Jump to ratings and reviews
Rate this book

Already Toast: Caregiving and Burnout in America

Rate this book
The story of one woman’s struggle to care for her seriously ill husband—and a revealing look at the role unpaid family caregivers play in a society that fails to provide them with structural support.

Already Toast shows how all-consuming caregiving can be, how difficult it is to find support, and how the social and literary narratives that have long locked women into providing emotional labor also keep them in unpaid caregiving roles. When Kate Washington and her husband, Brad, learned that he had cancer, they were a young professionals with ascending careers, parents to two small children. Brad’s diagnosis stripped those identities he became a patient and she his caregiver.

Brad’s cancer quickly turned aggressive, necessitating a stem-cell transplant that triggered a massive infection, robbing him of his eyesight and nearly of his life. Kate acted as his full-time aide to keep him alive, coordinating his treatments, making doctors’ appointments, calling insurance companies, filling dozens of prescriptions, cleaning commodes, administering IV drugs. She became so burned out that, when she took an online quiz on caregiver self-care, her result cheerily “You’re already toast!”

Through it all, she felt profoundly alone, but, as she later learned, she was in fact one of an invisible army of family caregivers working every day in America, their unpaid labor keeping our troubled healthcare system afloat. Because our culture both romanticizes and erases the realities of care work, few caregivers have shared their stories publicly.

As the baby-boom generation ages, the number of family caregivers will continue to grow. Readable, relatable, timely, and often raw, Already Toast —with its clear call for paying and supporting family caregivers—is a crucial intervention in that conversation, bringing together personal experience with deep research to give voice to those tasked with the overlooked, vital work of caring for the seriously ill.

224 pages, Hardcover

First published March 15, 2021

Loading interface...
Loading interface...

About the author

Kate Washington

2 books11 followers

Ratings & Reviews

What do you think?
Rate this book

Friends & Following

Create a free account to discover what your friends think of this book!

Community Reviews

5 stars
156 (32%)
4 stars
193 (40%)
3 stars
96 (20%)
2 stars
25 (5%)
1 star
9 (1%)
Displaying 1 - 30 of 105 reviews
Profile Image for Richard Derus.
2,891 reviews1,922 followers
March 22, 2022

My Review
: There's a slightly dystopian feel to reading this book. It's as though all the parts that were deemed too dark for fictional post-apocalyptic nightmares during the editorial process were snipped out then dumped into this tale. I mean, reading about a young wife and mother whose entire life was redefined by her fit young husband's horrific, aggressive cancer's near-success in driving him into the grave as she worked and raised their kids and managed his increasingly horrific treatments, all while fighting their insurance and medical providers? That's a bridge too far! It's too painful, it's too appalling!
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.

Yet it's completely factual.
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.

But, as insurance-company "care managers" will constantly remind you, "your family will be there for you! After all, you'd do it for them." Newsflash: No, they aren't; and, knowing what I know, I would never, ever do this again.

The love of my life died of AIDS thirty years ago this May. I was in Kate's shoes, sans legal rights, as his bizarre diseases racked up their tolls on him...trying to find answers at that time wasn't the impossible task it was a decade earlier, but it wasn't easy and it's amazing to me how many people will ghost you when you're most in need of support.
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.


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.

Oh yes...that rang a bell. The eternal demands, the unceasing needs, the fact that one simply needs...lunch. A shower. A half hour alone.
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.

I was so very deep into caregiving that I cared not at all. And so was Kate. So are so many, so are the ones who (unlike Kate) can't pay for help and can't rely on anyone...it's a vicious and unforgiving system of "health"care" because it's neither interested in anyone's heath nor in the smallest degree caring.
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.


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.

There is nothing, not one single thing, that I read in this book that did not feel as though it had been ripped out of my brain and splashed onto Kate Washington's computer screen in the mixed gall and bile of my outrage at the horrors of this "system" and the sheer overwhelm of the few who try, really try, to offer helping hands to those drowning in their pain. She clearly understands things now that aren't very fun to know about yourself...where one's limits are, how hard it is to be there, really be there for children...and has come to terms with them. She exists in a new reality. Kate Washington is a different human being now than she was before Brad, her husband, got cancer and became a chronically ill patient.
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.


