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

‘Is there anybody there?’ said the Traveller,   
Knocking on the moonlit door;
And his horse in the silence champed the grasses   
Of the forest’s ferny floor:
And a bird flew up out of the turret,   
Above the Traveller’s head:
And he smote upon the door again a second time;  
‘Is there anybody there?’ he said.
But no one descended to the Traveller;   
No head from the leaf-fringed sill
Leaned over and looked into his grey eyes,   
Where he stood perplexed and still.
But only a host of phantom listeners   
That dwelt in the lone house then
Stood listening in the quiet of the moonlight   
To that voice from the world of men:
Stood thronging the faint moonbeams on the dark stair,   
That goes down to the empty hall,
Hearkening in an air stirred and shaken   
By the lonely Traveller’s call.
And he felt in his heart their strangeness,   
Their stillness answering his cry,
While his horse moved, cropping the dark turf,   
’Neath the starred and leafy sky;
For he suddenly smote on the door, even   
Louder, and lifted his head:—
‘Tell them I came, and no one answered,   
That I kept my word,’ he said.
Never the least stir made the listeners,   
Though every word he spake
Fell echoing through the shadowiness of the still house   
From the one man left awake:
Ay, they heard his foot upon the stirrup,   
And the sound of iron on stone,
And how the silence surged softly backward,   
When the plunging hoofs were gone.
~Walter De La Mare “The Listeners”

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 was 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 my clinic work load and my 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.

Even so, in a moment of clarity about my role and commitment to those I was responsible for, I called my patient to find out how she was doing. She didn’t answer her phone.

I mulled over my options. Protocol was to call the police to go to her address for a “well-being” check. I looked up her apartment address and decided instead to drive 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 to open 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 inpatient 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 chaos and delay, and the possibility of an involuntary detainment.

She agreed to come with me and be admitted voluntarily for stabilization. When I went to the hospital to see ger the next day, 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. It was the start of her climb out of her pain and depression.

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 it became the knock on the door 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_____”

Somehow I had the sense that I needed to go knock on her door because I was keeping my word to take care of her at her lowest point. 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 kept me on the job for another twenty years.

With her letter, she knocked, oh so gently, on my own locked door. I opened it, amazed that someone cared enough to let me know I kept my word.