The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures

This chapter describes the severity of Lia’s epilepsy in the early years of her life and her numerous visits to MCMC. Lia repeatedly suffers from “status epilepticus” where she seizes for more than 20 minutes without regaining consciousness (39). The seizures only stop when the doctors administer large doses of anticonvulsant medicines intravenously. Eventually doctors use restraints on Lia and nets over her crib to prevent her from moving around, even when she is conscious, so they can administer medicine in her veins more easily—an act her parents view as cruel and excessive, for it also prevents them from holding Lia.

Chapter 5 introduces two key characters in the book, Neil Ernst and Peggy Philp, who are the supervising pediatricians at MCMC. They are married to each other, devoted to their jobs, and the main pediatricians involved in Lia’s case. They help Fadiman review Lia’s medical records, which amounts “to five volumes, longer than the chart of any other child who has ever been admitted to MCMC” (40). When reviewing the records, Neil and Peggy (whom Fadiman refers to by their first names) note many medical mistakes and point out their own errors, showing a high degree of critical self-awareness.

The medical staff instruct the Lees to use certain medicines at home, in varying amounts and at different times of the day. Fadiman lists the staggering number of medicines prescribed, noting that in less than four years Lia’s prescription changed 23 times. Because the Lees do not understand English, it is difficult for them to follow instructions of: “Take as directed” (47). When the staff send nurses to the Lee’s home, it is apparent that the Lees, even when given illustrated directions and different tools for administering the drugs correctly, do not want to use the medicines as prescribed. The Lees recognize that the drugs have side-effects that exacerbate Lia’s symptoms and cause problems when there were none before. As a result, the medical staff label the Lees as “non-compliant” parents (48).

Fadiman notes that over time, Lia suffers from developmental delays, which her doctors view as tragic because they believe the drugs, if administered correctly, would reduce the seizures. They blame Lia’s parents for not adhering to their directions. In retrospect, Neil and Peggy realize they could have been more compassionate towards the Lees, but at the time they mainly are concerned with Lia’s welfare and frightened and frustrated by the lack of progress in her development. They also are annoyed that the Lees never thank them or show gratitude for the medical care Lia receives. In 1985, after many incidents of the Lees not administering medicines to Lia correctly, including overdosing her, Neil sends a letter to the Health Department and Child Protective Services requesting that the state remove Lia from her parents’ custody because of their noncompliance. The Superior Court of California grants Neil’s request.

The chapter begins by contrasting the specialization and subdivision of American biomedicine with Hmong views of healthcare, which they approach holistically. As Fadiman explains, “I concluded that the Hmong pre-occupation with medical issues was nothing less than a preoccupation with life. (And death. And life after death)” (61). The chapter describes many of the cross-cultural misunderstandings between American medical practitioners and the Hmong, who narrate their humiliating experiences with doctors at MCMC. Fadiman attributes some of these negative experiences to language barriers, but she also highlights the ignorance and ethnocentrism that American doctors exhibit towards the Hmong.

Fadiman incorporates the perspective of doctors who, most times, want to communicate with their Hmong patients respectfully, yet fail in their attempts because they do understand Hmong cultural values, particularly in regard to age and gender hierarchies. Fadiman first learns about the Hmong from a close college friend, Bill Selvidge, who once worked at MCMC as chief resident. Bill describes the frustrations of his fellow doctors, some of whom “suggested the preferred method of treatment for [Hmong patients] was high-velocity transcortical lead therapy,” which is another way of saying, “The patient should be shot in the head” (63). The statement reveals the enormity of the cultural conflicts between American doctors and their Hmong patients, which is what prompts Fadiman to conduct her research at MCMC.

One American doctor, Roger Fife, is successful with the Hmong who flock to his private practice in Merced. While the medical staff at MCMC do not hold Dr. Fife in high esteem and view him as “a little thick,” his Hmong patients appreciate that he “doesn’t cut”—a reference to Dr. Fife’s avoidance of surgery and forcing his patients to comply with conventional medical practices (76).

Fadiman questions whether the Lees would have been better off if Lia received care from Dr. Fife instead of the doctors at MCMC. She notes the dilemma that Neil faces in his commitment to provide Lia with optimal care, which for him means complete adherence to a rigorous medical regimen. Neil’s uncompromising stance comes to head when he reports the Lees for child endangerment, which he admits is fueled, in part, by his desire to send a message to the wider Hmong community that medical non-compliance is not tolerated. Neil’s concern for Lia’s welfare also is a legal obligation. Public health workers must report abuse to higher authorities, or they may be held accountable. When the residents at MCMC learn Neil is responsible for taking Lia away from her parents, they are shocked and disagree with his decision. They all recognize the immense love Lia receives from her parents and view them as good caretakers.

Child Protective Services (CPS) places Lia in a temporary foster home to provide the Lees with the opportunity to show they can administer Lia’s medicines correctly. The Lees fail to give her the medicines, and the court places Lia with another foster family—Dee and Tom Korda—for six months. Lia’s father attends the court hearing but does not realize he can object to the decision. Fadiman describes the trauma the Lees experience losing custody of Lia, as initially they are not allowed to visit her or know where she has been taken. Although the Kordas are generous and kind foster parents, Lia suffers, as she misses her family and regresses emotionally, socially, and developmentally. She continues to have seizures despite the correct administration of her medicines. When the Lees and Kordas finally meet, they develop a good relationship, to the extent that Dee regularly leaves her baby with Foua when she takes Lia to her medical appointments. Like the medical residents, Dee does not think Lia should have been removed from her family and makes a formal recommendation for CPS to reunite Lia with her parents.

The recommendation is not requested since the Lees repeatedly fail to give Lia her medicines. Jeanine Hilt, a social worker, recognizes that the Lees may lose custody of Lia permanently and makes it her mission to show them how to give the medicines correctly. Her work is simplified when a specialist recommends a new drug, Depakene, that is easier to administer. The Lees begin to trust Jeanine and gain confidence with the new drug regimen. They nearly lose the chance to regain custody of Lia though when Sue Xiong, a Hmong interpreter, comes to the house. Sue accompanied the police officers who originally removed Lia from her family, and Nao Kao views her as a sell-out and threatens to kill her with his baseball bat. She does not enter the house again, and Jeanine does not report the incident in her recommendation for the Lees to regain custody of Lia who finally returns home after 10 months.