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.

I encourage anyone who has not faced the worst health crises imaginable to read this book. I encourage you to see, from the inside, how much your fellow human beings are being asked to do. Then I hope I won't need to encourage you to do something, anything, to improve life for these suffering souls, be it spending time or giving money or even haunting GoFundMe and its siblings to do more than the nothing most people do.
Profile Image for Hannah Spector.
84 reviews3 followers
November 22, 2020
Disclosure: the author is a friend and I'm a longtime fan of her as a writer and a person.

Caring for a critically ill spouse and caring for newborn babies/small children are two of the bleakest, darkest periods of my life; periods I got through with an enormous improvised network of support. They were isolated, stressful times which are illustrated so deftly here. Kate weaves together her personal narrative of caregiving with the literary and cultural history of caregiving to show how fragile the underpinnings of care in this country are- unsupported, invisible, and pushed to the limit. She highlights the crisis of care with laser sharp insight, clarity, and humor. This is a must read for anyone who has ever needed to care for another or needed care- i.e., all of us.
Profile Image for David.
512 reviews37 followers
October 17, 2021
Good overall and great at times but overall a mixed bag. The best parts focused on the author's descriptions of the day-to-day challenges caring for her seriously ill husband along with her young daughters. Her frustration and anger were raw and very real. You don't need to have shared any of her experiences to feel her agony. Despite support from family and friends and sufficient financial resources hers was an intractable problem.

While her brutal honesty was illuminating I thought it was just too much at times. She seemed incapable of seeing perspectives beyond her own. Her husband came across as a one dimensional selfish jerk. Maybe he is but I would have liked to know how he felt about the prospect of facing death as a person in his early forties with two young children. It's disappointing that she didn't share that information. Perhaps she never asked.

The author writes from the perspective of a care giver and that viewpoint is exclusive. She raises the existential point we've all experienced about never noticing things until they're actually happening to us. For me it's noticing new roofs when I'm about to replace mine and for her it's the description of care givers in 18th & 19th century literature. The author takes us on a too long tour of Anne of Green Gables, Jane Eyre and a few others I don't recall. I'm not sure why she didn't go back to the bible other than it wasn't her field of study.

I share the care giver title and although the circumstances are different many of the difficulties are similar. Emotions can run high, relationships can get strained and it can be very easy to lose patience with the people we care for. I'm fortunate to be part of a strong support system with wonderful siblings but there are days when I'm mentally exhausted. It's comforting to know that you're not alone and the author does a great job of highlighting the many issues faced by care givers of all kinds.
Profile Image for Mommy Taco.
214 reviews3 followers
November 2, 2021
Despite the title, this book is not really about caregiving in America. This book is about a privileged white woman thrust into acute care when her husband is diagnosed with a rare cancer. There are statistics and anecdotes sprinkled in, but this is far from the normal caregiving experience.

I found myself vacillating between loving and hating this book. Some of it I felt was so real and raw and I connected with it immediately with all of those feelings of resentment and guilt and exhaustion... And then some of it felt like she had listed caregiver on her resume and needed to put every single minute detail in order to pad what she actually did.

Less than halfway into the book, the author's husband comes home from the hospital and requires 24/7 direct care. She feels that if she has to provide this care that their marriage will be irrevocably broken so she hires two full-time caregivers. One works 12 hours and then the other one works 12 hours and she pays them $40,000 for the summer. Yeah. Ok if that's something that you can afford fine, but don't spend the next 100 pages lamenting how you had to make 8 to 12 phone calls a day while you hire two brown women to wipe your husband's ass. Two brown women who by the way you never even interview. Two brown women who are part of this statistics that you mentioned throughout the rest of the book but yet you never think to talk to them? The auther tries to tie in modern day caregiving with examples like Jane Eyre and Anne of Green gables and it's very telling that she has to go back a century to find people to connect with but can't connect to the two women that are in her basement cleaning out her husband's bucket. Perhaps she tried to talk to them but they didn't want to, but there's no mention of it and despite that they are the subjects of her book she barely even acknowledges them.

