For years, Catalina Maldonado had worked as a medical assistant in a harried community clinic much like the ones we saw in chapter 5, with the “hamster wheel” of appointments one after another. “In and out, in and out,” recalled Catalina, a compact woman with long black hair who immigrated to the United States from Mexico as a child. “Physicals, hearing test, eye test, urine test, immunizations, the doctor’s visit, all in fifteen minutes they had to be done.” She loved serving the largely Latino clientele there in California’s Central Valley, but was also troubled by the medical care they were getting. “It was like, ‘Medication and you’ll follow up in a month,’ and it was just like this circle over and over again. And no-body-I felt like nobody really ever got better. It was so fast, you hardly ever had time to do anything extra.” But the circle came to a stop at her new employer, who had figured out how to halt the hamster wheel.
多年来，卡塔琳娜·马尔多纳多一直在一家忙碌的社区诊所担任医疗助理，这家诊所与我们在第五章中看到的那些类似，患者预约接连不断，像“仓鼠轮”一样不停转动。“进进出出，进进出出，”卡塔琳娜回忆道。她是一个身材紧凑、留着长黑发的女性，小时候从墨西哥移民到美国。“体检、听力测试、视力测试、尿检、免疫接种、医生问诊，所有这些都必须在十五分钟内完成。”她喜欢为加州中央谷地主要是拉丁裔的客户服务，但也对他们所接受的医疗感到担忧。“就是那种‘吃药，一个月后复诊’，然后就这样不断循环。我觉得没人真正好起来。节奏太快了，几乎没有时间做额外的事情。”但这个循环在她的新雇主那里停止了，因为他们找到了让“仓鼠轮”停转的方法。

Catalina now worked for a new clinic-University Transformational Care-reserved for patients with complex medical histories, a facility that made relationships the center of their practice. The founders who designed the unit were guided by a focus group of thirty patients, and how they answered four questions: What’s the worst moment you’ve ever had with regard to your illness, how did you survive, what did health care do that helped, and what did health care do that hurt?
卡塔琳娜现在在一家新诊所——大学转型护理中心工作，该中心专门为有复杂病史的患者服务，将关系作为其医疗实践的核心。设计该部门的创始人由一个由三十名患者组成的焦点小组指导，焦点小组回答了四个问题：关于你的疾病，你经历过的最糟糕时刻是什么，你是如何挺过来的，医疗服务做了哪些帮助你的事，医疗服务又做了哪些伤害你的事？

Their answers led to a radical experiment in primary care. Instead of fifteen-minute appointments, the clinic offered first-time patients two
他们的回答促成了一场初级护理的激进实验。诊所不再提供十五分钟的预约时间，而是为首次就诊的患者提供两个小时（医生一小时，前后各半小时由医疗助理陪同）；后续就诊时间为整整一小时。
hours (one hour with the physician, bookended by a half hour with the medical assistant); subsequent visits were a full hour. At the Central Valley clinic, Catalina saw thirty-two patients a day. At University Transformational Care, she saw six. And when patients were referred to specialists, Catalina was even available to go with them, helping them ask questions, clarifying answers, and relaying what was said back to the primary care physician.
在中央谷诊所，卡塔琳娜一天要看三十二名患者。在大学转型护理中心，她一天只看六名患者。当患者被转诊给专科医生时，卡塔琳娜甚至会陪同他们，帮助他们提问，澄清答案，并将所说内容反馈给初级护理医生。

The clinic served a select group of patients, to be sure, but not the easy ones-instead only those people who had three or more chronic conditions and who used five or more medications could visit it. These were the patients who tended to use the hospital more, according to a federal government report, with risk factors about two and a half times higher than the average primary care patients in the system, and health care spending three to four times the average. All were affiliated with the local university-another condition of entry-which acted as their insurer and thus had a strong incentive to save money on their care. For these particularly difficult cases, clinic founders argued, the key catalyst for change was their relationship to their doctors. “If you look at the 5 percent of the patients who cause 50 percent of the money [healthcare spending] in any given year, almost always relational stuff matters and health care has blown it,” said Gabriel Abelman, a physician who cofounded the clinic with his wife, another physician, in 2011. The way to help them get healthier, and along the way reduce their spending, was to start with connection, he told me.
这家诊所确实服务于一群特定的患者，但并非那些容易治疗的患者——只有那些患有三种或以上慢性疾病且使用五种或以上药物的人才能前来就诊。根据一份联邦政府的报告，这些患者往往更频繁地使用医院服务，其风险因素约为系统中普通初级护理患者的两倍半，医疗支出则是平均水平的三到四倍。所有患者都与当地大学有联系——这是另一项入院条件——该大学作为他们的保险方，因此有强烈的动机节省他们的医疗费用。诊所创始人认为，对于这些特别棘手的病例，促成改变的关键催化剂是他们与医生的关系。“如果你看看那 5%导致任何一年 50%医疗支出的患者，几乎总是关系因素起作用，而医疗体系对此一无所知，”2011 年与妻子（也是医生）共同创办该诊所的医生加布里埃尔·阿贝尔曼说。他告诉我，帮助他们变得更健康，并在此过程中减少开支的方法，是从建立联系开始。

I spoke to Gabriel one day at a sunny California picnic table, listening as he narrated the clinic’s tale. Short, bald, and intense, he had the driving energy of the charismatic visionary, and his stories were replete with pride and humor and scorn for those who would stand in their way. I asked Gabriel how much that initial panel of thirty patients talked about relationship, when the clinic was in its design phase. It was “almost universal,” he said. How did they phrase it? “Someone who knows me and cares about me,” he recounted. “‘Someone who has my back.’”
有一天，我在加利福尼亚一个阳光明媚的野餐桌旁与加布里埃尔交谈，听他讲述诊所的故事。他个子矮小，秃头，神情专注，拥有那种富有魅力的远见者的驱动力，他的故事充满了自豪、幽默以及对那些阻碍他们的人们的蔑视。我问加布里埃尔，在诊所设计阶段的最初那批三十名患者中，有多少人谈论过关系问题。他说，“几乎是普遍的”。他们是怎么表达的？“了解我并关心我的人，”他回忆道。“‘有人支持我。’”

Catalina was one of University Transformational Care’s secret weapons - the reason why they were able to offer so much time - in the battle for their patients’ hearts. In most practices, the medical assistant
卡塔琳娜是大学转型护理的秘密武器之一——他们能够在争取患者心灵的战斗中提供大量时间的原因。在大多数诊所里，医疗助理
is the person who puts you in a room, takes a few measures of weight or blood pressure, and then gets out of the way. Their training is fairly minimal compared to other healthcare professionals, and they need just a high school education. But at the new clinic, they were asked to do much more. “So, what we did was, [we asked,] ‘What are all the functions that people need, based on our interviews and our knowledge, and then how do we put most of the functions that are not requiring a physician in one person?’” Gabriel explained. “And so that became the medical assistants, and they’re the person that-rather than a series of tasks that they do, they have responsibility for people.”
是把你带进房间，测量体重或血压几项指标，然后就离开的那个人。他们的培训相对其他医疗专业人员来说比较简单，只需要高中学历。但在新诊所，他们被要求做更多的事情。“所以，我们所做的是，[我们问，]‘根据我们的访谈和知识，人们需要哪些所有功能，然后我们如何把大多数不需要医生的功能集中到一个人身上？’”加布里埃尔解释道。“于是，这些人就成了医疗助理，他们不仅仅是完成一系列任务，而是对病人负有责任的人。”

That responsibility meant that the medical assistants, called “care transformers” at the clinic, stayed in the room while the physician was there, served as a scribe, managed phone calls and appointments from patients, presented their details in all-clinic meetings, and accompanied them to specialist visits. “Most of all,” Gabriel said, “because they were part of what we call ‘crucial conversations,’ the patients trusted them, so when the patient would call in and get Delilah on the phone, they weren’t saying, ‘Just have Dr. Abelman call me back,’ it was 'Delilah, can you help me?”
这种责任意味着，被诊所称为“护理转化者”的医务助理会在医生在场时留在房间内，担任书记员，管理患者的电话和预约，在全诊所会议上汇报患者情况，并陪同患者前往专科就诊。“最重要的是，”加布里埃尔说，“因为他们参与了我们所说的‘关键对话’，患者信任他们，所以当患者打电话给德莱拉时，他们不会说，‘让阿贝尔曼医生给我回电话’，而是说，‘德莱拉，你能帮帮我吗？’”

The expansion of the medical assistant job was at the core of the University Transformational Care model, what allowed them to offer so much time to the individual patients without breaking the bank. To get there required convincing not just patients about the potential and possibilities of medical assistants, but also doctors. Gabriel described an exercise where they put physicians and medical assistants in the same room, talking about how they ended up there. “The doctors’ jaws fell open when they realized the depth and passion of the MAs, which was every bit as vital [as their own],” Gabriel recalled.
医疗助理职位的扩展是大学转型护理模式的核心，这使他们能够在不超出预算的情况下为每位患者提供大量时间。要实现这一点，不仅需要让患者相信医疗助理的潜力和可能性，还需要说服医生。加布里埃尔描述了一个活动，他们让医生和医疗助理聚集在同一个房间，谈论他们是如何走到这一步的。“当医生们意识到医疗助理的深度和热情与他们自己同样重要时，简直目瞪口呆，”加布里埃尔回忆道。

The doctors would say, “When I was ten, you know, my parents are doctors, my uncle’s a doctor, my aunt’s a doctor, all my siblings-I was always going to do it.” Versus these MAs who said, “Well I was undocumented, I came-You know, I was a DREAMer, I came in at age four, my grandmother was sick and I cared for my grandmother. Then in high school I realized I couldn’t go to college because I’m not
医生们会说：“我十岁的时候，你知道的，我的父母是医生，我的叔叔是医生，我的姑姑是医生，我所有的兄弟姐妹——我一直打算成为医生。”而这些医疗助理则说：“嗯，我是无证移民，我是……你知道的，我是梦想者，我四岁时来的，我奶奶生病了，我照顾奶奶。然后在高中时我意识到我不能上大学，因为我不是……
documented, so [being an] MA was the best I could do and here I am.” And you just sat there and went-
有记录的，所以[成为]硕士是我能做到的最好选择，而我就在这里。”你就坐在那里，心想—

His jaw dropped in simulated shock. “And so it changed the doctors’ view of who they were working with.”
他的下巴因假装震惊而掉了下来。“所以这改变了医生们对他们所合作对象的看法。”

The clinic hired medical assistants of a particular kind-“people who were getting in trouble for doing too much,” Gabriel said-and trained them for about a month, including mentoring and shadowing. They embraced the work, he said. “[It was a] big job, they loved it, and the job satisfaction [was] through the roof. I mean they wanted, ‘Can’t we be on salary so I can work at night and weekend?’” In contrast to many primary care providers, there was almost no burnout reported. Was that because the clinic was careful to restrict their hours? I asked him. “No, it’s because people have meaning and relationships in work,” he said. The relationship model fed the workers as well as the patient.
诊所雇佣了一种特定类型的医疗助理——“那些因为做得太多而惹上麻烦的人，”加布里埃尔说——并对他们进行了大约一个月的培训，包括指导和跟随学习。他说他们很投入这份工作。“这是一份很重要的工作，他们很喜欢，工作满意度极高。我的意思是，他们甚至问，‘我们能不能拿工资，这样我就能晚上和周末工作？’”与许多初级保健提供者相比，几乎没有人报告过职业倦怠。我问他，这是否因为诊所小心限制了他们的工作时间？“不，是因为人们在工作中找到了意义和关系，”他说。关系模式不仅滋养了患者，也滋养了工作人员。

Catalina told me she could not imagine loving her job more. “It feels very rewarding,” she said. “Like I go home and I feel like I’ve accomplished something. Even when work is hectic, I can sit at my desk and say, ‘Wow, I love what I do.’” We were talking in an exam room in the clinic, as she sat next to her computer. The contrast between the new clinic model and her old employer was stark, she said. “I feel that [the Central Valley patients] didn’t understand really what medical and health care really is. And the importance of taking care of yourself and kind of taking charge. Here we kind of want to push our patients and we help them, right? But there, it just seemed like if you didn’t help them, they just kind of got lost.” Suddenly her voice broke, and she looked down. She wished her own parents could get this kind of care, she said, tearing up. “Everybody deserves this.”
卡塔琳娜告诉我，她无法想象自己会更爱这份工作。“这感觉非常有成就感，”她说。“就像我回家时，会觉得自己完成了些什么。即使工作很忙碌，我也能坐在办公桌前说，‘哇，我爱我所做的事。’”我们在诊所的一个检查室里交谈，她坐在电脑旁。她说，新诊所的模式和她以前的雇主形成了鲜明对比。“我觉得[中央谷的患者]并不真正理解医疗和健康护理的真正含义，以及照顾自己和掌控自己健康的重要性。在这里，我们想要推动患者，我们帮助他们，对吧？但在那里，似乎如果你不帮他们，他们就会迷失。”突然，她的声音哽咽了，低下了头。她说，她希望自己的父母也能得到这种护理，眼眶湿润。“每个人都应该得到这样的照顾。”

Connective labor has enormous power, in conveying meaning, dignity, and purpose for workers and their charges. Yet its power does not solely depend on a particular worker’s skill or a client’s receptiveness. Instead, as chapter 5 outlined, organizations have a social architecture that can make it easier or harder to see each other well. As we saw there, too often firms are getting it wrong, cutting corners in service to profit or efficiency campaigns that ultimately weaken the relationship and drain
连接性劳动具有巨大的力量，能够为工人及其服务对象传达意义、尊严和目标。然而，这种力量并不完全依赖于某个工人的技能或客户的接受度。正如第五章所述，组织拥有一种社会架构，这种架构可以使彼此更容易或更难以真正理解对方。正如我们在那里看到的，企业往往做得不够好，为了利润或效率的追求而走捷径，最终削弱了关系并耗尽了其力量。
it of its power. The demands of scripting and counting crowd out the seeing and hearing, and the degradation of connective labor makes automation more appealing, even more likely. But is anyone getting it right?
脚本化和计数的要求挤压了观察和倾听的空间，连接性劳动的退化使得自动化变得更具吸引力，甚至更有可能实现。但有没有人做对了呢？

This chapter will explore the contexts where connective labor thrives, and identify some of the factors that help it to do so. Where and how is this work supported? What does that entail? How do people build a social architecture that works?
本章将探讨连接性劳动得以蓬勃发展的环境，并识别一些有助于其发展的因素。在哪些地方以及如何支持这项工作？这意味着什么？人们如何构建一个有效的社会架构？

Doing the research for this book meant that I had the opportunity to meet and talk with scores of people who provide connective labor for a living. An unusually warm, reflective, engaging group, they talked about helping people grow, seeing their dignity, finding the powerful meaning and purpose of their work. It felt sometimes like bathing in human light.
为这本书做研究的过程中，我有机会遇见并与许多以提供连接性劳动为生的人交谈。他们是一个异常热情、深思熟虑且富有感染力的群体，谈论着帮助他人成长、看到他们的尊严、发现自己工作的强大意义和目的。有时感觉就像沐浴在人性的光辉中。

Many of them came to seem like heroes to me, battling it out for connection to others in need, despite expanding client rolls and demands for metrics. Katya Moudry, whom we saw in chapter 6 lamenting the survey she had to give to a military veteran who was thinking about suicide, was a good example. A therapist who recently joined the VA hospital, she was chafing at their requirements that she see more people more efficiently. “It is a lot of mental effort to fully engage, to give that part of yourself to another person for a while, and that’s the part I’m not willing to give up,” she said. “I’ve been questioning lately, ‘Is this sustainable? I can’t just jump in and be a hundred percent with someone and feel their emotion. It is what I have to give to somebody, but if I have twenty people, do I have the capacity to give it to them and to my personal life?’ If I had to choose between seeing more people and not doing that, I’d rather bow out of the profession than not give it all.” In the face of productivity pressure, Katya faced two daunting choices: to either make her connective labor more efficient, betraying her commitment to “be a hundred percent with someone,” or to take on an unsustainable load as an individual hero.
他们中的许多人在我眼中仿佛成了英雄，尽管客户数量不断增加、对绩效指标的要求也在加重，他们仍在为与有需要的人建立联系而奋战。第六章中我们见到的 Katya Moudry 就是一个很好的例子，她曾为不得不给一位正考虑自杀的退伍军人做调查而感到痛心。作为一名最近加入退伍军人医院的治疗师，她对医院要求她更高效地接待更多病人感到不满。“要全身心投入，暂时把自己的一部分交给另一个人，这需要很大的心理努力，而这正是我不愿放弃的部分，”她说。“我最近一直在质疑，‘这能持续下去吗？我不能只是跳进去，百分之百地陪伴某人，感受他们的情绪。’” 这是我必须给予某人的东西，但如果我有二十个人，我是否有能力同时给予他们和我的个人生活？”如果我必须在见更多人和不这样做之间做选择，我宁愿退出这个职业，也不愿意不给出全部。”面对生产力的压力，Katya 面临两个艰难的选择：要么让她的连接性劳动更高效，从而背叛她“全心全意陪伴某人”的承诺，要么作为一个个人英雄承担无法持续的负荷。

