The Spirit Catches You and You Fall Down

by

Anne Fadiman

Teachers and parents! Struggling with distance learning? Our Teacher Edition on The Spirit Catches You can help.
A little girl who is part of Merced, California’s population of Hmong immigrants. The Spirit Catches You And You Fall Down tells the story of treating Lia’s epilepsy, examining her medical experience in Merced in order to consider divides between Hmong and American culture. Lia is the first Lee child born in an American hospital; her mother, Foua, delivered Lia’s thirteen brothers and sisters while standing over the dirt floor of their home in Laos. Three months after Lia is born in Merced Community Medical Center (MCMC), she begins having violent seizures. In Hmong culture, epilepsy is called quag dab peg, meaning “the spirit catches you and you fall down,” which is a culturally significant ailment because of the fact that it afflicts all of the community’s shamanistic healers. Thus, Nao Kao (Lia’s father) and Foua are conflicted; they want their little girl to be healthy, but they also like the idea that she may one day become a respected healer. Despite their misgivings—and despite the fact that they distrust Western medicine, favoring their own spiritual herbal remedies—they take her to MCMC, initiating a years-long struggle with the American medical system. Lia is a characteristically loving, affectionate child who is prominently affected by the side effects of the ever-changing combinations of medicine she must take. When she is four years old, she suffers from septic shock, sending her into status epilepticus—a life-threatening state of constant seizing—that leaves her essentially brain-dead and nonresponsive. Despite all odds, though, she continues to live, even without any form of life support.

Lia Lee Quotes in The Spirit Catches You and You Fall Down

The The Spirit Catches You and You Fall Down quotes below are all either spoken by Lia Lee or refer to Lia Lee. For each quote, you can also see the other characters and themes related to it (each theme is indicated by its own dot and icon, like this one:
Cultural Values, Spirituality, and Medicine  Theme Icon
). Note: all page numbers and citation info for the quotes below refer to the Farrar, Straus, and Giroux edition of The Spirit Catches You and You Fall Down published in 2012.
Preface Quotes

After I heard about the Lees’ daughter Lia, whose case had occasioned some of the worst strife the Merced hospital had ever seen, and after I got to know her family and her doctors, and after I realized how much I liked both sides and how hard it was to lay the blame at anyone’s door (though God knows, I tried), I stopped parsing the situation in such linear terms, which meant that without intending to, I had started to think a little less like an American and a little more like a Hmong.

Related Characters: Anne Fadiman (speaker), Lia Lee
Page Number: viii
Explanation and Analysis:
Chapter 3 Quotes

Although the inklings Dan had gathered of the transcendental Hmong worldview seemed to him to possess both power and beauty, his own view of medicine in general, and of epilepsy in particular, was, like that of his colleagues at MCMC, essentially rationalist. Hippocrates’ skeptical commentary on the nature of epilepsy, made around 400 B.C., pretty much sums up Dan’s own frame of reference: “It seems to me that the disease 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 to divine things.”

Related Characters: Anne Fadiman (speaker), Lia Lee, Dan Murphy
Page Number: 29
Explanation and Analysis:
Chapter 5 Quotes

The MCMC nursing staff came to know Lia well—better, in fact, than most of them would have wished. After she was old enough to walk, whenever she was well enough to get out of bed she ran up and down the corridor in the pediatric unit, banging on doors, barging into the rooms of other sick children, yanking open the drawers in the nursing station, snatching pencils and hospital forms and prescription pads and throwing them on the floor.

Related Characters: Anne Fadiman (speaker), Lia Lee
Page Number: 44
Explanation and Analysis:

The idea that the drugs prescribed to cure, or at least attempt to treat, an illness are in fact causing it is not one that most doctors ever encounter. Doctors are used to hearing patients say that drugs make them feel bad, and indeed the unpleasant side effects of many medications are one of the main reasons that patients so often stop taking them. But most patients accept the doctor’s explanation of why they got sick in the first place, and even if they resist the recommended treatment, they at least believe their doctor has prescribed it in good faith and that it is not designed to hurt them. Doctors who deal with the Hmong cannot take this attitude for granted. What’s more, if they continue to press their patients to comply with a regimen that, from the Hmong vantage, is potentially harmful, they may find themselves, to their horror, running up against that stubborn strain in the Hmong character which for thousands of years has preferred death to surrender.

