We implemented an end-to-end notification system that pushed urgent clinical laboratory results to Blackberry 7510 devices over the Nextel cellular network. We designed our system to use user roles and notification policies to abstract and execute clinical notification procedures. We anticipated some problems with dropped and non-delivered messages when the device was out-of-network, however, we did not expect the same problems in other situations like device reconnection to the network. We addressed these problems by creating cascading "fault tolerance" policies to drive notification escalation when messages timed-out or delivery failed. This paper describes our experience in providing an adaptable, fault tolerant pervasive notification system for delivering secure, critical, time-sensitive patient laboratory results.