Personally I think the PCA is a BIG mistake. I can understand why a physician wouldn't want to order it. PCAs are for initial post-op pain, not 2 weeks post-op. Yes, he is still getting dilaudid frequently, and yes, it is a pain for you, but he really probably shouldn't be placed on a PCA. Whenever I have a patient who I suspect is drug seeking I try to remember that there may be a psych component to their illness. Many drug addictions co-exist with mental illness. Addiction, if indeed he is struggling with this, is very difficult for caregivers to deal with. You have every reason to be frustrated. But, you must remain professional with the patient and not convey that to him. Set limits and take the time to calmly discuss treatments and medications with him.
Sorry you're having a rough time. This probably won't be the last patient that you will deal with in your career who you suspect is drug seeking. Just remember, I have suspected this in the past about patients and have been wrong! Something to keep in mind.