Cheryl came to work at 11 pm. She accepted care for a 67-year-old female who was here for abdominal pain and diverticulitis. The patient had a chest x-ray completed at 6 pm prior to her arrival on the unit. Cheryl was able to recognize the patient's abdominal pain had become more severe and began looking through the medical record to discover the reason why. When she discovered that the patient had free intraperitoneal air on the x-ray she alerted the covering hospitalist, ensured that all follow-up testing was completed timely, and ultimately assisted with transferring the patient out to a tertiary facility by the end of her shift. I have no doubt that this patient could have a poor outcome if had not been for Cheryl's alertness to her patient's deteriorating symptoms and to her subsequent discovery of the perforated bowel. This an example of excellence in nursing care that I want to recognize for a truly excellent nurse.