Turning her focus away from Mrs. Jackson’s particular case, Abraham examines the urban emergency room, which she argues “is where the inequities and distortions of a health-care nonsystem—one driven more by patients’ ability to pay than by their medical need—are most obvious” (93). Over the course of one night shift, she follows the emergency room doctors at Mt. Sinai as they juggle an overwhelming and fast-paced caseload. Uninsured patients flock to the emergency room because they cannot afford other doctors and because the emergency room doctors cannot turn patients away. While shadowing this particular night shift, Abraham watches the doctor juggle 12 cases at the same time with a limited number of beds available, including two teenage pregnancies, a gunshot wound victim, and a young boy with a soccer injury. Though several of these cases could (and probably should) have been handled by doctors in other departments, emergency doctors are so used to this way of working that they find a way to manage with minimal complaints.

Having established the fraught working conditions at Mt. Sinai in the book’s present day, Abraham provides an overview of the hospital’s history up to that point. This history helps to explain why the emergency room workers of the late ‘80s and early ‘90s found themselves overwhelmed and under-resourced.