In Sickness and in Health.

So how do you preserve the romance in the relationship when your partner has been put in a caregiving role?

On a balmy, St. Patrick's Day night several years ago, I met the man who would eventually become my spouse. Andrew and I dated for a year and a half before we married. Then on September 28th, 2013 we vowed to love, honour- but not obey one another for all the days of our lives.

As a woman who had survived a brutally violent and abusive first marriage, these vows were not undertaken lightly. In fact, I had not expected to ever willingly marry again. But in Andrew I found a person who became my best friend and home. Someone I felt implicit trust in and who made me feel safe again.

When we found that on June 20th, 2015 we had lost my (grand)father to cancer and then on June 21st we were in the hospital getting ready for the medical D&C that would terminate the fetus. At the time, I thought we had weathered the worst storm that life could throw at us. Funny how life has a way of turning the tables on us when we least expect it.

May, 2018 I had a heart attack. I was 38. My biological father passed away when I was 6 years old, well before his time. I inherited his love of potato chips and his bad cardiological genes; not the best case scenario for a long life.

I had felt mild discomfort for a few days prior, but I thought it was just some mild heartburn. I went to work, put in overtime even, and ignored my discomfort as long as I could. When I finally gave in and went to the hospital for treatment, I learned that I was in the midst of a massive heart attack. Two hours later I was being admitted to the regional hospital with cardiological-ICU specialists and was being medically stabilized.

I was in the hospital for about 2 weeks, during which I underwent a 10-hour long open heart surgical

quadruple bypasse. The interior vein from my left leg was removed to patch my diseased valves. Through it all Andrew was at my side. Recovery was hellish painful. Initially I couldn't dress myself, shower by myself or cook for myself. I was a 38-year old invalid.

Balancing work, parenthood and becoming my PSW was no small feat. My first weeks of recovery were rough. I could barely move. Everything was in a haze of pain. Mentally, I was a wreck. The feel of my own pulse, the sound of my own heartbeat, sent me into panic attacks. Every twinge and pain made me think it was the big one.

The person left to pick up the pieces was Andrew. He cooked for me, cleaned the house, helped me bathe, helped me with my rehab and generally did everything I could not. This was on top of a physically demanding day-job and parenting two very active children.

Through most of my recovery I slept in my armchair; and sex with a recovering open heart patient is a no-no for at least a solid two months. Not that sex was even remotely a priority for me at the time.

In short, our lives as a young (ish) couple in love changed fundamentally with my ailing health. We were and are, still deeply in love, but the hot, steamy part of our relationship was cooled naturally, due to Andrew's new role as caregiver and my own physical discomfort in a body that felt no Ionger felt like my own.

Living with my new zipper scar (the vertical scar where my chest was opened to access my heart and lungs) was initially difficult. I was self-concious of how it looked- especially as it and my leg scar; from where they harvested the vein to graft onto my heart (which ran the entire length of my left leg) were still healing. People stared when I went out in the summer in shorts and t-shirts, they whispered. Sometimes-kids especially, they just asked what happened. That I much preferred.

By the time I was healed enough to be mobile and try to test the social waters again, I was utterly devoid of confidence in my bodys' appearance. I felt like a monster. I jokingly refered to myself as the Bride of Frankenstein.

So our regular date nights became less frequent. Intimacy was non-existent. And Andrew was still bearing the majority of the weight of parenting and housework.

This was an excellent recipe for disaster.

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Caregiver burnout is not a new idea to the world. Usually it's spoken about in terms of children caring for elderly parents, parents caring for infirm children etc.

Web MD defines caregiver burnout: "Caregiver burnout is a state of physical, emotional, and mental exhaustion. It may go along with a change in attitude -- from

positive and caring to negative and unconcerned."

A more honest definition might be:

"Someone is in charge of everything. Someone else is way less useful then they used to be. Everyone is upset and life is shitty and unfair for everyone."

Fun times.

The Mayo clinic offers some ideas on how to cope with caregiving fatigue, the website suggests:

"Accept help...

Focus on what you are able to provide. ... Set realistic goals. ... Get connected. ... Join a support group. ... Seek social support. ... Set personal health goals. ... See your doctor."

The effects of caregiver burnout go beyond just a passing sense of resentment, irritability and exhaustion. A variety of physical and emotional symptoms are also frequently attributed to the condition.

Unlike many who experience caregiver burnout, Andrew was not in charge of my health and welfare indefinitely. After about 12-weeks. I was considered fully healed enough to be a regular member of society again.

