The Spirit Catches You and You Fall Down

Neil Ernst Character Analysis

One of Lia’s primary doctors (along with his wife, Peggy Philp) at Merced Community Medical Center. Neil is a highly intelligent and inquisitive pediatrician who specializes in infections, asthma, and allergies. Incredibly driven and willing to seek out the truth even if it unearths his own mistakes, Neil eventually comes to believe that Foua and Nao Kao are unfit to care for Lia, due to the fact that they refuse (or fail to understand how) to comply with the medicinal regimen he prescribes for their daughter. Although he never asks them what, exactly, they believe, Neil tries to explain the importance of closely adhering to the prescriptions he issues. Eventually, when he fails to get through to the Lees, he writes to Child Protective Services and suggests that Lia be placed into foster care. Despite his frustrations with the Lee family, he develops a complicated bond with them. When Fadiman, who interviewed him extensively for The Spirit Catches You And You Fall Down, asks if he wishes he never met Lia, he says, “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.”

Neil Ernst 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 Neil Ernst or refer to Neil Ernst. 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.
Chapter 5 Quotes

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:

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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:

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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:

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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:

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Neil Ernst Character Timeline in The Spirit Catches You and You Fall Down

The timeline below shows where the character Neil Ernst appears in The Spirit Catches You and You Fall Down. The colored dots and icons indicate which themes are associated with that appearance.
Chapter 5: Take as Directed
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 married couple) came to know her and her parents very... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Blame and Power Theme Icon
Integration and Assimilation Theme Icon
...they didn’t want to give Lia the prescribed medications, she remained unsure. Both she and Neil were becoming frustrated with the level of miscommunication between them and the Lees and started... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Blame and Power Theme Icon
...words),’” and posited that it was possible the child suffered from developmental delay. She and Neil—though not surprised—were upset by this conclusion because they wholeheartedly believed it could have been avoided... (full context)
Chapter 7: Government Property
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Unlike other doctors, Fadiman points out, Neil Ernst remained unbending in his care for Lia, ultimately unwilling to compromise the quality of... (full context)
Chapter 9: A Little Medicine and a Little Neeb
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Not long thereafter, Lia was admitted to MCMC once again, at which point Neil saw that the Depakene—which seemed to have been so effective—wasn’t working. He began to worry... (full context)
Chapter 11: The Big One
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...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... (full context)
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When Neil arrived at MCMC, the doctors continued to have trouble establishing an IV line, and Lia... (full context)
Chapter 13: Code X
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...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... (full context)
Chapter 15: Gold and Dross
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The first time Neil saw Lia in a routine checkup after her final seizure, he found himself very emotional.... (full context)
Chapter 17: The Eight Questions
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Neil Ernst and Peggy Philp continued to practice, winning awards and gaining promotions. When their son... (full context)
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Fadiman repeated Hutchinson’s theory to Neil and Peggy, who pored through their notes before determining that it was indeed a possibility... (full context)
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...she thought the Lees would respond and brought the results to Kleinman. In contrast to Neil and Peggy, who were baffled to learn what the Lees actually believed, Kleinman was excited... (full context)
Chapter 18: The Life or the Soul
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...have been better if she had been treated by somebody like Arthur Kleinman instead of Neil Ernst and Peggy Philp. Regardless, she says, the real culprit of Lia’s demise was no... (full context)
Afterword to the Fifteenth Anniversary Edition
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...and families are fully involved with their medical treatments and free to voice their wishes. Neil and Peggy joined Dan’s practice and often think about Lia—they think that the results of... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Blame and Power Theme Icon
...one of the Lee daughters was a student) to speak about her book, Fadiman invited Neil and Peggy to join her on the panel. She also invited Foua and Nao Kao... (full context)