Americans go on a hike; the English go for a ramble. Whichever word you prefer for the outdoor recreational activity of walking, Harry Ramble is your man. His name was given to him by the avid ramblers of our congregation at Gunnersbury Baptist Church in London W4, a group he led twice a year, in April and October.
When my husband, Raja, and I moved to London in 2002 and met Harry at church, he told us that he had done this for 20 years since he retired from the post office when he was 55, and had never repeated the same trail. Harry was six foot three inches tall and weighed 100 kilograms of muscles. A month before the scheduled rambles, Harry would take a solo walk from Chiswick where we all live, to the Chilterns, a chalk escarpment in South East England and an Area of Outstanding Natural Beauty 35 miles away, and seek a new trail with a view. His claim to fame is that he walked eight times between the two extreme points of Great Britain, from John O’Groats in the northeast to Land’s End in the southeast. Distance by road is 875 miles and cyclists take an average of 12 days to cover it. Harry took ten weeks walking 1200 miles off-road for the expedition.
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It was a given whom my oncologist was going to be. Six months earlier, I’d profiled Dr. Ang for a regional health magazine as one of the top oncologists in Asia. Upon discovering the lump in my breast in September 1998, I emailed him the mammogram results. Inconclusive. Further tests required. He responded immediately and told me to come in to see him that very day.
After examining the lump, Dr. Ang performed a fine-needle aspiration. “The lump feels like an unripe pear when I put the needle in. This is suggestive of cancerous tissue. I recommend removing it as soon as possible,” he said. He then arranged for surgery with Dr. Wong for the following afternoon. Raja and I were grateful for his honesty and stayed up all night rattled, but with enough wits about us to talk about how the ensuing events were going to fit into our lives if the biopsy confirmed malignancy. We prayed it wouldn’t be cancer. But if it was, that it hadn’t spread.
Raja waited alone for over four hours in a cold sterile room just outside the operating suite. The surgeon had told us that a frozen section biopsy of the lump would be done while I was on the operating table, and he would have to wait for the results to determine whether he should do a lumpectomy with axillary clearance if it was malignant, or just a removal of the lump if it was benign.
I woke up to half a breast, a hole in my left armpit, and a lot of pain. I knew immediately the lump was malignant. Stage 2B breast cancer with spread to the lymph nodes, the oncologist said. Chemotherapy started immediately: eight rounds of cocktail every three weeks followed by 31 daily shots of radiation.
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One of the first things Harry taught us about rambles was that we had to dress the part. As it is cool in April and October, he recommended a lightweight waterproof jacket which we could take off if it got warm, and which would get us through drizzles that seem to appear from nowhere on the British Isle. Hiking boots would be great for navigating the rockier terrain, he said. We could carry a single walking pole, or a pair for balance, and to anchor points to lift ourselves up or down the slopes, and to get into the rhythm of walking. But Raja and I didn’t do that because of vanity — in our 40s, we didn’t want to look “elderly.” We didn’t want to be old before our time, what with a strong family history of cancer on both sides. Harry added that a fresh pair of socks and a change of undies might not be a bad idea in case we got soaked, and a hairband for a windy day. You never know what might come in handy.
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My hair started to fall out precisely two weeks after I started chemotherapy, just as Dr. Ang said it would. He said it would still be a shock even though I knew it was coming. I marveled at how prescient he was. When my hair started dropping by the handful, I decided to take control of the situation and got Raja to shave it all off for me. I ran my fingers over my head — a strange feeling because no hair slid through them. I looked at all my hair on the floor. Stoic since the diagnosis, I finally crumbled. Raja held me in his arms until I was ready to be let go.
The wig made me look fake, and a scarf tied up Russian babushka style worn by my fashionable cancer buddies was not for me either. So I wore a hat. I quickly learned that how I dealt with my baldness determined people’s response to “the hat” or rather, what was beneath it. To put friends at ease, I made reference to my baldness nonchalantly, joked about it, showed them what was under the hat. It was unexpectedly comfortable being bald and I had no bad hair days. I soon took to my new hairdo and celebrated the light-headedness for a season.
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After being initiated into the art of rambling with Harry, Raja and I were hooked. In between Harry’s bi-annual rambles, we set out on our own on weekends. We started with simple trails that we printed from the internet, and quickly moved to the London Hiker website to satisfy our hill-walking cravings. Very soon we fell into the “glutton for punishment” category of readers. We walked Leith Hill which was a bang for our buck — short, sweet, and a great reward at the end with a proper incline for the final push from which we could see forever: all 14 counties, the Channel, and Big Ben. Then we graduated to treks we had no prior knowledge of, such as the Worcester Beacon in the Malvern Hills. We tried different routes every day we were in Malvern that week. The changing perspectives of the landscape were exhilarating but it was also scary when we lost our way. Once we fell into a deep pit hidden by undergrowth. “Harry could have saved us from that incident,” I said as we climbed out of the hole and surveyed for broken bones and bruises.
