Impossible patient of the month

A simple-sounding case came in. Middle aged woman with advanced ovarian cancer that's metastasized to the abdomen. Underwent a major abdominal surgery (small bowel resection) just about a month ago. Decided two days ago to stop taking her pain medication (because pain medicine just masks the problem and she knows there's something wrong with her and refuses to be on pain medication until her real problem is addressed). So she presents with (surprise!) abdominal pain. We've done a workup. All her labs are essentially normal and an abdominal CT shows nothing other than expected post-surgical changes.

Easy, I think to myself, and walk in to the room prepared to have a conversation about how recovering from surgery takes time and how she has a good reason to have abdominal pain and how very logical it is that she may be dependent on pain medication for a little while.

I'm not even in the door when she starts:

"You all walk in here with your glib remarks and your know-it-all answers. But I know my body and I know when something's wrong with it and telling me that the cancer or the surgery is responsible for my pain is simply unacceptable."

(Which of course is the cause of her pain, and is what I was just about to tell her). She kept going:

"Five years ago, the doctors told me I had three months to live, if I'd listened to doctors (pronounced in the same tone of voice most patients use to describe things like poop or intestinal parasites) I would have been dead four years ago."

(I resist the urge to point out that a prognosis is not exactly a direct order to die immediately when the time is up.)

She continued for a good 20 minutes, calling me glib about three more times (I still hadn't spoken), and informing me that she did research on the internet and he presentation is classic for pancreatitis. I finally timidly interject, pointing out that we looked at her pancreatic enzymes and performed a CT and that she doesn't have any indicators of pancreatitis. She gives me a look that vaguely resembles the way people look at a puppy who keeps running into a glass window. Speaking very slowly: "People are not textbooks, dear. I have never presented typically."

I finally gave up and called her surgeon who agreed to talk to her. Long story short? A terminal cancer patient with abdominal pain following abdominal surgery who refused to take pain medication for her thoroughly expected pain was admitted to the hospital for a thoroughly unnecessary workup of her aforementioned pain.

The kicker. As I walked out I peeked at her chart. She'd been requesting Dilaudid (the strongest pain medicine we have in the ED) every 30 minutes since arriving.