Hi, thanks for the responses; I appreciate it. To shed light on the incident in question, here are the details. I work in a long term care facility. I had a woman who has advanced Alzheimers that I sent to the ER for a query bowel obstruction. It is the ER doctor who filed a complaint; in fact he was FURIOUS that I sent her! My reasoning for sending her was: - No one had witnessed her having a bowel movement in 11 days. - Her abd was distended, and she was guarding it. She hit me when I tried to touch it. - I couldn't hear bowel sounds in the LUQ. - She has been given suppositories 2 days in a row with no result except a hard marble sized poop. When I came on my night shift the following night no one had yet to give her an enema. We normally give supps/enemas around 6:00 in the morning but she had woke up around 2am screaming. After almost 2 hrs of screaming I figured she was probably uncomfortable d/t constipation and decided to give her the enema at 4am thinking it would give relief. I did not get much of a result so I was concerned. - I tried paging her doctor twice (before and after enema) but he never answered. - For the last 3 days she had straining on the toilet complaining of pressure. - She was screaming in pain and I had nothing left to give her. I just felt like I had no other option but to send her. Please be honest. Was I wrong in sending her, as the doctor furiously suggested?