Yet an organization that impedes connective labor, and relies on its employees to forge relations on their own without support, will surely not be able to offer connections to its clients very well, or for long. Sto-
然而，一个阻碍连接性劳动的组织，并且依赖员工自行建立关系而不提供支持，肯定无法很好地或长久地为其客户提供连接。Sto-
ries of people’s suffering and redemption encourage us to think about workers as individual heroes, as people with the “magical listening ears” that we heard about in chapter 7. As psychologists tell us, however, empathy is not wholly innate but in part depends on conditions that produce it. Studies in schools, for example, have documented particular circumstances that help support teacher-student relationships, which generally involve increasing the time and opportunity that teachers have to connect with particular students, from smaller classes to block scheduling to protecting them from the impact of accountability measures. In short, the conditions of connective labor shape the kind of work people are able to do, and ultimately, no one works alone. ${}^1$${}^1$^(1){ }^{1}
人们的痛苦与救赎故事促使我们将工人视为个体英雄，视为拥有第七章中提到的“神奇倾听耳朵”的人。然而，正如心理学家所指出的，同理心并非完全天生，而在一定程度上依赖于促成它的条件。例如，学校中的研究记录了有助于支持师生关系的特定环境，这些环境通常包括增加教师与特定学生接触的时间和机会，从小班教学到模块化课程安排，再到保护教师免受考核措施影响。简而言之，连接性劳动的条件塑造了人们能够完成的工作类型，归根结底，没有人是孤立工作的。 ${}^1$${}^1$^(1){ }^{1}

Drawing from my own research as well as that of others, there appear to be three vital components to supporting connective labor: an organization’s relational design, connective culture, and resource distribution. By relational design, I mean the ways that people are put in relation to one another, such as through leadership, mentors, and peer groups acting as sounding boards. By connective culture, I mean the shared values, practices, and rituals that serve to bind individuals to these meaning systems. Finally, the resources that matter start with the time an organization allows for a given interaction, but also includes the ratios of worker to client, the cognitive load workers face, the extent of technology and data use-any of the material conditions that underlie and shape people’s connection.
结合我自己的研究以及他人的研究，支持连接性劳动似乎有三个关键组成部分：组织的关系设计、连接文化和资源分配。所谓关系设计，是指人们彼此之间建立联系的方式，比如通过领导、导师和同伴小组作为反馈平台。所谓连接文化，是指将个体绑定到这些意义体系中的共享价值观、实践和仪式。最后，重要的资源首先是组织为特定互动所允许的时间，还包括员工与客户的比例、员工面临的认知负荷、技术和数据的使用程度——任何构成并影响人们连接的物质条件。

Before a client even enters the room, the people of an organization exist in relationship to each other, and the relational design, or the way people are positioned vis-à-vis each other, can impede or support the connective labor that the client receives. Relational design matters in three particular ways: when leaders can convey a relationship-centered vision, when mentors can help shepherd connective labor of others, and when peers are able to build a community of practice for feedback and consultation. A relational design helps others-leaders, mentors, and peers-provide connective labor to the practitioners themselves.
在客户进入房间之前，组织中的人们已经存在于相互关系之中，而关系设计，或人们相对于彼此的位置方式，可能会阻碍或支持客户所获得的连接性劳动。关系设计在三个方面尤为重要：当领导者能够传达以关系为中心的愿景时，当导师能够帮助引导他人的连接性劳动时，以及当同伴能够建立一个用于反馈和咨询的实践社区时。关系设计帮助其他人——领导者、导师和同伴——为从业者本人提供连接性劳动。

Gabriel Abelman, the cofounder of Catalina’s clinic, was a relationship evangelist. A friend and another physician, Mark Aaron, himself an influential figure in state and federal medical policymaking, noted how unusual Gabriel was. “Gabriel thinks that it’s all about relationships and that if you don’t at the very beginning signal that you are personally invested in this person and care about them, it’s not going to work,” Mark said. “He believes that particularly for people who are strugglingand many of whom have been wounded before by bad relationships in health care-what they need is a gigantic dose of relationship.”
加布里埃尔·阿贝尔曼，卡塔利娜诊所的联合创始人，是一位关系传道者。一位朋友兼医生马克·亚伦，他本人也是州和联邦医疗政策制定中的有影响力人物，指出加布里埃尔的不同寻常。“加布里埃尔认为一切都关乎关系，如果你一开始没有表明你个人投入并关心这个人，是行不通的，”马克说。“他相信，特别是对于那些挣扎中的人——许多人之前在医疗关系中受过伤——他们需要的是大量的关系支持。”

The reforms that Gabriel and his cofounders were proposing as part of setting up University Transformational Care were not uncontroversial. “They hated him on campus because he would insist on spending so much time with each patient at the beginning,” Mark told me. “He actually would draw them out on depersonalized adverse experiences they’d had in health care. He said getting it out on the table and letting them emote helps them then re-trust somebody.”
加布里埃尔和他的联合创始人在建立大学转型护理时提出的改革并非没有争议。“他们在校园里讨厌他，因为他坚持一开始要花很多时间陪每个病人，”马克告诉我。“他实际上会引导他们讲出在医疗中经历的非人性化不良经历。他说，把这些摆到桌面上，让他们表达情感，有助于他们重新信任别人。”

Gabriel’s approach to relationship in medicine was forged in his own desperation. Sitting at the picnic table, he narrated for me how he had initially gained notice for his novel approach to diabetes patients, an approach he developed almost by accident. Diabetes was the disease that most frightened him in medical school, he said, because a close friend’s father had had it-“I loved the guy because he was really funny, and I watched him go blind, lose his legs, lose his kidneys, and die”-and because the medical approach was so primitive-"‘You’re going to die about twenty years early. Minimize medical mistakes and do the best you can’ was kind of the message."
加布里埃尔对医学中人际关系的处理方式是在他自身的绝望中锻造出来的。坐在野餐桌旁，他向我讲述了他最初如何因对糖尿病患者采取新颖的方法而受到关注，这种方法几乎是他偶然发展出来的。他说，糖尿病是他医学院时最害怕的疾病，因为一位亲密朋友的父亲患有这种病——“我喜欢那个人，因为他真的很幽默，我看着他逐渐失明，失去双腿，失去肾脏，最终去世”——而且当时的医疗方法非常原始——“‘你大约会早死二十年。尽量减少医疗失误，尽力而为’大概就是那个意思。”

Shortly thereafter, he found out that he himself had the disease. Frantic to do something different, he knew the technology to self-monitor glucose was just emerging, and became an avid experimenter; at the same time, almost instantaneously, his clinic roster was full of diabetes patients. “They all came to me saying, ‘You understand us,’ [while] I kept saying, ‘How the hell do I live with this?’ to them, so the usual doctorpatient separation broke down and we were all just a peer group,” he said. “Over thirty years, they all did well, you know, pretty much.” What he learned about patient self-management he was able to implement on a
不久之后，他发现自己也患上了这种疾病。为了做些不同的事情，他知道自我监测血糖的技术刚刚出现，便成为了一个热衷的实验者；与此同时，几乎是瞬间，他的诊所名单上全是糖尿病患者。“他们都来找我，说‘你理解我们’，而我则一直对他们说，‘我到底该怎么和这个病共处？’所以，通常的医患隔阂就这样打破了，我们都成了一个同伴群体，”他说。“三十多年来，他们都过得不错，你知道，基本上都是这样。”他所学到的关于患者自我管理的知识，他能够在实践中应用。
community-wide level, he said, where deaths from diabetes declined by 29 percent over eight years. But the path to that understanding-the patients helping him with their accumulated knowledge-was a partnership model that he since turned to again and again.
他说，在社区范围内，糖尿病导致的死亡率在八年内下降了 29%。但通向这一理解的道路——患者用他们积累的知识帮助他——是一种合作模式，他此后一次又一次地采用了这种模式。

Leaders are vital for generating a connective culture-perhaps more than one might think, given that they are not actually party to any particular interaction between workers and clients. By leaders, of course, I mean not just managers-people in a position to organize other people’s jobs-but those who have the “moral, intellectual, and social skills required” to influence others. It is not that people look to leaders for particular tips on how to conduct relationships. It is not even that leaders who value their workers necessarily produce workers who value other people. Instead, leaders are important for developing a shared vision in which connective labor matters, for establishing or reinforcing a culture that conveys that seeing each other is worth the effort, and for creating the time, space, and recognition for such emotional collaboration. ${}^2$${}^2$^(2){ }^{2}
领导者对于营造一种连接文化至关重要——这点可能比人们想象的还要重要，尽管他们实际上并不直接参与员工与客户之间的具体互动。当然，我所说的领导者不仅仅是管理者——那些有权组织他人工作的职位上的人——而是那些具备“影响他人所需的道德、智力和社交技能”的人。人们并不是因为向领导者寻求如何处理人际关系的具体建议而看重他们。甚至也不是因为重视员工的领导者必然会培养出重视他人的员工。相反，领导者的重要性在于他们能够发展一种共同的愿景，使连接性劳动变得重要，建立或强化一种文化，传达出彼此关注是值得付出努力的理念，并创造时间、空间和认可，促进这种情感上的协作。 ${}^2$${}^2$^(2){ }^{2}

It’s a truism that inspiring leaders offer a vision that rallies people; it is when that vision centers relationship that they create a social architecture that works. Scholars have written about the importance of flexible, relationship-focused skills such as “trust-building” as a fundamental part of strong leaders, who know what motivates employees, what concerns them, and what conditions they require to do their best. These findings tell us more about how leaders themselves do connective labor, however, rather than how they support the connective labor of others. ${}^3$${}^3$^(3){ }^{3}
激励人心的领导者能够提供一个凝聚人心的愿景，这是不争的事实；而当这个愿景以关系为核心时，他们便创造出一种有效的社会架构。学者们曾论述过灵活且以关系为中心的技能的重要性，比如“建立信任”，这是强有力领导者的基本素质，他们了解员工的动机、关切以及发挥最佳表现所需的条件。然而，这些研究更多地告诉我们领导者自身如何进行连接性劳动，而非他们如何支持他人的连接性劳动。 ${}^3$${}^3$^(3){ }^{3}

But when does leadership help other people make stronger connections themselves? Education scholars have tackled this very issue, for example, as they try to crack the mystery of the principal, who rarely teaches yet profoundly affects student learning. Research suggests that a good principal is responsible for 25 percent of a school’s impact. Scholars have developed a model of “transformational leadership,” through which school leaders are said to affect teacher motivation and commitment, which then in turn affects student learning. Wrote one influential review: “The principal’s efforts become apparent in . . . school conditions that produce changes in people, rather than in promoting specific instructional practices.” Principals affect teachers’ emotions at the
但领导力何时能帮助他人建立更强的联系呢？教育学者们一直在研究这个问题，例如，他们试图破解校长之谜——校长很少亲自授课，却对学生学习产生深远影响。研究表明，一位优秀的校长对学校影响力的贡献高达 25%。学者们提出了“变革型领导”模型，认为学校领导通过激发教师的积极性和承诺，进而影响学生的学习。一篇有影响力的综述写道：“校长的努力体现在……创造改变人的学校环境，而不是推动具体的教学实践。”校长影响着教师的情感，进而...
organizational level “because they promote a culture of care in the schools.” While principals can influence individual teachers’ emotional well-being, by affecting how an individual teacher feels about their work, they also create a particular emotional climate in the school overall, with implications for morale, engagement, and a shared culture focused on relationship. ${}^4$${}^4$^(4){ }^{4}
组织层面“因为他们在学校中促进了一种关怀文化。”虽然校长可以通过影响个别教师对工作的感受来影响他们的情绪健康，但他们也在整个学校营造了一种特定的情绪氛围，这对士气、参与度以及以关系为中心的共享文化都有影响。 ${}^4$${}^4$^(4){ }^{4}

Bert Juster was one such principal and a founder of a new all-boys independent school in a West Coast city. He had worked at a vibrant all-girls private school in the same town for years, but noticed that “I was working to prepare these really confident and capable women, and then they would go to high school, and kind of be with schmucks,” by which he meant boys who were sexist jerks. He found himself inspired by the book Boys Will Be Men (1999), which described how communities can raise boys in a collective committed to racial justice. “I actually think my calling is to work with men, because that’s what our world needs more from me,” he said, and with a woman colleague, he set out to found the new school. Ten years later, the school had a strong reputation and ringing testimonials on local parent websites.
伯特·贾斯特就是这样一位校长，他是西海岸一座城市中新成立的一所全男校的创始人之一。他曾在同一城镇一所充满活力的全女子私立学校工作多年，但他注意到，“我一直在培养这些非常自信且有能力的女性，然后她们进入高中，却不得不和一些混蛋在一起，”他指的是那些性别歧视的男孩。他受到《男孩终将成为男人》（1999 年）一书的启发，该书描述了社区如何在致力于种族正义的集体中培养男孩。“我实际上认为我的使命是与男性共事，因为这是我们的世界更需要我做的事情，”他说。于是，他与一位女性同事一起着手创办了这所新学校。十年后，这所学校在当地家长网站上拥有良好的声誉和热情的推荐。

Relationships were fundamental to Bert’s vision of good teaching. “Teaching is kind of like the art of relationship to some degree,” he said. “Like, it is this dance of kind of working magic with their brains, with them understanding themselves better, and you creating a platform for that.” As a head of school, his task was to help make those relationships happen, and he talked about the intentional practices they had put in place to emphasize them, from daily greetings to “restorative justice circles.” “Education is such a relational business,” he said. “Middle school, loving kids is almost more important than content. Yeah, relationships are super important in this world.”
关系是 Bert 对良好教学理念的基础。“教学在某种程度上有点像关系的艺术，”他说。“就像是一场与他们的大脑共舞的魔法，让他们更好地理解自己，而你为此创造了一个平台。”作为校长，他的任务是帮助促成这些关系，他谈到了他们为强调这些关系而制定的有意为之的做法，从每日问候到“修复性司法圈”。“教育是一个非常依赖关系的行业，”他说。“中学阶段，爱孩子几乎比内容更重要。是的，关系在这个世界上非常重要。”

Bert’s focus on relationship made him more open to hiring people who did not have teaching experience or credentials, he said. “I’d be willing to take a risk on someone who’s super exciting,” he said, offering as one example someone he hired to teach welding, design, and fabrication, who had “never taught a day in his life,” but “I could tell pretty early on that the boys were listening to him, responding to him. He came in and it was a little touch and go, there was a pretty steep learning curve, but he
Bert 对关系的重视使他更愿意聘用没有教学经验或资质的人，他说。“我愿意冒险录用那些非常有激情的人，”他说，并举了一个例子：他曾聘请一位教授焊接、设计和制造的老师，这个人“从未教过一天书”，但“我很快就能看出男孩子们在听他、回应他。他刚来时情况有些不稳定，学习曲线相当陡峭，但他…
worked under somebody who was really good at guiding him, and now he’s one of the best teachers we have.” For Bert, a teacher’s capacity to connect to the kids was such a priority that he was willing to risk bringing on someone who had no formal training in how to teach.
他曾在一个非常擅长指导他的人的手下工作过，现在他已经成为我们最优秀的老师之一。” 对于伯特来说，教师与孩子们建立联系的能力是如此重要，以至于他愿意冒险聘用一个没有正式教学培训的人。

