On the morning of October 31, 2019, concerned parents, Mustapha and Hanane, brought their 10-month-old son to the emergency room at Saint Mary’s Hospital in Waterbury. For a few days, their baby had been vomiting, irritable, and showed sudden weight loss. Saint Mary’s emergency medical staff examined the infant and discharged the family less than three hours later with the diagnosis of viral gastroenteritis (stomach flu) and dehydration. They were instructed to follow up with their pediatrician, who had referred them to the ED in the first place. Approximately twelve hours later, the frantic parents returned to the ED as their baby’s symptoms had worsened. It was then that their child was properly diagnosed with a life-threatening condition known as intussusception—when a segment of the intestine slides or telescopes into an adjacent segment of intestine, often blocking food and fluid from passing through and cutting off blood supply to the affected intestine. The child was promptly transferred to Yale-New Haven Hospital for critical treatment. In failing to properly work through the correct list of differential diagnoses during the family’s first ER visit, and prematurely discharging an acutely ill patient, the infant was deprived of curative non-surgical treatment, suffered profound septic shock, and required multiple surgeries to remove substantial portions of necrotic (dead) bowel. The child also required a lengthy hospitalization and subsequent care to address infection, bowel repair, and nutritional support. Now a toddler and the youngest of the family’s four children, Mustapha and Hanane’s son still suffers the effects of his delayed diagnosis and will likely incur further medical costs well into his future.