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A side effect of chemotherapy is abnormally low levels of neutrophils. These are white blood cells — the body’s first line of defense. Without them, the patient is exposed to infections. I took precautions by avoiding crowds and not injuring myself — and still managed to develop an abscess in the armpit, cellulitis in the left breast, folliculitis and yeast infection on the scalp, and a chest infection. So, there I was, a regular hospital bird, being admitted every couple of weeks for severe infection. In addition, I suffered from depression. The dark brooding mood came insidiously. I only realized that something was wrong after there had been a blow-up with Raja. For days I hovered around the edge of the dark pit. Then a minor issue such as getting my food order wrong at the cafe would tip me into it. Once in it, it’s impossible to come out. My doctor couldn’t tell me precisely what was causing the depression: “It could be due to chemical imbalances caused by chemo, or hormonal changes of chemo-induced menopause. Most likely it’s due to everything that is happening: the diagnosis, the treatment, menopause at age 42.” There were times when I behaved like a person possessed: grabbed whatever I could get my hands on and smash it against the wall, screaming until my lungs hurt. Then I’d be filled with remorse for directing my anger at Raja. Violent scenes, over which I had no control, played endlessly in my mind. One night when I couldn’t sleep, I got up from bed at 2 am, went downstairs and took the cleaver from the kitchen drawer. I wrapped it in newspaper, went outside and threw it in the dumpster. I was afraid of what I might do to hurt myself and my family. I emailed my doctor about the depression and violent behavior. When I saw him for my following dose of chemo, he said, “Been grumpy lately, eh?” He can be such a tease sometimes. A much-needed relief.
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We enjoyed the camaraderie of fellow ramblers in our church group, catching up with old friends and getting to know new ones. Food was an integral part of the ramble. We always started the ramble by convening in Henley-on-Thames for tea and scones with clotted cream, before driving to the start of our trail. Lunch was at a spot carefully chosen by Harry for its commanding view of the river, mountain, or valley, and at approximately two hours before a pub for mid-afternoon tea or a pint. When out on our own trail, Raja and I met kind people who helped us as we struggled to conquer the steep craggy incline or needed help finding our way back to civilization.
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People with cancer bond quickly. The tie that binds is the deadly disease. In woundedness and pain, cancer buddies open their hearts to each other; they give comfort and they receive comfort in return. When women with breast cancer meet, they compare notes: When were you diagnosed? What stage is your cancer? How many lymph nodes were affected? Who’s your oncologist? They compare every detail of their lives, and are relieved to find that their enormous appetite, frequent infections, and emotional highs immediately after chemo are normal phenomena after all. It’s especially nice to meet someone healthy and normal-looking who completed her treatment six months or a year earlier. You hope to see yourself looking just as well a year on. For a moment, the road didn’t seem so long or the burden so heavy.
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Harry told us that rambling is a gentleman’s sport and there is etiquette on how to share the tiny trail space with others. He knew by heart the guidelines published by The Ramblers, the non-profit organization that protects the interests of walkers in the U.K., and then some. Such as when we meet equestrians, we should give way to the horses, keep a wide berth and not make abrupt movements or we will startle them. Ramblers going uphill have the right of way. When overtaking a rambler, we say “hi” to announce our presence. When in a group, we walk in a single file on the trail so that we do not erode the shoulder of the trail. When we are walking alone, the single rambler yields to a group. The etiquette is unwritten rules that ensure safety — even on the bunny slopes. For riskier climbs in the mountains, there are more rules because the sport has inherent risks such as rockfall, extreme weather, and crevasses.
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During the first two years after diagnosis, several of my cancer buddies with a less advanced stage than mine had the cancer return and a couple of them died. In cancer, treatments do not guarantee cure. Unlike a cold or an infection on your toe, you can never say you are cured from cancer while you are alive — only in hindsight when it has not reappeared in your lifetime. There is always the imminent fear of its reappearance because there may be microscopic collections of cancer cells that cannot be identified by current diagnostic techniques. I’ve lived in this indeterminate extension of remission for 20 years now. Despite the comprehensive treatments I’ve had including five years of taking oral tamoxifen, I technically have a 43% chance of recurrence at 20 years. The odds of winning the Powerball lottery is 1:175,000,000. My chance of cancer recurring is slightly lower than 1:2.
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When I finish a challenging course through the hills, I get an unadulterated sense of euphoria from the endorphins released by the high-octane exertion, and a sense of achievement from completing the trail. 20 years on, I still keep Harry’s tradition of celebrating with a pint at the pub at the bottom of the hill. Made even more meaningful if the pub had a literary connection such as the Unicorn Pub, the lesser-known pub in Malvern where C.S. Lewis used to meet with J.R.R. Tolkien to discuss their manuscripts. As I make my way to the pub for the prize, my mind automatically shifts with anticipation to the next ramble as it flips through the calendar for the next available window. Trekking is addictive for it gives me the feeling of being active and healthy. Capable and alive.
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Completing cancer treatment, however, was more complex. Family and friends joined us for the mandatory victory lap with a meal at a fancy restaurant. The jubilant moment was upended when I reached to scratch the itch on my scalp — and felt my hat, a vivid reminder that I have cancer. Counting down days to the next dose was now replaced by counting down weeks to the next blood work and oncology check-up. Will I make it to the first year? The fifth-year benchmark? Cancer is capricious. So the benchmark is arbitrary. There’s never pure joy post-treatment like a day spent hiking the Greylock in Western Massachusetts because it is sullied by the underlying, but real possibility of recurrence. This is life now. After the disastrous fall in the thickets on the way down from the Worcester Beacon, we attempted the same trail the very next day and made it down with no mishaps. Fear didn’t keep me from walking the treacherous trail. Neither will I cower from the constant fear of the cancer’s return. I set up notifications for airfares to destinations on my bucket list and subscribe to the travel blog, Discovery. In the spring, I’m doing a Kerouac from Boston to Big Sur without a plan, for the giddy thrill. The girl’s got to live some. •