The emotional labor that she details is very real and it is exhausting, and she does acknowledge her privilege... But then she kind of goes right back and goes "ugh it was the absolute worst trying to deal with HR for my tenure track husband who's in a union job who got disability and had insurance that paid for all of his treatments and he got to retire and he gets a pension OMG THE PAPERWORK!" It's very out of touch.

I have been a caregiver and since my husband's condition is chronic I probably will be caregiving for the rest of my life, on top of having four children who are neurodivergent, so perhaps I'm just sort of being petty? But it feels like this woman got to fly first class in the caregiving red eye and then complained the entire way that her Mimosa was flat.
Profile Image for Rachel.
Author 10 books25 followers
April 7, 2021
Well written but much more of a personal memoir of caregiving with some statistics added than I was expecting. She also made some detours into caregiving in literature which was interesting and enjoyable but also not quite what I expected from the subtitle which suggested a much broader focus.
Profile Image for ❤Marie Gentilcore.
874 reviews40 followers
April 2, 2021
I really enjoyed this book about Kate Washington’s experience caring for her husband when he contracted a rare cancer. She had to care for him as well as her two young children. I appreciated her sharing her personal story as well as providing information about care giving and how it is undervalued and doesn’t get enough support. I related to this as my husband was primary, unpaid family care giver for his mom for the last several years of her life. I hope there will be changes made so that care givers can get more support for this difficult job that is made harder by work constraints. Unpaid FMLA was helpful the first year but for the second year he did not qualify because he didn’t have enough hours since he had taken off so much time during the year before. It was stressful trying to balance financial, employment, and family needs. I listened to the audio but I won an autographed hard cover book. I'm excited for this Saturday's book club where we will discuss this book and author Kate Washington, who is from Sacramento, will attend.
Profile Image for Beth Given.
1,232 reviews33 followers
April 4, 2021
When Kate Washington's husband contracts a rare lymphoma, she finds herself thrust into the world of caregiving. Already pressed between being a mom to young children and a freelance writer, the additional burden of caring for her husband's illness is overwhelming: there are medical procedures she's expected to perform without any professional training; there's family to keep updated; there are appointments to drive to and phone calls to make and paperwork to fill out and help to hire. She recognizes the extreme privilege she comes from -- they have insurance, a nest-egg, and help from extended family -- but the load our society expects caregivers to take on as unpaid labor can be crushing even in the best of circumstances.

In desperation one evening, she takes one of those goofy online quizzes to rate her level of caregiver burnout. After the questions are answered, the website returns the cheeky result: "already toast." She is not on her way to burnout; she's already there! The internet quiz not-so-helpfully offers solutions like arranging for an overnight away or getting a massage. But she had done those things, and it still wasn't enough.

This book weaves memoir into well researched nonfiction, examining the ways that caregiving burdens families, especially women. She examines the dichotomy of professional caregiving, which is an underpaid profession -- especially for women of color -- while also being completely unaffordable for most families who need care. There is discussion on what caregivers sacrifice: their own professional and financial goals, their relationships with the person needing care, their own psychological well-being due to the trauma and duration of the experience.

As a bonus for book-lovers, the author's background in English literature means she includes examples of caregiving from books, too: Bertha Mason (from Jane Eyre), Jo (from Little Women), Leslie Moore (from Anne's House of Dreams). I always love a book about books.

I appreciated the author's vulnerability in writing so candidly about something so personal. There is a lot of social pressure for women to angelically support their husbands in whatever challenges arise, whether it's professionally or physically. She plainly recounts episodes in which she reacts with anger or frustration, and I wonder if readers -- both strangers and friends -- might judge her for it. But in telling the whole story of caregiving -- including those times which might paint her as petty or bitter -- she diminishes the shame surrounding those human reactions, and reminds us that pedestalizing caregivers does not actually help them.

