The Spirit Catches You and You Fall Down explores the clash between a small county hospital in California and a refugee family from Laos over the care of Lia Lee, a Hmong child diagnosed with severe epilepsy. Lia's parents and her doctors both wanted what was best for Lia, but the lack of understanding between them led to tragedy. Winner of the National Book Critics Circle Award for Nonfiction, the Los Angeles Times Book Prize for Current Interest, and the Salon Book Award, Anne Fadiman's compassionate account of this cultural impasse is literary journalism at its finest.
Lia Lee 1982-2012
Lia Lee died on August 31, 2012. She was thirty years old and had been in a vegetative state since the age of four. Until the day of her death, her family cared for her lovingly at home.
About the Author
Anne Fadiman was born in New York City and was raised in Connecticut and Los Angeles. After graduating from Harvard, she worked as a wilderness instructor in Wyoming before returning to New York to write. She has been a staff writer at Life, editor-at-large of Civilization, and editor of The American Scholar. Fadiman is also the author of Ex Libris and At Large and At Small, and the editor of Rereadings. She now lives with her family in western Massachusetts and serves as the Francis Writerin-Residence at Yale.
Read an Excerpt
THE SPIRIT CATCHES YOU AND YOU FALL DOWN (Chapter 1) Birth
If Lia Lee had been born in the highlands of northwest Laos, where her parents and twelve of her brothers and sisters were born, her mother would have squatted on the floor of the house that her father had built from ax-hewn planks thatched with bamboo and grass. The floor was dirt, but it was clean. Her mother, Foua, sprinkled it regularly with water to keep the dust down and swept it every morning and evening with a broom she had made of grass and bark. She used a bamboo dustpan, which she had also made herself, to collect the feces of the children who were too young to defecate outside, and emptied its contents in the forest. Even if Foua had been a less fastidious housekeeper, her newborn babies wouldn’t have gotten dirty, since she never let them actually touch the floor. She remains proud to this day that she delivered each of them into her own hands, reaching between her legs to ease out the head and then letting the rest of the body slip out onto her bent forearms. No birth attendant was present, though if her throat became dry during labor, her husband, Nao Kao, was permitted to bring her a cup of hot water, as long as he averted his eyes from her body. Because Foua believed that moaning or screaming would thwart the birth, she labored in silence, with the exception of an occasional prayer to her ancestors. She was so quiet that although most of her babies were born at night, her older children slept undisturbed on a communal bamboo pallet a few feet away, and woke only when they heard the cry of their new brother or sister. After each birth, Nao Kao cut the umbilical cord with heated scissors and tied it with string. Then Foua washed the baby with water she had carried from the stream, usually in the early phases of labor, in a wooden and bamboo pack-barrel strapped to her back.
Foua conceived, carried, and bore all her children with ease, but had there been any problems, she would have had recourse to a variety of remedies that were commonly used by the Hmong, the hilltribe to which her family belonged. If a Hmong couple failed to produce children, they could call in a txiv neeb, a shaman who was believed to have the ability to enter a trance, summon a posse of helpful familiars, ride a winged horse over the twelve mountains between the earth and the sky, cross an ocean inhabited by dragons, and (starting with bribes of food and money and, if necessary, working up to a necromantic sword) negotiate for his patients’ health with the spirits who lived in the realm of the unseen. A txiv neeb might be able to cure infertility by asking the couple to sacrifice a dog, a cat, a chicken, or a sheep. After the animal’s throat was cut, the txiv neeb would string a rope bridge from the doorpost to the marriage bed, over which the soul of the couple’s future baby, which had been detained by a malevolent spirit called a dab, could now freely travel to earth. One could also take certain precautions to avoid becoming infertile in the first place. For example, no Hmong woman of childbearing age would ever think of setting foot inside a cave, because a particularly unpleasant kind of dab sometimes lived there who liked to eat flesh and drink blood and could make his victim sterile by having sexual intercourse with her.
Once a Hmong woman became pregnant, she could ensure the health of her child by paying close attention to her food cravings. If she craved ginger and failed to eat it, her child would be born with an extra finger or toe. If she craved chicken flesh and did not eat it, her child would have a blemish near its ear. If she craved eggs and did not eat them, her child would have a lumpy head. When a Hmong woman felt the first pangs of labor, she would hurry home from the rice or opium fields, where she had continued to work throughout her pregnancy. It was important to reach her own house, or at least the house of one of her husband’s cousins, because if she gave birth anywhere else a dab might injure her. A long or arduous labor could be eased by drinking the water in which a key had been boiled, in order to unlock the birth canal; by having her family array bowls of sacred water around the room and chant prayers over them; or, if the difficulty stemmed from having treated an elder member of the family with insufficient respect, by washing the offended relative’s fingertips and apologizing like crazy until the relative finally said, “I forgive you.”
