The Last Straw: What Do You Do When You Reach Your Breaking Point? Part 1

I had a conversation with a smart, insightful, articulate woman this week who has reached her breaking point.

She has been the primary caregiver for her husband who has had cancer for many years.  But even before the cancer, their marriage was troubled.  She described her husband as self-centered, angry, quick to blame, and slow to  forgive.  He is also a proficient verbal sniper -- firing off ugly names and harsh critiques with great dexterity.

A few years ago his disease went through a period of acceleration.  His symptoms grew more pronounced.  And his selfishness and harshness kept pace.

Recently, he began experiencing another round of increased symptoms and is about to go through some diagnostic test to reassess his cancer's status.

This self-aware woman has reached her breaking point.  She knows that if he declines, physically and emotionally, and she is in position to play the caregiver role, she will "be destroyed."

What should she do, as she assesses her options at this intersection of love and obligation?

This is an intersection many partners living with illness arrive at.  Ill partners may worry about adding greater burdens and decide to suffer in silence.  Or they may feel that their illness requires that their well partner pick up the loads they can no longer carry.  Well partners may feel it is their duty to willingly pick up those loads.  And well partners may also feel that one more straw dropped on their load will break their backs.

How do you balance your obligation to your partner (whether it comes form love or a sense of duty) and your obligation to yourself?

There are no hard and fast rules in the illness playbook that answer this question.  Each partner must dive into their repository of personal values, family legacies, love for yourself and for your partner, disappointments in yourself and in your partner, and your vision of the future.

In Part 2, we will explore how to dive into that repository and come up with the path that is right for you.

Romantic Break-Ups Cause Real Pain

From an article on foxnews.com:


"Rejection quite literally hurts — the experience and the memory of getting dumped by a loved one trigger brain regions linked with physical sensations of pain, scientists find.

Smith and his colleagues put out fliers in Manhattan and online ads on Facebook and Craigslist looking for people who had been through an unwanted breakup of a romance in the last six months. As the brains of the 40 volunteers were scanned through functional magnetic resonance imaging (fMRI), half the time they looked at photos of their ex, and half the time they looked at photos of a friend. During both situations, participants were asked to focus on experiences they shared with the people in the pictures.

For comparison to their response to physical discomfort, the participants also had probes placed on their forearms that could get painfully hot.

The scientists found that parts of the brain linked with physical pain also lit up when individuals were remembering bad breakups.

"Rejection literally hurts," Smith said."

Couple Faces Separation in Nursing Home

As I continue to mourn my father's death eight months ago and witness my mother's slow, seeping decline in her assisted living facility, I am becoming acutely aware of not only mortality, but of the gnarled and hazardous path you have to walk to get to the end of life. How many people get to die quietly, in their own beds, holding the hand of their beloved? The story below about an elderly couple facing separation from each other because of institutional regulations and efficiencies makes me very afraid.

Do you have stories to tell about this issue? What are your thoughts about your own mortality road? How do you want your end to be? These are questions we rarely say out loud, or write. They frighten me as I type them. But I am interested in your thoughts.

Here is an excerpt from the story by Max Harrold in the Montreal Gazette, June 25, 2010

Couple Survived the Holocaust; Now Faces Separation at Nursing Home

"They survived the Holocaust, but now Elena and Francisc Basch - married for 65 years - face the prospect of being separated in the Côte de Neiges nursing home where they live in adjacent rooms.

The case highlights the difficult choices faced by long term care facilities and the often disorienting consequences for frail residents. The couple's son says separating them - both his parents have Alzheimer's - would be too traumatic. The nursing home says it is legally entitled to do what it feels is best, based on each resident's needs.

The Baschs, both age 90, have different stages of the illness that impairs memory, thought, speech and can lead to complete helplessness. The Montreal Jewish Eldercare Centre says Elena must be moved to a different ward as soon as possible because she needs a more advanced level of care, her son Max Basch, 59, told The Gazette this week.

"They cannot survive without one another," explained Max, from his home in Tenafly, N.J. His mother's more advanced condition makes the familiarity of her surroundings critical and her husband in the next room is a big part of that, he said.

"They always hold hands," Max said. "They kiss each other. They're this incredible, great couple in theirs 90s. When he went to the hospital for a few days, she said 'Maybe I can go to the hospital and check in on him and cook for him.' She doesn't realize exactly where she is but she knows they are together."

Advice Columnist Tells Well Partner To Leave

Advice from a Boston Globe columnist, Meredith Goldstein, about the well partner separating from the ill partner. I would be very interesting in hearing your perspective.

And very interested in hearing from those well partners who did choose to leave -- what was the tipping point for your choice and how ha our life been since the separation?

