BRIAN LAMB: Dr. Alfredo Quiñones-Hinojosa. You write in your book that you were an illegal, homeless, immigrant, farm worker. Illegal, homeless, immigrant farm worker and now you are a brain surgeon. How long ago were you a farmer?
DR. ALFREDO QUIÑONES-HINOJOSA, AWARD-WINNING NEUROSURGEON: Well thank you Brian. I think that it’s a pretty comprehensive description. I came to the United States in 1987 and I talk about that in that recent book that we published. So not too long ago at least a little bit over 20 years ago.
You know, I was just, came into this country with literally $63, $64 in my pocket. I spent $60 on my first trek landed in LAX with about $3 left and then found my way all the way out to northern California where I began to work with these very same hands that now get to touch the human brain at one of the most prestigious institutions in the world which is Johns Hopkins.
LAMB: Can you remember the first time you saw the brain?
QUIÑONES-HINOJOSA: Can I remember the first time? Imagine, Brian. I mean, I was just a kid now that I look back. I started medical school at Harvard when I was 26 years old. And sometimes people have asked me, ”Did you know you were going to be a doctor?” And I say, ”No.” ”Did you know you were going to be a brain surgeon?” And I say ”No.” How did I end – how did I end up in this journey, you know, that I have lived for the past two decades?
Sometimes things happen for a reason. And I used to think that chance and good luck comes to anybody who wants it. But I began to realize that it’s not just that. It comes to those who look for it. And one day I was walking in the hallways of Harvard Medical School and a very, very distinguished brain surgeon looked at me on a Friday night around 11 pm and he asked me, ”Where are you going?” And I said, ”I’m going to the library to study.” And he said, ”Have you ever done brain surgery?” And, ”Have you ever seen brain surgery?” And I said, ”No.”
And he said ”Would you like to see brain surgery?” And I said, ”I would love to.” And I started thinking this is going to happen in the future and I talked about that in my book. And he said, ”Let’s go right now.” So next thing I know, I walk into this operating room and imagine the magic that I felt when I saw that beautiful brain on a patient that was awake; which is incidentally what I do now a days. One of my specialties is doing brain surgery and taking brain tumors from patients that are awake.
And this was 1997. And I see the human brain pulsating with a beautiful rhythm and a patient that was awake dancing with the heart. And right there, immediately right then, I was captivated and the idea was born as to whether or not one day I would be able to do the same thing. And here I am.
LAMB: How many times have you operated on a brain?
QUIÑONES-HINOJOSA: I, by now, imagine going through residency six years of, you know, three to four hundred cases a year. And now as attending at Johns Hopkins I do anywhere between 250 to 300 brain tumors a year.
And I’ve been there for now six years. So you can imagine thousands of times that I have seen the human brain. And it doesn’t matter how many times I do it. It doesn’t matter how many times I see that brain. I still go back to the same feeling every time I peel back the dura and I open it, I see the human brain pulsating with such a beauty.
And it makes me wonder, you know, every patient whether you’re brown, whether you’re black, whether you’re Hispanic, whether you’re Muslim all our brains, once you peel back that dura, we all look the same.
LAMB: What’s the toughest part of being a brain surgeon?
QUIÑONES-HINOJOSA: I think the toughest part about being a brain surgeon is the challenges that we face. The uncertainties that we face every day in the operating room that sometimes no matter what you do. You can do the most perfect brain surgery. You can remove a whole tumor and at the end of the day we still cannot defeat the natural history of brain cancer, for instance.
And I have so many patients that come now that’s from all over the world, hoping that I can cure them from the most devastating disease that affects the human body, which is brain cancer. Similar disease that affected Senator Kennedy as you know.
No matter how much power, how much knowledge we have, we still can’t defeat that disease and that to me is the most frustrating part of what I do is that I still have to go out and talk to the patients’ families and I got to look at them face to face and I said, ”I’m very happy with the surgery that we have done, yet I know this is only the first of many battles that you are going to fight with your loved ones.”
And that feeling of knowing that no matter how much of an expert I am on the disease, I can’t win the war. I may win a battle when I do the surgery. But at the end, the war is going to be fought by my patients and their families.
LAMB: Is the cancer called GBH that Senator Kennedy had?
QUIÑONES-HINOJOSA: Glioblastoma multiforme. GBM.
LAMB: GBM. Because you write – you use those letters a lot in the book.
LAMB: When you see that and what do you see when you see that? Is there any chance at all? Or what are the percentages today?
QUIÑONES-HINOJOSA: Thank you Brian. I mean I can tell you every time I go into the operating room and I find myself in that dilemma of knowing that I am in front of this killer, this massive killer, because it kills thousands and thousands of people every year, this type of cancer alone. I’m not talking about any other cancer in the body. I’m talking about specifically the cancer that affects the brain.
And I go in and I know I am the underdog when I’m fighting that fight for my patients. My patients trust me with their life. So when I am in there, I am like the special forces of brain surgery. I go in there with all the passion, all the knowledge, all that energy that I have gathered from the patient and their families and my role is to go in and take as much as I can safely.
And that is what I do a lot of times. I weigh craniotomies to make sure that I take as much as I can. The odds are against me making an incredible difference on that patient’s life at the end of the day.
Because the bottom line is that the disease is devastating. All right, at the end of the day the disease keeps growing. The tumors keep growing. But I never lose hope. Every patient I treat, every surgery I do on specifically that type of cancer, I always hope that this is going to be the patient that is going to defeat this disease and from that patient we will learn and make history for many other patients to come.
And I have that feeling in my heart every single time I enter that arena in the operating room. I have to; otherwise, I wouldn’t be able to do what I do every day. Hope is the last thing; I hope I will ever lose. And I don’t want my patients to lose it either.