In contrast, some leaders seemed less committed to relationship, or perhaps incapable of building it in as a systematic priority. Conrad Auerbach taught at a public middle school in a large Virginia city. He talked about how he strove to see his students, to get to know them, and how his teaching had changed over time as he got better at it. Not everyone in his school was on board, however, he said. “One of the recent things my school did, it’s kind of funny. I think they got wind of a few teachers who were just putting absolutely no effort into relationships, so I think our principal printed out a list of twenty things - they left it in the men’s staff room in front of the toilet, I’m not sure if it was on purpose-but [it was a list of] about twenty or twenty-five ways to build relationships with students.” Conrad’s principal may have been just as dedicated to relationship as Bert Juster, but stymied by a few recalcitrant refusals. Still, hanging a list of twenty-five tips in the men’s staff room in front of the toilet was not going to transform much, and I said so to Conrad.
相比之下，有些领导似乎对建立关系不那么投入，或者说无法将其作为系统性的优先事项来构建。康拉德·奥尔巴赫在弗吉尼亚州一座大城市的一所公立中学任教。他谈到自己如何努力去了解学生，如何认识他们，以及随着教学水平的提高，他的教学方式是如何改变的。然而，他说，并不是学校里的每个人都支持这一点。“我们学校最近做了一件事，有点好笑。我想他们听说有几个老师根本不努力建立关系，所以我们的校长打印了一份二十条左右的清单——他们把清单放在男教师休息室的厕所前面，我不确定是不是故意的——这份清单上写着大约二十到二十五种与学生建立关系的方法。”康拉德的校长可能和伯特·贾斯特一样致力于建立关系，但却被少数顽固的拒绝所阻碍。不过，把二十五条建议挂在男教师休息室厕所前面，并不会带来多大改变，我也对康拉德这么说了。
“But when, when would we do that?” he asked. “It’s just impossible for teachers to be trained on all the things. We have a few days of professional development and there’s a million things that we’re supposed to be talking about. Sure, we do some, but . . .” He trailed off. At Conrad’s school, relationship was another on a long list of items for which teachers needed training; the “How to Connect to Students” list tacked up in the restroom was merely an attempt to use absolutely every minute for that training. Leaders communicated their priorities, and what they made space and time for conveyed that vision.
“但是，我们什么时候，什么时候才能做到呢？”他问道。“老师们不可能接受所有方面的培训。我们只有几天的专业发展时间，而我们应该讨论的事情有一百万件。当然，我们会做一些，但……”他的话戛然而止。在康拉德的学校，关系建设是教师需要培训的众多项目之一；贴在洗手间里的‘如何与学生建立联系’清单，只是试图利用每一分钟进行这方面的培训。领导者传达了他们的优先事项，而他们为之腾出空间和时间的内容则体现了这一愿景。

Mentoring and shadowing also contributed to people’s capacity to see each other, when the relational design enabled a trainee to work closely with someone more experienced. As a clinical practice, connective labor was often trained via apprenticeship, like the teachers and therapists who worked under supervision for months and sometimes years. Apprenticeships combined experiential learning, considered vital for practical skills, with the connection to a mentor or supervisor
当关系设计使得受训者能够与更有经验的人密切合作时，指导和跟随也有助于人们相互理解。作为一种临床实践，连接性劳动通常通过学徒制进行培训，就像那些在监督下工作数月甚至数年的教师和治疗师一样。学徒制结合了被认为对实用技能至关重要的体验式学习，以及与导师或监督者的联系。
who could nurture the development of connective labor. Indeed, mentoring-itself a form of connective labor, requiring understanding and reflecting the other so they learn more about themselves - can actually enhance people’s capacity for self-awareness, empathy, and communication. ${}^5$${}^5$^(5){ }^{5}
谁能够培养连接性劳动的发展。事实上，指导本身就是一种连接性劳动，要求理解并反映他人，从而使他们更多地了解自己——这实际上可以增强人们的自我意识、同理心和沟通能力。 ${}^5$${}^5$^(5){ }^{5}

People also valued mentoring for the opportunity it offered to talk about different approaches. Bella Albrecht was a therapist who-unusually-started her own private practice right after graduate school. Most of her classmates joined a clinic or school, with some sort of structure around them, guiding them as they started, but Bella was much more isolated, and thus very dependent on her supervisor-someone with his own practice who agreed to meet with her periodically-as confidant and guide. When Bella went to him about a recalcitrant client, he urged her to share more of her own feelings with the man in the sessions-feelings like “I’m getting frustrated”-but she was skeptical, thinking that kind of messaging would be threatening even for her close friends to hear. She ended up switching supervisors to someone who offered a different framing: the new one urged her instead to simply be more human with her client. “This was the difference that changed things,” Bella told me. Her new supervisor said, “‘You don’t need to be his therapist, you just need to be a person that he feels is supporting him and that’s it.’ For me, all of the anxiety and the not knowing what to do and feeling like I’m not getting anywhere with him sort of dissolved, like, ‘Oh yeah, I can just be a human, great. Easy.’”
人们也重视指导，因为它提供了讨论不同方法的机会。贝拉·阿尔布雷希特是一名治疗师，她不同寻常的是，刚毕业后就开设了自己的私人诊所。她的大多数同学都加入了诊所或学校，有某种结构支持他们，指导他们起步，但贝拉则更加孤立，因此非常依赖她的督导——一个有自己诊所的人，定期与她会面，成为她的知己和指导。当贝拉向他求助一个顽固的客户时，他鼓励她在会谈中更多地表达自己的感受，比如“我感到很沮丧”——但她持怀疑态度，认为这种表达即使对她的亲密朋友来说也会显得具有威胁性。最终，她换了一个督导，后者提供了不同的视角：新督导反而鼓励她对客户更有人情味。“这就是改变一切的不同之处，”贝拉告诉我。 她的新主管说：“你不需要成为他的治疗师，你只需要成为一个他觉得支持他的人，仅此而已。”对我来说，所有的焦虑、不知道该怎么办以及感觉自己和他毫无进展的情绪都消散了，就像，“哦，是啊，我只需要做一个普通人，太好了。简单。”

And with the client, the new framing opened the spigots. “It’s so funny how quickly these things can snap,” Bella marveled. “He finally shared some things that he’d never spoken about before. He’s never told me some of the things in this last month and a half under this new supervisor.” Mentoring had gotten her unstuck, and as a result her client was also freer. “So even that [mentoring] relationship that I have external to my clients,” Bella observed, “it has already profoundly impacted my work and my relationships with my clients.” Mentoring provided the crucial guidance to allow people to frame and refine their connective practice, making space for trying out new ideas, acting as a sounding board to enable change.
而对于客户来说，这种新的框架打开了阀门。“真有趣，这些事情竟然能这么快发生转变，”贝拉感叹道。“他终于分享了一些以前从未说过的事情。在这一个半月里，在这位新主管的带领下，他从未告诉过我这些。”指导让她摆脱了困境，结果她的客户也变得更加自由。“所以即使是我与客户之外的那种[指导]关系，”贝拉观察道，“它已经深刻地影响了我的工作和我与客户的关系。”指导提供了关键的引导，使人们能够构建和完善他们的连接实践，创造尝试新想法的空间，充当变革的试验场。

Mentoring was also an opportunity to pursue relationship as a value, to find support for making connection a cultural priority. Andy Cooper was a physician dedicated to humanistic practice, with his own research investigating how to help physician empathy and mitigate burnout; his warm mildness made it hard to imagine he would ever need guidance on connecting to patients. Yet he credited his own path to early mentors.
指导也是一种将关系视为价值的机会，旨在为将连接作为文化优先事项提供支持。安迪·库珀是一位致力于人文主义实践的医生，他自己的研究探讨如何帮助医生提升同理心并减轻职业倦怠；他温和的亲切让人难以想象他会需要关于如何与患者建立联系的指导。然而，他将自己的成长路径归功于早期的导师。

A gentle giant of a man, Andy was about sixty, white, with an air of calm expectation, like you might be about to tell him a small joke or some good news. He had toyed with the idea of a research career, he said, but always came back to “that human connection I found actually more satisfying.” An early trip to Nicaragua to help a study of diarrhea conducted by a physician there-a man “very, just so humanistic and so caring as a pediatrician”-cemented his decision. “That just continued to make me realize that another passion of mine was health care for those who need it the most. I started getting more involved with homeless healthcare and then realized that I really wanted to be a doctor.” Along the way, he kept seeing the kind of caring practice he aspired to, he said. “I had the opportunity to, you know, work with a lot of doctors who are very humanistic as a role model,” he said. “So I felt it was supported. I mean obviously there were parts of med school where you felt like in certain rotations it was a grind. There was, you know, no sleep and you were sort of stripped of your humanity sometimes. But that was pretty rare.”
安迪是个温和的巨人，约六十岁，白人，带着一种平静的期待感，就像你即将告诉他一个小笑话或一些好消息一样。他说自己曾考虑过从事研究工作，但总是回归到“我发现真正令人满足的是人与人之间的联系”。他早年曾去尼加拉瓜，协助一位医生进行腹泻研究——这位医生“非常人文关怀，作为儿科医生非常有爱心”——这坚定了他的决定。“这让我不断意识到，我的另一个热情是为最需要帮助的人提供医疗服务。我开始更多地参与无家可归者的医疗工作，然后意识到我真的想成为一名医生。”他说，在这个过程中，他不断看到自己所向往的那种关怀式实践。“我有机会与许多非常有人文关怀精神的医生共事，他们成为了我的榜样，”他说。“所以我觉得这是被支持的。虽然医学院的某些轮转确实让人觉得很辛苦，没睡觉，有时甚至感觉被剥夺了人性，但那种情况相当罕见。”

Andy had also served as a mentor himself with many medical students over the years; one day, I observed him with students in his own practice. I joined Andy and the student as we stepped into the clinical exam room to see Mr. Thompson, a seventy-five-year-old African American man with a host of chronic diseases who was sitting against the wall. Andy sat down next to him while the student positioned herself in front of the computer, ready to take notes (I sat down on the other side of the tiny room). “I can just tell you what’s going on with him,” Andy said to the student, and recited a lengthy list of facts about his patient. “He has heart failure, kidney failure, he had prostate cancer but that’s cured, he has edema but it’s stable.”
安迪多年来也曾担任过许多医学生的导师；有一天，我观察到他在自己的诊所里与学生一起工作。我跟随安迪和学生走进临床检查室，去见汤普森先生，一位七十五岁的非裔美国老人，患有多种慢性疾病，正靠着墙坐着。安迪坐在他旁边，学生则站在电脑前，准备做笔记（我坐在这个狭小房间的另一边）。“我可以直接告诉你他的情况，”安迪对学生说，并背诵了一长串关于他病人的事实。“他有心力衰竭、肾功能衰竭，曾患前列腺癌，但已经治愈，他有水肿，但情况稳定。”

Mr. Thompson broke in: “I’ve had that for sixteen months.”
汤普森先生插话道：“我已经得了十六个月了。”
“That can cause him to gain weight, but he’s lost weight, if anything,” Andy continued.
“这可能会导致他体重增加，但他实际上是减重了，”安迪继续说。
“I’m 177 now, I used to weigh 220,” Mr. Thompson added.
“我现在 177 磅，过去体重是 220 磅，”汤普森先生补充道。
“They’ve got him on Ensure,” Andy kept going, and Mr. Thompson chimed in, “But it’s been six weeks since I’ve had no Ensure. They’ve ordered it.”
“他们给他用的是 Ensure，”安迪继续说，汤普森先生插话道，“但我已经六个星期没用 Ensure 了。他们已经订了。”
“They’ve ordered it,” Andy repeated, adding for the scribe, “He’s followed by a dietitian.” At that point he asked the student “what was going on metabolically,” which she answered, mentioning “electrolytes.” Andy responded, “Well, sure, but what else does that cause?” The student replied, “Muscle wasting.”
“他们已经订了，”安迪重复道，补充对书记员说，“他有营养师跟进。”这时他问学生“代谢方面发生了什么”，学生回答时提到了“电解质”。安迪回应道，“嗯，当然，但这还会引起什么？”学生回答，“肌肉萎缩。”

Mr. Thompson appeared to be enjoying Andy’s performance. “He knows all about me. For sixteen years he’s been my doc. Before that, Dr. Eton was my doctor.” Andy smiled, and noted to me as an aside, with gentle amusement, “Dr. Eton is now the chief of staff,” an exalted position at the top of the medical center food chain.
汤普森先生似乎很享受安迪的表现。“他对我了如指掌。十六年来他一直是我的医生。在那之前，伊顿医生是我的医生。”安迪微笑着，带着温和的趣味对我说，“伊顿医生现在是医务主任，”这是医疗中心食物链顶端的一个崇高职位。

The student sat facing the computer, entering the data gleaned from the visit, but she also asked some questions of her own-“So you are new to [the town]?” “Are you sleeping well?” “Do you take your blood pressure at home?” After the patient would answer, Andy would sometimes interpret it for the student, saying, “Social work can help with that,” for example, in references to his complaints about car troubles getting in the way of his access to his appointments. The visit continued, with Mr. Thompson talking about some new worries-“I have trouble with my throat”-and Andy discussing the medications he was on. “You keep my medications up to date,” Mr. Thompson said. “Thank God for you!”
学生坐在电脑前，输入从访问中收集到的数据，但她也提出了一些自己的问题——“所以你是新搬到[这个镇]的吗？”“你睡得好吗？”“你在家测血压吗？”患者回答后，安迪有时会为学生翻译，比如在提到他因汽车故障而影响就诊时，安迪会说：“社会工作可以帮忙解决这个问题。”访问继续进行，汤普森先生谈到一些新的担忧——“我喉咙不舒服”——安迪则讨论他正在服用的药物。“你一直帮我更新药物，”汤普森先生说，“感谢上帝有你！”

When it came time to take his blood pressure, Andy and the student both leaned into Mr. Thompson, reading the number on the monitor. A stillness descended upon the room while the man’s heart slowly pumped the blood out to his toes and back again. I had the sense of a sacred ritual being played out before me, and we all stayed quiet until Andy pulled back and announced, “Blood pressure of 162 over 82.”
到了测量血压的时候，安迪和学生都靠近汤普森先生，读取监测仪上的数字。房间里陷入一片静谧，男人的心脏缓缓将血液泵送到脚趾再回流。我感觉眼前正上演一场神圣的仪式，我们都保持安静，直到安迪后退一步，宣布：“血压是 162 比 82。”
“It will be OK as soon as I leave here,” Mr. Thompson said. He seemed to be trying to get Andy and the student not to worry or take any prolonged action. Andy said instead that they would take it again, but in the
“我一离开这里就会没事的，”汤普森先生说。他似乎在试图让安迪和学生不要担心，也不要采取任何长时间的行动。安迪则说他们会再试一次，但在此期间，
meantime they discussed whether he could see the social worker to get help with the Ensure. “The woman who brought me here, she’s got someplace to go,” Mr. Thompson said doubtfully, referring to his ride. When Andy asked whether she could wait, Mr. Thompson talked about how she had forgotten that he even had an appointment that day. She had told him, “Well, everybody forgets,” Mr. Thompson said, but then he observed primly: “She should have written it down if she was like that.” Still, he added, philosophically, “You can’t say that to someone, you have to be calm and collected, otherwise people will be through with you pretty quick.” Surprised, Andy chuckled with real enjoyment at this bit of folk wisdom.
他们讨论他是否可以见社会工作者，寻求关于 Ensure 的帮助。“带我来这里的那个女人，她还有别的地方要去，”汤普森先生怀疑地说，指的是他的接送人。当安迪问她是否能等一会儿时，汤普森先生谈到她甚至忘了他那天有预约。汤普森先生说，她曾告诉他，“嗯，大家都会忘的，”但随后他一本正经地说：“如果她是那样的话，应该写下来才对。”不过，他又哲学性地补充道，“你不能那样对别人说话，你得冷静沉着，否则人们很快就会不理你。”安迪听了这句民间智慧，惊讶地笑出了声，是真心喜欢这句话。

