Care to Care: Competing priorities
Watch the corresponding Care to Care episode here.
In the face of my fight against breast cancer, the idea of “competing priorities” has come up a lot. How do I balance the things that matter most to me? With cancer has come the feeling of a shortened “time horizon.” Rather than having the luxury of being able to pretend I am not dying– a luxury that often comes with good health– the timescale of my life feels shortened (even if in reality it may not be). This is something that commonly happens with when people age or face illness. Of course, everyone responds differently to the existential realization that we are all just dying. Some people find this freeing. It gives them permission to do things they may not have prioritized previously. For others, like me (at least during this initial stage of disease), it feels overwhelming. How do I prioritize my health, my work, my family in every moment…knowing that my moments may be limited?
In addition to showing up for me, the balance of competing priorities has shown up in those who are helping in my care. In a recent conversation, my husband Chase and I discussed how competing priorities have impacted him during this time. He stated that the balance has been difficult. Although he wants to spend time with me, what that looks like has been a source of anxiety. At times when I am limited in my activities (for example following surgery, in the days following chemo, and on those random days that my body is just not feeling well) he wants to be able to lay with me and sit with me and he wants to be doing other things. Chase is a “doer” and it is important to him to take care of our house, make sure he is learning for his job, cook, and exercise. Making the choice to spend time with me in the context of my current limitations means that he cannot do things that are in line with the other things that matter to him. While under different circumstances this may not cause so much stress, with a diagnosis of cancer and a worry about shortened time horizons, stress is exactly what shows up.
During dinner the other day, Chase made a comment about not having the opportunity to go out for a bike ride that day. I had absolutely no idea he had wanted to go for a ride and immediately felt terrible that he had not been able to do so. On that day in particular, I was feeling okay. I was slightly queasy most of the day, slept in during the morning, but made a concerted effort to spend the day with him and my son. I thought I was doing a great job, and to hear him say he did not get what he needed that day was difficult. We talked for a while and realized that we had not communicated with each other. From his perspective, it looked like I was having a “good” day and he would have appreciated me asking what he needed that day to take care of himself. From my perspective, I was working really hard to have a “good day” and was giving everything to spending time with them. Physically I was queasy and tired, but emotionally I was doing well and likely could have watched our son for a few hours if I had known my husband wanted to ride. Knowing his perspective and him knowing mine was incredibly helpful. It dawned on us that we needed to check in with each other. Realizing our miscommunication, we set out to find a system of communication that might work for both of us. I will ask him each day what he needs and he will ask me how I am feeling physically, emotionally, and in terms of how much I can take on that day. Then together, we can then make a plan of attack. He may not always be able to do the things he wants to do and he may be surprised that there will be more opportunities than he thinks. While this exact solution will not be feasible for every caregiver/care-recipient duo out there, it highlights the importance of communication in this context. On the surface checking in may seem simple or obvious. But figuring out what that looks like for each unique caregiver/care-recipient pair, troubleshooting problems that come up, and being consistent with the behavior takes time and skill. In our duo we are at the beginning of the process– and I’ll admit it has not gone perfectly!
Another takeaway from our conversation was the importance of scheduling “prophylactic support” for Chase. Chase described his stress around competing priorities as cumulative– everything seems fine and then suddenly he reaches his breaking point. This usually happens if there has been a period of time he has not been able to take care of himself. Although initially resistant to the idea of scheduling help even outside of times he is feeling stressed, he ultimately acknowledged that this might be a useful strategy to try. Just like people take prophylactic measures to prevent disease, caregivers need to take prophylactic steps to prevent burnout. By definition, prophylactic measures are taken before a person becomes sick (e.g., they likely do not feel sick at the time). Similarly, prophylactic support or self-care must happen before a caregiver reaches the breaking point.
Clearly, competing priorities are challenging. Identifying what matters and how to make moments count in the context of what may feel like a shortened time horizon can create a sense of pressure and overwhelm for both care-recipients and caregivers. Watch the related YouTube video to this post to hear more about my experience and navigating these competing priorities together.