Why Gratitude is the Best Answer for Difficult Expat Emotions

hands in mittens holding warm hot cup of coffee with gratitude written in bold

Five years ago when my middle child was suddenly diagnosed with Type 1 Diabetes, we left everything behind from our life in Antananarivo, Madagascar and headed to my parents house in Texas for 6 months.

It was an incredibly emotional time, full of ups and downs and doubts about what our expat life would look like from then on. And, it was also a time of reevaluating and refocusing. We started to see that we could live quite normally even in the face of challenge and that our international existence would actually return, more or less, to normal.

It was also one of the most wonderful times for my children to reconnect with their grandparents. For just a little while – we saw what our life would have been like had we never left Austin. Baseball and soccer, tacos and live music, Barton Springs and fire ants.

Within a year of our 6-month stay in Austin, however, my step-dad was diagnosed with cancer. He died just shy of 2 years from our emergency evacuation from Madagascar.

There is a part of me that will never fully be able to accept my stepdad’s death. It seems he was too young, too healthy, too much a part of our lives to be gone so suddenly. It seems so wrong to have befallen a man that was so universally loved, a person that seemed to want nothing much more than to love the people in his life…and go fishing…and drink an ice-cold Corona on a sweltering Texas day.

Never in a million years would I wish to repeat the chaos and upheaval of our departure from Madagascar. If I could wave a magic wand, I would take my son’s diagnosis any day so that he could go on living as carefree as a 10 year old should. And yet, because we were in Austin, we had those precious 6 months with my stepdad. I can’t say I’d change it.

The deep, deep well of gratitude I feel for having had that time in which every day my kids got to know their PawPaw offers a sense of peace and acceptance about the way things turned out. My gratitude for those unexpected days in Texas provides a sort of balm that softens the sting of the loss and reminds me that having been loved so unconditionally by this one person is an incredible blessing, even if he wasn’t in our lives as long as we all wanted.

Gratitude serves this purpose in our lives. It’s not that by being grateful we suddenly erase the shittiness of bad things that happen. I strongly disagree with the idea that in our most difficult emotions we should simply apply a little gratitude and everything will be okay. What we can see, however, is that gratitude offers us the chance to see our experiences and our emotions in the context of the larger picture.

For expats, one of the biggest gifts of practicing gratitude is that it’s so portable. You can step into a grateful mindset no matter where you are – from the airport security line to the first loving embrace of a brand new friend. Learning to engage with gratitude provides unique ways in which to deal with many of the difficult emotions that plague our unpredictable international lives – not so that we can always feel exactly the way we want to feel, but so that we can better address the very real emotions that sometimes knock us flat.

Gratitude requires reflection, insight and mindful awareness and these are all traits that help us get a handle our difficult emotions. It helps us to see ourselves at a distance so that we can make clear, thoughtful decisions about how we want to embrace and honor the ways we feel.

Moreover, more than being simply a state of mind, gratitude inherently offers us a chance to take action. We can feel thankful with our thoughts or our hearts (and sometimes that’s enough to help us address our emotions), but gratitude also compels us to act. It encourages us to actually say thank you – to write the letter, to make the phone call, to rephrase the complaint, to offer and to receive the support we need.

If you’re feeling helplessness, sadness, envy, anger, rejection or grief, it can be helpful to process those emotions by seeing them as part of your complex life – a life that also includes good things…even good things directly related to the challenges you’re facing.

If you find you’re in a rut, try these gratitude-centered, self-coaching questions. They might get you started in gaining new space to see, move through and heal from the difficult emotions you encounter in your expat life.

  • What uncomfortable emotions am I feeling right now?
  • What might I appreciate about these difficult emotions? What might they be trying to tell me? What gifts might be hidden within these emotions?
  • Who in my life has been the most supportive and understanding during this challenging experience? How can I acknowledge my gratitude to this person?
  • What skills or abilities do I possess that have helped me to move through this experience? What person or situation has supported my cultivation of these abilities? How can I offer gratitude to that person or situation?
  • Who have I witnessed overcome challenges? In what ways am I grateful for the opportunity to learn from this person?

How has maintaining gratitude helped you deal with difficult expat emotions? Based on your experience, what questions would you add to the list above? I’d be honored to hear more about how gratitude has supported your expat journey in the comments.

Throughout the month of December 2018, I’ll be posting more self-coaching questions on gratitude on my Facebook page. Like the World Tree Coaching Facebook page to join the conversation.

Little Bits of Light in the Woods

A couple of nights ago we faced a life-threatening health emergency with one of our children. Our middle son has Type 1 Diabetes. It’s well controlled and even though it’s a big part of our lives, it mostly now feels like a background fact. It’s been almost 4 years and, except for his initial diagnosis, he hasn’t faced a single emergency or hospitalization…until the other night.