They talked about some pills he was taking, and that he needed to get a colonoscopy. Andy leaned in and touched the man’s knee. “Can you try to reschedule the colonoscopy appointment, and get a ride with someone?” Mr. Thompson heard him, the touch getting his attention. “Yes,” he said. Later on, in an interview, Andy told me he used the touch on purpose, to accentuate Mr. Thompson’s role. “I think if there’s something really important and they actually need to do something and be proactive, you have to sort of really connect,” he said. “I wasn’t facing him but I tried to, I think, and touched him. Because there’s a certain responsibility. Like getting those tests like the colonoscopy that he needs to do that I can try to troubleshoot. But it actually takes a responsibility for him to get the ride. I can’t really organize that. It takes time for him to call the GI suite to schedule it for his time frame. So there’s some important things that are really his responsibility.”
他们谈到了他正在服用的一些药片，以及他需要做一次结肠镜检查。安迪倾身过去，触碰了那位男子的膝盖。“你能试着重新安排结肠镜检查的时间，并找人帮你搭车吗？”汤普森先生听到了他的声音，触碰引起了他的注意。“可以，”他说。后来，在一次采访中，安迪告诉我，他是故意用触碰来强调汤普森先生的角色。“我觉得如果有些事情真的很重要，他们确实需要采取行动并积极主动，你必须真正建立联系，”他说。“我当时并没有正对着他，但我试着这样做了，触碰了他。因为这是一种责任感。比如做那些他需要做的检查，比如结肠镜，我可以尝试帮他解决问题。但实际上，安排搭车是他的责任。我不能真正帮他组织这件事。他需要花时间打电话给胃肠科安排适合他的时间。所以有些重要的事情确实是他的责任。”

After Mr. Thompson held forth for some time about his financial troubles-his car had broken down, and he couldn’t pay his utility bills, and Andy told him and the student that the social worker could help with housing and transportation-they rechecked the blood pressure, this time rolling up his shirt sleeve. The same stillness returned to the scene. “Perfect,” Andy announced. “138 over 63.”
汤普森先生讲了他的一些经济困难——他的车坏了，付不起水电费，安迪告诉他和学生，社工可以帮忙解决住房和交通问题——之后，他们重新测量了血压，这次卷起了他的衬衫袖子。现场又恢复了那种静谧。“完美，”安迪宣布，“138 比 63。”

Mr. Thompson moved to the examining table, and Andy had the student feel his chest through his shirt. “Feel this, he has a heave, feel the chest here, that’s from surgery, the generator is up here, but feel that right there, pressing against you, it is the right ventricular heave, the
汤普森先生走到检查台前，安迪让学生透过他的衬衫摸他的胸部。“摸这里，他有心脏隆起，摸这儿，那是手术留下的，起搏器装在这里，但摸这儿，压着你的，就是右心室隆起，那个
heart is very big,” Andy said, to the student, and then to Mr. Thompson, joking, “Your heart is very big, Mr. T. We’ve known that for some time.” “Is it worse?” Mr. Thompson asked, disregarding the joke. “You’re a very nice man,” Andy said, explaining the joke, but then, soothingly, “It’s about the same.” He and the student put on their stethoscopes to listen to his chest. “I didn’t hear anything. He usually has these little crackles,” Andy said. The student said she heard the crackles. “That’s a good pickup,” Andy said to her. “The fine crackles, it’s not unusual for heart failure patients.”
“心脏很大，”安迪对学生说，然后对汤普森先生开玩笑道，“汤普森先生，您的心脏很大。我们早就知道了。”“情况更糟了吗？”汤普森先生问，没理会玩笑。“您是个很好的人，”安迪解释玩笑的意思，但随后安慰道，“情况差不多。”他和学生戴上听诊器听他的胸部。“我没听到什么。他通常会有这些细微的爆裂音，”安迪说。学生说她听到了爆裂音。“你听得不错，”安迪对她说，“细微的爆裂音，对于心力衰竭患者来说并不罕见。”

Andy spoke to Mr. Thompson: “We may have dried you up too much, we’ll give you less of the Lasix. I know you don’t like that Lasix.” “I can’t get enough water,” Mr. Thompson said. “And your weight is down, and the kidney function is a little worse,” Andy said. “But we don’t want you to have too much water because you’ll end up in the hospital like last time.” ${}^6$${}^6$^(6){ }^{6}
安迪对汤普森先生说：“我们可能让您脱水过度了，我们会减少给您的呋塞米剂量。我知道您不喜欢呋塞米。”“我喝水喝不够，”汤普森先生说。“而且您的体重下降了，肾功能也稍微差了一点，”安迪说，“但我们不希望您喝太多水，否则您会像上次那样住院。”

That day he concluded the visit by asking Mr. Thompson, “Did we address everything?” “I think so, thoroughly,” the man replied.
那天，他结束访问时问汤普森先生：“我们有没有解决所有问题？”“我想有，彻底解决了，”那人回答。

The visit was a study in connective labor by a master of the craft, and like us, the student was in a front row seat. In addition to the blood pressure rituals, we can see Andy’s attunement to Mr. Thompson’s worries about his finances, about being “too dry,” about how he managed the uncertainties of his ride. We also can see his use of touch to elicit Mr. Thompson’s attention. It was highly collaborative, with Mr. Thompson chiming in and attempting to shape the way they understood his first blood pressure metric, all the way to the end, when Andy checked in on whether Mr. Thompson thought they were finished. It also featured a gentle open-hearted sort of affection, a positive regard between both of them, built up over sixteen years.
这次访问展示了一位连接劳动大师的精湛技艺，而我们和学生一样，坐在了第一排。除了测量血压的仪式之外，我们还能看到安迪对汤普森先生关于财务的担忧、对“太干燥”的担心以及他如何应对乘车不确定性的细致关注。我们还可以看到他通过触摸来引起汤普森先生注意的方式。这是一次高度协作的过程，汤普森先生不断插话，试图影响他们对他第一次血压测量结果的理解，直到最后，安迪还确认汤普森先生是否认为他们已经完成。整个过程中还流露出一种温柔而真诚的情感，是双方十六年来建立起来的积极关怀。

Andy’s mentoring was similarly deft. He watched - and stepped back a bit-as the student asked the patient questions, trying to both connect to him (Was his new apartment in a new town for him?) and to elicit medically relevant information (Was the blood pressure the same at home?). Andy gave low-key quizzes (about the electrolytes), some helpful asides about what to worry about (retaking the blood pressure) and what not to (tasks the social worker can take care of), and positive
安迪的指导同样娴熟。他观察着——并稍微退后了一些——当学生耐心地提问，既试图与病人建立联系（他的新公寓是在一个新城市吗？），又试图获取医学相关的信息（家里的血压是否一样？）。安迪进行了低调的小测验（关于电解质），提供了一些有用的旁注，告诉学生该担心什么（重新测量血压）和不必担心什么（社工可以处理的任务），并给予积极的肯定（“这是个很好的发现”）。
affirmation (“That’s a good pickup”). Students slow you down at first, he told me later, but are more helpful as time goes on; this student even put some orders through on the computer while Andy was attending to Mr. Thompson.
他后来告诉我，学生一开始会拖慢你的节奏，但随着时间推移会变得更有帮助；这位学生甚至在安迪照顾汤普森先生时，通过电脑下达了一些医嘱。
“I’ve had some students where I thought: 'Well, God, this is going to be a struggle,” he said, raising his eyebrows. One such student was planning on being a radiation oncologist, and “they actually need to have some hands-on skills too, because it’s not just the radiation, but they are oncologists and they do need to examine the patients,” he recalled. “I worried because he struggled with his physical exam skills and he failed one of our major examinations that we do here. I worked with him and worked with him and he actually got better, and it was just a matter of him slowing down and being meticulous about each component of the exam and me just guiding him through that again.” Later Andy got an email from the student just as he had finished medical school, “you know, just thanking me and saying, ‘Guess what? I got the intern award for the best clinician.’ And I thought, ‘Wow.’” Andy took mentoring seriously.
“我遇到过一些学生，我当时心想：‘天哪，这会很难搞，’”他说着，扬了扬眉毛。其中一个学生计划成为放射肿瘤科医生，“他们实际上也需要一些动手技能，因为不仅仅是放射治疗，他们还是肿瘤科医生，确实需要给病人做检查，”他回忆道。“我很担心，因为他在体格检查技能上很挣扎，还挂掉了我们这里的一项重要考试。我和他一起努力，一遍又一遍地辅导他，他确实进步了，关键是他放慢了速度，对每个检查环节都非常细致，而我只是再次引导他完成这些步骤。”后来，安迪刚刚完成医学院学业时，收到了那位学生的邮件，“你知道的，就是感谢我，还说，‘猜猜看？我获得了最佳临床实习医生奖。’我当时想，‘哇。’”安迪非常认真地对待指导工作。

Mentoring seemed valuable less for conveying particular tips about how to connect to patients or clients, and instead for supporting the notion that relationship mattered. “I actually felt lucky,” Andy said, recalling his own training. “I felt like I worked with a lot of physicians in my training that were very humanistic. I remember it was at the height of the AIDS epidemic. I worked in an HIV clinic at the time. Initially, they really didn’t know what it was. But the doctors there were just so dedicated. And I could see them as role models.” Mentoring helped light the path toward a relationship-centered practice.
指导似乎更有价值的不是传授如何与患者或客户建立联系的具体技巧，而是支持关系重要性的观念。“我实际上感到很幸运，”安迪回忆起自己的培训时说。“我觉得我在培训期间与许多非常有人文关怀的医生共事。我记得那正值艾滋病流行的高峰期。当时我在一家艾滋病诊所工作。起初，他们真的不知道那是什么。但那里的医生们非常敬业。我能把他们看作榜样。”指导帮助点亮了通往以关系为中心的实践之路。

While leaders and mentors are important, practitioners also seemed to hunger for groups of peers with whom they could share ideas and struggles. Of all the groups I observed, the chaplains had the most occasions for this kind of exchange, from formal presentations and feedback to more ad hoc processing of moments during and after their shifts, and I watched many instances where they shared their struggles with each other to derive guidance or comfort. They gathered regularly to listen to each other, sitting around a conference table in a tiny room they borrowed
虽然领导者和导师很重要，实践者们似乎也渴望有一群同行，可以分享想法和困难。在我观察的所有群体中，牧师们有最多这样的交流机会，从正式的演讲和反馈，到更临时地处理班次期间和之后的时刻，我看到许多他们相互分享困难以寻求指导或安慰的场景。他们定期聚集，围坐在一间借来的小会议室的会议桌旁，倾听彼此。
weekly from a sleep science research group, which had posted a few signs in the hallway about being quiet.
每周都会收到来自一个睡眠科学研究小组的邮件，该小组在走廊里贴了几张关于保持安静的标志。

One day, they were discussing how to serve new parents when they confronted baby sickness and sometimes death. Leading the discussion was fellow trainee Cassidy Lewis, an angular woman who had made it her project to win over the NICU nurses to chaplain service. She even looked like a labor and delivery nurse as she stood next to the blackboard, wearing a NICU fleece, scrubs-like pants, and flat shoes, with a hospital key chain around her neck. Cassidy had a different sort of emotional energy compared to her fellow chaplains; she had a quick impatience, even a bit of a raw edge that was unusual among the warm and gentle group. On another occasion, she admitted as much, telling the group bemusedly that she was in good contact with her anger.
有一天，他们正在讨论如何帮助新手父母应对婴儿生病甚至死亡的情况。主持讨论的是同为实习生的卡西迪·刘易斯，她是一个身材瘦削的女性，致力于争取新生儿重症监护室（NICU）的护士支持牧师服务。她站在黑板旁，看起来就像一名产科护士，穿着 NICU 的抓绒衣、类似手术服的裤子和平底鞋，脖子上挂着医院钥匙链。卡西迪的情感能量与其他牧师不同；她表现出一种快速的不耐烦，甚至带有一点生硬的棱角，这在这个温暖而温柔的团队中很少见。另一次，她坦言自己情绪激烈，带着些许愤怒，令团队成员感到好笑。

Talking to her fellow chaplains about serving parents in grief, Cassidy was blunt about the challenges they would face. “This is what’s unique about labor and delivery patients: when babies die, that’s what is different, they never had a chance, they never did anything wrong. Babies are considerably more complicated for people’s theodicy [an explanation for why a good God permits the existence of evil] because there was nothing they could have done, so it complicates theodicy. There are none of the things that give hope at the end of life-the life they’ve lived, the things she’s experienced.”
在与其他牧师谈论为哀悼中的父母提供服务时，卡西迪直言不讳地谈到了他们将面临的挑战。“这就是产科病人的独特之处：当婴儿去世时，这就是不同之处，他们从未有过机会，他们从未做错什么。婴儿对于人们的神义论（即解释为什么一个善良的上帝允许恶的存在）来说要复杂得多，因为他们什么都没做错，这使得神义论更加复杂。没有那些在生命终结时带来希望的事情——他们所经历的生活，她所经历的事情。”

Margaret, a middle-aged white woman with three kids of her own, commented that the trauma of these new parents was “so close to my own personal nightmare that it is hard for me to be present in the way I want to. How do I get past that?” “For me it’s the opposite,” a single woman about ten years younger said. “I have no experience with babies and I’m a little scared of them.” Erin Nash mentioned that L&D was a sort of closed unit, that she would be up there sometimes and the nurses would say something like, “Whoa, there’s too many people.”
玛格丽特是一位中年白人女性，有三个孩子，她评论说这些新父母的创伤“与我个人的噩梦如此接近，以至于我很难以我想要的方式全身心投入。我该如何克服这一点？”“对我来说正好相反，”一位比她小大约十岁的单身女性说。“我没有照顾婴儿的经验，而且我有点害怕他们。”艾琳·纳什提到产科是一个相对封闭的病区，她有时会在那里，护士们会说类似“哇，这里人太多了”的话。

Anne Reynolds, the head trainer, then led them in an exercise, asking them to stand up with a ball of yarn. “This could come too close to you if you have your own experience of this,” she cautioned. “I do have students come to training having never processed a loss they have had before.” The chaplains stood in a circle, tossing a ball of yarn to one an-
安妮·雷诺兹，首席培训师，然后带领他们做了一个练习，要求他们站起来，手里拿着一团毛线。“如果你有过类似的经历，这可能会让你感触很深，”她提醒道。“我确实遇到过一些学生，在培训时还没有处理过自己曾经经历过的失落。”牧师们围成一圈，互相抛着毛线球，同时大声说出当他们认识并关心的人即将有孩子时脑海中浮现的想法。
other while they said out loud what came to mind when someone they know and care about was going to have a baby. They said things like “I can’t wait to meet the baby,” “I hope it’s a son,” “I hope you let me get involved,” “Joy,” “I know you’ve been trying for this.” Despite the artificiality of the moment, they seemed to lose themselves entirely in the exercise; it felt like they were actually talking to real people who were not there. The yarn got more and more tangled as they tossed the ball back and forth. After a while, Anne stopped the sharing. “OK,” she said, “drop the threads.” The yarn fell to the floor, looking like a bedraggled heap of abandoned networks.
他们说着诸如“我迫不及待想见宝宝了”、“希望是个儿子”、“希望你让我参与进来”、“喜悦”、“我知道你一直在努力”等话语。尽管这一刻显得有些做作，他们似乎完全沉浸在这个练习中；感觉就像他们真的在和那些不在场的真实人们交谈。随着他们来回抛掷毛线球，线团变得越来越纠结。过了一会儿，安妮停止了分享。“好了，”她说，“放下线头。”毛线落到地上，看起来像是一堆凌乱废弃的网络。

Anne then directed them to go around the room saying what came to mind when they heard that the baby had died. The response was immediate and visceral-some of the chaplains cried, and one got a tissue-it was very moving to watch. The chaplains reminded each other there could be ambivalence, that we did not know how the parents felt about the birth or death. But the overall mood was deeply sad, and a pall descended on the room. I wondered to myself whether the yarn helped people focus on what they were saying as if it were real; the tangle on the floor had an air of finality.
安妮随后让他们围着房间轮流说出听到婴儿去世时脑海中浮现的想法。反应是立刻且强烈的——一些牧师哭了，其中一人拿出纸巾——看着这一幕非常感人。牧师们互相提醒，可能会有矛盾的情绪，我们并不知道父母对出生或死亡的感受。但整体氛围非常悲伤，房间里笼罩着一层阴霾。我心想，这根毛线是否帮助人们专注于他们所说的话，好像那是真的；地上的纠结带有一种终结的意味。

