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Standing at a Point of Tangency: Cultural Understanding in Literary Journalism

3 Nov

The Spirit Catches You and You Fall Down

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

the spirit catches you and you fall downCommon sense assumes that one understands a culture best when coming from inside it. When it’s ingrained in you. When you speak the language, practice the customs, know the history, etc.. But Anne Fadiman in her well known work of literary journalism, The Spirit Catches You and You Fall Down, takes a different approach. She uses her outsider status to understand the collision of two cultures about which she knows little by observing a Hmong family and their sick daughter and the American medical system they’re forced to engage with.

Fadiman’s in-depth research and reporting in the book indicate the need to work as an outsider; to try to understand two sides, but be removed enough from both to pick up where the miscommunications lie. She places herself on the perimeter to report on a story with no winners and somehow provide a tangible and powerful takeaway.

In the Preface of my edition, the 1997 paperback version, Fadiman artfully recalls her process of researching and writing the book. She points out her marginal position and how it helped her observe and illustrate the cultural clash more clearly.

“I have always felt that the action most worth watching is not at the center of things, but where edges meet. I like shorelines, weather fronts, international borders. There are interesting frictions and incongruities in these places, and often, if you stand at the point of tangency, you can see both sides better than if you were in the middle of either one.”

Fadiman isn’t just an outsider in this story; she’s on the perimeter observing a collision. She could have written a history of the Hmong in the U.S. Much of the research would have been the same. She could have immersed herself in the midst of a Hmong community like the one in Merced where The Spirit is set. She could have drawn on Hmong global history, their millennia-long streak of independence from any one nation, their deep history of persecution, and their involvement with the U.S. during the Vietnam War.

And that story would have been interesting enough. She thoroughly reports on each of those points in The Spirit. But, like Fadiman so eloquently puts it, “if you stand at the point of tangency, you can see both sides better than if you were in the middle of either one.” She takes her work a step further to examine the rich Hmong history in relation to its frictions with American communities, namely American medicine.

Through the lens of the Lee family and their encounter with the American medical system, Fadiman is able to paint a fair portrait of both the Hmong and American medicine, causing her reader to see the nuances on each side and realize there’s not only one way to understand an issue. Sometimes there’s no right or wrong, just difference.

I wonder if we all took an approach like Fadiman’s – to examine cultures from a point of tangency – if we’d come away with a better understanding of the world. For example, if we really examined the deep history of African American culture and the much publicized collisions with police, how would the story change from looking at each side in isolation? If we spoke with police officers, studied how they’re trained, and examined the history of policing in the U.S., how could we gain a new perspective beyond placing blame? If we looked back to the root of African American poverty, the history of persecution back to the days of slavery, and spoke with people living in African American communities that have been affected by collisions with police, how would the story become clearer?

Impact on American Medicine

It’s rare, in my experience, that one can point to a book as impacting change in direct and tangible ways. Fadiman’s The Spirit has. It’s required reading for many medical students and has been written about by a number of American physicians. In a New York Times piece published shortly after Lia Lee’s eventual, but much delayed death in 2012, the writer, Margalit Fox, reflects on the book’s power to bring cultural understanding to light within American medicine.  

“Lia’s story, as few other narratives have done, has had a significant effect on the ways in which American medicine is practiced across cultures, and on the training of doctors.”

Like Fadiman points out, however, it’s impossible to place blame or pass judgement.

“After I realized how much I liked both sides and how hard it was to lay the blame at anyone’s door (though God knows I tried), I stopped parsing the situation in such linear terms, which meant that without intending to, I had started to think a little less like an American and a little more like a Hmong.”

The doctors in the story were not neglectful. The actions they took were what they thought were best for the patient. As Americans, we’re taught to think in a certain way – a linear way – with the history of medicine at our fingertips and scientific studies to support our decisions. Fadiman suggests that escaping this singular way of seeing the world is the first step.

