The First Day Of Summer - Foul Mouth (3) - Soul Louis (Cassette)


An english speaking relative available tonight, stated that the patient had had intermittent fever and cough for 2—3 days prior to being admitted.

The head was held to the left with intermittent tonic-clonic [first rigid, then jerking] movements of the upper extremities. Respirations were suppressed during these periods of clonic movement. Grunting respirations persisted until the patient was given 3 mg. Foua and Nao Kao had no way of knowing that Dan had diagnosed it as epilepsy, the most common of all neurological disorders. Dan had learned in medical school that epilepsy is a sporadic malfunction of the brain, sometimes mild and sometimes severe, sometimes progressive and sometimes self-limiting, which can be traced to oxygen deprivation during gestation, labor, or birth; a head injury; a tumor; an infection; a high fever; a stroke; a metabolic disturbance; a drug allergy; a toxic reaction to a poison.

Sometimes the source is obvious—the patient had a brain tumor or swallowed strychnine or crashed through a windshield—but in about seven out of ten cases, the cause is never determined. During an epileptic episode, instead of following their usual orderly protocol, the damaged cells in the cerebral cortex transmit neural impulses simultaneously and chaotically. Except through surgery, whose risks consign it to the category of last resort, epilepsy cannot be cured, but it can be completely or partially controlled in most cases by anticonvulsant drugs.

The Hmong are not the only people who might have good reason to feel ambivalent about suppressing the symptoms. What does it matter that it is an abnormal tension, if the result, if the moment of sensation, remembered and analysed in a state of health, turns out to be harmony and beauty brought to their highest point of perfection, and gives a feeling, undivined and undreamt of till then, of completeness, proportion, reconciliation, and an ecstatic and prayerful fusion in the highest synthesis of life?

It has a natural cause just as other diseases have. But if they called everything divine which they do not understand, why, there would be no end of divine things. He admitted her to MCMC as an inpatient. Among the tests she had during the three days she spent there were a spinal tap, a CT scan, an EEG, a chest X ray, and extensive blood work.

None of the tests revealed any apparent cause for the seizures. Lia was found to have consolidation in her right lung, which this time was correctly diagnosed as aspiration pneumonia resulting from the seizure. Mom informed to keep babe covered with a blanket for the babe is a little cool.

Awake, color good. Mother fed. Held by mother. Her parents were instructed, via an English-speaking relative, to give her milligrams of ampicillin twice a day, to clear up her aspiration pneumonia, and twenty milligrams of Dilantin elixir, an anticonvulsant, twice a day, to suppress any further grand mal seizures.

Paul, Minnesota, visited Ban Vinai, the refugee camp in Thailand where she had lived for a year after her escape from Laos in She was the first Hmong-American ever to return there, and when an officer of the United Nations High Commissioner for Refugees, which administered the camp, asked her to speak about life in the United States, 15, Hmong, more than a third of the population of Ban Vinai, assembled in a soccer field and questioned her for nearly four hours.

Some of the questions they asked her were: Is it forbidden to use a txiv neeb to heal an illness in the United States?

Why do American doctors take so much blood from their patients? After you die, why do American doctors try to open up your head and take out your brains? Do American doctors eat the livers, kidneys, and brains of Hmong patients? When Hmong people die in the United States, is it true that they are cut into pieces and put in tin cans and sold as food? The general drift of these questions suggests that the accounts of the American health care system that had filtered back to Asia were not exactly enthusiastic.

The limited contact the Hmong had already had with Western medicine in the camp hospitals and clinics had done little to instill confidence, especially when compared to the experiences with shamanistic healing to which they were accustomed. Txiv neebs could render an immediate diagnosis; doctors often demanded samples of blood or even urine or feces, which they liked to keep in little bottlestook X rays, and waited for days for the results to come back from the laboratory—and then, after all that, sometimes they were unable to identify the cause of the problem.

Txiv neebs knew that to treat the body without treating the soul was an act of patent folly; doctors never even mentioned the soul. Most Hmong believe that the body contains a finite amount of blood that it is unable to replenish, so repeated blood sampling, especially from small children, may be fatal. When people are unconscious, their souls are at large, so anesthesia may lead to illness or death. If the body is cut or disfigured, or if it loses any of its parts, it will remain in a condition of perpetual imbalance, and the damaged person not only will become frequently ill but may be physically incomplete during the next incarnation; so surgery is taboo.

If people lose their vital organs after death, their souls cannot be reborn into new bodies and may take revenge on living relatives; so autopsies and embalming are also taboo. Some of the questions on the Ban Vinai soccer field were obviously inspired by reports of the widespread practice of autopsy and embalming in the United States.

To make the leap from hearing that doctors removed organs to believing that they ate them was probably no crazier than to assume, as did American doctors, that the Hmong ate human placentas— but it was certainly scarier. Most Hmong have little fear of needles, perhaps because some of their own healers not txiv neebs, who never touch their patients attempt to release fevers and toxicity through acupuncture and other forms of dermal treatment, such as massage; pinching; scraping the skin with coins, spoons, silver jewelry, or pieces of bamboo; applying a heated cup to the skin; or burning the skin with a sheaf of grass or a wad of cotton wool.

An antibiotic shot that could heal an infection almost overnight was welcomed. A shot to immunize someone against a disease he did not yet have was something else again.