Soon after the birth, while the mother and baby were still lying together next to the fire pit, the father dug a hole at least two feet deep in the dirt floor and buried the placenta. If it was a girl, her placenta was buried under her parents’ bed; if it was a boy, his placenta was buried in a place of greater honor, near the base of the house’s central wooden pillar, in which a male spirit, a domestic guardian who held up the roof of the house and watched over its residents, made his home. The placenta was always buried with the smooth side, the side that had faced the fetus inside the womb, turned upward, since if it was upside down, the baby might vomit after nursing. If the baby’s face erupted in spots, that meant the placenta was being attacked by ants underground, and boiling water was poured into the burial hole as an insecticide. In the Hmong language, the word for placenta means “jacket.” It is considered one’s first and finest garment. When a Hmong dies, his or her soul must travel back from place to place, retracing the path of its life geography, until it reaches the burial place of its placental jacket, and puts it on. Only after the soul is properly dressed in the clothing in which it was born can it continue its dangerous journey, past murderous dabs and giant poisonous caterpillars, around man-eating rocks and impassable oceans, to the place beyond the sky where it is reunited with its ancestors and from which it will someday be sent to be reborn as the soul of a new baby. If the soul cannot find its jacket, it is condemned to an eternity of wandering, naked and alone.
Because the Lees are among the 150,000 Hmong who have fled Laos since their country fell to communist forces in 1975, they do not know if their house is still standing, or if the five male and seven female placentas that Nao Kao buried under the dirt floor are still there. They believe that half of the placentas have already been put to their final use, since four of their sons and two of their daughters died of various causes before the Lees came to the United States. The Lees believe that someday the souls of most of the rest of their family will have a long way to travel, since they will have to retrace their steps from Merced, California, where the family has spent fifteen of its seventeen years in this country; to Portland, Oregon, where they lived before Merced; to Honolulu, Hawaii, where their airplane from Thailand first landed; to two Thai refugee camps; and finally back to their home village in Laos.
The Lees’ thirteenth child, Mai, was born in a refugee camp in Thailand. Her placenta was buried under their hut. Their fourteenth child, Lia, was born in the Merced Community Medical Center, a modern public hospital that serves an agricultural county in California’s Central Valley, where many Hmong refugees have resettled. Lia’s placenta was incinerated. Some Hmong women have asked the doctors at MCMC, as the hospital is commonly called, if they could take their babies’ placentas home. Several of the doctors have acquiesced, packing the placentas in plastic bags or take-out containers from the hospital cafeteria; most have refused, in some cases because they have assumed that the women planned to eat the placentas, and have found that idea disgusting, and in some cases because they have feared the possible spread of hepatitis B, which is carried by at least fifteen percent of the Hmong refugees in the United States. Foua never thought to ask, since she speaks no English, and when she delivered Lia, no one present spoke Hmong. In any case, the Lees’ apartment had a wooden floor covered with wall-to-wall carpeting, so burying the placenta would have been a difficult proposition.
When Lia was born, at 7:09 p.m. on July 19, 1982, Foua was lying on her back on a steel table, her body covered with sterile drapes, her genital area painted with a brown Betadine solution, with a high-wattage lamp trained on her perineum. There were no family members in the room. Gary Thueson, a family practice resident who did the delivery, noted in the chart that in order to speed the labor, he had artificially ruptured Foua’s amniotic sac by poking it with a foot-long plastic “amni-hook” that no anesthesia was used; that no episiotomy, an incision to enlarge the vaginal opening, was necessary; and that after the birth, Foua received a standard intravenous dose of Pitocin to constrict her uterus. Dr. Thueson also noted that Lia was a “healthy infant” whose weight, 8 pounds 7 ounces, and condition were “appropriate for gestational age” (an estimate he based on observation alone, since Foua had received no prenatal care, was not certain how long she had been pregnant, and could not have told Dr. Thueson even if she had known). Foua thinks that Lia was her largest baby, although she isn’t sure, since none of her thirteen elder children were weighed at birth. Lia’s Apgar scores, an assessment of a newborn infant’s heart rate, respiration, muscle tone, color, and reflexes, were good: one minute after her birth she scored 7 on a scale of 10, and four minutes later she scored 9. When she was six minutes old, her color was described as “pink” and her activity as “crying.” Lia was shown briefly to her mother. Then she was placed in a steel and Plexiglas warmer, where a nurse fastened a plastic identification band around her wrist and recorded her footprints by inking the soles of her feet with a stamp pad and pressing them against a Newborn Identification form. After that, Lia was removed to the central nursery, where she received an injection of Vitamin K in one of her thighs to prevent hemorrhagic disease; was treated with two drops of silver nitrate solution in each eye, to prevent an infection from gonococcal bacteria; and was bathed with Safeguard soap.
Foua’s own date of birth was recorded on Lia’s Delivery Room Record as October 6, 1944. In fact, she has no idea when she was born, and on various other occasions during the next several years she would inform MCMC personnel, through English-speaking relatives such as the nephew’s wife who had helped her check into the hospital for Lia’s delivery, that her date of birth was October 6, 1942, or, more frequently, October 6, 1926. Not a single admitting clerk ever appears to have questioned the latter date, though it would imply that Foua gave birth to Lia at the age of 55. Foua is quite sure, however, that October is correct, since she was told by her parents that she was born during the season in which the opium fields are weeded for the second time and the harvested rice stalks are stacked. She invented the precise day of the month, like the year, in order to satisfy the many Americans who have evinced an abhorrence of unfilled blanks on the innumerable forms the Lees have encountered since their admission to the United States in 1980. Most Hmong refugees are familiar with this American trait and have accommodated it in the same way. Nao Kao Lee has a first cousin who told the immigration officials that all nine of his children were born on July 15, in nine consecutive years, and this information was duly recorded on their resident alien documents.
