PinkMonkey Literature Notes on . . .

http://monkeynote.stores.yahoo.net/

Sample MonkeyNotes 
Note: this sample contains only excerpts and does not represent the full contents of the booknote.  This will give you an idea of the format.

The Spirit Catches You and You Fall Down
A Hmong Child, Her American Doctors, and the Collision of Two Cultures

by

Anne Fadiman
1997

MonkeyNotes Study Guide by Diane Clapsaddle

The full study guide is available for download at: 
http://monkeynote.stores.yahoo.net/

Reprinted with permission from TheBestNotes.com Copyright  2008, All Rights Reserved 
Distribution without the written consent of TheBestNotes.com is strictly prohibited.

KEY LITERARY ELEMENTS
SETTING 
Merced, California
Laos, Southeast Asia
Mid 1960s to 1997

LIST OF CHARACTERS
Major Characters
Anne Fadiman - She is the author and narrator of the book whose experiences with the Lia and her family are re-told in intimate and tragic detail. She learns while others do not the importance of understanding the culture of the patient in order to properly treat his illness.

Lia Lee - She is the epileptic Hmong child who is at the center of this story. She eventually ends up in a vegetative state, because understanding her from the perspective of the whole patient was ignored.

Foua Yang and Nao Kao Lee - They are Lia’s parents who love her very much and become totally committed to her care even after she enters the vegetative state. However, they are partially to blame, but nowhere nearly as much to blame for their child’s medical condition as the doctors who treated her. 	

Neil Ernst & Peggy Philp - They are Lia’s main doctors at the Merced Community Medical Center and unlike most of the physicians there, are open to understanding the Hmong culture. However, they never understand the concept of the soul in healing illnesses and for them, the bottom line is always about life.

Jeanine Hilt - She is the social worker who makes Lia her personal cause. She fights against the medical establishment whenever she can on Lia’s behalf and truly cares for the Hmong as a culture.

Minor Characters
Dan Murphy - The family practice resident that was on the duty in the……..
Additional characters are identified in the complete study guide.

CONFLICT
The conflict of a plot is the major problem experienced by the protagonist. 

Protagonist
The protagonist of a story is the main character who traditionally undergoes some sort of change.  He or she must usually overcome some opposing force.  In this story, the protagonist is Anne Fadiman whose experiences with the Hmong in researching and writing this book is the…….. 

Antagonists
The antagonist of a story is the force that provides an obstacle for the protagonist. The antagonist does not always have to be a single character or even a character at all.  In this plot there are two antagonists: at times, the Lees are antagonistic when trying to deal with……...

Climax
The climax of a plot is the major turning point that allows the protagonist to resolve the conflict.  The climax occurs when Lia suffers the “big one,” or the seizure that……..

Outcome
Lia’s brain impairment is never resolved and she is taken home by her parents to be loved and cared for by them. The doctors in Merced and other medical

SHORT PLOT / CHAPTER SUMMARY (Synopsis)
This true story involves the life of Lia Lee, a Hmong child who is epileptic. She suffers severe grand mal seizures and eventually, as a result, becomes vegetative for the rest of her life. The key point of the book, however, is not Lia’s epilepsy as much as it is the cultural barriers that led to them destroying her brain. The proper treatment and so-called compliance with it becomes the basis of…….. 

THEMES	
The first and most important theme is: cultural understanding. The author uses the battle between the doctors of Merced and Lia’s parents as a way of emphasizing that we, as Americans, need to be more sensitive to the various aspects of different cultures or we are no longer the……. 

Additional themes are identified in the complete study guide.

MOOD
The mood is one of frustration and stress throughout much of the book as the author attempts to explain how the collision of two cultures led to the tragedy of seven year old girl left in a ……..
 
Anne Fadiman - BIOGRAPHY
Anne Fadiman was born on August 7, 1953 in New York and grew up in Southern California and Connecticut. 
She graduated from Harvard University in 1975 and is married to George Howe Colt, also an author.  They have two children and reside in Massachusetts.

After college she worked in Montana as a wilderness skills and mountaineering teacher.  

Anne Fadiman began her writing career at Harvard, where she was a columnist on the Harvard Magazine.  She has written for Life magazine and Harper’s, served as the editor of ……..