When Foua Yang and Nao Kao Lee brought their three sick children to the hospital at Mae Jarim, they were engaging in behavior that many of the other camp inhabitants would have considered positively aberrant. Hospitals were regarded not as places of healing but as charnel houses.

They were populated by the spirits of people who had died there, a lonesome and rapacious crew who were eager to swell their own ranks. In this last case, the plant, Jatropha curcas, is crushed and its The First Day Of Summer - Foul Mouth (3) - Soul Louis (Cassette) left in a cup, to be consumed not by the patient but by the dab.

Wendy Walker-Moffat, an educational consultant who spent three years teaching and working on nutritional and agricultural projects in Phanat Nikhom and Ban Vinai, suggests that one reason the Hmong avoided the camp hospitals is that so many of the medical staff members were excessively zealous volunteers from Christian charitable organizations.

A group of doctors and nurses were talking to a Hmong man whom they had converted and ordained as a Protestant minister. They had decided that in order to get the Hmong to come into the hospital they were going to allow a traditional healer, a shaman, to practice there. I knew they all thought shamanism was witch- doctoring. So I heard them tell this Hmong minister that if they let a shaman work in the medical center he could only give out herbs, and not perform any actual work with the spirits.

Instead of working in cooperation with the shamans, they did everything to disconfirm them and undermine their authority…. Is it any wonder that the Hmong community regarded the camp hospital as the last choice of available health care options? In the local hierarchy of values, consulting a shaman or herbalist, or purchasing medicine available in the Thai market just outside the entrance to the camp, was much preferred and more prestigious than going to the camp hospital.

The refugees told me that only the very poorest people who had no relatives or resources whatsoever would subject themselves to the camp hospital treatment. To say that the camp hospital was underutilized would be an understatement. Unlike the other camp volunteers, who commuted from an expatriate enclave an hour away, Conquergood insisted on living in Ban Vinai, sharing the corner of a thatched hut with seven chickens and a pig.

His first day in the camp, Conquergood noticed a Hmong woman sitting on a bench, singing folk songs. Her face was decorated with little blue moons and golden suns, which he recognized as stickers the camp clinic placed on medication bottles to inform illiterate patients whether the pills should be taken morning or night. The fact that Conquergood considered this a delightful example of creative costume design rather than an act of medical noncompliance suggests some of the reasons why the program he designed turned out to be the most indeed, possibly the only completely successful attempt at health care delivery Ban Vinai had ever seen.

He decided on a Rabies Parade, a procession led by three important characters from Hmong folktales—a tiger, a chicken, and a dab —dressed in homemade costumes. The cast, like its audience, was one hundred percent Hmong. As the parade snaked through the camp, the tiger danced and played the qeej, the dab sang and banged a drum, and the chicken chosen for this crucial role because of its traditional powers of augury explained the etiology of rabies through a bullhorn.

When he contracted dengue fever for which he also sought conventional medical treatmenta txiv neeb informed him that his homesick soul had wandered back to Chicago, and two chickens were sacrificed to expedite its return. As long as they persisted in this view, Conquergood believed that what the medical establishment was offering would continue to be rejected, since the Hmong would view it not as a gift but as a form of coercion.

Before Lia fell, she would run to her parents to be hugged. She also demanded plenty of hugs from them when she was feeling fine, but they recognized these occasions as different because she had a strange, scared expression, and they would gently pick her up and lay her on the mattress they kept for this purpose on the floor of their living room which was otherwise unfurnished.

Sometimes there was twitching on one side of her body, usually the right. Sometimes she had staring spells. Sometimes she seemed to hallucinate, rapidly scanning the air and reaching for invisible objects. As Lia got older, the abnormal electrical activity spread to larger and larger areas of her brain and triggered more frequent grand mal episodes.

As she lay face up, her back would arch so violently that only her heels and the back of her head would touch the mattress, and then, after a minute or so of rigid muscle contractions, her arms and legs would start to thrash.

During the first phase, her respiratory muscles contracted along with the rest of her body, and she would often stop breathing. Her lips and nail beds turned blue. Sometimes she gave high- pitched gasps, foamed at the mouth, vomited, urinated, or defecated. Sometimes she had several seizures in a row; between them, she would tense, point her toes, and cry a strange deep cry.

In the most serious episodes, Lia would continue seizing and seizing without regaining consciousness. Inserting a needle into the vein of a baby who is having convulsions is like shooting, or trying to shoot, a very small moving target.

Frightening as it was to be on duty when Lia was brought in at a. The residents were merely the first line of defense. Every time Lia came to the emergency room, either Neil Ernst or Peggy Philp, the two supervising pediatricians who served on the faculty of the family practice residency program, was paged and, no matter how late it was, drove to the hospital a trip that could be accomplished, at just under the speed limit, in seven minutes.

One leading to a grand mal seizure. I feel that probably the grand mal seizure caused an aspiration pneumonia and hence apnea, causing her extreme distress when she showed up in the Emergency Room on the day of admission. The child has apparently done well on her Dilantin, although she has continued to have some right focal seizures…. My feeling is that this child probably has some form of benign focal seizures of infancy. These are not especially common, but can often be quite benign in nature.

Since there is apparently some chance that these will generalize, it is probably worth while to keep the child on Dilantin therapy to suppress a grand mal seizure. I would check the Dilantin level to make sure that it remains therapeutic…. Neil and Peggy once went through a photocopy of it with me.

