The Spirit Catches You and You Fall Down (35 page)

Stanford, like several other medical schools, is trying to bring back what has been called the “whole doctor-whole patient” model, in which the doctor brings his or her full humanity (not just the part that aced the MCATs) to the hospital, and the patient is viewed as a complete person (not just the appendix in Room 416). This model is nothing new; in fact, it is what all doctors used to be taught. As William Osier once said—or is said to have said—“Ask not what disease the person has, but rather what person the disease has.” Between 1992 and 1995, the percentage of medical-school seniors who chose to become generalists—internists, general pediatricians, and family physicians—nearly doubled: a trend that may help bring Osier’s charge back into circulation. Some of these choices have been influenced by economic factors (managed care plans prefer primary to sub-specialized care because it’s cheaper), but others are surely idealistic. If there were more Osler-type generalists around, the Hmong, among others, would stand to benefit. The anthropologist Elizabeth Kirton has commented that a Hmong patient she knew, referred to a specialist for further treatment, did not ask the referring physician to find someone skilled or famous. He asked, “Do you know someone who would care for me and love me?”

It was probably unfair of me to caption Dr. Zinn’s article
THE AMERICAN WAY
. Once, several years ago, when I romanticized the Hmong more (though admired them less) than I do now, I had a conversation with a Minnesota epidemiologist at a health care conference. Knowing she had worked with the Hmong, I started to lament the insensitivity of Western medicine. The epidemiologist looked at me sharply. “
Western medicine saves lives
,” she said. Oh. Right. I had to keep reminding myself of that. It was all that cold, linear, Cartesian, non-Hmong-like thinking which saved my father from colon cancer, saved my husband and me from infertility, and, if she had swallowed her anticonvulsants from the start, might have saved Lia from brain damage. Dwight Conquergood’s philosophy of health care as a form of barter, rather than a one-sided relationship, ignores the fact that, for better or for worse, Western medicine
is
one-sided. Doctors endure medical school and residency in order to acquire knowledge that their patients do not have. Until the culture of medicine changes, it would be asking a lot of them to consider, much less adopt, the notion that, as Francesca Farr put it, “our view of reality is only a view, not reality itself.” However, I don’t think it would be too much to ask them to
acknowledge
their patients’ realities—to avoid the kind of blind spot that made a Merced health department employee once write, about a child from a family that views the entire universe as sacred:

Dwight Conquergood’s
txiv neeb
may have had no trouble crossing the threshold between earth and sky, natural and supernatural, medical and spiritual. Regular mortals find the transit difficult.
How
difficult was borne out to me the night I invited Bill Selvidge and Sukey Waller to dinner at the Red Snapper Seafood Grotto. (Since my experience with Jonas Vangay, I was steering clear of the Cask ’n Cleaver.) Although they knew each other by reputation, Bill and Sukey had never met. I thought that because they were both Peace Corps veterans, and because they both worked with the Hmong—Bill as a doctor, Sukey as a psychotherapist—they would have much in common.

Over our fish, we discussed Hmong shamanism, about which Sukey knew a great deal. She volunteered that she had once told a doctor at MCMC that a
txiv neeb
of her acquaintance had a direct line to God. The doctor had responded, “Well, I have a direct line to biochemistry.” Although it was clear where Sukey’s sympathies lay, Bill did not appear offended.

By dessert, we had moved on to Lia’s case in particular, and cross-cultural pediatrics in general.

“You have to act on behalf of the most vulnerable person in the situation,” said Bill, “and that’s the child. The child’s welfare is more important than the parents’ beliefs. You have to do what’s best for the child, even if the parents oppose it, because if the child dies, she won’t get the chance to decide twenty years down the road if she wants to accept her parents’ beliefs or if she wants to reject them. She’s going to be dead.”

“Well,” said Sukey tartly, “that’s the job you have taken on in your profession.”

“I’d feel the same way if I weren’t a doctor,” said Bill. “I would feel I am my brother’s keeper.”

“That’s tyranny,” said Sukey. “What if you have a family who rejects surgery because they believe an illness has a spiritual cause? What if they see a definite possibility of eternal damnation for their child if she dies from the surgery? Next to that, death might not seem so important. Which is more important, the life or the soul?”

