What penance costs you

Add it up, since the guilt never does.

Your health, in the specific sense chapter 13 gave. Not hours, strain. Pinquart and Sörensen's 84 studies put carers well above non-carers on depression and stress, and the chapters before this one say where the strain comes from. Guilt predicting burden over and above the actual load, in Gonyea's daughters. Obligation predicting burden where attachment didn't, in Cicirelli's. Lack of choice predicting stress and physical strain after everything else was allowed for, in Schulz's 1,397. Every one of those is the penance component, separable from the care, and every one is a cost you're paying on top of the care.

Your marriage, if you have one. A partner watching you leave every Sunday tired and come back angry, for a year, is a partner who has stopped saying anything, which is not the same as a partner who is fine. Your children, who are getting the version of you that's left over after the visit and the drive, and who are learning, from watching, what caring for a parent looks like. They'll do it to you one day the way they saw you do it.

Your work, in the missed hours and the mornings at the hospital and the concentration that isn't there. Your money, which chapter 22 touches, since there's help available that penance won't claim because claiming it feels like admitting it's a burden.

And the visits themselves. This is the cost the guilt hides best. Penance is spending the afternoons, the finite ones from chapter 17, on visits that don't count as visits even to you. The one thing the debt was supposed to buy, time with your mother while there's time, is the thing penance most reliably ruins.

There's one more thing on the other side of the sheet, and it's worth knowing. Stephanie Brown and colleagues followed older married adults for five years in 2003 and found that giving practical support to friends, relatives and neighbours predicted living longer, while receiving support didn't once giving was taken into account. Care can be good for you. The study doesn't say which care. But taken with everything above, I'd read it as care that's given rather than extracted.