Often the patients that Jackie cares for are the patients who have been "outcasts" from our society. Most recently the patient, we will name MJ, was found to be throwing cans of food in the grocery store at his parents and the store's other customers. The police were called and the patient was brought to the ED on an emergency petition.

The patient is autistic, cared for at home by his parents - who during his 8 day stay in the ED demonstrated clear caregiver fatigue - yet they would not leave his side except for brief breaks. They became frustrated with the prolonged stay in the ED as there were no psychiatric hospitals with available beds that could manage a patient of MJ's acuity.

Jackie was able to reach out to the family, providing DVD's and other safe diversions for MJ in his small crisis room. She communicated frequently with the patient's family and caregivers with updates regarding bed availability and need for changes in medications to reduce MJ's escalating agitation and anxiety, which ultimately required occasional locked door seclusion.

On day 8 the family was increasingly frustrated with the psychiatric system that still could not provide an inpatient bed for their son. They verbalized their frustrations at the staff who attempted to listen empathetically, but could not provide the answer they wanted - when would their son move to a psych facility. Through this frustration they continually praised the efforts of Jackie; for her kindness towards their son who they identified as being a difficult patient to manage, her ability to communicate and establish a trusting relationship with MJ and them, and for advocating for medications that would assist MJ to tolerate the long stay in a confined area.

After approximately 180 hours in the ED, MJ was finally placed on an inpatient unit for ongoing care.