Rainy season in Burma1 is spectacular. At night, I love to lie in bed, listening to the torrential rainfall drenching the earth and bringing life and vitality to the land. Between showers, the air is so thick that you can hear the moisture dripping from leaves and branches. And if you listen very carefully, you can almost hear the grass sighing and burbling with delight as it wallows in the rainwater. When the rains come down, they do so thick and fast. Even with an umbrella and raincoat you are quickly drenched. In the intervals between the downpours, it is hot, humid and sticky.
When I arrived in Burma in mid June of 2009 to start a new job, rainy season was in full force. Having lived in Asia for more than a decade, I have become close friends with the monsoons, which bring welcome respite from stifling heat and humidity. Being caught in a sudden downpour, or even listening to the rain from outside, brings energy and feels like a revitalising force. I have many fond memories of standing, drenched to the skin, grinning from ear to ear after only a few moments in an unexpected cloudburst. It helps that the rain is warm! Coming from Scotland, where the rain can be just as heavy but usually accompanied by grey skies and often a biting wind, I have never tired of this warm torrential rain.
When the rains make their first annual appearance, they usually arrive dramatically, and the world is transformed. There is a festive feeling; smiles and laughter return. The sight of children playing in the rain, splashing in puddles and letting the rain soak them through is ubiquitous. And not just children—adults too! The city turns green, mosquitoes hold crowded parties, and the frogs grow to such a size that they sound like male tigers as they croak in the night. The ground and pavements are covered with a layer of slippery, slimy moss in the hidden spaces which have not already turned to mud.
Such was Yangon when we arrived with our suitcases, papers, and a crate of enthusiasm, to take up a new life in this enigmatic country. It is quite an experience looking for a home in such a setting. We had a temporary place to live but were keen to settle and unpack properly. In those first weeks, we tramped round a number of potential homes, the mosquitoes nipping at our ankles and the rain teeming down.
It was not too long before my husband found the perfect place, a simple bungalow within walking distance from work. We made arrangements to view it, and the heavens opened shortly before the visit. The road outside the office flooded, and we had to wade through warm, murky water to get there. It was well worth the effort, though. The bungalow was indeed perfect: modest, but deceptively spacious. The wooden floors gave it a cosy warmth and the large, high windows made it feel light and optimistic. Unusually for Yangon, it had ceiling fans throughout. My fear of earthquakes was assuaged by the fact it was all on one level. The generous garden was gloriously tropical and mature, bounded by bamboo, mango trees, and hedging, and filled with pink, white, and yellow bougainvillea, crimson foliage, pink and purple hibiscus, and scented frangipani. It was ideal. We would share it with several families of geckos, some of which were the tiniest ones I have ever seen. They added to the nighttime chorus with their characteristic chirruping sound.
After a series of one-year postings in different countries in the South and Southeast Asian region, we were very happy at the prospect of a longer posting. We were keen to move into this peaceful space and finally unpack. Particularly back in 2009, Burma had an air of mystery, and were eager to learn about our new environment. We made arrangements to rent this house and moved in as soon as everything was in order. It was a marvelous feeling to be settling at last.
By late September, the rainy season had truly left its mark: the vegetation was lush and vibrant from the rains, clothes seemed to be neither clean nor dry, almost everything was growing a layer of mould, and the humidity made me feel constantly grimy.
One unremarkable evening, as another hot, sticky, and wet day was drawing to a close, I had my usual shower to refresh myself and clean off the day’s grime. It was in the shower that I felt a hard, solid area where one should not have been, in my left breast.
I was instantly transported back in time twenty-six years to when I had found a lump one evening while bathing. I vividly remembered the sensation of sick fear as I checked that I had not imagined it. It had indeed been real all those years ago, and I had had it investigated promptly the next day with my local doctor. It had turned out to be nothing sinister and was shrinking by the time I had a hospital appointment a couple of weeks later. Although the lump at that time was not worrisome, the emotions and fear that I felt at that time were very real.
My reaction was different, however, on finding this lump all these years later. My stomach didn’t sink in quite the same way. In the previous days, I had noticed some changes in my left breast, and was intending to seek medical advice. However, I believed these to be related to my age. When my fingers rested on the hard mass, I knew that the lump plus changes must constitute worrying signs. This really could be sinister this time. I comforted and contradicted myself, focusing on the fact that eighty percent of breast lumps are benign, and moreover, there was no history of cancer at all in my family.
I swallowed the sense of fear and uncertainty. My mind had to absorb the possibility that I might have cancer. And I was living in a new and foreign environment. I had no idea what the implications might be. The next morning, I found a recommended medical center and made an appointment to see the doctor.
