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When I asked her if she ever says no at work, her reaction is to laugh sardonically. "It's a bit of a shell game," she said. "I said yes to every request for probably 15 years. I took the hardest cases, worked the worst hours, volunteered on holidays—I'd do anything to make it into the hospital on those snow days when other doctors couldn't get their cars out of their garages. I stockpiled goodwill as if a nuclear war were coming." That strategy, she said, is what allows her to say no—selectively—now, and like magic, her life appears balanced. "In reality," she told me, "I paid up front."

Her husband, also a doctor, was listening in on our conversation. "She is also damned good at what she does," he said. "It helps a lot that she's made herself indispensable. The other docs desperately need her brain on the team."

His remark led to the three of us comparing notes on the professional women we've known who've started their careers with the boldly stated goal of work-life balance. "I've seen them a million times," my friend said, rolling her eyes. "They come in right after their residencies and immediately start trying to negotiate time off. Everyone can't stand them. They get managed right out. You can't say no until you've earned it, unless, of course, you're willing to pay the price of irrelevancy."

With that one comment, all the voices I'd been hearing began to harmonize. The question, I realized, is not whether you always have to say yes or when you can start saying no, but how you want to live your life. How much your identity is connected to career success. How fast you want your career to unfold and where you would like it to end up. There are as many answers to those questions as there are women.

And men. To be fair, men make career choices and feel their consequences, too, although usually not with the same blunt force as women. "My husband can say yes at work without too much hand-wringing," one of my stay-at-home friends said of her spouse, a senior manager at a high-tech company, "because I can clean up the mess when he does. Like when he said yes to the Denver transfer. I was packing the house and interviewing new pediatricians and everything else. He didn't have to think about any of that. His yes was easier." Even my working friends find their husbands can say yes to career choices with less angst because they know their wives will "mop up the logistics," as a partner in a PR firm I know puts it. When her husband, a lawyer, was asked to run his department and then the entire organization, she said, "it did not dawn on him how the kids would feel about his basically vanishing all of a sudden." To get through that period, she said, "I went to work, came home early, took the hit for saying no to a few clients, and fronted for him. And if I hadn't told him what I was doing for our lives, he wouldn't have noticed."

Her words, it is important to say here, were not angry or bitter. She loves her husband. She loves her job; she quickly regained lost ground. And she did that by saying yes to every challenge put in her path for a few months afterward.

Will she say no again someday?

Maybe. The choice will be hers. So, too, will the consequences—and the lives these decisions create for all of us.

Suzy Welch, a contributing editor at O, is the co-author of Winning (HarperBusiness).

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