It was a promise Matt Perrin wasn't able to keep.
"I'll never take away your independence," he'd told his mother, Rosemary, then 71, who lived alone on Cape Cod, Mass., in a much-loved cottage.
That was before Rosemary started calling Perrin and his brother, confused and disoriented, when she was out driving. Her Alzheimer's disease was progressing.
Worried about the potential for a dangerous accident, Perrin took away his mother's car keys, then got rid of her car. She was furious.
For family caregivers, this is a common, anxiety-provoking dilemma. They'll promise Mom or Dad that they can stay at home through the end of their lives and never go to assisted living or a nursing home. Or they'll commit to taking care of a spouse's needs and not bringing paid help into the home. Or they'll vow to pursue every possible medical intervention in a medical crisis.
Eventually, though, the unforeseen will arise -- after a devastating stroke or a heart attack, for instance, or a diagnosis of advanced cancer or dementia -- and these promises will be broken.
Mom or Dad will need more care than can be arranged at home. A husband or wife won't be able to handle mounting responsibilities and will need to bring in help. A judgment call -- "this will only prolong suffering, there's no point in doing more" -- will be made at the bedside of someone who is dying.
"We want to give loved ones who are sick or dying everything we think they want -- but we can't," said Barbara Karnes, 78, an end-of-life educator and hospice nurse based in Vancouver, Wash. "And then, we feel we've failed them and guilt can stay with us for the rest of our lives."
She hasn't forgotten an experience with her mother-in-law, Vi, who moved in with Karnes, her husband and two children after becoming a widow 30 years ago. At the time, Vi was in her 70s, weak and frail. Karnes was working full time and keeping the household going.
"My mother-in-law and I got into a disagreement, I don't remember what it was about. But I remember her saying to me, 'You promised you would take care of me,' and making it clear that she felt I'd let her down. And I said, 'I know, I was wrong -- I can't do it all,'" she remembered. "I still feel bad about that."