Sounding boards allow professionals-not just students-to be vulnerable in front of each other, to process difficult moments aloud, and to learn about alternative approaches. For the chaplains, their sessions were an explicit moment to think about relationship, including how they related to one another. “That’s just space for them to use,” Anne told me. “A big piece of it is also reflecting how they [the chaplain trainees] experience each other, because they [educators] don’t really train us for that in divinity school or seminary. They don’t really teach us how we’re coming off to other people.” One chaplain had even spent a meeting coding the way the group interacted, keeping track of critique, support, conflict, and response; Anne showed me the result (see figure 8.1). The group then spent twenty minutes talking about what the chart revealed, Anne told me. The image meant they were able to see “where the lines of sort of communication were going,” she said. “This one was pretty even, actually.”
倾听板让专业人士——不仅仅是学生——能够在彼此面前展现脆弱，公开处理困难时刻，并学习替代方法。对于牧师们来说，他们的会议是一个明确的时刻，用来思考关系，包括他们彼此之间的关系。“那只是给他们使用的空间，”安妮告诉我。“其中很大一部分也是反思他们（牧师实习生）如何体验彼此，因为他们（教育者）在神学院或神学学校里并没有真正训练我们这方面。他们并没有真正教我们别人是如何看待我们的。”一位牧师甚至在一次会议中对小组互动的方式进行了编码，记录批评、支持、冲突和回应；安妮给我看了结果（见图 8.1）。安妮告诉我，小组随后花了二十分钟讨论图表揭示的内容。这个图像让他们能够看到“沟通线路大致走向”，她说。“这个其实相当均衡。”

Outside of formal training programs like that of the chaplains (and even in some of those), these communities are not at all inevitable, and
在像牧师这样的正式培训项目之外（甚至在其中的一些项目中），这些社区并非必然存在，且

FIGURE 8.1. A chaplain’s rendition of group dynamics in discussion.
图 8.1. 一位牧师对讨论中群体动力的诠释。
often require deliberate nurturing and commitment. “The extent to which caregivers are emotionally ‘held’ within their own organizations is related to their abilities to ‘hold’ others similarly,” writes the organizations scholar William Kahn. Joyce Fletcher, another organizations researcher, called that nurturing the work of “creating team,” arguing that “individuals who feel understood, accepted, appreciated, or ‘heard’ are more likely to extend the same acceptance to others, leading to a kind of group life characterized by . . . a zest for interaction and connection.” ${}^7$${}^7$^(7){ }^{7}
常常需要刻意的培养和投入。组织学者威廉·卡恩写道：“照顾者在自己组织中被情感‘支持’的程度，与他们同样‘支持’他人的能力有关。”另一位组织研究者乔伊斯·弗莱彻称这种培养为“创建团队”的工作，她认为“那些感到被理解、被接受、被欣赏或‘被倾听’的个体，更有可能将同样的接受态度扩展到他人，从而形成一种以……对互动和连接充满热情为特征的群体生活。” ${}^7$${}^7$^(7){ }^{7}

Just a few weeks after the chaplains practiced thinking about grief and babies, the exercise became real for them. Margaret came into the tiny sleep lab room from being on call all night, and told the group she had been called to a hospital room where a little boy had just died of cancer. Yet when she got there, she realized she did not know enough about the suffering family to be able to do much of anything helpful. A nurse who knew the family’s situation better stepped up and said, “the most beauti-
就在牧师们练习思考悲伤和婴儿问题的几周后，这个练习对他们来说变得真实起来。玛格丽特从整夜待命中走进那个狭小的睡眠实验室房间，告诉大家她被叫到医院病房，那里的一个小男孩刚刚死于癌症。然而，当她到达时，她意识到自己对这个受苦家庭了解不够，无法做出什么有帮助的事情。一位更了解该家庭情况的护士站出来说：“最美丽的——
ful heartfelt thing. The nurse was a better chaplain than I was,” Margaret said, with gratitude and regret all at once. “It was so beautiful and really spoke to the heart.”
“那真是一件发自内心的事。那位护士比我更像个牧师，”玛格丽特一边说着，一边充满感激和遗憾。“那太美了，真的触动了心灵。”

When she had finished, Anne, the group leader, asked gently, “What would it be like to just trust that you are there? What would it feel like to let go of that feeling uncomfortable, that you are not enough?”
当她说完后，组长安妮温柔地问：“如果你只是相信自己在那里，会是什么感觉？如果你放下那种不舒服的感觉，放下觉得自己不够好的感觉，会是什么样子？”

Margaret looked at her and repeated her words: “To let go of that . . .”
玛格丽特看着她，重复了她的话：“放下那种感觉……”
Hank jumped in. “There’s power in just you seeing what you saw, being the witness,” he declared. “Those moments of deep, deep grief. Just seeing them validates something, makes it real. Even that-I think there’s power in that.”
汉克插话道：“仅仅是你看到你所看到的，成为见证者，这本身就有力量，”他宣称。“那些深深的悲痛时刻。仅仅是看到它们，就确认了某些东西，让它变得真实。即使是那样——我认为这其中也有力量。”

The case had also troubled Cassidy, the chaplain in the NICU fleece, and when it was her turn to share, her characteristic confidence faltered. “What sticks with me when a child dies is not their dead body, I can handle that, even though it feels a little bit callous to say, that is not what haunts me,” she said. “What haunts me, what keeps replaying in my mind, is when a mother-there are mother’s voices in my mind that I can’t get out. This mom was screaming, ‘What did he do to deserve this? He’s only three. What did I do?’” The memory stayed with her, Cassidy said. “If everything else fades, what continues for me is the women’s helpless cries for change, and there’s nothing that they can sacrifice to make it different. And I couldn’t get her screams out of my mind last night. And I don’t know what to do with that, because I can’t . . .”
这个案例也让 NICU 穿着抓绒衣的牧师卡西迪感到困扰，当轮到她分享时，她一贯的自信出现了动摇。“当一个孩子去世时，留在我心里的不是他们的尸体，我能应付得了，虽然这么说听起来有点冷酷，但那并不是困扰我的东西，”她说。“困扰我、不断在我脑海中重播的是母亲的声音——我脑海中有母亲的声音挥之不去。这位妈妈在尖叫，‘他做了什么才配得上这个？他才三岁。我做错了什么？’”卡西迪说，这段记忆一直伴随着她。“如果其他一切都渐渐淡去，留给我的是这些女性无助的呼喊，渴望改变，而她们却无能为力，无法通过任何牺牲来改变现状。昨晚我无法将她的尖叫声从脑海中驱散。我不知道该怎么办，因为我无法……”
“There’s this box of screams, but when another one is added it just brings back all the other ones.” Erin, her fellow trainee, responded to her agony. “I wish we all had pillows right now, I wish we could scream into the pillow,” she said. “You’re holding all these sounds and images, and the toll it takes on you and all of us is worth lamenting too. Where is our space to lament for what seems like an impossible profession sometimes? Next to the Sleeping Lab! I seriously would invite us all to lament as loudly as we could, go out and smack a tree or something, scream, go out and scream at God, or whatever.”
“这里有一个尖叫的盒子，但每当再加一个尖叫声，它就会把所有其他的尖叫声都带回来。”她的同伴实习生 Erin 回应她的痛苦。“我真希望我们现在都有枕头，真希望我们能对着枕头尖叫，”她说。“你承载着所有这些声音和画面，这对你和我们所有人造成的影响也值得哀叹。我们哪里有空间去哀叹这有时看似不可能的职业呢？就在睡眠实验室旁边！我真心想邀请我们所有人尽可能大声地哀叹，出去拍打一棵树什么的，尖叫，出去对着上帝尖叫，或者随便什么。”

Later on, on a brief break, I was in the restroom with Margaret and Cassidy, who were still talking about the little boy’s case. “You did
后来，在一个短暂的休息时间，我和玛格丽特以及卡西迪一起在洗手间，她们还在讨论那个小男孩的案子。“你确实
something important there, you did what had to be done,” Cassidy said. Margaret agreed weakly.
“那里有重要的事情，你做了必须做的事，”卡西迪说。玛格丽特虚弱地点头同意。

Back in the tiny room, before the group left for the day, they talked about the community they were building. Anne warned them that they may not have the same kind of community in their future jobs that they had forged in their training. “It is hard when and if you move into chaplaincy, it’s impossible to rebuild a place like this, a community like this, people who understand what you’re doing on a daily basis. Your family can’t do it, and it’s not their role for you to sit them down and say, ‘This is what happened last night.’ It’s important to find people who can hear you and understand.” We might be used to turning to our family for solace, but they could not serve as a sounding board for these kind of experiences, she said, urging them to find other sources of comfort. Otherwise, “it can be really lonely.” Workers without sounding boards were on their own, serving perhaps as individual heroes but without the support that could make their paths sustainable.
回到那个狭小的房间里，在小组准备离开之前，他们谈论起正在建立的社区。安妮提醒他们，未来的工作中可能不会有像培训时那样的社区。“如果你们进入牧师工作，那就很难，几乎不可能重建像这里这样的地方，像这样的社区，那里的人们能理解你每天所做的事情。你的家人做不到这一点，也不是他们的角色让你坐下来告诉他们，‘昨晚发生了这些事。’找到能倾听你、理解你的人很重要。”她说，我们可能习惯于向家人寻求安慰，但家人无法成为这些经历的倾诉对象，她敦促他们寻找其他的慰藉来源。否则，“会非常孤独。”没有倾诉对象的工作者只能孤军奋战，或许成为个人英雄，但缺乏能让他们的道路可持续的支持。

Sounding boards require support from their organizational settings, so that people have the time and capacity to see each other regularly, to talk about their practice, to develop a history with each other. But they wither in conditions of burnout. After Margaret’s session concluded, I ran into her in the parking lot, just before she finally went home. She told me it’s really important “to unwind, to process it all so it doesn’t build upon itself,” so you don’t feel like every child on a bike is going to get hit by a car, or every car is not going to wrap itself around a tree. You have to realize it’s really extreme, she said. “But sometimes it’s hard to do that, under overwork conditions.”
倾诉对象需要组织环境的支持，这样人们才有时间和能力定期见面，讨论他们的工作，彼此建立起共同的经历。但在倦怠的情况下，这种关系会逐渐枯萎。玛格丽特的会议结束后，我在停车场遇到了她，就在她最终回家之前。她告诉我，“放松，处理所有事情非常重要，这样它们才不会积累起来”，这样你就不会觉得每个骑自行车的孩子都会被车撞，或者每辆车都会撞到树上。她说，你必须意识到这真的很极端。“但有时在过度工作条件下，这很难做到。”

At the University Transformational Care clinic, they were explicit about trying to create such a community, particularly because they were relying so much on medical assistants to expand their role. Yet the status differential among the participants could make a discussion feel a bit more like lecturing and a little less like sharing. One Friday morning, I sat in on their weekly clinic meeting. In attendance were physicians, social workers, nurses, and a cadre of former medical assistants who were the “care transformers”; most of the transformers seemed to be Latina and most of the others appeared to be white. At the meeting, the transformers presented
在大学转型护理诊所，他们明确表示试图创建这样一个社区，特别是因为他们非常依赖医疗助理来扩展他们的角色。然而，参与者之间的地位差异可能会让讨论感觉更像是讲课，而不那么像是分享。一个星期五的早晨，我参加了他们的每周诊所会议。出席者有医生、社会工作者、护士，以及一群被称为“护理变革者”的前医疗助理；大多数变革者似乎是拉丁裔，而其他大多数人看起来是白人。在会议上，变革者们介绍了
the profile of a given patient-who they were, their medical goals, their history-and the group talked about their care, as well as any issues or problems that came up in the week.
某位患者的情况——他们是谁、他们的医疗目标、他们的病史——小组讨论了他们的护理情况，以及本周出现的任何问题或困难。

The meeting was supposed to create a team, and to provide a site where people could talk about the hard work of connecting. They started the meeting with a meditation, heads bowed as they listened to music. They made plans for a retreat at a winery, and somewhere in the middle they handed around a “team jar,” in which people commented on appreciating someone else (“Janine, thank you so much for helping on a patient on Monday who went to Express Care, you’re amazing”). As one of the nurses announced at the meeting, “If we don’t take care of ourselves, we can’t take care of anybody.”
会议的目的是组建一个团队，并提供一个让人们讨论连接这项艰难工作的场所。会议开始时，大家低头冥想，聆听音乐。他们计划在一个酒庄举办一次静修活动，会议中间还传递了一个“团队罐”，人们在里面写下对他人的赞赏（“Janine，非常感谢你周一帮助那位去了急诊的病人，你真了不起”）。正如一位护士在会议上所说：“如果我们不照顾好自己，就无法照顾任何人。”

But the bulk of the meeting was about a problem that Dorothy, the social worker, sought to solve. It turned out that a care transformer, Luisa, had been stepping out for lunch when she passed by an anxious clinic patient waiting for lab results. The patient was upset, pacing, spiraling out of control, wondering out loud about why the lab results were not forthcoming when her EKG was normal. Luisa interceded with the lab reception to make sure she was seen more quickly, and then sat with her until she got her results a few minutes later.
但会议的大部分时间都在讨论一个社会工作者多萝西想要解决的问题。事实证明，一位护理转换者路易莎在午餐时路过一位焦虑的诊所病人，那位病人正在等待化验结果。病人情绪激动，来回踱步，情绪失控，边走边大声质疑为什么化验结果迟迟未出，而她的心电图却是正常的。路易莎介入，与化验室接待沟通，确保她能更快被接待，然后陪伴她直到几分钟后拿到结果。
“I did eat. I took her to the café, and then I went back to work,” Luisa reported.
“我确实吃了。我带她去了咖啡馆，然后又回去工作了，”路易莎报告说。
“That was very generous of you,” said Dorothy, but in a way that suggested it was a mistake. “She has a history of medical trauma and severe anxiety.”
“你真是太慷慨了，”多萝西说，但语气中似乎暗示这是个错误。“她有医疗创伤和严重焦虑的历史。”
“I understand boundaries are important,” Luisa said. “I don’t know how to meet her needs and still have boundaries.”
“我明白界限很重要，”路易莎说。“我不知道如何满足她的需求，同时又保持界限。”

But the social worker seemed to blame Luisa for responding. “I want [the patient] to practice saying, 'I have a panic disorder and it would help all of us if I could be seen,” she said, as she held forth about being an “overfunctioner,” apparently meaning someone who helps others more than is good for them. “As a woman, I know I can be an overfunctioner for someone else,” Dorothy said, noting how “that’s tough behavior to change.” Nancy, a clinic physician, chimed in: “Our model of being infinitely accessible is not good for this patient.”
但社工似乎责怪路易莎做出回应。“我希望[患者]练习说，‘我有恐慌症，如果我能被看见，对我们所有人都会有帮助，’”她说着，谈论自己是个“过度功能者”，显然指的是那种帮助别人超过对自己有益的人。“作为一个女性，我知道我可能会成为别人身上的过度功能者，”多萝西说，指出“那是很难改变的行为。”诊所医生南希插话道：“我们无限制可接触的模式对这个患者并不好。”

While the clinic meeting moved on to discuss other items, Dorothy circled back around to talk again about boundaries for the last ten minutes, while people fidgeted and rustled papers. Luisa’s confusion highlighted the difficulty in drawing the boundary between serving and overserving, especially in an institution set up to meet needs that had been forsaken by others.
当诊所会议继续讨论其他事项时，多萝西又回过头来，在最后十分钟里再次谈论界限问题，而人们则坐立不安，翻动着文件。路易莎的困惑凸显了划定服务与过度服务之间界限的难度，尤其是在一个旨在满足被他人遗弃需求的机构中。

It was a little hard for me to gauge whether the meeting was sowing community or division, however. On the one hand, the air of reprimand made the meeting seem more like a site of evaluation rather than one of refuge and experimentation. But later on, Catalina told me she found the clinic meetings effective for team building at University Transformational Care. At her old practice in the Central Valley, they had monthly meetings that were much more fraught, she said. “I felt that there was a lot of tension already built up from a lot of issues. But it’s like built over a whole month. How do you not explode at that moment, right? Or how do you even bring it up at that moment, you know? You just kind of held it in already for so long. I feel like if they had a lot more, like, team building . . . you can kind of set the guidelines of ‘This is the right way to do it,’ right?” Perhaps what I had perceived as a reprimand from Dorothy was to the rest of the group an instance of helpful feedback, especially in light of their regular meetings, and the meditation, “team jar,” and other ritualistic moments they used to gather themselves together.
不过，我有点难以判断这次会议是在促进社区的凝聚，还是在制造分裂。一方面，会议中那种训斥的氛围让它更像是一个评估场所，而非一个避风港或试验场。但后来，Catalina 告诉我，她觉得诊所的会议对大学转型护理团队建设很有效。她说，在她以前位于中央谷的诊所，他们每月开一次会议，气氛要紧张得多。“我感觉那里面已经积累了很多紧张情绪，都是因为各种问题。可是这些情绪是整整一个月积累起来的。那时你怎么可能不爆发呢？或者你怎么可能在那个时候提出来呢？你已经憋了很久。我觉得如果他们有更多的团队建设……你就能设定‘这是正确的做法’这样的指导原则，对吧？”也许我之前觉得 Dorothy 的训斥，对其他人来说却是一次有益的反馈，尤其考虑到他们定期的会议，以及他们用来凝聚团队的冥想、“团队罐子”和其他仪式性时刻。

