This case involves the care of a patient who had stroke-like symptoms which were recognized by nursing staff members. However, the internist on call was unavailable to see the patient and the delay in treatment lasted more than 3 hours. The symptoms were first recognized as “stroke like” within 1 hour of presentation and this patient would have otherwise been a candidate for tPA. Since the patient wasn’t seen by the internist until after the 3 hour window, the patient was no longer a candidate for TPA. The patient suffered from a massive stroke and died 2 months later of resulting complications.