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( Read Ebook ) õ The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures ï Lia Lee Was Born InTo A Family Of Recent Hmong Immigrants, And Soon Developed Symptoms Of Epilepsy ByShe Was Living At Home But Was Brain Dead After A Tragic Cycle Of Misunderstanding, Over Medication, And Culture Clash What The Doctors Viewed As Clinical Efficiency The Hmong Viewed As Frosty Arrogance The Spirit Catches You And You Fall Down Is A Tragedy Of Shakespearean Dimensions, Written With The Deepest Of Human Feeling Sherwin Nuland Said Of The Account, There Are No Villains In Fadiman S Tale, Just As There Are No Heroes People Are Presented As She Saw Them, In Their Humility And Their Frailty And Their Nobility Anne Fadiman addresses a number of difficult topics in her depiction of a Hmong couple s quest to restore the soul to their child While I consider myself a culturally sensitive individual, having been raised in a family of doctors and nurses, I have long held the conviction that the world s best doctors whether imported or native tread on American soil Reading Fadiman s account which sometimes includes actual excerpts from the patient s charts , I was forced to take a hard look at my assumptions In the course of reading this book, I have redefined my idea of what constitutes a good doctor Fadiman spent hundreds of hours interviewing doctors, social workers, members of the Hmong community anyone who was somehow involved in Lia Lee s medical nightmare She pored over years of medical records, trying to make sense of the events that caused a spirited, loving toddler to slowly devolve into a vegetative state What she found was that the doctors orders, prescribed medications, hospital care, etc., were all based on a number of Western assumptions that did not take the family s and child s best interests into consideration No attempt was made to understand how the family saw the disease or what efforts they were making on their own to address the situation More than a translator, what doctors and other professionals involved in Lia s case needed was a cultural broker who could have stepped in and possibly saved Lia s brain from further deterioration Fadiman s book is a difficult read, not because of specialized vocabulary or lofty philosophical concepts, but because there comes a point when the reader realizes that the barriers faced by those involved were muchcultural than they were linguistic In a very real way, the Lees inhabited a different world than the doctors, and vice versa Each assumed that their way was best, and neither made a genuine effort to understand the other s motivations, much less their logic In the end, there was no simple solution to their plight, butmutual respect and understanding of the differences between the cultures would have benefitted everyone involved If there is a moral to Fadiman s work, it may be this The best doctors are not those who know the most, but rather those who admit what they do not know, and try to understand the full picture Good doctors may treat the disease, but the best doctors treat the individual. If nothing else can be said about this book, it should be said that it will cause a reaction Most books are a monologue The author is telling you something and you listen Anne Fadiman s book is so engaging, and touches on so many sensitive subjects, that it slike a dialogue between author and reader And I use the word dialogue literally During the course of this book, I found myself audibly voicing my opinions at the page like a crazy person My wife would ask me what I was saying, and I d tell her I m not talking to you I m talking to the book Sometimes I agreed with Fadiman Sometimes I didn t In any event, I was locked in, absorbed The Spirit Catches You and You Fall Down is a sad, beautiful, complicated story that is ostensibly about a tragedy that arose from a clash of cultures, but is really about the tragedy of human beings.Lia Lee was three months old when she suffered her first epileptic seizure Her parents, Nao Kao and Foua, were Hmong refugees from Laos who didn t speak any English They took Lia to Merced Community Medical Center, a county hospital that just happened to boast a nationally renowned team of pediatric doctors None of those doctors spoke the Hmong language From this initial collision different languages, different religions, different ways of viewing the world sprang a dendritic tree of problems that resulted in a medical and emotional catastrophe for Lia, her family, and her doctors When Lia first came to the hospital, the language barrier an inability to take a patient history caused a misdiagnosis The next time she arrived, however, she was actively seizing Thus, her doctors were able to determine her malady and come up with a game plan on how to treat it For a variety of reasons both spiritual and practical , the Lees did not follow the treatment plan, and Lia didn t receive the specific care her doctors ordered Eventually, one of her doctors filed a petition with the court to have Lia removed from the home and placed into a foster home This allowed for a rough sort of compromise to be reached Lia s treatment plan was simplified and madepalatable to the Lee s wishes On the other hand, the Lees promised to follow the new plan as prescribed For a time, Lia seemed to thrive This d tente looked good on the surface, but masked an unfixable wound to the relationship between the Lees and their daughter s doctors By the time the final seizure came for Lia Lee, her family actively distrusted the people working at the Merced Community Medical Center Fadiman intercuts her narrative of Lia Lee s care with sections on the history of the Hmong in general and the journey of the Lees in particular The Hmong people are an