Relational design, or the way people are positioned vis-à-vis each other in a given organization, can help contribute to a supportive social architecture. But leaders, mentors, and sounding boards are not sufficient on their own; a successful social architecture seemed also to rely on having a shared set of beliefs and practices that reinforced empathic emotional collaboration. Common values, norms, and rituals comprised the connective culture that gathered people under its umbrella.
关系设计，或者说人在特定组织中相互定位的方式，可以帮助构建支持性的社会架构。但领导者、导师和倾听者本身并不足够；一个成功的社会架构似乎还依赖于拥有一套共同的信念和实践，这些信念和实践强化了富有同理心的情感协作。共同的价值观、规范和仪式构成了连接文化，将人们聚集在其伞下。

Bert Juster, the head of the school for boys, was certainly committed to relationship. But he knew that his vision alone was not enough to drag the staff and children into connection. Instead, he was explicit
男校校长伯特·贾斯特（Bert Juster）无疑致力于关系建设。但他知道，单靠他的愿景不足以将教职员工和孩子们拉入连接之中。相反，他明确表示
about the importance of not just sharing a philosophy with school personnel, but enacting it through planned practices. “We’ve actually been talking a lot about how to create systems and structures that can allow us to bring our mission into the day-to-day experience of the school,” he said. “Because you can’t just wish for it, and you can’t just talk a good story about your mission and hope that it shows up in your classroom. You really need to create systems in order to do that.” The conversation led to thinking about the aspects of the school that they do well, that they want to be sure to keep for the future.
关于不仅要与学校人员分享一种理念，更要通过有计划的实践来落实这一理念的重要性。“我们实际上一直在讨论如何创建系统和结构，使我们能够将使命融入学校的日常体验中，”他说。“因为你不能只是空想，也不能仅仅讲一个关于使命的美好故事，希望它能在课堂上体现出来。你真的需要创建系统来实现这一点。”这段对话引发了他们对学校哪些方面做得好、希望未来继续保持的思考。

We were talking about “What are the things at the school that are like magic? What are the things that we do really well, that we need to not forget as we grow, and as new people come in, we don’t want to lose that?” One of the things . . . was love. “How do we systematize love? How do we systematize joy?” So, what we did at that time, was we just brainstormed as a group, all the ways that we were doing love in the school. “What does it look like in the morning? What does it look like in the afternoon? What does it look like in the science class?”
我们在讨论“学校里有哪些像魔法一样的东西？我们做得非常好的事情是什么？随着学校的发展和新人的加入，我们不想失去这些东西。”其中一项是爱。“我们如何将爱系统化？我们如何将快乐系统化？”于是，当时我们作为一个团队集思广益，列举了在学校中表达爱的所有方式。“早晨表现出来是什么样子？下午又是什么样子？在科学课上又是什么样子？”

One result of this reflective moment, he said, was to build explicit conversation about love into the admissions process, so that families knew from the start that the school made it a priority, which “weeds out the families who are not right for us.” “We just have a school where we talk about love, a lot,” Bert said. “You know, if a boy is in trouble the first thing that I say to him is ‘You know I love you, right?’” Not every family was open to that kind of language, he said, and they did not have time to win over those who were not convinced already.
他说，这种反思时刻的一个结果是将关于爱的明确对话纳入招生过程，让家庭从一开始就知道学校将其作为优先事项，这样“就能筛选出不适合我们的家庭。”伯特说：“我们就是一所经常谈论爱的学校。你知道，如果一个男孩遇到麻烦，我对他说的第一句话就是‘你知道我爱你，对吧？’”他说，并不是每个家庭都能接受这种语言，他们也没有时间去说服那些还没被说服的人。

Another occasion for “systematizing love” was to create the term “love space,” instead of “safe space,” to frame how to have difficult conversations. For Bert, the distinction was crucial. “Safe space is all about what you can’t say, what you can’t do, and a love space is all about saying, ‘No, if you have a racist thought in your head you can say it, but you, you gotta own it, yeah.’ So ‘love space’ is all about challenging each other to be the best that you can be, instead of assuming the worst and just preparing fences or barriers. That ‘agree to disagree’ drives me crazy.”
另一个“系统化爱”的场合是创造了“爱空间”这个术语，取代“安全空间”，用来界定如何进行困难的对话。对伯特来说，这一区别至关重要。“安全空间关注的是你不能说什么，不能做什么，而‘爱空间’则是说，‘不，如果你脑子里有种族主义的想法，你可以说出来，但你必须承担责任，是的。’所以‘爱空间’就是相互挑战，成为最好的自己，而不是假设最坏的情况，只是筑起围栏或障碍。那种‘同意不同意’的态度让我抓狂。”

The school enacted “love space” in its “restorative justice circles,” in which students in conflict talked openly about their experiences and made plans to alleviate harm. The circles had been crucial for the school, Bert said. “I was thinking how important they’ve been, for us at least, in having students not actually result in just having shame, or ignoring a transgression or whatever they did to hurt the community, or to hurt another person. Whether or not you’re doing a restorative justice circle with just three, or whether you’re doing it with the entire grade, or the entire school, it’s a way to have that aha moment solidified in repairing your relationship with the community and making it right.”
学校在其“修复性司法圈”中实施了“爱之空间”，学生们在冲突中公开谈论他们的经历，并制定计划以减轻伤害。Bert 说，这些圈子对学校来说至关重要。“我一直在想它们对我们来说有多重要，至少让学生们不会仅仅感到羞愧，或者忽视他们对社区或他人造成的伤害。无论你是和三个人进行修复性司法圈，还是和整个年级，甚至整个学校一起进行，这都是一种让‘啊哈’时刻得以巩固的方式，修复你与社区的关系并使之正确。”

The school’s culture had been both challenged and represented at a recent graduation, where they had a nascent tradition that every graduating boy would give a short speech. Bert told the story of an African American boy who stood up to give his speech (about half of the class was non-white, and of that group, about a quarter was African American). The poorest boy in the class, he was also the darkest-skinned boy, Bert said.
学校的文化在最近的一次毕业典礼上既受到了挑战，也得到了体现。那次毕业典礼上有一个初步的传统，每个毕业男生都会发表简短演讲。Bert 讲述了一个非裔美国男孩站起来发表演讲的故事（班上大约一半是非白人，其中约四分之一是非裔美国人）。Bert 说，他是班上最贫穷的男孩，也是肤色最深的男孩。

Even though the boy’s speech did not show the school in the best light, just the fact that he gave it reflected the school culture of including every voice, in its authentic moment. It also reflected Bert’s emphasis on connection. “The act of me trusting him, to say, ‘I believe you, you do your speech.’ Even though it might not shed good light on the school, on graduation day, live streamed to grandparents across the country . . .” he
尽管这位男孩的演讲没有把学校描绘得最好，但他能发表这番话本身就反映了学校包容每一个声音的文化，在那个真实的时刻里。这也体现了伯特对连接的重视。“我信任他，说，‘我相信你，你去做你的演讲。’即使这可能不会让学校看起来很好，在毕业典礼当天，通过直播传给全国各地的祖父母……”他继续说道。
chuckled ruefully. “But because of that trust, and because of the relationship that we had developed over time, he learned something in a super authentic way.”
他苦笑着说：“但正因为那份信任，以及我们随着时间建立起来的关系，他以一种非常真实的方式学到了东西。”

Bert thought the speech was also unforgettable for the other boys who were listening, the privileged kids carpooling in from the affluent suburbs. “The power of that moment for the other boys in the class, right? That’s a highly relational act,” he said. “That wouldn’t have happened without relationships.” But being able to say his truth in front of the community was also important for the boy who gave the speech, Bert said. He quoted the philosopher Levinas about how “a person cannot learn until they are held hostage by someone else’s gaze.” Being witnessed in that moment gave the boy something also, Bert said. “If I hadn’t allowed him, well, then it was a missed opportunity for all of us to hear his story and he would not have fully integrated it into his being, going back to that self-reflection piece. And [if he were not] held witness, being held hostage by all of our gaze in that moment, he wouldn’t actually be able to learn that night.” Bert continued, “In order to have a community kind of steeped in love and intimacy, you have to give kids the opportunities to kind of love themselves. And that means understanding the self, it means interrogating the self, and I think you can only do that in relationship with other people.” The speech embodied the school’s culture-and reflected its emphasis on relationship-even as it also revealed the relational harms that had happened there.
伯特认为，这次演讲对其他正在聆听的男孩们来说同样难以忘怀，那些从富裕郊区拼车来的特权孩子们。“对班上其他男孩来说，那一刻的力量，对吧？那是一个高度关系性的行为，”他说。“没有关系，这事儿是不会发生的。”但能够在社区面前说出自己的真相，对那个发表演讲的男孩来说也很重要，伯特说。他引用哲学家列维纳斯的话说，“一个人只有在被他人的目光俘虏时，才能真正学习。”在那一刻被见证，也给了那个男孩某种东西，伯特说。“如果我没有允许他，那对我们所有人来说都是错失了听他故事的机会，他也不会完全将其融入自己的内心，回到那个自我反思的部分。如果他没有被见证，没有在那一刻被我们所有人的目光俘虏，他实际上那晚是学不到东西的。”伯特继续说道，“为了拥有一个充满爱与亲密感的社区，你必须给孩子们机会去爱自己。” 这意味着理解自我，意味着审视自我，我认为只有在与他人的关系中才能做到这一点。”这段演讲体现了学校的文化——并反映了其对关系的重视——同时也揭示了那里发生的关系伤害。

Rituals and routines like graduations and restorative justice circles both reflect and establish culture as it permeates an organization. But culture also reveals itself in how people interpret and experience spontaneous events, particularly those that represent a clash of cultures. A good example is a particularly traumatic event that Catalina narrated to me, about a visit she had made with a patient to a specialist. ${}^8$${}^8$^(8){ }^{8}
毕业典礼和修复性司法圈等仪式和惯例既反映又建立了文化，因为文化渗透于组织之中。但文化也通过人们如何解读和体验自发事件表现出来，尤其是那些代表文化冲突的事件。一个很好的例子是 Catalina 向我讲述的一个特别创伤性的事件，关于她和一位病人一起去看专家的经历。 ${}^8$${}^8$^(8){ }^{8}

One of the remarkable services that University Transformational Care offered was the option to have a “care transformer” accompany patients to appointments with specialists. Catalina’s patient had been suffering excruciating back pain, and was dissatisfied with the advice from the neurology clinic, which to date had been simply that she
大学转型护理提供的一项显著服务是可以安排“护理转化者”陪同病人去看专家。Catalina 的病人一直饱受剧烈背痛折磨，对神经科诊所的建议不满意，而到目前为止，诊所的建议仅仅是让她
should lose weight. She had asked Catalina to go with her to her next appointment.
减肥。她请求 Catalina 陪她去下一次的预约。
“During the visit, her legs, her back were manipulated in ways that were very painful to her, and I’m not sure if the provider sympathized with her pain, you know,” Catalina recalled. It was excruciating for her to sit through, but she also felt like the patient was asking her not to say anything in the moment. I asked whether the patient was clearly expressing the pain. “Yes,” Catalina replied. “She was crying. Yes.” I wondered aloud how Catalina managed that difficult moment, when she may have felt trapped between what she was witnessing and what the patient wanted her to do. She recalled, “I was just sitting there, like, stunned. Yeah, like, wow, she’s really in pain and she’s crying, and I would ask the patient, ‘Are you OK?’ [and she would reply,] ‘Yes. Yes, I’m fine.’ And she would just kind of like, tell me just ‘It’s fine,’ that she’s OK. Even though she’s crying.”
“在那次就诊过程中，她的腿和背部被以一种对她来说非常痛苦的方式操作，我不确定医生是否能体会到她的痛苦，你知道的，”卡塔琳娜回忆道。她坐在那里忍受着极大的痛苦，但她也觉得病人当时是在请求她不要说什么。我问病人是否清楚地表达了痛苦。“是的，”卡塔琳娜回答，“她在哭。是的。”我自言自语地想，卡塔琳娜是如何应对那个艰难时刻的，当时她可能感到被自己所目睹的情景和病人希望她做的事情之间困住了。她回忆说，“我只是坐在那里，像是震惊了。是的，就像，哇，她真的很痛苦，她在哭，我会问病人，‘你还好吗？’[她会回答，]‘是的。是的，我没事。’她只是那样告诉我‘没事的’，她没事。尽管她在哭。”
“So it seemed like the patient was saying, 'Don’t intercede on my behalf,” I said to Catalina. “Basically,” she agreed. “I mean, I think so. Yeah, it was hard. It was hard seeing that.” At the end of the visit, Catalina said, “I left the clinic possibly as upset as she was.”
“所以看起来病人在说，‘不要替我出面干预，’”我对卡塔琳娜说。“基本上是这样，”她同意道。“我是说，我想是的。是的，看着那个场景很难受。”就诊结束时，卡塔琳娜说，“我离开诊所时，可能和她一样难过。”

We might not necessarily be surprised that a neurologist would refrain from changing anything about his approach in the presence of a medical assistant; the two occupy distant ends of the spectrum of status and pay, as a neurologist could easily have ten to fifteen years of training on top of a college degree, earning anywhere from five to ten times the salary of a medical assistant. But in her experience, Catalina said, when specialists saw the medical assistant there in the appointment, they would actually treat the patients better. “So that was very unusual to have that provider not respond to your presence,” I said. “Exactly,” she said. In this visit, she saw firsthand what happened when physicians were indifferent. ${}^9$${}^9$^(9){ }^{9}
我们可能不会对一位神经科医生在有医疗助理在场时仍坚持自己的做法感到惊讶；两者在地位和薪酬上相差甚远，因为神经科医生在大学学位基础上可能还要接受十到十五年的培训，收入是医疗助理的五到十倍。但卡塔琳娜说，根据她的经验，当专科医生看到医疗助理在场时，他们实际上会更好地对待患者。“所以那个医生对你的存在没有反应，这非常不寻常，”我说。“没错，”她说。在这次就诊中，她亲眼见证了医生冷漠时会发生什么。 ${}^9$${}^9$^(9){ }^{9}

I asked her how she handled it after they left. First, she said, she apologized to the patient on behalf of the neurologist. “I told her that I would bring it up to my manager and to the team and see how we can best help her with the situation. And so that’s what I did when I got back. And we did get the manager from that clinic, a call.” The manager said
我问她医生离开后她是如何处理的。她说，首先她代表神经科医生向患者道歉。“我告诉她，我会把这件事反映给我的经理和团队，看看我们如何能最好地帮助她应对这种情况。所以我回去后就这么做了。我们确实给那家诊所的经理打了电话。”经理说
they would speak to the neurologist about the report. “And hopefully he would be more mindful with other patients as well,” Catalina said. “Just because we don’t feel it, that doesn’t mean they’re not.”
他们会和神经科医生谈论这份报告。“希望他对其他病人也能更加留心，”卡塔琳娜说。“只是因为我们感觉不到，并不代表他们没有感受到。”

