Julie noticed the patient's bilateral leg weakness and lack of reflexes on her initial exam. The patient had stated that these complaints were voiced in the emergency room, but they had not been noted on an ER exam. Julie was concerned enough to bring the deficit to the attention of her charge nurse, the clinical supervisor, and eventually the nocturnist. The patient had an emergent MRI and was taken to the University of Cincinnati and had surgery within hours of arrival to relieve pressure on her spinal cord. Without her observations and concern, the patient could have been paralyzed! Strong work Julie!