After Bagan

When things fell apart in Myanmar, part one.

We awoke to the sound of knocking. It was just after sunrise, and our taxi driver had come to drive us to the bus station on the outskirts of town.
Jess and I were headed to Ngapali beach to enjoy what remained of our time together in Myanmar, before we traveled back to Yangon, where she would return to Australia and I would fly on to Dhaka.
Our room, though dirty and thick with humidity, was colourful and served its purpose as a cheap overnight stop to break up the long journey from Bagan. Exhausted, we’d fallen asleep watching a documentary on gorillas the night before after traveling. Those experienced know finding something interesting to watch on TV in English is rare in the middle of nowhere in Asia.  
 
We arose and started packing our things, excited to head out and take a long journey on one of our beloved Burmese busses with vibrant interiors, golden buddhas on the TV screens, and soothing metta chants on loop played through tinny, distorted speakers. As we got up, however, I noticed a twinge of pain in my lower-right shoulder, which felt as though I had slept badly and then tweaked a muscle in my haste to pack. I told Jess, who massaged the area in an attempt to relieve the discomfort. I was not yet in a great deal of pain. However, feeling a sensation of fluttering in my chest, I pressed my hand to my heart and noticed it was beating very fast. This worried me, and although Jess tried to convince me that people can have panic attacks without feelings of anxiety, which she believed I was, I felt as though something more serious was afoot. As the strange sensation in my chest grew, so too did the pain, now radiating from my right shoulder down to the middle of my back. In addition, I began to find it increasingly difficult to breathe. “I think I need to go to hospital”, I said, as Jess grew worried and tried to console me while quickly packing the rest of our stuff.
I exited the room by myself and went downstairs, where our taxi driver, Kaung, was waiting for us outside the building. Kaung was a young, handsome Burmese guy with a positive demeanor and a beaming smile which made you feel as though he was always on the brink of laughter. Kaung greeted me enthusiastically, asking if we were ready to go. “I need to go to hospital”, I said. “Hospital?” he replied, his excitement replaced by concern.
Jess came down the stairs carrying all of our bags, and we piled into the back of Kaung’s rickshaw.

Pyay.
 
We didn’t know where we were going. The road was full of holes and the sun was hot as we bumped around in the back, the air thick with dust, humidity and pollution. People, colourful rickshaws, scooters, stalls and shop fronts whizzed past in a torrent of visual and sonic sensation, as I tried not to panic. The fluttering sensation in my chest and the pain in my back now combined to become almost overwhelming, as I struggled to breathe properly. Jess helped calm me down. After some time, Kaung began to pull off the road and into a compound surrounded by a white concrete fence. We drove down the long driveway towards a large building, and arrived at Pyay General Hospital. We clambered out of the rickshaw and went up to the reception, which was right at the building’s entrance and exposed to the outdoors. Kaung spoke to the receptionist in a hurried manner who, visibly distressed by our presence, tried to figure out what to do with me. Eventually, we were beckoned forward to enter the hospital. Jess, Kaung and I followed the receptionist into the building, down long corridors towards an unknown destination. Inside, the hospital was dark, stuffy and packed full of people. The walls, painted a soft green, were sporadically splashed with the orange-red splatter of betel nut spit. Each corridor was lined on both sides with people sitting or lying on the ground. Some visibly sick and injured, others not, but all staring as we walked.

We made it to a waiting room where we were told to sit. Everyone in the room looked at us as we waited. After sitting for some time, my breathing became more constricted. Jess panicked, and went and demanded that someone look at me. Almost immediately, three or four nurses rushed out, picked me up by my limbs, and carried me up the hallway, still in sight of the staring others waiting to be seen. I was laid onto a bed as the nurses proceeded to lift off my shirt. Although Kaung often did his best to translate what was being said, most of the time, I just received whatever actions were taken on me. As the pain peaked and I struggled to breathe, the Burmese nurses crowded around me. Someone wheeled a dusty and ancient-looking electrocardiogram machine from another room. I would later learn that most of the hospital’s medical devices were still in use since the building’s foundation in the 1980’s. The nurse ladies then attempted to attach black suction cups to my chest to take a cardiogram reading. Much to their amusement, however, they constantly fell off my body. Whether due to my chest hair, or the hospital’s antiquated technology, they would not stick. As I lay on the bed wincing in pain, Kaung and the nurses began erupting into laughter every time they fell off my body. The futile exercise had progressed into some sort of game to press the suction cups on, watch them in suspense, and roar with laughter together as they eventually popped off. Kaung was in tears, and I concluded that I probably wasn’t getting a cardiogram. It was peak absurdity and although I struggled to breathe, I couldn’t help but join in for a round or two of laughter, as Jess and I looked at each other to visually communicate our shared state of complete bewilderment.

Outside Pyay General Hospital.

Inside the Hospital.

