The Spirit Catches You and You Fall Down


Anne Fadiman

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The Spirit Catches You and You Fall Down: Chapter 13 Summary & Analysis

When Peggy first saw Lia after the girl’s return from Fresno, she was heartbroken: Lia was hardly alive. Talking to Fadiman later, she and her husband tried to describe what it was like to see Lia in such a terrible state. Neil admitted that, after all of his efforts and the building of tension before her cataclysmic seizure, he simply couldn’t face her anymore, so Peggy stepped in to provide her primary pediatric care. During this time, Foua and Nao Kao attended to their daughter by bringing her herbal remedies, which they fed her through a nasogastric feeding tube. Thinking Lia would soon die anyway, Peggy allowed this to happen. Instead of joyously celebrating the Hmong New Year—an important cultural holiday—Foua brought funeral clothes to the hospital to dress her daughter for death.
With the release of tension precipitated by Lia’s final seizure came something like cross-cultural cooperation and understanding. Finally, Neil and Peggy no longer had to worry about what the Lees were doing to their daughter, and Nao Kao and Foua were at last able to treat Lia however they saw fit. It is unfortunate, of course, that this could only happen after Lia’s final seizure.
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Nao Kao insisted on Lia’s second day back at MCMC that the intravenous line delivering all her medications be taken out. Peggy had a discussion with the Lees in which she explained that, without the antibiotics coming through the IV line, Lia’s infection could return, causing her to die more quickly—Foua and Nao Kao understood this and expressed that they still wished to move forward with the plan, to which Peggy consented. When they insisted upon taking her home, though, Peggy told them that Lia needed to stay at MCMC a bit longer; “I was sure she was dying,” she later told Fadiman, “but that’s the quandary of Western medicine, that you can’t let people die.” In the meantime, Jeanine Hilt made sure that the Lees were prepared at home to receive their daughter.
Peggy’s statement about the quandary of Western medicine is interesting because it acknowledges the circular futility medical ethics can often engender. Having devoted her life to keeping people alive, she found herself in a position of having to sustain Lia despite her certainty that the girl would soon die anyway. In this moment, it’s clear Peggy was upset that the dictates of her own practice disallowed her from giving Lia and her parents what they wanted.
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In one final misunderstanding between MCMC and the Lees, Nao Kao became incredibly frustrated on the day of Lia’s discharge. He was asked to sign something he believed said Lia was going to die in two hours, though the staff of MCMC later maintained that this paper actually said he could take her home in two hours. Nao Kao furiously wondered, “Is this a hospital that fixes people or makes them die?” At this point he took Lia in his arms and ran down the stairs. This incident only complicated Lia’s discharge, since the police were called after Nao Kao pushed a nurse and because the doctors had to reinsert her nasogastric feeding tube. Hours later, Lia finally returned home, where the Lees laid her out on the living room floor and bathed her in boiled herbs. She stopped sweating and, despite everyone’s expectations, she did not die.
It’s noteworthy that, after all the miscommunications and misunderstandings the Lees had been through with the hospital, MCMC still failed to grasp the fact that they had to be extra careful in spelling out what they were asking him to sign. Furthermore, in addition to demonstrating his intense devotion to his daughter, Nao Kao’s attempted escape once more supports Fadiman’s idea regarding the Hmong tendency to either fight or flee when faced with oppression—for what it’s worth, in this case Nao Kao both ran and fought.
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