The errors were invariably made by transcribers, nurses, or other physicians; their own contributions were flawless and usually even legible. 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 Ernst and Peggy Philp are married to each other. Neil and Peggy are both the children of physicians, both high school valedictorians, both Phi Beta Kappa graduates of Berkeley.

They met when they were nineteen and eighteen, two tall, good-looking, athletic premed students who recognized in each other the combination of idealism and workaholism that had simultaneously contributed to their successes and set them apart from most of their peers. Their schedules were arranged in such a way that one of them was always home in the afternoon when their two sons got out of school.

Every morning, the alarm buzzed at If it was Monday, Wednesday, or Friday, Neil got up and ran eight miles. If it was Tuesday, Thursday, or Sunday, Peggy got up and ran eight miles. They alternated Saturdays.

Their runs were the only time either of them was entirely alone for more than a few minutes, and they never skipped or traded a morning, even if they had been up most of the night on call at MCMC. Peggy was on call at the hospital. We get along real well. Real, real well. Medically, we complement each other. My strengths are infections, asthma, and allergies. Am I thinking okay? Would you offer anything else?

Can I do anything else? If I feel like a dumbshit I can be a dumbshit with her. If she was not in my life it would…well, take a while for me to be able to function. They are perfect. Few other people I know would have gone to the lengths they did to provide good medical care to Lia.

They were always thinking about her. Her Physical Growth chart shows that although her height usually hovered around the fifth percentile for her age not unusual for a Hmong childher weight climbed as high as the seventy- fifth percentile.

Her thick subcutaneous padding compounded the challenges that awaited the doctors in the emergency room. Considerable effort has gone into weight control in this child. The father apparently likes Lia the way she is and is somewhat resistant to this problem.

A vein hidden under fat is hard to palpate. Like a drug user who loses veins after repeated needle sticks, Lia eventually lost the antecubital veins in both forearms and the saphenous vein above her left ankle after doctors frantically searching for needle placement cut them open and tied them off. During most of her hospitalizations, the arm or leg with the IV line was bandaged to a board, and sometimes she was secured to her crib as well.

Father here. Soft restraint to L arm. Returned child to bed, soft restraint to R arm. Tried to explain to father reason but difficult due to communication barrier. His confidence in their ability to care for Lia was further strained the morning after this note was written, when he left the hospital at a.

Foua and Nao Kao believed the best way to keep Lia safe and content, especially when she was ill or in pain, was to have her sleep next to them, as she always did at home, so they could immediately comfort her whenever she cried. You see them put a bag on your kid to measure the output of urine and stool. When your child is in the hospital, suddenly somebody else is feeding them, somebody else is changing their pants, somebody else is deciding how and when they will be bathed.

It takes all the autonomy of being a parent away, even for folks who have had a lot of medical experience. Mom here. Babe content. Cruises sides of crib. Makes baby sounds. Father trying to put her back to sleep. No seizures this shift. After she was old enough to walk, whenever she was well enough to get out of bed she ran up and down the corridor in the pediatric unit, banging on doors, barging into the rooms of other sick children, yanking open the drawers in the nursing station, snatching pencils and hospital forms and prescription pads and throwing them on the floor.

She was a little Houdini. With other Hmong families the sons are the ones who are loved. Hmong fathers say, Girl okay if die, want many boy. But this family, they wanted so much for her to live, they just adored her. When you asked for a hug you could always get one from Lia. So you kind of liked her because she was a character, even though you hated her because she was so frustrating and she caused you so much grief. Lips pursed tightly to prevent this med given. Spits well.

And even when Lia was co-operative, Foua and Nao Kao were often uncertain about exactly what they were supposed to give her. Over time, her drug regimen became so complicated and underwent so many revisions that keeping track of it would have been a monumental task even for a family that could read English. For the Lees, it proved to be utterly confounding. The anticonvulsant medication originally prescribed by Peggy Philp was Dilantin, which is commonly used to control grand mal seizures.

Three weeks after her first MCMC admission, after Lia had a seizure in the hospital waiting room that appeared to be triggered by a fever, Peggy changed the prescription to phenobarbital, which controls febrile seizures better than Dilantin. Lia seized several times during the next two weeks, so since neither drug appeared to work adequately alone, Peggy then prescribed them both simultaneously. Consulting neurologists later prescribed two other anticonvulsants, Tegretol which was originally to be used along with both Dilantin and phenobarbital, and then just with phenobarbital and Depakene which was to be used in place of all the previous anticonvulsants.

Because these medications were prescribed in varying combinations, varying amounts, and varying numbers of times a day, the prescriptions changed twenty-three times in less than four years.

Several of the medications were available in different forms, and were sometimes prescribed as elixirs all of which were pink or red and came in round bottles and sometimes as tablets almost all of which were white and came in round bottles. Foua and Nao Kao, of course, had no idea what the labels said.

Even if a relative or the hospital janitor was on hand to translate when a bottle was handed to the Lees, they had no way of writing down the instructions, since they are illiterate in Hmong as well as English; and because the prescriptions changed so frequently, they often forgot what the doctors told them.