One of the most upsetting things about what happened is that it was a simple mistake – picking up the wrong insulin and injecting him with fast-acting instead of short-acting insulin. He was fine in the end, but the whole thing was really scary. I won’t mince words here – it was potentially fatal.

I hesitate in some ways to make this statement – it seems so cliché – but mindfulness totally saves me in moments like this. In looking back, I can see how having spent years practicing more mindful responses to stress (as opposed to my old way which was full-freak-out) has helped me even in the most critical of moments.

When things like this happen, the definition of mindfulness comes into vivid focus. And I’m reminded that this is why we practice, practice, practice at tuning in…even when we don’t always feel like we’re “succeeding.”

I’m in no way different from anyone else. Next time I might lose it. But the practice comes to you when you need it. It’s like running a marathon. Even if you haven’t trained, you’ll probably be more prepared if you’re running a few miles every day than if you’re sitting on the couch watching movies.

Everyday mindfulness is about seeing life as it is. It is about paying attention to what is really happening, taking in what we witness there and moving through that experience to the next place. It helps us to live more in tune with ourselves and with those around us. It helps us move closer to being the people we really want to be in the world and it supports us in getting back on track when we’ve lost our way.

It does not mean avoiding stress. It is not about pretending everything is okay when it’s not. It’s not about making yourself feel calm or relaxed all the time. It’s not about being perfectly happy with every moment. It’s about living fully aware of the way things really are and responding from that place so that we live more fully.

Mindfulness also helps me to recognize that my natural tendency is to chase worst-case scenarios, to imagine endless what-ifs. It helps me get up close and personal with that fact of my personality. There were certainly moments the other night when I thought – “What if…!”. I know I’ll mess up and fail and feel overwhelmed a million times in my life. Sometimes I worry that the next big “catastrophe” will be the final straw to stability. We all do…right…just me? When I’m mindful, I’m freed to see that that’s only one part of the story.

When things are well, mindfulness helps me notice and be grateful. When things are tough, it provides the little bits of light in the woods.

The good news is, none of this is rocket science. We can all practice becoming more mindful. These are skills we all have – listening to what our bodies are telling us, naming and honoring all of the emotions we feel, seeing the ways in which our assumptions get in the way of more creative solutions to the problems we face each day.

Often, we’ve simply unlearned these abilities. Moments like this really remind me of why it’s important to keep relearning. It’s like going from black and white to full color again and again and again.

What if you could face all sorts of challenges and still hold yourself together enough to come out the other side wiser, stronger and still laughing? Maybe not every time, but at least some times…or even just a bit more than you are now.

It sounds impossible and yet these skills exist. Mindfulness is not the cure-all for all of the things that we face in life and certainly, many life events are so painful we can’t even bear to consider them. Trust me, my brain has gone there.

But what if you have an entire toolbox of abilities that you’re not accessing? What if you could rediscover those tools, learn when and how to access them and put into place the habit of using them every day?

You know, it might even be simpler than you think.

Want to learn how you can bring more mindfulness into your life?

Join me for my upcoming Mindfulness Skills for Parenting Workshop. We’ll be using the very practical and totally accessible methods outlined in the Personal Leadership program. Read more about PL here and check out my reflections on becoming a PL facilitator here.

Or, check out these resources below. Note – this list is far from exhaustive. These are some of my favorites.


Headspace (website and app)

Insight Timer (app)


UC Berkeley Greater Good Science Center

University of Massachusetts Medical School Center for Mindfulness

Mindfulness/Meditation Teachers to trust:

Tara Brach

Jon Kabat-Zinn (Google him for more info)

Jonathan Froust

Jack Kornfield

Sharon Salzberg

Pema Chodron


Making a World of Difference: Personal Leadership a Methodology of Two Principles and Six Practices – Schaetti, Ramsey and Watanabe

Wherever You Go There You Are and Full Catastrophe Living – both by Jon Kabat-Zinn

10% Happier – Dan Harris (This is a great, easy to read book for people who find themselves somewhat skeptical about how to go about living more mindfully.)

The Happiness Project – Gretchen Rubin (not specifically mindfulness, but still a good resource)

Making the Most of Worry


As we come up on the one-year anniversary of my son’s Type I Diabetes diagnosis, I am thinking a lot about worry. When we moved to Madagascar with our children ages 6, 4 and 2 months I was really worried about the lack of health care. It seemed like a silly worry though. Actually, it didn’t seem silly to me at the time, but I kind of knew it was ridiculous to worry about it. My mantra for unpredictable health issues was, “Could happen. Probably won’t.” Now, while that’s technically still true with any health-related worry, for obvious reasons I’m finding it less reliable than I once did. I mean, what could happen did indeed happen!

In this last year, I haven’t completely abandoned “Could happen. Probably won’t,” but I do find I’m moving towards something a bit more solution-focused. And that’s got me thinking – have you ever noticed how sometimes worry can lead you to be more productive and at other times it can leave you feeling completely paralyzed?

