The Spirit Catches You and You Fall Down

by Anne Fadiman

  During these troubled times, total disorder prevailed; what government there was intervened only to attend to the most pressing situations. The heat and the rains, compounded by the lack of hygiene among people accustomed to living in relative isolation, quickly led to the spread of disease and epidemics, ravaging the teeming refugee population, particularly the children.

  In the space of only a few years the southwest part of the Plain of Jars, once a lush green forest where tigers roamed, has been “urbanized” under the pressure of a continuing exodus that has no relationship whatsoever to the normal sort of economic development linked to industrialization. Today more than 200,000 people live in settlements and military bases ranging from 500 to 30,000 inhabitants, confined to a mountainous strip only 50 by 90 kilometers in area. The rest of the province is total desolation.

  In some spheres, the Hmong reacted to these upheavals, as they had to calamities throughout their history, by grasping their traditional culture even more tightly. Yang Dao reported that displaced families who had lost their livestock continued to go through the motions of ritual sacrifice, using stones in place of animals. The dwindling practice of polygyny, which at the beginning of the war was observed mainly by leaders like Vang Pao as a status symbol, became common again as a response to the mismatched wartime survival rates of men and women. The institution of levirate marriage, in which a widow was expected to wed her dead husband’s younger brother, was also revived. This practice kept the children and their inheritance in their father’s clan but often saddled the new husband, who might well be fifteen years old or have ten children already, with crushing responsibilities.

  For the most part, though, the experience of the “internal refugees” was a chaotic and involuntary crash landing into twentieth-century culture. A popularly held notion is that the Hmong refugees who came to the United States after the war were, as one newspaper reporter put it, “transplanted from Stone Age to Space Age.” Not only does that view grossly underestimate the complexity of traditional Hmong culture, but it also ignores the immense social, cultural, and economic changes that many Hmong had already gone through during the course of the war itself. The way of life that had survived centuries of persecution in China, as well as the nineteeth-century hegira to Laos, was irreversibly altered, at least in its outward forms, within a few years. I once asked Jonas Vangay to summarize the effects of the war on the Hmong. “My parents used to travel barefoot and on horse,” he said. “We lived in a rural and mountainous area where we never saw a car or a bus. Suddenly, in 1960, everything went upside down. The French wars hadn’t really influenced us so much. Less than twenty percent of the Hmong were involved in the battle of Dien Bien Phu. But with the U.S. war, it was ninety percent. You couldn’t stay in your village. You moved around and around and around. Four years later, when I went to Vientiane, what struck me is that you cannot see a lot of Hmong with their black clothing anymore. All are wearing khaki and green soldier clothing. And where we had lived, before the war it was all covered with forests. After the bombardments…il n’y a plus de forêts, il n’y en a plus, il n’y en a plus, il n’y a rien du tout.” Jonas tended to lapse into French—his fourth language, after Hmong, Lao, and Thai—when he could not adequately express his emotions in English, his fifth language. (“There are no more forests, there are no more, there are no more, there is nothing at all.”)

  Although some Hmong had been exposed to lowland life during and after the Second World War, many saw cars, trucks, tractors, bicycles, radios, flashlights, clocks, canned food, and cigarettes for the first time when they were forced to leave their villages for temporary relocation sites. Swidden farming was moribund. A market economy began to rise in its place, encouraged by the soldiers’ cash wages and the availability of manufactured goods. Lao kip replaced silver as a means of exchange. Long Tieng became a desultory megalopolis, an unpaved, sewerless city of more than 30,000 where Hmong ran noodle stands, cobbled shoes, tailored clothes, repaired radios, ran military-jeep taxi services, and interpreted for American pilots and relief workers. Except for ceremonial occasions, many Hmong women discarded their embroidered black garments and adopted lowland-Lao lungi skirts and short blouses of factory-made material. Both men and women wore polyvinyl thongs. Some children attended school; others trailed after the Americans, begging chewing gum and coins, or squatted in the dirt, playing with bullet casings instead of toys made of corncobs and chicken feathers. Even the Hmong language adapted. Many of the traditional onomatopoeic expressions expanded to make room for new associations. Plij ploj, the sound of bamboo breaking, gained the additional meaning of “bullet impact.” Vig vwg, the roar of wind or fire, now meant “small airplane motor” as well. Plhij plhawj, the sound of birds making brief flights from roost to roost, also meant “helicopter propellers.” A new expression, ntsij ntsiaj, meaning “pushing or pulling the bolt on an M-16,” came into use.

