mystery, ancestry and history together.

Seek a destination for mind and heart,
A journey through the wardrobe,
Navigate the night path to reach a
Lit lone lamp post in the wood.

Beaming light as it shines undimmed,
A beacon calling us home, back home
Through the open door, to step out transformed,
No longer lost or longing, now found and filled.

The Walkabout


I wake restless, knowing
Time is moving on and so must I.
In my dreams, the spirits lit the path
I must follow.

I must move on, reaching out for the land.

The dust beneath my feet
Rises up with each step
To cling, traveling with me
Along this journey.

I must move on, holding close to the land.

The sun rises behind me
An orb of expanding orange flame
Across the horizon, heating my skin
Moistening with sweat dripping.

I must move on, watering the land.

The plants, scarce, speak to me
Birds cry out as they pass over
The howling hills call to me
My throat hums with each step.

I must move on, singing with the land.

The sun sets fiery before me
Pulling me forward, my stick in hand,
Drawing me toward the end of day,
To sit quiet by flame now grounded.

I must move on, dwelling within the land.

The sickle shaped moon casts no shadow
As I wrap myself in sleep,
Wandering in my mind’s landscape
To follow where dreams lead.

I must move on, looking for another land

Another song
Another dream
Another hope
In which I can finally rest.

Silver Thaw


Winter has hit with a vengeance with snow closing many roads, airports and schools, and then an ice storm blanketed us during the night, resulting in significant tree and power line damage and over 100,000 homes without electricity. We’re feeling pretty fortunate where we are farther north–the ice damage was less, though it is persisting in our 9th day of sub freezing temperatures. We awoke to to a 1/2 inch of ice coating everything, and it remains unthawed, creating hazards everywhere.

It is conditions like earthquakes, hurricanes, tornadoes, firestorms and silver thaws that remind us how little control we have over our environment and how much control it has over us. Being unable to walk anywhere outdoors that isn’t coated with ice is a humbling, helpless, feeling. Yet I’m grateful for the reminder of our helplessness. We dwell in this often hostile world and try to steward it, but we adapt to it, not the world adapting to us. We cannot stop the frozen rain from falling, but must wait patiently for the southerly winds to blow.

In fact, the warming is coming. Only 10 miles to the south of our farm, the temperature is a full 20 degrees higher, the ground is thawed and the ice is gone. When I listen out our back door to the south, I can hear the frozen trees in our woods knocking their branches together in a noisy cacophony as the south wind warms the ice, and chunks drop from the branches, clattering and clacking their way to the ground. From stony frozen silence to animated noisemakers with a steady puff of warm wind.

At times I am iced over as well–rigid in my opinions, frozen in my emotion, silent and cocooned in myself. That is when the approach of warmth from a touch, an empathic word, or heartfelt outreach breaks me free. Perhaps a little frostbitten around the edges, but I am freed again, warmed by relationships with friends and family and a host of virtual acquaintances from around the world.

I’m ready for the coming of the warm wind. It is well worth the wait.


The Gratitude of the Guilty

As a physician-in-training in the late 1970’s, I rotated among a variety of inner city public hospitals, learning clinical skills on patients who were grateful to have someone, anyone, care enough to take care of them. There were plenty of street people who needed to be deloused before the “real” doctors would touch them, and there were the alcoholic diabetics whose gangrenous toes would self-amputate as I removed stinking socks. There were people with gun shot wounds and stabbings who had police officers posted at their doors and rape victims who were beaten and poisoned into submission and silence. Someone needed to touch them with compassion when their need was great.

A 25 year old idealistic and naive student, I really believed I could make a difference in the 6 weeks I spent in any particular hospital rotation. That proved far too grandiose and unrealistic, yet there were times I did make a difference, sometimes not so positive, in the few minutes I spent with a patient. As part of the training process, mistakes were inevitable. Lungs collapsed when putting in central lines, medications administered caused anaphylactic shock, pain and bleeding during spinal taps–each error creates a memory that never will allow such a mistake to occur again . It is the price of training a new doctor and the patient always–always– pays the price.