It's fortunate that as my overall health and independence improved, so did my spouses symptoms of caregiver burnout.

Life slowly returned to something closer to "normal." Less than four months post heart attack I went camping on the Sleeping Giant near Thunder Bay. Andrew and I went on dates. The wheel turned.

After my December, 2019 diagnosis of End-Stage Kidney failure we were once again thrown into the fray. This time my energy was depleted to the point of being bed ridden at least part of the day.

As I became a shadow of my former self, the old demons reemerged with a vengeance. Resentment, anger, hopelessness...both of us were fighting a variety of negative emotions, desperate to remain anchored together upon common ground.

Andrew was feeling taken for granted, under appreciated, stressed financially, emotionally burnt out. I was reeling from the finality of my diagnosis, scared of my uncertain future and despondent.

And the just when life seemed at it's worse: COVID hit full force.

Suddenly everything was 8000% more difficult. From essential doctors appointments and medical tests to applying for EI and eventually LTD. Everything was impossibly hard.

There were few resources out there. What few there were mainly focused on the needs of a much older demographic.

Much less attention is focused on the plight of the young(ish) couple.

We were living pay-day to pay-day after The Big Heart Attack of 2018. By December 2019, there was nothing left in the pot when I was coldly laid off by my employer and denied disabilty accomodations at work.

Everyday a new feature was added to the vicious hellscape that my life had become.

Financially destitute, unemployed and physically crippled; my spirit dimmed. I became depressed.

Our water was almost turned off at one point. We had to sacrifice cell phones, internet and cable to make sure we had food to eat.

Andrew was on seasonal layoff when life as we knew it ended. He'd just started his seasonal job again when the kids were dismissed from school and the world was quarantined due to the pandemic.

Then the fun really started.

We had to find a more affordable home. Moving mid-pandemic was nightmarish.

The stress of so much uncertainty, of providing for a family and the many demands that go-along with being caregiver weighed upon Andrew. Naturally tears formed. He was snappish. Cranky. He withdrew into himself.

For my part I was more emotionally needy than usual. I was despondent and feeling useless. I became more than a bit self-loathing.

Things took a stiff downturn in our relationship. Fights blossomed over the smallest things. The slightest perceived slight turned into a shouting match and then a day or more of silence between us.

Andrew has always been the do-er in our relationship. I'm the talker and feeler. By Mid-May 2020 he was sick of doing and I didn't feel like talking or feeling.

Caregiver burnout and compassion fatigue scar a relationship. They burn it through toxic behaviour and failed communication. If you let it, caregiver burnout will destroy the foundation of your relationship.

The professionals will tell you to find solace through support groups, self-care and seeking outside support.

These are all tried and tested methods. Sadly in the age of COVID-19, they were also all off limits. There were online and virtual support groups and those were helpful. But we needed something more.

Coming home from dialysis one night the song Peace by O.A.R. was playing. Listening to the lyrics, I broke down. I sobbed, sitting in my car for twenty minutes before I got myself together to get into the house.

I realized enough was enough.

Andrew was sitting in the living room watching t.v. and pointedly ignoring me when i came in. Still mad at whatever slight had occured earlier before I left.

I approached him and spoke to him. I told him how I felt. Asked how he felt. We argued.

It was hard to hear some of the things that were said. On both our parts. For me, I had to admit that were times I checked out. Put unfair burden on my partner due to ennui and depression. For him, he had to acknowledge that his experience with compassion fatigue had made him less sensitive than was appropriate and that his shortened temper was unacceptable.

It wasn't a fairytale ending.

We still had to work on it. But we communicated. We set boundaries and respected them. We continue to evolve this in an ever continuing negotiation. We try to express our love and appreciation for each other and for the deeds we undertake for each other.

We don't (try not to) hold onto grudges. Play it for tat (that's the hardest impulse to smother for me and him). Or stay silent when something is festering.

I've worked on becoming more of a "do-er" and he has worked on his communication and learning to express his emotions.

For us, the key to battling caregiver burnout (we don't defeat it but we do keep it at bay) has been communication. It's also been a willingness to humble ourselves and to compromise.

Eventually, a day will come when I hope that the world quits being on fire. Then we'll re-build "us." We'll find family and friends to watch the kids and spend time alone together. Date. Go to therapy.

For now we talk.

While we continue to be a work-in-progress, we continue to stand together in that progress and that is all that matters.