Lexi knew something was wrong with her patient. The patient had a diagnosis of a partial small bowel obstruction. The patient had no NG and had been told, “We were waiting on surgery to determine a plan of care.” Her patient was in EXCRUCIATING pain, even after five doses of prn pain meds, given since arrival. Lexi addressed her concerns first thing in the am while rounding with the hospitalist, and medications were changed and trialed. Lexi watched her patient, who was declining throughout the morning. At 11 am, she came to me, as charge, and asked me to look at him. She again mentioned her concerns at interdisciplinary rounds and was again told… “awaiting surgery for the plan of care.” One hour later, she again came to me and said that the patient now had a panic lactic acid level and asked me to intervene. Lexi felt the MD was not taking her concerns seriously.

We messaged (perfect-served) the doctors. Both the hospitalist and the surgeon arrived on the unit. The surgeon had re-examined the CT scan, and with the elevated lactic and now elevated white blood cell count, they took the patient to emergent surgery. The patient had a laparotomy, lysis of adhesions, small bowel resection (15 inches removed), and an appendectomy. All of these surgeries at 91 years old!! I feel that Lexi’s persistence helped lead to this patient having a positive outcome instead of the patient continuing to deteriorate.