Jodi Gragg

Wagnes 4240
Due March 31, 2010
“The Spirit Catches You and You Fall Down”
When reading a book, I enjoy the satisfaction of making a predetermined
judgment on what I believe the title means. I believed that “The Spirit That Catches You
and You Fall Down” meant that the spirit would catch me, as the reader, and I would
hypothetically fall down related to the emotional impact of the story. Chapter three
proved my judgment to be wrong and struck a chord with me that the idea of epilepsy had
another meaning besides symptoms of abnormal brain activity. The Hmong believe that
these symptoms, what I consider to be seizures, are a quag dab peg. To the Hmong quag
dab peg is when a soul-stealing spirit catches or hits you and causes you to fall down.
(p.20)
The nurses appear to be culturally insensitive but factors such as lack of
translators did not help to fix the cultural barrier. It must have been frustrating to care for
someone who you cannot talk to and that is noted throughout the book. The author adds
in some of the nursing documentation. “Language barrier prohibits communication but
TLC was given to mom.” (p. 151) Can you provide TLC to a mother with a sick child
when you cannot tell her what is going on and why her child has tubes all in her body?
The nurse documents that a family translator is available but there is no documentation
stating that she utilized the interpreter to answer the family’s questions. If you cannot
communicate, then I perceive that TLC is physical at this point. I cannot imagine Foua
letting one of the nurses physically comfort her. I contemplated if the author had left out
parts of the documentation or if the patient advocate responsibility just did not exist.
I felt bad for Neil when he made the decision to call in Child Protective
Services (CPS). Neil seemed to be genuine, caring and truly concerned for Lia’s health.
I believe he tried to do everything he best knew before he resorted to calling CPS. On
pages 79-81, his debate on making the best decision is obvious. Not only did I
sympathize for Neil, but I also felt sad for Lia’s parents. The day CPS came to take Lia,
Foua, her mother, was not home. Lia’s father, Nao Kao didn’t know where they were
taking Lia and assumed the doctors where mad at them and that is why she was taken
away. When Foua came home, her child was gone. My heart broke for the mother who
had her child taken away. If Foua and Nao Kao had been terrible parents, I would not
have felt so bad. They loved Lia and truly tried to care for her the best way they knew
how. Too sides, both doing what they felt best; one with the authority to take away a
child.
I have learned to use the word non-compliant for individuals who are not
following medical advice, typically seen in failure to take medication as prescribed. Non-
compliance is a judgmental word used to describe someone who is not doing what they
are told. After reading this book, I agree with Kleinman, to throw the word out. Yes,
there are people who are ‘non-compliant’; when advised to finish an antibiotic, they do
not. In the case with Lia, Foua and Nao Kao were trying to do what they felt was best.
They saw the Dilantin change their daughter and the Phenobarb cause diarrhea. (p. 49)
Foua and Nao Kao told this to the social workers and explained why they were not giving
Lia the medications. Non-compliance should be a red flag that something needs to be
changed and/or reevaluated, not a label when we disagree with someone else’s opinion.
On the topic of more discriminatory in terms of optimal care versus care
tailored to compliance, I believe both should be given to each patient. Medical care
should start with the plan of optimal care. If that optimal care is not provided related to
compliance of the patient and/or family, then I feel, in the best interest of the client, it is
beneficial to provide treatment that can be complied with. Optimal care that is not being
utilized might as well not be a plan of care. At least, with tailored treatment, you are
showing respect to ones wishes and still providing care.
Nurses serving the role as advocates can help the power between physicians and
parents/patients equal out. Nurses can explain situations, ask for permission and
incorporate beliefs one hopes will be respected. Doctors do have the power to call the
police and access state officials however new ways are developing for patients, parents
and families to gain back their power. Current in place items are advocates who can be
called upon to intervene when the patient, parent or family believes they are not receiving
the care or respect they should. Nurses should inform patients of these rights to access
and encourage individuals to utilize them when they feel the need.
It would be impossible to incorporate education on every culture we as nurses
may encounter. With Hmong culture you should take off your shoes. “Don’t offer to
shake hands with a man or people will think you are a whore.” (p.92) I believe
assignments as such, help us to realize that there is much out there that we do not know.
When entering a patient’s room, we should keep in mind that they may have cultural or
religious beliefs that affect their care. Acknowledge those beliefs and respect them.
After reading this book, I was at work one night. A Hispanic woman in her mid-
30’s came in complaining of abdominal pain. The doctor and the translator came in; they
were asking her questions and then told her they needed a urine sample, would draw her
blood and then have a CT of her abdomen completed. I had never thought much about it
before tonight. No one explained to her why she had to give urine, why they had to draw
her blood and what a CT was. Did she know what was happening and why? How
frightening that must be. Did she feel as if we were taking her soul? I made it a point that
when I went to take her to CT that I ask the translator to tell her what a CT was and why
she was getting it. Then I ask her if that was okay.
I believe that we will all learn from this, to go on in our nursing careers aware that
there are people outside of our own culture and that they have beliefs that are important
to them as well. I think it is great the cultural differences we have in nursing so they we
can each learn from and help each other in situations we are not educated on.
References
Fadiman, A. (1997). The Spirit Catches You And You Fall Down. 19 Union Square West, New
York 10003: Farrar, Straus and Giroux.