ethnic group who once lived in southern China The Chinese pushed many of the Hmong from their borders, and they ended up living in Burma, Vietnam, Thailand, and Laos During the Vietnam War, the CIA secretly recruited the Hmong to fight against Communism When America pulled out of Vietnam, a Communist government in Laos persecuted the Hmong, and many fled the country in fear of their lives The Lees left northwest Laos, spent time in a Thai refugee camp, and eventually ended up in California, where Lia was born Fadiman explores the complicated system of rituals and beliefs that govern traditional Hmong life The Lees, like many Hmong, are animists, with a belief in a world inhabited by spirits This faith dictated how the Lees understood Lia s illness and how they wanted it treated When Lia was about three months old, her older sister Yer slammed the front door of the Lees apartment A few moments later, Lia s eyes rolled up, her arms jerked over her head, and she fainted The Lees had little doubt what had happened Despite the careful installation of Lia s soul during the hu plig ceremony, the noise of the door had been so profoundly frightening that her soul had fled her body and become lost They recognized the resulting symptoms as qaug dab peg, which means the spirit catches you and you fall down On the one hand, it is acknowledged to be a serious and potentially dangerous condition On the other hand, the Hmong consider quag dab peg to be an illness of some distinction.I read The Spirit Catches You and You Fall Down for my Husband s Book Club a shadow book club created after all our wives started one of their own It came as a surprise pick from one of our quieter members, but proved to be one of our best choices There are a lot of things to discuss A veritable cornucopia of debate, dissention, and gentlemanly disagreement Vietnam, CIA, Laos, and the debt owed the Hmong refugee crises and how they are handled the assimilation of refugees and immigrants and even end of life decisions We met to discuss this book at a local brew pub where we could drink IPAs and eat pretzels with cheese Most of us got pretty drunk Usually, six drunks sitting around a table can solve most of the world s problems In this case, though, we mostly ended up in total divergence I think that s a testament to Fadiman s willingness to take on every third rail in modern American life religion, race, and the limits of government intervention An aside One of Fadiman s chapters, called The Life or the Soul, posits the question of whether it isimportant to save someone s life in which medical decisions trump all or their soul in which a person wouldn t receive certain treatments that contradicted their deeply held beliefs I m not sure if it was the high alcohol content by volume in the beer, but the Husband s Book Club somewhat surprisingly split 3 3 on the issue.Judging from other reviews I ve read, this is a book that angered people Much of the vitriol is aimed at the Hmong who are accused, among other things, of being welfare mooches this book was published right before Clinton signed the Personal Responsibility and Work Opportunity Act, gutting welfare of ingratitude for the millions of dollars of free medical care they received of parental negligence and for their refusal to assimilate into American society If you read this book and only feel anger Well, I d never tell someone they re reading a book wrong, but in this case, you re clearly reading this book wrong These are difficult, fraught topics that Fadiman handles with grace There are no heroes and villains There are only individuals doing the best they can with what they have, based on who they are It should also be noted that Fadiman is a beautiful writer, and in terms of sheer journalistic enterprise, I ve rarely stumbled across a better example of diligent, on the ground research Fadiman isn t out to piss people off She does not structure her book to lay blame at anyone s feet Nevertheless, the central conflict of her story pits the Lees verses her doctors Who was responsible for Lia s fate The parents who did not follow their doctors orders Or the doctors, who never took the time to understand their patient, her family, and the context in which they lived their lives On this question, Fadiman is admittedly biased It is a gentle bias She faults the doctors for a lack of cultural curiosity, yet admits that in order to gain the Lees trust she spent hundreds and hundreds of hours with them, speaking to them through a handpicked interpreter The time she spent allowed her to see the Lees as fully formed people, not the seemingly ignorant, oft mute other that presented at the hospital She recognizes that it s hardly reasonable for any doctor to spend hundreds of hours with a single patient just to understand how they view the world There are moments where I think that Fadiman is rather a bit too hard on some of her non Hmong interview subjects She gets intensely irritated with a waitress who says the Hmong are bad drivers I don t know why this angered her It s perfectly rational to think that the Hmong, unable to understand American traffic signs, might be terrible behind the wheel My dad and I once drove from Paris to Normandy Neither of us speak French We were honked at the entire time Literally The entire time Don t know why To this day we don t know why Her sympathies lie with the Lees, and perhaps rightly so yet she isn t quite willing to extend the same empathy or generosity of viewpoint to others she comes across I wonder if she d have the same tolerance for a white anti vaxxer who doesn t have their kid inoculated for a deadly disease, or a Jehovah s Witness who refuses consent for a child s blood transfusion.I like to think of myself as generally broadminded, with a liberal and accepting