Three months after her healthy birth, Lia went into a seizure after her older sister Yer loudly slammed the apartment door. Foua and Nao Kao immediately suspected what happened: the loud sound so frightened their daughter that her soul fled her body, a phenomenon known to them as quag dab peg, meaning the spirit catches you and you fall down. In English—and medical—terms, this is called epilepsy. In contrast to how Western medicine approaches this affliction, the Hmong believe quag dab peg brings a person distinction, as seizures often deem people “fit for divine office.” Indeed, many Hmongs with epilepsy often become txiv neebs, or shamanistic healers—a very well-respected position in Hmong culture. Such illnesses often indicate to the Hmong that a person “has been chosen to be the host of a healing spirit.” As such, the Lees were conflicted about Lia’s affliction, for while they wanted their daughter to be healthy, they were also fond of the idea of her assuming such a culturally sought after and important role.
Given that her parents were unable to conduct her soul calling ceremony for three months after her birth, it is noteworthy that Lia suffered from an ailment believed to be in direct relation to the loss of the soul. The fact that her parents were conflicted about her affliction is also important, as this starkly contrasts the attitude of Western medicine, which seeks to solve anything perceived as potentially difficult for or harmful to the body. This illustrates the difference between American and Hmong cultural values—whereas the former prizes physical health, the latter prizes spiritual prosperity.
Fadiman notes that the Hmong are well-known for showering their children with love and affection. Their attentiveness and caretaking abilities score very high in studies on parent-child connections. She writes that Jeanine Hilt, a social worker who worked closely with the Lees, once said, “They felt Lia was kind of an anointed one, like a member of royalty.” Indeed, Fadiman remarks that Lia was her parents’ favorite child. Unfortunately, the family seemed to blame Yer for slamming the door, despite Jeanine’s insistence that this had nothing to do with Lia’s seizures.
By viewing Lia as “an anointed one” because of her epilepsy, the Lees demonstrated a sentiment that would seem strange to non-Hmong Americans—they’re championing illness rather than trying to eradicate it. Still, though, it is clear their feelings about Lia’s health were mixed, as evidenced by the fact that they blamed Yer—this blame perhaps signified their desire to control their understanding of the situation, a sentiment that further indicates their mixed feelings about the circumstances of their daughter’s health.
After her first seizure, Lia had at least twenty more during the next few months. Despite the fact that they didn’t entirely trust or invest themselves in the efficacy of Western medicine, Foua and Nao Kao brought her to MCMC on two of these occasions, though Lia had stopped seizing both times by the time they arrived. MCMC didn’t have sufficient interpreters on staff (despite that one in five residents of Merced was Hmong), so the Lees had no way of communicating to the doctors why they brought in their daughter. The only symptoms she exhibited were congestion and a cough, and so she was sent home without a proper diagnosis.
That the Lees brought Lia to the hospital despite their misgivings about Western medicine reinforces the idea that they are diligent parents who are perhaps not as unbending in their beliefs as others may think. Unfortunately, MCMC failed to provide them with interpreters—the second failure of American healthcare to attentively treat the Lees (after having burned Lia’s placenta).
Lia’s third trip to the hospital went differently than the first two. First of all, she arrived while seizing. Fortunately, there was a doctor on rotation, Dan Murphy, who was particularly interested in Merced’s Hmong population. Second of all, Foua and Nao Kao brought their nephew, who was able to translate (though not very well). Fadiman includes Dan Murphy’s recollection of this first encounter with the Lee family, in which he felt “very anxious” because he needed to get an IV of Valium inserted into Lia’s scalp as she was seizing, all the while trying to explain to the Lees what he was doing.
In this moment, the direness of Lia’s condition comes to the forefront of Fadiman’s writing; the serious threat her epilepsy posed to her is discernible in Dan Murphy’s mounting anxiety. Of course, amidst all this worry stood the seemingly insurmountable obstacle of the language barrier between the Lees and Lia’s doctors, which only exacerbated both the immediate concerns of Lia’s health and the broader concerns regarding differing cultural values, which, for the moment, were ignored.
Dan eventually diagnosed Lia with epilepsy, having no idea that her parents had already determined that she was afflicted by the spirit catches you and you fall down. Fadiman notes that Dan would have been surprised to learn that Foua and Nao Kao attributed Lia’s seizures to “soul loss”; conversely, Foua and Nao Kao would have been surprised to learn that Dan attributed the seizures to “an electrochemical storm inside their daughter’s head that had been stirred up by the misfiring of aberrant brain cells.”
By stating that each party would have been surprised to hear what the other believed was causing Lia’s illness, Fadiman highlights the gulf standing between Dan Murphy and the Lees. Beyond the issue of a language barrier, this problem was the result of a lack in cross-cultural curiosity, since neither group even thought to ask each other about their beliefs. As such, everybody seemed to have foolishly assumed they were more or less operating under the same set of assumptions.
Fadiman calls Dan’s view of epilepsy “essentially rationalist,” saying that, like the rest of his medical colleagues, he follows in the footsteps of skeptics like Hippocrates, who said in 400 B.C, “It seems to me that [epilepsy] is no more divine than any other. It has a natural cause just as other diseases have. Men think it is divine merely because they don’t understand it. But if they called everything divine which they do not understand, why, there would be no end of divine things.” As such, Dan saw Lia’s epilepsy as something to be cured. He set about trying to do just that, admitting her as an inpatient to MCMC and running a battery of tests before discharging her more than a week later. Her epilepsy, the tests determined, was “idiopathic,” meaning that the causes were unknown. Before the Lees took home their daughter, they were instructed—by way of a translating relative—to give her certain amounts of ampicillin and Dilantin (an anticonvulsant) twice a day.
Hippocrates is a towering figure in medical history who represents rationality and the necessity of saving lives. Although scholars debate whether or not he actually wrote it, he is the namesake for the Hippocratic Oath, an oath that many physicians have taken, promising to uphold certain standards of medical ethics. As such, most modern doctors are in some way involved in the rationalist thought set forth by Hippocrates that encourages them to adhere to the idea of scientific morality. This means that if a doctor believes he or she is doing the right thing for a patient, he or she is morally obligated to continue to do so.