In my own vast experience with worry, I’ve come to find that productive worries are usually ones that are based on true and immediate facts. For example, I feel worried that my kids won’t be ready to start at a new school, but the reason is that I’ve done absolutely no work on their applications. In these cases, I usually get my list out and get down to business. The worry subsides.

But paralyzing worries are usually based on uncertainty, unpredictability or what I like to call “disaster thinking.” It’s the kind of worry that goes from a Point A like “My 2 year-old has hives,” to a Point B like “My 2 year-old has developed some strange nervous condition that will result in her hospitalization, my husband’s reassignment and our family’s confinement to Washington, DC…FOREVER.”

So I’ve been trying out a new little worry-test for myself. I’m no expert yet (and trust me, I’ll tell you when I’ve abandoned all worry), but I’m finding it works pretty well. I’m calling it FACT OR INVENTION.

Here’s how it works.

Let’s say you’re faced with a worry. Like this one (keeping with the Type I Diabetes theme from above), “Sam had a really active soccer day today. His blood sugar might go low over night. I should probably test him again before I go to bed. But I don’t want to test him too much. What if one day he’s angry about having Type I? What if he goes years without testing his blood sugar? What if he goes blind? What if he blames me for dragging him around the world and has no permanent home and no one to care for him…when he’s blind?”

Here’s what happens when I use the FACT or INVENTION test on this scenario.

First I ask,

What are the facts here?

  • Super-active day playing soccer
  • Lots of activity increases his chances of having low blood sugar overnight

Then I ask myself,

What am I inventing? What unnecessary burden am I creating for myself here?

  • What if some day he’s angry?
  • What if he stops testing his sugar?
  • What if he goes blind?
  • Then the big snowball – What if he hates being a TCK and that all culminates in a big TCK/Type I Diabetes Nightmare!!

See the difference? One worry is based on real and immediate facts, has a solution (an extra blood sugar test) and therefore has the potential to release me from worry. The other is based on the fear of some daunting, uncertain future, has no immediate solution and traps me in a mental tape of disaster thinking.

By asking these questions I take a step back, sort it all out and come up with the stuff that’s solvable based on fact and the stuff that is cluttering up my tenuous sense of calm and increasing my stress levels.

And get this! I’m not going to tell you to stop worrying. Sure, there are things you can do to keep worry from running amok, but a certain amount of worry is just part of being human. But – I do want to invite you to focus on what you gain by putting this FACT or INVENTION question to work for you.

Identifying the practical, fact-based worries helps you focus on solutions. Make a list, take some action, put that doubt behind you by doing what needs to be done.

But what about those pesky unproductive worries? While it’s true that unproductive worries can be paralyzing, we still learn from them. They serve as powerful reminders to reach a little deeper into our survival tool kits and rely on those things that keep us steady (a nice long run, a good book, a quiet night in, a Skype session with a friend).

And the big take-away from all of this is that as life continues to be unpredictable and worry stays a part of the normal human experience, you can focus in on what you’re telling yourself about how you face what’s in front of you, make decisions about where to go with what you learn and reapply the insight you gain again and again.

 Worrying is carrying tomorrow’s load with today’s strength- carrying two days at once. It is moving into tomorrow ahead of time. Worrying doesn’t empty tomorrow of its sorrow, it empties today of its strength. Corrie ten Boom

Expat Life with a Double Buggy

Working Through the Hard Days

Today was one of those days. You know, the days in your expat life when you think, “Why are we doing this? Again.” I find these days always hit me completely out of the blue. We’re going along, no big deal, feeling on top of the world and (honestly) quite proud of ourselves and our children. We feel like transition rock stars. And then – Bam!

Yesterday we were looking at some family photos from our last home in Madagascar. Because of his Type I Diabetes diagnosis my middle son was never able to say goodbye. He got sick. He went to the doctor. He got on a plane. He’s never been back. He found the photos upsetting. He got teary-eyed seeing his toys and his room and his friends reflected in the pages as we recalled our favorite memories. His siblings had closure. He never really did. At bedtime he was saying, “I want to go home.” But, of course, it’s not home…anymore.

Last night I had a dream that he and I were in a foreign country and we got distracted by something that was happening in the street and laid our bags down, then a civil war broke out, then our bags were stolen, then a small, starving child latched on to us and wouldn’t let us go. That’s my psyche working out the conflicts that always come up living this lifestyle. We wouldn’t give this up. We’re happy. It’s a way of life and the benefits, for now, far out-weigh the downsides. But man, that dream really hit me.

And then I remember:

  • Expat or not, I’d probably still worry sometimes (or…always?) that I’m screwing up my kids.
  • Sad days happen no matter where you are.
  • This lifestyle can be hard, but not always. Today is just one of the hard days.
  • There’s a lot to be said for love…and hugs.
  • I’m not alone.
  • Some things are portable – like fun, and silliness, and getting outside, and (more) love.

