Anchorage Daily News

First came the problem with the stairs. Ryan Lee's older sisters noticed right away.

A stout, stubborn 4-year-old, Ryan had been climbing the short flight from their basement apartment for more than a year. But one day in early December 2006, he crumpled at the base and wailed to be carried up, as if he were afraid of something no one else could see.

At the time, fatigue distracted his mother, Mai Xiong. A Hmong refugee in her late 30s, she was 8½ months pregnant and on her own. Each morning she drove home from work at about 1 a.m. after an eight-hour shift on the sandwich line at McDonald's.

Xiong's oldest daughter, Melvina, then 15, and Nancy, the next oldest at 9, dealt with the diapers and the homework for the three youngest children while Xiong worked. When she had time to think, Xiong's mind filled with practical concerns -- rides to school; keeping milk in the refrigerator and rice in the cooker with the few hundred dollars left each month after paying the rent.

Christmas came. A charity sent someone to the apartment dressed as Santa Claus with a food box and wrapped presents. By then, Ryan had given up walking altogether, reverting to a strange lopsided crawl, like a wounded animal.

Xiong came home from work one morning to find him awake on the living-room sofa where he slept, his skin moist and hot. She gave him Tylenol and rocked him until he relaxed. Maybe, she thought, he had the flu.

But weeks passed and he didn't get better. Nighttime Tylenol became routine. In early January, Xiong's baby, Kevin, was born. Days later, Ryan stopped climbing off the couch. Tylenol wouldn't ease his fussiness. He didn't want to eat.

Xiong climbed to an apartment upstairs and banged on the door, looking for the shaman known as "Mr. Lee."

MAGIC

Pasert Lee, a stocky veteran of the Vietnam war, is the patriarch of Xiong's four-plex on Parsons Avenue in Mountain View. The old, the sick and the conflicted arrive daily at his apartment. He presides from a faded love seat in a Hawaiian shirt, making magic in front of a big-screen TV. For his counsel, he's paid in cases of cola and beer and live chickens. Visitors tuck $20 and $50 bills into his altar among the boiled eggs and bowls of rice set out to feed the spirits.

Shamanic faith healing, what's called "the old ways," is a quiet, common practice among a few thousand Hmong in Anchorage. Leaders estimate half the community attends Christian churches, but many, especially in the older generation, also turn to shamanism when they are sick or depressed. They believe unseen activities in the spirit world influence the welfare of the living. Many perceive illness as a strictly spiritual problem.

Lee performs marriages and funerals. For the sad and sick he makes house calls. He goes into a trance, traveling from their living room to the other world, searching out lost ancestor spirits. To lure spirits back, he may burn golden paper, an offering of money, or sacrifice livestock -- a chicken, a pig, a cow.

Ancestors communicate with him by way of a cow's horn, split lengthwise into two crescent-shaped halves. He throws the halves on the floor like dice. When spirits are pleased, the halves land flat, tips pointing inward, making the shape of a horseshoe.

In a community where many are poor and uneasy with English-speaking culture, some view doctors with suspicion, as expensive and alien. For them, the shaman may function as a primary health care practitioner, a choice of tradition over science that can turn deadly when an illness grows serious.

SICKNESS

Lee padded down the stairs, past the laundry room where a rooster crowed over the thrum of the dryer.

Ryan lay in Xiong's apartment, shafts of light cutting through the curtains. His legs ached. Lee felt his glands. They were swollen and round. He washed Ryan with magic water and told Xiong to wait.

Word of Ryan's illness spread quickly through the block of four- and six-plexes filled with Hmong families. Soon, neighbors came trooping through the chain-link gate. Some whispered to take him to the hospital, but Lee told Xiong to be patient. They would try the magic three times, he said.

"I knew that if he don't get better, I have to take him to the doctor somehow," Xiong said. She trusted Lee's advice. She wasn't sure how to pay for a doctor.

"(It) maybe help him to catch the spirits."

Lee consulted other elders. They tied red strings around Ryan's wrists to lead spirits back. They chanted. They threw the cow's horn on the carpet and studied it. The spirits were content, they concluded. Ryan would improve.

But Ryan didn't.

At night Xiong held his listless body. Unable to sleep, she listened to his breath catch in his throat. Finally, she couldn't wait any longer. She woke a neighbor and they drove to Providence Alaska Medical Center.