When Lia Lee was released from MCMC, at the age of three days, her mother was asked to sign a piece of paper that read:
I CERTIFY that during the discharge procedure I received my baby, examined it and determined that it was mine. I checked the Ident-A-Band® parts sealed on the baby and on me and found that they were identically numbered 5043 and contained correct identifying information.
Since Foua cannot read and has never learned to recognize Arabic numerals, it is unlikely that she followed these instructions. However, she had been asked for her signature so often in the United States that she had mastered the capital forms of the seven different letters contained in her name, Foua Yang. (The Yangs and the Lees are among the largest of the Hmong clans; the other major ones are the Chas, the Chengs, the Hangs, the Hers, the Kues, the Los, the Mouas, the Thaos, the Vues, the Xiongs, and the Vangs. In Laos, the clan name came first, but most Hmong refugees in the United States use it as a surname. Children belong to their father’s clan; women traditionally retain their clan name after marriage. Marrying a member of one’s own clan is strictly taboo.) Foua’s signature is no less legible than the signatures of most of MCMC’s resident physicians-in-training, which, particularly if they are written toward the end of a twenty-four-hour shift, tend to resemble EEGs. However, it has the unique distinction of looking different each time it appears on a hospital document. On this occasion, FOUAYANG was written as a single word. One A is canted to the left and one to the right, the Y looks like an X, and the legs of the N undulate gracefully, like a child’s drawing of a wave.
It is a credit to Foua’s general equanimity, as well as her characteristic desire not to think ill of anyone, that although she found Lia’s birth a peculiar experience, she has few criticisms of the way the hospital handled it. Her doubts about MCMC in particular, and American medicine in general, would not begin to gather force until Lia had visited the hospital many times. On this occasion, she thought the doctor was gentle and kind, she was impressed that so many people were there to help her, and although she felt that the nurses who bathed Lia with Safeguard did not get her quite as clean as she had gotten her newborns with Laotian stream water, her only major complaint concerned the hospital food. She was surprised to be offered ice water after the birth, since many Hmong believe that cold foods during the postpartum period make the blood congeal in the womb instead of cleansing it by flowing freely, and that a woman who does not observe the taboo against them will develop itchy skin or diarrhea in her old age. Foua did accept several cups of what she remembers as hot black water. This was probably either tea or beef broth; Foua is sure it wasn’t coffee, which she had seen before and would have recognized. The black water was the only MCMC-provided food that passed her lips during her stay in the maternity ward. Each day, Nao Kao cooked and brought her the diet that is strictly prescribed for Hmong women during the thirty days following childbirth: steamed rice, and chicken boiled in water with five special postpartum herbs (which the Lees had grown for this purpose on the edge of the parking lot behind their apartment building). This diet was familiar to the doctors on the Labor and Delivery floor at MCMC, whose assessments of it were fairly accurate gauges of their general opinion of the Hmong. One obstetrician, Raquel Arias, recalled, “The Hmong men carried these nice little silver cans to the hospital that always had some kind of chicken soup in them and always smelled great.” Another obstetrician, Robert Small, said, “They always brought some horrible stinking concoction that smelled like the chicken had been dead for a week.” Foua never shared her meals with anyone, because there is a postpartum taboo against spilling grains of rice accidentally into the chicken pot. If that occurs, the newborn is likely to break out across the nose and cheeks with little white pimples whose name in the Hmong language is the same as the word for “rice.”
Some Hmong parents in Merced have given their children American names. In addition to many standard ones, these have included Kennedy, Nixon, Pajama, Guitar, Main (after Merced’s Main Street), and, until a nurse counseled otherwise, Baby Boy, which one mother, seeing it written on her son’s hospital papers, assumed was the name the doctor had already chosen for him. The Lees chose to give their daughter a Hmong name, Lia. Her name was officially conferred in a ceremony called a hu plig, or soul-calling, which in Laos always took place on the third day after birth. Until this ceremony was performed, a baby was not considered to be fully a member of the human race, and if it died during its first three days it was not accorded the customary funerary rites. (This may have been a cultural adaptation to the fifty-percent infant mortality rate, a way of steeling Hmong mothers against the frequent loss of their babies during or shortly after childbirth by encouraging them to postpone their attachment.) In the United States, the naming is usually celebrated at a later time, since on its third day a baby may still be hospitalized, especially if the birth was complicated. It took the Lee family about a month to save enough money from their welfare checks, and from gifts from their relatives’ welfare checks, to finance a soul-calling party for Lia.