Measuring the correct doses posed additional problems. Liquids were difficult because the Lees could not read the markings on medicine droppers or measuring spoons. Pills were often no easier. At one point, when Lia was two, she was supposed to be taking four different medications in tablet form twice a day, but because each of the pills contained an adult dose, her parents were supposed to cut each of the tablets into fractions; and because Lia disliked swallowing the pills, each of those fractions had to be pulverized with a spoon and mixed with food.

If she then ate less than a full helping of the adulterated food, there was no way to know how much medicine she had actually consumed. This was a dismaying realization. The only way to determine the optimal type and amount of anticonvulsant medications for Lia was to observe the level of her seizure activity and repeatedly test the medication level in her blood, but the test results were inconclusive unless the doctors knew exactly what was going into her system.

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. She was the first of a succession of public health nurses who were to visit the Lees over the next four years.

Febrile seizures, noncompliant mother, noncompliant mother, noncompliant mother, noncompliant mother, noncompliant mother. When Lia was taking elixirs, they tried drawing lines on the plastic syringes or medicine droppers to mark the correct doses. When she was taking pills, they tried posting charts on which they had drawn the appropriate pie-shaped fractions. They tried taping samples of each pill on calendars on which they had drawn suns and sunsets and moons.

They tried putting the pills in plastic boxes with compartments for each day. There they would be, a little stack of bottles in the kitchen next to the tomatoes and onions, sort of like a decoration in the corner. Because Lia was on such high doses, she had an appointment with Dr. Philp or Dr. Ernst almost every week and had a blood level drawn two or three days before and maybe another blood level two or three days afterwards, and there were so many changes that it was just totally mind-boggling.

My general impression was that they really felt we were all an intrusion and that if they could just do what they thought best for their child, that child would be fine. They were courteous and they were obstinate. They told us what we wanted to hear. Parents state infant is doing the same. Were unaware of appt. Peds clinic for today. Were confused about proper dosage of medicine and which to give…. Several meds in refrigerator that are outdated included Amoxil and Ampicillin. Also one bottle of medication with illegible label.

Ernst contacted concerning correct dosage of Phenobarb and Dilantin. Correct administration demonstrated. Outdated medication discarded. Mother states she went to MCMC as scheduled for blood test, but without interpreter was unable to explain reason for being there and could not locate the lab.

Is willing to have another appt. States infant has not had any seizures. Have finished antibiotic. Are no longer giving Phenobarb because parents insist it causes diarrhea shortly after administration. Mother states she feels intimidated by MCMC complex but is willing to continue treatment there.

Agree to have continued care at Peds clinic. Home visit made with interpreter. Mother has now decided to give mg. Phenobarb at night. Mother seems very agitated. Father out of house for rest of day—shopping. Assured mother that child can be seen in Peds clinic Monday even without the Medi-Cal card.

Home visit by interpreter to discuss childs care with father. Mother states they just returned from hospital that AM…. Diagnosis for hospitalization unknown to mother but antibiotic prescribed. Their faith in medicines had not been strengthened by two routine immunizations Lia had received against diphtheria, pertussis, and tetanus, to which, like many children, she had reacted with a fever and temporary discomfort.

In some cases phenobarbital can cause hyperactivity—it may have been responsible for the riotous energy the nurses always noticed when Lia was hospitalized—and, in several recent studies, it has been associated with lowered I. Dilantin can cause hair to grow abnormally all over the body, and gum tissue to bleed and puff out over the teeth. Too much phenobarbital, Dilantin, or Tegretol can cause unsteadiness or unconsciousness. Doctors are used to hearing patients say that drugs make them feel bad, and indeed the unpleasant side effects of many medications are one of the main reasons that patients so often stop taking them.

Doctors who deal with the Hmong cannot take this attitude for granted. John Aleman, a family physician in Merced, once hospitalized a Hmong infant with severe jaundice.

After two or three samples, the parents said their baby might die if any more blood was removed. The doctor explained through an interpreter that the body is capable of manufacturing new blood, and he poured one cc of water into a teaspoon to demonstrate what an insignificant amount was being taken. They said if the doctor drew any more blood against their will, they would both commit suicide. Fortunately, at this point Dr.

The baby had the blood tests and was successfully treated with phototherapy. His parents, both teenagers who had attended American high schools and spoke and read English fairly well, consented, though reluctantly, to the surgical removal of the affected testis. She handed the parents a piece of paper on which she had typed the names of the drugs he would receive and their possible side effects.

Her predictions turned out to be accurate. Arnie, who had appeared perfectly healthy after his surgery, lost all his shiny black hair within three weeks after his first cycle of chemotherapy, and every time the drugs were administered, he vomited.

I say, Wait for my husband. I say, Please that you go away. I hold my son. I hold him so tight. I say, Give my son back. Two police, they hold my hand behind my back. I am scared. My two daughters are crying. The police hold my hand, they take my son away! I scream and cry. They were two long guns. We bought them to shoot squirrels and deer, not to shoot people. I just yell, Please bring my son back to me. I say, Just bring!

I want to hold my son! Finally some police officers brought Arnie back from the hospital, and when Dia Xiong saw him, she dropped the guns and was driven, in handcuffs, to the psychiatric unit of a local hospital.

She was released the next day, and no criminal charges were filed against her. Arnie is still in remission today.

It is likely that the only Western drugs Foua and Nao Kao had encountered in Asia were fast-acting antibiotics. I felt they really cared for Lia, and they were doing the best, the absolute best they knew how as parents, to take care of the kid. That is what I felt about them. It was very foreign to me that they had the ability to stand firm in the face of expert opinion.