  The most drastic change bred by the war was the loss of the single asset the Hmong prized most highly: their self-sufficiency. With their fields left rotting, their livestock abandoned, and their mountains emptied of game, more than 100,000 Hmong were kept alive by U.S.-sponsored food drops—weather and enemy fire permitting, fifty tons of rice a day, delivered by parachute from Air America cargo planes. As one pilot put it, “There is a whole generation of Meos who are going to be damn surprised when someone tells them that rice doesn’t grow in the sky.” One consequence of feeding the Hmong was that those who still lived in tillable regions could spend more time growing poppies, to the benefit of the opium trade. Not all Hmong villages and relocation sites were supplied with rice, and in those that were, the daily allotment per person was about a pound, half what the Hmong were used to. The memory of the rice drops still rankles. When I asked Jonas Vangay about them, he said, “Are you accusing the Hmong to be idle or lazy? Do you think they were just waiting for rice from the sky? The Hmong have always grown their own rice. Lao used to get rice from Hmong in exchange for salt and material. The Hmong never bought rice from Lao! But in the Plain area, there is not enough rice in the war. Ils n’ont plus de choix.” (“They no longer have any choice.”)

  In January of 1973, the United States signed the Paris Agreement, pledging to withdraw all its forces from Vietnam. Two weeks later, on his way to Hanoi, Henry Kissinger stopped in Vientiane to talk with Prince Souvanna Phouma, the Prime Minister of Laos, who feared the United States would similarly withdraw support from Laos, leaving it to the mercy of North Vietnam. “The very survival of Laos rests on your shoulders,” Souvanna Phouma told Kissinger. “But your shoulders are very broad. We are counting on you to make our neighbors understand that all we want is peace. We are a very small country; we do not represent a danger to anybody. We count on you to make them know that the Lao people are pacific by tradition and by religion. We want only to be sovereign and independent. We ask that they let us live in peace on this little piece of ground that is left to us of our ancient kingdom…. Therefore we must count on our great friends the Americans to help us survive.”

  In his 1979 memoirs, Kissinger, whose shoulders turned out to be far less broad than the prince had hoped, wrote, “I cannot, even today, recall Souvanna Phouma’s wistful plea without a pang of shame.” In February 1973, the Vientiane Agreement was signed, calling for a cease-fire in Laos, a coalition government, and the end of American air support. USAID discontinued its relief program, and in June of 1974, the last Air America plane left Laos. On May 3, 1975, two weeks after the Khmer Rouge took control of Phnom Penh, three days after the North Vietnamese occupied Saigon, and seven months before the communist Lao People’s Democratic Republic supplanted the six-hundred-year-old Lao monarchy, the Pathet Lao crossed the ceasefire line into territory held by Vang Pao. On May 9, the Khao Xane Pathet Lao, the newspaper of the Lao People’s Party, announced: “The Meo [Hmong] must be exterminated down to the root of the tribe.” On May 10, surrounded by Pathet Lao and North Vietnamese troops, with few surviving Hmong fighter pil
ots and no American combat support, Vang Pao reluctantly bowed to the counsel of his CIA case officers and conceded that he could no longer hold Long Tieng. During the next four days, between 1,000 and 3,000 Hmong—mostly high-ranking army officers and their families, including the family of my interpreter, May Ying Xiong—were airlifted by American planes to Thailand. (During the month before the fall of Saigon on April 30, American airlifts and sealifts had evacuated more than 45,000 South Vietnamese.) Hmong fought to board the aircraft. Several times the planes were so overloaded they could not take off, and dozens of people standing near the door had to be pushed out onto the airstrip. On May 14, Vang Pao, in tears, told the assembled crowd, “Farewell, my brothers, I can do nothing more for you, I would only be a torment for you,” and boarded an evacuation helicopter. After the last American transport plane disappeared, more than 10,000 Hmong were left on the airfield, fully expecting more aircraft to return. When it became apparent that there would be no more planes, a collective wail rose from the crowd and echoed against the mountains. The shelling of Long Tieng began that afternoon. A long line of Hmong, carrying their children and old people, started to move across the plateau, heading toward Thailand.

