PASSAGE ONE

(1)When I was 10 years old one of my father’s customers had caught a big catfish on a weekend trip to the Colorado River. It weighed 86 pounds, a swollen, gasping, grotesque netherworld creature pulled writhing and fighting up into the bright, hot, dusty world above.

(2)The man had brought the fish, wrapped in wet burlap, all the way out to my father’s service station in the back of his car. We were to have a big barbecue that weekend, and I was given the job of keeping the fish watered and alive until the time came to kill and cook it.

(3)A11 day long that Friday — in late August, school had not yet started — I knelt beside the gasping fish and kept it hosed down with a trickle of cool water, giving the fish life one silver gasp at a time, keeping its gills and its slick gray skin wet: the steady trickling of that hose, and nothing else, helping it stay alive. We had no tub large enough to hold the fish, and so I squatted beside it in the dust, resting on my heels, and studied it as I moved the silver stream of water up and down its back.

(4)The fish, in turn, studied me with its eyes, which had a gold lining to their perimeter, like pyrite. The fish panted and watched me while the heat built all around us, rising steadily through the day from the fields, giving birth in the summer-blue sky to towering white clouds. I grew dizzy in the heat, and from the strange combination of the unblinking monotony and utter fascination of my task, until the trickling from my hose seemed to be inflating those clouds — I seemed to be watering those clouds as one would water a garden. Do you ever think that those days were different — that we had more time for such thoughts, that time had not yet been corrupted? I am speaking less of childhood than of the general nature of the world we are living in. If you are the age I am now — mid-50s — then maybe you know what I mean.

(5)The water pooled and spread across the gravel parking lot before running in wandering rivulets out into the field beyond, where bright butterflies swarmed and fluttered, dabbing at the mud I was making.

(6)Throughout the afternoon, some of the adults who were showing up wandered over to examine the monstrosity. Among them was an older boy, Jack, a 15-year-old who had been kicked out of school the year before for fighting. Jack waited until no adults were around and then came by and said that he wanted the fish, that it was his father’s — that his father had been the one who had caught it — and that he would give me five dollars if I would let him have it.

(7)“No,” I said, “my father told me to take care of it.”

(8)Jack had me figured straightaway for a Goody Two-Shoes. “They’re just going to kill it,” he said. “It’s mine. Give it to me and I’ll let it go. I swear I will,” he said. “Give it to me or I’ll beat you up.”

(9)As if intuiting or otherwise discerning trouble — though trouble followed Jack, and realizing that did not require much foresight — my father appeared from around the corner, and asked us how everything was going. Jack, scowling but saying nothing, tipped his cap at the fish but not at my father or me, and walked away.

(10)“What did he want?” my father asked.

(11)“Nothing,” I said. “He was just looking at the fish.” I knew that if I told on Jack and he got in trouble, I would get beaten.

(12)“Did he say it was his fish?” my father asked. “Was he trying to claim it?”

(13)“I think he said his father caught it.”

(14) “His father owes us $67,” my father said. “He gave me the fish instead. Don’t let Jack take that fish back.”

(15)“I won’t,” I said.

(16)I can’t remember if I’ve mentioned that, while not poor, we were right at the edge of poor.

(17)The dusty orange sky faded to the cool purple-blue of dusk. Stars appeared and fireflies emerged from the grass. I watched them, and listened to the drum and groan of the bullfrogs in the stock tank in the field below, and to the bellowing of the cattle. I kept watering the fish, and the fish kept watching me, with its gasps coming harder. From time to time I saw Jack loitering, but he didn’t come back over to where I was.

(18)Later in the evening, before dark, but only barely, a woman I thought was probably Jack’s mother — I had seen her talking to him — came walking over and crouched beside me. She was dressed as if for a party of far greater celebration than ours, with sequins on her dress, and flat leather sandals. Her toenails were painted bright red, but her pale feet were speckled with dust, as if she had been walking a long time. I could smell the whiskey on her breath, and on her clothes, I thought, and I hoped she would not try to engage me in conversation, though such was not to be my fortune.

(19)“This’s a big fish,” she said.

(20)“Yes, ma’am,” I said, quietly. I dreaded that she was going to ask for the fish back.

(21)“My boy and my old man caught that fish,” she said. “You’ll see. Gonna have their pictures in the newspaper.” She paused and stared at the fish as if in labored communication with it. “That fish is worth a lot of money, you know?” she said.

(22)I didn’t say anything. Her diction and odor were such that I would not take my first sip of alcohol until I was 22.