The funny thing is, by today he was completely back to his usual self. That makes me think that that list up there, all those things I say to give myself some perspective aren’t just things I say, they’re habits that my husband and I live out…and the kids know that. They’ve learned to tell themselves those things too. They’ve come to believe them to be true. So…now I’m back to thinking – wow, we’re kind of transition rock stars…most of the time.

To Know or Not to Know…

As many of you know, my youngest son is a Type I Diabetic. I have found the learning curve, while steep, to be incredibly fascinating. If there’s some sort of degree that combines nutrition, chemistry, math and nursing in a six month crash course – I’ve earned it, hands down.

One of the most challenging aspects that any parent of a Type I Diabetic will tell you is that there is just simply so much guesswork going on. Every step of the way you’re calculating carbs and insulin and exercise and stress to come up with a magic number that keeps blood glucose from going too high or too low. Right there in front of me is this 6 year old person whose body actually has the correct answers – the right dosing, the right exercise, the right amount of carbs – for any given situation and yet there is just no way, no tool, that can tell us EXACTLY what we need to know.

But, we’re lucky that now we can get closer to finding the best answers. Last week, my son started using a Continuous Glucose Monitor. If you’re curious you can read more about it here. The gist is that he wears a small device on his stomach that automatically calculates his blood glucose every five minutes and then sends the information to a receiver that looks a bit like a cell phone circa 2004. One week in and we’re loving this thing! Suddenly we have all of this important information that helps us make better decisions, faster.

However, here’s the catch…having this much information is addicting. When Sam’s sensor fell off yesterday in the pool and then we had trouble putting on a new one, I just let him keep it off for the night. I found myself really feeling the absence of the constant feed of information that, in just one week, I have come to see as so important…more than important – essential for addressing Sam’s diabetes.

This got me thinking about how we deal with this sort of thing all of the time as expats. We think we know something (or need to know something), we think we can get all the answers we need, whenever we want and then BAM! – no internet, no television, no language skills, no IDEA what’s going on…anywhere! So, I reminded myself that this is not the first time I’ve found myself without information that I’d really like to have. I’ve survived the information void during international transitions, so surely I can use those skills to get over this 15-hour hump of non-continual glucose monitoring. After facing down the hellish void of reduced information (Seriously, how did I grow up in the pre-Google world?) I came up with this personal Q&A for dealing with the space between knowing and not knowing:

1) Is it really necessary to have this info? (Facebook – I’m talking to you!)

2) Have I been able to get by without this information in the past?

3) When I’ve been without this info, what did I do? How did I get things done anyway?

4) What’s the worst thing that could happen?

5) (My favorite) What might be the benefit of not having this information at my fingertips…or breathing down my neck?

To be fair, we’re back to the CGM today – safe and sound. We survived last night. Of course we did, because before 6 days ago that’s what we’d been doing for almost 6 months. I’m happy to have it back though and oddly pleased with having had to handle a forced hiatus. Nothing like going without all that info to make you appreciate what it’s like to have it back.

Major Milestone

Today I watched my 6 year-old walk across the stage at his Kindergarten graduation. He’s the same kid who almost died four months ago. The same kid who played one day with his friends and then left almost everything he loves, with no prior warning, to get on a small plane to a hospital in a country he’d never been to. The same kid who gets four shots a day and anywhere between six and twelve (or even sometimes more) finger sticks over the course of each and every 24 hours.

And, he’s the same kid that is a natural with anything that requires running or jumping or sliding or involves a ball. He’s the kid who can now read, add single digit numbers with no fingers (usually) and tell you what items on your plate contain carbohydrates. He’s the kid with the killer blue eyes, the mischievous, pure-love smile, and the blonder than blond, still baby-fine hair. He’s the one who’s grown over an inch since January. He wears either (and only) soccer cleats or cowboy boots…always. He’s the one who loves hugs and babies and super heroes.

He’s nothing short of incredible – when the going’s easy and when the going’s just plain tough.

Not to exaggerate here, but really, aren’t we all? I don’t know about you, but I look at my children, my husband, my family and my many friends in all of the corners of the globe and I think – these people are Amazing!

While it may seem that sometimes (or lots of times) we arrive at every major milestone rather easily, the truth is – it takes a lot to get here. It takes a lot to get wherever you are. Whether you’re dodging bullets or vomit, climbing mountains or stumbling over Legos – if it feels easy, it’s easy because you’re good at it, you hold your head up and focus on putting one foot in front of the other. If it feels difficult, it’s difficult because you’re human and sometimes life throws us some really nasty stuff. We all fall on both ends of this spectrum – the person who sails through and the person who gets thrown off course.

Let’s remember this for ourselves and for the people who surround us. Take some time today to say, “Close call! Good job! Way to hang in there!” or “Wow, you’re getting good at this! Hard work’s paying off! Nicely done!” No judgment, just love, for all the dedication it takes to get here.

Welcome May!