LAMB: You write a lot in your book about being an illegal.
LAMB: How did you come to the country illegally and then how did you become legal?
QUIÑONES-HINOJOSA: So, it’s quite interesting. So you know that through the country. This country was built upon people who have come and immigrated to this country. Some of them legally, some of them illegally. In my case, I came in with no documentation and no ability to get a job or an education.
So when I first came in into the United States in the late 80s and I crossed the border between Mexico and the United States and ended up coming into the San Joaquin Valley to work as a migrant farm worker, it was no challenge to find a job.
There were not a lot of thousands of people trying to get the jobs of pulling weeds with the very same hands that are now doing brain surgery. I was pulling the weeds. And as you can imagine pulling the weeds from the – from the land that is doing all the products, cantaloupe, cauliflower, corn, all those kinds of things, my hands were bloody. I mean continuously being hurt. So there were not a lot of people lining up.
So I came in and asked for a job, and I immediately got a job. And then eventually, right around Ronald Reagan had the immigration reform that gave a working authorization specifically for people who had been in the United States a certain amount of years and then there was a special legislation for people who came and worked as migrant farm workers. And that legislation allowed you to have a working authorization. That was the first thing.
And to pay taxes. And eventually that working authorization you couldn’t go back anywhere. You couldn’t go back to your country. But it allowed you to work legally, pay taxes, and eventually apply for a Green Card which is eventually what I did.
So the country was welcoming people like me who worked in the fields. It was a different time, you know, and I felt that I was given an opportunity. An opportunity to live the American Dream. And it was quite interesting because we talked a lot. I mean, times have changed. Our borders have gotten more strict.
What I did back then wouldn’t happen, and I talk about this in the book. Nonetheless, the American Dream hasn’t changed. Some peoples’ perception of how to achieve the American Dream may have evolved over time. But the American Dream is still, is the same foundation of hard work. People who are coming into the United States with an idea that they can work as hard as they possibly can and to still be able to put food on the table of their children.
And to be able to give the children an education. And that was my dream back then. It was that simple. All I wanted to do was work hard enough so I would have food on the table of myself, my future children, my parents, and my siblings. And that’s exactly the journey that I took all the way from back then until where I am today.
LAMB: You quote an assistant or a nurse in the book as saying from a patient, ”Is it true that the doctor is a dirty Mexican? Isn’t there another surgeon I can see?” How often does that happen?
QUIÑONES-HINOJOSA: It happened very, very often when I first came to Johns Hopkins in 2005. So you realize that I’ve only been there for six years. And we’ve been so blessed that I have risen in the academic rankings all the way to now being nominated for full professor at Johns Hopkins. But when I first came, and people didn’t know my background, they could see from my skin color is different. They can detect a certain amount of an accent in some ways.
And some of them, they could have known a little bit of my history of being at Harvard and then in San Francisco training but they couldn’t get over the fact that I was from a different country. And I came from humble backgrounds. And it happened a lot to be honest with you.
And I always told my team that a lot of my patients who came to see me were not only suffering from biological diseases which is brain cancer, but they were also suffering from social diseases which is discrimination and sometimes seeing people for the way they look, and how they talk, and the accents they may have, fully ignoring, and not because I speak with an accent. That means that my brain works with an accent. It works as well as anybody else and we know that.
So I told my team continuously don’t worry, they will come around. And every single one of those patients always came around. And after surgery once they decided to trust me with their lives, I would come in and talk to them.
They would turn around and many times they would tell me or my assistants how sorry they felt for some of the comments. I attributed that to the disease. Once again, their biological disease. They’re dealing with the brain cancer that makes you think in ways that you really can’t explain.
But it did happen often. I didn’t pay much attention to it to be honest with you. I turned all that negative energy into positive energy. How did I do that? By doing research. By continuously making every single one of my patients part of history. Which is something that to me has been so simple.
But you’d be surprised how many brain surgeons have either given up fighting against brain cancer, or they have decided that they just want to go in and do their surgery every day and not necessarily fight the disease, you know, in the laboratory which is something that I have done.
LAMB: What’s the point of operating on the brain and having the patient awake?
QUIÑONES-HINOJOSA: Wonderful question Brian. So if as – I alluded to already in the discussion and there’s been several people who have come into the operating room to see how I do the surgery. I’m not the only one in the United States or in the world, there are several surgeons around the world who do a beautiful job, but the principal is simple. Imagine in our brain, especially in the left side, the majority of us have dominance for speech in the left side.
Right about right here we have the ability to produce the speech. It’s called Brocus’ area. Right around back here behind the ear we have the ability to understand language. That is called Wernickie’s area. And between these two areas there are connections.
And that’s how our brains interact. We understand and we produce language. So imagine if you have a tumor that is in this vicinity, many times these tumors if they’re the malignant brain cancer, you can’t tell the border between the tumor and the normal brain.
The only way that you can do this is by mapping the brain and knowing where normal function lies and then you take your resection all the way to that border and leaving that border intact. So you have the ability to take as much tumor as you can and leave behind the part of the brain that is necessary for language.
LAMB: How does the patient, though, not feel pain?
QUIÑONES-HINOJOSA: Well some of my patients have actually written about this. And one – I have a wonderful patient that I talk to in the book actually who is a sports writer. And he talked about, you know, it’s difficult, it’s challenging, you know, to be there awake and knowing that someone else is up in your brain, you know, keeping you awake as they’re touching your brain and stuff. But the truth is that the pain sensors are not in the brain surface.
You can elicit memories, you can elicit painful memories, but there’s no pain per se in the actual brain. The pain is on the scalp, on the skin, the pain is on the bone, and the pain is on the part that covers the brain. It’s called the dura matter.