PASSAGE TWO

(1)Improving the balance between the working part of the day and the rest of it is a goal of a growing number of workers in rich Western countries. Some are turning away from the ideals of their parents, for whom work always came first; others with scarce skills are demanding more because they know they can get it. Employers, caught between a falling population of workers and tight controls on immigration, are eager to identify extra perks that will lure more “talent” their way. Just now they are focusing on benefits (especially flexible working) that offer employees more than just pay.

(2)Some companies saw the change of mood some time ago. IBM has more than 50 different programmes promoting work-life balance and Bank of America over 30. But plenty of other firms remain un-convinced and many lack the capacity to cater to such ideas even if they wanted to. Helen Murlis, with Hay Group, a human-resources consultancy, sees a widening gap between firms at the creative end of employment and those that are not.

(3)The chief component of almost all schemes to promote work-life balance is flexible working. This allows people to escape rigid nine-to-five schedules and work away from a formal office. IBM says that 40% of its employees today work off the company premises. For many businesses, flexible working is a necessity. Globalization has spread the hours in which workers need to communicate with each other and increased the call for flexible shifts.

(4)Nella Barkley, an American who advises companies on work-life balance, says that large firms are beginning to understand the value of such schemes, “but only slowly”. For most of them, they still mean little more than child care, health care and flexible working.

(5)Yet some schemes go well beyond these first steps. American Century Investments, an investment manager in Kansas City, pays adoption expenses and the cost of home-fitness equipment for its employees. Rob Marcolina, a consultant with Bain & Company based in Los Angeles, was allowed time off to marry his partner in Canada. Mr Marcolina, who has an MBA from the high-ranked Kellogg business school, says his employer’s understanding makes him want to be “part of Bain for some time”.

(6)Businesses have other good reasons for improving employees’ work-life balance. Wegmans Food Markets, a grocery chain based in Rochester, New York, frequently appears near the top of lists of the best employers in America. It has a broad range of flexible-work programmes, which gives it one of the lowest rates of employment turnover in its industry — 8% a year for full-time workers, compared with 19% across the industry.

(7)Simple programmes can be surprisingly cost-effective. IBM, for instance, is spending $50m over five years on “dependant-care” facilities for its employees. Although that sounds generous, it is the equivalent of little more than $30 for each IBM employee every year. That is far cheaper than a pay rise and probably a better way to retain talented mothers and fathers. Ernst & Young, a global accounting firm, has a low-cost range of initiatives called “People First”. It provides breaks for people to provide care and has over 2,300 flexi-time employees in the United States. James Freer, a senior executive, says he is “absolutely convinced” the initiatives help produce better financial results.

(8)DeAnne Aguirre, a mother of four and a senior partner in San Francisco with Booz Allen Hamilton (BAH), says “it is easy to make the business case” for work-life balance programmes at the consultancy by looking at attrition rates. BAH calculated that it was investing more than $2m in turning a raw recruit into a partner, an investment it should be reluctant to write off. Corning, an American glass company, reckons that it costs 1.5 times a worker’s salary and benefits to replace him. If it can retain just 20 workers a year who would otherwise have left, Corning reckons it would produce annual savings of $2.6m.

(9)The spread of flexible work has come about at least partly as a result of initiatives to keep women workers. Companies have had to offer extended periods of leave for them to look after dependants (young and old), and flexible working in between. At BAH, women partners take an average of eight-and-a-half extended breaks during their careers. Men take an average of one-and-a-half. Ernst & Young, keen to show that part-time workers can also become partners, recently made the first such appointment in Houston, Texas.

(10)Some of these initiatives are spreading even to the castles of binge working, such as investment banks. Business schools are now climbing on the bandwagon, too. In October Tuck School at Dartmouth, New Hampshire, will start a course on returning to corporate life after an extended absence. Called “Back in Business”, the 16-day, $12,000 re-entry programme is open only to students with “work experience in a high-potential career”.

(11)The majority will inevitably be mothers wanting to rejoin the workforce. But fathers are also asking for sabbaticals (公休假). Work-life balance “is not just a women’s issue” any more, says Ted Childs, who is in charge of workforce diversity at IBM. “Men, too, are very concerned about it.”

(12)The demand is being stoked by the “Generation Y”, the under-28s. They look sceptically at the idea of lifetime employment within a single organisation and they are wary of the commitment they believe too often drove their parents to the divorce courts. Hay’s Ms Murlis says that today’s business-school graduates are “looking for a workstyle to go with their lifestyle”, not the other way round. They are happy to binge-work for a while, but in return want extended sabbaticals.

(13)Many of the more imaginative schemes come from organisations that are not under pressure to report quarterly to Wall Street. Wegmans and American Century Investments are family-controlled businesses and the big accounting firms and consultancies, such as Ernst & Young, KPMG, Bain and BAH, are partnerships. This allows them to take a longer-term view of growth and costs.

