She was thrashing around so much, that the IV team couldn't get a line in her. After she had been there three hours, the lab called and told us that there was only enough blood for them to run the lactic acid level... that I could forget about all the other tests I had ordered. So finally, I went in there and consented her for a central line insertion because if nothing else, I can't even admit someone for intractable pain if they don't have IV access.
She was sleeping soundly when I went in the room. After explaining the procedure to her, she started slamming her arms and legs into the bed, like your average two-year old throwing a tantrum in the candy aisle at the grocery store. I just stood there until she wore herself out. I had a long discussion with her about how I would not continue to give her muscular injections of morphine because if something bad happened I needed an IV line. She agreed to the line, and also agreed to let the nurses try one more time. This time, she miraculously held still so that we finally got her labs. Everything was negative.
A contrast-enhanced catscan was ordered. Then she started playing new games, "accidently" spilling her oral contrast solution all over the floor and whining about having to drink it. I went in there again and had another discussion with her about why she would come to the hospital for help and then refuse any kind of assessment from blood draws, to x-rays, to CT scans. She was still there drinking contrast at the end of my 8-hour shift. The new attending coming on decided to take over this patient personally. She has a reputation for not putting up with any behavioral crap, and was talking to me about putting restraining orders on patients that spit at her. I'm interested to find out how the situation turned out.