“I make no apology,” said Bill. “The life comes first.”

“The soul,” said Sukey.

Long before Shee Yee turned into a tiny red ant and bit the evil
dab
on the testicle, he spent three years apprenticed to a sorcerer. He learned how to change himself into anything he wished, to kill
dabs
, to fly like the wind, to heal the sick, and to raise the dead. Shee Yee’s services as a healer were sorely needed, because there was much illness in the world.

This is how the illness had come. The wife of a wicked god named Nyong laid an egg as large as a pig house. For three years, the egg did not hatch. Nyong’s father chanted to the egg and, in response, heard the jabbering voices of many evil
dabs
inside it. He ordered Nyong to burn the egg, but Nyong refused. So the egg burst, and out swarmed the
dabs
. The first thing they did was to eat Nyong’s wife, down to the last bone, hair, and eyelash. Then, still hungry, they came after Nyong. Nyong opened the door that led from the sky, where he lived, to the earth. Through it flew the
dabs
, as big as water buffalos and as red as fire, with showers of sparks in their wake. Nyong was safe, but from that day on, the people of the earth have known illness and death.

Shee Yee spent many years fighting the
dabs
and restoring sick people to health. He was assisted by a winged horse, a bowl of holy water, a set of magical healing tools, and a troupe of familiar spirits. One day Nyong murdered Shee Yee’s infant son and tricked Shee Yee into eating the flesh. When Shee Yee realized what he had done, he was so stricken with grief and horror that he fled the earth and climbed the staircase up through the door in the sky. To avenge his son’s death, he pierced both of Nyong’s eyes. Nyong, blind and enraged, now lives at the foot of a mountain in the sky, and Shee Yee lives in a cave at its summit, surrounded by his familiar spirits.

Shee Yee never returned to earth, but he did not leave its people entirely at the mercy of illness and death. After he climbed the staircase through the sky, he poured the bowl of holy water into his mouth, and then he spat it, with great force, on his healing tools: a saber, a gong, a rattle, and a pair of finger bells. The tools broke into pieces and fell to earth. Anyone who was sprayed with holy water, or who caught a fragment of one of Shee Yee’s tools, was elected to be a
txiv neeb
, a host for a healing spirit. The door in the sky is now closed to everyone but
txiv neebs
. When they pursue the lost soul of a sick person, they summon Shee Yee’s familiar spirits and ride Shee Yee’s flying horse up the staircase through the sky. In order to deceive any evil
dabs
they may meet en route, they pretend they
are
Shee Yee, and thus they partake of the first healer’s cunning, courage, and greatness.

The
txiv neeb
who was to perform a healing ceremony for Lia brought his own tools: saber, gong, rattle, finger bells. He also brought his own flying horse. The horse was a board about ten feet long and ten inches wide which, when attached to a pair of sawhorselike supports that fitted into four slots, became a bench. To the people who filled the Lees’ living room, the bench was not a piece of furniture. Nor was it a metaphor. It was truly a flying horse, just as to a devout Roman Catholic, the bread and the wine are not a symbol of Christ’s body and blood but the real thing.

The Lees had risen well before dawn. Foua told me, “We must have the
neeb
ceremony early in the morning, when it is cool, because that is when the soul can come back better. Also, if it is hot, the pig will get tired and die.” (I thought: But the pig is going to get killed anyway! Then I realized that a dead pig cannot be sacrificed.) The sun was rising when I arrived, sending pale shafts of light through the door that opened onto East 12th Street. Two translucent plastic painter’s tarps had been laid over the threadbare brown wall-to-wall carpet to protect it from the blood of the pig—or rather, pigs, since a small pig was to be sacrificed for the whole family and a large pig was to be sacrificed for Lia. The Lees had bought them the previous day at a local farm, paying $225, which came partly from welfare savings and partly from relatives’ contributions, for the pair.

