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Getting promoted to Detective results in you getting permanently fired from all other jobs, including Mick's gym.
Getting promoted to Sensei results in you getting permanently fired from all other jobs, including the police department.
Both of these promotions will pay your debt.
The debt increases so fast every day that you cannot grind enough money to pay it with work. Even if you hack the money into your save file, you can't actually pay the hospital bill. She's not getting that surgery until you make Detective or Sensei, and making either one requires a permanent choice of allegiance.