Ever find yourself really happy to have arrived at a particular time and place. I’m feeling that way about May. With my husband back in Madagascar, my sons running from sporting event to sporting event, my daughter celebrating all of the awesomeness of being two and, well there’s the whole Type I Diabetes learning curve, April’s been a month of craziness…or, if you will, blessings. We are healthy and happy and things continue apace.

But, somehow I really have felt like getting through April was this big giant challenge in front of me. And, while I didn’t want to just be focusing on arriving to May, I knew that May 1st would come and then I would be able to say, “Yay! I made it!”

I try not to do too much of this anticipatory thinking. I get excited about what lies ahead as much as anyone, but, as I was telling my husband the other day, you never know what will happen in May that will have you forever wishing to get back April. I’m knocking on wood here people….feeling a bit jinxing.

Anyway, like everyone I have my moments of pushing through to the next thing, but when I can I try to remember these simple things:

(1) When you find yourself thinking repeatedly about how much better it will be when you get to point A, stop and tell yourself, “I’m thinking a lot about point A. Point A will be awesome, but I’m not there yet.” I find this little acknowledgement is sometimes enough to bring me back to the moment.

(2) It’s also important to make mental lists of the things that are nice about the place in time where you actually are. For me in April this was two things – friends visiting from Madagascar and my kids’ sporting events…Oh, and we’re all safe and healthy.

(3) And, finally, as nice as it is to do things to put yourself back in the moment (because, like it or not, at the end of the day that’s what you have), go ahead and give yourself the time here and there to close your eyes and really envision how truly nice it is going to be to get to the other side. It’s okay to do it a little bit. And when you’re done, open up your eyes, smile and get right back to the work at hand.

So, here’s to May – just as good as, but maybe a bit more awesome than April!


I’ve been thinking a lot lately about detours. Obviously, since our son’s diagnosis with Type I Diabetes we’ve taken a pretty big detour from the path we were on in Madagascar. Then of course, in addition to this big, giant detour, there are all the little detours we encounter every day – school cancellations, finding we didn’t pick up an essential ingredient for a meal, plans for dinner out thrown off when a friend is working late, traffic, rain, etc., etc.

From my perspective, life’s not really about simply managing the detours, it’s more about recognizing that the path we’re on is just plain winding. We make all these plans and, in the best of circumstances, it all works out as we envisioned. The road spreads out ahead of us, each brick in its place, each blade of grass grows straight and perfect, the sun shining…and on and on. But, almost always, there are bumps along the way.

Few people understand this reality better than expats. It’s not that it’s easier for us (it’s not), but I do think that when your world is so big (and honestly so small at the same time) you realize really quickly that there are a whole, whole lot of things outside your control. We rely a lot on others, perhaps more than people who stay put. We also have a great internal locus of control – an “I can do this!” attitude. We become almost absurdly adaptable. We get really good at seeing the big picture – the world outside ourselves.

We’re not perfect and despite the ways in which we expertly go with the flow, sometimes, just like anyone else, we get knocked around a bit by the detours. But, let’s not forget in challenging times to tap into our inner adventurers, our nature as modern-day explorers and our deep understanding of the quirky. Because whether you’re on one giant detour or finding a moments respite in the straight and fully-paved – life’s really about the way you handle the road more than what path you’re bumping along on.

From There to Here in Twenty-Six Days

I’m faced with a dilemma. It has now been 27 days since my last blog post. It’s been 26 days since my son Sam’s life (and ours) was changed forever. The dust is starting to settle on our latest and scariest family adventure and I feel compelled to get back to the business of coaching, evolving and contemplating. Well, honestly, I never really leave all that even in times of stress – if anything it’s when I rely on those processes the most. But, all that work has been going on behind the scenes of what has been a major, giant, life-altering shift in our family. Now I have to decide where all of it fits in my professional life as a coach.

Interestingly, I think the answer lies in one of the things I love most about life coaching. When you’re a coach, you don’t hide the messy parts of your life. You don’t separate the personal and the professional as much as you are required to do in a lot of other work (say, traditional therapy). Your work with your clients is absolutely not about you, as the coach, but it’s also not about painting your own work, your own journey, as completely separate from the lives of those around you – even your clients. Coaching honors and values a high degree of interpersonal connection. This can be felt in the ways in which coaching focuses on the use of intuition as a guide for the coach and coachee. It can also be seen in the way in which finding the right coach/client connection is largely based on the right “feel” or seeking out the “type” of clients a coach most feels energized to work with.

So, in an effort to be true to myself, my work, and the relationships I will likely build with people over the course of my coaching journey, I would like to share here Sam’s story. Our story. I envision that over time and in certain instances I will share our experiences in ways that may provide guidance for people facing similar challenges – in much the same way my previous blog posts have focused on the expat life, transitions and building a home abroad.