It’s a small layer of tissue. And you put a local which is no different than the way we do to do dental work. As a matter of fact, many of my patients tell me when they undergo the surgery that it was actually more painful to have dental work than to have awake – awake surgery.
The difference is the psychological pressure. But I tell you it’s amazing. And just about three weeks ago, one of my patients a young man, 15 years old, is going to be featured in the Johns Hopkins, you know, newsletter. He underwent an awake craniotomy with me. I mean talking about being a true hero.
This young man was stronger than any patient that I have ever seen. He remained calm. He answered all the questions because I kept him awake. I interacted with him, I’m asking him questions, they’re looking at pictures, they’re reading words, all this is going, they are working with me. We are working as a team in trying to eradicate the disease and they do a beautiful job.
LAMB: How long can a patient stay awake and have the brain open like that?
QUIÑONES-HINOJOSA: It all depends. The surgeries range between an hour to sometimes up to three hours depending on the complexity of the tumor, depending on the size of the tumor, depending on how close they are, but they range.
So they can be awake and sometimes I put them to sleep a little bit with a little bit of anesthesia – local anesthesia, having a wonderful anesthesia team is crucial because they keep them nice and relaxed.
LAMB: When you’re doing the most difficult of all brain surgeries, how many people are physically involved?
QUIÑONES-HINOJOSA: Oh my goodness. So imagine that. So yesterday I did a case, right? Yesterday morning I did a case that lasted about 12 hours and I had -I was the captain of this team and I had two EMT surgeons or orthogonalogists, I had two plastic surgeons, and then I was leading a team of neurosurgeons obviously.
Surgeons alone we have about eight surgeons involved in this team and this was a patient that came from far away with a very complex tumor that we had to remove at the base of the skull.
In addition to that we have three anesthesiologists. In addition, to that we have about four nurses helping us circulate in the morning, four nurses in the afternoon. So all together I probably had a team of about 20 people in some of these are very, very complex cases that we do.
LAMB: If somebody had to pay out of pocket for that operation, do you have any idea how to describe the cost of it?
QUIÑONES-HINOJOSA: Every now and then that has happened because, as you can imagine, I am at an incredible institution with an incredibly international reputation. At Hopkins we have people that come from all over the world.
And I would say that most of the time some of my patients that come from all parts of the world and they have to pay cash, it ranges probably anywhere between sixty thousand dollars to depending on the complexity of the case up to several hundred thousand dollars and depending on how long they are in the hospital.
As you can imagine, you know, very wealthy people sometimes they come to the United States and choose to have their surgery because they want the best. And not necessarily because I lead a team, but also because I am surrounded by an incredible amount of incredibly smart and dedicated physicians, nurses, and everybody else that is involved on the care of the patient. So those are the ranges more or less for what I see.
LAMB: What’s the most difficult, and you probably hate this kind of question, but what is a very difficult operation and I mean I read in here about the skull, I mean the face being pulled down and all that. But what’s the most difficult situation you find yourself in?
QUIÑONES-HINOJOSA: I would say the most difficult situation, Brian, that I find myself is in those situations in which you are in the operating room, no matter how – what the case is, it could be a very complex brain tumor, or it could be a simple brain tumor. But the difficulty is when suddenly something unexpected happens.
You know, about three weeks ago, I was doing a young man, early 40s with a very large brain tumor. Soccer player, incredibly fit. And as soon as I opened the tumor, and I opened to begin to rescise the tumor, there were small but very significant bleeders.
And it was just like you open the gates and blood it starts pouring out uncontrollably. And the greatest challenge is that you know that there’s a fine line between life and death. Luckily, I remained calm. I kept my whole team calm and we were able to control the situation.
And that patient went home in two days. Imagine the pleasure that I had to know that. But I went home that night and I was still shocked. You know after that adrenalin calms down because you’re in the middle of this.
And like I said you are like the special forces, You have to lead the team and you’ve got to keep everybody calm, cool and collected and make sure that you are paying attention to every single thing that is going on, all the way from anesthesia, nurses, the people who are doing the neuro monitoring, my residents, the people who are bringing the blood and you are aware of everything.
It’s as almost as if time slows down and everything is moving around you and you’re focused and everything is quiet and that you’re aware of everything that is going on and you’re trying to save this life.
I went home that night and I sit and my son, David, is having dinner and this is around 9 pm and he said, ”Dad, how did your day go?” And I said, ”It was – it was a tough day. You know I had this patient. I took this tumor.” And my kids know a lot about tumors already because they see me doing a lot of stuff.
And I told him what happened with the blood. And then he asked me a question at age 10; he said, ”Dad, how much blood do you think you could have afforded to lose before the patient died?” And that’s when it hit me, not much.
We had lost about 6 liters of blood. And we were giving the patient blood. So we were this close to potentially losing him. And those cases are very, very emotionally and physically taxing for me.
LAMB: Did you have to go back the next day and do another operation?
QUIÑONES-HINOJOSA: Yes, I had to go back. I mean every day, the same day, in the afternoon I have to go back and do it all over again. And those are the challenges that we face. You know, we never really talk about the – the – the emotional weight that this kind of situations carry on you and the amount of arrogance and I talk about this in the book that, you know, I am the first one to admit I have to get up in the morning and tell myself I can do this.
There’s no one better to do this than I am. Because I have to believe that every time I go into the arena, into the operating room, I have someone’s life in my hand and I am fully capable of getting this patient in and out of the operating room because that’s the trust that these patients have in me. And I walk the fine line between confidence and arrogance.
LAMB: Let’s back up to – I want to eventually to get you to talk about what seems to be a metaphor in the book – you falling into the tanker. But let’s back up from that. You’ve been how long at Johns Hopkins?