This book spotlights a growing issue in America, concluding with some solutions for individual caregivers as well as what systemic change could happen through legislation. I really enjoyed listening to this book, as it challenged some of the beliefs I had about the issue. Definitely a worthwhile read for me.

CLEAN READERS: some swear words, including maybe a half-dozen f-bombs and the s-word for human excrement. I felt like they came mostly in the first half of the book.
3,224 reviews27 followers
December 16, 2020
Amazing story. I have no elders or significant other to ever have to care for, so I can't begin to imagine the situation. I do, however, know of four friends who are in this situation with 90 year old mothers and fathers. I pity them as no one can really help them at this time of covid. So isolated in their homes as full time caretakers. I can't even begin to imagine the hell. Most lived alone with the parent for some years and are now trapped. Few outside supports other than visiting nurses and doctors. I feel for Kate Washington. Her book sums up the horror she went through and what I imagine my friends are going through. And, though not from my own experience, I feel for the folks with elders (and others) in nursing homes and hospitals during these times..and likely all times. There is never a good time, it seems, for old age, or illness. And certainly nothing easy or simple in dealing with it. I'm not sure a caregiver would read this book, but am very sure everyone else should. There has got to be a better way of providing for the aged and ill as well as their caregivers. As a senior citizen, I keep reminding the younger adults who think their children are obliged to care for them just because they raised them- when you are very old and suffer from whatever maladies old age brings, just remember you are still going to be an adult and not get baby sized. Same story with the middle aged ill. One adult having to do it all is asking for some kind of a miracle worker. It's inhumane.
Also a reminder, the vast majority of people aren't going to have the resources to juggle the lot as Kate Washington noted in her book.
Great book! Real insight into what caregivers go through.

I received a Kindle arc from Edelweiss in exchange for a fair review.
Profile Image for Kate.
322 reviews20 followers
April 4, 2021
There need to be more books about caregiving. Period.

As a social worker with geriatrics, I work alongside informal caregivers daily, often helping their loved ones return home safely. Even without the anticipated boom of elderly population anticipated in the next few decades, it is tough to find any appropriate resources. Those that do exist often cost a pretty penny, or don't service rural areas like the one in which I work.

99.9% of the time, I see the daughter (or even daughter in law) of the family going over to the elderly person's home for 2-12 hours a day. They get 0 reimbursement, and they get burnt out. Heck, even I get burnt out from providing psychosocial care at my job in which I get adequately reimbursed.

I really liked that Kate gave an honest insight into caregiving, and also highlighted the issues that are faced in the caregiving industry as a whole. I found the literary comparisons to be my only grievance as I found there to be too many of them. Highly recommend.
Profile Image for Susan Wright.
485 reviews6 followers
November 26, 2020
4.5 stars rounded up. Yes, this is an eye-opening and unflinching account of a successful writer whose husband was diagnosed with a serious case of T-cell lymphoma in 2015 ... and who was thrown unexpectedly into two years of intense caregiving for him. Not only does she cover the details & toll of her husband's illness on her marriage and her family's lives, she also spotlights the issue of unpaid family caregivers who are sacrificing so much of their lives for others ... and yet receive no compensation or acknowledgement for doing so. She discusses various proposals to support family caregivers. Thanks to Kate Washington for this comprehensive look at such an important issue ... and her scary personal story dealing with his husband's cancer. All the best to her.
Profile Image for Jennifer Samander.
32 reviews6 followers
April 25, 2023
I am a nurse who works 12 hour shifts on a med surg oncology floor. I have been a nurse for 4 years now. I think I was born as a caregiver, a nurturer. I love taking care of someone. I love being depended on.
But it is so hard. My body hurts. I’ve injured my hips and had scans and physical therapy. Ive twisted my body in 100 different ways to connect a tubing or suction around a bed or under table. I’ve cried more than once during my job (out of stress or frustration or sadness). Sometimes I go home and can’t stop thinking about a patient or their family. Sometimes I’m filled with dread and anxiety knowing I have to go back to a certain situation the next day. I have witnessed good, dignified deaths. I have also witnessed a death that broke me down. I’ve seen so many lives sustained just for the sake of survival. I hear the call bell in my head when I’m showering or going to bed after a long shift. Sometimes I feel like I need 8 arms for all the people who are calling me/need me. Sometimes I go home and can still smell the things I’ve cleaned off people. Sometimes people can be so cruel because they’re at their lowest in a hospital scared shitless. Many times I feel like I’m a patient advocate and care coordinator on top of a nurse….I could go on, but this is supposed to be a book review LOL.

