Tag: Chronic Illness

※This is Puchiko’s experience and is not a substitute for diagnosis or treatment.

Puchiko seemed to have a good day yesterday. This is because she went to her favorite Sicilian restaurant with her parents. After eating her beloved oyster pasta, a dish she always orders at this place, she looked perfectly content. Seeing her from behind, I felt a sigh of relief.

This is because, just 3 days prior, Puchiko had received a Conditional Job Offer. It was back in June that Puchiko had applied for the employment exam.

1. Puchiko’s Job-Related Anxiety

As you know, Puchiko carries various chronic illnesses, primarily renal disease. Although she is currently in remission, there is always a risk of relapse if she catches an infection like a cold, influenza, or COVID-19. If that happens, she may need to be hospitalized again for steroid pulse therapy (【Steroid Pulse Therapy Renal Disease】Mischievous Steroid 5 Difficult Lessons from Puchiko’s Experience), forcing her to endure the side effects she overcame after a year: moon face, depression, and easy susceptibility to infection. As her ally, I want to prevent that.

However, in life, anything can happen. It’s unrealistic for Puchiko, in her mid-30s, to believe she will never catch such an infection until her death. If she does contract one, or if the 37% of her glomeruli already dead from renal disease cause her kidney function to progress for the worse, it’s entirely possible. What would happen if this woman, already burdened by many chronic diseases, suffered from another serious illness? During her hospitalization for steroid pulse therapy for renal disease, she was told that future necessary medication would affect potential pregnancies, and she cried bitterly in the hospital ward. Since she received a friend’s birth announcement on the very day she was told that, it was truly heartbreaking to witness. She must have thought, “Why me?” While she never particularly wanted children, having her options reduced was probably painful for her. Although she had already decided she didn’t need romance or marriage, that event solidified her resolve.

Puchiko’s immediate family consists of her parents and younger brother. But her parents will pass away before her. She becomes anxious when she thinks about being alone in her old age. She has a job, and to avoid losing it, she obtained qualifications as a certified professional and a Japanese language teacher. She currently works as a part-time specialized occupation worker, working just over 7 hours, 4 days a week. Since her employment is part-time, her contract must be renewed every year, but it terminates after 3 years. Each time, she must reapply through an organization call and go through an interview with other candidates. Some employees who previously worked there have failed to be rehired. If the project she is working on changes, her contract may not be renewed, resulting in unemployment. Unfortunately, the number of clients is drastically decreasing, and it is anticipated that she may lose her job someday. There is no severance pay. Furthermore, while she is granted a few days of sick leave, if she exceeds that limit, she will lose her job. In other words, a major illness means unemployment. When she is old, she will have no spouse or children to rely on. That is why she wants to save money and solidify her insurance—to secure her own future.

2. Why Puchiko Didn’t Apply for Permanent/Full-Time Positions

So, why hasn’t Puchiko actively sought stable, full-time employment until now? She has tried. But when she mentioned her renal disease, she was rejected. (She past some job interviews but she didn’t disclose the facts.) This was true even when she emphasized that she was in remission. If she had diabetes, which also involves kidney issues, employers might be more willing to hire her because many people imagine someone working with diabetes—and indeed, several such employees work in her current office. But this renal disease is a disease many people have never heard of and is designated as an intractable disease in Japan, leading to unwarranted avoidance. Some might suggest she simply hide her illness during the interview. But it’s not that simple. When applying for full-time or permanent positions, she is required to undergo a health check-up once she receives a job offer. In the end, the truth comes out.

In Japan, there is a disability employment system for those with a disability certificate, allowing them to receive accommodations at work. However, Puchiko, being a chronic illness patient in a limbo state—neither disabled nor fully healthy—does not qualify for this system. Puchiko’s renal disease was actually discovered during a health check-up after she joined her current workplace. Therefore, her colleagues know about it, and they see she can work without issues, which is why it doesn’t affect her contract renewal.

3. Puchiko Decides to Take the Challenge

As the 3 year mark approached since her last contract interview at her current workplace, Puchiko decided to apply for a civil service exam at a certain municipal office instead of waiting for another application for her current position. She had been in remission for a year without any issues. She felt she could pass the health check-up in her current condition. She had been debating taking the civil service exam for about 5 years since she started her current job, agonizing over whether to take it.

The reason is that Puchiko’s only viable path to victory was to compete for a professional position. At her age (mid-30s), she had to leverage her experience to survive an exam where new graduates are her rivals.

Puchiko is also keenly aware that the this field is tough and demanding. It is likely that if hired, she would be assigned to the department—the department most employees at a municipal office would dread. It is notoriously grueling, understaffed, and a typical environment where employees suffer mental health issues, leading to resignation or extended leave. Most citizens live modestly, but a small fraction—the handful of citizens who engage in customer harassment, who are aggressive, or who are ex-yakuza—inflict stress that breaks the staff. Although she doesn’t know if this particular municipal office is like that, this is a well-known reality in the welfare industry. She witnessed this reality firsthand in her previous job. The question is whether such a high-stress, overtime-heavy environment is bearable for someone with multiple chronic illnesses. In fact, her father, who was in an administrative role at that very municipal office, developed depression and took early retirement. The fact that he lasted decades there is impressive, given how challenging it is. Although it likely depends on the specific job duties, the reality is far removed from the overly optimistic image the public holds.

Despite all this, Puchiko decided to take the exam for the sake of the benefits. The risk of unemployment would be lower, allowing her to dedicate herself to hospitalization and treatment without worry. The salary for a professional is good. And it would reassure her parents. These benefits are the oasis that she seeks.

4. From Application to the Conditional Job Offer

Puchiko applied for theemployment exam. First was the document screening, which was likely just a confirmation of eligibility and checking for typos. This narrowed the field to twelve candidates. Then she took the written exam .