QUIÑONES-HINOJOSA: I’ve been for six years at Johns Hopkins.
LAMB: Before that?
QUIÑONES-HINOJOSA: I was for six years at the University of California in San Francisco and before that I was at Harvard for Medical School.
LAMB: How long was your medical school?
QUIÑONES-HINOJOSA: I did four years and then I spend one year with the Howard Hughes doing research investigation.
LAMB: And you’re only 43?
LAMB: OK. Go back then beyond Harvard where were you in school before that?
QUIÑONES-HINOJOSA: Before Harvard I was at the University of California at Berkley, UC Berkley and before that, you know, from 88 to 91 I was in the small community college in Stockton, California, northern California right before I went to UC Berkley. And right before that I was working in the fields.
LAMB: How long did you work in the fields?
QUIÑONES-HINOJOSA: I worked in the fields for about a year and a half. And then simultaneously as I was working – as I was studying English in community college – I was working in the rail road.
LAMB: All right let’s go back before you jump the fence.
LAMB: When did you fall into the tanker and why?
QUIÑONES-HINOJOSA: So this is around this time. This was when I was in community college learning English and I fell. And I guess – I guess we have to set up the story because it’s a metaphor in many ways as what’s it’s like to fight for your own life and what it’s like sometimes to give up control.
Alright? So right after I worked in the fields I am working in a railroad company, and I was doing the most menial job that you can imagine. I started first cleaning tanks that carry fish oil. And at the bottom there’ll be this fish lard that would accumulate and I had to clean that.
And then I advanced to cleaning tanks that carry liquefied petroleum gas. All right? And that’s exactly the story that we relate in the team as I am in a beautiful sunny northern California day in the summer.
I am working with one of my coworkers, that I mention in the book, Pablo, and I am in charge of fixing the security bottles so this tank wouldn’t explode or wouldn’t release all the gases that they carry, liquefied petroleum gases, (LPG).
So I’m in the top of this 35,000 gallon tanker and I have a hole about this big and a big bolt falls into the tank and I tell my coworker I’m going to go down and get it. Talking about arrogance. All right? That’s exactly what happened. And my friend goes to me, my coworker, says, ”Are you crazy? No. No. No. we’ll let it be, we’ll get someone else to do it.” And I said it will take me a minute.
This is when I thought that I was in the top physical shape in my life and I went down and as you can imagine, I didn’t make it back out. But I did try.
As I landed at the bottom of this liquefied petroleum tank, you know, and I realize that there’s no oxygen and I am with my whole equipment, you know, steel toed boots, big overalls, a lot of tools. I start dropping everything and I start driving this rope and I am about 18 feet right about the height of this ceiling at the bottom and I start going up on this rope.
And as I start doing this, and I relay that in the book, my whole life starts flashing. Just like when people talk about a near death experience. And I’m thinking to myself, oh my gosh, you know, I came to this country to fight for not only my life but also to provide for my siblings and my parents and this is where I’m going to end up. But I’m not going to go without a fight.
And I started going up, going up, climbing that rope, little by little with absolutely no oxygen in my lungs. And I made it all the way up to the top and I grabbed Pablo’s hands. And Pablo relays the story as to how when he saw in my face the agony but also the strength I could have almost crushed his hand, he thought we were safe and he asking for help.
Right around that time, my father comes because he was working in the railroad in the same place that I was working. And he comes out and he lands right on top of Pablo at the moment that Pablo couldn’t hold me anymore because I completely lost consciousness. And Pablo relays the story that right before I did this, I smiled and then I went down to the bottom of this tank...
LAMB: .... you fell all the way down...
QUIÑONES-HINOJOSA: ... I fell all the way down completely unconscious. And then the whole incredible journey and work of a team, just like – and led by a person that I mentioned in the book that subsequently died unfortunately when I was resting from traumatic brain injury. He led this team and my own brother-in-law went in not once but twice to save my life.
And it’s an incredible story as to how they were able to get me out when I could have not only died but the way that they got me out with a rope, and no resources, because we had nothing in this place. And they got me out of there.
The next thing I wake up – the next time I wake up I’m in a small hospital. All right? In Stockton, California and I am vomiting and I am completely strapped. I can’t – and you know in one of those yellow stretchers. And everybody – my neck is protected and now I know because I know what traumatic brain injury and a spinal injury the way you have to protect it. And the doctor is trying to examine me.
And he’s telling me to relax. And I said, ”How do you want me to relax?” I was vomiting. I needed to move to the side. I mean I was completely sick to my stomach. And my father relays the story hours went by. They did all kinds of tests.
CT scan, brain MRI. Because I’d been down there for minutes with no oxygen. They thought I had a stroke. Because I was having – I couldn’t feel some of my hands. I was having a lot of side effects from the liquid petroleum tank, the gas not fluid but the gas.
And they – I woke up a few hours later. My father came in and I see my father and my brother-in -law crying and I talk about this story. And a few hours went by. And then I asked my father, you know, I noticed that there were some young nurses taking care of me and my father knew that I was going to be OK when I asked my dad, ”Dad, how does my hair look?”
And so as you can imagine the whole idea of the moment that I grabbed my coworker Pablo I had to, you know, I knew that I had given it all that I had. And it was at this point, it was symbolic of me trusting that things were going to work out for me.
LAMB: When did you decide to tell this story?
QUIÑONES-HINOJOSA: You know I tell you Brian, I decided to tell the story right around 2008. You know they show Hopkins air, you know, ABC did a beautiful show at Hopkins. And, you know, how little did I know I was in the first episode the so called A story and the last episode I opened and closed the show.