I was finishing my last on call night on my obstetrical rotation at a large military hospital that served an army base. The hospital, built during WWII was a series of far flung one story bunker buildings connected by miles of hallways–if one part were bombed, the rest of the hospital could still function. The wing that contained the delivery rooms was factory medicine at its finest: a large ward of 20 beds for laboring and 5 delivery rooms which were often busy all at once, at all hours. There were a high number of deliveries of teenagers at this hospital. Some were married girls of 14, 15 and 16 whose husbands were stationed in the northwest, transplanting their young wives thousands of miles from their families and support systems. Their bittersweet labors haunted me: children delivering babies they had no idea how to begin to parent.

I had delivered 99 babies during my 6 week rotation. My supervising residents and the nurses on shift had kept me busy on that last day trying to get me to the *100th* delivery as a point of pride and bragging rights; I had already followed and delivered 4 women that night and had fallen into bed in the on call room, exhausted at 3 AM with no women in labor, hoping for two hours of sleep before getting up for morning rounds. Whether I reached the elusive *100* was immaterial to me at the moment.

I was shaken awake at 4:30 AM by a nurse saying I was needed right away. An 18 year old woman had arrived in labor only 30 minutes before and though it was her first baby, she was pushing and ready to deliver. My 100th had arrived. The delivery room lights were blinding; I was barely coherent when I greeted this almost-mother and father as she pushed, with the baby’s head crowning. The nurses were bustling about doing all the preparation for the delivery, setting up the heat lamps over the bassinet, getting the specimen pan for the placenta and suture materials for the episiotomy ready, and when I noticed there were no doctors in the room, I asked where the resident on call was. Still in bed? Time to get him up! Delivery was imminent.

I knew the drill. Gown up, gloves on, sit between her propped up legs, stretch the vulva around the crowning head, thinning and stretching it with massaging fingers to try to avoid tears. I injected anesthetic into the perineum and with scissors cut the episiotomy to allow more room, a truly unnecessary but standard procedure in all too many deliveries. Amniotic fluid and blood dribbled out and splashed on my shoes and the sweet salty smell permeated everything. I was concentrating so hard on doing every step correctly, I didn’t think to notice whether the baby’s heart beat had been monitored with the doppler, or whether a resident had come into the room yet or not. The head crowned, and as I sucked out the baby’s mouth, I thought its skin color looked dusky, so checked quickly for a cord around the neck, thinking it may be tight and compromising. No cord found, so the next push brought the baby out into my lap. Bluish purple, floppy, not responding. I quickly clamped and cut the cord and rubbed the baby vigorously with a towel. Nothing, no response. A nurse swept in and grabbed the baby and ran over to the pediatric heat lamp and bed and started resuscitation. Chaos ensued. The mother and father began to cry, the pediatric and obstetrical residents came running, hair askew, eyes still sleepy, but suddenly shocked awake with the sight of a blue floppy baby.

I sat stunned. I tried to review in my foggy mind what had gone wrong and realized at no time had I heard this baby’s heart beat from the time I entered the room. The nurses started answering questions fired at me by the residents, and no one could remember listening to the baby after the first check when they had arrived in active labor 30 minutes earlier. The heart beat was fine then, and because things happened quickly, it had not been checked again. It was not an excuse, and it was not acceptable. It was a terrible terrible error. This baby had died sometime in the previous 30 minutes. It was not apparent why until the placenta delivered and it was obvious it had partially abrupted–prematurely separated from the uterine wall and so the circulation to the baby had been compromised. Potentially, with continuous fetal monitoring, this would have been detected and the baby delivered in an emergency C section in time. Or perhaps not. The pediatric resident worked for another 20 minutes on the little lifeless baby.

Later, in another room, he made me practice intubating the body so I’d know how to do it on something other than a mannequin. I couldn’t see the vocal cords through my tears but did what I was told, as I always did. In the delivery room, the parents held each other, sobbing, while I sewed up the episiotomy in silence. I had no idea what to say and was mortified and helpless as a witness to such agony. I said I was so sorry, so sad they lost their baby, felt so badly there had been no way to know sooner. There was nothing I could say that could possibly comfort them or relieve their horrible loss. And they had no words of comfort for me as I struggled with my guilt.

