The words “in sickness and in health,” typically followed by “till death do us part,” are a central component of the marriage vows in many religions and cultures. The origin of the phrase is usually attributed to Thomas Cramner, who adapted the terminology in the original Book of Common Prayer published in 1549. The concept inherent in these words, of a lifetime commitment of companionship and support of two people to each other, has frequently come to be applied outside of marriage vows.
The phrase in sickness and in health has become so well ingrained and ubiquitous both in and outside of marriage ceremonies that it is often recited absentmindedly, or at least without serious thought. It is often said that many who speak these words assume that they are just ceremonial and not to be taken literally. Clearly, the literal interpretation of the phrase requires a serious commitment that has the potential to extremely impact an individual’s life and happiness.
I became interested in this topic when taking care of a very ill patient whose spouse had made extraordinary sacrifices to care for them over several years. Like nearly all physicians, over the years I have marveled at the dedication of family and others to many of the patients I have treated. I am still not sure what triggered my reaction to this particular couple. However, this experience was seminal in not only arousing my admiration for the caregiver but also causing me to reflect upon the enormous sacrifice and relative lack of recognition and appreciation given to such caregivers. At least in my experience, such caregivers are not given proportionate credit for their sacrifice in cardiovascular medicine.
There are, of course, several possible responses by a spouse or significant other of a patient who incurs a severe illness that renders them unable to care for themselves. Such events can, and not infrequently do, lead to divorce or dissolution of the relationship. Often, the stricken party encourages the other to go their own way. I certainly would not want to judge someone for whom the toll of a loved one’s illness on their own life is too great to bear. Rather, I celebrate those who, for religious or other reasons, are willing to subjugate their own lives to some extent to care for someone to whom they have made a commitment in sickness and in health.
In reading about this topic, I encountered the responses of individuals whose loved ones had a severely disabling illness. The central theme that emerged from all these descriptions was uncertainty. There was, of course, uncertainty regarding what would happen to their loved one and when. There was often anxiety in undertaking tasks that had not been performed previously. They wondered about how much of their own career and life aspirations would need to be sacrificed. Would there be economic stress associated with the disability? Would they be alone during the illness and especially after death? Some even expressed guilt at feeling sorry for themselves or at even thinking of divorce. Nevertheless, despite the stress they are under, many find the strength to make the care of a loved one the number one priority in their lives.
I continue to marvel at the selflessness of many of the spouses and significant others of my patients who dedicate their lives to the care of their loved ones. In many cases, it appears clear that the patient could not survive without the attention they provide. This is done despite the stress that they themselves experience due to the illness. The motivation for such devotion is probably multifactorial. For some, intense love drives them to dedicate themselves to the task. For others, affection is combined with a sense of responsibility to fulfill their vow to be there in sickness and in health. Regardless of the motivation, I find their sacrifice an inspiration, and one that surely needs more appreciation and recognition.
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