The Spirit Catches You and You Fall Down
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Chapter 3
Chapter 3: The Spirit Catches You and You Fall Down
1. What caused Lia to get sick according to her parents? What caused Lia’s illness
according to her doctors?
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Parents: soul got frightened and left b/c older sister had slammed the door
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Doctors: epilepsy of an unknown cause
2. What does quag dab peg mean? Why is it considered a blessing in Hmong culture?
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“the spirit catches you and you fall down”
-dab (soul-stealing spirit), peg (catch/hit), qaug (fall over ones roots still in the
ground, as grain might be beaten down by wind or grain)  generally translated into
epilepsy
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Hmong epileptics often become shamans
-“The seizures are thought to be evidence that they have the power to perceive things
other people cannot see, as well as facilitating their entry into trances, a perquisite for
their journeys into the realm of the unseen
-because they get ill themselves this gives them an intuitive sympathy for the suffering
of others and lends them emotional credibility as a healer
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Becoming a txiv neeb is an offer a sick person cannot refuse b/c if he rejects he
will die
(usually male b/ not always); few refuse in any case: enorm. a/m of social status in the
community and publicly marks the person of high moral character
3. What is the ratio of insured vs non-insured patients at MCMC? What ratio of the
population in Merced is Hmong? Why are these details important to the story?
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More than 80% of Hmong patients are on Medi-Cal (not privately insured)
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1 in 5 residents of Merced is Hmong
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Why are the above stats important:
-significant pop. should have professionnal interpreters (not burnt out staff already
working there, interpreters should be available in the night [no Hmong hospital staff
work on the night shift], shouldn’t have to have young children hacing embarrassing
talks about cesareans or make the decision of whether or not to resuscitate family
member)
-Simple questions but important questions can’t get answered (Are you pregnant,
Have you lost consciousness…)
-e.g. Have you recently eaten? - important: since anesthetized pat’s with full
stomachs can aspirate the partially digested food into their lungs and die if they choke or
if their bronchial linings are badly burned by stomach acid
4. What kinds of situations lead a doctor to practice what he calls “veterinary medicine”?
Why is this statement significant?
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The doctor practices veterinary medicine because like animals, he cannot
communicate
with the Hmong (situation “Have you recently eaten?” leads to this practice)
-such a language barrier that he has to treat them like animals; perhaps evidence of
racism; doesn’t help the situation any better
5. What happened the first two times Lia went to the hospital? What 3 circumstances were
different about her 3rd visit?
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First Visit
-Lia’s seizures had stopped by the time they reached the hospital; only obvious
The Spirit Catches You and You Fall Down
Chapter 3
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symptoms were cough and congested chest  X-ray diagnosed as having early
brochiopneumonia or tracheobronchitis (author: no way of knowing that the bronchial
congestion was probably caused by aspiration of saliva or vomit during the seizure; a
common problem in epileptics
-no interpreter; Nao Kao signed a form he couldn’t read (so didn’t know about the 10day follow-up appointment, or how to use the ampicillin [prescribed])
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Second Visit
-Same scene repeated; same misdiagnosis
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Third Visit [3 different circumstances]
-Lia was still seizing when they arrived
-They were accompanied by a cousin who spoike some English
-One of the Doctors on duty was a family practice resident named Dan Murphy
-Dan was friends with a Hmong
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After three days spent getting a spinal tap, a CT scan, an EEG, a chest X ray, and
extensive blood work doctors could not identify the cause of Lia’s epilepsy and deemed
it idiopathic (cause unknown)