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 couple: professionals with ascending careers, parents to two small children. Brad’s diagnosis stripped those identities away: 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 declared: “You’re already toast!”
Through it all, she felt profoundly alone, but, as she later learned, she was in fact one of millions: 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.
“This is a timely and crucial appeal.”
—Booklist, Starred Review
“A biting critique of how America is failing its unpaid caregivers . . . . The result is a bracing antidote to ‘sentimentalized narratives’ that cast unpaid caregiving as its own reward when, the author makes clear, better Family and Medical Leave Act benefits would be far more useful . . . A startling, hard-hitting story of a family medical disaster made worse by cultural insensitivities to caregivers.”
—Kirkus Review
“[A] wrenching debut . . . Washington’s tale serves as both an evocative memoir and a strident call to action.”
—Publishers Weekly
“Vitally important . . . A gift to caregivers everywhere . . . If we are ever to untangle this multi-limbed crisis, it will be with large thanks to Washington.”
—Abby Maslin, author of Love You Hard
“Already Toast is a must-read for those concerned about the coming crisis of care and those currently facing the challenges of the caregiver life. Kate Washington describes caring for her husband suffering from cancer while raising two small children and, in doing so, is not afraid to ask tough questions about how we think about care—an activity both highly valued and taken for granted. A moving, lucidly written true story, Already Toast offers a glimpse into the lives of millions of Americans who give selflessly by providing care to sick, disabled, and/or elderly loved ones, but who pay a steep price in their emotional and physical health and financial stability. Washington argues eloquently that we urgently need to change how we view this practice if we wish to build a compassionate, truly caring society.”
—Chris Gabbard, author of A Life Beyond Reason
“Kate Washington movingly describes caring for her extremely ill husband. . . . With [a] keen wit to leaven her load, Washington&rsrquo;s description of a young family turned upside down and the difficulty in finding support and respite hits home, and underscores the societal cost of millions of unpaid family caregivers.”
—Marilyn Dahl, Shelf Awareness
INTRODUCTION
Collateral Damage
CHAPTER ONE
The Learning Curve: Beginning Caregiving
CHAPTER TWO
The Thick of It: BMTU, Part One
CHAPTER THREE
On His Blindness: BMTU, Part Two
CHAPTER FOUR
Careworn: Life After Discharge
CHAPTER FIVE
To a Crisp: Burnout
CHAPTER SIX
Invaluable: Work and the Economics of Caring
CHAPTER SEVEN
A Lack of Reasonable Options: Sandwiched Caregiving
CHAPTER EIGHT
Something Is Not Right: Post-Caregiving Stress
CHAPTER NINE
The Aftermath: Rebuilding from Caregiving
CONCLUSION
Damage Control: How to (Really) Help Caregivers
Key Sources and Resources
Acknowledgments
Notes
Index
- “Already Toast: Caregiving and Burnout in America,” Medical Monday/Tulsa Public Radio, interview
- “Episode 3: Already Toast: Caregiving and Burnout in America,” Sharing about Caring, podcast interview
- “Learning on the Job: The Family Caregiver Reality,” Generations Today/American Society on Aging, essay
- “Honest story of caring for sick loved one reveals need for helpers | The Biblio File,” The Chico Enterprise-Record, write-up
- “Already Toast: Caregiving And Burnout In America With Kate Washington On Monday's Access Utah,” Access Utah/Utah Public Radio, interview
- “Caregiving is a vital part of the nation’s infrastructure like bridges and roads,” MarketWatch, op-ed
- “Already Toast — Caregiving & Burnout with Kate Washington,” The Caregiver’s Bakery, podcast interview
- “Already Toast, by Kate Washington,” Politics and Prose.com, staff pick write-up
- “How a Bone Broth Suggestion Set This Caregiver Off,” Next Avenue, excerpt
- “Family Caregiver Burnout: This Author’s Personal Experience and Advice,” Next Avenue, Q&A
- “A Q&A With Kate Washington, Author of Already Toast,” Maria Shriver’s Women Alzheimer’s Movement (WAM), Q&A
- “Caregivers Can’t Catch A Break,” KERA Radio (Dallas NPR), interview
- “Already Toast,” C-SPAN/Book TV, author event recorded at Capitol Books
- “The Power of Kindness Can Change the World for Caregivers,” Huntington’s Disease News, book mentioned in newsletter
- “Beyond Burnout: The Exhausting Reality of Unpaid Family Caregivers,” AARP Magazine, coverage
- “A family caregiver’s story,” Equal Parts, podcast interview
- “Hidden Helpers: Unpaid Caregivers And The Pandemic,” 1A/NPR, live interview/panel discussion
- “Out of the Attic: A Caregiver’s Rage and Jane Eyre,” Literary Hub, adapted excerpt
- “Sacramento’s Kate Washington reflects on husband’s lymphoma recovery in Already Toast,” San Francisco Chronicle, Q&A
- “Sacramento author shines a bright spotlight on caregivers’ struggles,” Sacramento Bee, feature
- “Hot New Nonfiction Books From the First Half of March,” Daily Kos, included in book roundup
- “March Preview: The Millions Most Anticipated (This Month),” The Millions, book one of “15 Most Anticipated” for the month of March
- “8 author-approved books to add to your spring reading list,” Today Show/NBC TV, Jasmine Guillory recommends Already Toast in “8 Best New Books for Spring”
- “The Costly, Painful, Lonely Burden of Care,” New York Times/In Her Words, interview
- “When It Comes to Caregiving, Women Are Already Toast,” Bitch Media, excerpt
- “Already Toast: Caregiving and Burnout in America,” Booklist, review selected as “Review of the Day”
- “New Book Shows How A Broken Health Care System Feeds Caregiver Burnout,” Texas Public Radio/Texas Standard, interview
- “Don’t Tell a Caregiver to Stay Positive. Here’s How to Help Instead,” TIME.com/Ideas, op-ed
- “Who Cares,” Sacramento Magazine, 6-page feature with excerpt in March issue
- “50 Million Americans Are Unpaid Caregivers. We Need Help,” The New York Times, op-ed
- “Mobilize family caregivers to speed the rollout of Covid-19 vaccines,” STAT, op-ed ran in “First Opinion” column
Already Toast: Caregiving and Burnout in America by Kate Washington
Readers’ Guide Discussion Questions
Download the readers’ guide.
