Wednesday, 16 March 2016

Work-Sick Divide?

There is always a grey area when judging how miserable you must be, to be "ill enough" to stay off work.

When I was still teaching, I once had 3 weeks off work with a severe flu.  I was very miserable for most of that time, yet the last day of that absence period I remember thinking that I felt okay-ish, and I felt quite guilty for still being off work.

In those days I tended to return to work as soon as I could stagger in, confident that my body would heal itself in due course.

So now that I've become long-term sick I wonder about where the "well enough" boundary should lie?

Does this well-ill boundary fall in the same place on the way down as it does when going back up?

And does sickness duration affect your approach to returning to work?

I like to visualise things, so I created this graph, to show how I think most people regard a period of work absence due to illness. (Click on image to make it bigger):


Let's assume our "normal person" has reasonable health, but they get the odd cold, so they are not adverse to sometimes pushing on into work feeling a bit below par.  Yet their basic health is good, so dips in well-being might not much change their ability to work.

Then if our normal person gets flu - well that can happen quite quickly, so although they may "struggle on" for a bit in what I have called the "grey zone", it will soon become clear that they need to take to their bed and rest.

Yet on their return to work, they are unlikely to go back whilst feeling as miserable as they did on the last day before their absence period.  There is a general understanding that people should stay off work long enough to recover sufficiently to properly function once more.

So the work-sick boundary is not the same on the way down as it is on the way back up.  We tend to stay either "working" or "not working" long enough to see what direction things are really going. We neither rush to take time off, nor rush to return until we are sure. 

All the same, it seems clear to me that time in the "grey zone" for a healthy person, can be a short transit between two extremes.

Absolute full health can, of course, still take a bit longer to return, so for a time our normal person might cut out a few after-work social activities until they feel fully back on their feet.

When I was in normal health, that "return to wellness" was an assumption that I never doubted.

So what about the Chronically Ill person?

I've assumed this person is still working, and that their health is such that they are really only just "well enough" to work.  For this person each cold is a serious problem, and they might regularly dip into that "grey zone".

 Now assuming this person gets the same 'flu as our normally healthy person, let's look at what might happen.


Like the "normal person" flu acts quickly to knock the chronically ill person off their feet, but sadly recovery is likely to be slower - simply because there is less wellness to draw on.

This chronically ill person is also likely to be incredibly aware of the time they take off work.   So what do they do?  Do they try to go back as soon as vaguely possible, and risk a relapse and another period of absence? Or do they wait until they are really "well enough" to work, and in doing so take an extended absence?

It is a hard choice for others to understand, because although "normal" folk may have some experience of attempting to work whilst in that "grey zone", their transit through this zone is short-lived and their experience very temporary.  Bluster from the healthy, about how "I just pushed on through..." sounds shallow to an individual having to cope with long term ill-health.

Sadly I have no answers to provide, but I think the concept of ill health lingering for long periods in this insufferable "grey zone" is a useful one to consider.

Going back to the 'flu I mentioned earlier - because I was generally healthy at the time, my transit through the grey zone back to "well enough" was so rapid, that I ended up feeling "better" sooner than I had expected.  A day later I was back in work and functioning normally.

A chronically ill person has a much slower transit through that "grey zone" and consequently much more difficult choices to make about when to attempt a return to work.

11 comments:

  1. It is hard when working pretending to be 'normal' when you're really not. If you're not chronically ill enough not to work, you become very sensitive to taking time off, lest you be seen as a malingerer. Which pushes you back to work too soon.

    OTOH, we don't want to encourage 'normal' people to stay home on the off chance they might be ill.

    One of the only advantages to my CFS was that it was quickly plain that there was NOTHING I could do to function at work in my previous capacity (research physics). I went on disability hoping I would get better and get back to work, but I had no choice about doing so: I could not THINK, whether I was at work or at home.

    27 years later, that still isn't much better.

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    1. No easy answers for any of us I think. So frustrating

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    2. Alicia, I had the same experience with cfs and leaving work as a research physiologist. It simply requires too much energy, both mental and physical. 8 years later I've accepted that I'll never get it back. I'm finding new passions instead. Love and spoons, Cath x

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  2. In 2008 I got thyroid cancer. I had two surgeries within 1 month plus radiation and I went back to work 4 days after each surgery. I figured I was still healing, but I was in no paid so why not go to work? Everyone thought I was nuts! I was fighting cancer, but actually all the cancer had been cut out and I was just recovering. I sit most of the day so what was the difference about sitting at home or sitting at work?

    In April of 2010 the dread disease Sciatica hit me. OMGoshness, that was the most pain I have ever had in my life! I wanted to die. Nothing helped, nothing eased the pain. I actually had to take a month off of work. There were no if, ands or buts about it! I thought I was going to be permanently disabled. I couldn't stand, sit, walk or lay down. I would get up and force myself to get ready and get to work and I couldn't do anything and a couple of times I had to have a family member come drive me home! It was a devastating time for me. But I recovered and went back to work.

    I've had Sciatica off and on throughout the years, I have it really badly right now and I'm at work because I know that it's just pain, there is nothing that can be done, but it's rough.

    So enough of my rantings, let me just sum this up to say that only you know when and if you can return to work and only you know how productive you can be. I enjoyed your blog post and look forward to reading more.

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    1. Yes... individuals I think are the best judgement of their own health. If only that were recognised and respected.

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  3. After diagnosis I struggled into work as ill health had followed me for a number of years, probably a precursor of my Fibro. Every day in work was agony and my productivity was certainly lower than my previous norm. I came home and it was straight to bed! This went on for some months but eventually the day came when I couldn't deny it and came off sick. I never returned and have not worked for a few years.
    Although colleagues encouraged me to go on the sick a lot earlier than I did, knowing the problems associated with long term sickness kept me going. I was worried about keeping my job and the effect that would have on my family.
    I still sometimes wonder if struggling into work when in the Grey Zone made my symptoms worse and somehow contributed to my longterm loss of ability.
    Sometimes we may wish to acknowledge our level of sickness but stubborness and external factors keep us going.

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    1. Sadly I think this is a common experience. Working whilst in that "grey zone" is really not sustainable. ((Hugs))

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  4. If you're interested, in Engineering this lag effect is known as a hysteresis curve. A well known effect that applies to all kinds of systems, no surprise to find it here.

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    1. I'm married to an engineer and he too mentioned hysteresis when I was talking about this blog post... I'd never heard the word before, so I learn something new each day. Makes sense that the concept should have a name. Thanks for your comment. :)

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  5. It's getting worse for everyone in recent years. My family, all 3 of us are getting over flu at the moment. I was bed bound and my daughter was pretty much the same. Hubby however dragged himself to work against all odds every day this week. He was coming home, checking on us and going straight to bed. Now he is the healthy normal individual in our family (me and Missy both have fibro/cfs) and even he didn't feel allowed to lose time in work. He's on probation with a new job after redundancy last year and afraid of 1, falling behind and 2, failing probation. People are so afraid of losing their jobs now that far too many are making themselves ill. It's plain wrong. I failed probation in my last job on sick days and was sacked. I've never been employed since. We have little chance if even the healthy are struggling. Cath xx

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    1. The whole situation in the UK is deplorable. I don't understand how it got this bad. Hope your household is on the mend after the flu Cathy.

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