Medicine, as a scientific discipline, is discursively constructed, and medical discourse is constitutive of medical work. In the modern hospital, the official record of this activity is the patient’s medical chart. The medical chart both records the patient’s progress and inscribes the expert division of labor, documenting the structuring of participation and the manner in which the work is performed. This paper examines the impact of institutional structure on medical work through a comparison of notes recorded in the obstetrical units of two hospitals where the division of labor is differently distributed. Both cases involved a patient who was admitted to the hospital in apparently-normal latent labor but was found on initial examination to display signs of placental abruption, a life-threatening obstetrical emergency. By comparing the recording and management of this condition on the two units, I demonstrate the relationship of organizational structure to the structuring of medical work. In so doing, I reveal the subtext constructed by the writers’ discursive practices, through which their professional and institutional identities are enacted and displayed.