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224 pages, Hardcover
First published March 15, 2021
Graft-versus-host disease (GvHD) is a confusing, uniquely modern ailment, like the inverse of rejection in a solid organ transplant. If you were to need and get a kidney donated from someone, for instance, there’s a good chance your immune system would identify it as a foreign body and attack it. Thus, organ transplant recipients are given immune suppressants. In a stem cell (or bone marrow) transplant, sometimes the new immune system (the graft), in its unfamiliar environment, looks around and sees the entire body around it (the host) as foreign. It then, in unscientific terms, freaks the fuck out. GvHD can pop up in the liver, skin, gut, eyes, and plenty of other spots; its attacks, as with many autoimmune responses, often seem random.9 The possibility of GvHD—which is termed “acute” when it arises within the first 100 days of transplant and “chronic” when it continues in the longer post-transplant period—is why stem cell transplant patients are kept on immunosuppressant medications even though the effectiveness of the transplant at fighting the cancer depends on the immune response. The medical team has a delicate balance to maintain: just enough immune response to keep the cancer from returning but not so much that GvHD gets out of control.
On one bad day I ran into {her husband's} nurse coordinator from the Cancer Center in the elevator. I told her about how bad Brad seemed, and how much pain he was in, and how hard it was to watch. “The good news,” she said with gentle compassion, “is that he won’t remember much of it.” She was right; he doesn’t, at least not the worst of it. But I do. Part of the onus of caregiving is carrying memory.
I needed a human connection of some kind in order to face the next frightening day, which felt like a closing trap. So I called a suicide hotline—the thing we tell all people experiencing despair to do. There’s help out there, we’re assured. I called, nervous. The voice at the other end of the hotline asked if I was actively suicidal. I said I wasn’t planning anything right then but I was in despair. She asked if she could place me on hold to continue talking with someone in more serious crisis. I thanked her and hung up.
–and–
What chafed the most was not the private demands from my husband, but the public, official ones from nurses, doctors, and therapists, many of whom seemed to discount my personhood in any other realm than as a caregiver. I wanted them to recognize my humanity. I felt, on every level, unseen in my life, even as I was holding together the lives of four people. The longer I acted as a caregiver, the angrier I found myself at that erasure.
Burnout kills empathy and makes worse caregivers of all of us who suffer from it. More than that, it made me a worse person: less kind, less patient, less fun to be around. Being so depleted made me miserable and being miserable made me, frankly, a bitch. The trouble is that if you’re burned out you can’t take care of yourself very effectively, either. I was coping as best I could: going to the gym, trying to get enough sleep, maintaining a few supportive friendships—at least by text and online. But during the summer of 2016, often the only solution I found for my burnout was to leave home at every opportunity.
For many caregivers, their duties end only with the death of their beloved, a fact that necessarily comes with loss and grief and sometimes a guilty, perhaps half-smothered relief.
–and–
Despite the obvious value of {caregiving} there is no remuneration for most American caregivers. The time spent helping a family member is typically uncompensated by public programs or insurance, though there are states with programs offering caregivers economic support. Some families arrange to pay a family member by pooling resources. But our healthcare system and government programs do little, and in most cases nothing, to support caregivers.
At times, feelings of profound loneliness within the marriage have brought me to the brink of ending it. A lot of things kept me from leaving: the thought of our girls, deep senses of guilt and responsibility, the thought of how hard people (even readers of this book, I imagined) would judge me, and—a painful truth—the presentiment that a separation or divorce would just be another hard project of emotional and logistical work I’d have to do.
–and–
We’ve both had to compromise our approaches to emotional labor and mental load in attempts to build a newly equitable marriage. The results have been mixed. I still feel put upon a lot of the time; Brad still feels defensive and like he’s trying his best a lot of the time. Maybe he is. Maybe I need to lower my expectations some more. Some days are fine. But other days I don’t know how much lower my expectations can get.