A 92-year-old woman with a history of stroke comes to an emergency department and is found to have fractures of her cervical spine. Neurosurgery sees her but doesn't think she needs surgery. The emergency department physician tries to admit her to the hospital as she has a new functional disability due to the fall but the hospitalist refuses as the patient doesn’t meet criteria for inpatient admission. And there she sits for another 23 hours while her fate is being decided… She has now entered a new state in modern medicine: purgatory. "Purgatory" can be defined as "a place or state of temporary suffering or misery." This is a very apt description, used in a recent JAGS article by Timothy Platts-Mills, Scott Owens, and Marvin McBride , for what happens when patients are seen in the emergency room for an non-surgical injury but don't meet standard hospital admission criteria (as detailed in the InterQual guidelines) and can’t safely return home