And the other thing that was different between them and me was that they seemed to accept things that to me were major catastrophes as part of the normal flow of life. For them, the crisis was the treatment, not the epilepsy.

The parents report that they had discontinued the medications about 3 months ago because the patient was doing so well. At p. He therefore had to deal on his own with the most severe episode of status epilepticus Lia had yet suffered. He administered two more massive doses of phenobarbital.

First Dan gave her mouth-to-mouth resuscitation, and when she failed to resume breathing on her own, he decided that a breathing tube had to be placed down her trachea.

The First Day Of Summer - Foul Mouth (3) - Soul Louis (Cassette) time I saw what I needed to see and the tube went right in and it worked perfectly and I felt really good. I thought, well, I guess I am becoming a doctor. I remember that they were very upset about that. I remember that the mother just had a very displeased look on her face. She regained consciousness there, and was able to breathe on her own after twenty-four hours on a respirator. Lia spent nine days in Fresno, spiking high temperatures from aspiration pneumonia and gastroenteritis, but did not seize again.

Through an English-speaking cousin who accompanied Foua and Nao Kao to Fresno, the admitting resident was told that Lia had been off medications for one week rather than the three months recorded by Dan Murphy because the prescription had run out and the family had not refilled it.

It is not surprising that a child who had seized as frequently and severely as Lia was beginning to show the first signs of retardation, but Neil and Peggy found the situation particularly tragic because they considered it preventable.

Neil and Peggy perceived Lia as being more retarded though still only mildly so than the visiting public health nurses did. Unfortunately, the Lees had now decided that they liked phenobarbital, disliked Dilantin, and were ambivalent about Tegretol.

The mother brought a large sack full of medication bottles and on closer examination by myself there were 3 half empty bottles of Tegretol. The mother stated that she was unaware that these bottles were Tegretol. In addition, the mother also was unable to identify the Dilantin bottle and gave that bottle to me and said that she did not want it at home. On rereading this note many years later, Neil said he could still remember the rage he had felt when he wrote it.

A handful of times, Neil gave Foua a hug while Lia was seizing, but most of the time, while Lia was between the ages of eighteen months and three and a half years, he was too angry to feel much sympathy toward either of her parents. It was like banging your head against a wall constantly and not making any headway.

There was the frustration of the nighttime calls and the length of time it took and the amount of energy and sorrow and lack of control. I mean, every time I saw Lia I would just, you know, it was like—ohhhhh, you would just get so frustrated! When she came to the emergency room in status there would be sort of like a very precipitous peak of anger, but it was quickly followed by the fear of having to take care of a horribly sick child who it was very difficult to put an IV in.

From our own fear. No other pediatricians practicing in Merced at that time were willing to accept Medi-Cal patients. The Lees also never showed their doctors the kind of deference reflexively displayed by even their most uncooperative American patients. The worst aspect of the case was that as conscientious physicians and dedicated parents, they found it agonizing to watch Lia, as it would have been for them to watch any child, fail to receive the treatment they believed might help her lead a normal life.

And it seemed as if the situation would never end. However frustrated they were, they never considered abandoning the case. Unless Lia died, they could see themselves driving to the emergency room in the middle of the night until she was grown up and had graduated to the care of an internist, with whom they already felt an anticipatory bond of sympathy.

In June ofNeil and Peggy found out that Foua was pregnant again. They were appalled. This baby would be number fifteen; eight had survived. We were just dreading how this baby might turn out, that it might have Down syndrome and heart problems and that we were going to have to deal with two sick kids in this family.

Just what we needed. Not that she would have aborted anyway. She continued to breast-feed Lia throughout her pregnancy. On November 17,when Lia was two and a half, Pang Lee—a healthy, vigorous, completely normal baby girl—was born. After the birth, Foua breast-fed both Lia and Pang. In it, he also wrote that because of poor parental compliance regarding the medication this case obviously would come under the realm of child abuse, specifically child neglect….

It is my opinion that this child should be placed in foster home placement so that compliance with medication could be assured. It was also said that Hmong women were forced into slavery, forced to have sex with American men, and forced to have sex with animals.

Dinosaurs lived in America, as well as ghosts, ogres, and giants. With all this to worry about, why did the 15, Hmong who gathered on the Ban Vinai soccer field to voice their deepest fears about life in the United States choose to fixate on doctors?

A year after I first read the account of that gathering, as I was attempting to deal out a teetering pile of notes, clippings, and photocopied pages from books and dissertations into several drawerfuls of file folders, I had a glimmering of insight.

There were hundreds of pages whose proper home I was at a loss to determine. Should they go in the Medicine folder? The Mental Health folder? The Animism folder? The Shamanism folder? The Social Structure folder? I hovered uncertainly, pages in hand, and realized that I was suspended in a large bowl of Fish Soup. Medicine was religion. Religion was society.

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Download PDF. Translate PDF. To my friend and agent, Jake Elwell, for his enthusiasm and unflagging effort. To the legendary George Wieser, for convincing me to write novels.

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To Sylvia Cavazzini, for her gracious tour through the secret Passetto. And to the best parents a kid could hope for, Dick and Connie Brown. Antimatter is identical to physical matter except that it is composed of particles whose electric charges are opposite to those found in normal matter.

