This case involves an elderly male patient who presented to a rheumatology clinic for treatment of rheumatoid arthritis. The patient was placed on a regimen of methotrexate and instructed to visit the clinic on a monthly basis for follow-up. The patient was monitored by the clinic for one month before his dosage was increased. Despite the ongoing monthly follow-ups at the rheumatology clinic, no lab testing was performed. Eventually, the patient was admitted to the hospital with a variety of symptoms related to methotrexate-induced pancytopenia.