The Spirit Catches You and You Fall Down

The Spirit Catches You and You Fall Down Summary and Analysis of Ch. 19 - Afterword

Chapter 19: The Sacrifice  

According to Hmong folklore, Shee Yee, the sorcerer who had turned into a tiny red ant and bit the evil dab on the testicle, had spent many years fighting dabs and restoring health to the sick. Illness had come when the wife of a wicked god named Nyong laid an egg full of dabs. Nyong's father ordered Nyong to burn the egg, but he refused, and the dabs swarmed out. They first ate Nyong's wife, then came after Nyong. He opened the door between the sky (where he lived) and the earth. The dabs flew through, bringing with them illness and death.  

Shee Yee fought the dabs for many years, with the help of a winged horse, a bowl of holy water, a set of magical tools, and a troupe of spirits. One day Nyong murdered Shee Yee's infant son and tricked Shee Yee into eating the flesh. He was so angry that he climbed the staircase to the sky and pierced both of Nyong's eyes. He now lives in a cave at the top of a mountain in the sky.  

Shee Yee never returned to earth, but he did not leave its people without help. He poured the bowl of holy water into his mouth and spat it on his healing tools: a saber, a gong, a rattle, and a set of finger bells. The tools broke and the pieces fell to earth. Anyone who caught a piece of a tool, or was sprayed with holy water, was designated to be a tvix neeb, a host for a healing spirit. When tvix neebs do their work, they summon Shee Yee's spirits and ride his horse up the staircase through the sky. They pretend that to be Shee Yee in order to deceive the dabs.  

The tvix neeb who was going to perform a ceremony for Lia brought his own healing tools and a flying horse, in the form of a long board supported by a pair of legs. The Lees had risen early, as the soul can come back better in the morning, and if it is hot, the pig may die before it can be sacrificed. The Lees had purchased two pigs for $225 and covered their living room carpet with tarps to protect it from the pigs' blood. Pots of water boiled on the stove, and bags of vegetables and herbs sat in wait for the upcoming feast. Nao Kao had cut a stack of spirit-money to pay the pig for its soul and settle other spiritual accounts. The altar was a wooden table covered with a newspaper, on top of which the tvix neeb lay his sacred tools. Next to them lay a bowl with rice and an uncooked egg, sustenance for the familiar spirits. Three Styrofoam cups and a china bowl were filled with holy water, in case the tvix neeb's soul needed to plunge inside to escape evil dabs.  

The tvix neeb was named Cha Koua Lee. He wore American clothing and was watching cartoons on TV when Fadiman first met him. It was against his ethics to charge for his services, especially as he was part of the Lee's clan. However, he always received the heads and right front legs of the pigs that were sacrificed. After eating the meat, he put the lower jaws outside to dry, and then added them to a collection to be ritually burned at the end of the year. This would release the pigs' souls from their duty as proxies for human souls and allow them to be reborn.  

In the first ceremony, the tvix neeb tied a cord around the smaller pigs neck and around all of the Lees, binding the pig's soul to the souls it would protect. A cousin slit the pig's throat, as the tvix neeb had to maintain good relations with the animals. In Laos, there would have been many domestic spirits in the house: a chief household spirit, the spirits of ancestors and wealth, the spirit who watched over the livestock, and the spirits of the fireplaces. Here, there were no spirits because the apartment was rented, and it was difficult to maintain a sacred atmosphere, the television flashing lights and the refrigerator humming.  

Several relatives brought the slaughtered pig to the parking lot, where they gutted and cleaned it. Back inside, there was a difference in atmosphere. The TV had been turned off, the candle on the altar was lit, and a joss stick was burning. The tvix neeb had adorned his sacred clothes. It was now time for Lia's ceremony. Foua and Nao Kao believed her condition was probably beyond reach, but they hoped the ceremony would make her happier so she would stop crying at night. The tvix neeb placed a bundle of spirit-money on Lia's shoulder, where she sat on her mother's lap. A cousin waved a live chicken in the air; after it was boiled, it would be examined to see if Lia's soul had returned. Good signs were firm eyes, an up-curled tongue, a translucent cranium, and most importantly, tight feet. A mismatched toe was a bad sign.  

Lia’s immediate family and over twenty of her relatives surrounded her. The larger pig was carried into the room. The tvix neeb tied a cord around its neck, then wrapped it around Foua and Lia. He walked around them many times, shaking his rattle loudly so Lia's soul would hear. He beat his gong again and again to summon the familiar spirits, and then tossed the halves of a water-buffalo horn on the floor to see if the spirits had heard him. He took a thick pile of spirit-money and placed it next to the pig, then spoke quietly to it, explaining that it would be well rewarded and that at the end of the year its soul would be set free. He threw the horns again to see if the pig had accepted. When they said yes, he thanked the pig, unwound the cord, and brandished his saber to cut away Lia's sickness. He poured some water into his mouth and spat it out, to wash away the sickness.  