I had multiple interviews and a lot of people were asking me already since I was actually a medical student when I finished Harvard Medical School and I had an article that made the cover of the Boston Globe, a lot of writers came to me and said we’d love to write your story. And I wasn’t ready. Mentally and physically I wasn’t mature yet.
And I came to Hopkins and I wasn’t ready yet. I needed to climb the ladder of academic, you know, medicine. I needed to go from an assistant professor all the way up to full professor before I released my story which is has what happened now likely, I have been nominated, as I was saying, earlier. But right around that time I realized that there was an incredible story to be told.
Not just my story, but my interactions with so many people that have mentored me in not most recently my patients, as you know. And I realized that this was the American Dream. And we were losing focus of what the American Dream is all about. You know, I think the American Dream comes back to the same principal of hard work.
And I wanted to tell the story about this underdog, this kid, who came to the United States with nothing and now based on hard work, mentorship, and doors being opened, and opportunities being given, and me taking those opportunities I was able to show the world that you can still fulfill the American Dream and that America is still the most beautiful country in the world. And that’s why I decided to tell that story around that time.
LAMB: At all worried that some of your colleagues will think you’re show boating?
QUIÑONES-HINOJOSA: Of course, I always worry about this. I – you know, you always do. And it’s happened and many times and that’s why exactly I wanted to move up the ladder. Believe me, they wouldn’t give me promotions at Hopkins based on this book alone.
It has to do with publications, peer review publications, scientific papers, you know, just about last week we had a big article featuring our laboratory nature – Nature Magazine. It has to be based on grants that we get from the government.
Peer review grants, you know that I’m only one of the few hand of brain surgeons in the United States that has funding from the National Institute of Health. Multi-million dollar grants to study brain cancer. So that’s how you get promoted. And that’s how I said this is what I’m going to do first before I release that story.
LAMB: I’m not absolutely sure of this but I think that Johns Hopkins has a 1.6 billion dollar grant year that they get grants from the government and everywhere. They are number one hospital but US News and World Reports for how many years now?
QUIÑONES-HINOJOSA: For 20 years. In over 20 years now.
LAMB: What do they do with all that money?
QUIÑONES-HINOJOSA: Well you got to come in and see. And I always welcome people, I tell you. It’s all going back to research. I think that that’s what makes this place such an incredibly special place. That we’re constantly striving to make history with our patients. Not alone and not letting them make history. But as a team.
We use all those resources to find new cures. We’re using all those resources specifically for me. The lab money that I am getting and the money that many of my patients donate, you know, through philanthropy. We’re using it back so we can find a cure to fight the disease.
So five, ten, fifteen, twenty years from now, two decades from now we can say we are going to defeat your disease that is not only affecting you but maybe your future generations. And that’s what we do.
And you’ll see all buildings being put up – you know laboratories, my laboratory alone is about 20 people. So you can imagine I have to pay their salaries, I have to pay their experiments that they do every day. They know that money is constantly being put back into the economy so that we can find cures for the disease.
LAMB: Go back to the basics of brain surgery. What is the average, and I don’t know whether average, or regular story that you hear of a patient that leads to brain surgery? What’s caused it?
QUIÑONES-HINOJOSA: Beautiful, beautiful question. I tell you. This is what I hear from my patients. All right? My patients. And one of the reasons that my practice has been so successful is first of all when my patients come to see me they get all access to everything in my team, and including my own personal cell number in the event that they have an emergency.
But what I commonly hear from them is the moment that they got their diagnosis. And I write about this in our book. The moment they hear the diagnosis it’s like the whole world collapsed. And one patient, beautifully described it to me as if imagine that you’re driving in California on highway five between Fresno and Bakersfield which is a beautiful drive. It’s a straight drive and it’s nice and quiet.
And you’ve had the beautiful classical music and you have your a/c on and you’re driving comfortably and something suddenly comes from the side and just hits your car and your whole world collapses and turns over and over and over and you just have no idea where that came from.
That is how my patients describe their new diagnosis of brain tumors. And when they are first given the diagnosis of brain tumor they don’t know whether the tumor is cancerous or noncancerous. The truth is that there are many, many brain tumors that are not cancerous. That at the moment they’re given the diagnosis all they know we are giving a diagnosis of brain tumor. And that by itself it’s a life changing experience.
LAMB: You say in your book that there’s 600,000 Americans living with primary brain or nervous system tumors, that there are 130 different types of brain cancer, that there are 124,000 who have malignant brain cancers.
QUIÑONES-HINOJOSA: That’s right. And these are the ones that are not only the primary brain tumors but now a days as you can imagine because we are getting much better at treating other cancers in our body, renal cancer, lung cancer, breast cancer, some of these tumors when they are growing or they release their little cells they end up making it up into the brain.
And the brain, is I like to think is like a sanctuary. It’s a very privileged organ that we have. It’s not only what makes us different from other species but also drugs don’t get so well up into the brain so we can cure cancers here but many times they end up making it into the brain and that obviously is a devastating problem. So that’s why we have so many patients that end up having tumors in their brains, cancerous tumors.
Not only tumors that are born in the brain, like Senator Kennedy’s. That was a tumor that was born in the brain. But then we have many others that make it up north.
LAMB: What’s the usual way you know you’ve got a problem?
QUIÑONES-HINOJOSA: This is the way. So once again this is how their life is changed. But many times patients present with a convulsion. They suddenly have a seizure. They’ve never been sick in their lives and then suddenly their lives, one day they’re doing something and they start having a convulsion or they start having really bad headaches.
I’m not talking about a small little headache that you resolve with Tylenol or aspirin. I’m talking about headaches that keep getting worse and worse. And I’m not talking about migraine headaches here. Many patients know that they have migraines. These are patients that keep getting worse and worse and the patients are taking a lot of medications and then suddenly boom they have a seizure.