It follows a woman who’s husband is diagnosed with an aggressive cancer. She immediately assumes the caregiver role. I physically ached for her. And holy hell it was SO validating and relatable. I love how she criticized this country in how we deal with healthcare and caregivers. Abysmal. I really enjoyed her storyline with her husband and his constant horrible diagnoses and struggles. I’m already in the practice of now asking the family members of patients I care for how THEY are doing. (I often get a huge sigh and honest answers).

Now for what I did not love: the literary references I understood but sometimes it was a little too constant. Chapter 6 entirely. Too drawn out and saying the same thing over and over again in different words.

Sending every caregiver my love, thoughts, and votes in elections for pay and better healthcare.
Profile Image for Michelle Boehm.
222 reviews2 followers
December 1, 2021
This was such a well done novel that examined caregiving through the author's lens of caring for her gravely ill husband. I wanted to be shocked but couldn't at some of the things this family experienced at the hands of our merciless "healthcare" system - such as telling a woman with 2 minor children that her husband was going to be discharged from the hospital to home care, and he couldn't be left alone for one moment, 24/7, but don't worry, insurance will cover someone to help her...6 of those hours per week. We should be shocked! This is shocking! What will it take us to burn this system to the ground? (This is rhetorical, obviously, it takes politicians not taking gobs of money from insurance companies, etc).

But when Ms Washington cut me to the core was when she described her caregiving role BEFORE her husband fell ill:
"What must it be like, I wondered, to show up on a vacation simply trusting that there would be airline tickets, a rental car, a hotel room, all planned and ready for you to step into?...To know dinner will appear and the mortgage will be paid?...How carefree, but how alienating. Talk about something not being your beautiful life."
MMMHMMMM. And more specifically for me:
"Like my mother before me, I became a contract worker-a freelancer...My work was fungible and flexible and, in the end, dispensable."
Ooof. This one hurt, because during the early months of the pandemic, my flexible work was viewed as dispensable by my husband, and I'm still not over it, you guys. Hell, I went back to work full time partially because I knew that to escape dispensability, I had to become inflexible, it was perhaps my only way out.
178 reviews1 follower
May 24, 2021
Washington combines her caregiving story with a clarion call for action. I found the beginning slow. As the primary caregiver of my adult son with special needs our “emotional baggage” differs. But the second half gets the 4 stars as the PTS and raw vulnerability and honesty she displays is very appreciated. Washington’s awareness of her privilege (which I share) increases her credibility. She doesn’t shy away from any of the hard stuff. I’m rooting for her and her family. But in our society I have less faith. Her book is one more warning of the crisis of care headed our way. We must recruit, retain and value the work of care. As Washington concludes so aptly—“if society wants us to continue to care for others, it’s going to have to care a little more for us.” Thanks for spreading the word! Hopefully people pay attention.
Profile Image for Rachel.
154 reviews13 followers
May 10, 2021
Kate Washington's account of her experience caring for her husband, who contracted a rare cancer, as well as their two children, is a must-read.

Whether you've been a caretaker or know someone who has gone through a similar ordeal, this book is the frank discussion we need to have on what it means to care for others, too often at the expense of our own mental and physical health. Raw, unflinching, heartbreaking and sometimes hilarious, it uses Victorian-era literature to draw some critical parallels to modern expectations and customs.

Highly recommend.
Profile Image for Jill E Bean.
550 reviews33 followers
May 14, 2021
Almost everyone at some point will need to provide care for a sick or dying loved one. And the problem is that so many of us will face burnout in this caregiving role. In the case of Kate Washington, when she googled something about caregiver burnout, she checked enough boxes to determine that she was “already toast.”