By then, it was mid-February. He'd been sick for six weeks.

MOTHER

Without her platform slippers, Xiong is tiny, under 5 feet. She has close-set black eyes and a frantic, high-pitched giggle. She smiles often. If Xiong had some other life, she might be an artist. In her few solitary moments, she embroiders with mathematical accuracy, sewing heart-shaped ornaments meant to bring healing, stitching into cloth stories about men and women and perfect love.

Xiong remembers singing English hymns at a church in Laos when she was a little girl. She remembers the tall buildings and wide blue skies of Kansas City, where they moved with the help of a church when she was in elementary school. Xiong taught herself English by watching "Sesame Street" on television. Since childhood, she has been a translator for family and friends.

Raised in Christian churches, Xiong paid little attention to the old ways until she met her first husband at a Hmong New Year celebration when she was in her late teens. They were married during her senior year and she dropped out of school, moving in with her husband's family in another town. His father was a shaman. As time passed, she came to believe in the power of shaman magic. After that, she rarely visited a doctor, except to give birth and to get her children vaccinated for school. She gave birth often, as befits a good Hmong wife.

Hmong women see children as a gift and a duty. The cycles of the female body and the biology of conception aren't always spoken of between mothers and daughters. Shaman birth control, which is allowed only under special circumstances, is delivered in the form of a monthly tincture, according to Lee. For many women, especially among Xiong's generation and older, it's common to be either pregnant or nursing for a decade or more.

Xiong never found the perfect love she sews into her tapestries. Her first husband was involved with a gang in California and ended up in prison. Xiong left their four children with relatives and moved to Alaska maybe 10 years ago, looking to start anew. But a relationship here left her pregnant and unmarried. She doesn't like to talk about the father of her youngest children. She says he has moved away. Lee says he might be dead.

She found her way to Mountain View, to a four-plex owned by Lee's son and occupied by Lee's relatives. In the house, she feels the weight of Lee's expectations. To please him, she helps with translation and runs his errands. When Lee plans a community celebration, she might cook 12 hours with the women in his family, grinding meat, slicing cabbage and shaving carrots, while the children run about.

DIAGNOSIS

Under the bright light at the emergency room, there were needles and questions and worried faces. Laura Schulz, a pediatric oncologist, gave Xiong the news. Ryan had cancer. Leukemia. Four foreign syllables.

Schulz had seen many sick children, but Ryan was among the sickest, she said. The good news: His cancer was a kind that could be cured. He had to go to Seattle for his initial round of chemotherapy. Right away. The swelling in his neck was putting pressure on his airway.

Ryan had to stay in the hospital.

The problem was his blood, Xiong translated to Lee over the phone. She repeated for him the doctor's explanation about white cells. She repeated the word "chemotherapy." At home, Lee threw the horns on the carpet. He consulted with elders.

Wait, the elders urged, wait for the shaman medicine to work.

"The family was very, very interested in just staying here," Schulz said. She wasn't sure what Xiong herself wanted.

Xiong's worries piled on. How would she pay? Her baby Kevin was only 2 months old. Who would watch him? How would her other children eat without her working? And she didn't want to go against Lee's advice.

She told Schulz she wanted Ryan to stay in Alaska.

Ryan's condition worsened. Schulz moved him to the ICU. A day passed, then another.

Schulz considered the hospital's options if Xiong didn't change her mind.

"Ryan's cancer is pretty curable. He's got probably at least a 90 percent chance of being cured with traditional western medicine," she said, in a recent interview. "So unlike some cancers, we really do feel pretty strongly this is the way it needs to be treated and I think legally that's held up.

"This is one of the few diagnosis where we really can have a kid taken away from a family."

But it didn't come to that.

Ryan was getting weaker. He could die in flight, Schulz told Xiong. Time was running out.

Xiong felt like she was being forced to pick one kind of magic over another. To her the doctor held no more authority than the shaman. Each dealt in mysteries.

She watched Ryan in his hospital bed, puffy and pale, attached to machines that clicked and purred.

"My mind is really clear at that time," she said. "I got to take care of my child. I have to take him to Seattle."