Although the Hmong believe that illness can be caused by a variety of sources—including eating the wrong food, drinking contaminated water, being affected by a change in the weather, failing to ejaculate completely during sexual intercourse, neglecting to make offerings to one’s ancestors, being punished for one’s ancestors’ transgressions, being cursed, being hit by a whirlwind, having a stone implanted in one’s body by an evil spirit master, having one’s blood sucked by a dab, bumping into a dab who lives in a tree or a stream, digging a well in a dab’s living place, catching sight of a dwarf female dab who eats earthworms, having a dab sit on one’s chest while one is sleeping, doing one’s laundry in a lake inhabited by a dragon, pointing one’s finger at the full moon, touching a newborn mouse, killing a large snake, urinating on a rock that looks like a tiger, urinating on or kicking a benevolent house spirit, or having bird droppings fall on one’s head—by far the most common cause of illness is soul loss. Although the Hmong do not agree on just how many souls people have (estimates range from one to thirty-two; the Lees believe there is only one), there is a general consensus that whatever the number, it is the life-soul, whose presence is necessary for health and happiness, that tends to get lost. A life-soul can become separated from its body through anger, grief, fear, curiosity, or wanderlust. The life-souls of newborn babies are especially prone to disappearance, since they are so small, so vulnerable, and so precariously poised between the realm of the unseen, from which they have just traveled, and the realm of the living. Babies’ souls may wander away, drawn by bright colors, sweet sounds, or fragrant smells; they may leave if a baby is sad, lonely, or insufficiently loved by its parents; they may be frightened away by a sudden loud noise; or they may be stolen by a dab. Some Hmong are careful never to say aloud that a baby is pretty, lest a dab be listening. Hmong babies are often dressed in intricately embroidered hats (Foua made several for Lia) which, when seen from a heavenly perspective, might fool a predatory dab into thinking the child was a flower. They spend much of their time swaddled against their mothers’ backs in cloth carriers called nyias (Foua made Lia several of these too) that have been embroidered with soul-retaining motifs, such as the pigpen, which symbolizes enclosure. They may wear silver necklaces fastened with soul-shackling locks. When babies or small children go on an outing, their parents may call loudly to their souls before the family returns home, to make sure that none remain behind. Hmong families in Merced can sometimes be heard doing this when they leave local parks after a picnic. None of these ploys can work, however, unless the soul-calling ritual has already been properly observed.
Lia’s hu plig took place in the living room of her family’s apartment. There were so many guests, all of them Hmong and most of them members of the Lee and Yang clans, that it was nearly impossible to turn around. Foua and Nao Kao were proud that so many people had come to celebrate their good fortune in being favored with such a healthy and beautiful daughter. That morning Nao Kao had sacrificed a pig in order to invite the soul of one of Lia’s ancestors, which was probably hungry and would appreciate an offering of food, to be reborn in her body. After the guests arrived, an elder of the Yang clan stood at the apartment’s open front door, facing East 12th Street, with two live chickens in a bag on the floor next to him, and chanted a greeting to Lia’s soul. The two chickens were then killed, plucked, eviscerated, partially boiled, retrieved from the cooking pot, and examined to see if their skulls were translucent and their tongues curled upward, both signs that Lia’s new soul was pleased to take up residence in her body and that her name was a good one. (If the signs had been inauspicious, the soul-caller would have recommended that another name be chosen.) After the reading of the auguries, the chickens were put back in the cooking pot. The guests would later eat them and the pig for dinner. Before the meal, the soul-caller brushed Lia’s hands with a bundle of short white strings and said, “I am sweeping away the ways of sickness.” Then Lia’s parents and all of the elders present in the room each tied a string around one of Lia’s wrists in order to bind her soul securely to her body. Foua and Nao Kao promised to love her; the elders blessed her and prayed that she would have a long life and that she would never become sick.
THE SPIRIT CATCHES YOU AND YOU FALL DOWN Copyright © 1997 by Anne Fadiman
Table of Contents
1 Birth 3
2 Fish Soup 12
3 The Spirit Catches You and You Fall Down 20
4 Do Doctors Eat Brains? 32
5 Take as Directed 38
6 High-Velocity Transcortical head Therapy 60
7 Government Property 78
8 Foua and Nao Kao 93
9 A Little Medicine and a Little Neeb 106
10 War 119
11 The Big One 140
12 Flight 154
13 Code X 171
14 The Melting Pot 181
15 Gold and Dross 210
16 Why Did They Pick Merced? 225
17 The Eight Questions 250
18 The Life or the Soul 262
19 The Sacrifice 278
Afterword to the Fifteenth Anniversary Edition 289
Note on Hmong Orthography, Pronunciation, and Quotations 305
Notes on Sources 307
Reading Group Guide
This guide is intended to enrich your experience of reading The Spirit Catches You and You Fall Down, winner of the National Book Critics Circle Award. This moving chronicle of a very sick girl, her refugee parents, and the doctors who struggled desperately to treat her becomes, in Anne Fadiman's deft narrative, at once a cautionary study of the limits of Western medicine and a parable for the modern immigrant experience.