(14)To some extent, the proliferation of work-life-balance schemes is a function of today’s labour market. Companies in knowledge-based industries worry about the shortage of skills and how they are going to persuade talented people to work for them. Although white-collar workers are more likely to be laid off nowadays, they are also likely to get rehired. Unemployment among college graduates in America is just over 2%. The same competition for scarce talent is evident in Britain.

(15)For some time to come, talented people in the West will demand more from employers, and clever employers will create new gewgaws to entice them to join. Those employers should note that for a growing number of these workers the most appealing gewgaw of all is the freedom to work as and when they please.

PASSAGE THREE

(1)The blind, overweight patient in the wheelchair has terrible pain in her back and burning pain in her legs. She also has advanced arthritis in her knees and end-stage circulatory disease, which have left her with two useless legs that are red, swollen and infected. Now her shoulder has started to hurt. She can’t raise her arm to comb her hair. Five or six other things are wrong with her — she tells me about each. Some we can help; most we can’t. I tell her as much.

(2)In my office, she listens carefully. I hardly ever have to repeat myself with Doris (not her real name). She asks questions — mostly good ones. She needs lots of tests, various therapies. I ultimately recommend an operation on her shoulder. Sick, weakened by multiple symptoms and with lousy insurance, Doris is — surprise — a really good patient. She communicates efficiently with her doctors and treats us with respect and trust. She has reasonable expectations. I can tell she looks things up, but her knowledge is helpful — never challenging. I’ve talked about her with other doctors, and we agree on this: when you see Doris’ name on your day’s list, you know you’re going to work hard. But you’re usually glad her name is there.

(3)Few patients realize how deeply they can affect their doctors. That is a big secret in medicine — one doctors hate to admit. We think about, talk about, dream about our patients. We went into clinical medicine because we like dealing on a personal, even intimate level with people who have chosen to put their bodies in our hands. Our patients make or break our days.

(4)Take the compliment. Our career choice means we really do think that you — with your aches and pains — are more interesting than trading hot securities, more fun than a courtroom full of lawyers. Massaging the ego is the key to manipulating responsible types like doctors. When we feel your trust, you have us.

(5)The most compelling reasons to be a good patient are selfish ones. You will get more than free drug samples if your doctor is comfortable and communicates easily with you. You’ll get more of the mind that you came for, a mind working better because it’s relaxed — recalling and associating freely, more receptive to small, even unconscious clues. That means better medical care. But you should try to be a good patient for unselfish reasons too. We worry about you 60 hours a week. We gave up our 20s for you. Why not show us some love? It’s not hard.

(6)The medical relationship is intrinsically one-sided. It’s about you and your problem. I am going to find out more about you in the next 20 minutes than you will find out about me. Don’t fret about that. We don’t expect you to ask much about us. Good patients answer questions accurately and completely. They ask questions too.

(7)But many patients talk too much. You might notice that we are writing when we see you—we are creating your chart. We need specific facts but not every fact in your life. Here’s a classic exchange:

(8)How long has your shoulder hurt, Beatrice? “Oh, for quite some time now.” But for how long? How many months? “Oh, at least since the wedding—well, then again it did act up a bit when Margaret came back from Ireland…”

(9)A11 I want to do is write something like “Right shoulder, 6 months, no trauma” on my chart. Although I lack the heart to tell her, Beatrice would be a better patient if she tried to be a bit more concise. There are lots of Beatrices.

(10)Here’s another classic:

(11) “Well, I don’t need to have good manners—I’m sick—and I’m not going to be a patsy for some smooth talker in a white coat. The squeaky wheel gets the grease, you know.”

(12)That is the mind-set of many patients who abuse their doctors; my bet is they abuse other people as well. Any good doctor knows when you’re too sick to be polite and will let it roll off his back. The squeaky wheel we don’t like is the one playing a dominance game. That big wheel is likely to get a shorter, less sensitive examination and more tests, and then still more tests to follow up the abnormalities in the first tests, followed by extra consultations with specialists—anything to relieve the doctor’s responsibility for a bad patient.

(13)Are doctors good patients? Others may disagree, but I think they are. Medical terms don’t faze them, so communication is easier, and their expectations tend to be more reasonable. Anyone in medicine is painfully aware that there are plenty of problems for which we have no good answer. Nurses tend to be even better patients, being adept at following doctors’ orders — a virtue lacking in doctors.

(14)Doctors and nurses also know when to respect an educated opinioa When the MRI says one thing and I want to do another, they are more likely to be on my side. But you need not be a medical professional, or educated at all, to be a great patient. It’s pretty much the same strain of human decency — a truthful consideration of who the people around you are and of what they are trying to do — that infects a good patient and any good person.

PASSAGE ONE

PASSAGE TWO

PASSAGE THREE