Themes
Key
LitCharts assigns a color and icon to each theme in The Spirit Catches You and You Fall Down, which you can use to track the themes throughout the work.
Cultural Values, Spirituality, and Medicine
Blame and Power
History and Ethnic Identity
Integration and Assimilation
Summary
Analysis
On the night before Thanksgiving in 1986, Lia had a massive seizure and went into status epilepticus. Sensing that this episode was more serious than the others, her parents decided to call an ambulance rather than running the three blocks to the hospital with her in their arms (they thought that she would be attended to with more concern if she was escorted into MCMC by paramedics). Unfortunately, the ambulance ultimately took twenty minutes to get her to the hospital. Once there, the doctors tried desperately to establish an IV, but she was thrashing so hard that none of them could get the needle into a vein. Neil, who was at home preparing to go away for the long weekend, was paged to the hospital and knew in his gut that this seizure was the one he’d been dreading for so long.
The fact that the Lees believed Lia would receive more urgent attention if she arrived in an ambulance shows that they were willing to work within the paradigm of Western medicine when they saw fit to do so. Unfortunately, they misjudged the efficacy of this approach, endangering Lia once again due to a misunderstanding of the American medical system.
Themes
When Neil arrived at MCMC, the doctors continued to have trouble establishing an IV line, and Lia wasn’t responding to Valium. Finally, one of the doctors suggested that they try a procedure called a “saphenous cutdown,” in which the patient’s vein is cut open and a catheter is inserted and then sutured into place. This finally stabilized Lia, who had been in status epilepticus for almost two hours (even just 20 minutes of status epilepticus is considered life-threatening). Oddly enough, she also had diarrhea and a fever—something the doctors noted but to which they paid no attention. Thinking that the situation was under control, Neil called Valley Children’s Hospital in Fresno (which was better equipped to handle such serious problems) and arranged for Lia to be transferred for the weekend, instructing them on the details of her case so that she would be adequately cared for in his absence.
Once again, Fadiman emphasizes the urgency of Lia’s medical condition, this time making it clear that the Lees’ failure to bring her to the hospital as quickly as possible—an innocent mistake, but a mistake nonetheless—may have harmed her brain. In addition, she shows that Neil is doing his best to make sure that Lia gets the best care, even though ignoring her fever and diarrhea was also an innocent mistake that would harm her health.
Themes
Unfortunately, Lia arrived at Valley Children’s Hospital in the middle of another grand mal seizure. The doctors there found that her white blood-cell count was high and that she was running a temperature of 104.9º. The presiding specialist also noted that she was experiencing “explosive diarrhea showing large amount of water, foul smelling stools, with pus appearance.” This doctor worked on Lia for twelve consecutive hours that night (the night before Thanksgiving), failing to correctly identify her gender despite the fact that he correctly diagnosed her as suffering from septic shock, “the result of a bacterial invasion of the circulatory system” that can cause “the failure of one organ after another.” This subsequently lead to other serious conditions, eventually leaving Lia in a permanently nonresponsive state.
The fact that the doctor at Valley Children’s Hospital failed to accurately notice Lia’s gender is an example of the worst elements of Western medical practice, which is the tendency to treat parts of bodies without ever fully considering patients on a human level. One gets the sense that a Hmong shaman—who in the throes of seizing risks his life for his patients— would never make this kind of mistake.
Themes
Nao Kao and Foua arrived at Children’s Valley Hospital after Lia and were troubled to learn about the spinal tap that had been inserted. Fadiman notes that many Hmong believe spinal taps are “potentially crippling both in this life and in future lives.” Afterwards, Foua maintained that Lia got more and more sick because the doctors “gave her too much medicine.” After a week of procedures and tests, the doctors determined that Lia was, simply speaking, brain-dead. Jeanine Hilt helped drive many relatives to the hospital. When they arrived, the doctors were “preparing the family for Lia to die.” Dee and Tom Korda also visited; Dee later recalled in conversation with Fadiman that the doctors rudely tried to address them instead of Foua and Nao Kao because they saw the foster parents as white and intelligent.
Yet again, Foua and Nao Kao were assumed to be stupid because of their unfamiliarity with American culture. In addressing Dee and Tom Korda instead of the Lees, the doctors at Valley Children’s Hospital gave power not to their patient’s parents, but to the people who matched their idea of what it means to be capable of processing medical information.
Themes
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At one point, while Foua was sitting by Lia’s bed, a doctor entered, explained that Lia was going to die, and took her off life support—this appalled Foua, who framed this moment by saying that the doctor “wanted to take Lia’s medicine away from her and give it to someone else.” Apparently the doctor was only following Dr. Hutchinson’s orders to “discontinue all life-sustaining measures so that Lia could die as naturally as possible”—a sentiment to which Hutchinson thought the family had agreed. Although the doctors expected Lia to die shortly after being taken off life support, she continued to live, and Jeanine Hilt advocated for the Lee family—who wanted Lia to die at home—by organizing for a transfer back to MCMC.
Aside from the fact that Dr. Hutchinson should have ensured that he fully understood what Foua and Nao Kao wanted, it is to his credit that he essentially tried to carry out exactly what the Lees did want: for Lia to be taken off all medication. Confusingly enough, the Lees seemed to change their mind in this moment, a reversal that indicates a certain reflexive adversity to anything the doctors did. Under this interpretation, Lia’s doctors were doomed to fail no matter what they tried to do.
Themes