Next was the first interview. During the interview, she was asked, “This is not directly related to employment, but do you have any illness we might need to hospitalize?” When she asked “Hospitalization?” in return, the interviewer said, “Something like an illness that requires 1 month of hospitalization.” Puchiko thought to herself, “True, my renal disease treatment involved 3 separate hospitalizations for 10 days each—for the kidney biopsy, tonsillectomy, and steroid pulse—but they were all separate, and I didn’t take a full month off at once. My doctor even said it wouldn’t affect my work…” She replied, “No.” She didn’t feel she was lying. She passed those exams.

Puchiko went on to the final interview. The questions heavily focused on topics like “How do you relieve stress,” “When do you feel stressed,” and “How do you handle problems at work.” She realized, “There are indeed people here who suffer from stress and mental illness.”

The result of the final interview was sent by mail. The result was “Passed.” However, it wasn’t a definitive “Hiring” but a conditional notification: “There is a possibility of employment within 11 months, but only if a person resigns or is no longer able to take the position.” I shouted, “Is that even a thing?!” Although the letter said “Passed,” it was essentially an “Alternate” position. In other words, if no vacancy arises during that time, she won’t be hired. I was worried about her state of mind.

5. Puchiko’s Reaction After receiving the Conditional Job Offer

Despite the result being “effectively an alternate,” Puchiko seemed less bothered than I had expected. Perhaps she was slightly relieved somewhere deep down, knowing how demanding and difficult working as a full-time civil servant professional can be. The questions about stress tolerance and mental health in the final interview had convinced her of the intensity of the job.

As mentioned earlier, Puchiko lives with the anxiety of not knowing when her illness might flare up and require hospitalization. If she works part-time, there is a risk of losing her job during a long hospitalization. However, she doesn’t qualify for employment under the disability hiring system. She also doesn’t have the stamina to work full-time and healthy. She had told me that, being single and considering her physical condition, she wouldn’t have children, and she wanted to earn a little more money to live alone in her old age with this condition. The truth is, people with intractable diseases are often in a limbo within society.

That is why, a year after her renal disease went into remission, she took the full-time employee exam. She wanted to reduce the risk of losing her job even if hospitalized. However, she was also aware that the job would be extremely demanding and involve significant stress.

If the result had been “Hired,” Puchiko would have readily accepted the position without a second thought. If it had been “Rejected,” she would have given up and reapplied to her current workplace. But this middle ground means she will continue to struggle with the decision: “What should I do… it’s too much stress… but the benefits are so appealing…” This is exactly where she is now.

Amid all this, yesterday was a “cheat day” for Puchiko. She usually maintains a restrictive diet, but a cheat day is when she can freely eat what she likes. When a person is feeling low, even the most delicious food can seem tasteless, but she was genuinely enjoying her meal yesterday. Watching her laugh and spend time with her parents warmed my heart.

While eating, Puchiko mentioned to her parents, “When I have work-related worries, even if I’m eating delicious food like this on my day off, I lose my appetite and can’t enjoy it. I think I would be happier in a lower-paying, unstable employment where I can still savor my food and enjoy my time. If a staff member resigns and they call me with an offer, maybe I should decline it.” It is a difficult decision.

By the way, Puchiko is planning for 2-week trip to Belgium in March of next year, 4 months from now. She has already made all the reservations. She said, “What if they call me with an offer while I’m in Belgium? I won’t be able to answer the phone!” While it’s not entirely impossible to answer the phone, I agreed that the timing would be terrible if the call didn’t go through. But worrying about that phone call—does that mean she still holds onto a thread of hope for the job?

Postscript: Developments Since Then

This morning, just after 9 AM, Puchiko’s smartphone received a call. However, she was washing her face and didn’t notice it. I immediately told her that she had just received a call. She hurriedly grabbed her phone. Looking at the number, she had a hunch.

The reason was, as I wrote in a previous script (1. Puchiko’s Job-Related Anxiety, 2. Why Puchiko Didn’t Apply for Permanent/Full-Time Positions), she had taken an employment exam and received a passing notification, but it wasn’t a direct job offer. It was a conditional job offer, meaning she would only be hired if someone resigned or retired. In essence, it was a waitlist acceptance. She immediately thought that this call might be the job offer following a resignation or retirement, fulfilling the condition of the conditional offer.

When Puchiko called back, it was indeed the job offer based on the conditional acceptance. The content was, “We would like to hire you.”

As also mentioned in this (1. Puchiko’s Job-Related Anxiety, 2. Why Puchiko Didn’t Apply for Permanent/Full-Time Positions) , she had initially been relieved that the result was merely a “passing notification” and not an “employment notice.” This was because she was fully aware that the job was extremely demanding and stressful. Even with good pay and benefits, she knew a hellish period awaited her—so bad that her current workplace would feel like heaven in comparison. She couldn’t bring herself to fully commit.

However, the call came much earlier than Puchiko had anticipated. She had thought she might receive a call about the conditional offer in December, March, and June. Why December and June? Because she assumed people might resign after receiving their bonuses.

In any case, because she received the offer much earlier than expected, she wasn’t mentally prepared. She responded without much thought, almost by a spinal reflex. “I will gladly accept,” she replied. I thought, “Seriously?”

But she is the one who will actually be working, not me. I know full well how much she has agonized over this, as stated in this (1. Puchiko’s Job-Related Anxiety, 2. Why Puchiko Didn’t Apply for Permanent/Full-Time Positions) . All I can do is support her. The representative then said, “We will send the necessary documents again,” and she replied, “Thank you, I look forward to it,” before hanging up.

After ending the call, she thought, “Was this the right choice? Did I truly make the right decision?”