Later I cried in the bathroom, selfish. Instead of achieving that “perfect” 100, I learned that death intervenes in life unexpectedly without regard to age or status or wishes or desires. I went on as a family physician to deliver hundreds of babies during my career but could never forget the baby that might have had a chance, if only born at a hospital with adequately trained well rested staff, without a student trying to reach a personal meaningless goal. This baby should be in his 30’s with children of his own, his parents now proud and loving grandparents.

I wonder if I’ll meet him again someday, this little soul that almost was, if I’m ever forgiven enough to share a piece of heaven with innocent babies who never got to draw a breath. Then, maybe then, forgiveness will feel real and grace accepted with the gratitude of the guilty.

Rearranging the Pile

manureThe sun has actually shown itself for two days, after weeks of rain, then wind, then snow, then sleet, then rain, then flooding, then fog.  The light above finally reappeared and it shone brightly, cheerfully, unblinkingly…. on my manure pile.

During all the bad weather, the chief barn cleaner (that would be me) really didn’t enjoy wheelbarrowing all the manure out to the pile, through the elements, whether it was an arctic blast wind, or a foot of snow, or ice covering the pathway, or huge deep puddles.  I went for a “dump and run” technique which meant I didn’t pile things up in a careful methodical way.  Instead I left piles randomly everywhere.  This is not the way to build a manure pile.  Nothing really heats up and decomposes when it is not piled together.  Instead it just sits there, taking up space and not doing what manure does best–become useful fertilizer for the spring pastures.

So I had no excuses yesterday.  It had to be done.   I had to pitch and move the manure pile into a semblance of orderly compost, flattening it out into a sloping ramp for ease of future dumping.  Yes, it took time and muscle and patience–all things I did not exercise much of in the last few weeks of excuse-laden poor weather.  Today, when I went out to the barnyard to survey my good work,  I only had to lift one shovelful to see the steam rise happily from beneath.  This is now happy manure, if there is such a thing.

My life is too often a dump and run affair too.  I don’t measure out my minutes carefully enough to take care of things in the orderly way they should be managed.  Anyone who has been to my house knows this about me.  I know what are in those piles of books, papers, clothing, etc.   It just doesn’t look like I do when I start searching for something…

I know what is in the piles of stuff I’d sooner forget about, kind of like the manure pile in the barnyard.  There are parts of me that I’d like to dump and run away from: things I say or do or think that I’m certainly not proud of, that I regret the moment it happens. I leave it in a little pile, all by itself, not wanting to ever return to it and do what really needs doing.  Instead it needs to be ceremonially heated up and decomposed so it never happens again, or with all the other stuff I do every day, it needs to someday become fertilizer for a better life lived down the line.

Maybe my children will learn from watching me manage my personal manure piles,  and benefit from my mistakes, rather than being busy creating their own.

The Light is shining on the manure piles of my life.    It is unblinking, stark and at times blinding.   It is time for me to quit the “dump and run” and to face the heat, knowing it will inevitably create something better out of me.  I will become the fertilizer someday.

Tied in Knots


One of my favorite things about my Haflinger horses is their long lovely manes–the whiter, and wavier, the better. I enjoy everything about that long hair — except sometimes the maintenance involved. It usually doesn’t take a lot of fuss, but this time of year, when the air is moist and there is frequent rainfall, I find that those long manes come in from the fields all a-tangle and frequently in elaborate tight knots. Not just uncombed dreadlocks, but tight, cinched up and truly snarled knots.

I have two theories about how these knots and tangles happen: Most likely, I suspect the Haflingers tend to toss their heads and shake their necks more in the rain, to shower off the raindrops that are dripping down their faces. There is something about this repetitive movement that causes the long mane strands to knot and then flop and fold back into themselves with each neck shake, so that there are sometimes three, four or five successive knots tied in a collection of strands. A second theory involves one very agile Haflinger mouth, tying knots in her unsuspecting pasture mates’ manes. I haven’t witnessed this personally, but this theory is suggested by the fact that I have several horses who always come in with knotted manes and one who never does. The “knotter” and the “knottees?” Perhaps….

