In this qualitative study, we explore variations in leader behavior that allow individuals to engage in “upward voice.” Under the extreme conditions of hierarchical distance in medical teams and task volatility, deciding whether to speak up is a delicate situation: remaining silent can endanger patients, but questioning superiors brings its own risks. Our sample comprises 12 acute care teams that solved cases in the simulation suite of a leading hospital. We deployed a microethnographic approach to analyze the unfolding of upward voice through vocal, emotional, and spatial cues. Facilitation emerged as the leadership style that resulted in most speaking up. Leaders must not only acknowledge input from team members, but also provide an explanation for acting (or not) on their remarks. This finding contributes to voice literatures by suggesting an interpersonal strategy for leader-member exchange in the discrete moment of speaking up. Besides verbal cues, the gesticulation of some participants revealed a physical tension when engaging in speaking up, which provides evidence for the balancing of opposing forces in such emotionally charged moments. We also add to an emerging theme in management that connects the discussion of emotions to that of behavioral change, which we ground in Schein and Lewin’s early theorizing.