Chapter 11: The Big One
On November 25, 1986, the day before Thanksgiving, Lia was eating as normal when she began to seize. Her seizures normally lasted only a few minutes, but when she didn't get better, Nao Kao's nephew, who spoke English, called an ambulance. Nao Kao and Foua had always carried Lia to the hospital before, but Nao Kao believed that taking her in an ambulance would make the doctors pay more attention to her. Unfortunately, the time it took for the ambulance to bring Lia to the hospital may have cost her life.
Lia was on the verge of death when the ambulance arrived. The EMT tried but failed to insert an IV three times. At the hospital, she was rushed to the room reserved for the most critical cases. Her clothes were cut off and the doctors gave her a large dose of Valium, which usually halts seizures. It had no effect. Lia was having trouble breathing, and a resident managed to insert a breathing tube. Neil Ernst was paged and came to the hospital as quickly as he could. Even with restraints on, Lia was practically jumping off the table. Finally the doctors were able to insert an IV by cutting a vein, enlarging the hole with forceps, inserting a catheter, and suturing it in place. They gave her an enormous amount of medicine, and finally she stopped seizing.
Everyone at the hospital assumed that Lia had the same thing wrong that she had had on her previous fifteen admissions to the hospital, only worse. However, nobody thought to take her temperature (101 degrees) or to pay attention to two other unusual signs, diarrhea and a very low platelet count. Lia had seized for nearly two hours; even a twenty-minute bout is seen as a life-threatening situation. When she stopped, she was breathing but still unconscious. Since MCMC doesn't have a children's Intensive Care Unit, they transferred her to Valley Children's Hospital in Fresno. With the help of their English-speaking nephew, Neil tried to communicate what was happening to Foua and Nao Kao. However, they misunderstood and believed she was being transferred not due to the severity of her condition, but because Neil was going on vacation.
Lia was in the midst of another grand mal seizure when she arrived at Valley Children's Hospital. Her fingers and toes were blue, her blood pressure was dangerously low, and her temperature was 104.9. A critical care specialist named Maciej Kopacz diagnosed her condition as septic shock, in which bacteria in the circulatory system causes circulatory failure followed by the failure of one organ after another. To stop her seizures, Dr. Kopacz gave her a highly potent sedative, which more or less put her under general anesthesia. The doctors put her on a respirator delivering 100% oxygen, inserted two more catheters to monitor her blood pressure and deliver drugs, and put a third catheter through two chambers of her heart to monitor heart function. By the next morning, Lia had developed a disorder called disseminated intravascular coagulation, in which her blood could no longer clot and she started to bleed both from her IV sites and internally. In desperation, Dr. Kopacz removed her entire blood supply - twice - and replaced it with blood that was able to clot. Thankfully, the transfusion finally worked.
Nao Kao was the most distressed by the spinal tap, a routine procedure to find out if the bacteria had passed from her blood to her central nervous system. He attributed her condition to this procedure, which many Hmong believe to hold the potential of crippling a patient for both this life and future lives. Foua attributed it to the doctors giving her too much medicine. Lia was, in fact, given an inordinate amount of medication and was also subjected to a large number of diagnostic tests. The Lees stayed at the hospital for nine days, although they were only allowed to visit Lia for ten minutes once an hour. Hospital staff tried to explain what was happening, but despite the presence of interpreters, the Lees remained confused. When doctors tried to obtain permission to perform two more invasive diagnostic tests along with a tracheostomy, a hole cut into the windpipe, they noted that the parents consented -- yet Foua and Nao Kao had little understanding of what they had been told.
Later that day, the doctors gave Lia a CT scan and an EEG and found that she had essentially become brain-dead. Jeanine Hilt received a call and drove a number of relatives to Fresno; Dee and Tom Korda came as well. At the hospital, the doctors were preparing the family for Lia to die. They discontinued all life-sustaining measures so Lia could die naturally. They also took her off anticonvulsives since, without electrical activity in her brain, she couldn't seize anymore. Lia's parents requested to take her to Merced, where she could be with other relatives. Jeanine arranged to transfer her back to MCMC, where she could be supported until her death.
Chapter 12: Flight
When the Lees first tried to escape from Laos in 1976, they were captured by Vietnamese soldiers and forced back to their village at gunpoint. One of their children died soon afterwards, as there was no medicine. Their village, Houaysouy, had escaped fighting during the war, as it was isolated from the rest of Laos by the Mekong River. However, because they were Hmong, the residents were treated as traitors and abused by the occupying forces. The Vietnamese would kill them for minor offences such as stealing food, and they took away the majority of what they harvested. In 1979, the Lees' infant son died of starvation.
One month later, they tried to escape again, along with about four hundred others. The Vietnamese tried to stop them with fire and land mines, but somehow they survived. After walking for twenty-six days, they arrived in Thailand, where they lived for one year in two refugee camps before being allowed to immigrate to the United States.
Approximately 150,000 Hmong fled to Thailand after the war; their prewar population in Laos had been between just 300,000 to 400,000. Only those who had supported the communist cause were safe from harsh treatment in Laos. The Vietnamese forced Hmong into the lowlands, burned villages, separated children from parents, made people change their names to get rid of clan names, and forbade the practice of Hmong rituals. Many of those who were forcibly relocated contracted tropical diseases such as malaria, which did not exist at the higher elevations. Pathet Lao soldiers infiltrated most villages and spied on families day and night. Sometimes men were led away to a "seminar camp," which combined forced labor and political indoctrination. The camps housed other Lao as well, including the king, queen, and crown prince, all of who died there.