My Scandinavian friends tell me there is a little gnome named Tomten in a gray coat and red cap who lives in the barn and ties knots in pony manes as a way to show how much he is caring for the farm. I haven’t seen him at work, as my little Tomten gnome swings on a swing in our back yard and I have yet to see him do anything except smile and make me happy when I look at him. But I like the thought that he may be responsible for these tangles.

So these wet evenings, I find myself working down the barn aisle, releasing all these knots that have formed during the day. This can be a bit time consuming and not a little aggravating, but necessary if I hope to keep these three and four foot manes intact and growing. So far I’ve not had to take scissors to any, but that is only because in matters of Haflinger mane, I’m extremely motivated and patient. Long white flowing wavy manes are part of the “fairy tale” that Haflingers embody. They are sadly being lost in some of the modern bloodlines, as the trend is toward a lighter weight hair that is more easily hunter braided and thinned, more like a warmblood type sporthorse’s minimal mane. True, all the long Haflinger mane can get tangled in the reins or the lines and represent a hazard, and though there is always the question of just how much a Haflinger can actually see through all that forelock, nevertheless, I want the hair to stay, and it kills me to even cut a bridle path.

What is the good of all that hair besides aesthetics? It surely is an outer protective layer in the harsh weather conditions to which Haflingers had to adapt long ago, and it is amazingly effective at keeping the head and neck warm and dry. The double manes are incredible umbrellas, allowing the rain to drip down that top oily layer of hair and drop to the ground, never touching the fur and skin underneath. But what a sauna it creates in the heat of summer!

There are times I wish I wore such a “veil” myself–able to hide my face when I need to, and impervious to the harshness sometimes flung my way– the “slings and arrows” of every day life. But when things heat up, it can be quite a liability with the heaviness and uncompromising barrier it creates.This is a difficult trade off for the potential comfort of privacy and protection risking smothering, knotting and tangling. Like the Haflingers, I can only hope that when I’m all tied up in knots, someone will care enough to untangle me gently, smooth me out, and braid me up so I feel relief in the midst of the heat, respecting me enough to not destroy something that helps define me.

So I keep caring for those manes, knowing their loveliness has its downside, and recognizing they are part of what makes my horses “Haflingers”, the fairy tale horses that dance in my dreams, which are part of what makes me who I am.


Lost in the Fog


There has been pea soup fog the last several mornings when I’ve gone out to do barn chores. This is fog that literally drips from the trees and soaks like rain, swallowing up all visible landscape, hushing bird song, erasing all color, homogenizing everything.

It also sucks up my horses as I send them out to the field from the barn. They lead slowly out to the gate, sniffing the wet air, hesitant to be turned out into the grey sea surrounding them. What is there to eat out here in this murk? Each one, when turned loose, wanders into the soup, disappearing, as if never to be seen again. One by one they move boldly forward to look for their buddies, although seeing nothing, hearing nothing, smelling nothing–lost and alone and bewildered until somehow they meet up in the mist.

I muse at their initial confusion and then their utter conviction there must be “something out there” worth finding. They are dependent on all the usual cues–visual, auditory, olfactory–all useless in the fog. Instead they rely on some inner sonar to find each other and bunch together in a protective knot, drops of fog dew clinging to their manes, their eyelashes and their muzzle whiskers. As day wears on, the fog dissipates, their coats dry under the warming sun, and the colors of the fields and trees and palomino horses emerge from the cocoon of haze.

Sometimes I feel lost in fog too–disconnected, afloat and circling aimlessly, searching for a touch point of purpose and direction and anything that is not smothering and gray. Perhaps I’ll bump into a fellow fog wanderer and we’ll stay knotted together, relieved in the connection to something solid and familiar. The isolation I sometimes feel may simply be a self-absorbed state of mind, sucking me in deep, separating me from others, distancing me from joy. I’m soaked, dripping and shivering.

If I only had the faith of my horses in the mist, I’d charge into the fog fearlessly, knowing there are others out there ready to band together for company, comfort and support, to await the sun. When warm rejuvenation does come, though not always as quickly as I would wish for, it will be enough to dry my whiskers, put color back in my cheeks and refresh my hopes and dreams.

