We develop a practice perspective that integrates thought, context, and action to understand the work of a union representative as she tries to change, rather than reproduce, conditions for workers in an industrializing and downsizing hospital. By alternating our narratives, Suzan Erem, the union representative in the story, speaks for herself to present an inside view of motives, responses, and reactions, while Paul Durrenberger, an anthropologist, provides an outside observational and analytical perspective.