Rather than place blame on Lia’s individual doctors, (Fadiman paints them as caring and trying their best in a difficult situation) she suggests changes in the American medical system as a whole. Perhaps students should be taught to bend some of their scientific medical knowledge to better care for patients with different beliefs and cultures. There should be systems in place, especially in communities with high immigrant populations, to support understanding: translators, shamans, space to accommodate various cultural practices. Fadiman doesn’t come right out and offer these suggestions, but those are the sort of waves her book is making in the practice of American medicine.

Bringing about a Common Language

In the Preface, Fadiman listens to the tape recordings she took during interviews with the Lee’s and the American doctors. She reflects on how knowledge of both sides has changed her: as a parent, as a medical patient, as an American. And she concludes with a final wish:

“Now and then, when I play the tapes late at night, I imagine what they would sound like if I could somehow splice them together, so the voices of the Hmong and the voices of the American doctors could be heard on a single tape, speaking a common language.”

I think Fadiman’s book may be a start to bringing about that common language.

Photo credit: Simon Schmitt via Unsplash


Match Day: an outsider’s journey through residency

30 Sep

One Day and One Dramatic Year in the Lives of Three New Doctors

Match Day 2

“We looked at the dean. We looked at the envelope. Stephanie turned to me. “Do you want to be the one to open it?” she asked.

Someone called time.”

I didn’t used to read nonfiction. I figured I got enough through the news and magazine articles.  When I went to a library or bookstore to choose a book for pleasure, I was drawn to the classic literature or even the fantasy stories over the shelves of nonfiction hardbacks staring back at me. I guess I’m just a sucker for a good story. Or maybe it’s my own prejudice, assuming nonfiction is boring and tedious. Whatever my past excuses, Brian Eule’s book Match Day made me a convert.

As stated in the book’s subtitle, Match Day is about “one day and one dramatic year in the lives of three new doctors.” More specifically, it chronicles the journey of the days leading up to match day–the infamous day in March when every fourth-year medical student in the US finds out where he or she has been placed for residency–and moves into details about the new doctors’ experiences as interns and first-year residents.

Why it works

Aside from its catchy writing and clever mix between the history of medicine, the state of medical schools today, and personal anecdotes, I was especially drawn to Match Day because of the author’s point of view.  Brian Eule is not a doctor nor a medical student, but writes the book as an observer. He experienced the turbulence of the medical life through his wife, Stephanie, the surgical resident in the book. I connected so well with Eule’s words because my fiancé, Sam, is a second year medical student, or M2, as they call it. Eule conducted interviews, observed Stephanie’s trials, and chronicled his own hardships as the lonely significant other of a resident working 80 hours/week; something I fear I’ll be able to relate to all to well in the coming years.

Honestly, I only read the book in the first place because Sam checked it out from the library and recommended it. But as soon as I started reading I couldn’t get enough. I was dying to hear about the relationships so severely strained because of lack of time, energy, or physical distance forced upon them as a result of an unfortunate residency match. I hungrily flipped through the pages, imagining myself in Brian’s position, knowing that his situation in the book is my future as the spouse of a medical resident.

future doc

Sam, the future doc.

Since Sam is still a couple years behind where Eule’s story begins, the book gave me a glimpse into the future. Eule’s note in the back of the book makes the story all the more powerful.

“This is a work of narrative nonfiction. All of the characters in this book are real…there are no composite characters.”

These things really happened. These are real people. This is Sam’s life. This is my future. This is nonfiction.

Whatever my past excuse for disregarding nonfiction, I will no longer shy away from the rows of books written from real life experience or beautiful portrayals of real-life events. My fear that I would miss out on a good story proved irrational. Match Day revealed how sometimes our real lives make the best stories.

simple divider

So, now I’m on a quest to make up for lost time. I realize the potential of a well researched, well written nonfiction text and I’m anxious to experience more.


Sam is currently reading Bill Bryson’s A Short History of Nearly EverythingI can’t wait until he’s done so I can get started.

Because I’m so new to this genre, I know little about the theories and discussion surrounding nonfiction. Please share in the comments section what you know and love about nonfiction. And give some recommendations too!

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