Many details foreshadow Lia's tragedy. One of the clearest is Neil Ernst's premonition: "I felt like there was this giant snowball that was coming down the mountain and we were trying to hold it up there and it just kept pushing us. I remember talking to the parents and telling them that Lia's seizures were getting worse and more frequent and that someday she might have one we couldn't stop. It was so haunting. I started to have nightmares that it was going to happen, and I would be the one on call, and I couldn't stop it and she was going to die right before my eyes. It was inevitable. It was just a matter of when" (118).
Fadiman continues to foreshadow the tragedy that befalls Lia as she describes the evening of her big seizure. When she tells us about Lia's trip to the hospital via ambulance, she notes: "If her parents had run the three blocks to MCMC with Lia in their arms, they would have saved nearly twenty minutes that, in retrospect, may have been critical" (141). Describing the doctors' reactions at the hospital, she shares details that suggest they have missed some vital signs: "No one thought of taking her temperature, which was 101, until after Neil had returned home. Two other unusual signs - diarrhea and a very low platelet count - were simply noted without comment on Lia's chart, eclipsed into invisibility by the monumental scale of her seizures. No antibiotics were administered because no infection was suspected" (144). Later, we learn that Lia was actually suffering from septic shock, a far more deadly condition that led to her brain damage.
More generally, Fadiman's descriptions of Hmong beliefs about illness and western medicine foreshadow the difficulties that they will have with the American medical system.