And, to be honest, I also want to share this story in its entirety because this all came so much out of the blue and I think maybe it will help someone to have this information…even in the age where a quick Google search gives you all the info you need in seconds. It’s cliché, but knowledge is power – if I’d known then what I know now…

So, here it is (names protected accept for mine and Sam’s):

On January, 19th, our five-year-old Sam was diagnosed with Type I Diabetes. The three-and-half weeks since have taken us to 3 hospitals, 3 countries, countless exhausted, worried hours and now, back home…our real home, Austin, TX.

Sometimes we can look at life and see a very clear delineation of before and after. The clear moment where something was one way and then, suddenly, it was another. Looking back over the events of the past 26 days I can’t help but feel the simultaneous weight and clarity of seeing this before and after.

Here are the very, pinpoint, exact moments that I remember in the week leading up to Sam’s diagnosis.

On Sunday, January 12th, we joined a great big crowd of some of our closest friends for brunch at Tana’s Café de le Gare. There were 10 adults and 14 children. It was wonderful, summer-weather madness. We ate and talked and played games, but oddly Sam didn’t seem himself. He was eating a lot, but seemed tired. While the other kids played, he fell asleep in his dad’s lap. A bit strange, but not huge. Maybe he’s a little under the weather? It is Tana after all – seems like everyone is always a bit sick.

By Tuesday he still didn’t seem like himself. He had a bit of a cough, but no fever, diarrhea or vomiting. He had vague complaints of a stomachache, but he would say something about it then go off to play. I noticed he looked a bit thinner. He said his muscles hurt. I went for a walk with a friend and asked her what she thought of it. She thought maybe he was growing. I agreed, but wondered if he should have blood work done.

These mismatched and random seeming symptoms continued throughout the week. One day he said he felt sick and began to cry – the teacher called us to come pick him up. He just didn’t seem like himself. His teacher agreed. But then he would go off and play. Could it be  some virus he’s just having trouble shaking? Something didn’t seem right, but none of us could put our finger on exactly what it was.

Saturday he rested most of the day. I felt more worried about what was starting to seem like pretty significant weight loss…even in just two days. When I was making the kids’ dinner that night, he was raiding the fridge, eating and eating. When I told him to stop, that I was about to give him some Mac-n-Cheese, he started to cry. My husband and I went out to dinner with friends and we all discussed what was going on. The consensus was something like tapeworm. Yes, we thought, definitely worms…or a parasite.

However, Sunday morning he woke up and it was clear his breathing was labored and his mouth was so dry he couldn’t drink enough water. He was also going through tons and tons of milk. Drinking thermos after thermos. We willed ourselves to wait until 8:00AM to call the medical officer. We didn’t want to wake him up. But, we were really freaked out. And scared. The medical officer came over around 10:00. I think he diagnosed him within seconds, although he said it was just a possibility. He’d need to test his blood and urine.

Waiting for the med officer to call us back seemed like an eternity. When he did call we knew what he was going to say – Sam’s blood glucose level and the ketones in his urine were very high.

Here’s something I’ll never forget – Sam dozing in and out on the couch. Me trying to eat a few bites of a black bean taco knowing that we were headed to the hospital and might be there a few hours or even over night. The rain outside. I packed a bag for us – I didn’t forget my Kindle, which in retrospect seems absurd because there was no chance that I was going to be reading. We got in the car. We’ve never been back.

It turns out Sam was in Diabetic Ketoacidosis or DKA. Here’s my rather simple and unscientific explanation of what happens, why someone becomes a Type I Diabetic and how they get to this point (and so quickly):

Type I Diabetes (previously called Juvenile Diabetes because it is usually diagnosed in childhood) is an autoimmune disorder (unlike Type II Diabetes which is a metabolic disorder). Basically, the body gets a virus. Antibodies designed to fight off the virus, get confused and attack the insulin producing cells in the pancreas (bad thing #1). Insulin’s job is to help glucose in the blood reach the cells so that the cells can produce the energy you need to live. When glucose can’t get reach the cells then it builds up in the blood (bad thing #2). Then the body starts looking for other sources of glucose and pulls it from places like the liver (bad thing #4). It also starts burning fat (bad thing #5). When the body burns fat the byproduct is ketones. When ketones build up in the urine that’s bad news.

Type I Diabetes is, quite simply, really bad luck. There’s no cure. Type I Diabetics will take insulin for the entirety of their lives. If you want more details, you can read more about it here.

In short, it’s some pretty scary, scary stuff. Things went from strange to really bad over the course of about 12 hours. All the random things in the week leading up to his diagnosis seemed minor. From Saturday evening until Sunday morning, nothing seemed minor at all.

