A recent report found that personal care and service workers have the highest rate of major depressive episodes among all professions. While to some this data might back up preconceived notions regarding the stress and occasional heartache associated with care giving, the reality remains too complex for easy answers. Because as anyone who has worked as or with a personal care giver knows, just as there are moments of pain and loss, there can also be many more moments of friendship and fulfillment. The fact that the more negative aspects of these positions are inextricably tied in with the greatest parts perhaps makes the job of care giver that much more enriching.

A former housekeeper/companion anonymously discussed perhaps the toughest emotional challenge caregivers face. He recalled an eighty-nine-year-old client with Alzheimer’s: “He’d forget what he’d just said, but he had a fresh pot of coffee waiting every morning,” said the caregiver. “The man’s house hadn’t had a good cleaning since his wife died thirteen years before, but he wanted a companion more than a housekeeper.

“He just wanted to talk. He’d tell the same stories over and over, but that didn’t matter because he didn’t remember,” said the caregiver. “We’d sit in the living room drinking coffee, with the client’s black and white collie mix named Timba at their feet, and the old man would say: ‘It’s a good life, unless you weaken.’ Then he’d smile at me like I was his best friend.”

In the living room there was a portrait-sized photo of the old guy in uniform. It had been taken sixty years before, when he’d been an army cook during the war. He’d been a big strong young man. He was still over six feet tall, but now he walked with two canes.

“My title was housekeeper/companion, but there was no sense cleaning the man’s house while he died of loneliness, so I had to pull off a balancing act,” said the caregiver. “I told him my supervisor wouldn’t be happy if she found the house dirty, so I had to clean.” They agreed an unhappy supervisor wouldn’t be good. They’d have coffee, then it was cleaning time, then lunch and TV news together, then the caregiver would do the dishes and let Timba out before he left. “That was our winter routine, and the house slowly began shaping up,” he said.

With spring came a big change. A friend of the old widower’s deceased wife had heard his Alzheimer’s was getting worse, and thirteen years before she’d promised her dying friend she’d look after him if he ever needed it. She’d been handling his finances, but now he needed more help, and she’d promised. She announced that in two weeks she’d be moving in.

The caregiver panicked. The house wasn’t a health hazard anymore—the guys could talk, drink coffee, and watch TV. A little dust and dog hair never hurt anyone. But now he had two weeks to turn this guys’ hangout into grandma’s house! He got authorization for extra hours making the house grandma-friendly while still being a companion. He didn’t want the woman to think he hadn’t been working.

“I know, dear,” she said with an approving smile. She understood perfectly. “She was fussy, like old ladies should be—hadn’t lowered her standards,” said the caregiver. The sidewalks were swept after the lawn was mowed. She used a walker inside, and directed flower gardening through window screens. She understood the old man too. “He was never close to any woman except his wife,” she said. “When us girls came over he’d be in the yard or garage.” She’d known him for forty years; he needed a guy friend.

The woman caused some major disruptions; she thought carpets needed shampooing every couple of decades, for instance. The old man would grumble, “Why can’t you leave things be?” and the caregiver played peacemaker, “Oh, just let her—you know how women are.” “Yeah—a pain in the butt!” the old man bellowed, then smiled as if to say, guess I told her! The caregiver caught a radiant smile from the old woman who understood everything.

She also thought the old man needed a check-up, and that seeing a doctor required a shave and a button-down shirt. “After that ordeal we drove around the neighborhood where he’d lived all his life,” said the caregiver. “He showed me the park where he’d played ball as a kid.”

Then one night he fell and broke his shoulder. “The hospital says he’s not eating,” said the woman. I’ll fix that, the caregiver thought. After taking care of the woman, Timba and the house, he made the old man’s favorite, chicken corn chowder, that always got an “Oh, boy!” “But when I got to the hospital he didn’t even recognize me,” said the caregiver. “The nurse said he was too old and frail for the shoulder to heal. They’d given him painkillers and sedatives.”

“I stayed on for a while working for the woman who’d come to help take care of him,” said the former caregiver. “She didn’t let me get depressed. She eventually moved in with her son and his wife,” he said. “The last time I saw her she just glowed—that’s how I remember her.” He hasn’t taken on another client, but wouldn’t rule it out. “I couldn’t work in a hospital or nursing home though,” he said, “You’d have to be a strong person.” Then he had a question: “Does this study mention job satisfaction?” he asked. “Caring for people isn’t assembly work. Spend fifteen or twenty hours a week with someone for months—even years; you become part of each other’s lives,” he said. ”On your worst day you lose a friend, but on good days their face lights up just because you came to work. I was that old man’s last best friend,” he said, “and I’m glad I was.”