And I would be interested in hearing from those ill partners - what was your life like after the separation?

HERE'S THE ADVICE COLUMN:

Q: I enjoy reading your columns everyday -- it provides such a welcome distraction at work. I find myself in a difficult, sad situation, and would appreciate any advice you and your readers have to offer.

I have been in a relationship for about four years. My boyfriend and I are very young -- we started dating when we were about 20 -- and we’ve had a great relationship and are very much best friends. We agreed early on there was no need to rush and get married, but we frequently discussed our desire to be together for a very long time. Two years ago we moved in together and it was wonderful; we had a great life, great experiences, great friends.

My boyfriend has always had health problems, but a little over a year ago, things really got bad. There’s no need to go into the details, but suffice it to say, it isn’t going to go away, and it has impacted every aspect of our lives. Because it is often difficult for him to move around, we started going out less and less. Our home became less social as he didn’t like having people over as much. His interests narrowed, his mood soured (he’s being treated for depression). Our sex life dried up. I took it upon myself to do whatever I could to make life better for him; I have taken on more and more responsibilities; I physically take care of him; and I have been patient, accommodating and understanding as our lives changed.

Now I’m at a point where I have accepted that this is not temporary, and I feel increasingly hopeless. I have all of the responsibilities in the relationship, with no help from him; I ask for help when I think it is reasonable, but the general rule is, if I don't do it, it won't get done. What's more is that we basically have no lives. His only real interest now is sitting on the couch watching our favorite TV shows, and it’s the only activity we really do together anymore. I’ve told him on more than one occasion that I miss the things we used to do together and with others, and that despite his pain, I hope we can try to have some fun again, even if it’s limited. He tries sometimes, but even if he manages to get out the door with me, we usually can’t stay out for long before he wants to come home. I’ve tried to broaden his interests beyond the TV even within our apartment (books, board games, video games, anything) but that hasn’t really worked either. His interest in other people has also reached new lows, so socializing beyond the infrequent visits of our few remaining close friends is rare. I have started going out on my own from time to time just to escape the negative and monotonous atmosphere of our home (I always make sure to invite him), but it’s not the same, and since our jobs take up much of our time, it doesn’t feel right to spend a large portion of my limited free time elsewhere. I’ve brought up all of these problems separately on numerous occasions, but I have to be delicate about it because he quickly begins to feel massively guilty and depressed, and sees himself as inadequate.

I feel isolated, stuck, and sad, and have been fighting the urge to flee. I think he may suspect my feelings, because he is reminding me more frequently how he loves me and couldn't go on without me. But I just don't know. On the one hand, I have all the responsibilities of the relationship, and none of the emotional or physical joy that should come with it. I don't think he is either willing or capable of living beyond the lifestyle we currently live. I’m 24 and I am terrified at the prospect that this is it, that this is going to be my life. On the other hand, he’s still my best friend, and I love him and deeply care for him. He’s in pain, both physically and emotionally, and he needs me. If I left, it would break his heart, and when I think about the reality of that, it absolutely shakes me.

What should I do? It’s been over a year, and I feel I have tried everything, and things are not getting any better. Am I a horrible person to be thinking about leaving him?

-- Stuck and Hopeless, Boston

A: S&H, You’re allowed to leave. You’re 24. You didn’t sign up for this. I fear the longer you stay, the worse it will be when you bolt.

He’s your friend. You owe it to him to be honest. Tell him you’re not up for this. You can’t commit to this life, at least not as a romantic partner. You can explain that part of your decision is about age and place in life. I truly believe it’s not just his illness. You want to discover more of the world. You want to get to know yourself better. That's what unmarried people do at your age. You will feel like a jerk -- but being a jerk is better than being a martyr.

Give him the whole picture. Explain that you’ve thought about leaving for a number of reasons, but that his health and depression has kept you around. Tell him you've lost track of how serious the relationship would be if his illness wasn't a factor.

If he can’t get his mind around losing you -- if he begs you to stay (and he probably will) -- assure him that you’ll be there as a friend if he wants you around in that capacity. Remind him of all of the other people in his life who care for him. Tell him to seek out as much support as possible. Dealing with a chronic is miserable. He needs to learn to cope without alienating everyone he loves. If you fear that leaving him will send him into a dangerous depression, talk to his friends and family -- even his doctor. It's their job to get him through this.

There’s no way to avoid feeling like a bad person. It's going to be ugly and there's going to be a lot of guilt and shame. But that's life. You can’t always be the good guy. And frankly, I’m not sure that sticking around would make you the good guy. It would just make you miserable.

Go be 24.