By Michelle Falkoff, CAS ’95
Last week, a group of Penn alumni who live in Chicago got together to talk about the Penn Reading Project book selection, The Spirit Catches You and You Fall Down: a Hmong Child, Her American Doctors, and the Collision of Two Cultures, by Anne Fadiman. The book is an exploration of the ways that miscommunication between doctors, patients, and their families can affect healing, and it raised fascinating questions about the ways that cultural perspectives of rank and authority can (but don’t have to) complicate the doctor/patient/family relationships. The book group was the Penn Club of Chicago’s first in a series of events themed around Penn’s Year of Health.
Since many of the members of the group hadn’t met before the discussion, we started by introducing ourselves and giving some background into our relationships to Penn and Chicago. While this served as a lovely icebreaker, it also provided some initial context for how we all came to the book itself: some, like our discussion leader, Dave Pacifico CAS’03, had extensive knowledge of the subject matter through study of anthropology; others, like our host, Saul Rosenberg, C’61 and one of the Penn parents, Rose Hilmara (mother of a current Penn sophomore) had a lifetime of professional experience with medicine and pharmacology that gave some perspective on the medical issues the book raised. And many of us, myself included, brought just our personal experience with the medical profession and our opinions about the way American cultural norms affected our reading experience.
Our conversation was rich and varied, starting with our initial impressions of the events the book related and moving on to more complex exploration of the relationship between the body and the soul. We agreed up front that there were several basic communications that led to the medical tragedy on which the book focuses.
First, there was the basic issue of linguistic translation, which affected all aspects of patient care—in the absence of effective literal translation, doctors had trouble getting complicated concepts across to the patient’s parents, and the parents had difficulty explaining what they did and didn’t understand. Second, though no less important, was the issue of cultural translation. The patient’s parents didn’t trust the doctors because they didn’t perceive the doctors to be acting in the patient’s best interest, and the doctors weren’t (at least initially) interested in making the family understand why what they were asking was so important.
The issue of how best to medicate the patient implicated both types of miscommunication: the parents didn’t understand what the doctors asked of them in terms of things like dosage, but they also didn’t trust that the doctors were medicating the patient correctly, and so they’d adjust the dosages themselves if they perceived a particular drug to be working, or not working, which was a significant factor in the eventual tragedy on which the book focuses.
We found that, in our experience, these types of literal and cultural miscommunication aren’t limited to circumstances in which there are language and cultural barriers. Medical language has become so specialized that it’s often difficult for lay people to understand what doctors tell them without additional research; insurance has made negotiating the medical landscape byzantine and intimidating. Culturally, we tend to put medical professionals on pedestals, but the Internet has served a democratizing function in its provision of access to medical knowledge to lay people, even as it’s provided additional opportunities for confusion and hypochondria. This meant that, for us, the book proved helpful beyond its basic narrative; we weren’t surprised to learn that it had been required reading at Penn’s nursing school several years ago, and we agreed that it would make for useful reading for all medical professionals.
One of the most fascinating topics for us was the way the book described the benefit of integrating non-Western healing methods into the patient care experience. We talked about ongoing research into the effect of spiritual practices on healing and the ways in which the union of the two approaches has often proved successful in increasing rates of healing, no matter the perspective of the patient. While there was some spirited debate about this topic in particular, we agreed that the progress the doctors had made in the community the book described was very encouraging.
Overall, the discussion of the book itself was very enjoyable, and it was also exciting to feel like we were experiencing something similar to that of the first-year Penn students—it was a nice way to stay connected to our college experience, no matter how far away it was. With the help of our Regional Alumni Director Laura Foltman and the support of the University, Penn Club of Chicago President Michal Clements did a wonderful job organizing, so if other alumni groups are interested in doing this for next year’s book, they will be happy to serve as resources.
(Editorial Note: Michelle Falkoff’s forthcoming book: Playlist for the Dead, is eagerly anticipated by the Penn Club of Chicago book group. This young adult book will be released Jan. 2015)