Fair warning: this books is a difficult read. Because Kate Washington doesn’t sugarcoat what it’s like to nearly watch her husband die. Then have to lose her identity as a mother, a freelance writer, a friend and a wife as she has to pick up every piece of life and try to keep things afloat. With a smile.

Thankfully, her husband lives!

This is part memoir and part cultural critique. Yes, it’s Kate’s story, but it’s also chock full of stats about caregiving in the U.S. and how our policies and expectations are all wrong. If I had not read this book on my e-reader, I would have earmarked the hell out of the paper copy.

I empathize with Kate as a mom, wife and freelancer. And, at times, I felt like she was a bit of a narcissist in her resentment—especially toward her husband. (She even considered leaving her him in the middle of his illness). But I’m not in her shoes. And she didn’t leave.

All I know is that I would *easily* break into a million pieces if I had to take care of a very aggressive cancer, my two kids, the bills, the medications, the advocating, the sterilization of the house, the family and friend communication, the housekeeping, the grocery shopping and the cooking. So I feel super judgmental thinking anything negative about Kate. Because, after all, that’s what society does to caregivers… especially women. We put them in boxes and tell them to smile and look pretty, and make everything look perfect. And to just make it work, despite the grief, the loneliness and the thankless labor.

Meanwhile, our caregivers are, themselves, dying inside. And we don’t give them the help or the support that they really need. I highly recommend “Already Toast” because we can and must do better.

Kate is an excellent writer, who’s paid to write for a living, so she grabs you in and takes you on her emotional journey. Plus, she includes a lot of useful resources. That said, I much prefer the memoir portion vs. the stats and resource guide. She's not just bitching about the problem ... she's offering solutions, advice and help for those in need.

So if you’ve already been the caregiver for a child, spouse, parent or grandparent, this book is for you. Or, if you know of someone who’s been thrust into this role, this book is for you (so you can support someone else). And if you are likely the one who will be tapped to take on caregiving in the future, this book is for you.

Special thanks to Beacon Press/Random House for an advanced reader copy of this book, via Edelweiss+, in exchange for my honest review.
Profile Image for Lisa Roney.
195 reviews7 followers
May 14, 2021
I needed this book and found much of the content helpful and comforting. Kate Washington lays out very clearly what a travesty will befall you should someone in your family become ill, disabled, or aged. She makes a strong argument that as a society we really don't value the traditionally female caregiving role and that our medical world makes family members' lives living hells due to lack of clear information and support. I couldn't agree more with all of those things--it is truly appalling how difficult it is to even learn how all the parts and pieces of caregiving work, what the options are, and how to pay for them if you can afford to. In that regard, this is an important book, and I'm grateful for it.

However, the book walks an uneasy line between general nonfiction and memoir. Though books often work well when combining personal experience with research, stats, interviews, and other background information, for some reason this time the focus on Washington's own experience seemed to me to distract from the main points. Perhaps that's just me--Washington is recounting the story of her husband's cancer and subsequent problems, and my own personal problems are the much more common eldercare issues. But there was also something about the voice that bothered me and that I can't decide how I feel about. Washington had virtually no sympathy or empathy for her husband. On the one hand, I appreciated her honesty about her marriage being in distress, which is understandable. But on the other hand, I kept feeling as though she were just cold. We all struggle with what our caregiving situations can and do ask of us--I'm in the process now of trying to set some boundaries in order to preserve my career and sanity, so I get it--but I just hope that I never lose sight of the terrible distress and humanity of the person I'm caring for. The reason that caregiving is important, after all, is that the people who need help are deserving as human beings of our care and love. I didn't feel that in this book.
Profile Image for Roan.
314 reviews
October 2, 2021
It’s telling that this was the book that broke my month-long stress-related reading slump and not any of the light fiction I tried to read for escapism. I guess I want my reading to be relatable more than I want it to be escapist. Anyway, this book is partially the author’s memoir about being a caregiver for her catastrophically ill husband, which is not my experience at all. But the basic premise/take away is that our society and economy fundamentally rely on and yet wholly do not value work related to caregiving. Which is highly relatable and one of the basic ways that patriarchy and capitalism and white supremacy work together to make people’s lives hell during Covid and always!

