In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the authors explore care for a patient with history of being abused, borderline personality disorder, substance use disorder, and a complex psychiatric history who was labeled by staff as a "hateful patient." He presents frequently after self-harming, requiring surgery and short-term psychiatric treatment. Complex behavioral issues and erratic acceptance of nursing and medical care led to staff frustration and unprofessional chart notes. Transfer to a long-term treatment setting was difficult to negotiate. Several months after discharge, the patient died. The authors are haunted by the patient’s desperation and deep loneliness. He wished he could remain hospitalized where he felt cared for. Authors wondered what more could have been done to help him.