Elder Series – Against Medical Advice

M Dawn Thacker has compiled a series of short stories about elders, their experiences aging, and the challenges they face. M Dawn continues her series with Against Medical Advice…


When Missy met John Smith, he seemed as simple a man as his name suggested. He wasn’t big, nor was he small. The hair under his dirty “Built Ford Tough” cap hung on his shoulders, and long gray whiskers sprung wiry from his chin. What skin showed on his face and neck was wind burnt and leathery. His jeans were frayed at the hem and faded to almost white. He wore layers of shirts, tee, long sleeve pullover, and button down plaid flannel. The only thing he carried was a pair of too-small running shoes. They rested in his lap as he sat in the wheelchair, right elbow on the armrest, forehead resting on his fist.

Missy found out that the shoes were his ticket into the nursing home. They had squeezed the sore onto his foot. It wouldn’t heal, became infected, and gave him a fever. The hospital report documented a 911 call from a woman who said she was a friend of Mr. Smith. She called to report that he began talking out of his head. His friend couldn’t get him warm enough to stop his teeth from chattering. When the ambulance picked him up he was alone on the sidewalk outside a convenience store, covered in a woman’s wool coat. The ambulance dropped him off at the emergency room. After a three night stay at the hospital, he came to the nursing home for a month of IV antibiotics.

After taking his vitals, Missy sat down for Mr. Smith’s history. “Where do you live?”

He kept his eyes and his voice lowered. “Here and there, mostly in town.”

“Do you have a wife, children?”

Mr. Smith slowly shook his head from side to side. “Used to, not anymore. What did you say your name is?”

Missy reached out to touch his hand as it rested on his knee. He drew it back, crossed his arms over his chest.

“My name is Missy. Do you have any family or friend to contact in case of emergency?” She asked.


He either had a scant medical history, or didn’t want to discuss it, because his answers were all monosyllabic. Missy offered him a snack to tide him over until dinner, a soda, a shower. He shook his head no, pulled the small television in front of his face, turned it on to one of the Judge shows, and tuned Missy out.

“I’ve seen him on the street,” Missy told one of the other nurses. “He hangs out in front of the Lucky Seven on Tolbert Avenue. I’ve given him money sometimes and bought him a sandwich once I think. Maybe that’s why he’s so quiet. Maybe he recognizes me.”

John never became a talker, but spoke with Missy more than most. He told her she reminded him of someone. He stayed to himself, accepted help with his care, let the nursing assistants give him a shave and haircut. He was in the nursing home through Christmas. Missy organized staff members in adopting John. Santa arrived, sounding like Luke, the evening Orderly, and unpacked his sack at John’s feet. John’s face turned a deeper shade of rust, but he thanked the staff for his gifts as they stood watching him open what “Santa” had brought.

He got a bright green and yellow John Deere cap to replace the old dirty one he’d come in with. His stocking overflowed with candy, cookies, fresh fruit, toiletries, a Timex watch, and a comb for his hair. He received enough new clothes to fill his dresser and a pair of insulated low-top boots that were a size Ten-E, and fit. If he didn’t act it, John looked like a new man.

Missy came in one morning and announced, “Your antibiotics are finished John. I’m going to remove the catheter.”

“Does that mean I can go?” he asked.

Missy knew he didn’t have anywhere to go but the street. Professionally, and ethically, she was required to recommend discharge only to a safe place. “Your medical treatment’s complete, but the doctor has to give an order for discharge.”

“Can you talk to him and get me the order?”

“I don’t think he’ll write it John. You don’t have anywhere to live.”

“What’s to keep me from walking out?”

“Nothing really, but you’d have to sign out against medical advice. If you do that, we can’t help you. We’re not allowed to call in your prescriptions or equipment you might need. The home health agency wouldn’t check on you.”

“I didn’t have none of those things when I came in here,” he countered.

Missy shook her head and sighed. “No you didn’t, but you were in pretty bad shape with the wound on your foot. It’s dangerous to go back to the streets. Why would you want to anyway with a warm bed, three hot meals a day, and people who care about you here?”

