The Turning Point: Lia's "Big One"

After the events previously described in the last blog post, we were introduced to Leah's condition, her treatment, and background on the cultural identity and beliefs of the Hmong people. In continuation of the cultural and communication gap between the American doctors and Hmong patients, especially the Lee family, Fadima once more analyzes the numerous ways in which the Hmong distrust American hospitals. If a Hmong patient walked into a doctor's office complaining of a stomach ache, they may actually be complaining that the entire universe is out of balance. Bill Selvidge, a former chief resident of MCMC, explains that most doctors remain unable to fully help them because they are unlikely to ask their Hmong patients what they believe the problem is caused by. Salvage explains that Hmong behavior can be quite different from an outsider's perspective, and to this, doctors suggest the best way to treat the Hmong illnesses is to subject them to “ high-velocity transcortical lead therapy” (the title of chapter 6). When Fatima asks what this means, he replies, “The patient should be shot in the head”. This comment alludes to the dark and bitter attitude in which doctors feel. Once again, the book argues that the issues between doctors and the Hmong are not a result of stubbornness but rather big cultural differences, language barriers, and mistrust. While the US Healthcare System tends to prioritize efficiency and authority, the Hmong cultural approach emphasizes family involvement, traditional healing, and spiritual beliefs. 

More specifically, the last blog post left off at a very critical moment for the Lee family, in which Lia was taken from the custody of her parents. On May 2nd, 1985, Child Protective Services placed Leah in a temporary foster care for two weeks. After she returned home, her parents, Foua and Nao Kao, continued their pattern of non-compliance by neglecting to properly administer her drugs again. As a result, she was taken away for the second time on June 6th, but this time it was for 6 months. Lia was placed in foster care with Dee and Tom Corda, where Dee cared for Lia and made an effort to understand Foua and Noa Koa's culture. They eventually built a close relationship with the Lees and even advocated for Leah to return home. However, Lia was not immediately returned home because her parents refused to sign a medication agreement and later failed to give her medicine during a trial visit, which led to another seizure. Despite these challenges, their social worker, Jeanine Hilt, continued helping the family learn how to manage Leah's treatment. After months of effort and support, Lia was reunited with her parents in 1968 

In an attempt to connect with the Hmong community in Merced, Fadiman’s first attempts to interview Hmong people failed because her interpreters were relatively unhelpful. With the help of Sukey Waller, she explains the importance of understanding Hmong culture and spiritual beliefs when working with patients. With this advice, Fadiman is eventually welcomed by the Lee family and begins building a relationship with them. Through these interactions, she learns more about their beliefs about illness, including the idea that both medicine and spiritual healing should be used together. It highlights the Lee’s feelings of displacement in the United States and the challenges immigrants continue to face when their culture is not understood or valued. So when Lia came home, and her parents held a sacrificial ceremony in which they killed a cow,  Fadima asked them if they thought this might disturb non-Hmong Americans. To this, Noa Koa replies, “Americans should think it was okay because we had the receipt for the cow”.  Despite the ceremony they held for Lia, her parents began to feel that she was in worse condition than when she went into foster care, believing the doctors gave her too much medicine. When Leah seized again and was admitted to MCMC, Neil saw that her medication wasn't working. This began to worry him that someday they wouldn't be able to set up an IV and give her the right medicine to stop her seizures. He soon began to dread the day that Lia would have a seizure that he wouldn't be able to stop. 

The “big one” eventually came on the night before Thanksgiving in 1986, when Leah suffered a severe seizure and was taken by ambulance to the hospital. Once there, the doctors tried desperately to establish an IV, but because she was thrashing so hard, none of them could get the needle into a vein. The doctor described Lia as if her whole body was jumping up and down on the bed. When one of the doctors suggested they try a saphenous cutdown, a procedure in which the patient's vein is cut open and a catheter is inserted, Lia was finally stabilized. Neil then called Valley Children's Hospital in Fresno and arranged for Lia to be transferred for the weekend since they were better equipped to handle a serious situation like this. Leah arrived at the hospital in the middle of another grand mal seizure, where the doctors there found that she had a high white blood cell count and was running a high fever. After a week of the doctors performing procedures and tests on Lia,  the doctors concluded that she was in a permanently non-responsive state. When the doctors explained to Foua that they were going to take her off life support so she could die as naturally as possible, Foua saw this as the doctors taking away her medicine and giving it to another patient. Although the doctors expected her to die shortly after being taken off life support, she continued to live. After Jeanine Hilt arranged a court order to have Leah die at home, it was decided that she should be transferred back to MCMC. Ultimately, Leah's condition marks a turning point in the story, revealing the heartbreaking consequences that can arise when cultural differences in medical systems struggle to work together.