Betty was a 72-year-old paraplegic patient with a full thickness ischial pressure ulcer. After an overview of the care delivered in hospital, this case study will focus not on the management of the wound but on the attempts made towards safe discharge home of the patient after an initial failed discharge. The diversity of problems encountered over a period of 18 months proved extremely challenging for all disciplines involved and required the development of close working relationships to achieve an eventual successful outcome. On reflection there are many aspects of this case that would undoubtedly be now managed differently. I had been in post for only a short time when my involvement with the patient began and my links with other members of the multidisciplinary team were tenuous. However the relationships fostered over this period of time have ensured that future cases have been dealt with efficiently and effectively. The case study concludes with a happy ending for the patient when successful surgery to repair the ulcer was initiated, not by medical or nursing personnel but by the patient herself.