The incident was traumatic for Catalina, not to mention the patient, because it was shocking to bear witness to the neurologist having so little care for the effect of his manipulations. But it also reflected a collision that illustrates for us an important point: organizational cultures are internal spheres of interaction, with their own rules and routines that may or may not reflect the external environment. In the neurologist’s clinical exam room, a different culture prevailed, one in which the patient felt unable to assert herself, in which her discomfort and tears did not count enough to stop the procedure, and in which her witness-Catalina, a “care transformer” but perhaps “only” a medical assistant in the eyes of the neurologist-did not matter enough to improve the connective labor at hand, to make the specialist better able to “see” the patient.
这件事对卡塔琳娜来说是一次创伤，更不用说对病人了，因为目睹神经科医生对自己操作的影响如此漠不关心令人震惊。但这也反映出一种碰撞，向我们展示了一个重要观点：组织文化是内部互动的领域，有其自身的规则和惯例，这些规则和惯例可能反映也可能不反映外部环境。在神经科医生的临床检查室里，盛行着一种不同的文化，病人感到无法为自己发声，她的不适和眼泪不足以阻止检查的进行，而她的见证者——卡塔琳娜，一位“关怀转化者”，但在神经科医生眼中或许“仅仅”是个医务助理——并没有足够的重要性来改善当下的连接性劳动，使这位专家更能“看见”病人。

When the visit ended and they returned to University Transformational Care, Catalina’s actions threw the contrast between two clinics’ cultures into vivid relief. She apologized to the patient on behalf of the specialist, which reflected the responsibility to her that Catalina felt, as well as the priority of relationship: an apology was taking steps toward redressing relational harm. Furthermore, Catalina took the matter up with her own manager and the clinic staff, seeking to make changes on the patient’s behalf. Instead of silencing Catalina with observations about the medical hierarchy, the clinic helped her make a report to the manager of the neurologist’s practice. We do not know-and Catalina does not know-what ultimately happened (“I believe that the provider was talked to. At least that’s what they said they were going to do”), which further reflects the fact that the two clinics were not part of the same solar system, culturally speaking, and that University Transformational Care could not enforce its own cultural tenets on another clinic. But Catalina’s outrage, her response, and her employer’s support tells us a story about the values embedded in the connective culture at University Transformational Care, how they promote and prioritize relationship, and how they established a social architecture that worked, if only in the micro-environment of the clinic itself.
访问结束后，当他们返回大学转型护理中心时，Catalina 的行为鲜明地凸显了两家诊所文化的对比。她代表专家向患者道歉，这反映了 Catalina 对她所感受到的责任感，以及关系的优先性：道歉是修复关系伤害的一个步骤。此外，Catalina 还将此事向她自己的经理和诊所工作人员反映，试图为患者争取改变。诊所并没有用医疗等级制度的说辞来压制 Catalina，反而帮助她向神经科医生诊所的经理提交了报告。我们不知道——Catalina 也不知道——最终发生了什么（“我相信那个医生被谈话了。至少他们是这么说的”），这进一步反映出两家诊所在文化上完全不在同一个体系内，大学转型护理中心无法将自己的文化准则强加给另一家诊所。 但卡塔利娜的愤怒、她的反应以及她雇主的支持，向我们讲述了一个关于大学转型关怀中连接文化所蕴含价值观的故事，讲述了他们如何促进和优先考虑关系，以及他们如何建立了一种社会架构，这种架构在诊所这个微观环境中确实起到了作用。

The third dimension of organizations who were “doing it right” was the distribution of material resources, including the allotment of time and space, the ratios of worker to client, the cognitive load workers faced, the extent of technology and data use, the compensation workers receive-all the resources that underlie a given interaction.
那些“做得对”的组织的第三个维度是物质资源的分配，包括时间和空间的分配、员工与客户的比例、员工所面临的认知负荷、技术和数据的使用程度、员工所获得的报酬——所有这些资源都是特定互动的基础。

The most important of these is time. As we saw in chapters 5 and 6, the sense of time scarcity was palpable among connective labor practitioners. Outside of exceptional organizations, the only people who felt like they had enough time were those who opted for the “personal service” model of providing connective labor to rich people. Part of what made University Transformational Care so radical was the sense of luxuriant time there. The expanse of time was a feature of their “capitated” model in which they did not have to charge a separate fee for every service. "You know, I tell [the patients] exactly in the beginning of the office visit, “This is two hours long. This is your two hours,” Catalina said. “If you take less, that’s really because, you know, things move a lot quicker than they should. But if you want to take up the whole two hours, that is OK with me.’ I think after the first visit, it really builds their trust, or the relationship.”
其中最重要的是时间。正如我们在第 5 章和第 6 章中看到的，连接性劳动从业者普遍感受到时间的匮乏。除了少数特殊组织外，唯一觉得时间充裕的人是那些选择为富人提供“个性化服务”模式的连接性劳动者。大学转型护理之所以如此激进，部分原因就在于那里那种充裕的时间感。时间的宽裕是他们“定额付费”模式的一个特点，在这种模式下，他们不必为每项服务单独收费。Catalina 说：“你知道，我在看诊一开始就告诉病人，‘这次看诊是两个小时。这是你的两个小时。’如果你用时更少，那真的是因为事情进展得比预期快得多。但如果你想用满这两个小时，我也没问题。”我认为第一次看诊之后，这真的能建立他们的信任，或者说建立关系。

We measure time in quantities-an hour here, fifteen minutes therebut it has other characteristics as well. How crowded does it feel? How fast or slow? Sociologist Ben Snyder uses the word “timescapes” to capture some of these qualities. “Each work timescape features the braiding of multiple rhythms of mental and physical energy expenditure, giving the individual worker different experiences of pace, sequence, tempo and articulation,” he writes. Many organizations crowd the timescape of connective labor-loading many people onto one practitioner, stacking appointments one after the other with little or no break, requiring many different kinds of thinking and communicating in the same interactive space. These dimensions affect the rhythms of the work as much as the sheer quantity of time. ${}^{10}$${}^{10}$^(10){ }^{10}
我们用数量来衡量时间——这里一小时，那里十五分钟——但时间还有其他特性。它感觉有多拥挤？快还是慢？社会学家本·斯奈德用“时间景观”一词来捕捉这些特质。他写道：“每个工作时间景观都交织着多种心理和体力能量消耗的节奏，赋予个体工作者不同的节奏感、顺序感、速度感和表达方式。”许多组织使连接性劳动的时间景观变得拥挤——将许多人集中到一个从业者身上，连续安排多个预约，几乎没有休息时间，要求在同一互动空间内进行多种不同类型的思考和沟通。这些维度对工作的节奏影响与时间的绝对数量一样大。 ${}^{10}$${}^{10}$^(10){ }^{10}

The complexity of time also explains a certain unevenness in organizational support for connective labor, even among those units
时间的复杂性也解释了即使在那些单位中，组织对连接性劳动支持存在某种不均衡的现象
with a social architecture that mostly fostered witnessing work. In particular, the chaplains in training spent hours together talking about relationship and how to make connections, which were undoubtedly a priority for them and their supervisors. Yet they also endured a grueling schedule of being on twenty-four-hour call every week and having to spend the morning in class the next day. They did not face the pressure of having to process a certain number of people every fifteen minutes like the primary care physicians, but as we know, this site asked them to log their interactions with patients for three different tracking systems. Away from their supervisors, they talked to me about feeling overwhelmed and burned out, about overwork and exploitation, even as they were surrounded by leaders who prioritized relationship, spent hours cultivating a warm and caring community, and shared a common set of norms and rituals that valued connecting. The complexity of time meant that for the chaplains their experience was partially buoyed by their social architecture, and partially depleted.
拥有一种主要促进见证工作的社会结构。特别是，受训的牧师们花费数小时一起讨论关系以及如何建立联系，这无疑是他们和他们的主管的优先事项。然而，他们也要忍受每周全天候待命的艰苦日程，并且第二天早晨还得上课。他们不像初级保健医生那样面临每十五分钟必须处理一定数量病人的压力，但正如我们所知，这个场所要求他们为三种不同的追踪系统记录与患者的互动。在远离主管的情况下，他们向我诉说感到不堪重负和精疲力竭，谈论过度工作和剥削，尽管他们周围的领导者优先考虑关系，花费数小时培养一个温暖关怀的社区，并共享一套重视连接的共同规范和仪式。时间的复杂性意味着，对于牧师们来说，他们的经历部分得益于他们的社会结构，部分则被消耗殆尽。

Time was not the only dimension that mattered, of course, although it was a vital one. Another important factor was what scholars have called the “attentional load.” How many different clients or students or patients did one person maintain, and how many at any one time? Even when workers faced just one patient, how many other things-emails, data entry, scheduling, testing-were they being asked to do at the same time? As we saw in chapter 6, teachers and physicians in particular were asked to balance enormous loads simultaneously; recall Simon, the physician who likened the experience to getting periodically shocked in an experiment. Those organizations whose social architecture supported connective labor took steps to control the attentional load-reducing Catalina’s patient roster to six, for example. ${}^{11}$${}^{11}$^(11){ }^{11}
时间当然不是唯一重要的维度，尽管它是一个关键因素。另一个重要因素是学者们所称的“注意力负荷”。一个人要维持多少不同的客户、学生或病人？在任何时刻又要同时处理多少？即使工作人员只面对一个病人，他们同时还被要求处理多少其他事务——电子邮件、数据录入、排班、检测？正如我们在第六章看到的，尤其是教师和医生被要求同时平衡巨大的负荷；还记得西蒙那位医生，他将这种体验比作在实验中被周期性电击。那些社会架构支持连接性劳动的组织，会采取措施控制注意力负荷——例如，将卡特琳娜的病人名单减少到六个。 ${}^{11}$${}^{11}$^(11){ }^{11}

Ultimately, organizations offering an alternative social architecture took attention seriously. Not only did that mean limiting how much a worker had to attend to; it also meant treating that attention as if it were precious, a unique catalyst for reflective resonance. Mariah Dreyfus ran several programs for inmates and formerly incarcerated people out of an elite university on the West Coast. One program involved teaching
最终，提供替代社会架构的组织认真对待注意力。这不仅意味着限制工人必须关注的内容数量，还意味着将这种注意力视为宝贵的、独特的反思共鸣催化剂。Mariah Dreyfus 在西海岸一所精英大学负责多个针对囚犯和曾被监禁者的项目。其中一个项目涉及教学
entrepreneurial skills to ex-inmates, with four-month sessions of classes lasting four hours at a time. “So it’s a lot of time we’re spending together as a group,” she said.
向前囚犯传授创业技能，课程为期四个月，每次上课四小时。“所以我们作为一个团队一起度过了很多时间，”她说。

But in addition to time, the concentrated attention of multiple others was the program’s treasure, she said. Every other week, the entrepreneur-to-be would also meet with a local business executive, as well as two students-one each from local law and business schools. She described to me the slow transformation the process provoked in the men. “So it’s like all those people are investing in them,” she said. “And what’s interesting is that it takes a while for our entrepreneurs to begin to feel comfortable having that much attention on them. Like, 'You mean, you just want to know about what I think? You mean, you just want to be here and invest in my plan? Like we’re just going to be talking about what I want to do?” Shocked by the experience, they asked plaintive questions that revealed just how uncertain they were, how unsure that they even warranted all that focus from others.
但她说，除了时间之外，多人集中注意力也是该项目的宝贵财富。每隔一周，准创业者还会与一位当地的企业高管以及两名学生——分别来自当地的法学院和商学院——会面。她向我描述了这一过程在这些男性身上引发的缓慢转变。“所以就像所有这些人都在投资他们，”她说。“有趣的是，我们的创业者们需要一段时间才能开始习惯被这么多人关注。就像，‘你的意思是，你们只是想知道我的想法？你的意思是，你们只是想在这里支持我的计划？我们只是要谈谈我想做的事？’”他们被这种经历震惊，提出了哀求般的问题，暴露出他们有多么不确定，甚至不确定自己是否配得上别人如此关注。

It was a sharp contrast to the entitlement that characterized the student body at her elite institution. She described the process of teaching the men, who had most recently been inmates inside a correctional facility, stripped of their individuality: “And we have to-‘train’ is not the right word—but, like, empower them to think about: ‘You need to set the agenda. Like this meeting is about you and what you want to get out of it. What is helpful is to come in with an agenda of what you want to get accomplished.’ All that stuff is [a form of] undoing, particularly for those people who have been inside for so long, where they were completely disempowered.”
这与她所在精英院校学生群体所表现出的特权感形成了鲜明对比。她描述了教导这些男性的过程，这些男性最近还身处矫正设施，被剥夺了个性：“我们必须——‘训练’这个词不太合适——但要赋予他们思考的能力：‘你需要制定议程。这个会议是关于你和你想从中获得什么。带着你想完成的议程来会面是有帮助的。’所有这些都是一种解构，特别是对于那些在里面待了很久、完全被剥夺权力的人来说。”

For formerly incarcerated people, that kind of attention, focused on eliciting a plan that would best reflect their desires and skills, was a potent elixir. But the first step was convincing them they deserved it, Mariah said. “Last year I had a guy who had done twenty-six years,” she told me. “He’s starting a handyman business. He got up, he was working with a professional speaking coach, and at the end the professional speaking coach says, ‘The one thing I might gain from you, Jerry, is like the value of your business is what it is. Like why you’re totally worth $\mathrm{\$}50$$\mathrm{\$}50$$50\$ 50 an hour. Like that needs to come across.’ And Jerry sheepishly sat there
对于曾经入狱的人来说，那种关注，专注于引导他们制定最能体现自己愿望和技能的计划，是一种强有力的灵丹妙药。但第一步是让他们相信自己配得上这种关注，Mariah 说。“去年我遇到一个做了二十六年牢的家伙，”她告诉我。“他正在开一家修理工生意。他站起来，正在和一位专业演讲教练一起工作，最后那位教练说，‘Jerry，我可能从你这里学到的一件事是，你的生意价值就是它的价值。就是说，你完全值得 $\mathrm{\$}50$$\mathrm{\$}50$$50\$ 50 每小时。这个信息必须传达出来。’Jerry 害羞地坐在那里
and he said, 'But I got paid nine cents an hour for twenty years. Like, I actually don’t believe it myself.”
他说，‘但我二十年里每小时只拿九分钱工资。说实话，我自己都不相信这点。’”

I marveled to her that Jerry was able to say that out loud, to which Mariah responded: “Well, that’s the magic of the cohort and being in the class together for so long and actually building trust.” The time and duration of the program built that trust, which was vital. Research tells us that those who need the most help are often those who feel least entitled to ask, in part because they have often been mistreated by institutions in ways that undermine trust. But it was the people’s focused attention that was going to reap the most rewards for the ex-inmates, Mariah thought. ${}^{12}$${}^{12}$^(12){ }^{12}
我惊讶于杰瑞竟然能当面说出那番话，玛丽亚回应道：“嗯，这就是同伴群体的魔力，大家一起上课那么久，真正建立了信任。”项目的时间和持续性建立了这种信任，而这至关重要。研究告诉我们，那些最需要帮助的人往往是最不敢开口请求帮助的人，部分原因是他们经常受到机构的虐待，这种虐待破坏了他们的信任。但玛丽亚认为，正是人们的专注关注将为这些前囚犯带来最大的回报。 ${}^{12}$${}^{12}$^(12){ }^{12}
“I’m a strong believer in high touch,” she said. “And that can be a faculty member, and for a college student, it could a college advisor, like a college counselor. It could be another student who’s like two years ahead of you, who is your person. But I think we all need people. I mean like, ‘Who are your people?’ And I think this population needs those people just as much as we do.” In Mariah’s program as for others, the gaze of others became a resource whose distribution-or unexpected concentration-lent power to the interaction.
“我坚信高接触，”她说，“这可以是教职员工，对于大学生来说，可以是大学顾问，比如大学辅导员。也可以是比你高两届的学生，成为你的那个人。但我认为我们都需要有人。我的意思是，‘你的人是谁？’我觉得这群人和我们一样需要这样的人。”在玛丽亚的项目中，和其他项目一样，别人的目光成为了一种资源，其分配——或意外的集中——赋予了互动力量。

