Guilt and Grief — a Husband’s Long Decline

Dear Dr. Neimeyer,

I am married to a man more than a dozen years older than I am, and through most of our four decades together he has been the strong one who has taken care of most things.  Over the last decade he has had many surgeries.  He has many different things wrong, but not one disease that says an end is near.  He has had prostate cancer, surgery with that and then it returned, so radiation.  He has had his hip, shoulder, wrist and just recently his knee replaced.  His heart is always in afib.  He is mid-70s.  Since a few years ago, I have slowly taken over everything.  And the things I can not do, are just not getting done.  He thinks he is OK, but I have seen such change.  I have lost a lot of my friends, because he will drink (only 3 or 4 drinks a day) and  starts arguing and there is no talking to him or calming him in the moment.  He has had 3 TIA’s , so I believe he has vascular dementia.  He is so medicated with heart pills, blood thinners, anti-depressants.  I know I am rambling, but I guess my question is, what do you do when you have someone who has many issues but not just one disease, and I feel guilt each time he seems like he is getting better, because I know it won’t last long.

Dolores

Dear Dolores,

I am struck by the many losses you and your husband have had to face—of his health, one condition at a time, and of his ability to provide a sense of security to you as a strong and in-control life partner.  Now, over a period of 7 or 8 years, so much has changed as his health has eroded, and with it your own responsibilities have grown in number an heaviness.  Complicating all of this seems to be the sense that you have already lost much of the husband you knew to the fog of medication and alcohol, and perhaps encroaching dementia as well.  In the face of all this, you could be forgiven for finding hope in his recovery difficult to sustain.

How might you handle this slow slide toward loss, and the many very real losses you yourself have already sustained?  One answer is to begin with self-compassion:  your husband surely must be suffering the losses of his autonomy, competence, and physical integrity, and each of these has ushered in equally substantial losses of freedom, security, and more for you.  If a friend were in your shoes, what might you do for her, and what caring counsel might you offer?  Ultimately this might include some form of self care for yourself, so that you might also better provide support for your husband.  For example, many cities have specific day treatment facilities that can provide respite care for families, engaging even cognitively challenged older adults in meaningful activities, while also giving family caregivers the hours off they require to restore some semblance of normality, friendship and practical functioning in their lives while knowing their loved one is in good hands.  A further benefit of such a program would be its role in curbing your husband’s drinking, which likely grows more significant in isolation.

Whether you seek respite through professional services onsite, in your home, or from a friend, it could be valuable to consider what your husband needs as well.  Though he might defensively put on a brave face—even belligerently at times—it seems clear that he is also suffering from the cascade of losses and what must feel like the growing specter of helplessness and death.  Consulting a therapist together about how best to manage his illnesses, and perhaps even talk through healthcare decisions going forward, could help you both open communication about necessary things, ideally helping rebuild a sense of teamwork that you seem to have enjoyed for decades, as life now presents so many new challenges.

Dr. Neimeyer

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