Antimatter is the most powerful energy source known to man. It releases energy with percent efficiency nuclear fission is 1. Antimatter creates no pollution or radiation, and a droplet could power New York City for a full day. There is, however, one catch. Antimatter is highly unstable. It ignites when it comes in contact with absolutely anything. A single gram of antimatter contains the energy of a kiloton nuclear bomb—the size of the bomb dropped on Hiroshima.

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They can still be seen today. The brotherhood of the Illuminati is also factual. He stared up in terror at the dark figure looming over him. There was the hiss of broiling flesh. Vetra cried out in agony. The figure glared. I was afraid of that. The blade hovered. But it was too late. I knew I should have married a younger man! He struggled to keep up, but his legs felt like stone. There was a thundering in his ears. I must reach her! But when he looked up again, the woman had disappeared.

In her place stood an old man with rotting teeth. The man stared down, curling his lips into a lonely grimace. Then he let out a scream of anguish that resounded across the desert.

Robert Langdon awoke with a start from his nightmare. The phone beside his bed was ringing. Dazed, he picked up the receiver. Langdon sat up in his empty bed and tried to clear his mind.

It was A. I have something you need to see. This had happened before. One of the perils of writing books about religious symbology was the calls from religious zealots who wanted him to confirm their latest sign from God. Last month a stripper from Oklahoma had promised Langdon the best sex of his life if he would fly down and verify the authenticity of a cruciform that had magically appeared on her bed sheets.

The Shroud of Tulsa, Langdon had called it. The site for your book. The man was obviously lying. He closed his eyes and tried to fall back asleep. It was no use. The dream was emblazoned in his mind. Reluctantly, he put on his robe and went downstairs. The April moon filtered through the bay windows and played on the oriental carpets. The image was distorted and pale. An aging ghost, he thought, cruelly reminded that his youthful spirit was living in a mortal shell.

On weekends he could be seen lounging on the quad in blue jeans, discussing computer graphics or religious history with students; other times he could be spotted in his Harris tweed and paisley vest, photographed in the pages of upscale art magazines at museum openings where he had been asked to lecture. As Langdon sat alone, absently gazing into the darkness, the silence of his home was shattered again, this time by the ring of his fax machine.

Too exhausted to be annoyed, Langdon forced a tired chuckle. Wearily, he returned his empty mug to the kitchen and walked slowly to his oak-paneled study. The incoming fax lay in the tray. Sighing, he scooped up the paper and looked at it.

Instantly, a wave of nausea hit him. The image on the page was that of a human corpse. The body had been stripped naked, and its head had been twisted, facing completely backward. The man had been branded. It was a word Langdon knew well. Very well. He stared at the ornate lettering in disbelief. In slow motion, afraid of what he was about to witness, Langdon rotated the fax degrees. He looked at the word upside down.

Instantly, the breath went out of him. It was like he had been hit by a truck. Barely able to believe his eyes, he rotated the fax again, reading the brand right-side up and then upside down. Stunned, Langdon collapsed in a chair. He sat a moment in utter bewilderment. Gradually, his eyes were drawn to the blinking red light on his fax machine. Whoever had sent this fax was still on the line. Langdon gazed at the blinking light a long time.

Then, trembling, he picked up the receiver. You want to explain yourself? I run a research facility. You saw the body. His mind was racing from the image on the fax. The Worldwide Web. The site for your book, The Art of the Illuminati. His book was virtually unknown in mainstream literary circles, but it had developed quite a following on-line.

The image was overpowering, possibly representing the epigraphical find of the century, a decade of his research confirmed in a single symbol. Illuminati, he read over and over. His work had always been based on the symbolic equivalent of fossils—ancient documents and historical hearsay—but this image before him was today.

Present tense. He felt like a paleontologist coming face to face with a living dinosaur. The implications were frightening. He gazed absently through the bay window. The first hint of dawn was sifting through the birch trees in his backyard, but The First Day Of Summer - Foul Mouth (3) - Soul Louis (Cassette) view looked somehow different this morning. As an odd combination of fear and exhilaration settled over him, Langdon knew he had no choice.

The chamber was dark. He was seated in the shadows, out of sight. Do you have what I asked for? He produced a heavy electronic The First Day Of Summer - Foul Mouth (3) - Soul Louis (Cassette) and set it on the table. The man in the shadows seemed pleased. Get some rest. Tonight we change the world. Three hundred yards down the access road a hangar loomed in the darkness. He pulled into the parking lot and got out of his car.

A round-faced man in a blue flight suit emerged from behind the building. Follow me, please. He was not accustomed to cryptic phone calls and secret rendezvous with strangers.

Not knowing what to expect he had donned his usual classroom attire—a pair of chinos, a turtleneck, and a Harris tweed suit jacket. As they walked, he thought about the fax in his jacket pocket, still unable to believe the image it depicted. Branded corpses are a problem for me. Flying I can handle. The man led Langdon the length of the hangar. They rounded the corner onto the runway. Langdon stopped dead in his tracks and gaped at the aircraft parked on the tarmac.

What the hell is it? It was vaguely reminiscent of the space shuttle except that the top had been shaved off, The First Day Of Summer - Foul Mouth (3) - Soul Louis (Cassette) it perfectly flat. Parked there on the runway, it resembled a colossal wedge. The vehicle looked as airworthy as a Buick. The wings were practically nonexistent—just two stubby fins on the rear of the fuselage.

