“Guilt is a common feeling in the landscape of caregiving. Guilt can propel you to be the best you can be …or it can immobilize you,” says Vicki Rackner, M.D., the founder of Medical Bridges, the organization that conducted this informal survey.

For caregivers, painful feelings -- such as guilt, sadness and anger -- are like any other pain. "It’s your body’s way of saying, 'Pay attention.' Just as the pain of a burned finger pulls your hand from the stove, so, too, guilt guides your actions and optimizes your health," explains Dr Vicki, a physician who helps patients and caregivers become more involved in their own health care decisions.

You have a picture of the "Ideal You" with values you hold and how you relate to yourself and others. Guilt often arises when there’s a mismatch between your day-to-day choices and the choices the "Ideal You" would have made, notes Dr. Vicki when advising her caregiver clients. The "Ideal You" may be a parent who attends all of the kids’ soccer games. Miss a game to take your dad to the doctor, and you think you’re falling short.

You may have needs out of line with this "Ideal You." You may believe that your own needs are insignificant, compared to the needs of your sick loved one. You then feel guilty when you even recognize your needs, much less act upon them. Alison asked Dr. Vicki, “How can I go out for a walk when my sister is at home in pain?” (A hint for Alison: she can give more to her sister with an open heart when she takes good care of herself.)

You may have feelings misaligned with the "Ideal You." Feeling angry about the injustice of your loved one’s illness? You might even feel angry at your loved one for getting sick! Recognizing those feeling can produce a healthy dose of guilt. Yes, you may even feel guilty about feeling guilty.

“Why did my loved one get sick?” you may ask. Perhaps, if the "Ideal You" acted more often, your loved one would be healthy. What if you served more healthful meals? What if you called 911, instead of believing your husband when he said his chest pain was just “a little heartburn”?

If you’re the kind of person prone to guilt, learn to manage guilt so that guilt serves you rather than imprisons you. Here are Dr. Vicki’s tips for managing guilt:

Recognize the feeling of guilt: Unrecognized guilt eats at your soul. Name it; look at the monster under the bed. “Sometimes I feel better just saying to myself, ‘I’m feeling guilty about not bringing my brownies for the school bake sale,’ ” Sally said.

Identify other feelings: Often, there are feelings under the feeling of guilt. Name those, too. Dan told Dr. Vicki: “I hate to admit this to myself, but I’m resentful that dad’s illness changed all of our lives. Once I put it into words, I had a new perspective. I reminded myself how fortunate I am that we have what it takes to take care of dad.”

Be compassionate with yourself: Cloudy moods, like cloudy days, come and go. “I got it! There’s no one way a caregiver should feel," Cathy said. "When I gave myself permission to have any feeling, and recognized that my feelings don’t control my actions, my guilt subsided.”

Look for the cause of the guilt: What is the mismatch between this "Ideal You" and the real you? Do you have an unmet need? Do you need to change your actions so that they align with your values?

Take action: Meet your needs. Needs are not bad or good; they just are. If you need some time alone, find someone to be with your loved one.

Change your behavior to fit your values: Clara felt guilty because her friend was in the hospital and she didn’t send a card. Her guilt propelled her to buy some beautiful blank cards to make it easier for her to drop a note the next time.

Ask for help: Call a friend and say, “I’m going through a hard time. Do you have a few minutes just to listen?” Have a family meeting and say, “Our lives have been a lot different since grandma got sick. I’m spending more time with her. Let’s figure out together how we’ll get everything done.”

Revisit and reinvent the "Ideal You": You made the best choices based on your resources and knowledge at the time. As you look to the future, you can create a refined vision of the "Ideal You." What legacy do you want to leave? What values do you hold dear? Then, when you wake up in the morning and put on your clothes, imagine dressing the "Ideal You." Let this reinvented "Ideal You" make those moment-to-moment choices that create your legacy.

Understand that you will be a more effective caregiver when you care for the caregiver first. Loved ones neither want nor expect selfless servants. As a caregiver, when you care for yourself, you increase and improve your own caring. Yes, guilt is part of caregiving, but this guilt can help you become the caregiver you and your loved one want you to be.

Vicki Rackner M.D. president of Medical Bridges, is a surgeon who left the operating room to help patients partner more effectively with their doctors. She's a speaker, author and consultant.

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