Lia Lee

Another Square in the Quilt

UPDATE: An email from Jeff, “I am writing with sad news. Lia Lee, the daughter of Hmong immigrants whose life story inspired the The Spirit Catches You and You Fall Down, died Friday, August 31st, 2012.”

There is no update in the news, but since allowing journalist Anne Fadiman into their confidence, the family has maintained their privacy.

We send our deepest condolences to the family of Lia Lee. Caring for a child with such need creates a powerful love, and I know she will be sadly missed.

Anne Fadiman’s book, ‘The Spirit Catches You and You Fall Down’ is a powerful work of journalism, years in the making, that analyzes step by step the failures in communication and a clash of cultures that left a little girl in a chronic vegetative state– caught between life and death.

There were many mistakes, and even more missed opportunities to prevent this catastrophic outcome, but no villains. That is, unless the villain is war itself. Specifically, the war in Southeast Asia where the Hmong were recruited as soldiers and then left stranded in refugee camps or dropped into a life in the US they weren’t prepared for. The following passages are from Marcy Sheiner, taken from her website Dirty Laundry. Check out the whole article for insight into the history that brought the Hmong to the United States, and Lia Lee to Merced, California. Thank you to Marcy for letting me quote her here.

For assisting the CIA in Laos, the Hmong were promised they’d be welcome in the U.S.—but when the troops left the country, they jetted only generals and hotshots out, leaving the rest of the populace to fend for themselves. With the Laotian army hunting them down as enemies of the state, Hmong families set off on foot, carrying whatever they could manage. Many, particularly the old and the young, died along the way. Most possessions were eventually shed.

When they arrived in Thailand they were put into refugee camps, where they waited to be rescued by the Americans. Those who were finally brought to the States were ‘resettled’ all over the map, without regard for family cohesion or transferability of survival skills: Detroit, Minneapolis, Utah, Vermont—the Hmong were distributed all over the country so as not to unduly ‘burden’ any one locality.

A recent article on the fate of the Hmong left behind is here. For supporting the United States they are fugitives and nationless.

The Lee family settled in California, and Lia was born American. She should have had the best medical care in the world. Her doctors and nurses were well-intentioned, her care expensive. But mis-communication thwarted the best efforts of all the people involved in her care.

From an interview with Anne Fadiman—

Q: Can you talk a little about Lia’s doctors (Neil Ernst and Peggy Philp) as doctors?
They are as excellent in the medical sphere as Lia’s parents are in the parental sphere. Neil and Peggy are warm, competent, highly skilled clinicians, both Phi Beta Kappa graduates of Berkeley who chose Merced because they wanted to serve the underserved. If I lived there they would be my children’s pediatricians. Communication between them and the Lees was defeated when the culture of medicine ran up against the culture of the Hmong: two very strong, stubborn, uncompromising cultures. The impasse had nothing to do with any professional or personal shortcomings on the part of these excellent doctors.

Unlike many American patients, Lia Lee had continuity. Her pediatricians, Drs. Ernst and Philp, were husband and wife. They alternated taking call at night. They lived just a few minutes from the hospital and responded many times to Lia’s medical emergencies. Lia was not shuffled from doctor to doctor, but had the care of experienced doctors who knew her from infancy. This shouldn’t have turned out so badly. From Mai Na M. Lee, Professor of History at University of Minnesota, via Hmongnet

When Fadiman arrived in Foua and Nao Kao Lee’s apartment in 1988, she found Lia, their seven-year-old daughter who was pronounced brain dead two years earlier by her American doctors, alive and lovingly cared for. Lia had her first epileptic seizure when she was just three months old. According to the Lees, recent immigrants from the Secret War of Laos who did not speak English and could not even communicate their infant daughter’s sickness to the doctors, the seizure stemmed from spiritual causes. After several seizure episodes, and only when Lia was brought in still convulsing did the doctors properly diagnosed her as suffering from epilepsy. From the American doctors’ perspective, Lia’s condition was biological in origin and could be alleviated with drugs. Over the next four years Lia’s anticonvulsant prescriptions changed 23 times. Gradually, the Lees doubted the effects of these complicated multiple prescriptions. When they refused to administer the drugs to Lia, the doctor had Lia placed in foster care. A few months after returning home to her parents, Lia had a massive seizure which left her brain dead. With death imminent, the doctors allowed the parents to take Lia home. Two years later, when Fadiman arrived to investigate the story, the Lees still harbored hopes of reuniting Lia’s soul with her body and arranged for an elaborate pig sacrifice.

