When we marry, despite our pledge, we don’t consider what “in sickness and in health” might require. Perhaps it is best we are blissfully ignorant of what life can eventually bring to us.

“Although it is illogical, illness can feel like betrayal, a miscarriage of marital hopes and promises,” suggests author Beth McLeod. The losses are great—companionship, security, intimacy, and our dreams. However, out of the heartache of caring for a partner comes lessons to inform us, strengthen us, and set examples for the next generation.

Harlan cares for his wife Carol, who has dealt with almost a decade of chronic back pain. Only in their forties, they have searched for diagnosis and relief. Harlan says the physical and logistical elements, no matter how frustrating, are easier than providing emotional support and feeling responsible for his wife’s self-esteem. “When Carol’s okay, she’s a joy to be around—smart, funny, warm, compassionate. The problem is, she is not okay an awful lot of the time. What I’ve had to do more than anything is recognize my anger, because rationally you know this is nobody’s fault. And you know that however bad you’re feeling, she’s feeling worse.”

“My wife knows she’s sick, and there’s always the question, ‘Am I ever going to get better—or well?’ We want off the roller coaster, but dumping her in a nursing home, or divorce and remarriage, are not among the possibilities. The great hope is we’ll get back to a normal life. If we can’t, then I hope she comes to terms with it in such a way that she can at least enjoy the life she has to the greatest level possible.”

As Harlan and Carol, and multitudes of other couples, have faced the heartaches of chronic illness, they have been called upon to change their familiar ways. Beth McLeod suggests that in caring for a spouse, “we learn that only the present is given to us and that [it] is our choice how to react to it.... It is in the now that we live, and in the now that we can give.”

Talk about illness and dying while you are both still healthy.

Create legal and financial documents to clearly state your wishes. Update these documents every few years and/or when there is a change in family composition.

Make inventories of all your important possessions.

Learn to identify uncomfortable emotions and talk about them so hurts and misunderstandings don’t fester.

Tell your children where your important papers are kept. Discuss estate matters and end-of-life issues before a crisis hits.

Delegate responsibilities so you can retain the more important aspects of your partnership without fatigue or resentment.

Use the Internet to develop support networks and to educate yourself, or as a supplement to local support groups.

Remember, your children still need the attention of parents. Involve them in the illness and care plan so they know you are all still a family, despite disruptions.

Susan Murray is an associate professor of family studies who teaches behavioral science and social work at Andrews University. She is a certified family life educator and licensed marriage and family therapist.