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

When Lia returns to her parents in 1986, at the age of four, they celebrate her homecoming with a ceremony meant to improve her health. They use Lia’s disability stipend to purchase a cow to sacrifice during the ceremony. The Hmong sacrifice animals to appease ancestors and cure illnesses. The animal’s soul serves as a type of exchange for the loss of a human soul. Txiv neebs officiate during these ceremonies and perform chants to enter other worlds. When the ritual ends, the host family provides a large feast.

While the ceremony marks a significant life event for Lia, it does not improve her condition. After returning from foster care, Lia speaks less and is not fully aware of her surroundings. The Lees attribute Lia’s regression to missing her family and being given too much medicine when she was in foster care. They also think Lia was taken away from them because the doctors wanted to punish them. The Lees view themselves as reasonable because they accommodate both cultures by using “a little medicine and a little neeb” to heal Lia while their doctors are uncompromising and use a lot of medicine (110).

In an effort to help Lia, her parents try many traditional remedies and take her to a txiv neeb in Minnesota. Her doctors are unaware of these ritual undertakings and view this period in Lia’s life as uneventful. Fadiman questions why nobody at MCMC ever asks their Hmong patients how they treat illnesses, and Bill Selvidge speculates that it is because the Hmong look Americanized; subsequently, doctors do not question whether the Hmong have different healing practices. The only American who asks the Lees how they heal Lia is their social worker and most ardent advocate, Jeanine Hilt.

In September 1986, Lia falls off a swing and hits her head, causing her to go into status epilepticus. She has unremitting seizures for hours with no intervals of consciousness. The seizures lead to many complications and infections, some caused by her doctors, necessitating a lengthy hospital stay. After this incident, the Depakene is not as effective at controlling Lia’s seizures, and her doctors increasingly worry about the inevitability of a “big one” (118).

Fadiman begins the chapter with a Hmong folktale that explains their preference for living in the mountains. For the Hmong, the mountains offer an escape from external pressures to assimilate to other societies. The Hmong value their self-sufficiency and survived in the mountains in Laos during the early and mid-20th century as farmers. They practiced swidden agriculture (rotational farming) and moved around a lot to cultivate new fields. In addition to growing crops, like rice and corn, the Hmong also grew opium, which they used selectively for medicinal purposes and in ritual trances. They sold the rest to outsiders. Subsequently, opium has special significance in Hmong society, with many terms referring to its cultivation, uses, and associations with wealth.

The rest of the chapter details the involvement of the Hmong in the Vietnam War. While the Geneva Conference of 1961-62 declared Laos a “neutral” country; in reality, the country was a key player in American foreign policy to combat communism. The CIA recruited the Hmong to fight a proxy war in Laos and form a guerilla army, known as the Armée Clandestine. The Hmong collaborated with the US, which supported the Royal Lao government, for several reasons. They worried about agrarian land reforms that could threaten their livelihoods. They also feared reprisals from the North Vietnamese, as the Hmong originally sided with the French in colonial Indochina. Just as significantly, many Hmong were forced into the war by General Vang Pao, a CIA-supported Hmong leader, who used brutal tactics of recruitment. Meanwhile the US recognized the advantages of using the Hmong as fighters since they knew the mountains intimately, had a reputation as scrappy fighters, and were an extremely cheap labor force.

For participating in the “Quiet War” (131), the cost to Hmong lives was profound. They died at a rate 10 times higher than American soldiers in the Vietnam War. They also suffered immense ecological devastation to their lands, resulting in widespread hunger and disease, as “more than two million tons of bombs were dropped on Laos, mostly by American planes attacking communist troops in Hmong areas” (131). Fadiman describes the erosion to the Hmong’s sense of self-sufficiency, as they increasingly relied on US food drops to survive. In 1975, the communist government overtook the territory held by Vang Pao. The CIA airlifted approximately 1,000-3,000 high-ranking Hmong to Thailand. The rest, more than 10,000 Hmong, were left on the airfield to fend for themselves, making their way to Thailand by foot.

The chapter opens with a scene of Lia eating dinner with her family. She has little appetite and runs to her parents for a hug right before she starts having a seizure. Unlike previous episodes, Lia does not recover after 10 minutes, and her parents call their nephew who speaks English to summon an ambulance. Fadiman estimates that it would have been quicker for the Lees to have carried Lia to the emergency room since they live close to the hospital, perhaps saving 20 minutes. The Lees choose the ambulance because they think the emergency doctors will triage Lia into their care more quickly.

Fadiman details the doctors’ attempts to stop Lia’s seizures. The seizures only stop, after two hours, when a doctor performs a saphenous cutdown on Lia’s ankle to administer large doses of intravenous medicine. As Neil recalls, “I knew that this was it. This was the big one” (143). He decides to send Lia to a hospital in Fresno because it has a children’s intensive care unit. Neil informs the Lees of Lia’s critical condition. They think she is being moved to Fresno because Neil is going on vacation and does not want to take care of her.

At Valley Children’s Hospital, a team of specialists recognize Lia is in septic shock and use an aggressive approach to treat her. Lia undergoes a spinal tap, which Nao Kao finds especially distressing. He attributes this procedure to the ultimate loss of Lia’s soul: “They just sucked her backbone like that and it makes me disappointed and sad because that is how Lia was lost” (148). The hospital limits Nao Kao and Foua’s time with Lia and provides counseling sessions that make them feel angry and confused. When Dee, Tom, and Jeanine visit the hospital, the medical staff addresses them and do not look at Nao Kao and Foua.

A CT scan reveals that Lia has no brain activity and flat brain waves. A doctor removes Lia’s intravenous lines when Foua is in the room. She tells Foua that Lia is brain dead and will die soon. Foua thinks the doctor is mean and taking the medicine to give to another patient. The Lees want Lia to return home but, with Jeanine’s help, decide to send Lia to MCMC for supportive care first.