Screen Shot 2015-07-19 at 8.06.29 AM

nobody said: notes about culture shock

I spent the weekend with dear friends. This morning, they dropped me off at the airport so I could fly to my next speaking engagement.

Over the weekend, we talked about culture shock. We talked about it, and I said I didn’t have it, that I was so relieved to be home that maybe I wouldn’t experience it.  Also, because I had a chance to write about it, it was like going to talk therapy and processing everything well.  And on top of that, I get to spend the fall and spring traveling and speaking, recruiting people to invest in kids in the developing world so we can end the ridiculous level of suffering I witnessed in Togo, and maybe because I feel so empowered, I won’t experience culture shock.

I checked my bag and went through the security checkpoint at the airport.  (Who knew that glittery sweaters light up on the TSA screening devices as if your whole torso is one big explosive device?)

I got a bottle of water and a gluten-free, fat-free pastry (It’s Portland. Of COURSE it’s gluten free.)

I’m walking to my gate, and all of a sudden, I see his face.

Screen Shot 2015-07-19 at 8.06.29 AM

I see the face of the first patient I lost in Togo.  He is having a hard time breathing.  We crank up his oxygen, then put him on a BiPap device. Then on a C-Pap device, the strongest respiratory device we have.

The hospital can’t afford ventilators and all the other equipment needed to put people on respirators. So I know that if he can’t breathe on his own, we’re going to lose him.

He fails oxygen. He fails BiPap. As the nurses are setting up the C-Pap device, this 50 year-old Togolese man looks at me.  He’s working hard to breathe.  We don’t know what’s wrong with him. Maybe a blood clot in his lungs?  Maybe he’s in heart failure?  Our equipment isn’t sophisticated enough to know for sure.

“Madam,” he says as his chest is heaving, as he’s using every muscle in his body to move air in and out.  (How is it possible that he’s in such distress and yet he’s so fricking polite?)

“Madam, I can’t breathe,” he heaves.  His eyes connect with mine.  I want to look away, but instead I hold his gaze.

“I know.  We’re coming,” I say, because it’s all I know how to say in French, and all he needs to know.  We’re coming. We’re trying.

He died that night.

“Madam, I can’t breathe.”  It echoes in my head as I’m walking toward my gate at the airport this morning.  I duck into the bathroom and lock myself into a stall.

My plane is boarding and I’m ashamed to get on the plane with tears freely flowing down my face, so I wait.

“Madam, I can’t breathe.”

I see his hollow cheeks and his desperate eyes.

And I tried so hard.

But I couldn’t save him.

I couldn’t hold him.

I board the plane, looking at the floor, watching my feet, ashamed to make eye contact with fellow passengers who might detect that I’ve been crying.

The lead flight attendant makes an announcement.  “If there’s anything we can do to help you, please ring your flight attendant call button.”

I want to ring the button.

I want help.

The plane takes off.

“Madam, I can’t breathe.”

I still hear his words in my head. I still see the terror in his eyes.

And the only thing I can tell myself, the only thing I can repeat in my head to keep myself from being so tortured by this memory, is,

“It’s not your fault, Sarah.”

It’s not your fault.

I have a layover in Salt Lake City.  I’m sitting in a restaurant and overhead, there’s a Coldplay song playing.

Nobody said it was easy…

No one ever said it would be this hard.  


I take a sip of my water and look down at my laptop, trying not to let other travelers see how hard I’m crying. Maybe this is what everyone meant when they warned me about culture shock.

Crying in inappropriate places.

Saying to yourself over and over and over again:

It’s not your fault.

It’s not your fault.

It’s not your fault. 


Thanks for sharing!

6 thoughts on “nobody said: notes about culture shock

  1. Sarah, my heart went out to you because of the the death of the man that you wanted so desperately to save. Just keep saying it’s definitely NOT your fault; if God wanted him to live, he would have lived even though you did all you could for him. But of course because you’re such a compassionate, caring person, it touches your heart because you want all to get well. Keep in mind the many you encouraged and were able to make well.; you’re a special person, Sarah, and God is continuing to use you for His purpose. Keep your head high and keep up the good work. Love ya!

  2. Dear Sarah, I don’t know you personally, and I’m also not a doctor, but what you describe sounds not so much like culture shock as it does post-traumatic stress. Your patients went through unimaginable things. So did you. Please take care of yourself, and if you keep having overwhelming flashbacks like this, don’t be afraid to seek help.

  3. Hi Sarah. I am the medical director for ABWE International – a post i took on after 20 years working as an OB/GYN at Memorial Christian Hospital in Bangladesh. ABWE also has two hospitals in Togo. My nurse colleague, Ruth Wood, and i do a lot of teaching to prep our short term and career missionaries before they leave for the field. I would like to be able to use this blog in our teaching on burnout and depression. Would you allow us to do that? Thanks.

    1. yes – by all means. i blogged for the three months i was working at hospital of hope, and you’re welcome to use any or all of that. thanks for what you do!

Leave a Reply

Your email address will not be published. Required fields are marked *