Sad follow-up

A co-worker just forwarded me an obituary for one of our former subjects.  Lia Lee, the Hmong heroine of The Spirit Catches You and You Fall Down, passed away August 31st in Sacramento of pneumonia.  Attached you will find the link to the New York Times article/obituary.

Lia Lee, 1982-2012



Reviews by people involved

I cannot wait to hear your reviews tonight but, to tide everyone over until then, here are some Amazon reviews by Doctors and Lia’s sister.

A divine liqueur distilled from a murky cultural clash, April 6, 1998

I was one of the physicians involved in the care of Lia Lee. I’m referred to in the book as the physician that first diagnosed Lia’s spells as seizures. Neil Ernst and Peggy Philp, the principal pediatricians in the book, were and are good friends of mine. Having experienced Lia Lee’s saga personally, and then having read the book, I can only refer to Anne Fadiman’s talent as astounding. Anne walks an incredibly fine, and very well documented, line as she describes what happens when American medical technology meets up with a deep and ancient Eastern culture. My team (Western medicine) failed Lia. Never have I felt so fairly treated in defeat, and never have I felt so much respect for an author’s skillful distillation of a tragically murky confrontation of cultures.

ADDENDUM (8/8/09) I wrote the above review almost a decade ago. The experiences that I had during the events described in this book have continued to guide the way that I practice medicine. The Spirit Catches You has become a true classic in the medical and anthropological fields, being read in college, medical school, and nursing classes throughout the United States every year. This speaks to the enduring quality of the work that Anne Fadiman did in a book that remains unique in the skill with which it was written. The story it contains remains fresh and astoundingly relevant to the practice of medicine in particular, and cross-cultural relationships in general.”

This is an exceptional piece of work!!, November 4, 1997
By A Customer

I don’t think I should be writing in here since I am a part of the book. This book was amazing! It took me two days to read it and of course I shed a few tears on the way. My sister, Lia Lee, is doing well although she will never be able to see the bright sunlight or the incredible stars that we see everyday and everynite. She is an incredible child with so much love and affection from her family and the many friends she have encountered during her hardships.
I was only 7 when all this happened, but I do recall everything from the door slamming incident to the day the doctors told my family that it was okay for her to come but she will not live pass 7 days. I will never forget that week or those many years of pain my family or the doctors had to go through.
This book has given me a better view of what can really happen when two different cultures have their own ways of interpreting medicine or life in general. We must understand that different cultures have different ways of curing a person and doctors have their policy they must follow. To avoid another incident like this, we must work together as a whole and not blame each other for not cooperating with one another. Lets hope this book tells us what can happen in the future if we don’t work with this now.
Anne did a great job on this book! My family couldn’t have ask for more. She has become a great friend of my family and we are greatful for it. Anne-thank you!”



Blog Silence

Sorry for the interruption in content for the last couple days, but I wanted to come back with a bang…and by that I mean my interview with Anne Fadiman.  I asked her five questions (one of which she pointed out was six in one).  I need to make a couple edits, but it’ll be up before 3:00 this afternoon in preparation for tomorrow night.  Please check back later.  And tomorrow I dug up some interesting reactions to the book from the doctors and people involved.

Five Questions (more or less) with Anne Fadiman

1) Your name has become synonymous with the Hmong.  This book is the first of its kind to address such issues and is required reading in both Anthropology classes and classes for different medical professions.  Which do you view this book more as?  A tale of the clash of medicine vs. tradition?  Or more a book about the Hmong people?

I never wished my name to become “synonymous with the Hmong,” and I hope it hasn’t! I don’t view the book primarily as either of the options you mention. I view it as a book about cross-cultural communication and what makes it fail. Of course I’m keenly interested in both medical culture and Hmong culture, but Spirit has more in common with a (hypothetical) book on, say, a problematic legal case involving Somalian refugees than with a comprehensive anthropological study of the Hmong.

2) You say your book moved you to be a better mother but did it prompt you to become a better patient?  Did you reevaluate your stance on the traditional Western medicine techniques?

Techniques, no. Attitude, yes. When my children are ill, I don’t bring them to a Hmong txiv neeb, I bring them to a doctor, and I’m grateful that the panoply of Western knowledge and technology exists. However, American doctors could benefit greatly if they learned something from the attitude of a txiv neeb–a man who knows your family intimately, comes to your home, cares about you and your family as people. When I choose my doctors now, expertise still comes first, but it has to be accompanied by humanity. So I wouldn’t say I’m “a better patient”; I’m merely a more selective one, and, when doctors excel in both skill and compassion, a more grateful one.

3)  You shoulder a huge responsibility as being the first person to give the Hmong an “American” voice.  With articles coming out after your book was published like this one and other hospitals adopting plans/programs educating and making options available to the Hmong, how big a role do you think Lia’s story (your book) have to do with those changes?  Do you think hospitals were adapting and your book just brought light to those changes?  Or do you feel Lia’s story acted as a true catalyst?

I wasn’t the first person to give the Hmong an American voice. Just look at my bibliography, which consists entirely of books, dissertations, and articles written before Spirit! But, actually, I’m not sure any of us “gave the Hmong a voice.” We wrote about the Hmong, but that’s not the same thing. Only Hmong writers can have a Hmong voice. There are now some very good ones, including Kao Kalia Yang and Mai Neng Moua, who are more than able to speak for themselves.

