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Dee Korda, one of whose foster children was severely retarded and also attended Schelby, frequently saw Lia there, lying on her back with her hands strapped to blocks in order to prevent her fingers from stiffening into claws. She could hardly bear to look. The Kordas had all taken Lia’s neurological catastrophe hard. The entire family had gone through therapy at the Merced County Mental Health Department in order to deal with what Dee called “Lia being dead but alive.” At their counselor’s suggestion, the children—biological, foster, and adopted—drew pictures on butcher paper. “Wendy drew a mom and a baby, because Lia was with her mom,” said Dee. “Julie drew a rainbow with clouds and birds, because Lia didn’t have to cry anymore. Maria is real withdrawn, but when we told her about Lia she cried. Lia got through to her! She drew a broken heart with a jagged fence and an eye looking in from the outside. The heart was the sadness. The fence was the wall that Lia had gotten over by touching our lives. The eye was my eye, watching the sadness, with a tear that cried.”

In 1993, while she was vacationing at Disneyland, Jeanine Hilt had an acute asthma attack, went into respiratory failure, and suffered oxygen deprivation so severe that she lost all brain function: in other words, she developed hypoxic ischemic encephalopathy, exactly the same fate that had befallen Lia. She died three days later with her partner of eighteen years, Karen Marino, at her side. “When I heard Jenny was dead, my heart broke,” Foua told me. “I cried because Jenny had told me she wasn’t going to get married and she would never have any children of her own, so she would help me raise my children. But she died, so she couldn’t do that, and I felt I had lost my American daughter.”

Neil Ernst won the MCMC residency program’s first Faculty Teacher of the Year award. Peggy Philp became Merced’s County Health Officer, a post her father had held more than forty years earlier. They continued to share their pediatric practice as well as housework and child care, scrupulously negotiating what one of their Christmas letters described as “a blur of laundry, lunches, cleaning, patient care, newborn resuscitation, and resident teaching.” Their understanding of the Lees, and the Lees’ understanding of them, deepened significantly when they, too, experienced a child’s grave illness. During his last month of third grade, their elder son, Toby, was diagnosed with acute lymphocytic leukemia. When Neil tried to tell Dan Murphy about the diagnosis, he cried so hard he couldn’t talk. After one of Lia’s checkups, Neil wrote me:

Mrs. Lee had heard that our son had leukemia. It was truly amazing how quickly she heard of this. When Peggy saw Lia in our clinic, Mrs. Lee was very concerned about Toby’s health, how he was doing etc. There was very genuine concern expressed by her questions and facial expression. At the end of the visit Mrs. Lee was hugging Peggy and they were both shedding a few tears. Sorrows of motherhood cut through all cultural barriers.

Toby underwent three years of chemotherapy and achieved what seems to be a permanent remission. “Lia’s mother continues to occupy a special place in our thoughts,” wrote Neil in a later letter. “She always asks about Toby. Our contacts with her are very infrequent because her family provides excellent care for Lia, but they are special nonetheless.”

Since Lia’s brain death, whatever scant trust Foua and Nao Kao had once had in American medicine had shrunk almost to zero. (I say “almost” because Foua exempted Neil and Peggy.) When their daughter May broke her arm, and the doctors in the MCMC emergency room told them it needed a cast, Nao Kao marched her straight home, bathed her arm in herbs, and wrapped it in a poultice for a week. May’s arm regained its full strength. When a pot of boiling oil fell from the electric stove onto Foua’s skirt, setting it on fire and burning her right hip and leg, she sacrificed two chickens and a pig. When Foua got pregnant with her sixteenth child, and had an early miscarriage, she did nothing. When she got pregnant with her seventeenth child and had a complicated miscarriage in her fourth month, Nao Kao waited for three days, until she started to hemorrhage and fell unconscious to the living room floor, before he called an ambulance. He consented to her dilation and curettage only after strenuous—in fact, desperate—persuasion by the MCMC resident on obstetric rotation. Nao Kao also sacrificed a pig while Foua was in the hospital and a second pig after she returned home.

Before she was readmitted to Schelby, Lia was routinely vaccinated against diphtheria, pertussis, and tetanus. At about the same time, she started to develop occasional seizurelike twitches. Because they were brief, infrequent, and benign—and also, perhaps, because he had learned from bitter experience—Neil decided not to prescribe anticonvulsants. Foua and Nao Kao were certain that the shots had caused the twitches, and they told Neil that they did not want Lia to be immunized ever again, for anything.