Several relatives held down the pig while one cut its neck and another held a bowl to catch the blood. The tvix neeb held the spirit-money in the stream of blood, which would mark the money as belonging to the pig. He called his familiar spirits and touched Lia's back with a finger bell, marking her and preventing any evil dabs from touching her. He washed away more sickness, then took the spirit-money from Lia's shoulder and placed it on the pig. With the pig's blood on her back, Lia could travel anywhere and be recognized as a child in need of healing. Since she was no longer needed at the ceremony, Foua carried her into the bedroom and placed her on the bed.  

The tvix neeb now prepared for the most dangerous part of the ceremony. He flipped part of his headdress over his face, blocking his sight of this world but allowing him to see other realms. The veil, the incense, the gong and rattle, and the tvix neeb's movements put him into a trance. He sat on the wooden winged horse, doing a kind of tap dance as the rattle and finger bell he wore echoed the sound of the horse's bells. His assistant beat the gong to tell the spirits the journey had started. After about half an hour, the assistant placed his arms around the tvix neeb's waist and the shaman jumped backwards onto the bench. Now his soul was traveling far from his body, and if he fell, he would die. He started to gallop, sometimes on the horse, sometimes on the ground. Sometimes he was the horse. He chanted loudly, speaking to his spirits and negotiating with the dabs to release Lia's soul.  

During the tvix neeb's journey, a cousin opened the door and faced the street. On a small table at his feet lay the sacrificed chicken, some rice, an egg, and a joss stick. In his hands he held a pair of divination horns and a rattle. Every so often he tossed one or the other on the ground as he chanted to Lia's soul to come home.  

Afterword to the Fifteenth Anniversary Edition  

As of 2012, Lia was still alive. (GradeSaver note: she died later that year.) Most people in vegetative states die within six months, with the rest dying within five years. Lia's family has cared for her for 25. Her skin is now dry, her fingers stiff and curled. Foua is old now, so her daughters have been taking care of Lia. The family finally consented to a feeding tube, greatly decreasing the time it takes to feed her; however, it still takes a lot to bathe her, dress her, change her diapers, suction her phlegm, and sooth her when she cries. The family still celebrates her birthday, and once or twice a year a tvix neeb still comes to ease her suffering. Only Lia's brainstem is functional, but she may have some sort of consciousness, as she whimpered for hours when her mother was away.  

Before meeting Lia, Fadiman would have considered Lia deserving of kindness but of little value. However, now she sees how much she has contributed to so many people's lives, including her own.  

Nao Kao passed away of congestive heart failure in 2003. With the exception of the two eldest children, all of Lia's siblings have now attended or graduated from college and have good jobs. Foua has twenty-nine grandchildren, all of whom live within an hour of each other. Of Fadiman's four guides, Blia Yao Moua left his job counseling Hmong students and now works in financial services and marketing, Dang Moua works as a medical and court interpreter, Jonas Vangay teaches Hmong and directs international student services at Merced College, and May Ying Xiong works for the Hmong Women's Heritage Association, where she was once the executive director. She has won several leadership awards, along with a grant of over $100,000 to her organization.  

All of Lia's doctors have left Merced. Bill Selvidge works in a rural clinic in North Carolina, and Dan Murphy directs a clinic in Oregon, where he spends double the standard amount of time with each client and advocates an approach called Patient- and Family-Centered Care. After visiting a few times, Neil Ernst and Peggy Philp moved north to join his practice. Their older son, Toby, who had leukemia as a boy, has just celebrated his twentieth year of remission with a triathlon.  

MCMC (now called Mercy Medical Center Merced), improbably, has become a model for cross-cultural innovation across the country. In 2009, they instituted the country's first shaman policy. An agency called Healthy House launched a training program called Partners in Healing, in which tvix neebs spend forty hours learning about Western medical treatment. Graduates of the program are allowed to visit patients in their rooms and conduct nine types of ceremonies. (Animal sacrifice, gongs, rattles, and finger-bells are not allowed, due to blood and noise concerns.) The tvix neebs' endorsement of the hospital has had positive effects throughout the community. In addition, most Hmong are now bilingual and bicultural and more likely to trust their doctors.  

Mercy's attention to cultural issues reflects a trend across the country. Most hospitals now offer interpreters, and the majority address cultural needs. Terms such as "cultural competence," "cultural humility," and "cultural responsiveness" have come into use, helping doctors to acknowledge that they have their own cultural baggage and to try to respond to patients both as members of their cultures and as individuals.  

This book was written in the 1990s about the 1980s. By now, most Hmong families have adult children who were educated in the United States and speak English better than they do Hmong. When the first refugees came to the US in the mid-1970s, most shared the same religion, occupation, economic status, and educational history. The 260,000 Hmong here now are far more heterogeneous in every category. Jobs now range from welfare recipient to state senator, and nearly half of all Hmong now own their own homes. Their political clout was evident when over 1,800 showed up in protest of the Patriot Act, which would have classified many of the Hmong as terrorists for engaging in unlawful activity in their home country (i.e., fighting on the side of the US during the Vietnam War).  