It’s impossible to say which changes were brought about by Spirit and which were brought about by the zeitgeist of which Spirit was merely a part. My guess is that the most significant changes came from the latter.

4)  If the Hmong didn’t have such and extravagant (to your average American) religion, do you think the culture clash would have been more minimal?  Doctor procedural shows like Grey’s Anatomy and House have profited on the sensationalism of the Hmong rituals when it comes to medicine.  Would there be such an uproar if the rituals didn’t include animal sacrifices?  Is it wrong to water down cultural beliefs to be more mainstream appropriate?  And do you feel that the Hmong should have to do that in order to “fit in”?  Lia’s sister seems to appreciate the story more when she read your book and placed the incident in the context of what she knows now, but the book has been lauded by Hmong-American’s as a true representation of the culture; “Fish Soup” is almost always the first example that strikes a chord.  Has that changed the way you write now?  Does everything now begin with the beginning for you?

Sorry, that’s just too many questions to digest! I’m not sure how they interrelate, so I’ll try to answer the first of the six. No, my guess is that those medical television shows would have paid less attention to Hmong healing rituals if they didn’t involve animal sacrifices.

5) Your other books are very much about reading and the art of the book.  I read an interview from The Atlantic Wire by Nicole Allan in 2010 where you described what you read.  You mentioned a lot of popular fiction on your nightstand at home.  As the signature question of Keepinitreal, I would ask you to name your favorite non-fiction book and why?

It would definitely be by John McPhee, the writer who introduced me to literary journalism and made me decide that’s what I wanted to spend my life doing. That first, life-changing McPhee book was Encounters with the Archdruid, and it still occupies a canonical spot not only on my shelf of most-admired works but in my life.

Anne Fadiman visits UC-Davis with Lia’s sister

December 6, 2002

Fadiman visit stirs emotions, understanding

By Ellen Chrismer

Mai Lee, left, the sister of Lia, talks to the audience as author Anne Fadiman looks on during the panel discussion for The Spirit Catches You and You Fall Down. The book centered on Lee’s family’s struggle to care for their epileptic daughter.

Anne Fadiman never spoke to Lia Lee, nor was it possible for the little girl to speak to her. By the time Fadiman – who wrote the book chosen by UC Davis for its first Campus Community Book Project – met the young Hmong-American, Lia was profoundly disabled by a seizure disorder.

Yet spending time with Lia and her immigrant family, the subjects of The Spirit Catches You and You Fall Down, greatly affected Fadiman’s life, the author told an audience at the Mondavi Center Monday.

During the late 1980s and early 1990s, Fadiman and her Hmong interpreter, May Ying Xiong Ly, spent many an evening sitting on the floor of the Lees’ Merced apartment talking to the family about Lia’s needs. Their explanation of her condition became the title of Fadiman’s book.

“Lia mainly taught me because she was so beloved by her family,” Fadiman said. “I learned to love her myself – she became a complete person to me.”

Fadiman was joined onstage during a finale event for the book project by Ly, Lia’s sister, Mai Lee; and Lia’s former doctors.

Knowing Lia and her family’s struggles had a tremendous impact on them, too. As a panel they discussed the changes in family life, medical practice and cultural awareness that have occurred in their lives, thanks to Lia.

“What an extraordinary journey we’ve all been on,” said Dr. Neil Ernst, who with his wife, Dr. Peggy Philp, was one of Lia’s physicians at the Merced Community Medical Center.

Ernst, who with Philp now practices in Oregon, said he once referred to Lia as “dead” after she suffered the seizure that left her in a vegetative state. He doesn’t do that anymore.

“The Lees taught me about life and death,” Ernst said.

Mai Lee, now a student at UC Davis, recalled that it was difficult to be a teen-ager in her bi-cultural home. “I’ve never had the respect for my parents until the book was published,” she said, breaking into tears. “I saw what my parents went through.”

And Ly, who now heads the Hmong Women’s Heritage Association in Sacramento, described how becoming Fadiman’s interpreter enabled the “assimilated” college student to learn more about the history of her ethnic community.

As Fadiman asked Ly questions, “all those puzzles in my head about my own culture … sort of came together,” Ly said.

The panelists agreed that toughest part of Lia’s story and The Spirit Catches You comes when the little girl is placed in a foster home temporarily because her doctors learned that Lia’s parents weren’t giving her her anti-seizure medicine.

“This is the hard one; this is the tooth ache; this is not fun,” Ernst said. He said he’s not sure he had another choice, however.

“I agree that what (the county) did was a good thing, if the seizures would have been controlled,” Mai Lee said. “But since the outcome was different, I fall in between.”

Over the years, she and her husband and the medical profession have generally increased their “cultural competency,” Philp said. But much more still needs to be done. In one of her last cases at the Merced hospital, now owned by a private corporation, a Mien-speaking patient was denied an interpreter.

“I felt like we were spiraling back to where we had begun,” Philp said.

Since September, UC Davis faculty and staff members and students have met for group discussions on The Spirit Catches You. A number of faculty members also incorporated the book’s themes into their courses.

Ted Conover interviews Anne Fadiman about her new non-fiction novel. Part 1

This is from an interview at NYU, it is also required watching for anthropology classes.

This is Part One of Five – I will include the links to the other parts but, to save space, won’t embed them.

Part Two               Part Three               Part Four                     Part Five