This book was very liberal and its critique didn’t go far enough. But it was also good, very readable, good use of combining research with memoir. I haven’t read any of the other goodreads reviews of this book but I’m willing to bet at least of them criticize the author for seeming cold, shut off to her husband‘s suffering, centering her own needs, etc. There is some definite ableism in this book, which the author tries to be self-aware about but doesn’t fully succeed. But also, that kind of critique exemplifies some of the problems this book is about in terms of how we value care work, and the impossible situation that most caregivers are stuck in, especially those caring for loved ones that definitely deserve the kind of wholehearted, intensive, deeply attentive care that very few family caregivers are actually supported and resourced enough to provide.
Profile Image for Helen.
37 reviews1 follower
March 16, 2021
A little too close to my heart. Excellent writing....just excellent
Profile Image for Liz.
752 reviews
October 6, 2021
This excellent book seamlessly blends the author's unvarnished memoir of years managing her husband's care while he was treated for aggressive cancer with a deep dive into the history, representation, and injustice of caregiving in American society. The author doesn't shy away from acknowledging the great privilege that wealth and race offered during her family's crisis, nor from how deeply the crisis fractured her marriage.

In the conclusion, she writes: "Readers might be forgiven, at this point, for wondering how on earth the United States could go from a society with out-of-control, often profit-driven healthcare costs and essentially no provisions for supporting care to a humane, community-oriented society." Ain't that the truth, and for so many other issues besides! Despite this disclaimer, her highly readable conclusion avoids the anodyne trap of so many other popular policy tomes, with compelling, large-scale solutions from other, functional countries (natch) and promising, potentially even scalable approaches from this broken one.
Profile Image for Linda Anderson.
798 reviews6 followers
February 25, 2022
I identified with this book on so many levels. She knew how to put words on things I felt but couldn’t describe. I really appreciated her honesty and heartfelt writing.
Profile Image for Sarah.
431 reviews
December 4, 2021
Maybe don’t read this if you’re in the middle of caregiving for your spouse. Wait until after, or not at all and just ask your doctor and therapist (you’re in therapy, right? You should be. Go do that.) for help and resources. If you need to read it now (too late for me!), take breaks and ask for support and write down what strikes you as important at the time. Take what you need and leave the rest. Sit with your fears about your loved one if you have the time even if just to feel something. You’re not alone on this journey but it sure as hell feels like that most of the time.
Profile Image for Mel.
224 reviews
April 7, 2021
This book hit me right in the gut. Having been a caregiver myself, it was an eye opening look into the things that made me say, "THAT WAS ME." Or, "That totally explains what happened." And while I loved her story, and felt a strong connection to it I was more interested in the parts of the book that explain what TO DO about it. So the information around Fureai kippu in Japan, or Federal caregiver leave were enticing, but also I wonder then about the self-employed or those in the gig economy. You can't get mandatory paid time off if you work for yourself, or just have multiple jobs. We continually forget about those people (as show during the early packages offered for small biz revealed in the pandemic). I was a small business owner when I was a caregiver. It was incredibly difficult - how do we make ourselves a more empathetic country?

This is a great book for a topic many may not understand, but reveals a lot about where we are as a country when it comes to giving each other care.

20 reviews
April 21, 2021
Alright, I'll admit I skimmed the book heavily. This account of caregiving for her extremely sick husband is told by a freelance journalist, ex-academic and is written like one long thesis. Kate Washington explores interesting themes of caregiver burnout and injustice--women are often the informal caregiver, responsible for more of the "home" tasks and take a backseat to the needs of the patient, while immigrants are often professional caregivers, performing heavy labor and not getting paid much. She writes extensively about the woes of her individual experience (which is a crazy story in itself--her husband has a rare form of cancer and the eobs total over a few million) but could've provided a more balanced portrait. Tell us stories about other caregiver experiences. Tell us how your friends, family coped or supported you. Tell us more about the failures of the Healthcare system and what homegrown solutions have popped up in lieu of it.
Profile Image for Jana.
702 reviews
July 28, 2021
Disclosure: the author is a close friend, and I have been a fan of her work for many years.

