In these final two chapters, Fadiman identifies cross-cultural miscommunication as the primary cause of Lia’s life being cut short. Septic shock and noncompliant parents were a part of the problem, but the core issue was misunderstanding. The final chapter also gives an account of the txiv neeb ceremony Lia’s family has a shaman perform. During the ritual, the shaman chants and goes into a trance that allows his spirit to leave his body, and travel the spirit world to negotiate with the other spirits to return Lia’s lost soul.
In my first blog post, I discussed Fadiman’s vantage point as an “involved-but-objective” third party observer. Fadiman believed this vantage point was the ideal perspective to examine the situation from. By the novel’s end, however, Fadiman has shifted from describing the story in third person to first person, indicating how she now considers herself to be a direct part of the story. Perspective plays an important role in this story, and is definitely influential in one’s perception of who (or what) is at fault for Lia ending up brain dead.
Lia’s doctors persisted in regarding Hmong beliefs as ignorant and superstitious while holding Western medicine as an infallible, objective set of practices that had managed to transcend culture. Her doctors certainly cared for Lia and genuinely wanted her to get well, but all their efforts stemmed from their training in Western medicine and Western medical culture. If healthy communication had existed between the Lees and Lia’s physicians from the beginning, Lia’s story would have likely ended differently.
In an interview she gave in 2003, Fadiman explains her own take on what Lia’s doctors should have done differently. She says, “The most important lesson is the necessity of seeing a case from the patient’s point of view. Even if the doctor’s knowledge exceeds the patient’s by an incalculably huge factor, that knowledge will do little good if the patient does not trust the doctor or it the doctor does not understand the patient. The best remedy for both those problems is for the doctor to look at things from the patient’s perspective (which may be culturally influenced).” (from an interview with Kathy Lammert, published 15 Sep 2003 by the Epilepsy Therapy Project-- http://www.epilepsy.com/articles/ar_1063680870)
Physicians need training in cultural sensitivity in order to understand the patient’s perspective (as is the standard in most medical schools nowadays), but it is also important to recognize the overarching presupposition that cultural misunderstanding can operate under; namely that Western medicine is infallible and without its own set of biases. This was the case for the Lees and Lia’s physicians. Cross-cultural miscommunication was the core problem, but it reflected the larger, overarching notion inherent in Western medicine that it does not possess its own set of biases or practice a set of rituals it believes will lead to a desired result. Medicine is a science, but it is not an exact science. It involves a lot of guesswork. It is also limited. It cannot predict and cure all pathologies with complete accuracy. It can tell us that Lia’s epileptic seizures were caused by her neurons misfiring, but it cannot yet tell us why this misfiring happens in the first place. Hmong medicine sought to explain why the misfiring occurred, attributing the etiology to the spirit leaving her body.
Science also sets much store by empirical evidence and observable, testable phenomena, but cannot apply this model to the unobservable, spiritual realm. In valuing empirical evidence, it devalues other kinds of evidence, which in some sense, is a kind of bias. Science is a way of knowing, but is not the ultimate way of knowing. Western medicine is surrounded by its own culture, meaning that it cannot be purely objective. If Lia’s physicians had been able to recognize Western medicine as a culture, and had known how to look beyond their own cultural tendencies, they may have been able to incorporate Hmong culture into Lia’s care. Doing so could have had completely changed her life. I say this not to condemn Lia’s physicians, because they did everything they knew how to do, and acted out of genuine compassion for her suffering.
To respect the Hmong aversion to drawing blood, perhaps Lia’s physicians could have limited their use of blood tests, opting for other methods to gather information about Lia’s condition. Interpreters could have also been used more frequently and throughout the story to overcome the language barrier. Overall, the aim would be to meaningfully incorporate the patient’s cultural practices into their care.
What Fadiman aims to show her reader (and what I have come to understand from reading this book) is this: Western medicine may strive for objectivity, but is still beset with its own set of biases and rituals. It may seem strange to think illness is caused by a spirit getting scared and leaving a person’s body, but to someone not immersed in Western medical culture, it would also seem strange that physicians extract bodily fluids to examine and run tests on them (i.e. blood tests), then fail to glean any answers from the fluid extraction. To think that Western medicine is not a culture or that it has managed to transcend cultural subjectivity or bias is a fallacy. Western medicine certainly has its own paradigms and brand of evidence (i.e. empirical evidence) it holds in higher regard than other kinds of evidence, and as such, has its own degree of fallibility. Perhaps the failure of Western medicine in Lia’s case was to assume its own infallibility, or to not recognize it had the capability of being fallible.
Western medicine values objectivity, experimentation, predictability, and sterility. We place much more confidence in pharmaceuticals than “herbal remedies”. We believe a product of Western medicine, produced using sterile methods in a factory somewhere, will always cure our ailments more effectively than a simply herb that grows in our backyard ever could. Yet recent research debunks this cultural claim. Bitter melon, a fruit indigenous to Asia and Africa, has been shown to decrease cell growth in breast cancer. Turmeric, a spice commonly used in Indian cooking, has shown promise in the prevention and staving off of cancer cell growth. Western medicine has given us chemotherapy to treat cancer once patients have it, but has yet to produce something to preemptively treat cancer. Perhaps that in itself is a reason to value complementary alternative medicine along with Western medicine.
Just as Western medicine found Hmong practices strange and ignorant, it also (to some degree) regards Christian practices in much the same way. Physicians who see their patient’s culture or religion as something to work past, as opposed to something to work with, denigrate what the patient values as centrally important to them, and by extension, denigrate the patient themselves.
The lingering question I have after having finished this book (and this class) is this: How do Christians hold onto and practice their beliefs while respecting others’ beliefs? In other words, how can we be in the world but not of it? Furthermore, how do Christian physicians treat patients in a culture that believes it has transcended culture? How do they apply the Christian narrative to patient treatment and practice medicine without compromising their values, all while respecting and honoring their patients’ culture and/or spirituality?
Christianity is supposed to be counter-cultural, so it is difficult to live the Christian life, particularly in the world of medicine. Physicians routinely interact with patients of differing faith backgrounds and are trained in Western medical culture, which values certainty and that which can be observed and tested. The task for Christian physicians, then, is to hold onto their beliefs with certainty and humility. They can aim to treat patients as beings created by God in his image and likeness. They can identify patients in their social, cultural, and spiritual contexts while acknowledging that these are all aspects of their whole personhood. To relate to people in such a way honors their humanity, which is ultimately our call as Christians. We are called, after all, to “love the Lord your God with all your heart, with all your soul, with all your mind, and with all your strength” and to “love your neighbor as yourself. There is no other commandment greater than these.” (Mark 12: 30-31)