So, we found ourselves on Sunday night at the hospital. Me, the Embassy med officer and Sam. From the very first seconds of this experience Sam was the most amazing, brave and calm trooper. The whole thing was so scary, but (thankfully) he’s never been afraid of needles. I don’t think he ever cried more than a few tears. I, on the other hand, was quite a mess those first few hours. It took all of my strength to hold it together. I knew right away that Sam and I would need to leave Madagascar, but the most upsetting thing was that the care he was getting was so inadequate while we were there. One of the first things that must be done to reverse DKA is to give IV fluids. Sam waited in the ER for 4 hours before they agreed to give him fluids. It was a nightmare, frankly. Thankfully, our med officer remained calm. This helped because I was never totally sure about what should be done, not done and what steps we should expect next.

In the end, we waited 18 hours before the air ambulance arrived from South Africa. Words cannot express the relief I felt when the nurse and doctor walk into our room. They carried, in two backpacks, more proper medical equipment than the entire Polyclinique Ilafy (the best hospital in Tana) stocked in the entire hospital. And, despite being kind, the Polyclinique doctors, frankly, seemed to have no idea what they were talking about. I keep thinking back on things that were happening now that I’ve learned so much. But, I try not to think back on it too much. The pain of knowing what wasn’t being done is overwhelming…and yet, that time has passed, so I’m trying to remember not to replace my ignorance in those moments with new fears in hindsight.

And so, Monday morning, Sam and I drove our last drive through Tana…our typical route from Ivandry (our neighborhood), past the boys’ school (I saw several friends dropping off their children in the early morning traffic. Sam and I blew kisses to his big brother), past our house (without stopping), past the Embassy (closed for the MLK holiday) and out to the airport. I hate tiny planes. I loved this one. My fears were starting to subside.

The fear is all relative I guess. We weren’t out of the woods, but we were out of Tana…it was the next best thing.

And, then of course, it was so sad to leave. I never loved Tana, but I LOVED our Tana life. The outpouring of love and support we have received through this event is not possible to capture in words…but, I’ll try. I think about it this way – you spend your life, if you do it right I think, focusing closer and closer, every passing year, on the things that matter. For each of us, it’s different. Maybe career matters most, or a nice house in the woods, or lots of time to play sports or music. For my husband and I, more than anything else we have worked to create a home life that is constantly surrounded by friends and family. And, because in the Foreign Service your friends are your family, you nurture those relationships as if your life depends on them. Sometimes you discover that your life, or at least your sanity, actually does.

So when everything was up in the air, when we were running only on adrenaline and worry, we somehow found ourselves surrounded by an outpouring of love and prayers that we never imagined (or ever had to imagine) we would need. And in those first few days it was the key to survival. I actually felt the love and embrace of those around us. We were never alone.

Sam and I, leaving Daddy, big brother and baby sister behind, landed in South Africa around 11:00 AM on Monday, January 20. Phase two began with an ambulance ride…a real, working and well-equipped ambulance this time…to the Little Company of Mary Hospital in Pretoria. It’s funny the things you remember in retrospect. I kept thinking the ambulance driver looked like Val Kilmer, then I decided he looked like Jim Morrison…then I realized that likely meant he just looked like Val Kilmer. Anyway, he did and he loudly sang romantic pop songs, refused to turn on the AC or roll down the windows and smacked his lips loudly while eating Cheetos. Random details forever burned in my brain. Sam rested in the back, enjoying the sirens through the red lights…despite feeling crappy, that medevac flight and the ambulance, were without a doubt the rides of his life.

The air ambulance doctors got us checked in and then we were there. South Africa. Land of adequate healthcare.

When you’re living in Madagascar, South Africa is one of those places everyone longs to go. Getting back to the US, or even to Europe, is such a long, long journey, but if you can make it to South Africa, shopping and eating and “normality” can be right at hand. In fact, in the weeks leading up to Sam’s diagnosis we had been planning a 10-day trip to Cape Town for early April. And, even as we arrived in the midst of a major, life-changing emergency there were still lots and lots of people who were encouraging us to take in the sights, eat some good food, enjoy the sense of order.

I have to say, while we never really got to do much sightseeing, I did appreciate the sense of order from the very first minutes. As we were arriving at the hospital all I kept feeling was a huge sense of relief. It looked just like a regular American hospital. Every nurse and every doctor we saw actually seemed to know what he or she was doing. There was a normal cafeteria, gift shops, café, restaurant…everything. It’s amazing what it can feel like to just know that people are going to have, at a minimum, the basic skills to care for your child.

We settled in quickly. I’ve never felt more tired in my entire life. Taking a shower and falling asleep that first night, knowing Sam was going to be fine and that they were taking good care of him was so comforting. He and I even found time to laugh over strange little things – like the other child Sam’s age who briefly shared our room, who would run over to Sam’s bed and chat away with him in Afrikaans (to Sam’s complete bafflement). Or, the fact that people mostly spoke our language, but not entirely. Words like “loo” and “wee” really sent Sam looking at me for guidance. And then there were the strange foods – like when I thought I was ordering French fries (chips), but ended up with some sort of deep-fried goat cheese thing with Thai chili sauce on the side.