Related Characters: Anne Fadiman (speaker), Lia Lee
Page Number: 50
Explanation and Analysis:

And the other thing that was different between them and me was that they seemed to accept things that to me were major catastrophes as part of the normal flow of life. For them, the crisis was the treatment, not the epilepsy. I felt a tremendous responsibility to stop the seizures and to make sure another one never happened again, and they felt more like these things happen, you know, not everything is in our control, and not everything is in your control.

Related Characters: Dan Murphy (speaker), Lia Lee, Anne Fadiman
Page Number: 53
Explanation and Analysis:

A handful of times, Neil gave Foua a hug while Lia was seizing, but most of the time, while Lia was between the ages of eighteen months and three and a half years, he was too angry to feel much sympathy toward either of her parents. “The best thing I could have given Lia’s mother was compassion, and I wasn’t giving her any and I knew that I wasn’t giving her any,” he said. “There was just too much aggravation. It was like banging your head against a wall constantly and not making any headway. There was the frustration of the nighttime calls and the length of time it took and the amount of energy and sorrow and lack of control. […] When she came to the emergency room in status there would be sort of like a very precipitous peak of anger, but it was quickly followed by the fear of having to take care of a horribly sick child who it was very difficult to put an IV in.” Peggy added, “Some of the anger came from that. From our own fear.”

Related Characters: Anne Fadiman (speaker), Lia Lee, Neil Ernst, Peggy Philp
Page Number: 56
Explanation and Analysis:
Chapter 7 Quotes

Neil was pretty sure, however, that because Lia’s condition was progressive and unpredictable, he could treat it best by constantly fine-tuning her drug regimen. If he had chosen a single pretty-good anticonvulsant and stuck with it, he would have had to decide that Lia wasn’t going to get the same care he would have given the daughter of a middle-class American family who would have been willing and able to comply with a complex course of treatment. Which would have been more discriminatory, to deprive Lia of the optimal care that another child would have received, or to fail to tailor her treatment in such a way that her family would be most likely to comply with it?

A decade ago, that is not the way Neil looked at the situation. He never seriously considered lowering his standard of care. His job, as he saw it, was to practice good medicine; the Lees’ job was to comply.

Related Characters: Anne Fadiman (speaker), Lia Lee, Foua Lee, Nao Kao Lee, Neil Ernst
Page Number: 78
Explanation and Analysis:
Chapter 11 Quotes

Their technology was cutting-edge and their clinical skills irreproachable. At first, however, they were too busy trying to save Lia’s life to focus on a great deal besides her pathology. [The doctor], for example, who worked on Lia for more than twelve hours straight, failed to notice her sex. “His metabolic acidosis was decreased after initial bolus of bicarbonate,” he wrote. “His peripheral perfusion improved and pulse oximetry started reading a value that correlated with saturation on the arterial blood samples.” Here was American medicine at its worst and its best: the patient was reduced from a girl to an analyzable collection of symptoms, and the physician, thereby able to husband his energies, succeeded in keeping her alive.

Related Characters: Anne Fadiman (speaker), Lia Lee
Page Number: 146
Explanation and Analysis:
Chapter 13 Quotes

Calling Lia a vegetable was, it seemed to me, just one more form of avoidance. In describing what had happened to her, [Neil] and Peggy both used the kinds of terms favored by the doctors in MASH, gallows-humor slang wielded in times of extreme stress on the theory that if you laugh at something it can’t break your heart. “Lia gorked.” “She crumped.” “She fried her brain.” “She vegged out.” “She crapped out.” “She went to hell.” “No one’s at home, the lights are out.”

Related Characters: Anne Fadiman (speaker), Lia Lee, Neil Ernst, Peggy Philp
Page Number: 173
Explanation and Analysis:
Chapter 15 Quotes

At this point, [Lia’s sister], who was three at the time, ran over to Lia and started banging her on the chest.