All right? A convulsion. And they drop on the floor and just like a fish out of water that’s the best way that I can describe it, they end up in the hospital with a scanner, boom, big lesion in their brain. And that is how they end up, you know, many of my patients presenting.
LAMB: All right let’s say today that somebody watching this has a convulsion and they want to get to you. What are the chances that they can get to you?
QUIÑONES-HINOJOSA: They’re very high. Anybody in the world can come to me, you know, I have a web page that’s dedicated to me that people find. They find my e-mail, they find my contact information, my office information, there’s information in my book coming up and anybody can send me an e-mail from anywhere in the world , you know, and I will make sure that either myself or one of my colleagues at Hopkins will take care of them.
And that is something that I’ve committed to my life, to this Brian. You know, I tell you I can give up what I do today and go into a different job and make a lot more money. I’m not here – I’m not poor either but I can assure you that in academic medicine you don’t make the same amount of money that you would make in other jobs.
And the job offers, I have gotten many. But I decided to be part of history. I want to help people. That’s it. I want to continue to live the American Dream. I am thankful for the things that this country has done for me.
LAMB: Where are your parents?
QUIÑONES-HINOJOSA: My parents are in California, San Diego.
LAMB: How are they living today compared to the way it was in the early days?
QUIÑONES-HINOJOSA: Well they are living much better. My brother and I helped them buy a house years back, actually and my siblings and I. You know, it’s quite interesting that you mentioned my parents because my parents they’re beginning to realize what I do.
As you can imagine, now with a book coming out. Even before the book, my parents they got a lot of requests for interviews. Especially Spanish television that are fascinated with the story, American television and they want to talk to my parents. They come from humble background.
My mom and my dad had one or two years of elementary school and that was it, you know. So they are beginning to realize what my life is all about and also what I do. Although for many years they couldn’t understand why is it that after I graduated from Harvard Medical School I was working 120, 140 hours a week. I was never home. They didn’t know that I was training to be who I am today.
But obviously they have a wonderful, wonderful life. I think they’re very proud of not just me, but also the rest of my siblings that are working very, very hard to fulfill the American Dream.
LAMB: You dedicate the book to your deceased sister but, what was her – how many other siblings are there now?
QUIÑONES-HINOJOSA: There was six of us total. So there’s only five left.
LAMB: And where are they now, are they in the United States? ...
QUIÑONES-HINOJOSA: ... they are all in the United States. In the San Diego, Vegas area. They are all in the southern California and Vegas area.
LAMB: Where did you meet your wife?
QUIÑONES-HINOJOSA: You know, and I talk about that a wonderful story as you can imagine my wife, her first name is Anna and her last name is Peterson, she comes from, you know, a Swedish family and she’s absolutely brilliant, smart, and witty. She’s beautiful.
And you know when I was in community college, learning English, right about the time that I fell into the liquefied petroleum tank, I was reevaluating my life and I was also had so much energy Brian. I – I – I cannot even relate to you. I mean I would go for days, you know, without sleeping. Working all the time. And then I still had to do track and field.
And one day I had an injury, you know. And I go into the swimming pool, the coach sends me in the morning, to run the swimming pool. I had a groin injury. And when I come out of the swimming pool, there’s a young woman who says hi to me. And I thought she was saying hi to someone else. And I looked side by side and it was to me. And I bolted the other way. I was so shy. People wouldn’t believe this.
And I said I’ve seen this woman before. And it turns out that two weeks prior I was sitting having lunch in the middle of this community college, you know, watching fish, a Koi pond, watching them and these two beautiful women sat right next to me and talked to me and my English was so terrible that I bolted out.
I ran out of the place because I was so shy. And it was the same woman. So we didn’t start dating until I was at UC Berkley, a year before I went to Harvard. And she’s seen the growth. She saw me when I had nothing. When I was working in the school, going to community college with my steel toed boots, my – my – my jeans smelling like sulfur because many of the days I was actually shoveling sulfur. So she’s been my life partner, as you can imagine.
LAMB: And Gabby, Olivia, and David, how old are they?
QUIÑONES-HINOJOSA: So Gabby’s 12 right now, David is 10, and Olivia is actually 6 years old. And I know you have a picture right there when they were, you know, a few years back. This is right around the time that Johns Hopkins came about and I’m very proud of our children. And I think I give full credit to Anna who’s done a beautiful job raising them with the principles and the values of the American Dream.
LAMB: How did you come close to getting AIDS?
QUIÑONES-HINOJOSA: You know it was interesting so this is around the time in the second period of my life at UC San Francisco when I was training to become a brain surgeon which I am today. It was an incredible experience, Brian. Very humbling, you know.
Trying to help a patient we were milking the knee of a patient that had a big collection of fluid. And this patient was moribund dying of AIDS. And another physician and I in our attempts to help this patient we have a big needle. And we’re trying to get all the fluid out.
Because this patient was in a lot of pain from this knee so we were trying. It was an orthopedic surgeon and myself. And I was doing my general rotations. Back then you had to do a lot of rotations before you went into becoming a brain surgeon to specialize. So we’re doing this and she’s got a big needle right there and there’s fluid everywhere. And suddenly she loses control of this needle and we both get stuck with blood, fluids, everything.
And you can imagine the same way that I relay that story of my patients getting the diagnosis of brain tumors, my whole life collapsed. Because right around that time we knew that there was a case that was reported at the University of California, San Francisco.
The San Francisco General Hospital which is mentioned here which had the first ward for AIDS patients in the whole United States. At that place there was a patient that had converted from negative to positive HIV. And it was a health care provider that also got stuck with the needle.