Six weeks earlier, back in Melbourne, I had been training Muay Thai in Brunswick a couple nights a week. One night at the end of training, I sparred with an older guy. He had a cocky attitude about him, and although I’d never seen him at the gym before, it was easy to see he thought himself better than everyone else, and wanted to prove it. During our sparring, he launched a leg kick which connected with the inside of my left knee. He kicked me way harder than he should have for light sparring, and in no time, my knee had developed a golf ball sized lump, which was slowly becoming purple-black. I was pissed, and before I went home, I approached the guy to show him what he had done. He replied “That wasn’t me, bro”, and left. Although amusing, I was angered by the combination of his arrogance and cowardly denial of any wrongdoing. The next day, Jess forced me to go to the doctor. They did an ultrasound and discovered that the inside of my knee was full of blood clots. I was told I couldn’t take my flight to Myanmar in two weeks’ time, or I would risk developing deep vein thrombosis, which, if resulting in a pulmonary embolism, could be fatal. We chose to go anyway.

Back in Pyay General Hospital, no one had any idea what was happening to me. I remembered what happened before we left Australia, and began to believe that I was likely having a pulmonary embolism. All the signs where there: difficulty breathing, pain and tightness in my chest. I remembered the doctor’s stark warning to not fly. As the nurses continued their game of suction cups, I began to wonder whether I was going to die. It seems melodramatic now, but I was told explicitly not to fly to Myanmar due to an increased risk of developing a pulmonary embolism, and it was all I could reasonably conclude was happening. It was a strange moment. Lying there, in the heat and confusion, I ran through significant life events in my mind. I felt calm and stressed, in pain and pacified.
Unfortunately, I never had any insights associated with a near-death experience, which, looking back, was probably because I wasn’t near death; or not as close to it as I thought, anyway. After about twenty, cardiogram-free minutes, Jess, Kaung and I were put into a small cubicle to wait further. They hooked me up to an oxygen tank, and gave me a panadol. It was all they had. I sat and winced at the pain, trying to keep it together. In the room, while we waited, Kaung showed us his tattoos and divulged stories of young love, heartbreak and growing up poor in Pyay. These stories, some of which were pretty awful, always ended with Kaung bursting into laughter. He had one of his first girlfriends faces tattooed on his chest. It was all we could do to not laugh along with him, even though it physically hurt to do so. To this day, in periods of personal struggle, I sometimes think of Kaung crying with laughter at his own suffering to help gain perspective.

Kaung and I in the cubicle as nurses check my heart rate.

At some point, a stout, charismatic, and jubilant male doctor came to talk to us. He seemed ecstatic about the whole situation; I don’t think foreigners made their way to Pyay General Hospital often. He was wearing a brown suit jacket, a white shirt and a traditional Longyi wrapped around his waist. He told me I needed to have my chest x-rayed. This would be the first of maybe fifty chest x-rays I would have over the coming two years. I was put back onto the bed, and wheeled down the hall. When we reached the stairs, people assembled to carry my bed down to the lower level. Kaung, Jess, nurses, and even a couple of people in the waiting room got up to help out. They all found the activity quite entertaining. There we no elevators in this hospital. Through the corridors of the sick and injured we went, journeying towards the x-ray room. Despite the absurdity and humour in the situation, I was feeling pretty overwhelmed. The hospital was dank, stuffy and dirty. On this journey through the hallways I distinctly remember seeing a Burmese man sitting on a bed with long, messy hair, his body reduced to mere skin and bones. With hollowed eyes he stared as I was wheeled past. “AIDS”, Kaung said, nodding his head towards the man. With a pang of guilt, for the first time I perceived the extreme privilege extended to me as a foreigner, the hospital mobilizing for my sake whilst countless others waited for assistance in each corridor; and not for the last time, that guilt was counter-balanced by a desperate desire for relief from my own pain. We made it to the x-ray room. Told to enter alone, through speakers in the white-tiled walls I was instructed to press my chest onto a cold slab of metal supported by a steel pillar. Afterwards, we returned to the cubicle. Still in pain, I resigned myself to exhaustion.  

The plump, exultant doctor returned, clutching my x-rays. “Your right lung has completely collapsed”, he announced. Holding the scans up to the light, he showed us the difference between my left and right lungs. One, full of blue-white colour. The other, black. Grinning, he explained to us what had happened. “Your lung is connected to the inside of your chest cavity. On the outside of the lung, a blister can develop and puncture, resulting in all the air in the lung escaping into your chest cavity. It is painful because the air has nowhere to go”. I took his joyful exclamation as a sign of hope. “What now?” I asked. “You need instant surgical intervention. A lung collapse this severe, left untreated, could be fatal, sir” he said, his grin Cheshire cat-like. My adrenaline began to pump. Surgery? Now? In this hospital? Our experience of the hospital’s hygiene and state of technical competence up until this point rendered the thought unfathomable. I looked at Jess to visually communicate my panic. I felt a strong sense of despair. Even Kaung wasn’t smiling. Nonetheless, the nurses mobilized, and I was wheeled down the corridor once again.  



Part two, soonish.