The other night I was working in our critical care area when a patient arrived via EMS looking like a poorly-drawn cartoon character. Massive swelling from edema from the neck down to the toes. Basically, he was a human Michelin Man. Hypertensive to the tune of 270/140s, CHF, SOB. Of course, he had prescribed meds for all his underlying conditions, but he hadn't taken them for months because he didn't like doctors.
Unfortunately, it got worse for the poor gentleman. To get a urine sample, the nurse tried to insert a foley. After a few tries, the doc attempted. Then urology. Turns out he was so swollen, even they couldn't get it in, and left the guy moaning in a blood-soaked gown. Probably didn't improve his opinion of doctors very much.
For so many of these kinds of patients, I often wonder at what point they realize that they have a problem. Many times it's family members who call 911, but if I were blown up like a balloon, I might try to do something about it.