Lia Lee was born in the San Joaquin valley in California to Hmong refugees. At the age of three months, she first showed signs of having what the Hmong know as qaug dab peg (the spirit catches you and you fall down), the condition known in the West as epilepsy. While her highly competent doctors saw the best treatment in a dizzying array of pills, her parents preferred a combination of Western medicine and folk remedies designed to coax her wandering soul back to her body. Over the next four years, profound cultural differences and linguistic miscommunication would exacerbate the rift between Lia's loving parents and her caring and well-intentioned doctors, eventually resulting in the loss of all Lia's higher brain functions. Fadiman weaves this personal tragedy, a probing medical investigation, and a fascinating look at Hmong history and culture into a stunningly insightful, richly rewarding piece of modern reportage.
Questions and Topics for Discussion
The two cultures
1. Do you think the author was evenhanded in her presentation of Hmong culture and medical culture?
2. The book contains many Hmong phrases and many medical phrases, both unfamiliar to most readers. Why do you think the author included them?
3. Over the centuries, the Hmong fought against many different peoples who claimed sovereignty over their lands. What role has this tumultuous history played in the formation of Hmong culture?
4. How does the Hmong folktale about how Shee Yee fought with nine evil dab brothers, told at the end of chapter 12, reflect Hmong culture?
5. What do traditional Hmong consider their most important duties and obligations? What do American doctors consider their most important duties and obligations?
6. In chapter 18, Fadiman writes, "As William Osler once saidor is said to have said‘Ask not what disease the person has, but rather what person the disease has.'" How might the events of this book have unfolded if Osler's dictum were universally followed in the medical profession? How would your relations with your own doctors change?
7. In matters of attitude, what might the average American doctor learn from a Hmong txiv neeb (shaman)? What might the txiv neeb learn from the doctor?
8. In her preface, the author says that while she was working on this book, she often asked herself two questions: "What is a good doctor?" and "What is a good parent?" How do you think she might have answered her own questions? How would you answer them?
9. At the end of chapter 18, Sukey Waller asks, "Which is more important, the life or the soul?" What do you think?
10. The Spirit Catches You and You Fall Down revolves around a small child who for much of the book is too young to speak for herself, and at the end is unable to. Do you nonetheless feel you know Lia Lee? Do you believe that even though she cannot walk or talk, she is a person of value? Why?
11. In chapter 8, after describing Foua's competence as a mother and farmer in Laos, Fadiman quotes her as saying, "I miss having something that really belongs to me." What has Foua lost? Is there anything that still "really belongs" to her?
12. How do you feel about the Lees' reluctance to give Lia her medicine as prescribed? Can you understand their motivation? Do you sympathize with it?
13. In chapter 7, Neil Ernst says, "I felt it was important for these Hmongs to understand that there were certain elements of medicine that we understood better than they did and that there were certain rules they had to follow with their kids' lives." Why didn't this message get through to the Lees? If you were Neil, would you feel this way too?
14. In chapter 15, Foua, who has heard that one of the Ernst sons has leukemia, embraces Peggy. After all the conflict between them, why are they finally able to resolve their differences? Do you think this could have happened earlier?
15. Since the publication of the book, Anne Fadiman has said that if she lived in Merced, she would choose Neil and Peggy as her children's pediatricians. Would you?
16. Fadiman describes May Ying Xiong as not just an interpreter but a cultural broker. What's the difference? What were May Ying's contributions to the book?
17. Were you surprised by the quality of care and affection given to Lia by her foster parents? How did Lia's foster parents feel about Foua and Nao Kao? Was foster care ultimately to Lia's benefit or detriment?
18. The only American who fully won the Lees' trust was Jeanine Hilt, their social worker. Why did Jeanine succeed where so many others had failed?
19. The book contains brief but important sections on three Hmong leadersJonas Vangay, Blia Yao Moua, and Dang Mouawho are multilingual and gainfully employed. What did they teach Fadiman? Why did she include them?
20. How might this book have been different if it had been written by a Hmong? A doctor? An anthropologist?
21. From a writer's point of view, what are the advantages and disadvantages of being an outsider in the two cultures Fadiman explores?
22. "The spirit catches you and you fall down" is a literal translation of the Hmong phrase for epilepsy. Why do you think the author chose such a long and difficult title?
23. The book has an unusual structure: Lia's story occupies the odd-numbered chapters, and background material occupies the even-numbered chapters. Why do you think Fadiman organized her narrative this way?
24. At the beginning of chapter 2, Fadiman tells the story of a Hmong student who gave an oral report on Fish Soup. What is the concept of "fish soup," and how is it reflected in the book itself?
25. One of the ways by which Fadiman places the doctors and the Lee family on equal footing is her decision to refer to all of them by their first names (instead of saying, for instance, "Dr. Ernst"). What are some other ways?
26. Many readers have commented that The Spirit Catches You and You Fall Down is a book without villains. Do you think that from a literary point of view this is a flaw?