  11

  The Big One

  On November 25, 1986, the day before Thanksgiving, the Lees were eating dinner. Lia, who had had a mild runny nose for several days, sat in her usual chair at the round white Formica table in the kitchen, surrounded by her parents, five of her sisters, and her brother. She was normally an avid eater, but tonight she had little appetite, and fed herself only a little rice and water. After she finished eating, her face took on the strange, frightened expression that always preceded an epileptic seizure. She ran to her parents, hugged them, and fell down, her arms and legs first stiffening and then jerking furiously. Nao Kao picked her up and laid her on the blue quilted pad they always kept ready for her on the living room floor.

  “When the spirit caught Lia and she fell down,” said Nao Kao, “she was usually sick for ten minutes or so. After that, she would be normal again, and if you gave her rice, she ate it. But this time she was really sick for a long time, so we had to call our nephew because he spoke English and he knew how to call an ambulance.” On every other occasion when Lia had seized, Nao Kao and Foua had carried Lia to the hospital. I asked Nao Kao why he had decided to summon an ambulance. “If you take her in an ambulance, they would pay more attention to her at the hospital,” he said. “If you don’t call the ambulance, those tsov tom people wouldn’t look at her.” May Ying hesitated before translating tsov tom, which means “tiger bite.” Tigers are a symbol of wickedness and duplicity—in Hmong folktales, they steal men’s wives and eat their own children—and tsov tom is a very serious curse.

  It is true that, whether one is Hmong or American, arriving at an emergency room via ambulance generally does stave off the customary two-hour wait. But any patient as catastrophically ill as Lia was that night would have been instantly triaged to the front of the line, no matter how she had gotten there. In fact, 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. As it was, it took about five minutes for their nephew to come to their house and dial 911; one minute for the ambulance to respond to the dispatcher’s call; two minutes for the ambulance to reach the Lee residence; fourteen minutes (an unusually, and in this case perhaps disastrously, long time) for the ambulance to leave the scene; and one minute to drive to the hospital.

  Years later, when Neil Ernst looked over the ambulance report, he sighed and said, “That EMT was in way over his head. Way over.” According to the report, when the ambulance arrived at 37 East 12th Street at 6:52 p.m., this is what the emergency medical technician found:

  Age: 4

  Sex:

  Illness: Seizure/Convulsions

  Airway: Compromised

  Respiratory Effort: None

  Pulses: Thready

  Skin Color: Cyanotic

  Pupils: Fixed

  Chest: Tense

  Pelvis: Incontinent of urine

  Eyes Open to Voice or Pain: None

  Verbal Response: None

  Lia was on the verge of death. The emergency medical technician fitted a plastic airway over her tongue to prevent it from blocking her throat. After suctioning her mucus and saliva, he placed a mask over her nose and mouth and forced oxygen down her trachea by squeezing a hand-held resuscitation bag. He then attempted to insert an intravenous line in one of her antecubital veins, in front of the elbow, in order to administer an anticonvulsant drug. He failed, realized crucial minutes were being lost, and ordered the driver to head at top speed for MCMC with the ambulance on Code III (the most emergent, with lights flashing and sirens blaring). En route, the EMT tried desperately to insert the IV again, and failed two more times. As he later noted, in shaky handwriting, “Pt continued to seize.”