“Don’t do that, there’s a good boy,” said Martin, addressing the little girl in English, of which she did not speak a word. “[… P]lease tell them they have got to watch these other little children. Lia is not a doll.”

Related Characters: Anne Fadiman (speaker), Lia Lee, Foua Lee, Nao Kao Lee, Martin Kilgore
Page Number: 222
Explanation and Analysis:
Chapter 17 Quotes

Once I asked Neil if he wished he had done anything differently. He answered as I expected, focusing not on his relationship with the Lees but on his choice of medication. “I wish we’d used Depakene sooner,” he said. “I wish I’d accepted that it would be easier for the family to comply with one medicine instead of three, even if three seemed medically optimal.”

Then I asked, “Do you wish you had never met Lia?”

“Oh, no, no, no!” His vehemence surprised me. “Once I might have said yes, but not in retrospect. Lia taught me that when there is a very dense cultural barrier, you do the best you can, and if something happens despite that, you have to be satisfied with little successes instead of total successes. You have to give up total control. That is very hard for me, but I do try. I think Lia made me into a less rigid person.”

Related Characters: Anne Fadiman (speaker), Lia Lee, Foua Lee, Nao Kao Lee, Neil Ernst
Page Number: 257
Explanation and Analysis:
Get the entire The Spirit Catches You LitChart as a printable PDF.