Other Books of Related Interest
Virginia Barnes Lee, Aman: Story of a Somali Girl; Michael Bérubé, Life as We Know It; Robert Olen Butler, The Deep Green Sea; Lan Cao, Monkey Bridge; Temple Grandin, Thinking in Pictures: And Other Reports from My Life with Autism; Jamaica Kincaid, My Brother; Maxine Hong Kingston, Woman Warrior; Oliver Sacks, The Man Who Mistook His Wife for a Hat: And Other Clinical Tales; Esmeralda Santiago, When I Was Puerto Rican; Susan Sheehan, Is There No Place on Earth for Me?; Abraham Verghese, My Own Country: A Doctor's Story.
Most Helpful Customer Reviews
As a physician myself, this book really hit close to home. It really was an eye-opener for everybody in the health care system as well as for anybody in the Western world to strive not to view the world in an ethnocentric manner. Most of the time, physicians have a 'tunnel vision' when interacting patients. Though oftentimes done without malice, it nevertheless disregards the patient as an individual with his/her own values and beliefs.This redefines medicine and focuses on it being an art rather than a science of treating patients as whole individual:body, mind and soul. Anne Fadiman succeeded in presenting the material not in an antagonistic way, by focusing on Lia and her family, and by providing a better understanding of the Hmong culture. I keep a copy in my office with the cover showing Lia's picture within easy view to serve as a reminder to me in my everyday interaction with patients.
This is a compelling story of a family of Hmong immigrants and their struggles with the American medical community following the onset of their daughter's epilepsy. This book made me care about a whole host of things and people I had never heard of, the Hmong. This powerful tale, (true), is about the clash of two cultures and is written beautifully with great feeling. The reader sympathizes with both the terrible trouble that the Hmong people have had in recent years and with the plight of the American doctors of trying to treat people whose cultural life is so different from their own. Reads like fiction.Really good!!
The Spirit Catches You and You Fall Down by Anne Fadiman, describes the tumultuous life of the Lee family, a Hmong immigrant family with an epileptic special needs child. Many misunderstandings and cultural clashes occur because the Hmong people refuse assimilation into the American lifestyle. The Hmong will not accept American norms and they stubbornly cling to their traditions and culture against great odds and tumult. Life for the average new Hmong immigrant family is very complicated and unnerving, but the life of the Lee family is even more turbulent and disrupted because their epileptic thirteenth child, Lia, requires frequent medical attention or hospitalization. The Hmong society has their own methods of treatment for the sick and they fail to comply with the regulations and laws of the American Medical system. The father, Nao Kao Lee, and mother, Foua Yang, do not understand the reasoning behind the American medical procedures. Problems communicating with the medical practitioners and doctors who serve the Lee family are further compounded because neither of the parents can read nor speak English. The parents can write their names in English and will often sign consent forms that they do not understand in attempts to shorten the hospitalization. The family often does not comply with hospital regulations or with norms that relate to the medical profession because what they perceive as healing practices are not followed and instead foreign methods that are perceived to be harmful or not nurturing are introduced. Problems escalate when the Lees fail to properly administer prescribed medications to Lia. A cycle of unfortunate hospitalizations occurs, always ending with doctors at wits end to deal with the Lee family. Eventually, Lia is sent to live with the Kordas, a foster care family. In the end of the story Lia is again hospitalized for a seizure that places her into a comatose state. The Lee family must fight a long battle for the right to take Lia home again and finally they are granted the permission to take her home to provide love and nurturing until Lia's pending death. Their goal is always to reunite the family by taking Lia home and caring for her in the method they believe is best for their child. The Lee family is fortunate because a support group of doctors and health care workers have taken an interest in Lia and they want to find the best solution for Lia and the family. Jeannie Hilt is the primary social worker that works with the Lee family case. Jeannie Hilt is accepted and trusted by the Lee family to the extent that she is welcomed into their home. Jeannie Hilt's efforts help the family regain Lia after foster care. Other characters of the story are medical professionals who come to the aid of the Lee family. Neil Ernst is a doctor that dedicates much of his time and profession to helping the Lee family. He rushes to Merced Community Medical Center (MCMC) whenever he can to alleviate Lia's pain and to help Lia with her seizure. Doctor Ernst works very closely with his wife, Peggy Philp, to care for Lia almost as their exclusive patient. The teams of Neil Ernst and Peggy Philp have almost crossed professional boundaries because of their extent of devotion to Lia and the Lee family.
A moving and informative story on two counts. First, it is the story of Lia Lee, a little Hmong girl born in Merced CA, who suffered from a severe form of epilepsy, and the tragedy that occurred because of the vast cultural differences between her family and the doctors at Merced Community Medical Center who wanted nothing more than to help her. Second, and just as important, it is also the story of the Hmong, many of whom emigrated to the US from Laos as a result of the Vietnam War, and of the culture shock a great number of them went through when they came here. Because of this culture shock, Lia's epilepsy eventually caused her to go into an irreversible coma, and at the time Fadiman wrote this book she was still alive although in a completely vegetative state. The tragedy is that nobody in particular is really to blame for Lia's situation - the differences between her community (the Hmong) and the community that wanted to help her (the MCMC doctors) were just so vast as to make it next to impossible for a resolution to her illness to be found. Fadiman patiently makes friends not only with Lia's family, but with the Merced Hmong in general as well as the doctors and staff at MCMC who tried to help her. And she does not show any signs of anger or impatience in this effort, which shows in her narration of Lia's story - indeed, she shows nothing but respect for them. She is just as respectful with her history of the Hmong. There are no boring statistics or dry history to be found in this book - Fadiman throws in several pieces of Hmong folklore and legends to make their story more interesting. Reading this book I really wished for a miracle towards the end - that Lia would somehow come out of her coma and once again become a happy and healthy little girl. But unfortunately life does not always give us everything we want.
