Against Medical Advice: What "Bad" Patients Teach Us by Mari Georgeson

    MARI GEORGESON, who is a Chicago native, lives in New York       City where       she is currently working as a Public Health Educator. " The Identification " appeared in the Fall 2015 Intima.

MARI GEORGESON, who is a Chicago native, lives in New York City where she is currently working as a Public Health Educator. "The Identification" appeared in the Fall 2015 Intima.

In “The Quixotic Pursuit of Quality,” by Dean Schillinger, and in my story, “The Identification,” (both Fall 2015 Intima) we have a couple of “bad patients.” They are not doing what their doctors want them to do.

John, in my story, makes quite a scene as he signs out of the hospital against medical advice. And Mr. Q repeatedly foils the painstaking efforts of his doctor to keep his precarious health afloat.

And then something unexpected, something mysterious happens in each story. “The underlying meaning of this role reversal still eludes me,” says Dean Schillinger, when Mr. Q, his patient, stands up and begins massaging him. But what is clear is that it marks a change in their relationship. And it brings about the question: can healing ever be one-directional?

The change in the relationship eventually led to a better understanding between doctor and patient, and it began to affect the patient’s health positively. Unable to say for certain what caused the change, Dr. Schillinger can’t add it to the list of best practices he implements with his patients, like annual eye exams. Whatever worked between him and Mr. Q cannot be applied across the board. It must be felt out at each step.

My patient had a much different outcome. In my story, I am called upon to identify John’s body after he has died. However, if you are willing to entertain the possibility of realms outside the physical, our relationship did continue, along with profound healing, on both sides. I believe that not only did I identify John, but he also “identified” me. As he was signing out of the hospital, John kept invoking my name, saying that he wanted me to take care of him. But I was not his doctor or his nurse or even his social worker. When he left the hospital, he kept my name with him in his pocket. On some level, again, if we admit to things slightly outside the known realm, John honored me by seeing who I really was, and knowing that I would see who he really was, in effect, “identify” him. Thus, we “identified” each other.

These stories remind us that patient/provider relationships are, in fact, relationships, with all the possibilities for misunderstanding, disagreement, frustration, conflict, mystery, healing, magic, and redemption that the word implies.


Mari Georgeson, who is a Chicago native, lives in New York City where she is currently working as a Public Health Educator. She strongly believes the relationship between patient and provider can be one of healing for both parties. Georgeson also writes fiction, and likes to spend her free time salsa dancing, or shushing down the highest mountain she can find.

© 2015 Intima: A Journal of Narrative Medicine