Already Toast

Caregiving and Burnout in America

By: Kate Washington

Narrated by: Siiri Scott

Length: 9 hrs and 14 mins

Publisher's summary

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.

©2021 Kate Washington (P)2021 Random House Audio

Critic reviews

“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)

A Woeful Awakening

As a 6-year Caregiver to my severely diabetic husband, I was astounded at the similarities of emotions and anxieties shared with the author. Her words were my life and validated the emotions I have been struggling with for years. Now I recognize my trauma as real and am no longer guilty about my reactions. Lots of valuable statistics which enlightened my perspective. I keep hoping healing will happen and we can return to our normal life but now I know we are changed forever.

Lot of insight

Blunt, sometimes brutally honest portrait of the caregiver struggle in modern America. Refreshing that it wasn't glossed over, romanticized, or demeaning to have honest feelings.

Who was it written for?

I learned of “Already Toast” from my wife’s Hematologist who is the same “Dr. T” mentioned in the book. Just to be clear, he had no opinions about the book. Maybe it was my mistake or misunderstanding, but I expected the book to offer utility to burned-out caregivers. In actuality, it’s mostly an account of Kate’s experiences as a multi-year caregiver for her husband “Brad,” peppered with mentions of her credentials, feminist ideology and weirdly white guilt.

I have just shy of two years of firsthand caregiver experience, most of it full time. My wife received blood cancer treatments at the same cancer center, administered by the same doctors and nurses as Brad.

Kate makes sure we know she didn’t take Brad’s surname, but she doesn’t explain why this is important. She doesn’t miss to remind us that she is very well-educated and equally well read. She rebukes society for undervaluing professional caregivers and then tells us she pays hers $15/hr. In a couple chapters Kate comments on caregiving during slavery and contemporary racism facing black and “Latinx” (whatever that is) patients in general. Slavery …ummm what? I can tell you one cancer center that isn’t racist and that’s UC Davis, where Brad as well as uninsured, Medicare, Medicaid and incarcerated patients all receive treatment. I have witnessed shacked prisoners (on two occasions), as well as the most vulnerable receive care.

Finally, the book ends with Kate discussing government assistance that should be provided to caregivers, along with a pitch to vote for democrats. Great, but this doesn’t provide any tools to assist me through my caregiver journey. The book left me with the question: who was it written for?