heart Like Jesus, withwine As a parent, though, I found myself periodically raging against the Lees This is your kid Give her the correct prescriptions Just do itAt the same time, I recognize the need for doctors to better remember their patients are people I ve dealt with a chronic medical condition for the last couple years that has sent me on a semi desperate search for a specialist who would listen to me I m a college educated white male with health insurance who often wore a business suit to my appointments since I came straight from work If I couldn t get a doctor to give me five minutes of uninterrupted time, I can only imagine the experience of an indigent, non English speaking patient who walks into the hospital with a life experience 180 degrees different from his or her physician One of the book s final chapters, The Eight Questions, provides a nice roadmap for doctors The titular questions, devised by a Harvard Medical School professor, are a deceptively simple, brilliant way of allowing the doctor and patient to share roughly equal footing in the patient s treatment It shouldn t be a binary question of the life or the soul, with the doctor standing in for God When I love a book, I talk to people about it In doing so, I found that it s on a lot of different curriculums One of my friends read it for an undergrad ethics course Another of my buddies, we ll call him Dr B, had it assigned while he was in medical school ME Did you read it It s really good.DR B No ME Why not DR B Because I was studying medicine His answer is what I expected, and why I hope this book continues to get read Final aside The Spirit Catches You and You Fall Down was researched in the 80s and published in the 90s, meaning that the Hmong experience in America has changed I recommend getting the Fifteenth Anniversary Edition with a new Afterword by Fadiman The Afterword provides a nice little update, as well as the cathartic tying of some loose ends. I knew a little about this case, and before I read the book, I was certain I d feel infuriated with the Hmong family and feel nothing but disrespect for them, and would side with the American side, even though I have my issues with the western medical establishment as well Not that I didn t feel angry and amused at times with both sides, but I also ended up empathizing with the people in both sides of this culture clash, which is a testament to Anne Fadiman s account of the events My culture is definitely that of an American well, a subculture anyway, as there are obviously many cultures within America and I am fairly wedded to it, but I really appreciated this look into a culture so different from my own.Anne Fadiman does a remarkable job of communicating both sides of this story it s probably one of the best examples of cross cultural understanding that I ve ever read It s ostensibly about a young Hmong girl with epilepsy and her family s conflict with the American medical establishment, and there is much about them here But it s also a wonderful history book There s much background about the Hmong people going back centuries and recent history also It also made me sympathize with the difficulties of the immigrant experience, especially for those who settle in a place so different from their homeland.I learned so much about the Hmong people I knew very little before reading this book, and what I knew contained some inaccuracies or at least a lack of context And, as I was reading, I was really struck by how cultural differences and the cultural differences between the Hmong and American cultures is about as far apart as it gets can completely hinder communication if they re not acknowledged and attempts are made to bridge the gap This is a great book to read if you want to try to understand any people who are different from you in any way.Beautifully written and an enjoyable read. This is the heartbreaking story of Lia, a Hmong girl with epilepsy in Merced It is intended to be an ethnography, describing two different cultural approaches to Lia s sickness her Hmong parents and her American doctors.Don t read any further unless you don t mind knowing the basic story told in this book there are no spoilers, since this is not a book with a surprise ending, but if you want to keep a completely open mind, stop now I have wavered between four and five stars for this one The book is so beautifully and compassionately written you feel for absolutely everyone in the story Like Lia s doctors, you can t help but feel frustrated with Lia s noncompliant, difficult, and stubborn parents At the same time, given their history, you can fully appreciate her parents dislike of hospital procedures and distrust of distant, superior American doctors There are no heroes or villains here The book is perfectly balanced When Lia ends up brain dead, your heart just hurts for everyone involved.There are a couple of reasons I finally settled on four stars 1 While the historical background provided in the book is excellent, it drags the story down I felt it could have been better incorporated into an otherwise almost flawless narrative 2 I found myself questioning the basic premise of the book I m not sure that cultural misunderstandings caused Lia s eventual death brain death, that is Lia s epilepsy, by all accounts, was unusally severe and unresponsive to medication So I was never convinced that a white, middle class American girl would have survived with her mind in tact, either This is not to dismiss the very real cultural struggle that this book describes, but some of the author s statements about how cultural misunderstandings killed Lia seemed a bit speculative to me.But overall, this is an absolutely beautiful, touching book, and should be required reading for everyone in California and everyone else, too.