CHAPTER SUMMARIES WITH NOTES AND ANALYSIS
PREFACE
Summary
The preface prepares the reader for what will be told in each chapter by hinting at the basic conflict and how she became a part of it. Ms. Fadiman begins by discussing a carton of cassette tapes that sits under her desk and which she listens to from time to time. Some are the voices of American doctors and the rest are the voices of the Lees, a family of Hmong refugees from Laos who came to the United States in 1980. The author mentions one aspect that she likes to hear: the eight tones of the Hmong language. Listening brings her a whoosh of sense-memories: the coolness of the red metal chair, reserved for guests that was always set up as soon as she arrived at the Lee apartment; the shadows cast by an amulet that hung from the ceiling and swung in the breeze; and the tastes of the unusual Hmong food. 

She had come there for the first time on May 19, 1988 – to Merced, California – when she had heard there were some strange misunderstandings going on at the county hospital between its Hmong patients and its medical staff. She says the doctors call these problems “collisions” as if two different kinds of people had rammed into each other, head on, to the accompaniment of squealing brakes and breaking glass. The encounters were messy, but rarely frontal. Both sides were wounded, but neither side seemed to know what had hit it or how to avoid another crash. Her intent in coming there had been to somehow position herself between the two adversaries and hope she didn’t get caught in the crossfire. 

This had all taken place nine years before this book was published when she had heard about the Lee’s daughter, Lia, whose case had occasioned some of the worst strife the Merced Hospital had ever seen. After she got past the tendency to lay blame at one door or the other, she started to think less like an American and a little more like a Hmong. Ironically, during the year she was writing this book, she also had many medical problems emerge among her family members, and she spent a great deal of time in hospitals, herself. It allowed her to gnaw on two important questions: What is a good doctor? And what is a good parent?

She has now known the people of this book for most of her adult life, and she believes that if she hadn’t met Lia’s doctors, she would be a different kind of patient, and if she hadn’t met Lia’s family, she would be a different kind of mother. She says to end the preface that now and then, late at night, she imagines what the voices on the tapes would sound like if she could somehow splice them together so that the voices of the doctors and the voices of the Hmong could be heard on a single tape, speaking a common language.

Notes
This entire chapter foreshadows the conflict that Ms. Fadiman entered in 1988 – the clash of cultures. She introduces us to the two sides and implies that it perhaps was never resolved. She leaves the reader with a kind of poignant wish that she had found a way to create a common language the two sides might have spoken.

CHAPTER ONE - Birth
Summary
This chapter focuses on Lia’s birth and all the Hmong customs that went along with the birth of any child. If Lia had been born in Laos, her mother would have squatted on the floor and pulled the baby out of her womb with her own hands. Even though she had a dirt floor, she would have been very careful to never allow her to touch the floor. She would also have labored in silence, so silent that her sleeping children lying on the floor around her would never have stirred until they heard the cries of their little sister. Lia’s father, Nao Kao, would have cut the umbilical cord and tied it with string. When they still lived in Laos, Lia’s mother, Foua Yang, had conceived, carried, and bore twelve children with ease. However, if she had had any problems, she had recourse to a variety of remedies commonly used by the Hmong. There was a shaman who was believed to have the ability to enter a trance, summon familiars, ride a winged horse, cross an ocean inhabited by dragons, and negotiate for his patient’s health with spirits that lived in the realm of the unseen. There were also all kinds of precautions the Hmong took to avoid the dab, a malevolent spirit. Once a Hmong woman became pregnant, she knew she could assure the health of her baby by paying close attention to her food cravings. 

After the baby was born, the father would bury the placenta in the dirt floor of their house under the parents’ bed for a girl and a more honorable place for a boy – near the base of the central wooden pillar of the house where a male spirit held up the roof of the house and watched over its residents. The Hmong word for placenta is the same word for “jacket,” because it is considered one’s first and finest garment. They believe that after death, one’s soul travels back place to place, retracing the life’s geography, to the house where its placenta is buried. It then puts on this first garment and continues on dangerous journeys until it is reunited with its ancestors and from where it can be reborn as a new baby. If it can’t find its placenta, it is condemned to an eternity of wandering, naked and alone. Because the Lees are among 150,000 Hmong who fled Laos when the communists arrived, they have no idea if their house is still standing and whether the jackets of their children are still there. They believe that the souls of all their family will have a tremendous journey to undertake to find their jackets.