I cared for a child in a vegetative state, and heard her grandparents calling to her, “Wake up, wake up.” It’s unbearable to witness. It seems so impossible that a child could be living and breathing but unreachable forever.

Lia Lee was 5 years old when she suffered her brain injury. She must be 27 years old now.

Lia’s family allowed Anne Fadiman into their home and their confidence. It’s all the more striking that they have not followed the American way of seeking attention, for vanity or for a cause. They don’t have an internet presence. It seems like everyone close to Lia or her family protects their privacy.

Anne Fadiman’s book is now used as a text for health professionals. Lia’s doctors teach other doctors how to care for patients across cultures.

UPDATE: Many are wondering how Lia and her family are doing now. They are very private people. Follow the Dirty Laundry link and scroll down to a comment by Janice K. for the most recent news I could find on the net.

I’m pasting a book review on Amazon.com here– the writer has not identified herself except as Lia Lee’s sister, it was posted in 1997…

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 !

Amazon is worth visiting for an intense discussion including people who were close to the case.

Professor Mai Na M. Lee’s article on HmongNet is excellent, and not to be missed if you want the perspective of a Hmong-American writer familiar with both cultures.

Yeng M. Yang, MD has an insightful review of the book in Hmong Studies Journal, Spring 1998.

RELATED NEWS: One of the soldiers murdered in the Fort Hood shootings was Kham Xiong a Hmong-American serviceman waiting to be deployed to Afghanistan.

CONNECTIONS: I gave my copy of ‘The Spirit” to a Hmong-American student who is training to become a medical assistant. She says she likes the book. She showed it to her family and she said she would email me their comments on it.

PROVIDENCE, RHODE ISLAND: On the way to a community garden party I saw some Hmong ladies walking together. They were dressed in their traditional clothes. South Providence was home to my Irish grandparents, now to Asian, Central American and African immigrants. We’re the smallest state with the richest culture.

A PRAYER: To always strive to listen to my patients, across whatever differences divide us.

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14 responses

  1. Thanks for quoting me (Paragraphs 3 and 4) but you ought to give me credit, not just the link to my post that comes before that.

  2. Thank you Marcy for visiting us, and for letting me quote you. I have revised the post with credit to you. I love your site, Dirty Laundry, and your history of how the Hmong came to the US was so good that I took it, but should have named you as the author. Sorry, and I hope you’ll visit us again.

  3. Thanks for doing the right thing.

  4. Hi. I read the book as part of a cultural competency workshop. very moving

  5. This is one of the most moving and insightful books I have ever read. I was studying cultures and mental health and I read the book as part of my studies. It was a wonderful depiction of the Hmong culture and its strength. It also showed how language barriers and lack of knowledge of different cultures can hinder treatment of people with health issues. I have recommended this book to everyone I know. Wonderful book.

  6. Does anyone know the status of Lia Lee, and of her family?

  7. They seem to be very private.

  8. Fabienne Dravers | Reply

    My daughter suggested I read the book whilst visiting this September. I was very moved by the story written by Ms Fadiman. I did not know anything about the Hmong people. Now I do.
    We passed Merced on the way to San Francisco to fly back to France and I thought of the Lees and of Lia.

    Fabienne

  9. It’s a very humbling book if you are a health care provider. One of the things that struck me most, as a nurse, was how Lia’s mother was able to bring her to physical recovery with her loving care. Everyone who was involved with her, I am sure, wishes things had turned out differently. It’s a constant responsibility to listen to our patients. Age, class, ability– these can be barriers even when we share a language and culture.

  10. [...] basis. It’s also gotten the most comments — 36. A good chunk of readers come from kmareka.com, a nurse who referenced the review on her [...]

  11. I am writing with sad news. Lia Lee, the daughter of Hmong immigrants whose life story inspired the The Spirit Catches You and You Fall Down, died Friday, August 31st, 2012.

    1. I’m very sorry to hear that. I send my deepest condolences to her family. Caring for a child, a sister, who needs so much is a bond of love, and I know she will be sadly missed.

  12. I’m here visiting you again–I think I have several times.
    I too recently received a message from Jeff that Lia Lee died. I tried to confirm it but could find nothing about it anywhere else on the Internet. If you hear anything further I’d appreciate it if you’d let me know.

    I recently learned that Fadiman’s book is taught not only in medical classes, but also in journalism courses. It’s considered a masterpiece of investigative reporting.

    I get so many readers referred from your site–thank you.

    1. Hi Marcys, as you can see from the top post today, the Modesto Bee published an obituary yesterday…best wishes to you and your site…glad we could help to bring you some visitors and that we have all done good work to bring the story of Lia Lee to more readers.

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