Samira contacted me regarding her concerns about one of her patients. She had worked all day on day shift and had been held over late. I was providing overnight coverage for the resident teaching service, and she contacted me around 8 pm with concerns about a patient’s mental status as well as elevated CO2 on a blood gas. After evaluating at bedside, I made the decision that the patient needed ICU level care. After the patient’s arrival to the ICU, she was placed on BiPAP but inevitably required intubation. She also ended up requiring pressors for hypotension, which shifted as well. I want to recognize Samira because, after a long 12-hour shift that turned into much longer (I saw her leaving the hospital close to 10 pm that night), I really appreciated that she contacted me and conveyed her concerns instead of passing them off tonight's coverage. It meant more coming from her because she had been with the patient all day long and could vouch that this was an acute mental status change from earlier in the day. Had this patient not been transferred to the ICU, she would have decompensated on the floor and very likely could have died. Job well done, Samira!!