The Spirit Catches You and You Fall Down by Anne Fadiman is the compelling story of Lia Lee, a young Hmong child with a progressive form of epilepsy, and the way in which her family's culture collided with the culture of her American doctors. Fadiman tells the Lee's story within the context of Lia's family history and the painful, complicated history of the Hmong people. The story she tells is a tragic one in which a lack of communication coupled with two radically different belief systems ultimately leads to a devastating cultural impasse. Fadiman tells Lia's story interspersed with descriptions of the struggles of the Hmong people during the Vietnam war, as well as how they were viewed once they came to America. For example, the Hmong viewed welfare checks as the promised repayment for their services in the war. Americans viewed the Hmong as draining limited services, jamming the schools, and taking money away from the states. Fadiman identifies the cultural barrier between the scientific based practices of the American doctors and the animistic, spiritual practices of the Hmong culture. This cultural barrier poses an even larger threat than the language barrier. She explains this effectively, while providing insight into methods that can be used to bridge the gap between them. Within the context of the book, there are many useful suggestions for anyone who is working with members of Hmong families or any family from a culture other than their own. One of the unique attributes of this book is the way in which Fadiman remains unbiased, or at least honest about her biases, towards both sides of the cultural dyad. Fadiman presents the Lee family in a positive light, showing their dedication to and love for their daughter Lia. She presents Lia's doctors in a positive light as well, presenting the reader with displays of their concern and commitment to Lia's welfare. While the information presented in the book would certainly have the most relevance for people working in a medical profession, it carries along many implications for other professionals as well. For speech-language pathologists (SLPs) working with members of a Hmong family, it is important to look beyond the language differences and recognize the cultural differences that will affect treatment at an even more fundamental level. For example, as with many cultures, when discussing something of importance, it is respectful to speak to the oldest male. When speaking through the use of an interpreter, speak to the family, not the interpreter. However, when possible, the interpreter should be bicultural, and be able to act as a cultural informant for the SLP. Perhaps one of the most summative and useful points of the book is when Fadiman discusses the following eight questions used by Arthur Kleinman, a psychiatrist and medical anthropologist from Harvard Medical School. 1. What do you call the problem? 2. What do you think has caused the problem? 3. Why do you think it started when it did? 4. What do you think the sickness does? How does it work? 5. How severe is the sickness? Will it have a short or long course? 6. What kind of treatment do you think the patient should receive? What are the most important results you hope she receives from this treatment? 7. What are the chief problems the sickness has caused? 8. What do you fear most about the sickness? If used correctly, these questions could provide great insight into doing any kind of medical work with patients from a different culture. Many of them can be altered quite easily to fit the clinician-client model that is used for speech language pathology. Had these questions been asked of the Lee family, and the answers to them taken seriously, the outcome of Lia's struggle may have been changed significantly. These eight questions could have also been appropriately applied to Lia's doctors. This may have helped her doctors realize that they approached Lia'
Love it! It was really educational. I feel like I learned a lot about the Hmong people and their culture and some of the challenges faced in healthcare every day with cultural barriers. As a nurse myself, I sometimes come in contact with patients who are from different cultures and ethinic groups and although my hospital does its best to provide interpreters either via live or phones or videos, there are the rare moments when we simply have no interpreter for a patient and communication becomes a really hassle at that point. I could see clearly relate to both Lia's parents and the doctors and thier struggles. As someone whose first language isn't English, I could realte to Lia's parents'struggles in dealing with a new country and new set of rules and regulations while trying to maintain their own cultural beliefs and practices. As a nurse in the Western World, I could also see the frustrations the healthcare providers were feeling when they thought they were doing their best and from their view points, it appeared that Lia's parents were not cooperating and seemed to be largely ignoring their recommendations in regards to their daughter's health. It was tragic that Lia's live ended up in such a state and I wish I knew what ever happened to Lia and her family after the book ended. Thumbs up to the author for doing a great job! Loved the book!
I love this book for its comprehensive dealing with a difficult subject. I liked that there seemed to be no bad side--just different sides that didn't understand each other. With more and more immigrants bringing differing cultural beliefs and expectations, it is a very relevant subject matter. It is one of the best books I have ever read. While I wished for a better outcome, the well-researched info on the Hmong culture was fascinating and well worth the time taken to read.
I bought this book for a social work student for her graduation. I am a social worker in a pediatric hospital. This book is so relevant for us because we are confronted with similar dilemmas every day. This book reminds us to take culture into consideration when assessing for medical neglect. For general readers, this book is just a great read.