Lia Lee Character Timeline in The Spirit Catches You and You Fall Down

The timeline below shows where the character Lia Lee appears in The Spirit Catches You and You Fall Down. The colored dots and icons indicate which themes are associated with that appearance.
Preface
Cultural Values, Spirituality, and Medicine  Theme Icon
Blame and Power Theme Icon
...explore the intersection between medicine and Hmong spirituality was originally “all theory,” Fadiman explains how Lia Lee’s story changed her perspective. Lia’s medical case challenged the Merced hospital by presenting difficult... (full context)
Chapter 1: Birth
Cultural Values, Spirituality, and Medicine  Theme Icon
Lia Lee was not born in the highlands of northwest Laos, where twelve of her older... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Integration and Assimilation Theme Icon
Lia was the first Lee child born in America. Foua gave birth to her in Merced... (full context)
Chapter 3: The Spirit Catches You and You Fall Down
Cultural Values, Spirituality, and Medicine  Theme Icon
Three months after her healthy birth, Lia went into a seizure after her older sister Yer loudly slammed the apartment door. Foua... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Blame and Power Theme Icon
...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... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
After her first seizure, Lia had at least twenty more during the next few months. Despite the fact that they... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Lia’s third trip to the hospital went differently than the first two. First of all, she... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Dan eventually diagnosed Lia with epilepsy, having no idea that her parents had already determined that she was afflicted... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
...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... (full context)
Chapter 4: Do Doctors Eat Brains?
Cultural Values, Spirituality, and Medicine  Theme Icon
History and Ethnic Identity Theme Icon
...such, hospitals were not considered restorative, healing places. Nonetheless, the Lees were willing to take Lia to MCMC because of their own conviction that Western medicine could, in certain very straightforward... (full context)
Chapter 5: Take as Directed
Cultural Values, Spirituality, and Medicine  Theme Icon
Lia continued to have frequent seizures, many of them violent and dangerous. When she convulsed without... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
As Lia’s trips to MCMC became more frequent, her primary pediatricians, Neil Ernst and Peggy Philp (a... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Lia’s medication regimen began to prove difficult for the Lees to follow. Peggy Philp originally prescribed... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Blame and Power Theme Icon
Integration and Assimilation Theme Icon
After raising Lia’s phenobarbital dosage and seeing that blood tests reflected the same lack of the medication she... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Integration and Assimilation Theme Icon
...Department started sending nurses to Nao Kao and Foua’s home in order to make sure Lia was taking the correct amounts of medication. These nurses tried diligently to instruct the Lees... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Blame and Power Theme Icon
Lia continued to have serious seizures and her parents maintained their skepticism of the prescribed medications.... (full context)
Chapter 7: Government Property
Cultural Values, Spirituality, and Medicine  Theme Icon
Unlike other doctors, Fadiman points out, Neil Ernst remained unbending in his care for Lia, ultimately unwilling to compromise the quality of his services to accommodate Foua and Nao Kao’s... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Blame and Power Theme Icon
For the six months that Lia was “government property,” she was placed in the care of Dee and Tom Korda, two... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Unfortunately, Lia was not returned to the Lees after six months because of two reasons. First, her... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Jeanine Hilt continued to work with Foua, teaching her how to correctly give Lia the proper amounts of medication. This task was made slightly easier by the fact that... (full context)
Chapter 8: Foua and Nao Kao
Cultural Values, Spirituality, and Medicine  Theme Icon
...only medicine. He maintained that medicine can be helpful, but not on its own; in Lia’s case, he said, it was best to use a little bit of medication in conjunction... (full context)
Chapter 9: A Little Medicine and a Little Neeb
Cultural Values, Spirituality, and Medicine  Theme Icon
Integration and Assimilation Theme Icon
When Lia came home in 1986, Nao Kao and Foua held a sacrificial ceremony in which they... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Blame and Power Theme Icon
Despite the ceremony they held for Lia, Foua and Nao Kao began to feel that she was in a worse condition than... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Blame and Power Theme Icon
Jeanine Hilt continued to advocate for Lia, arranging for her to attend the Schelby Center for Special Education in order to give... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Not long thereafter, Lia was admitted to MCMC once again, at which point Neil saw that the Depakene—which seemed... (full context)
Chapter 11: The Big One
Cultural Values, Spirituality, and Medicine  Theme Icon
On the night before Thanksgiving in 1986, Lia had a massive seizure and went into status epilepticus. Sensing that this episode was more... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Blame and Power Theme Icon
...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... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Unfortunately, Lia arrived at Valley Children’s Hospital in the middle of another grand mal seizure. The doctors... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Blame and Power Theme Icon
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... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Blame and Power Theme Icon
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... (full context)
Chapter 13: Code X
Cultural Values, Spirituality, and Medicine  Theme Icon
When Peggy first saw Lia after the girl’s return from Fresno, she was heartbroken: Lia was hardly alive. Talking to... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Nao Kao insisted on Lia’s second day back at MCMC that the intravenous line delivering all her medications be taken... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
History and Ethnic Identity Theme Icon
...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... (full context)
Chapter 15: Gold and Dross
Cultural Values, Spirituality, and Medicine  Theme Icon
Fadiman writes that Lia was seven when she first met her, which was two years after she had entered... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
The first time Neil saw Lia in a routine checkup after her final seizure, he found himself very emotional. He expected... (full context)
Chapter 17: The Eight Questions
Cultural Values, Spirituality, and Medicine  Theme Icon
Fadiman discloses that Lia neither died nor recovered. As her siblings aged and assimilated into American culture, Lia remained... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Blame and Power Theme Icon
In an effort to gain some clarity about the anticonvulsant medications prescribed to Lia, Fadiman visited Dr. Hutchinson at Valley Children’s Hospital. He explained that Lia’s final seizure was... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
...their notes before determining that it was indeed a possibility that the Depakene had made Lia especially vulnerable to infection. When Fadiman told Dan Murphy the same thing, he pointed out... (full context)
Chapter 18: The Life or the Soul
Cultural Values, Spirituality, and Medicine  Theme Icon
Blame and Power Theme Icon
Fadiman considers whether or not Lia’s life would have been better if she had been treated by somebody like Arthur Kleinman... (full context)
Chapter 19: The Sacrifice
Cultural Values, Spirituality, and Medicine  Theme Icon
History and Ethnic Identity Theme Icon
Fadiman describes a healing ceremony for Lia that she attended at the Lees’ apartment in Merced. Although Foua and Nao Kao believed... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Integration and Assimilation Theme Icon
...shaman convulsed and chanted on a wooden bench that represented a winged horse, one of Lia’s cousins stood looking out the door, surveying Merced’s East 12th Street, chanting, Where are you?... (full context)
The Afterword to the Fifteenth Anniversary Edition
Cultural Values, Spirituality, and Medicine  Theme Icon
Blame and Power Theme Icon
Fifteen years later, Lia is still alive. Fadiman writes that most people in similar nonresponsive states die within five... (full context)