Uhm, I usually don't get gifts, so I guess not much could be worse than nada. Though I think the worst I ever got was from someone who claimed to be my "best friend" several years ago for my birthday...we worked together (so we drove into work together, taking turns driving - this instance she drove) and after we got out of work (at 11pm) she wanted to go have sex with this guy that we worked with. He lived with his step dad, so for them to have the apartment to themselves, the step dad was going to drive me home (an hour's drive one way) and then he was going to get a motel room for the night. She had this all planned out and never told me until we were leaving work that night. But yeah, apparently this guy's step dad had no intentions of driving me home and instead just drove around suggesting that we go get some beer or something to eat as a "birthday present", but I refused, I just wanted to go home. Anyway, he got a motel room and I was stuck (this is a very small, rural area and we have no public transportation, I don't have a cell phone, either he eventually takes me home or I'm stuck in the middle of nowhere in the middle of the night). I never did get home until after noon the next day when I had to walk up to a gas station and call my mother to come get me.
Moral of the story: don't trust slut bitches who get you raped on your birthday (apparently she had "promised" me to this dirtbag to get the apartment in the first place) and of course that would be the worst gift I ever received. Honestly, none of my other birthdays have been much better.