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A 29 year old male with a history of swallowing objects and recent abdominal surgery presented to the emergency department (ED) after “accidentally” swallowing a pen. A chest radiograph was performed that verified the presence of the pen. The gastroenterology service performed an emergent EGD to remove the pen. Six hours after the procedure the patient signed out against medical advice. The patient returned to the ED 10 days later with complaints of hematemesis that was unwitnessed by any medical staff. On laboratory evaluation his hemoglobin was the same as the previous admission. Psychiatry subsequently interviewed the patient and found he had gone to Hahnemann Hospital after swallowing a knife and was subsequently transferred to a Psychiatric facility after being medically cleared with no knife having been found or retrieved from the patient’s abdomen. After re-presenting to Jefferson he left against medical advice once again.