Then I spent a ridiculous amount of time on the Internet, searching and searching and confusing myself with the wealth of information available. I frightened myself by searching the different diagnoses and the various types of treatment. The more I searched, the more I realised that my symptoms ticked a few of the "let’s get worried” boxes. And the more I searched, the more I realised that the entity we know very simply as breast cancer is actually a massively complex beast. I was on the threshold of a very strange territory, both physically and mentally. I gripped tightly to the hope that I would not have to cross over into that unknown and terrifying place.
My appointment with the doctor was the next day. That day was rather surreal. I didn’t feel as scared as I imagined I would; I felt myself shift to autopilot. My doctor confirmed my concerns: there was indeed some "asymmetry” and this should be checked out by a specialist. The regular protocol in Yangon is to be referred to Bangkok and have a diagnostic mammogram, ultrasound, and biopsy. She told me that I should do this as soon as feasible, and without doubt within two weeks.
At this stage I entered a strange limbo. I returned to work and quietly informed my boss and one colleague in an upbeat email, even though they sit next to me. Saying the words out loud would have been too difficult, and my mask might have cracked. I asked them to keep things low-key, in case it was nothing. I preferred people to think everything was "business as usual” until the limbo time was over.
In these waiting days, I mostly just got on with day-to-day matters and tried to put it to the back of my mind. I lurched from having an attitude of "well, this thing is not going to get me, if it is cancer” to lying awake worried sick in the night. At my most frightened moments, I believed that I would not be alive to see the coming Christmas.
The stress of not knowing whether I was harboring cancer was exacerbated by paperwork complications. We had to deal with the logistics and other difficulties and would be leaving Yangon on a one-way ticket. My husband’s passport only entitled him to a fifteen-day visa for Thailand. We did not know if and when we would be able to return to Yangon, irrespective of whether or not the diagnosis turned out to be cancer. We knew we would be leaving our new home and life, and truly stepping into the unknown.
The strange period between finding the lump and traveling to Bangkok lasted barely a week, but feels much longer in my memory. The day we were to leave for Bangkok we headed to Yangon’s spectacular and spiritual Shwe Dagon Temple for a barefoot circuit of the complex, slushing through ankle-deep water. Making offerings of flowers and pouring cups water over the Buddha’s head at the shrine dedicated to the weekday of your birth brings blessings, and whispered prayers may be heard. I stood at the Saturday shrine in my bare feet on the slippery ground, pouring one cup of water for each of my years on this earth and placed a spray of flowers in the urn for that purpose. It is not difficult to guess the plea in those prayers.
Less than hour later, I was sitting chittering in Yangon airport with an anxious husband by my side. Chittering is a useful Scottish word which describes a trembling and shaking which is so violent that it makes the teeth chatter. The fear was manifesting itself physically.
On the short flight to Bangkok, I settled a bit, distractedly munched the nondescript in-flight whatever-it-was and filled in our landing cards. We landed in Bangkok in the late afternoon as the sun hovered on the horizon, heavy and red. A car was waiting for us at the other side to go straight to the hospital and the diagnostic tests. I knew that I was going to learn in a matter of hours whether or not my life was about to change.
When we arrived at the hospital, we were already late for the imaging appointments. Our liaison manager appeared magically and guided me gently and with great care and professionalism through the next hours. I was led straight into the imaging department and asked to change into a hospital gown for the first test—the mammogram. I chose to ignore the fact that the hospital gown was a nondescript beige, and in no way related to blue, my most auspicious color. The technician took an unbelievable number of pictures from all angles, and I felt as if I was doing Bollywood poses at times. I had been prepared for pain and discomfort as I was squashed between the Perspex plates, but although the procedure was not pleasant, it was not an ordeal. I think, though, that this may have been because my mind was in overdrive, trying to pick up clues (and hope) from anything—a gesture, a smile, a question, an auspicious gown color, an auspicious room number…
Auspiciousness plays an important part in life in this part of the world. The auspicious time for our Himalayan marriage rituals several years earlier was deemed to be 9:00 am on a particularly auspicious date. That is why we had pre-marriage blessings and my favourite snacks at 7:30 that misty December morning. And that is why I put my auspicious midnight-blue traditional marriage attire on before the sun rose that morning to become a daughter-in-law of the Himalayan Tamang people. It is now second nature to seek out auspicious signs and indications around me, particularly from colors and numbers. But in desperate times, such as during cancer tests, one may look for auspicious signs in anything.
