Q: My sister-in-law was recently hurt in a car accident and was brain injured. She's recovering slowly, but frankly, I'm afraid my brother is worse off than she is. He's working 60-70 hours a week at a very stressful job--but he's got three kids to take care of. He's constantly on the phone with lawyers who are suing the driver who caused the wreck, and he also goes to the rehab center every day after work and stays until his wife goes to sleep. It's 50 miles away and he doesn't get home until late at night. I've been trying to help him by taking the kids as often as I can but my family needs me too. His kids miss him and they're beginning to act out. He's exhausted! And frankly, he's too hard on the kids because he's so angry and tired. How can I tell him that things can't keep going like this?
-Carolyn J.

A: First, Carolyn, let me commend you for stepping in and helping the kids and your brother. Caring for a brain-injured spouse is a long-term commitment and most caregivers, just like your brother, think they have to do everything themselves. You didn't say how long it's been since the accident but I'm guessing it's been at least a few weeks. Your brother is probably thinking he has no choice but to do all this and he hasn't noticed what's going on with you and with his kids. That's how I was after my husband's brain injury.

Don't just warn your brother or repeatedly tell him to stop doing what he's doing . He'll just shut you out. Have a frank conversation with him. Tell him you're concerned about him and that you're afraid he'll get sick and not be able to take care of his family, including his brain-injured wife. Ask if he has an alternative plan for child care in mind, because you need to take care of your own family too. Have some suggestions for him that are small steps-maybe he can leave the rehab center after dinner rather than after his wife is asleep. Or perhaps, a family friend or relative can spend time with his wife occasionally so he can have some time with the kids. Perhaps he can take a leave of absence, or shift some responsibility at work--maybe even take a different job. Can he make just one phone call a week to the lawyer? Tell him his anger and exhaustion are taking a toll on the kids and they need some stability. He may not have considered any of these things because he's focused only on taking care of all the things he thinks are necessary to deal with the brain injury. Suggest he contact a support group if there's one nearby or ask a social worker at the rehab center for help.

Accept that he may reject all this the first time you bring it up. He may be in denial right now and unable to accept that his family life won't be back to normal soon. As much as possible try to support him-perhaps you can enlist other relatives or friends to help too-but also let him know that you have responsibilities to your own family. Give him a little time and then if you don't see any changes have another talk with him. But don't make yourself crazy trying to make him change. You can only help when he's ready to be helped.
-Marilyn Colter

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