A pair of dorsal guiders rose out of the aft section. The rest of the plane was hull—about feet from front to back—no windows, nothing but hull. The director must be in one helluva a hurry to see you. The pilot smiled. You can kiss conventional jets good-bye. Watch your step. The pilot buckled him into the front row and disappeared toward the front of the aircraft.

The cabin itself looked surprisingly like a wide-body commercial airliner. The only exception was that it had no windows, which made Langdon uneasy. He had been haunted his whole life by a mild case of claustrophobia—the vestige of a childhood incident he had never quite overcome. It manifested itself in subtle ways. He avoided enclosed sports like racquetball or squash, and he had gladly paid a small fortune for his airy, high-ceilinged Victorian home even though economical faculty housing was readily available.

The engines roared to life beneath him, sending a deep shudder through the hull. Langdon swallowed hard and waited. He felt the plane start taxiing. Piped-in country music began playing quietly overhead. A phone on the wall beside him beeped twice. Langdon lifted the receiver. Geneva, Switzerland. He was a powerful man. Dark and potent. Deceptively agile. His muscles still felt hard from the thrill of his meeting. It went well, he told himself.

Had it really been only fifteen days since his employer had first made contact? The killer still remembered every word of that call. We share an enemy. I hear your skills are for hire. The caller told him. The brotherhood is legendary. The most dangerous enemy is that which no one fears.

Our roots infiltrate everything you see. They are invulnerable. A single act of treachery and proof. The killer became a believer. The brotherhood endures, he thought. Tonight they will surface to reveal their power. As he made his way through the streets, his black eyes gleamed with foreboding. One of the most covert and feared fraternities ever to walk the earth had called on him for service.

They have chosen wisely, he thought. His reputation for secrecy was exceeded only by that of his deadliness. So far, he had served them nobly. He had made his kill and delivered the item to Janus as requested. The placement.

The killer wondered how Janus could possibly handle such a staggering task. The man obviously had connections on the inside.

Janus, the killer thought. A code name, obviously. Was it a reference, he wondered, to the Roman two- faced god. Not that it made any difference. Janus wielded unfathomable power.

He had proven that beyond a doubt. As the killer walked, he imagined his ancestors smiling down on him. Today he was fighting their battle, he was fighting the same enemy they had fought for ages, as far back as the eleventh century.

His ancestors had formed a small but deadly army to defend themselves. The army became famous across the land as protectors—skilled executioners who wandered the countryside slaughtering any of the enemy they could find. They were renowned not only for their brutal killings, but also for celebrating their slayings by plunging themselves into drug-induced stupors. Their drug of choice was a potent intoxicant they called hashish. The word was still used today, even in modern English. It was now pronounced assassin.

A crisp breeze rustled the lapels of his tweed jacket. The open space felt wonderful. He squinted out at the lush green valley rising to snowcapped peaks all around them. Langdon checked his watch. It read A. We were at sixty thousand feet. Lucky we only did a puddle jump. All things considered, the flight had been remarkably ordinary. A handful of technicians scurried onto the runway to tend to the X The pilot escorted Langdon to a black Peugeot sedan in a parking area beside the control tower.

Moments later they were speeding down a paved road that stretched out across the valley floor. A faint cluster of buildings rose in the distance.

Outside, the grassy plains tore by in a blur. Langdon watched in disbelief as the pilot pushed the speedometer up around kilometers an hour—over miles per hour. What is it with this guy and speed? Why not make it three and get us there alive? The car raced on. A woman started singing. His female colleagues often ribbed him that his collection of museum-quality artifacts was nothing more than a transparent attempt to fill an empty home, a home they insisted would benefit greatly from the presence of a woman.

Langdon always laughed it off, reminding them he already had three loves in his life—symbology, water polo, and bachelorhood—the latter being a freedom that enabled him to travel the world, sleep as late as he wanted, and enjoy quiet nights at home with a brandy and a good book. Without warning the pilot jammed on the brakes. The car skidded to a stop outside a reinforced sentry booth. Langdon read the sign before them. He suddenly felt a wave of panic, realizing where he was. The sentry ran it through an electronic authentication device.

The machine flashed green. He turned and checked a computer printout, verifying it against the data on his computer screen. Then he returned to the window. Looming before them was a rectangular, ultramodern structure of glass and steel.

He had always had a fond love of architecture. Physics is the religion around here. Quarks and mesons? No border control? Mach 15 jets? Who the hell ARE these guys? The driver did not answer. The director will meet you at this entrance. He looked to be in his early sixties. Even at a distance his eyes looked lifeless—like two gray stones. The driver looked up. The man in the wheelchair accelerated toward Langdon and offered a clammy hand.

We spoke on the phone. My name is Maximilian Kohler. It was a title more of fear than reverence for the figure who ruled over his dominion from a wheelchair throne. Although few knew him personally, the horrific story of how he had been crippled was lore at CERN, and there were few there who blamed him for his bitterness.

The wheelchair was like none Langdon had ever seen—equipped with a bank of electronics including a multiline phone, a paging system, computer screen, even a small, detachable video camera. The Glass Cathedral, Langdon mused, gazing upward toward heaven. Overhead, the bluish glass roof shimmered in the afternoon sun, casting rays of geometric patterns in the air and giving the room a sense of grandeur.