Although Mai, their thirteenth child was born in a refugee camp in Thailand, and her placenta was buried under their hut there, Lia was born in the Merced Community Medical Center and her placenta was incinerated. Foua never thought to ask for it as some Hmong women did and even if she had, they were living in an apartment with wooden floors and carpet. There would have been no way to bury it. Foua gave birth just like American women on a metal table with sterile drapes and no anesthetic. She also couldn’t tell them her exact birth date, because the Hmong people never kept such records. She only knew that it was during the season when the opium plants were weeded for the second time and the harvested rice stalks were stacked – October. She had to invent the precise day in order to accommodate the American custom of recording every detail of a human life, and she willing signed her name – the only American writing characters that she knew when she left the hospital. Foua found Lia’s birth a peculiar experience, but she had few criticisms of how the hospital handled it. She was impressed with all the people there to help her, and how gentle and kind the doctor was. Her doubts about MCMC in particular and American medicine in general would not begin to gather force until Lia had visited the hospital several times. She was surprised to be offered ice water afterwards, because in Laos, she would have drunk warm water to make the blood in the womb flow freely. She also refused the food, preferring the steamed rice and chicken boiled in water with five post-partum herbs that Nao Kao brought her. 

Lia’s name was officially conferred on her in a ceremony called hu plig or soul calling, three days after her birth. The Hmong believed that the most common cause of illness was soul loss. The life-soul was the necessary for health and happiness and that life souls of babies were especially prone to disappearance. As a result, their mothers dress them in intricately embroidered hats which when viewed by a dab seeking their souls from above will appear to be flowers and protect them from the evil spirits. Foua made numerous hats for Lia. The little girl’s hu plig took place in the family apartment. A pig was sacrificed and roasted, and two chickens were killed and then retrieved from the cooking pot to see if their skulls were translucent and their tongues curled upward, both signs that her soul was pleased to take up residence in her body and that the name chosen for her was a good one. The guests would later eat both the chickens and the pig. Before the meal, the soul-caller would brush Lia’s little hands with a bundle of short, white strings; each elder would then tie one of the strings around her wrist to bind her soul to her body. Foua and Nao Kao would promise to love her and the ceremony would end with the elders blessing her and praying that she would have a long life and that she would never become sick.

Notes
This chapter serves to show the reader the beginning of the cultural clash between the Hmong and American doctors by showing all the many symbolic aspects of birth among the Hmong people. The emphasis placed on the jacket or placenta of a Hmong baby makes the fact that Lia’s was incinerated significant. It is also significant that the elders make such a point of blessing the child at her name-giving ceremony and praying that she never becomes sick when the basis of this book is all about her illness……..

OVERALL ANALYSES
CHARACTER ANALYSIS
Anne Fadiman - As a reporter and a researcher, it is apparent that Anne Fadiman entered this story prepared to believe that the doctors of Merced did the best they could under the circumstances, However, after she becomes acquainted with the Hmong community and the Lee family, we see that she comes to understand how truly tragic Lia’s story is. She looks at every aspect of the cultural collision and…….. 

Lia Lee - Although she is always too small or too sick to be seen from the perspective of her own viewpoint, Lia is a character who is very much alive and vivid to the reader. She is a spoiled child who is very demanding, and yet, she is also very loving and affectionate and always had…… 

Foua Yang & Nao Kao Lee - They are Lia’s parents as well as the parents of sixteen children, eleven of whom survived. They are of Hmong, the mountain people of Laos who helped the…….. 
Neil Ernst & Peggy Philp - They were two doctors, husband and wife, who first cared for Lia when she was brought to MCMC. Neither had ever had any experiences with Hmong, but accepted that they were dealing with a culture that was……. 

Jeanine Hilt - As a social worker, it was her job to defend the Lees from any and all outside forces that would have hurt them in a strange culture. However, Jeanine took her job above and beyond anything that might have been expected of her. She was one of the…….. 

PLOT STRUCTURE ANALYSIS
The narrative begins with a preface in which the author discusses her carton of cassette tapes to which she listens at times to remind her of her experiences with Lia Lee and the clash between the Hmong community and American medicine. This is followed by nineteen chapters that explain how………. 

THEMES – THEME ANALYSIS	
Cultural Understanding - The first and most important theme is cultural understanding. The basic premise of the book is that a collision of two cultures – Hmong and American – led to a medical tragedy for Lia Lee. The author investigated every aspect of the story: how the Lees were forced to immigrate to America; how their daughter was born her with epilepsy; how the Hmong flee when…….. 

AUTHOR’S STYLE
The style is difficult at times, because the author uses a sophisticated, academic style in writing the book. It is not always user-friendly, and at times, it can be……...

RISING ACTION
The rising action begins on July 19, 1982, with the birth of Lia Lee in the Merced Community Medical Center. It runs through her life and her experiences with…….. 

FALLING ACTION
The falling action involves the author’s analysis of how the Hmong came to Merced in…….. 

POINT OF VIEW
The point of view is first person throughout the narrative as it is told from the experiences of…….. 