I felt the author was depicting a culture that was so radically different from America's, that to simply come to America and learn to speak English, wouldn't have sufficed. I don't think the author was biased towards the Hmong. She gave a fascinating account of their very different culture and showed how difficult it was for the parents to deal with American doctors, as well as how difficult it was for the doctors to deal with the parents. I'd highly recommend this book.
As a Hmong woman who was born and raised in the US, this book was an eye opener. Not only did it teach me about my own culture, but it helped me to relate to the difficulties that all minorities in this nation face. Because of my personal experiences, I recommend this to, at the very least, all educators and health care providers. This story is very touching and is indeed, very sad. It's very disappointing that we live in such a free nation, yet we are so ignorant of all the different people and cultures around us.
The Spirit Catches You and You Fall Down is a beautifully written book about a culture that very few people know anything about. As a Puerto Rican with working-class roots, I can relate to the clash of culture and the problems with which immigrants/emmigrants must grapple in different hierarchical structures. Those qualities that gain respect for a family in a poor, rural village receive no admiration in the US, and the loss of respect and social status is quite painful. In a country of experts where a listing of one's degrees is all-important, individuals from oral cultures become invisible. The physicians who worked with the Hmong did not think they needed a translator because the doctors, with their deified positions in US society, did not think they could learn anything from the 'primitive' culture of the Hmong. However, all of life is observation and who could be more observant than people whose very survival is dependent upon their powers of observation. And science is based upon observation. But the physicians could not dream of having a reciprocal relationship with persons who were not published in medical journals and could not read numbers on a thermometer.
One of my all time favorites. I agree, it should be required reading for anybody in the medical field. I can only think to descibe it as a consequence of cultural misunderstanding.
This is one of my favorite non-fiction books ever. This story will change the way you view the world and other cultures. If you are interested in medicine, anthropology, or a wholly absorbing human interest story, you will not be disappointed.
Anyone involved in healthcare should be required to read this book. What an eye opener. Well written and impossible to put down.
Great book, gives great insight into cultural differences and perceptions. Was a required reading for one of my classes but it was wonderful! Makes you see differences between the American culture and the Hmong people. you will enjoy it!
I had to read this book for a Nursing class. At first I was irritated that I would have to read the whole book as well as the other 2 that came for the class. I started reading this story and I have to tell you that it was hard to put it down once I started it. I read the book in 1 day and reread it again for the class to catch all the details that I missed the first time. I also had to write a case study on the book and that was so much fun. This story tells the real life issues that face immigrants that come to our country and do not speak the language. Most Hmong can not read or write in their own language, for get them using ours. Not all, there are some that have been raised in America and can read and write English very well. I was at the hospital with my family and there was a poster that said "point to your language and we will get you a interpreter". I laughed, most Hmong could not read the sign, even though their language was one of them listed. Anne Fadiman know how to tell a story and the history and research that she did for this book is truely amazing. I wish she would write an update and tell us how Lia Lee is today.
This book was assigned to me for a course that I took. One of the best assigned readings I have ever had!
This is an important book and well written. We had it in college as common reading and I delighted at how easy it was for me to follow. I came away with a greater understanding of the cultural beliefs of the Hmong people. Another exceptional book to read on the Hmong is by Kao Kalia Yang. The book is entitled "The Latehomecomer."
This book really makes you think and puts your life into perspective. For a family who cares so greatly for their daughter to keep going during such a difficult time is amazing! I can't imagine being in their shoes.
Anne Fadiman does an excellent job in writing this book. Her style and grace made it all the better. I also wanted to recognize her impartialness when describing both the doctors and the Lee family. Anybody in the healthcare industry would benefit from reading this book.
Every health care professional should be required to read this book. The health care culture of this country is difficult for the average american to understand. I can only imagine the terror that the Lee family must have felt as they tried to help their daughter.
I read this book a few years back to do a paper on social problems. Being Hmong and raised in America, I thought this book did a good job of bringing to light the problems that are so common among many Hmong families and western medicine. I have had my own experience with this issue. My mother would rather suffer the pain of gall stones than to have her gall blatter removed because she was worried that she woudln't be complete when she dies and therefore couldn't enter the afterlife. Reading this book, I realize how crazy some of it may sound to an American because I'm Hmong and it's crazy to me. But it is my reality. This is a real issue and I hope that through books such as this, we can work on our parts to come to a civil solution. I highly recommend this book.
This thoroughly fascinating book is a must read for anyone interested in accounts of the collision of cultures that often ensues when immigrants arrive in America. The author has taken the time and energy to give us, not just an engrossing and tragic tale, but also very detailed and fair portraits of the people involved in it. It would have been so much easier for a lazy author to use this story to demonize the California medical system. Instead, Anne Fadiman gives us an even-handed, thoughtful account of how people of two very different cultures were forced to interact ¿ an unparalleled piece of investigative journalism.
Excellent comparison of the clash between Hmong cultural views of epilepsy and the american medical establishment's view, centered on a hmong family's daughter living in California.