The Door

This is a story of two people navigating the medical system: my story, and the story of a woman whose name I have forgotten. I want to point that out because it is the part I can’t forgive myself for. I can talk about her in a way that reflects the importance she once held in my life, yet I lost the most basic thing about her.

She studied English at NYU in the late sixties. Imagine how rare that was: a Thai woman, in that time, studying in that city, coming home fluent in a language she’d learned in a place most of her countrymen would only see in videos years or decades later.

I met her late in her life, in her café in Chiang Mai, shortly after I had moved to Thailand and before I moved down to Bangkok years ago. We became friends quickly, the way people do when they have both lived in more than one country and struggle to relate to others who lack those experiences. She would never let me leave without eating, always trying to refine her dishes based on my reactions. I got to hear about the city my mom and grandma grew up in from the perspective of someone who was there as a young adult, with fresh eyes.

I was in the United States when she told me she had been diagnosed with cancer. My grandmother had fallen, and I had gone back to help her heal from the injuries, so the news came to me through a Line message, from very far away. Cancer. And she did not have much family, or many people close to her. She had moved to Chiang Mai from Bangkok after retirement and had mostly kept to herself. I always wondered why this warm and friendly woman didn’t have people she felt she could lean on, and it was a special kind of pain to be there for my grandma while wishing I could be there for this friend as soon as I got the news.

With that in mind, I asked her what she was going to do.

She told me she was going to go pray at the temple. She cut off communication shortly after.

I have turned that decision over in my head more times than I can count. There was no panic in it. No plan to fight, no list of hospitals, no second opinion. Just the temple. I think about whether things would have gone differently if I had been there, if she’d had someone to drive her, to sit in the waiting room, to be loud on her behalf when being loud was required. I will never know. What I know is that she faced the largest door of her life alone, and she chose not to walk through it, and somewhere in that choice was a calculation about what the walking would cost a woman with no one beside her.

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So when I found a lump on my chest, I thought of her.

I wasn’t completely alone like her. I want to be honest about that. I was not completely without people. But I am a trans woman, and I have enough experience in medical settings to have learned exactly how those rooms receive me. I did the math she must have done. I did not believe I could survive the treatment. Not the disease. The treatment. The waiting rooms, the forms, the questions, the faces, the uncontrolled emotions of otherwise professional people.

I sat with the lump for a week and thought, with a calm that frightens me now, about how I would want to spend my last months if this was what I worried it might be.

Before anyone in a hospital had done anything to me at all, I was planning how to spend my last days, comparing the two kinds of suffering each path would cost me. No one walks out of cancer treatment unscathed, but I knew the act of accessing it would be a second scar I might not recover from. A week. I lost a week to expectations that had been installed in me long before I ever felt the lump.

I finally went, after much internal preparation. That day I prepared by tapping myself on the chest, chanting, “I am not human. I am not human. I am not human.” This is how I prepare myself for situations like this. If I don’t believe I am human, I won’t react to the inhuman treatment I should expect to receive. If I don’t react, I might get somewhat adequate care. If I do react, it will be used to deny me care.

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I walked in, and when I was asked why I was there, I told the nurses I needed a doctor to look at a lump on my chest.

It took a few exchanges before the words landed as what they were: breast cancer. And once they landed, the nurses did not move toward the doctor. They moved toward a protocol. Bloodwork, they said. You don’t need to see a doctor. In about a week, I would have a solid answer as to whether I had cancer or not.

I politely repeated, again, that I would feel better if the doctor just took a quick look and made that call himself.

I don’t want to put the focus on these people. They were a gate. They were the part of the machine that decides, fast and without quite thinking, who belongs in what category and whose concerns matter. Something about me had been sorted into confused before I finished my sentence. Once that happened, everything I said was interpreted through that category. The protocol was not designed to see me, so it didn’t.

It escalated. And then I did the thing I am most afraid to do in this country, the thing every year of learning how to live here has trained me never to do. I broke the code. I got loud. I made a scene in a public room full of people who would all agree, afterward, that the foreigner had made a scene.

They relented. They brought me to the waiting room near the doctor’s office.

From there, I could see them gather at the nurses’ station, a group talking with the particular heat of people who had been made to do something they did not want to do. After a while, one of them, a gay male nurse, walked over with a clipboard. He asked me, in a voice with maximum attitude, when my last menstrual period was, since I was so worried about breast cancer.

I told him I have never had one.

He rolled his eyes, turned with a sigh, stomped back to the station, and threw the clipboard down hard enough that the sound, and his loud complaints, followed me into the room.

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Finally, I saw the doctor.

I told him why I was there. He asked to look. The second I lowered my bra, he was already reaching for the phone, dialing as he spoke, telling me I was going for a mammogram immediately.

I had it done. I waited for the results. He called me back in.

An infected mammary gland, he said. The kind of thing that kills you if you leave it, but not cancer. A round of antibiotics was what I needed, not chemotherapy.

I asked him whether I had done the right thing by coming in, whether I had done the right thing by insisting on being seen. I wanted to know if I had acted in a way that was correct in the Thai context.

He said yes. He said it without hesitation, and then he said it again, telling me to always do exactly that, and mentioning, as a matter of plain fact, that trans women have higher than ordinary rates of breast cancer, and that with this the most important thing is finding it fast.

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That was the door. The doctor was behind it the whole time, competent, kind, and quick, and between me and him stood a gate that had already decided my concerns did not require immediate attention. I got through it because I was willing to do something I was deeply uncomfortable doing, while worrying it might carry consequences outside the hospital.

She went to the temple.

I think about how the doctor told me to always come in. I think about how many people never reach the part of the story where the doctor picks up the phone, how they are turned away at the door, or turn themselves away before they ever get there, having already done the math about what the walking will cost. I think about a woman who learned English in New York in 1968, came home, built a life, and, at the end of it, faced the largest door alone and chose to pray instead.

I have forgotten her name. I have not forgotten her decision. I am writing this for her, for myself, and for the next person standing at the gate, being told they’re not on the list while their body screams that this is an emergency.

Go in. Keep insisting. Be loud if you have to. “You did the right thing by coming.”