OTHER ELEMENTS
FORESHADOWING
There are several literary devices that pop up at various times in the story. One of the most prevalent ones is foreshadowing, which frequently presents clues of something that will happen later in the novel. Some examples of foreshadowing include:
1.	Fadiman says, to end the preface, that now and then, late at night, she imagines what the voices on the tapes would sound like if she could somehow splice them together so that the voices of the doctors and the voices of the Hmong could be heard on a single tape, speaking a common language. This foreshadows that they didn’t speak a common language. and it led to tragedy.
2.	The author says that Foua’s doubts about MCMC in particular and American medicine in general would not begin to gather force until Lia had visited the hospital several times. This foreshadows that the…….. 

IRONY 
Another important element is irony – when something happens, or is seen, or is heard that we may know, but the characters do not, or that appears opposite of what is expected. Some examples of irony include:
1.	To a Hmong, if a soul can’t find its placenta, it is condemned to an eternity of wandering, naked and alone. Ironically, Lia’s placenta was never buried and she became a lost soul as well…..
…..14. The soul-caller in Lia’s healing ceremony, began to chant, “Where are you? Where have you gone? . . . Come home to your house. Come home to your mother . . . Come home. Come home. Come home.” Ironically, Lia would never come home, because her brain has been lost forever.

IMPORTANT QUOTES – QUOTATIONS AND ANALYSIS
The following quotations are important at various points of the story (Farrar, Straus, and Giroux, 1997):
1.	Like the Hmong shamans, epileptics “experienced powerful senses of grandeur and spiritual passion during their seizures and powerful creative urges in their wake.” (pg. 29; This quote connects Lia to the Hmong belief that epileptics were potential shamans.)
2.	“It took all the autonomy of a being a parent away, even for folks who have had a lot of medical experience. It would be that much harder if you were from another culture and didn’t understand the purpose of these things.” (pg. 44; This quote refers to the way the medical establishment in…….. 

SYMBOLISM / MOTIFS / IMAGERY /  METAPHORS / SYMBOLS
Other elements that are present in this novel include symbols and metaphors. Symbols are the use of some unrelated idea to represent something else. Metaphors are direct comparisons made between characters and ideas. 
These are examples of metaphors:
1.	The author says the doctors call cultural problems “collisions” as if two different kinds of people had rammed into each other, head on, to the accompaniment of squealing brakes and breaking glass. The encounters were messy, but rarely frontal. Both sides…….. 

……. 13. After all, trying to understand Lia and her family by reading her medical chart was like deconstructing a love sonnet by reducing it to a series of syllogisms.

These are examples of Symbolism:
1.	The lees had a red metal chair for guests, that was always set up as soon as she arrived at the Lee apartment. The color and the fact that it was reserved for guests indicate it represented a respected spot in their home.
2.	The dab represented a…….. 

IMPORTANT / KEY FACTS SUMMARY
Title: The Spirit Catches You and You Fall Down: A Hmong Child, her American Doctors, and the Collision of Two Cultures
Author: Anne Fadiman
Date Published: 1997
Meaning of the Title: It refers to the description of epilepsy in the Hmong language.
Genre: nonfiction
Setting: Merced, California and Laos, Southeast Asia in the Mid 1960s to 1997
Protagonist: Anne Fadiman
Antagonist: The Lees and the doctors ……..
 
STUDY QUESTIONS – MULTIPLE CHOICE QUIZ
1.	A shaman ties cords around a baby’s wrist, because 
a.)	he wants to make the baby his.
b.)	he wants to bind her soul to her body.
c.)	he wants to place her name on it.
2.	The Lees believed that Lia had her first seizure, because
a.)	she was invaded by a neeb.
b.)	Yur dropped a book on the floor.
c.)	Yur slammed the door………

ANSWER KEY
1.) b.  2.) c.  3.) a.  4.) a.  5.) c.  6.) b.  7.) c. 	8.) b. 	9.) a.   10.)b.  11.) c.  12.) a.  13.) b.  14.) c. 15.) a.

ESSAY TOPICS – BOOK REPORT IDEAS
1.	Explain the meaning of the title.
In the history of the Hmong, they fought against a number of different peoples who claimed sovereignty over their lands. How did these upheavals affect the Hmong and what role has history played in the formation of their culture?……. 

The full study guide is available for download at: http://monkeynote.stores.yahoo.net/

Copyright ©2008 TheBestNotes.com.
Reprinted with permission of TheBestNotes.com. All Rights Reserved. 
Distribution without the written consent of TheBestNotes.com is strictly prohibited.