So I had to go into the triple AIDS therapy. I dropped about 17 pounds over the course of a month. I was vomiting every day. And in some ways some of our patients relate similar stories when they take chemotherapy to fight cancer specifically brain cancer.
So that’s how I have this incredible amount of respect for what they do. Because I – to a certain point I was only – I only did it for a month, you know. But imagine our patients would do it for years at a time.
It’s devastating. So that’s how I came – luckily everything went well, you know, and that’s why there’s a gap also in between David and Olivia. You know, because we also had to protect ourselves because we didn’t know what was going to happen. And every time I would go in and get a result from my test it was absolutely nerve wrecking and you can sense the amount of intense moments that my wife and I went through.
LAMB: Didn’t you have another time where you were operating on somebody and blood squirted onto your ...
QUIÑONES-HINOJOSA: ... that was at Johns Hopkins that was actually on television, national television. I am taking care of a beautiful young woman, lovely family that was featured on the show. Traumatic brain injury and I’m trying to reconstruct the whole brain, the bone and everything and right as I’m doing it.
You know, and I have complete eye protection, I have my special goggles that I use, with magnifying glasses and everything and they are completely protected and somehow I was able to hit a small little artery that sent blood perfectly located right above my eye, bypass my protection, and went right into my eye. And this was a young woman who had received a lot of blood transfusions.
But you know what, it was so beautiful at that moment is that the first thing that came out when I went to tell the mom that everything was fine she had heard the event and all this on the show and the first thing that she wanted to make sure that I was fine.
I mean that to me was so touching to know that I had her daughter’s life in my hands and I was taking care of her and she was still concerned for the two of us. Everything was fine luckily. I mean she had a risk because she had a lot of blood transfusions but it was – we were in good shape.
LAMB: What’s the worst thing that a family or a patient does to a doctor?
QUIÑONES-HINOJOSA: You know, I think, it’s a difficult question obviously. I have had experiences where I think it’s a relationship that you build with your patients, expectations. Sometimes patients come in with expectations that you are going to save their loved ones, you know, from brain cancer for instance, from the glioblastoma multiforme.
And I have had a few patients like this. And I think that the worst thing that a family can do to a physician sometimes that I have personally, I don’t know, I cannot speak for all the physicians, but to me one of the most devastating things that I have experienced that I’m always the last one to give hope.
But we reach a point in which we do things to patients that instead of helping them I think they’re working against them. Once we reach that end of life where we know that nothing is working and the disease continues to progress, the worst thing that I have experienced myself from the family members of a patient, is their inability to realize that no matter what we do things are not going to change.
And they are willing to continue to see their loved ones continue to suffer rather than deal with their own inabilities to cope with the fact that their loved ones are going to die. They’d rather see their loved ones suffering and that breaks my heart. And I struggle and I meet with them and I say please, you know, this is not going to change. We need to help this patient make that transition. Put them in Hospice Care.
LAMB: When in your professional training or your life at Johns Hopkins have you said to yourself I don’t want ever do what I see that doctor doing?
QUIÑONES-HINOJOSA: There’s been a few occasions obviously. I mean you learn likely at places like Hopkins where the privilege is where we have some of the most brilliant and best physicians in the world. I wouldn’t say that has happened at Hopkins to me as much as it happened in medical school.
And as much as it happened as a resident when I – so colleagues not only in my discipline but in other discipline doing things that I consider to not be good for either for the welfare of a patient. Making decisions to continue a treatment. Making decisions to stop a treatment.
Giving the family false expectations. I think that that is obviously something that I really feel strongly against it. And I told myself that I will never do that. I will – my goal in life is always to be honest to my patients.
When I come out of the operating room, the first thing that I do when I go and talk to them, I say, ”This is what happened, this is what we know, this is what we’re going to do. You know every single thing that is in my brain right now.”
LAMB: You say in the book that one of the things that you have changed is the patient no longer needs to have a relationship with their primary care doctor, that you go right in, other words, you go around that rather than waste that time. Explain that.
QUIÑONES-HINOJOSA: Well one of the things that I began to realize and that has made my relationship with my patients very strong is that sometimes what we do as surgeons in our specialty is we try to come in as like the Special Forces. We just go in and we think about taking the tumor out and we sometimes we tend to think that that’s it. That’s all we can do.
When in reality, what I’ve been able to do in my group and my team is to take, for instance, that tissue work in the laboratory and try to find a cure. And then I turn around, and I get the patients involved in not only their own care but also being part of history. I consent them so they can donate that tissue and those contents come in strictly from the Institution Review Board of Hopkins. So they feel part of history.
And my relationship with those patients continues to evolve beyond just taking care of their tumor, you know. And I think that is a role that we can fulfill very well as brain surgeons, especially the ones who specialize in brain tumors.
So I don’t necessarily take away the role of the primary care physician but I try to make it easier for the primary care physician who sometimes they feel frustrated because they don’t have the knowledge and the specialty to deal with patients with brain cancer and I do.
I have tried to put myself- surround myself by people who do this all the time. Who know how to talk to patients? Who know how to deal with the families who are upset? Who are frustrated because their loved ones are dying of brain cancer? So I try to take the role of the primary care physician into a sub specialty but I surround myself by a lot of people
LAMB: So when in your life did people stop questioning whether or not you got into all these places because of affirmative action and I assume that that has happened.
QUIÑONES-HINOJOSA: Of course, Brian, it’s never going to end. I bet you that people are going to see this interview and they are going to wonder why is that I am not there? Why is it that my son is not there? Why is it that my loved one is not there? He took a spot from someone else. I get this over and over. And as you can imagine, and writing this book is not going to be an exception.