The Hmong still maintain many of their traditions. Most elders still live in their children's homes, clans are intact, people help one another, animal sacrifice is still practiced, and traditional rituals are common. While the move to America was difficult for Hmong of Foua and Nao Kao's generation, life here is much better for their children. Younger Hmong do not wish to leave the US, but rather wish there were less ignorance about who they are and why they came.  

Unfortunately, most media coverage of the Hmong has been negative. They made the news in 2004, when a deer hunter shot and killed other hunters and the media tried to find evidence that he did so because of his culture. They did so again in 2007, when Vang Pao was arrested for plotting to overthrow the Lao government. In 2008, over twenty Hmong were cast for the movie Gran Torino, which unfortunately contained many inaccuracies.  

Fadiman acknowledges how much she didn't know and how many mistakes she made. She also met with failures, the largest of which was when the New Yorker editor who had assigned Fadiman the piece was replaced with another who decided not to run it. It is because of this that Fadiman decided to turn her research into a book. In addition, despite the fact that she knew each side of Lia's conflict had fallen into the trap of thinking their perspective was correct, Fadiman knew that she, too, was susceptible to the same error.  

Fadiman feels she understands things better now, but she is not tempted to rewrite the pages. The book belongs to its time. If she were to start from scratch today, she wouldn't write the book, as it would be too monumental a task. Also, a few Hmong have criticized her for telling a story that was not hers to tell. Now that Hmong writers are starting to publish, she is happy to be quiet and listen.  

Fadiman has maintained her friendship with Foua and her children. Who knows if her husband would have proposed if Foua hadn't dressed her up as a Hmong bride? Who knows what kind of a mother she would have been without Foua as a model? With Foua's guidance, Fadiman breast-fed for a long time and carried her children in a nyias.  

Nao Kao died a few years after Fadiman's own parents. His funeral lasted three days and three nights. One end of a string was tied to a cow, and the other to Nao Kao's hand in his casket. Although the cow could not be sacrificed there, it was done elsewhere and the head brought back to the hall. There were six qeej musicians and a drum. Fadiman compared the service to what happened with her parents, who had been cremated and instructed their children not to view the body. She realized her own culture was dry, and that her people don't know how to let their feelings out or to mourn.  

Several months before Nao Kao's death, something extraordinary happened. Fadiman had been asked to speak about the book at U.C. Davis, where Foua and Nao Kao's daughter Mai was a student. She persuaded the university to hold a panel with Mai, May Ying, Neil, and Peggy all speaking together. Foua and Nao Kao were able to attend. Neil spoke of how hard it had been to put Lia into foster care, and that he was sorry for the hurt it had caused. Afterwards, Nao Kao approached Neil and told him that he now understood how much Lia's doctors had cared about her. Then he thanked him.  


In Chapter 19, the final chapter in the book's original publication, Fadiman takes us into the Lees' home to witness a tvix neeb ceremony, utilizing rich sensory details to help us to see, hear, and even feel what is happening. The tvix neeb asks permission from the sacrificial pig to take its life, assures it that it will be released from its duty at the end of the year, and even pays it with symbolic spirit-money, thereby personifying the animal and revealing a cultural respect for and connection with the natural world.  

There is a connection between shamanism as a subject of storytelling, and storytelling as a form of shamanism. In a way, Fadiman's book can bring Lia back to life in some form by engrossing readers in her story.  

At least one critic has argued that Fadiman's interpretation of this ceremony is incomplete, as it is impossible for a non-Hmong to fully comprehend and appreciate its implication. By ending the book this way, however, she returns Lia's pathology to her and her family.  

Although the Afterword (written fifteen years later) adds a sense of finality to Lia's story, Chapter 19 opens the text to possibilities that the characters cannot know. The story is inconclusive, leaving room for hope that Lia's soul will return. The Lees are more willing to accept uncertainty than her doctors were; they never abandon hope, yet they also accept Lia as she is. This uncertainty mimics the open-endedness of Hmong narratives.  

In the Afterword, Fadiman shares what happened to the main characters over the previous fifteen years, and reflects on the influence that Lia and her family have had on society. In several interviews, she expands on lessons she has learned: for instance, that a person's value cannot be measured only by their achievements, that the rational approach is not always the most effective approach, and that it is wise to avoid taking doctors' advice as absolute truth. She acknowledges, too, the cultural biases that influenced her own perspective in writing the book, agreeing with critics who had pointed out these biases. 

Despite the tragic nature of Lia's story, the Afterword leaves us with hope. Great strides have been made in cross-cultural communication within the medical field, much of it influenced by Fadiman's book. The closing scene sums up this hopefulness, with Nao Kao telling Neil Ernst that he now understood how much Lia's doctors had cared about her. The two finally achieved a bit of cross-cultural understanding.