On the electric stove, three large aluminum pots, filled with water that would be used to singe the pigs’ bristles, had been set to boil. Bags of fresh vegetables and herbs, grown by the Lees and their relatives, rested next to the mortar and pestle Foua had brought from Laos. They would be used in the preparation of the traditional festal dishes: minced pork and vegetables rolled in rice wrappers; pig bones and meat boiled with homegrown greens; chopped intestines, liver, heart, and lungs (the dish May Ying called “doo-doo soup”); raw jellied pig’s blood; stewed chicken; two kinds of pepper sauce; and steamed rice. A Hmong proverb says, “With friends, flavorless vegetables are as tasty as meat, and water is as good as wine.” However, the combination of friends and good food is better still. The feast, which was to follow the
neeb
ceremony, would continue far into the night.

Early this morning, Nao Kao had used a special paper punch to cut a stack of spirit-money, which would pay the pig for its soul and settle other spiritual accounts. The spirit-money, thick and cream-colored and pinked into scallops, lay on the carpet next to the
txiv neeb
’s altar, which represented the cave of Shee Yee. In Laos, the altar would have been made from one of a pair of identical trees; one would have been left standing, and one would have been felled with an ax in the direction of the setting sun. Here, the altar was a crude wooden table that had been covered with the sports section of the
Merced Sun-Star
. Arrayed on top of a refrigerator ad that said
NO DOWN PAYMENT FOR 90 DAYS
! were the
txiv neeb
’s sacred tools, the same ones Shee Yee had used: a short saber ornamented with red and white streamers; an ancient iron gong; a monkey bone with a padded end wrapped in black cloth, which was used to beat the gong; a tambourine-sized iron ring strung with rattling metal disks; and two finger bells, which looked like bronze doughnuts and enclosed little tintinnabula made of jingling metal pellets. Next to the tools was a brown plastic bowl containing rice and a single uncooked egg, sustenance for the familiar spirits. Three Styrofoam coffee cups and a white china bowl—a lake into which the
txiv neeb
’s soul could plunge if he were pursued by evil
dabs—
were filled with holy water. A small candle at the front of the altar, not yet lit, would shed light on the unseen realm into which the
txiv neeb
was to travel.

I had read a number of ethnographic commentaries on the power and influence of
txiv neebs
. Somehow, I had never imagined that when I finally met the ultimate metaphysical interlocutor, the great plea-bargainer for the soul, the preeminent champion in the struggle for the demonic—to cite three of the many reverential epithets I had come across—he would be sitting in front of a television set, watching a Winnie-the-Pooh cartoon. The
txiv neeb
who was to perform today’s ceremonies was named Cha Koua Lee. He wore blue flip-flops, black pants, and a white T-shirt decorated with dancing pandas. May Ying Xiong had told me all
txiv neebs
were skinny, because they expended so much energy in the shaking trance during which they traveled to the realm of the unseen, and indeed Cha Koua Lee, who looked to be in his late forties, was thin and muscular, with sharp features and a stern expression. It was against his code of honor to charge for his services—especially with the Lees, who were members of his clan— and although some families voluntarily paid him, he was forced to live on public assistance. However, he always received compensation in the form of the heads and right front legs of the pigs over whose sacrifices he presided. After eating the meat, he left the lower jaws to dry outside his apartment, and then added them to a collection he kept on a shelf, to be ritually burned at the end of the Hmong year. At that time the pigs’ souls would be released from their duties as proxies for the souls of the people for whom they had given their lives, and allowed to be reborn. In Laos, Cha Koua Lee had burned his pig jaws in a fire pit. In Merced, he burned them in a disposable turkey-roasting pan. Then he placed the charred remains in the branches of a tree outside town, beneath the sky through which they had already journeyed.

After the smaller pig, a tan-and-white female, was carried into the living room and laid on one of the plastic tarps, the
txiv neeb
performed the day’s first order of business: a ceremony to safeguard the health and well-being of the family for the coming year. The Lee family stood in a closely packed huddle in the middle of the living room. Wearing a black cloth headdress, the
txiv neeb
tied a cord around the pig’s neck. The pig grunted softly. Then he ran the cord from the pig to the Lees, wrapping it tightly around the whole group. The pig’s soul was thus bonded to the souls it would protect. The
txiv neeb
regarded each person’s soul as a tripartite entity, composed of one part that, after death, would stand guard at the grave; one part that would go to the land of the dead; and one part that would be reincarnated. All three parts would be secured today. Then the pig’s throat was slit—by a Lee cousin, not by the
txiv neeb
, who must always maintain good relations with the animals of whom he has requested such a priceless gift.

