Christine, a receptionist in western Iowa, doesn't want to make her co-workers sick.

But the alternative isn't very appealing either: Skip a day's pay.

She has been at her job for only three months, so she doesn't have any sick leave or vacation time. "It puts me in a bad spot. I was feeling crummy the other morning but came to work anyway, and as the day wore on got worse and worse. I sure don't like potentially spreading something to my few co-workers, but is being altruistic worth one day's pay? Since I'm raising five kids on $10 an hour, the obvious answer is NO," she wrote in a recent e-mail. She spoke on condition that her last name not be published.

"No one ended up getting sick from me, which was quite a relief. I would have felt very guilty if they had, but still, it's not worth one day's pay to avoid others getting sick. Is that mean? Perhaps, but it's pragmatic, and I'm sure I'm not the only low-wage earner who has to make this sort of decision," she said.

The best employers provide paid sick leave precisely so that their workers don't get stuck making such a choice.

But it can be hard to decide when to use the time. Haul yourself into work when you should have stayed home, and you risk dragging out your own illness as well as making your co-workers sick. Stay home, and you risk being labeled a slacker.

And it doesn't help that some people abuse sick-leave policies.

Joe, a 35-year-old government contractor in Arlington who spoke on condition that his last name not be published, works with a particularly obnoxious sick-leave abuser. His office is casual, relying on an honor system for filling out time sheets. Most people abide by the system.

But one employee, a man in his mid-twenties, seems to call in sick more than he actually comes to work, Joe said. The co-worker also claims to work from home, but he doesn't have access to the company network. In the past four months he has called in sick more than 20 times, twice the 10 days they are allotted, Joe said. "Yet, when he fills out his time sheet, no sick days are included."

This behavior has hurt other workers' morale, Joe said.

Managers are equally frustrated by such behavior. Michelle, a 42-year-old supervisor in an agency within the Hawaiian government who also spoke on condition that her last name not be used, said sick-leave practices vary significantly in her office, ranging "from someone like me who has taken three sick days in three years to those who take their 1.8 sick days per month, every month."

She said, "As a supervisor I'm frustrated by those who call in sick to recover from a hangover, entertain visitors from the mainland, welcome back their partners who have returned from a trip, etc. It is a small enough office that it's no secret when any of these events occur.

"We also have a very generous vacation leave of three weeks, so why not take a vacation day instead? It just seems dishonest to me to call in sick when you are not."

Plus, there's the risk that if you use your sick leave frivolously, it won't be there when you need it.

Susan Miller, a 26-year-old chemist in Gainesville, Va., had been at her job for four years and had built up a cushion of sick days. This year, an MRI suggested that she might have a serious health problem. "Of course this led to numerous doctor's visits, tests, procedures and sick leave hours," she wrote in an e-mail.

"I was nervous about how my employer would perceive this since I hear some of my co-workers have been scolded for using too much sick leave. It seems some people just get labeled as sick leave abusers whether they deserve it or not. But maybe, since I hadn't used too much sick leave before, they haven't (so far) complained about my sick leave. They've never even asked for a doctor's note."

It turns out she didn't have the illness she feared, and now she's back at work full time. "After all that sick leave, I'm trying to build it back up."

She said, "I've learned that you never know when you are really going to need that sick leave. You gotta stock up, even if you're only 26."

Small-Biz Breakthroughs

Do you work at a small business? How did you get your job? E-mail me your story at slayterme@washpost.com.

Join Mary Ellen Slayter at 2 p.m. Oct. 24 for Career Track Live, an online discussion of issues affecting young workers, at www.washingtonpost.com/wp-dyn/liveonline/jobs/careertrack.