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The result: "I am highly regarded now," she says, "but I am no longer in the inner sanctum."

"Is it painful?" I asked her. There was a pause, and then she replied, "Well, I hate it. But I'd hate busting apart our lives more." As for her husband, an artist, she said, "He'd move, but it would be crushingly lonely for him in another city.

"Look," she added, "I've spent a fair amount of my career saying yes. I've learned, of course, to say no occasionally to the small things, just to keep it sane at home. About five years ago, I turned down a 15-day trip to Asia that would have been very good for my career. These days, I generally won't look at e-mail on Sundays. But there's no question I will tell my daughter to say yes at work for a long time if she wants to get to the top. Right now I am living the consequences of saying a big no. Luckily I am old enough to know it was the right choice. But it was a choice."

I repeated this story to another friend—the consulting firm CEO—and she nearly fell off her chair at the restaurant where we were sharing a quick lunch before she ran off to a meeting. "How could she not move?" she cried in disbelief. "After all she fought for all those years? To give it up at the end? That's crazy. It's awful."

I asked her if a professional can ever say no if she wants to get ahead. "Never, never, never" was her instantaneous reply.

Some context: This is a woman who delayed having her two children until she was 41 because she loved her job so much. With her husband's support, she's made her career paramount in her life. Many of the country's most powerful CEOs rely on her counsel.

"You know why I never say no?" she asked me that day. "Because I think about the consequences of someone else saying yes. Someone else gets my piece of the franchise."

"But what about the personal price?" I asked. I reminded her of a Christmas dinner party a year back. Thirteen of us, including her husband, laughed, ate, drank, and sang all night long as the snow fell gently outside, while she stayed at the office working with a client in crisis mode. "Fine, fine," she snapped. "You know, I miss my teacher conferences, too. I miss school picnics. That is why I am at the top."

At which moment, she dropped her voice and leaned in. "To get where I am," she said, "I have given up so much. My job has inflicted untold brutality on my marriage. Untold brutality on my life. I will not start saying no and take the hit in my career, too. The price I've paid is already high enough."

I gently mentioned that she is the CEO—the top boss. Doesn't that give her the freedom to leave at 5 p.m., even one day a week? Again, a quick and decisive answer. "It is this hunger and insecurity that has made me CEO," she said. "Man or woman, winners go to work every day never letting up. Never letting their guard down for one second."

I couldn't wait to take these comments—indeed, this entire version of reality—to my friend the anesthesiologist. She is not a boss, but she is a member of a much-admired team at one of the country's best hospitals. Her life seems to contain remarkable flexibility. She's always competing in some road race or another, or practicing a song with one of her kids. Could a successful woman who wasn't particularly interested in climbing the ladder any higher say no with more ease? Or did her choice to stay put—and her nonboss status—make it even harder?

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