Bat Goddess..it seems to me you are doing too much. Some stuff can be delegated and some can be postponed..updating binders etc. Or offloaded to someone else if available. It will keep. Your health won't if you keep pushing yourself too hard. I would ask Tom's friend to read him one of the articles...is there anyone else who can read to him? Can you download books on tape or whatever? Can Tom's friend help a bit in the garden? Are there neighbors? Kids who can be hired to do some lugging of rocks etc.? Can an automatic coffee pot be set up near Tom's bed? I know there are safety issues but maybe something can be figured out. Iced coffee? Could the house be rearranged so you don't have to run up and downstairs? Can the gardening be simplified? If you toast your adrenal glands, which I personally have done, recovery is very difficult...