Finally, it was not that this supportive social architecture was devoid of the scripting and counting that proved so problematic in chapter 6. Instead, these contexts managed to make templates and data needs feel meaningful, incorporating them within and subordinating them to their mandate of relationship. For example, one of Catalina’s tasks was to serve as a scribe, which alleviated the burden of the primary care physicians in the University Transformational Care clinic, unlike those who railed against the data entry demands in chapter 6. Yet taking on this work was actually an expansion of the medical assistant’s traditional role, so it felt like a bigger responsibility to her; moreover, it enabled her to stay in the exam room while the patient was being seen by the provider, further building her awareness and connection. With her responsible for the EHR, it was much better for the doctor-patient relationship, Catalina said. “I send referrals out, I order labs, I will put in this request, description, everything. I do it here while the provider talks. So that’s one benefit because the provider’s not looking into here [the computer] and getting
最后，这种支持性的社会架构并非没有第六章中被证明极具问题的脚本编写和数据统计。相反，这些环境设法让模板和数据需求显得有意义，将它们纳入并服从于其关系使命。例如，Catalina 的一项任务是担任书记员，这减轻了大学转型护理诊所初级保健医生的负担，不同于第六章中那些抱怨数据录入要求的人。然而，承担这项工作实际上是对医疗助理传统角色的扩展，因此她感觉责任更大；此外，这使她能够在患者接受医生诊疗时留在诊室内，进一步增强了她的意识和联系。Catalina 说，由她负责电子健康记录（EHR），对医患关系更有利。“我负责发送转诊，订实验室检查，我会在这里输入请求、描述，所有内容。我在医生交谈时完成这些工作。这是一个好处，因为医生不用一直盯着这里（电脑）看……”
lost if they don’t really know where to go. Scrambling through different tabs. But because we are here, we do that, we’re more familiar with the chart. The provider takes all their time looking at the patient, you know, ‘I’m here, I’m talking to you, I’m listening to what you’re saying.’”
如果他们真的不知道该去哪儿，就会迷失。不断切换不同的标签页。但因为我们在这里，我们会这么做，我们对图表更熟悉。医生会花所有时间看着病人，你知道的，“我在这里，我在和你说话，我在听你说什么。”

She actually did not mind the EHR at all, Catalina said, comparing it to the chaos of the charts at her old community clinic.
卡塔琳娜说，她其实一点也不介意电子健康记录（EHR），她把它和她以前社区诊所里混乱的病历对比了一下。

You’re looking for the last colonoscopy, it will bring you all that patient’s colonoscopies, instead of having to go through all those medical records and flipping pages, right? The orders, we’re putting them in right away. [When it was] the chart, the doctor’s writing down the orders [in the clinic room], then has to come out with the chart, give you the chart or tell you, “Hey, we need this, this, this and that.” And then you have to go back and get the lab order, fill that out for the patient, give it to the patient. It’s just, I think-
你在找最后一次结肠镜检查，它会给你显示该病人所有的结肠镜检查记录，而不用翻阅所有那些病历，对吧？医嘱我们会马上录入。[以前是]用纸质病历，医生在诊室里写下医嘱，然后得拿着病历出来，给你病历或者告诉你，“嘿，我们需要这个、那个、还有那个。”然后你得回去拿化验单，帮病人填写，交给病人。我觉得这真是——
“It’s ridiculous,” I finished for her. “Yes,” she said emphatically. “I mean, I think the electronic medical records is like the best thing.” After months of my hearing doctors complain about it, Catalina’s words came as a surprise, but they also illustrated a core truth: the problem was not necessarily the technology but how it was used, by whom, and for what purpose. With a scribe and detached from billing, the EHR actually felt like a means to enhance care.
“这太荒谬了，”我替她说完。“是的，”她强调道。“我的意思是，我觉得电子病历是最棒的东西。”在听了几个月医生们抱怨之后，Catalina 的话让我感到惊讶，但它们也揭示了一个核心真理：问题不一定是技术本身，而是技术被谁使用、如何使用以及出于什么目的。配备了记录员且不涉及账单，电子健康记录实际上感觉像是一种提升护理质量的手段。

The same was true for templates, which could be ways to connect rather than sources of distance. Bert Juster’s teachers had brainstormed a list of the school’s core values, and how to “systematize them,” for example. “Like for politeness, every day we have a duty station where a teacher stations themselves at the front of school and greets every kid with a handshake or a hug and looks them in the eye. If they don’t get the eyes, we make some sort of joke, or cute little ‘Oh, give me those blues!’ Or whatever, and then to get the kid to look at us. That was one way we’ve systematized kindness and politeness.”
模板也是如此，它们可以成为连接的方式，而非造成距离的源头。Bert Juster 的老师们曾集思广益，列出学校的核心价值观，以及如何“系统化”它们，例如。“比如礼貌，每天我们有一个值班点，老师们会站在学校前面，和每个孩子握手或拥抱，并与他们对视。如果孩子们不看眼睛，我们会开玩笑，或者说些可爱的‘哦，给我看看你的蓝眼睛！’之类的话，然后让孩子们看着我们。这是我们系统化善良和礼貌的一种方式。”

They also standardized the curriculum to some degree, so that every teacher had to think about building ten core questions into what they were teaching, he said. “One of the questions is: How are you introducing the students to art? How are you differentiating for the different
他说，他们还在一定程度上统一了课程标准，因此每位教师都必须考虑将十个核心问题融入他们的教学中。“其中一个问题是：你如何向学生介绍艺术？你如何针对不同的学生进行差异化教学？
kinds of learners in this unit? How are you developing autonomy in the learners? How are you developing a sense of self in the student? So, there are all these essential questions so that when teachers are developing a unit, there is, in every unit, in every class, in every grade, teachers are thinking about social justice and equity issues,” Bert said. “Whether that’s balancing molecular equations, or it’s the US Constitution, because those are important to the school.”
这一单元中有哪些类型的学习者？你是如何培养学习者的自主性的？你是如何在学生中培养自我意识的？所以，有所有这些核心问题，当教师设计一个单元时，在每个单元、每节课、每个年级，教师们都会考虑社会正义和公平问题，”Bert 说。“无论是平衡分子方程式，还是学习美国宪法，因为这些对学校来说都很重要。”

Finally, while as a private school it was not mandated to use standardized testing, the school did not shy away from examinations, but used them as a way of figuring out where the kids were, in preparation for them to apply to local high schools. “That’s why I think standardization is really awesome because it’s just another tool to leverage understanding about the self,” Bert said. Systems and standardization were part of the material resources that could contribute to a supportive social architecture, as long as they were subordinated to the priority of relationship.
最后，虽然作为一所私立学校，它并不被要求使用标准化考试，但学校并不回避考试，而是将其作为了解孩子们现状的一种方式，为他们申请当地高中做准备。“这就是为什么我认为标准化真的很棒，因为它只是用来加深对自我的理解的另一种工具，”Bert 说。系统和标准化是能够促进支持性社会结构的物质资源的一部分，只要它们服从于关系优先的原则。

The elite institutions, the independent schools, the private practicesthe examples in this chapter stem from places of great privilege. Of course, privilege does not necessarily characterize the people they serve-from the ex-inmates-turned-entrepreneurs to the grief-stricken families to the “darkest-skinned boy” who took “two buses and a subway” to get to his school-but the organizations themselves are a far cry from the community clinic in Appalachia we saw in chapter 5 or Pamela’s classroom from chapter 6, whose students came to school from a crime scene. Is a social architecture that supports a full-bodied witnessing only possible in rich institutions? Is such a social architecture a luxury?
精英机构、独立学校、私人诊所——本章中的例子都来自极具特权的地方。当然，特权并不一定是他们所服务的人的特征——从前囚犯转变为企业家，到悲痛欲绝的家庭，再到那个“肤色最深的男孩”，他为了上学“坐了两趟公交和一趟地铁”——但这些组织本身与我们在第五章看到的阿巴拉契亚社区诊所或第六章中帕梅拉的教室相去甚远，后者的学生是从犯罪现场来到学校的。支持全面见证的社会架构是否只能存在于富裕机构？这样的社会架构是否是一种奢侈？

The answer is yes and no. Connective labor is labor that involves “hightouch” attention from one human to another, and it resists the productivity gains that other kinds of work demonstrate; chapter 7 showed us some of what that resistance looks like, in stories of misrecognition and rupture. Furthermore, the relentless drive to extract efficiencies in this work is grounded in the perennial hunt for profit in the private sector, and in an environment of scarcity in the public sector, where neoliberal policies
答案是肯定的，也是否定的。连接性劳动是指涉及人与人之间“高接触”关注的劳动，它抵制了其他类型工作所表现出的生产力提升；第七章通过误认和断裂的故事向我们展示了这种抵抗的部分表现。此外，在私营部门中，这种劳动中不断追求效率的动力根植于对利润的长期追逐，而在公共部门中，则处于资源稀缺的环境中，那里新自由主义政策...
have made the welfare state wither. As we have seen in previous chapters, these factors mean that many private and public entities feature a social architecture that is unsustainable or unsustaining. ${}^{13}$${}^{13}$^(13){ }^{13}
已经使福利国家衰落。正如我们在前几章中所见，这些因素导致许多私营和公共实体呈现出一种不可持续或无法维系的社会结构。 ${}^{13}$${}^{13}$^(13){ }^{13}

Moreover, some institutions fostered connective labor by controlling whom they serve and how. Bert Juster talked about an admissions process that “weeded out” families that did not already believe in “love talk” in a boys’ school, for example; he said the school did not have time to convert those who did not already believe. Unlike a public institution, his independent school was not required to take all comers nor to bend their social priorities to testing requirements for funding.
此外，一些机构通过控制服务对象及方式来促进连接性劳动。比如，Bert Juster 谈到一所男校的招生过程会“筛除”那些本身不相信“爱的话语”的家庭；他说学校没有时间去改变那些不信的人。与公立机构不同，他的私立学校不需要接纳所有申请者，也不必为了获得资金而调整其社会优先事项以符合测试要求。

Yet the skills of seeing the other, of reaching an emotional understanding of another person with them, are by no means restricted to high earners. Catalina Maldonado is a medical assistant with a high school education; even though her job is expanded considerably, she is still much cheaper to employ than a doctor, even those in primary care who earn the least of all physicians. Indeed, as care scholars have documented, this emotional work is feminized and naturalized, meaning often considered to be part of the essential nature of women, and thus requiring no particular training or compensation. While such work might resist productivity gains, it is also true that the labor costs of managing data analytics and other administrative-focused positions have greatly expanded. Labor costs are a choice, an investment that employers, administrators, and policymakers decide to make in service to their priorities. To be sure, adequate compensation is crucial to support good connective labor-most obvious in its absence, as when exhausted home healthcare aides have to pile on multiple shifts in order to sustain their households-but the capacity to see the other is not reserved for those at the top of the pay ladder. Wages are not what makes this work a luxury.
然而，看到他人、与他人共同达到情感理解的技能绝不仅限于高收入者。Catalina Maldonado 是一名拥有高中学历的医疗助理；尽管她的工作内容大大增加，但她的雇佣成本仍远低于医生，甚至低于那些收入最低的初级保健医生。事实上，正如护理学者所记录的，这种情感劳动被女性化和自然化，通常被认为是女性的本质特征，因此不需要特别的培训或报酬。虽然这类工作可能抵制生产力的提升，但管理数据分析和其他行政岗位的劳动成本却大幅增加。劳动成本是一种选择，是雇主、管理者和政策制定者根据其优先事项决定的投资。 诚然，充足的报酬对于支持良好的连接性劳动至关重要——这一点在缺失时尤为明显，比如当疲惫不堪的家庭护理助理不得不连续多班工作以维持家庭生计时——但看到他人的能力并不仅限于薪酬阶梯顶端的人。工资并不是使这项工作成为奢侈品的原因。

Furthermore, the offices of University Transformational Care were festooned with posters and charts documenting how much money they were saving the institution (for an example, see figure 8.2). The relationship-focused approach meant that patients were taking better care of themselves, were managing their own conditions better, and were not going to the emergency room. While these gains seem patently
此外，大学转型护理办公室张贴了大量海报和图表，记录他们为机构节省了多少钱（例如，见图 8.2）。这种以关系为中心的方法意味着患者更好地照顾自己，更好地管理自己的病情，也减少了去急诊室的次数。虽然这些成果看起来显而易见，
clear, research suggests that relationship-focused approaches in other industries are also cost effective.
研究表明，其他行业中以关系为中心的方法同样具有成本效益。

One problem is that the costs of a social architecture that fosters relationship are often felt at a micro level, local to a school or clinic, while its gains are felt at a macro level, in a given society. Students who are seen, who feel connected to their teachers, stay engaged in school, and we all benefit when kids get a better education. Counselors who achieve a therapeutic alliance see better results in their clients, and we all benefit when people’s mental health needs are met. The radical experiment of University Transformational Care was possible in part because the costs and gains were both local-as the university was responsible for the healthcare spending of the target population. The benefits of a connective social architecture are thus bigger than any one organization, and more expansive than any cost-benefit analysis can itemize. Such a scope suggests that public support for policies that can enable organizations to make the right choices would be helpful and warranted.
一个问题是，促进关系的社会架构的成本通常是在微观层面上感受到的，比如在某个学校或诊所，而其收益则是在宏观层面上体现的，比如在整个社会中。被关注的学生，感受到与教师的联系，会持续投入学习，当孩子们接受更好的教育时，我们所有人都会受益。建立治疗联盟的咨询师在客户身上看到更好的效果，当人们的心理健康需求得到满足时，我们所有人都会受益。大学转型关怀这一激进实验之所以成为可能，部分原因在于成本和收益都具有地方性——因为大学负责目标人群的医疗支出。由此可见，连接性社会架构的益处远大于任何单一组织，也超出任何成本效益分析所能列举的范围。这种广度表明，公众支持能够帮助组织做出正确选择的政策是有益且合理的。

It is not that the people in this chapter are the only ones who are “doing it right.” Talking to all the different kinds of connective labor practitioners for this book-the teachers and therapists, the hairdressers, the medical professionals-I was often struck by the individual heroism of the people involved, how they fought to connect to their clients and students, even when their organizations made it difficult. Yet when connective labor is sustainable, it is ultimately deeply collaborative, reflecting a relational design that prioritizes connection, including a community with adequate support and a collective commitment from the top on down. Organizations like University Transformational Care or the boys’ school where Bert worked were unusual oases that reflected different dimensions, enabling not heroism but instead deep emotional collaboration and connection in their relational design, connective culture, and resource distribution.
本章中的人们并不是唯一“做对了事”的人。在为本书采访的各种连接性劳动从业者——教师和治疗师、美发师、医疗专业人员中，我常常被他们的个人英雄主义所打动，他们努力与客户和学生建立联系，即使他们所在的组织设置了重重障碍。然而，当连接性劳动可持续时，它最终是深度协作的，体现了一种以连接为优先的关系设计，包括一个有足够支持的社区以及从上到下的集体承诺。像大学转型关怀（University Transformational Care）或伯特工作的男校这样的组织，是不同维度的非凡绿洲，它们的关系设计、连接文化和资源分配使得这里不是英雄主义的舞台，而是深度情感协作和连接的体现。

Of course, each of the elements that construct a social architecture are interrelated. A community of practice is going to reflect the ambient
当然，构建社会架构的各个要素是相互关联的。一个实践社区将反映出其周围的环境
values, while norms and rituals are going to arise in a place that sets aside enough time for people to meet, and a dedicated leader is going to make sure the time and resources exist for connection and empathy. Conversely, any combination of these without one or the other leg of the triad makes it that much harder to do connective labor well. A principal might support the idea of teacher-student relationships, but without the time for teachers to devote to it, or a schoolwide culture that reflects those values, he or she-like the principal of Conrad’s schoolmay as well resort to tacking up a list of twenty-five tips on “How to Connect with Students” in the men’s restroom.
价值观，而规范和仪式则会在为人们提供足够时间相聚的场所中产生，而一位专职的领导者则会确保连接和共情所需的时间和资源得以存在。反之，若缺少三角关系中的任何一环，单凭其他两者的组合，就会使得进行连接性劳动变得更加困难。一位校长可能支持师生关系的理念，但如果没有时间让教师投入其中，或者没有反映这些价值观的全校文化，他或她——就像康拉德学校的校长一样——不如干脆在男厕所里贴上一张“如何与学生建立联系”的二十五条建议清单。

A high-touch social architecture may not be a luxury per se, but there is no question that it is rare to see these kinds of contexts, where practitioners are buoyed by time, community, and support as they worked to see the other well. If we continue to prioritize efficiency over relationship, we create a new kind of haves and have-nots: those divided by access to other people’s attention. Without addressing the conditions of connective labor, we foster the stratification of human contact.
高接触的社会架构或许不算奢侈，但毫无疑问，这种环境十分罕见，在这里，实践者们得以依靠时间、社区和支持，努力去真正理解他人。如果我们继续将效率置于关系之上，就会创造出一种新的“有”和“无”：被他人关注的机会所分隔的人群。如果不解决连接性劳动的条件问题，我们将助长人际接触的分层。