Reviewed by Hannah Straton
Kate Washington’s Already Toast: Caregiving and Burnout in America (Beacon Press, March 2021) is both a memoir of her caregiving experience when her husband, Brad, was diagnosed with a rare, life-threatening cancer while she also was raising two daughters, and a critical analysis of the state of caregiving in America. Washington proves that familial caregiving is taken for granted by doctors, absolutely necessary for patients’ recovery, and frequently devastating for the financial, emotional, and social lives of the disproportionate number of women who take it on. Already Toast is a must-read for anyone concerned with the looming care crisis.
Over the course of Brad’s illness, Washington fills his prescriptions and tracks them, sometimes doling out more than 30 pills a day. She learns to administer his antibiotics three times a day through an IV line and advocates for him to doctors. Washington keeps their family updated via phone and then sets up a blog Brad can write himself. When illness makes him incoherent, she wonders if she should cut him off from the blog, or if she even has that right. Washington researches Brad’s various diagnoses and at one point learns that 90% of all people with his condition die. While this is happening, she is hosting her in-laws at her house and raising two small children, having their birthday parties and helping with homework. When she accompanies Brad to an appointment, the doctor notices her condition: “As I broke down, the oncologist chided me for not taking good enough care of myself. If I didn’t, he said, how could I take care of my husband? Fragile and overextended, I heard in that question an implication that the only point of me, as a human and not coincidentally as a woman was to care for another person.” Washington begins researching burnout and self-care only to find the whole subject severely lacking. A massage or a bubble bath will not fix the big structural problems that created this mess.
Yet Washington is one of the privileged ones – and she is very upfront about that fact throughout the book. Brad had excellent insurance. They were able to afford for her to step back from her career so she could caretake full time. They paid $40,000 for a summer of round-the-clock professional caregiving after Brad’s bone marrow transplant. (The hospital billed $6 million for the transplant, their insurance paid significantly less, and the couple paid nothing at all.) They had family members who stayed to help with their daughters during this time. Washington always reminds the reader that, as a caregiver, she is at the privileged end of the spectrum: Most caregivers, especially black and brown women, have full-time jobs and significantly less resources at their disposal.
Washington establishes that caregiving is extremely difficult work in the memoir sections and in Chapter Six, “Invaluable: Work and the Economics of Caring,” she states, “The necessary work of family caregivers has enormous worth…[the] AARP estimate[s] of the market value of unpaid care labor at a staggering $470 billion.” Yet family caregivers are unpaid, burnt out, and often invisible to the doctors who rely on them. The final chapter of Already Toast, “Damage Control: How to (Really) Help Caregivers?”, explores bigger structural solutions like more paid family leave programs, expanding Medicaid, child tax credits, and Social Security credits for family caregivers. The lack of such resources, the growing aging population, and the increasing number of people caring for older parents while still raising children are adding up to a care crisis.
Washington is a writer with a doctorate in Victorian literature and Already Toast is filled with literary references, from Jane Eyre to Anne of Green Gables and Milton to Middlemarch. Avid readers will enjoy the trips down fictional lanes. These literary references provide brief respites to the often-infuriating look at a medical bureaucracy that will save a patient’s life while draining their caregiver’s. I recommend Kate Washington’s Already Toast: Caregiving and Burnout in America to any reader at all concerned with the impending care crisis in America.