Sickness and tragedy aren’t generally things at the forefront of an expat’s mind, until of course, something happens to a friend or family “back home”.

Often times the guilt rolls in waves, leaving you with “what if’s” and questions that can’t possibly be answered. Frankly, those questions shouldn’t even be entertained, but our brains work against us sometimes.

When the phone rings at 2AM there’s only one thing that runs through an expat’s mind, and that’s invariably “what’s happened back home?”.

So how do you cope with knowing that your decision to move away from your family means that you might not be with them or able to help if sickness or tragedy does strike?

I spoke to an American psychologist Dana Nelson, an expat in France, who works with expats amongst other overseas-dwellers and runs the Mindful Expat podcast. But first, a little about my own experiences.

TERMINALLY ILL FAMILY MEMBER

I was living in Perth, Australia, working in my dream job with the hopes of climbing the media ladder when my mum was diagnosed with single cell carcinoma around her stomach. I say “around” because the cancer had literally grown around the outside walls of her stomach, making it undetectable through a few years of various stomach pain tests.

The guilt was swift and unrelenting. I’d returned from a stint living in London a year before because I was worried about her health, and had only left Sydney again because we all thought she was back on her feet.

I spoke to her in hospital while walking to and from work every day. I sent flowers. I asked if she needed anything. I caught red-eye flights to visit for the weekend. But beyond that, there was really nothing I could do from so far away.

So I made the decision to go on leave (and eventually quit my job) to fly home and care for mum through her illness. I was lucky to have had that choice available, if I had a husband and kids it would never have been that simple.

It’s also not the decision that everyone can make, regardless of their situation. But it was right for me at the time.

WHEN A FRIEND IS ILL

This topic popped into my little brain recently when a good Australian friend was diagnosed with squamous cell carcinoma (cancer) in her gums.

Denyse has a blog of her own and you can read more about her diagnosis here. She’s having some fairly invasive surgery today that will take a good while to recover from. Denyse really encouraged me to develop my blog into something remotely readable and I’m forever grateful to her for that.

expat-illness-cancer

If I was back home and a friend was ill, I’d visit, make a few phone calls to check in, cook some meals or offer to babysit. But all the way over in San Francisco, all I can do is send a little care package and messages whenever I think it’s not too obtrusive.

All in all, it does nothing to make me feel useful.

HOW WE REACT IN A CRISIS

There’s no one way that every expat will respond to situations such as those described above. Everyone is different and Dr Nelson says our reactions depend on a number of factors:

  • how close we feel to the person in question,
  • whether we have a “complicated” relationship with them,
  • whether it feels like there are unresolved issues or things left unsaid,
  • how sudden or unexpected the illness is,
  • how other family members react,
  • how far away we are and how feasible it is to get back to see the person/attend a funeral.

“I think expats in this situation are likely to have a lot of the same reactions that anyone would​ – sadness, anxiety, fear, anger, guilt – although perhaps amplified in a way,” Dr Nelson said.

“When there is a sudden loss, most people feel sadness. When we get news that someone is seriously ill, however, that sadness is often combined with a lot of anxiety – we worry about what will happen, we feel the need to psychologically prepare ourselves for all possible outcomes, we feel the need to figure things out or do something to prevent the worst.

illness-and-death

When we’re there in person, we can channel some of this anxiety into caring for the person or helping out in practical ways. When we’re far away, this may be harder, so the anxiety and sense of helplessness may feel more overwhelming.”

But many expats will feel numb to the news of sickness or death back home, which can lead to them being critical of their own feelings and how they “should” be feeling.

“I think it’s really important for people to recognize that reactions to such news can really vary and that there’s no right way to feel. Different people have different ways of processing emotions (and different paces for moving through these emotions), and that’s OK,” Dr Nelson said.

“I do think guilt is a very common reaction when we’re far away. We tend to feel as though we “should” be there or that if we were there we could be doing something useful, and so we feel like we’re letting people down if we can’t be there – or if we choose not to be, because doing so would mean putting the rest of our lives completely on hold or spending money we don’t have, etc.”

HOW TO COPE

So how do you deal with guilt? Dr Nelson suggests focusing on what friends and family want for us.

expat-family

“They may have conflicted feelings about the choices we’re making or having us far away, but they want us to be experiencing life,” she said.

“In these situations, it can be helpful to stop and ask ourselves, am I living the life I want to be living? Am I making room for the things that are most important to me?

If we find that the answer is no, then we need to make some adjustments. Maybe our guilt is pointing to an awareness out we haven’t been living according to our values or priorities.”

But if we find the answer is yes, then we may just need to just acknowledge that we’re in a very challenging situation where there is no way to do it all, and we’re doing the best we can.”

WHAT YOU CAN DO

You might not be able to be there in person, but there are still ways that you can help out.

​”There may be other things that the expat can do from far away – they can coordinate finding other people to help out or can contribute financially to various arrangements if there are not other family members who can step in, they can help by doing research on various treatment options or other relevant issues and share this information with family members back “home,” etc.”

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But maybe the most important thing that expats can do is offer emotional support to friends and family who need it.

“If someone is terminally ill, it can be really helpful to ask them how they’re feeling about death,” Dr Nelson said.

“People are often afraid to ask the person, thinking that they’ll upset them, but people often do want to talk about this and it can be a real gift to them to just give them space and acceptance to talk about whatever feelings they may be having.”

SHOULD I FLY HOME FOR A FUNERAL?

It’s often a difficult decision to make, when we’re torn between loyalty to our deceased friend or relative, and the reality of our financial or life situation.

cemetery-funeral

Dr Nelson said funerals not only honour those who have died, but also help those left behind to accept the loss and continue the grieving process.

“Many people find it helpful to attend a funeral for this reason. Grief is painful, but it’s a process we can move through if we allow it to run its course — if we don’t give ourselves opportunities or allow ourselves to grieve, on the other hand, we often get stuck and feel unresolved about the loss,” she said.

“However, funerals are not the only way to do this. Certainly people can find other ways to say goodbye to their loved one and give themselves permission to grieve.

This is where our own expectations come into play. Where we think about what we “should” be doing, and what we assume others expect from us.

“I think it’s important for expats to ask themselves what being there for the funeral would mean to them and how they would feel about it later if they aren’t able to go, and just try to be honest with themselves about the response to those questions,” Dr Nelson said.

“And if part of what feels important is the fact that it’s important to other people in the family, that may be important too. But if being there for the funeral is not the most important thing to you (or simply not possible), then see if you can make a point to find other ways to say goodbye, make room for grieving, and remember your loved one.”


Have you ever received bad news from friends and family at home while you were living overseas? How did you cope? Do you have any thoughts or advice to share?