BETTER

Three nurses work in tandem. One holds a thick-paged children's book, pressing a button that makes the sound of a honking truck. Another swabs Ryan's arm with alcohol. The third braces him for the needle stick. Xiong talks to him in a high-pitched baby voice, soothing him in Hmong.

Over a year has passed since the ICU. Xiong spent six months in Seattle with Ryan. Her voice wavers when she talks about being there.

"I don't have no money, nothing," she says, a tear slipping down her cheek.

A local cancer society sponsored them. They stayed at the Ronald McDonald House. People from Mountain View School collected food for the children at home. A social worker at Providence helped. Her boss promised to hold her job.

"I feel like I was in a different world. The kids are here, I'm down there. I worry," she says.

There was so much waiting, time went fuzzy. She sat with Ryan in the muted world of the hospital, pushing her needle through cloth, stitching heart after heart.

Once she made the decision, Lee relented. Eventually he agreed to watch the other children.

Ryan began to improve. Xiong still talks about his recovery in incredulous tones, like someone who's witnessed a miracle.

On this day, Ryan runs through the children's cancer center, his wide feet squeaking on the floor. He pulls toys from the shelves, each one new and clean, but can't stay focused. He talks little and won't hold still to be examined, grabbing at Schulz's otoscope when she tries to look in his ears.

Soon it is time to sit so a nurse can push a syringe of chemo into his veins. An attendant puts a DVD player in his lap and turns on "Bee Movie." His mother sits by his side, her arm around him. For a moment, it's like he's an only child.

Since they've been home, Ryan and Xiong have fallen into an old rhythm. She goes to work. There's school. At night, when she's gone, the children share a big bowl of rice and broth on the kitchen floor. There's still more than a year of chemotherapy appointments at Providence. And every three months, there's a spinal tap.

"His numbers look good," Xiong tells anyone who asks.

CURES

At the four-plex, where the noise of children never stops, Melvina, the oldest daughter, moves like a ghost in the apartment. She emerges from the bedroom when the younger children cry, then disappears to talk on the phone. "I know" and "whatever" seeps through the cracked door. While her mother was away, they lived on food stamps, under Lee's loose supervision. Melvina couldn't manage everything so she quit going to school.

Mary, 9, and Brandon, who is 6, watch a Hmong music video, lying on their bellies on a plastic mat that covers the living room floor. Nancy, who just turned 11, holds baby Kevin on her hip, a bottle in her other hand. The toddler wears a black pouch of herbs around his neck to ward off sickness.

Ryan gallops down the stairs holding a bag of Cheetos, his mouth ringed in orange crumbs. He peeks in the door and laughs.

Nancy, the second oldest, is the family historian and spokeswoman, in love with school, a chatty American child. She keeps a stack of certificates -- for citizenship, attendance, participation -- in a backpack that hangs on her doorknob, ready to demonstrate her success to guests. She narrates her mother's absence, paging through a photo album. There's her brother before he was sick. There he is in the hospital. Now he's bald and swollen. Now he's getting better. Look, his hair is growing back.

The children call their brother Robert now. The spirits didn't like his old name. When he came home from the hospital, Lee had a ceremony to change it. The shaman went into a trance, chanting and hopping from foot to foot. He killed two chickens and two pigs and offered the head and feet of a cow. Ancestors listen to the cow, he says.

On a recent morning, Lee takes a rest, ignoring his ringing cell phone. His wife, Bea, is sweeping the stairs. Lee says he doesn't remember discouraging Xiong from going to Seattle. Maybe that was someone else. He visited her twice while she was there. He met Ryan's doctors. They are very wise.

After Ryan came back, a local doctor got in touch with him, he says. They talked about emergencies. There are certain times he must call 911, the doctor said. Certain things, like bleeding and broken bones, need to go to the emergency room where there are X-rays and CT scans. Lee agreed, he says, though he's seen broken legs cured with shaman medicine.

Ryan's recovery, he says, is "70 percent doctor, 30 percent shaman."

And his work is not complete. Ryan must keep taking his chemo pills. He must keep visiting the doctor. And there must be one more ceremony.

Lee is waiting for the sap to rise in the trees. And the moon must cut a sharp sliver in the night sky, skinny as a cow's horn. Then he will close his eye and don his black suit and ask the spirits to let the little boy be healed.

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Find Julia O'Malley online at adn.com/contact/jomalley or call 257-4591.

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