During the mammogram procedure, I picked up the word calcification at one point and immediately latched hope onto that. It sounded logical, and not harmful to my lay mind, so my heart lurched with optimism. Breasts are for producing milk, and milk is made of calcium, so calcification cannot then be sinister, my mind decided.
Next was the ultrasound. I was escorted almost directly into the room and the young, gentle technician started the procedure. Again the investigation was very thorough. This time though I could see the screen and all sorts of weird ghostly shapes emerged as she methodically worked her way through the process. Again, I tried to pick up clues and hints. Soon I heard a very big clue.
"Left side—problem.”
This was definitely not encouraging, but then, as I told myself, I knew there was a problem on the left side. I just needed to be told it was not sinister, thank you. The chittering started again.
"You need biopsy,” was the next clue.
That started another round of violent chittering!
The technician was lovely—calm and professional but very matter-of-fact and clear. I told her that I was worried and scared, and she smiled kindly at me.
"Don’t worry,” she reassured me. My stomach and heart lurched again with hope, only to be dashed by the second half of her sentence: "Your doctor is a great specialist in breast surgery, and you are in the best of hands.”
She then started pegging the dimensions of a shape she was seeing in the scan. I was compelled to watch, but kept looking away as she pegged a strange shape and clicked to save it. Then my stomach turned as she started to key in explanatory text. I saw the letters as they appeared on the screen one by one, spelling out M-A-S-S. That was a very big clue, and not a good one. My heart stopped as she continued to type and N-O-1 appeared on the screen. I closed my eyes and swallowed: Mass No 1.
Oh. My. Dear. God. There was more than one lump in my breast.
I think it was around then that the surgeon himself appeared, his Bluetooth flashing in his ear, and he joined the party. Or maybe it was a training workshop because he had a magic marker in his hand, and he methodically started to draw on my shivering chest. He and the technician reassured me that they were not going to hurt me, just draw on me! These were the markings for the biopsy.
Eventually the drawing was complete, the ultrasound images all recorded, and I knew that the time was coming for biopsy and review of the scans.
I changed from the gown back into my clothes and headed back to the waiting area. I was about to down when I was ushered into Room 59, the surgeon’s consulting room. Even at that stage, I seemed to have developed a strong sense of trust and faith in my doctor. That might have been connected with the fact that he had trained in Scotland. Of course, I grasped another auspicious sign in that. He examined me again, and all the while the biopsy instruments glinted at me wickedly. I knew that the biopsy procedure would be painful as well as frightening.
He invited me to sit down and started to talk through the findings of the mammogram and ultrasound. He talked about the calcification a bit, but I could not really make sense of his words. It seemed that calcification was not as innocent as I had assumed and hoped. He highlighted aspects from the mammogram, including large areas of calcification. Then he moved quickly on and focused on one of the masses from the ultrasound. The mass highlighted on his large computer screen was cigar-shaped, and he pointed out to me that it was irregular in form and growing in different directions.
He paused, turned away from the screen and looked directly at me.
Gently, irrevocably, he told me, "This is highly suspicious of cancer.”
At that single, defining moment, my life changed forever. I stepped into a new world, a world in the Tropic of Cancer and of tropical cancer. I could feel myself shrinking, detaching from reality, as his words danced in the air around me, rushing, echoing as they gathered speed and volume, pounding, thundering down all around me, just like a tropical rainstorm.
Epilogue
That day, October 2nd 2009, I did indeed step over into a different world. My official diagnosis came three days later, when I had major surgery and the pathology confirmed cancer in two of the three masses, as well as in my lymph nodes. This started a journey of acute treatment as I became a wheelchair-using, mask-wearing, single-breasted frequent flier commuting between Yangon and Bangkok during treatment and recovery.
The fact that I am telling this story today confirms that I am very much alive and kicking, albeit living with a fear and paranoia of recurrence and a cocktail of after-effects and side-effects from long term medications. I am wonderfully cared for by my medical team in Yangon and Bangkok who have seen me through a few bumps in the road, and whom I unashamedly adore!
I am still living and working in Myanmar/Burma in a different and changing context, still finding it a fascinating environment rich in inspiration, and still smiling when the monsoon rains pound down outside.
Scotswoman Philippa Ramsden is a development and humanitarian professional, writing in any leisure time. She had been to Asia only once when she stepped off a plane in Kathmandu in 2000 to take up a new job, with no idea what to expect—and has been in Asia ever since. She has lived and worked in Nepal, Mongolia, India, Sri Lanka, and Burma/Myanmar. She is currently working on a memoir, and blogs as Feisty Blue Gecko.