John had settled into the nursing home routine pretty well. He mostly kept to himself, but talked to the staff, kept his room tidy, followed his shower schedule and accepted care. He enjoyed television. On Tuesday evenings when the nurses ordered pizza for dinner, he came to the desk and joined them for a slice.

He looked at Missy for a long time before he answered her question. “I don’t know exactly. I just want to leave.”

Missy wondered about the alcohol. She’d seen him with a paper bag-covered bottle outside of the Lucky Seven. He’d not had alcohol since being admitted to the nursing home, but when he began with the shakes, the facility Medical Director ordered meds for John’s DT’s.

When the nurse did rounds a little after change of shift that day, John wasn’t in his room. He was known to visit the vending machines down the hall sometimes or even to go out to the parking lot occasionally and walk around once his foot healed, so she didn’t worry at first, but when John’s meal arrived and he wasn’t there, staff began a thorough search. John was gone.

The nursing home Administrator called the police, who took a report along with John’s history, surveyed his room and left. John’s new clothes were folded neatly in drawers. His toiletries were still there, arranged from shortest bottle to tallest in the plastic wash basin. His new John Deere Cap laid on his nightstand, facing the door to his room. The old “Built Ford Tough” hat was gone. He’d traded his faded jeans for new ones though, and the insulated boots along with several pairs of heavy socks were gone. John didn’t take many of his snacks, only the peanut butter crackers. The rest were wrapped in green striped tissue paper and packed in the red holiday box from Christmas. John’s bed was made, and the television was turned off. Staff kept his room untouched for a week, hoping he’d return.


The National Weather Service bulletin squawked its warning in monotone over the radio at the nurse’s station a month later. Missy looked out the window at the first fat flakes of snow swirling down. “A winter storm warning is in effect for the city of Charlottesville, the Counties of Albemarle, Augusta, Buckingham, Louisa, Nelson, Greene, Fluvanna. Wind north at twenty-five with gusts to thirty-five, producing wind chill of eleven. Snow and blowing snow will reduce visibility to one-eighth of a mile. Drifting and blowing snow will make driving hazardous.”

The sky was a dark, metal gray, and hung heavy. Missy thought about John. Then, she broke nursing home policy. She grabbed her boots, hat, coat, and an empty box from the utility room. She filled it with some thermal blankets, a heavy coat that had been hanging in the staff coat closet for over a year, and several pairs of unclaimed wool socks from the laundry. She stopped by the kitchen and asked Delores to wrap up some supper in a Styrofoam to-go container. She told the staff she was taking her dinner break and she clocked out.

The snow was coming down hard and beginning to stick to the roads. Missy’s car was a small, two door Toyota with little tread on the tires. She took it slow as she turned onto Marshall Drive which lead to Tolbert, toward the Lucky Seven. She pulled into the parking lot, but John wasn’t in his usual spot. Missy turned off the engine and went inside. The clerk hadn’t seen him in a few days, but that was not unusual. The Corporate people had been there and when they arrived, John and his friends scattered as police patrols picked up.

“Have you checked behind K-Mart? I hear there’s kind of a homeless compound there.” The clerk told Missy.

“Thanks, I’ll head that way.”

“You really shouldn’t go there alone,” the clerk warned. “It could be dangerous. You never know with those people.”

“Thanks,” Missy said. “John’s my friend. I’ll be alright.”

K-Mart was another two miles to the East at the top of a long hill. Missy tried to think of another way to get there, but couldn’t. There weren’t many cars on the roads. People were heeding the warnings and staying home. Missy wondered about her sanity. She almost turned the car around to go back to work, but her conscience got the better of her. She kept thinking about her father, or uncles and knew that she would want someone to be concerned about them if they were out in these conditions.

She sat at the bottom of Shepherd’s Hill and took a deep breath. She eased down on the gas and started up the incline. Halfway up, the back end of the car started sliding to the right. Missy remembered her father’s words, “Steer into the slide.” She turned the wheel to the right and the car straightened up, but she also let off the gas and when she put her foot back on the accelerator, she began to spin. She put her foot on the brake.

