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Dear Amy: I need help. My partner and I have been together for almost six years.

Through infertility treatment, we have a 2-year-old daughter, and I am currently pregnant again.

I love my partner. He is a wonderful man. However, I cannot bear his 10-year-old son, who lives with us half the time.

I have felt this way for most of the relationship but kept trying to make things work. I just can't do it anymore. I am angry and miserable, and my partner refuses to do anything to change our living environment or to change his custody arrangement (which isn't working for me and is harmful for the boy -- he doesn't have a base, both parents have started new families and he doesn't know where he fits in).

I'm now faced with leaving the relationship and breaking up my child's (and future child's) family, or remaining in a cold, angry, polarized home.

The reality is that I should have walked away at the start, but I didn't, and now I find myself mired in this heartbreak and dysfunction.

What should I do?

-- Desperate

Dear Desperate: I have to wonder at your judgment, to bring two children into a family and household from which you plan to flee. My heart also breaks for this 10-year-old boy. You seem to have sterling insight into how dislocated his life is (how can he succeed with the deck so stacked against him?), and yet you don't seem to have much compassion for him, presumably because you "can't bear" him.

With professional help, parenting instruction, therapy for the child and lots and lots of effort from you and your partner, your little fractured family would stand a chance of succeeding. As it is (you hostile, your partner checked-out), I don't imagine you will commit to attachment.

I very rarely (if ever) suggest that a parent should break up a family, but I'm thinking of this boy now, as well as your other children. Because you seem to lack the will or wherewithal to make the effort to create a healthy household, it might actually be best for all of the children if you and your partner separate.

Dear Amy: I've been dating my boyfriend for almost four years. He lives with his mother as her caregiver.

He works nights so he can be with her during the day and I stay with her at night.

We do not have any time together at all; there has not been any intimacy in more than a year.

Having someone come in and stay with her while we go away even for the night would upset her due to the stroke she had.

I want to get out of the relationship. My feelings toward him have changed, and at 63 I want to enjoy my life and be able to travel and get married.

He says he just cannot talk about our future while he's caring for his mom.

I try to tell him I'm not happy and want to leave the relationship, but I just can't seem to do it.

I've tried to talk to him about it, but he is a very sarcastic person and he jokes about everything.

What should I do?

-- Trapped

Dear Trapped: If you brought a caregiver into your home for even a few hours a week, your guy's mother would have a chance to adjust to that person. Once she had adjusted, you two could at least slip out for a movie or a bite.

Caregiving is extremely stressful; it is essential that caregivers also take care of themselves. And -- when a relationship is at stake -- you must both take care of the relationship.

You should pose this to your guy: "Things need to change. If they don't change, I'm going to leave. And if I leave, you'll be out a partner and a caregiver. Can you work with me on this?"

Dear Amy: "Worried Dad" described his doctor son-in-law's klutziness.

I am a fellow physician. His problem was obvious to me: Like many of us, he isn't getting enough sleep.

Maybe his sometimes-absent-mindedness is not a result of disease or poor life choices, but a consequence of the 80-hour-plus work weeks many doctors have to put in.

Our job is tough. Please consider more compassionate theories before jumping to conclusions.

-- Dr. K

Dear Dr. K: I don't know how doctors manage, given this punishing schedule. Sleep deprivation could definitely lead to all of the symptoms mentioned.

I also hope that this doctor gets a check-up.

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(You can contact Amy Dickinson via email: askamy@amydickinson.com. Readers may send postal mail to Ask Amy, P.O. Box 194, Freeville, NY 13068. You can also follow her on Twitter @askingamy or "like" her on Facebook.)