From the same official, in January 1925: “I beg to report that Reject Disc No 8339 died en-route to Ressano Garcia on the morning of the 13th instant. Body removed from the train at Komatipoort and 75 pounds returned herewith.” In most cases, however, state officials merely noted that an individual bearing an incomplete name of sorts had been ‘found dead’ on the train. It was a formulation that suggested that, in his final moments, the dying mn had been on his own only to be discovered dead sometime later.

It was added to an already growing vocabulary of work-related ailments specific to Japan, most notably “kacho-byo,” which translates to “manager’s disease” and was coined to describe the overwhelming stress felt by middle managers over promotions, letting down their team, shaming themselves and their families, or, worse still, disappointing their bosses and weakening the company. But where kacho-byo is a problem that only afflicts white-collar workers, karoshi is an equal-opportunity killer that preys as eagerly on blue-collar workers as it does on managers, teachers, healthcare workers, and CEOs.

But what makes the individual stories of karoshi and karo jisatsu different from these is the fact that what drove the likes of Miwa Sado to lose or take their lives was not the risk of hardship or poverty but their own ambitions refracted through the expectations of their employers.

Boston University professor Anita Tucker and I studied nurses carrying out the dozens of tasks that occupied them throughout long hospital shifts. Taking detailed notes, complete with time stamps, to document the work of these dedicated caregivers at nine hospitals, Anita observed that nurses confronted “process failures” surprisingly often—almost one an hour. A process failure was anything that disrupted a nurse’s ability to complete a task, such as an unexpected supply shortage in bed linens or medications. The nurses were acutely aware of these frustrating daily hurdles. Their jobs were hard enough! On average nurses were working an extra (unpaid) forty-five minutes simply to tie up loose ends before leaving the hospital.

11. Proper Sleep

“Sanjay rolled over to face the wall, refusing the salt water his mother prepared to force him to vomit. He lived for two hours after reaching the public hospital. After midnight, returning home to Dharavi ancient with grief, his mother tossed into the gutter the prescriptions the doctor had written for Sanjay. There had been no time to go out to the road and fill them.

The police inquiry into her son’s death was closed as swiftly as the inquiry into Kalu’s death had been.