The fog is never forever.


Burton's Little House in the countryside
Burton's Little House in the countryside
Burton's Little House swallowed up by the city
Burton's Little House swallowed up by the city

Global warming, which certainly has not been a problem this winter,  is blamed for many environmental changes but one of the most profound has only recently been described:

Solastalgia–a pining for a lost environment or a state of homesickness when still at home.  This word is derived from solacium (“comfort”) and algia (“pain”) and coined by Professor Glenn Albrecht in Australia in his research in Environmental Studies.  He has been studying Australian farmers displaced by climate changes that have rendered their land and homes uninhabitable dust bowls.  Their despair is losing not just their livelihoods but more emphatically, the familiarity and solace of surroundings lasting for generations of family members.  They become lost souls at home.

It is easy to dismiss talk of “home”  in this modern day as sentimental hogwash.  When we can travel globally in a matter of hours and via computer can arrive in anyone’s backyard, living room or even bedroom, “home” seems an outmoded concept.   Yet we, and our children, thrive on predictability, stability and familiarity.   When home no longer resembles home,  when the birds no longer sing as they once did, the native flowers no longer bloom, the trees no longer move in the breeze, where can we seek solace and comfort?  We are homesick right in our own back yards, if there is a back yard left to sit in.

As Joni Mitchell once wisely observed:  “They paved paradise and put up a parking lot.”

As a child, one of my favorite books was Virginia Lee Burton’s “Little House”, written in 1942, about a cottage built sturdy out in the countryside to last for generations of one family.

” The Little House was very happy as she sat on the hill and watched the countryside around her.  She watched the sun rise in the morning and she watched the sun set in the evening.  Day followed day, each one a little different than the one before… but the Little House stayed just the same.”

As the years go by, more houses are built near by and then a town surrounds the cottage, and finally it is engulfed in the noisy, smelly, sooty, smoky city.  Eventually a great-granddaughter finds the Little House and moves it out far in the countryside  to become “home” once again.

How many live somewhere that looks like it did 20, 60, 100 years ago?   How many would recognize our childhood homes if we drove by now?   How will our children remember “home”?

I have found one cure for solastalgia.  It is to create home where you are and where your people might be for the next one or two generations.  One of the most effective ways is to plant trees.  Again and again.  This cure is as old as Johnny and his appleseeds and the French fable “The Man Who Planted Trees” about the shepherd who restored an entire valley by planting acorns.   It had nothing to do with climate change, global warming or the Sierra Club.  It had to do with restoring life on the land.  Home is more than just the boards and doors and windows and fireplaces.  It is the earth we steward and the care we provide.

Solace is available for the homesick.

The Man Who Planted Trees:  http://home.infomaniak.ch/arboretum/Man _Tree.htm

Cured of a Fatal Disease


Considering myself a Dr. Doolittle of sorts, always talking to the animals, I reached out to pet a stray cat sitting quietly outside our barn one evening a month ago while doing barn chores.  This is a grayish fluffy cat I see around the barns every few months or so–he doesn’t put in frequent appearances and reminds me of a kitten we raised on this farm a few years back, though his markings are a bit different,  so I know it is not our cat.

We have 6 cats to pet here who claim “us” as their home and family, so there is no lack of fur balls to love.  There are probably that many more who hang out,  now and then,  considering our farm fair game and looking for an occasional free meal.  This cat just seemed to need a reassuring pat at that moment or maybe I needed the reassurance.  Wrong.

I found myself with a cat attached to my wrist by teeth and claws.  It took a bit of an effort to shake him off and he escaped into the night. I then surveyed the damage he inflicted and immediately went to wash my wounds.  They were deep punctures near my wrist joint–not good.  Lucky for me I was up to date on my tetanus booster.

