The Spirit Catches You and You Fall Down – Journal # 2

Having finished the book, I am still more in sympathy with Lia’s parents than with the doctors. Despite Anne Fadiman’s own bias toward the Hmong, I still feel she was objective enough in her portrayal to allow me to see both sides The short amount of time she spent with Neil and Peggy vs Lia’s family, coupled with the fact that it was spent reviewing documents prevents me from seeing them as “human” as I would have liked. I think I am trusting of doctors and medicine, but my trust has not been tested to any great extent, for which I feel very lucky. Yes, me too.

I am very curious about how this book would be viewed by my friends who are doctors, women I went to high school and college with and whom I still contact at holidays etc. One of my college friends is in the department of gynecology at Boston’s Brigham and Women’s Hospital, and she does a lot of research into the latest issues surrounding menopause and hormones. She is a divorced single mom with one son and she is busy all the time. Another friend, this one from high school, is a plastic surgeon in Miami. She and her husband remind me of Neil and Peggy a bit. My friend, like Neil and Peggy, was a serious runner in college, making her a pain in the butt to go on vacations with because she always had to carve out large portions of time to run no matter where we were, and she never wanted to go out to eat. Her running schedule was extremely regimented. Now, my friend and her husband have five children and four Spanish-speaking nannies, so I imagine them coordinating their household and parenting sort of like their plastic surgery practice. She has always been a person who does not convey much emotion. She is extremely smart in math and other subjects dealing with numbers. Yet her fluency in Spanish means that many of her patients in Miami are Hispanic, and she also travels to Africa to donate her time and skill as a plastic surgeon. Of these two doctor friends, I imagine she might have the most sympathy with being a doctor in a bi-cultural context.

I remember asking Jan (the Boston doctor) to describe her first cadaver lab in medical school, because I could not imagine anyone cutting into a dead human body. Jan said she had bought herself a pink sweat suit to wear as her dissecting clothes. She told me a lot more details about the actual dissecting and how she coped with it before, during, and after. Isn’t it interesting that the detail about the special pink sweat suit is the only one I can actually remember two decades later? !!

Although I cannot recall Jan’s descriptions, reading Fadiman’s description of how doctors are trained to deal with cutting up cadavers resonated with me because that is exactly how I imagine them being trained. Bodies do become “the appendix in Room 28.” Distance from the whole person is necessary, it seems to me, because I cannot imagine cutting up a live or dead body any other way, myself. This is a good point – there needs to be some level of detachment that allows your plastic surgeon friend to peel back someone’s face or something like that to do other work; or the whole thing with laser surgery or the instrument that you see on a screen, etc. I think it’s a very special person that can inhabit both that detached world and the “warm” one, or at least to make that transition easily, I do not think the Hmong parents are the only people who have serious questions about American medicine. I do not even think immigrants are the only group of people who question it, apart from Christian Scientists and other religions within America – yes, especially now. There is considerably less blind acceptance on the part of patients these days. . Wendell Berry, a writer I like a lot, wrote a collection of short stories called Fidelity. I cannot remember the name of the story that made the greatest impression on me, but I think it was the title story, “Fidelity.” This story was about a group of Kentucky farm people (as most of Berry’s stories and novels are) who lived very close to the land and objected to the prevailing belief in progress. Wendell Berry is often advocating “simpler values” in his books and this story focused on the absurdity of making someone die in a hospital and be buried according to hospital’s protocol. The upshot of it is that an elderly member of the farm family dies in the hospital and is kidnapped and taken back to the mountains to be buried on his own land. It is all illegal because the body was not released, the correct paperwork was not filed, etc. Yet the family believed they were honoring the dignity of this man. Wendell Berry writes much like Anne Fadiman, conveying respect and understanding of the culture that goes counter to the way most of America is going. Reading his fiction, it is impossible not to respect the values of the family, even though in the hands of a different writer they might come across as hillbillies or hicks. Have you ever read anything by Angela Pneuman (I think that’s the spelling); she writes similarly; the title story from Home Remedies sounds like it’d fit with Wendell Berry. She’s an “emerging” writer whose work just gripped me and I stayed up all night reading the collection.

The fact that Lia remained alive in the heart of her family without the aid of all the medical tools used to keep brain-dead people alive amazes me. Yes It simply makes me wonder if Lia’s parents knew something beyond what American medicine could. Yet even if Lia had died after being brought home, I think I would still sympathize more with the parents than the doctors. Anne Fadiman’s list of recommendations by Bruce Thowpaou Bliatout (pages 265-266) and her comments on doctors who “loved the Hmong” made complete sense to me. They were things I had been thinking as I read. I am also grateful that doctors today are receiving more training in cross-cultural treatment, such that cultural misunderstandings are hopefully more rare today than they were in the 1980’s. I still wonder if they really are, though. I hope I get a chance to talk to Jan about this book some day. It’s a great book to discuss with doctors; my experience is that it both intrigues and angers many people. My old neighbors (who now live in Olympia) read this book when they were still in Seattle and we had great discussions about it. The one who is a GP and did extensive work in the Peace Corps before going to med school was the most put off by it. That was a surprise to me. His wife, who is just, frankly, a genius, was more intrigued. She is a radiation oncologist. Her reaction surprised me because I expected her to be more prescriptive, but she said that in her specialty, people needed to want treatment. While she didn’t always agree with the decisions of her patients, as long as they were making informed choices, it wasn’t her place to judge. Although I wonder about the case of children – if her response would be the same.

An interesting tidbit is that this book is required reading in many, many medical schools; I think that the issue is coming across!