Introduction - Collateral Damage
- What is the first thing you think of when you hear “caregiver”? (1)
- The author writes, “Our culture undervalues caring and exploits those who care for others.” Do you agree? Can you think of an example of this in your own life? (3)
- The author admits, “I was among the most privileged of caregivers: I was well off and financially stable thanks to an inheritance from my mother, so Brad’s health crisis was not also a financial crisis for us.” If the author hadn’t had those advantages, how, do you think, would her experience have been different? (6)
- The author brings up Victorian caregivers in literature as a point of comparison. Do you agree that their portrayals have influenced the expectations of women as caregivers today? (48)
One: The Learning Curve - Beginning Caregiving
- When describing the discharge process, the author says, “That nurse in this case spent about half an hour training me how to keep my husband alive and left me nervous and unsure about my ability to do so.” If you had been in her shoes, how would you have felt? (29)
- A report issued by AARP, “Home Alone,” sharply criticizes the widespread practice of foisting nursing tasks onto family caregivers. The report urges healthcare providers to “fundamentally rethink and restructure the way they interact with family caregivers in daily practice.” What are your thoughts on this? (29)
- The author compares caregiving to first being sent home with a newborn baby. What do you think of that comparison? (29)
Two: The Thick of It - BMTU, Part One
- Do you agree that isolation has always been a part of illness? (40)
- When she talks about socializing, the author says, “When I did socialize I couldn’t relate to other people. I unfairly found their concerns trivial, so much so that I could hardly listen patiently; on the other hand, my problems were such a stone-cold bummer it really lowered the mood to talk about them.” (44) Do you think your friendships would have been affected in the same way? As Brad became sicker, the author says, “I knew I was withdrawing from Brad as he became sicker. To tell the truth, it was at least partly self-protective. I thought he was dying and I couldn’t really bear to keep our bond as strong as it had been when losing him entirely seemed imminent.” What do you think of this choice? (50)
Three: On His Blindness - BMTU, Part Two
- What do you think of the pressure that the author felt to be like Jane, the selfless, perfect caregiver in Jane Eyre? (54)
- Why, do you think, is there an underlying assumption in the healthcare industry that all patients have care help standing by at home? (63)
- The author mentions a hotline that she calls in a moment of despair. Do you think it would have helped her a lot more if she had been part of a support group with people going through the same thing? (65)
Four: Careworn - Life After Discharge
- Why do you think the author’s home caregivers preferred the longer hours, even though she offered more “humane” ones? (69)
- Do you agree that what the author did—delegating, at relatively low wages, the care of a loved one to women of color—is part of a problematic pattern? (69)
- In your experience, during this pandemic, has the unpaid caring labor fallen heavily on women? (81)
Five: To a Crisp - Burnout
- The trip to New York did a lot of good for the author, as did leaving her daughters with their grandparents to relieve the pressure. If you have children, do you feel guilt or comfort at asking family members to watch them so you can relax and have fun? (87)
- Why do you think female caregivers are more likely than men to take on the most difficult tasks? (88)
- What, in your opinion, should be done about caregiver burnout so it doesn’t lead to depression? (96)
Six: Invaluable - Work and the Economics of Caring
- Can you understand why the author projected herself into Brad’s writing? (103)
- Do you agree that caregiving fuels generational poverty? (106)
- Do you agree that people who are household caregivers should get paid? (109)
- Is it true, do you think, that men see nothing to gain in becoming more like women? (116)
Seven: A Lack of Reasonable Options - Sandwiched Caregiving
- Can you imagine asking your partner what kind of death they would want, as the author does? (120)
- How would you imagine the pressure of a sandwiched caregiver differs from one who only has to care for one person? (121)
- What do you think of, in Laura Esquivel’s novel Like Water for Chocolate, the traditional Mexican expectation that a youngest daughter will remain unmarried and childless so she can care for her parents in old age? What are the care expectations in your own culture? (124)
- What do you think of the author’s decision to stay home rather than go to New York with her husband? Would you have done the same if you were in her shoes? (134)
Eight: Something Is Not Right - Post-Caregiving Stress
- When it comes to caregiving for a loved one, would you be willing to risk going through vicarious trauma? (143)
- The author says she soothes anxiety with food and drink. If you experience anxiety as well, what do you do to ease it? (149)
- Do you think that going to therapy while simultaneously serving as a caregiver would be too much of a challenge? Why do you think some wait until later to seek help, if at all? (151)
Nine: The Aftermath - Rebuilding from Caregiving
- Do you agree that caregivers are invisible in our culture? (155)
- Do you agree with the author’s decision not to divorce her husband? (162)
- How do we make caregiving an issue that people will care about, like parental leave? (169)
- Do you think we should implement nationally the caregiver support policies piloted in Hawaii and Washington? If so, how can those programs be expanded? (171)
- Do you think a universal basic income would help ease things? (177)