Fadiman considers the fact that the Hmong view health concerns as not only relating to the body, but also relating to everything else in their lives. If a Hmong walked into a doctor’s office complaining of a stomachache, she says, he may actually be “complaining that the entire universe was out of balance.” This viewpoint stands in direct opposition to Western medicine, which invests itself in the study of specific body parts and illnesses that are treated in isolation. After making this point, Fadiman once more expounds upon the multiple ways in which the Hmong distrust American hospitals, which prove themselves utterly incapable of understanding their worldviews.
The example Fadiman uses to illustrate the Hmong belief that everything is related is in keeping with her earlier consideration of the young French student’s comprehensive presentation of fish soup. This is a difficult concept for doctors steeped in empiricism and research to wrap their heads around. Western medicine rewards specialization—even Neil and Peggy, pediatricians, are specialized in a particular area of care. Once again, Fadiman brings opposing Hmong and American health-related beliefs to the forefront of her analysis.
Fadiman’s old college friend Bill Selvidge (and the former chief resident at MCMC) explained to her that, due to the fact that most doctors are unlikely to ask their Hmong patients what they actually believe, they unfortunately remain unable to fully help them. Instead, they adopt a sardonic and black humor, suggesting that the best way to treat Hmong complaining of vague illnesses is to subject them to “high-velocity transcortical lead therapy”; when Fadiman asked what this means, he replied, “The patient should be shot in the head.” Much of this bitter attitude is the result of the thankless atmosphere in which the doctors are made to constantly toil—Selvidge explained that Hmong behavior can be quite strange to outsiders and that the doctors at MCMC often find themselves frustrated by the fact that the Hmong distrust them.
It’s worth noting that, though this conversation with Bill Selvidge unearths yet another friction between the Hmong and MCMC’s staff, it also suggests a similarity between the two cultures. Just as shamanistic healers are highly respected in Hmong culture, medical doctors have become accustomed to the same respect in the context of the hospital, a fact that would perhaps not be so hard for a Hmong to understand if somebody took the time to explain it in such terms.
In an attempt to illustrate the seemingly inscrutable atmosphere MCMC doctors must work in when treating Hmong patients, Fadiman lists the many things that seem odd about Hmong culture, eventually describing the practice of coin-rubbing, wherein a coin is rubbed against the skin to create lesions. She relates one story she heard from Dan Murphy, who told her that a Hmong father was jailed in Fresno after a teacher found coin-rubbing lesions on his child’s chest—the father ended up hanging himself in the jail cell. Fadiman notes that, though the story is quite likely exaggerated, the doctors of Merced “were shaken to realize how high the stakes could be if they made a tactical error in dealing with the Hmong.”
Once more, Fadiman emphasizes the high-stakes environment that MCMC doctors faced when treating Hmong patients. Such worries regarding the horrific possible results of cross-cultural misunderstandings added to the already intense stressors placed on Lia’s doctors, stressors that centered on the dire and urgent nature of her illness. Once more, it is no surprise that the doctors of MCMC ended up clashing with the Lees, given the tense circumstances.
Fadiman details the myriad difficulties doctors faced when treading into Hmong culture. One of the easiest ways to offend a Hmong family, she says, was by addressing an English-speaking teenager instead of the head of the household. Indeed, problems of translation were difficult to avoid, especially considering the fact that some English words required sentence-long translations that still failed to retain the original meaning. There were also issues surrounding decision-making, since in many cases a Hmong patient wouldn’t consent to certain procedures without consulting the respected members of their clan, a caveat that often proved life-threatening when doctors needed fast-acting consent to perform surgeries in moments of crisis. Fadiman asked one doctor what she did when a Hmong patient’s wishes went against her medically informed opinion; “I have the same standard of care for the Hmong as I have for everyone else,” she said. “My hands are just tied to provide it. So I give them suboptimal care.”
Although it may seem irresponsible to provide “suboptimal care” to a patient in need, this doctor’s decision to do so is an example of what it might look like to come to terms with the complicated cultural barriers at play. Of course, this attitude would prove challenging for any doctor firmly rooted in the rationalist notion that the ethics of practicing medicine require physicians to do whatever they believe will help a patient.