Angular shadows fell like veins across the white tiled walls and down to the marble floors. The air smelled clean, sterile. A handful of scientists moved briskly about, their footsteps echoing in the resonant space. His accent was rigid and precise, like his stern features. Kohler coughed and wiped his mouth on a white handkerchief as he fixed his dead gray eyes on Langdon. Langdon followed past what seemed to be countless hallways branching off the main atrium.

Every hallway was alive with activity. The scientists who saw Kohler seemed to stare in surprise, eyeing Langdon as if wondering who he must be to command such company. They see us as nothing but a quaint shopping district—an odd perception if you consider the nationalities of men like Einstein, Galileo, and Newton.

He pulled the fax from his pocket. Not here. I am taking you to him now. Kohler took a sharp left and entered a wide hallway adorned with awards and commendations. A particularly large plaque dominated the entry. Langdon slowed to read the engraved bronze as they passed.

Langdon had always thought of the Web as an American invention. Then again, his knowledge was limited to the site for his own book and the occasional on-line exploration of the Louvre or El Prado on his old Macintosh. It enabled scientists from different departments to share daily findings with one another. Of course, the entire world is under the impression the Web is U. CERN is far greater than a global connection of computers. Our scientists produce miracles almost daily.

Miracles were left for the School of Divinity. Do you not believe in miracles? Particularly those that take place in science labs. I was simply trying to speak your language. How simple of me. One does not need to have cancer to analyze its symptoms. As they moved down the hallway, Kohler gave an accepting nod. As the pair hurried on, Langdon began to sense a deep rumbling up ahead. The noise got more and more pronounced with every step, reverberating through the walls.

It seemed to be coming from the end of the hallway in front of them. He felt like they were approaching an active volcano. He offered no other explanation. He was exhausted, and Maximilian Kohler seemed disinterested in winning any hospitality awards. Langdon reminded himself why he was here. He assumed somewhere in this colossal facility was a body.

They rounded the bend, and a viewing gallery appeared on the right. Four thick-paned portals were embedded in a curved wall, like windows in a submarine. Langdon stopped and looked through one of the holes. Professor Robert Langdon had seen some strange things in his life, but this was the strangest. He blinked a few times, wondering if he was hallucinating.

He was staring into an enormous circular chamber. Inside the chamber, floating as though weightless, were people. Three of them. One waved and did a somersault in midair. My God, he thought. The floor of the room was a mesh grid, like a giant sheet of chicken wire. Visible beneath the grid was the metallic blur of a huge propeller.

For stress relief. One of the free fallers, an obese woman, maneuvered toward the window. She was being buffeted by the air currents but grinned and flashed Langdon the thumbs-up sign. Langdon smiled weakly and returned the gesture, wondering if she knew it was the ancient phallic symbol for masculine virility.

The heavyset woman, Langdon noticed, was the only one wearing what appeared to be a miniature parachute. The swathe of fabric billowed over her like a toy. He never suspected that later that night, in a country hundreds of miles away, the information would save his life. The scene before him looked like an Ivy League campus. A grassy slope cascaded downward onto an expansive lowlands where clusters of sugar maples dotted quadrangles bordered by brick dormitories and footpaths.

Scholarly looking individuals with stacks of books hustled in and out of buildings. Our physicists represent over five hundred universities and sixty nationalities. The universal language of science. He dutifully followed Kohler down the path.

Halfway to the bottom, a young man jogged by. Langdon looked after him, mystified. Where did we come from? What are we made of? The questions seem spiritual.

Langdon, all questions were once spiritual. The rising and setting of the sun was once attributed to Helios and a flaming chariot. Earthquakes and tidal waves were the wrath of Poseidon. Science has now proven those gods to be false idols.

Soon all Gods will be proven to be false idols. Science has now provided answers to almost every question man can ask. There are only a few questions left, and they are the esoteric ones. Where do we come from? What are we doing here? What is the meaning of life and the universe? These are questions we are answering. As they walked, a Frisbee sailed overhead and skidded to a stop directly in front of them.

Kohler ignored it and kept going. A voice called out from across the quad. Langdon picked up the Frisbee and expertly threw it back. The old man caught it on one finger and bounced it a few times before whipping it over his shoulder to his partner.

My lucky day. It took Langdon and Kohler three more minutes to reach their destination—a large, well-kept dormitory sitting in a grove of aspens. Compared to the other dorms, this structure seemed luxurious. Imaginative title, Langdon thought. It had a red brick facade, an ornate balustrade, and sat framed by sculpted symmetrical hedges. As the two men ascended the stone path toward the entry, they passed under a gateway formed by a pair of marble columns.

Someone had put a sticky-note on one of them. Langdon mused, eyeing the column and chuckling to himself. Ionic columns are uniform in width. A common mistake. Ionic means containing ions—electrically charged particles. Most objects contain them. Langdon was still feeling stupid when he stepped from the elevator on the top floor of Building C.

He followed Kohler down a well-appointed corridor. The decor was unexpected—traditional colonial French—a cherry divan, porcelain floor vase, and scrolled woodwork. Evidently, Langdon thought. One of your upper-level employees? I came up here to locate him and found him dead in his living room. His stomach had never been particularly stalwart. Kohler led the way to the far end of the hallway. There was a single door.

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