  The ambulance arrived at MCMC at 7:07. Lia’s gurney was rushed into Room B. Of the emergency room’s six cubicles, this was the one reserved for the most critical cases, since it contained a crash cart, a defibrillator, and intubation equipment. Lia had been there several times before. Room B is a twenty-by-twenty institutional-beige cell smelling faintly of disinfectant, sheathed from floor to ceiling in synthetic materials from which blood, urine, and vomit can be easily cleaned: a clean, bland backdrop against which hundreds of cataclysmic dramas have been played out and then scrubbed away. Lia was thrashing violently. Her lips and nail beds were blue. There was no time to undress her. A nurse tore off the blanket in which she was wrapped and, using bandage scissors, cut off a black T-shirt, an undershirt, and a pair of underpants. An emergency physician, two family practice residents, and the nurse surrounded Lia, trying to start an intravenous line. They took more than twenty minutes to insert a butterfly needle, attached to a small-bore tube, in the top of her left foot—a stopgap measure, since any movement on Lia’s part was likely to cause the needle, which was left in the vein, to poke through the vessel wall and spill the IV solution into her tissues instead of her bloodstream. A large dose of Valium, a sedative that usually halts seizures by depressing the central nervous system, was pushed into the line. It had absolutely no effect. “We gave her Valium, more Valium, and more Valium,” recalled Steve Segerstrom, one of the residents. “We did everything, and Lia’s seizures only got worse. I went very rapidly from calm to panic.” Steve tried repeatedly to start a more reliable IV, and failed. Lia continued to seize in twenty-second bursts. Vomited rice began to pour from her nose and mouth. The aspirated vomit, in combination with the impaired ability of her diaphragm to move air into her lungs, was compromising her ability to breathe. A respiratory therapist was summoned. An arterial blood-gas test showed that over the last hour or so, Lia’s blood had probably contained levels of oxygen so low as to be nearly fatal: she was asphyxiating. Despite her seizures and her clenched jaw, one of the residents somehow managed to pass a breathing tube into her trachea, and she was placed on a hand ventilator.

  Neil’s pager went off at 7:35. He and Peggy were eating dinner with their two sons. They were planning on spending the evening at home, packing for their Thanksgiving vacation at the family cabin in the Sierra foothills, for which they would leave the next morning. Neil called the emergency room. He was told that Lia was in prolonged status epilepticus, that no one could get in a good IV, and that the Valium wasn’t working. “As soon as I heard that,” he recalled, “I knew that this was it. This was the big one.”

  Neil had been afraid for months that when this moment came, he would be the one on call, and he was. He told the resident to give Lia more Valium and, if that didn’t work, to switch to Ativan, another sedative, which, when administered in large doses, is less likely than Valium to make a patient stop breathing. He jumped in his car, drove to MCMC as fast as he could without breaking the speed limit, and at 7:45 walked briskly—no matter how frantic he felt, he made a point of never running�
�through the emergency room door.

  “It was an incredible scene,” Neil said. “It was like something out of The Exorcist. Lia was literally jumping off the table. She had restraints on, but her motor activity was so unbelievable that she was just jumping, just hopping off the table, just on and on and on and on. It was different from any seizure I had ever seen before. I remember seeing her parents standing out in the hall, just outside the emergency room. The door was open and people were running in and out. They must have seen everything. I caught their eye a couple of times but I was too busy to talk to them right then. We had to get in a more substantial IV and there were the usual problems—her fat, her sclerosed veins from previous IVs—only much worse this time because of her absolutely tremendous muscular activity. Steve Segerstrom said, Do you think it’s worth trying a saphenous cutdown?” (To perform a “cutdown,” a physician makes a skin incision, nicks a blood vessel—in this case a large vein above Lia’s right ankle—with a scalpel, dilates the hole with forceps, introduces an intravenous catheter, and sutures it into place.) “And I said, Gee, Steve, at this point, anything is worth it, go ahead and try. The atmosphere in the room was just charged. People were literally lying on Lia’s legs while Steve started the cutdown. And he got it! And then we gave Lia just a ton of medicine, a lot, and a lot, and a lot. And finally, she stopped seizing. She finally stopped. It took a long time, but she finally stopped.”

  I had never seen Neil so upset as he was when he told me this. Steve Segerstrom sounded upset too when he recalled the incident, but Steve is an excitable man and a fast talker, so the contrast between his normal tone and his tone as he described the scene in Emergency Room B was far less noticeable than it was with Neil, who is usually so calm. When Neil finished talking, I could hear him breathing—not heavily, but audibly, as if he had been interrupted partway through his morning’s eight-mile run.