Some Hmong resisted through armed rebellion. Between 1975 and 1978, former members of the Armee Clandestine retaliated against the Pathet Lao by shooting soldiers, blocking roads, destroying bridges, blowing up food convoys, and pushing rocks onto enemy troops below. The resistance movement was defeated in 1978, following 50,000 deaths. However, Hmong guerrillas remained in the jungles between Laos and Thailand, launching sporadic attacks on the Lao communist forces.
The majority, however, responded by migrating, as their ancestors had so often done. They were motivated not only by fear of the communists but also by famine. Families had to leave behind pretty much everything they owned. While a few "privileged" families were airlifted or paid a driver to take them to Thailand, most walked. Most families took about a month to reach Thailand, although some lived in the jungles for two years or more. Babies were often drugged with opium to prevent them from making noise; occasionally, an overdose would kill the child. Adults usually took turns carrying the elderly, sick, and wounded, but when they could no longer do so, they had to leave their relatives by the side of the trail. The Hmong revere their elders and believed that the proper funeral rites were necessary for the souls of the deceased to find rest; thus, leaving them to die and their bodies to rot was a horrible choice to have to make. On the way, they passed abandoned villages with former treasures, decomposing corpses, and starving children. Living west of the Mekong River, the Lees were able to cross into Thailand by foot, but the river posed an additional challenge for most Hmong. Many drowned or were shot trying to cross the river. The majority of those who survived suffered from malnutrition, malaria, anemia, and infections.
Thailand was willing to temporarily house the refugees as long as other countries paid the bills and promised them permanent asylum. Most of the Hmong were eventually consolidated in one large camp in northeast Thailand near the Mekong River called Ban Vinai. The camp was the largest Hmong settlement in history, with over 40,000 residents at its peak. It lacked electricity, running water, and sewage disposal, and there was little for people to do except eat and sleep. Camp officials tended to blame the Hmong for their dependence, poor health, and lack of cleanliness, and Westerners at the camp often made disparaging remarks.
The majority of the camp's inhabitants eventually immigrated to the United States. The best-educated refugees came in the first wave, and the least-educated came later on. Because for several years the U.S. limited the size of extended family groups to eight but not the size of nuclear families, the Hmong grew accustomed to lying to immigration officials about their kinship ties. Others, however, preferred to stay at Ban Vinai. They heard rumors about the United States about urban violence, welfare dependence, being unable to sacrifice animals, doctors who ate the organs of patients, and so on. Ban Vinai, although it was dirty, crowded, and disease-ridden, at least allowed the Hmong to maintain their culture. Women sewed paj ntaub, families raised chickens or tended vegetables, children listened to their elders, and the arts flourished.
In 1992, Ban Vinai was closed and the remaining 11,500 inhabitants had only two choices: to apply for resettlement in another country or to return to Laos. Many who had resisted coming to the US now decided it was the better of the two options, yet nearly 2,000 Hmong were denied refugee status. Since 1991, around 7,000 Hmong have returned to Laos, promised that conditions have improved and their lives will not be in danger. However, there have been reports (all denied by governments and by the United Nations High Commissioner for Refugees) that some Hmong have been forced to return and then been persecuted or killed.
More than 10,000 Hmong said no to both choices and fled to Wat Tham Krabok, a Buddhist monastery north of Bangkok. Just like the hero of the greatest Hmong folktale, Shee Yee, who escaped nine evil dab brothers by shapeshifting into many different animals, the Hmong have always been able to find ways to get out of tight spots.
Tensions continue to build as Lia's story approaches its climax. The foreshadowing, which began with Neil's premonition at the end of Chapter 9, continues. "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), Fadiman writes, hinting at the tragedy which is about to happen. Later, she points out what the doctors didn't pay attention to - her high temperature, diarrhea, and a very low platelet count - which later turned out to be signs of septic shock.
Fadiman uses detailed visual imagery to transport us to the hospital, where we can feel the stress and confusion of those present. The doctors did their best, but even they missed vital signs that indicated what they needed to do. As for Foua and Nao Kao, they had little understanding of what was going on. Many Hmong taboos were broken; Lia had her entire blood supply removed twice, though many Hmong believe taking blood can be fatal, and she was given a spinal tap, which they think can cripple a patient in both this and future lives. The outcome confirmed the Lees' worst fears and eroded whatever trust they still had in the U.S. medical system.
There is a great deal of irony in this chapter. While Foua and Nao Kao usually carried Lia to the hospital, they recognized the severity of her symptoms and called an ambulance instead, believing it would make the medical staff pay more attention to her. However, it may be that the additional time required for the ambulance to arrive and respond could have cost Lia her life. It is ironic, too, that the Lees believed Lia could have been saved, had Neil been the one to treat her – Neil, after all, had been the one to have Lia taken away from them.
The story of the Hmong, though nonlinear, also comes to a climax, as war refugees brave the dangers of escaping from Laos. The ordeal required an immense amount of tenacity and courage and demonstrates the enormity of the United States' betrayal, introduced in Chapter 10. The Hmong assumed they would be taken care of if they lost the war; instead, the U.S. allowed thousands to die attempting to flee their homeland and even denied refugee status to 2,000 of those who made it to Thailand. As mentioned in the analysis of the previous section, this betrayal helps to explain why the Hmong were wary to trust Americans. It is an unfortunate parallel to Lia's story; in both cases, those in power failed to save the Hmong entrusted to their care.
At the end of Chapter 12, Fadiman introduces the character of Shee Yee, the hero of the greatest Hmong folktales. Shee Yee escaped nine evil dab brothers by shapeshifting into various forms and eventually biting a dab in the testicles. Fadiman presents Shee Yee as a symbol of the Hmong people. He is clever and resourceful, able to fight and escape rather than be captured or forced into an undesirable situation. Like Shee Yee, many Hmong refugees in Thailand found an unanticipated solution when pressured to either return to Laos or immigrate to the United States and instead fled to a Buddhist monastery near Bangkok.