In Laos, this ceremony would have taken place in the Lees’ house, which Nao Kao and Foua had built to shelter not only their family but also a host of kindly domestic spirits: the chief household spirit, who lived in the central pillar, above the place where the placentas of the Lee sons were buried; the spirits of the ancestors, who lived in the four side pillars; the spirits of wealth, who lived near the uphill wall; the spirit who watched over the livestock, who lived in the downhill door; and the spirits of the two fireplaces. The presence of these spirits would have been felt by everyone in the house. It seemed to me that at 37 East 12th Street, Apartment A—where there were no pillars, no fireplaces, and indeed, according to the Lees, no benevolent spirits, because it was rented—the maintenance of a sacred atmosphere was an uphill battle. The television was still on, though without sound. Winnie-the-Pooh had been succeeded by a wrestling match between Hulk Hogan and Randy “Macho Man” Savage, broadcast from Atlantic City. Five feet from the altar, on the other side of the wall, hummed a refrigerator that contained a case of Budweisers, one of which would later be consumed by the
txiv neeb
. To the left of the front door, through which the familiar spirits would pass, there was a king-size carton of Attends youth diapers. The door was open. This worried me. What if an American were to stroll past and see a dead pig on the floor and nine people tied up with twine?

While the
txiv neeb
prepared for the next ceremony, several of the Lees’ male relatives carried the slaughtered pig to the parking lot, which, fortunately, was behind the apartment building and could not be seen from the street. First they poured scalding water over the carcass and scraped the hide with knives. Then they expertly gutted the pig, threw the offal in a Rainbow low-suds detergent pail, unfurled and re-coiled the intestines, and rinsed the abdominal cavity with a green garden hose. Rivulets of bloody water, dotted with bits of hair and pig flesh, flowed through the parking lot. Cheng, May, Yer, True, and Mai watched with interest but not surprise. Like children raised on a farm, they were familiar with death, and indeed could probably have done the job themselves. They had all learned how to kill and pluck chickens before they were eight, and the older ones had helped their parents butcher several pigs.

When we walked back inside the apartment, I could tell in an instant that there had been a sea change. By some unaccountable feat of sorcery—I was never able to figure out exactly how it had happened—the bathos had been exorcised from Apartment A. Everyone could feel the difference. The Lee children, who talked and giggled as they walked from the parking lot, fell silent as soon as they crossed the threshold. The television was off. The candle on the altar had been lit. A joss stick was burning, filling the apartment with smoke trails that would guide the familiar spirits. The
txiv neeb
had put on a black silk jacket with indigo cuffs and a red sash. His feet were bare. He had shrugged all the American incongruities off his outer aspect, and his inner aspect—the quality that had singled him out for spiritual election—now shone through, bright and hard. I saw that I had underestimated him.

It was Lia’s turn now. Foua and Nao Kao believed that her condition was probably beyond the reach of spiritual healing. Another
txiv neeb
had told them that medicines must have hurt her irreparably, because if the cause were spiritual, the frequency of their
neeb
ceremonies would certainly have restored her ability to talk. However, within her status quo, there were degrees of illness. They hoped this
txiv neeb
would make Lia happier so that she would stop crying at night. And there was still the faintest flicker of a chance, not altogether extinguished even after years of failed sacrifices, that Lia’s soul would be found after all, that the
dabs
who were keeping it would accept the pig’s soul in its stead, and that she would be restored to health.

Foua sat in the middle of the living room on a red metal folding chair, wearing black pants and a black-and-blue blouse: American clothes, but traditional Hmong colors, the same colors the
txiv neeb
was wearing. A yard of shining black hair fell down her back. Lia sat on her lap, bare-legged, wearing a striped polo shirt and a diaper. Foua nestled Lia’s head in the crook of her neck, smoothing her hair and whispering in her ear. Lia fit into the curves of her mother’s body as tightly as a newborn infant.