Already Toast is a compelling examination of the state of caregiving in America through the lens of one family's experience. Washington does an excellent job of framing the difficulty she experienced as an untrained health care provider against the context of this massive gap in social safety nets - whose responsibility is it to care for ill people at home and why? Her reflections on the most difficult period of her life and how she held it together were especially moving. I'm not sure why society is set up to burden families in crisis, but Washington explores the topic with bravery and honesty. I can't wait for her next book.
248 reviews1 follower
April 5, 2021
A scorchingly honest look at the bleak reality of all the caregiving that's been offloaded from health care professionals onto untrained and already busy family members--usually women. That said, though the book is frequently angry, it's never depressing. And though I'm sure there are some people who start to yawn at the very thought of reading a whole book about caregiving, I can assure you that it's never dull, ponderous, or preachy. Washington's own story of having to manage the her husband's nearly fatal illness and frequent crises is complemented by frequent dips into all the caregivers, again women, who show up so often in Victorian literature. Highly recommended.
186 reviews3 followers
July 27, 2021
I really tried to like this book after be a caregiver for my parents. I just couldn’t finish it. Found the author too self centered. Do we choose to be a caregiver for a cancer loved one? No. But we do what we must. This was a horrible read!
555 reviews1 follower
April 25, 2022
This is such an important issue that truly needs attention and resolving. Unfortunately this book did not do it justice. And you get some good information only in the conclusion and sprinkled in throughout the book. Unfortunately
Issues facing Americans with caregiving of their family member is overshadowed in this book by a middle-age woman unsatisfied with her life. I’m sorry but that’s how this book reads. I’m sure she’s lovely and has legitimately run the course but it’s really hard when she’s in affluent woman with family help. To open up this tragedy in our country, we need to explore what the average American who continues caregiving to the family member as well as holding down a full-time job. Throughout the book, she’s able to take mini vacations by herself to get away from it all, send her kids to camp so she can get a break. Have in-laws come down. Able to send soiled toiletries to have laundered. Able to pay for help with other caregivers. I’m not minimizing her level of stress but again it’s just how this book reads. It sounds as if she’s unsatisfied because she did not sign up for her life to be this way. I’m sure it was very stressful for her and not trying to minimize it but she’s on the lucky side of the coin. Most Americans cannot afford anything that she was able to get because of her financial situation. So to have a better impact on letting people know how much importance this issue is, I think it would’ve been better served if someone with realistic limitation viewpoint on the subjects. Furthermore a few things that rubbed me the wrong way in this book, when she spoke about she wasn’t sure why in isolation in a transplant unit, she had to wear gown and gloves but not shoe coverings. Couldn’t understand the concept of that. For each hospital that I worked at in every transplant unit, you had to wear shoe coverings as well. So I’m not sure if her particular hospital didn’t enforce that and therefore she has a legitimate grievance on that part. She also spoke of superstition and again it read as if it might B using isolation gloves, gown, shoe coverings for people psyche superstition versus truly effectiveness of spreading of
Diseases. I hope that’s not what she was trying to relay because as she stated in the book, the infected person immune system is suppressed and they are the ones who benefit from everyone else suiting up. One more thing, when husband came home and they receive some marital counseling, the husband replied to the counselors question of what he appreciates from her, his reply was I like what The life she has made for me. She flew off the handle with that. Her feeling was that she created this Life and he was just a hanger on. Wow! I interpret this as she orchestrated the life and he was forced to go along with it. She even suggested that she wanted kids and him not so much.
Displaying 1 - 30 of 105 reviews

Can't find what you're looking for?

Get help and learn more about the design.