By the next day the wounds were getting inflamed and quite sore.  I know all too well the propensity of cat bites to get badly infected with Pasteurella Multocida, a “bad actor” bacteria that can penetrate deep tissues and bone if not treated with aggressive antibiotics.  After getting 6 opinions from my colleagues at clinic, all of whom stood solemnly shaking their heads at my 12 hour delay in getting medical attention,  I surrendered and called my doctor’s office.  I pleaded for a “no visit” prescription as I was up to my eyeballs in my own patients, and he obliged me.  I picked up the antibiotic prescription during a break, sat in the car ready to swallow the first one and then decided to wait a little longer before starting them, knowing they wallop the gut bacteria and cause pretty nasty side effects.  I wanted to see if my own immune system might just be sufficient.

So the bacterial infection risk was significant and real but I was prepared to deal with it.  For some reason I didn’t really think about the risk of rabies until the middle of the night when all dark and depressing thoughts seem to come real to me.

I don’t know this cat.  I doubt he has an owner and it is highly unlikely he is rabies vaccinated.  My own cats aren’t rabies vaccinated (and neither am I) though if I was a conscientious owner, they would be.  Yes, we have bats in our barns and woods and no, there has not been a rabid bat reported in our area in some time.

But what if this cat were potentially infected with the rabies virus but not yet showing symptoms?  Now my mind started to work overtime as any good neurotic will do.  Last summer a rabid kitten in North Carolina potentially exposed 10 people when it was passed around a softball tournament, no one aware it was ill until it died and was tested.  Lots of people had to have rabies shots as a result.

This cat who had bitten me was long gone–there was no finding him in the vast woods and farmland surrounding us.  He couldn’t be kept in observation for 10 days and watched for symptoms, nor could he be sacrificed to examine his neural tissue for signs of the virus.

I called the health department to ask what their recommendation was in a case like this.  Do they recommend rabies immune globulin injection which should have been done as soon as possible after the bite?   I talked with a nurse who read from a prepared script for neurotic people like me.  Feral cats in our area have not been reported to have rabies nor have skunks or raccoons.  Only local bats have been reported to have rabies but not recently.  This cat would have had to have been bitten by a rabid bat to be rabid.  This was considered a “provoked” attack as I had reached out to pet the cat.  This was not a cat acting unusually other than having wrapped itself around my arm.  No, the Health Dept would not recommend rabies immune globulin in this situation but I was free to contact my own doctor to have it done at my own expense if I wished to have the series of 5 vaccination shots over the next month at a cost of about $3000.   Yes, there would be a degree of uncertainty about this and I’d have to live with that uncertainty but she reassured me this was considered a very low risk incident.

I knew this was exactly what I would be told and I would have counseled any patient with the same words.  Somehow it is always more personal when the risk of being wrong has such dire consequences.  I could see the headlines “Local Doctor Dies From Rabid Cat Bite”.

This is not how I want to be remembered.

Rabies is one of the worst possible ways to die.  The cases I’ve read about are among the most frightening I’ve ever seen in the medical literature. Not only is it painful and horrific but it puts family and care providers at risk as well.  It also has an unpredictable incubation period of a up to a month or two, even being reported as long as a year after an exposure.  What a long time to wait in uncertainty.  It also has a prodrome of several days of very nonspecific symptoms of headache, fever and general malaise, like any other viral infection before the encephalitis and other bad stuff hits.  I was going to think about it any time I had a little headache or chill.  This was assuredly going to be a real test of my dubious ability to stifle my tendency for 4-dimensional worries.

I decided to live with the low risk uncertainty and forego the vaccination series.  It was a pragmatic decision based on the odds.  My wounds slowly healed without needing antibiotics.  For ten days I watched for my attacker cat whenever I went to the barn, but he didn’t put in an appearance.  I put out extra food and hoped to lure him in.  It would have been just be so nice to see his healthy face and not have to think about this gray cloud hanging over me for the next few months, as I wondered about every stray symptom.  No gray kitty to be seen.

Almost a month has gone by now and he finally showed up last night.  I could have grabbed him and hugged him but I know better now. No more Dr. Doolittle.

He is perfectly fine and now so am I, cured of a terminal case of worry and hypochondria which is not nearly as deadly as rabies but can be debilitating and life shortening none the less.

You’d think I’d eventually learn…

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.