Anne Fadiman: The Spirit Catches You and You Fall Down
Selected Excerpts
“He had forgotten that she had had epileptic seizures for five months before they were diagnosed and medicated, and was wondering in retrospect whether the course of her life might have been different if his hospital had offered her optimal medical care from the beginning.”
“Neil felt that Nao Kao put up a ‘stone wall’ and was sometimes deliberately deceitful. Peggy felt that Foua was ‘either very stupid or a loonybird’ because her answers, even on those occasions when they were accurately translated. Often didn’t make sense. Neither doctor could tell how much of their inability to get through was caused by what they perceived as defects of intelligence or moral character, and how much was caused by cultural barriers.”
“Because of poor parental compliance regarding the medication this case obviously would come under the realm of child abuse, specifically child neglect...Unless there could be some form of compliance with the medication regimen and control of the child’s seizure disorder, this child is at risk for status epilepticus which could result in irreversible brain damage and also possibly death. It is my opinion that this child should be placed in foster home placement so that compliance with medications could be assured.”
Full Text (Chapter 5, “Take as Directed”)
Discussion Questions
What stands out to you in this excerpt? What was most striking?
In your experience, what is the attitude taken towards patients who don’t speak English? Do you believe they receive the same care as English speaking peers?
What are your thoughts on the framing of the situation in this excerpt? How does it compare to what you have seen in your practice?
Why do you think Peggy and Neil went to such extremes with the Lee family? How would the response have differed if they had been English-speaking?
What does this excerpt teach us about partnering with and caring for people who do not speak English?
Reflections from #MedHumChat
“What stood out to me the most reading this chapter (especially going back & rereading it to curate this chat) was how familiar the interactions between Lia’s family and the medical team were. I’ve seen similar frustrations and outcomes many times before.”—@GraceOliverMD
“As Fadiman wrote in the opening of the book, it's frustrating to enter these past events in third person. Years removed and in a learning in a (slightly) different medical culture, I catch myself thinking that, if I were there, I could explain the disconnect. But could I?”—@theprodigal_sun
“I think they’re viewed as extra work because conversations take twice as long with a translator and even then understanding is not always clear with complex care. Their care certainly suffers from the limitations of communication”—@jennifermcaputo
“Interpretive services are passive, and we must do more to reach out and show patients we are making active attempts at understanding them. Still, as much as we try to be culturally competent, we will fall short. To ameliorate this we could bring in cultural translators, but more importantly we need to support URiM health care workers and students because they are the ones who can best bridge that gap.”—@medicurioso
About this #MedHumChat
Chapter 5 of The Spirit Catches You and You Fall Down was selected as a stand-alone piece for a #MedHumChat on September 16, 2020 discussing Cultural Barriers in the Doctor-Patient Relationship.
The pieces for this chat as well as the discussion questions were curated by Grace Oliver, MD (@GraceOliverMD).
About the Artist
Anne Fadiman is an American essayist, reporter, teacher, and author of several books. She is the first Francis Writer-In-Residence at Yale University.