Things remained stressful, but it was like a level of humor and comfort set in amid the stress. We made some new FS friends and even got to catch-up with some old friends from Tana, now serving in South Africa.

In Pretoria, we started learning more about Type I Diabetes. Sam immediately took to the process – he was excited to learn about giving his own injections and testing his blood sugar. He couldn’t wait to win the award given to all kids who learned the required info before being discharged. We also spent a lot of time playing computer games and making little lands out of toys and paper. And, we really, really bonded. It’s rare when you have three kids that you get such an extended period of uninterrupted interaction with just one of them. I’ve come to find this one of the many silver linings of a less-than-ideal situation.

As they started to prepare us for Sam’s discharge, I have to say I felt completely overwhelmed by the sheer volume of stuff I was supposed to be learning. It wasn’t that it didn’t make sense – there’s a lot of math and measuring that goes into managing Type I Diabetes, but I find most of that doable and kind of like a really hands-on extended science project – but it is true that all of this information was coming in through a filter of stress, trauma and sadness for the life we had so suddenly left behind. Sam was feeling better, so that helped alleviate some of the deepest stressors, but knowing that so much of his life was now in this delicate balance of the things I had to learn was really overwhelming at times. It felt like cramming for the most important test of your life…only the stakes are more than just red marks on paper.

It was during these moments, the moments where I felt like, “There is no way I can do this,” that I found myself surprisingly able to stop, slow down and, frankly, say, “Well, you have no choice.” I remember once asking a friend who is a cancer survivor, “How did you do it? Get through each day, keep moving, without feeling completely overwhelmed?” She said, “You just do it. You have no choice.” While Type I Diabetes is distinct from cancer, there is this thing that kicked in with me – one foot in front of the other. Don’t look back, don’t look too far forward, just look right where you are.

I also felt at every moment that the prayers and well wishes of our friends and family were palpable. I honestly felt wrapped-up and connected to every single person I knew that was pulling for us, thinking of Sam and sending up their blessings. I’ve always been a big believer in the power of prayer and meditation. In this case, more than in any other time in my life, I felt sustained and buoyed by that love.

And through all of this, Sam just kept on being his smiley self. He missed Daddy and especially his siblings terribly. Every day he would wonder what they were doing and talk about feeling sad he wasn’t there with them. One morning he woke up and the smile on his face faded within in seconds. It was as if he woke up from a dream and realized that all this was real. Tears rolled down his cheeks. “I want J**,” he said. Having these adventures without his big brother, his best friend, was really hard. But, when it came to the diabetes, he just rolled with it. I wonder if this is a potential upside of being diagnosed so young – he’ll soon forget what it was ever like to live without it. It will start to seem more and more normal.

By the time they were ready to discharge him, we were both really, really ready to be out on our own. I faced that moment with a combination of relief and dread – relief that we could sleep in comfortable beds and eat more normal food, dread that the calculations and insulin and balancing was going to be up to me. Our three days in the hotel before my husband and the kids arrived ended up being less scary than I thought they would be. We were fortunate to be able to spend each day (or at least part of the day) with friends. It helped to pass the time and left us feeling like we had something to look forward to. We went to the zoo and on a mini-safari. Both our new and old friends in South Africa really looked out for us. It all felt like Sam and Mommy’s special adventure. We became more confident. We developed a system. And, we waited intently for the others to arrive.

Truth be told, we got pretty used to our quiet little existence. When my husband and the other kids arrived, it’s like everything went back to our hectic, silly household – with diaper changes and snack times and laundry and Legos. We were so incredibly happy to be back together, but all five of us in a small hotel was exhausting. Getting back to the US, in the end, really couldn’t come soon enough.

Finally, just ten days after his diagnosis, we landed back home. But where are we now…really?

Well, we’re reminded constantly of why we have so many rituals and routines – we rely on them even more now. We are thinking a lot about the structures we’ve put in place for discipline and bedtime and mealtime and play time. While so much has changed, these things continue apace as they always have. It’s a saving grace really – that and the fact that love and compassion continue to guide us in everything we do. We’ve always told the boys (and now Imogen) that no matter what, we have each other, that if all else fails we go home (to Austin) and that every moment is really just a great big adventure. Sometimes you wonder if you’ll ever really need to live out these messages. Now I can say we’ve put them to the test.

And we’re now down to the business of living life as it looks now. We don’t think Sam’s diagnosis will affect our onward assignment. This relieves some of the stress. It doesn’t look like we’ll need to rebid or scramble to find a position in DC. We’ll have a few weeks of separation here and there. We’ll get through it. The Foreign Service has been good for us, individually and as a family. Does having spent the last 5 years wandering the globe make things like this easier? I don’t know. Right now, for our family, I think it does. Five days from now I might change my mind. I don’t really bank on certainty…never have really. But, there are a few things where I feel I can invest my confidence – love, flexibility, a good cry, a good laugh, friends, family…and hugs.