“What kind of idiot am I?” she asked out loud to the box of blankets in the passenger seat. “I should have my head examined. What’s wrong with me?”

She backed down to the bottom of the hill, backed further and took off a little faster to get up some speed going up the hill. Again, halfway up, the back of the car started sliding. Missy turned the wheel in the direction of the slide, but kept her foot on the gas this time and slowly crept up the hill to the top. K-Mart’s red sign shined its encouragement as Missy pulled into the parking lot and made her way down the gravel lane behind the store.

The lane stopped. There were no other cars back there, only a stand of thick evergreen trees and darkness beyond them. She didn’t know what she expected to see, tents she guessed, or big cardboard boxes with cut out doors and welcome mats. She shook her head to clear the images. Taking another deep breath, Missy pulled her hat down low over her ears, put on her gloves and flexed her fingers in their leather casings. “I can do this,” she said.

She opened the door, grabbed the cardboard box and started walking toward the woods. It was so quiet. The snow muffled any noise, except the squeak under her boots as she walked toward the trees. She ducked beneath some low hanging branches of a Pine and the snow stopped falling. It was clear under the trees. A thick bed of pine needles cushioned her steps as she pressed forward. In the distance she could see some hulking forms. She almost put the box down and ran, but saw a movement to her right. It was a person.

“Who are you?” the woman asked in a voice full of gravel and sand. She had on a puffy olive green coat. Gray frizzy hair stuck out from under a brown knit wool stocking cap and she had a purple crocheted afghan around her shoulders. Her pants were long and black. She wore hiking boots.

“My name’s Missy. I’m looking for John Smith.”

“Sure your name ain’t Pocohontis?” the woman cackled at her own joke.

Missy smiled. “Positive,” she said. “Do you know a man named John Smith?”

“I might,” said the woman, her eyes turning to slits, her brow turning to furrows. “Why do you want to know?”

“I have some things for him.” Missy said, pointing her chin toward the box.

“Oh really?” asked the woman, her bushy eyebrows raised in curiosity now.

“Can you tell me where he is?” asked Missy.

“Not really sure,” the woman said, eyeing the box. “Haven’t seen him in a few days. You wanna leave that with me, I’ll make sure he gets it.” Missy imagined the woman rubbing her hands together.

“I appreciate that, but I’d really rather give it to him myself.”

In the distance, a couple more people appeared, their shoulders hunched against the cold. They were wrapped in coats. One had a hat, the other a fur-trimmed hood. The taller of the two had a blanket around his shoulders. They moved toward Missy and the woman.

“She’s looking for John”, the woman said. “You two seen him lately?”

A tall, bent man with a pony tail hanging below his hat, and a cigarette between his fingers, said, “He was here yesterday or the day before. I haven’t seen him today.” As the man exhaled smoke, it mixed with his breath, making a big white cloud above his head.

“Do you have any idea where I might find John?” Missy asked. Snow was beginning to make its way into the canopy of trees and flakes landed in the cardboard box in her hands and on the heads and shoulders of the homeless people standing around her.

“Oh, he’s hold up in a shed somewhere keeping warm with a bottle or Miss Millie, or both,” the other shorter man said, laughing. “Don’t have to worry about John. He’ll take care of himself.” The man brought his hands together in front of his mouth and blew.

“I brought him some things I thought he might need,” Missy said, her voice and gaze dropping.

“That was real nice of you young lady,” the tall man said. If you want to leave them here. I’ll make sure he gets them.”

Missy believed the man, but it didn’t really matter anymore. “That’s alright. If there’s anything in here you can use, please help yourselves. She handed the tall man the box, turned and walked to her car. She drove back and finished her shift at work.

That night Missy dreamed about an eagle, perched high on the ledge of a mountain top. He held tight to a limb, sitting straight and tall, his coat of feathers warm against his muscles. He opened his eyes and looked up into the snow as it fell. He lifted off the mountain and glided through the flakes, colder as he flew, but free.


Against Medical Advice © 2011 M Dawn Thacker. Read M Dawn’s latest on Now.readthisplease.com and check back for the next story in her Elder Series.



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