And that’s why you asked me why is that I can publish my stories. Cause I needed to be ready for this. When the show Hopkins came out, I can tell you, I got death threats. I got e-mails. I got people who hated me and people who loved me.
People who missed, you know, the message. You know, they think that I have taken someone else’s spot in medical school. That I have done – that someone else who was born and raised in the United States should be the brain surgeon now here in front of you doing this interview. So that’s never going to end, you know.
I welcome. I think that that’s what makes this country the most beautiful country that people can express their opinions. I don’t agree with them but I respect their opinions. As long as it doesn’t affect my life, or the life of my patients, or the life of my family. I welcome, words come and go but what never – what stays is ideas and what you do for people.
LAMB: How often is race an issue in your life?
QUIÑONES-HINOJOSA: I would say that it’s every day. I mean every day that I get a request for an interview, a possibility of doing something, people will always say, you know, we want to have this guy because he’s famous, because he’s Mexican, and no one else is like him. And I say look this is my agenda. And as you know, I want to talk about my story and what I do as a brain surgeon.
So there are things that I can do. But that plays a role every single day in my life. To be honest with you, I don’t shy away from it. I welcome it. I realize that when I was in medical school that what I thought was a weakness that I came as a poor immigrant and now I was a brain surgeon what I thought was a weakness; it turned out to be the greatest strength of my life.
The true definition of the American Dream.
LAMB: Take us through a day from the very beginning to the end.
QUIÑONES-HINOJOSA: Well take today, let’s take today. I got up at 5 am and I went out....
LAMB: ... you do this every day?
QUIÑONES-HINOJOSA: I do this every day. 5 am. Every day. my alarm goes off around 4:50. I take a little 10 minutes to gather my thoughts and then I get up. I went for a run because I’m training for a half marathon that I’m running on – in honor of my patients that are battling brain cancer, small little thing that I can do.
I’m not going to lie to you; I’m not completely in perfect shape to be able to do that. But I’m giving it my best. And I’m going to do it. And it’s going to be the Baltimore marathon.
I then went in – drove to my office, made several phone calls, saw a few patients, came here to Washington, D.C. with you. I’m going to go back into the operating room and then tonight I’ll get home about 8 pm, have my dinner with my kids, you know for about 30 minutes, tell them a story, put them to bed, go back to my office until about 10 or 10:30 and then spend about half hour to an hour with my wife, you know, and watch the news.
And then go to bed around midnight and then I get called all night. Overnight, I am on call for the hospital. So I receive about four or five calls throughout the night. I’m always on call for my patients. Any patient that wants to get hold of me.
They always have my phone. The truth is they know better sometimes they call the hospital because they know I need to get some rest at night. But that I do that every single day. Seven days a week, I’ve done it 365 days a year and I’ve done it always since I remembered. That’s my level of energy.
LAMB: How much fatigue do you have?
QUIÑONES-HINOJOSA: Well I’m human, of course I get tired. And I always tell people and I’m just human. I get tired. And every morning when I get up at 5 am my body aches, you know, and I’m sore because I’ve been training and I am tired but, you know, I think about all those patients that are struggling every day and as soon as I do that and I get up it’s like the world starts and I love to watch the sun coming out every morning if it does. I love rainy days like this as well. It’s part of life. It’s a cycle of life.
LAMB: So 10 years from now, based on what you’ve watched happening in medicine what do you think will be different about the art of brain surgery?
QUIÑONES-HINOJOSA: I would say that 10 years from now we are going to be seeing more personalized medicine. Right now for instance in my profession in brain surgery for a brain tumor we take as much as we can. We give the patient chemotherapy and radiation.
Ten years from now what I envision is a thanks to the work that a lot of people around the world including our laboratory is doing we’re going to be able to take this tumor and say this patient specifically responds to this treatment. And we’re going to turn around and we’re going to give personalized medicine to that patient. And that’s what I think is going to revolutionize our system.
And we can’t allow our country not be able to do that. And that is why I feel so strongly that we still need to support research. We still need to be able to support those creative minds that are going to be able to help us to live a long and healthy life.
LAMB: Looking back over all of your education, Harvard, University of California, Berkley, what was the toughest time during your medical training?
QUIÑONES-HINOJOSA: I would say through my medical training was undoubtedly being a resident. Right around that time that I got stabbed with the needle, working 120, 140 hours...
LAMB: ... San Francisco?
QUIÑONES-HINOJOSA: ... San Francisco, yes, no question about it. There were different challenges. I would say coming to Hopkins as a young attending and having to face all these other issues that we talked about racism, patients, establishing your practice was a challenge of a back then working as a resident to train to become the special forces with little sleep, a lot of work, little money, no resources, being in the hospital all the time, not seeing my children.
That was undoubtedly some of the most challenging times that I had to – to – to survive in, you know, and the problem with the HIV, the actual deal with the fact that the you know San Francisco was a beautiful city but it was also excruciatingly painful to live there because of how expensive it was.
This was around the time that we were at the peak of the dotcom companies, you know, in San Francisco. That was a very, very challenging time in my life and I talk about that in the book, obviously. Different challenges by the time I came to Hopkins.
But those I have incredible memories, but the memories that pain the most are those memories, those times when I would wake up and my kids were in my face, little ones, Gabby and David, and they were trying to play with me and I was completely spent.
LAMB: You have a coauthor, Ms. Rivas.
LAMB: How did you relate to her in this? Did you – I mean did she interview you?
QUIÑONES-HINOJOSA: Yes. I tell you Mim is absolutely incredible. You know she has written several incredible successful books. She was part of the team that wrote ”The Pursuit of Happyness” with Chris Gardner and an incredible, you know, and ”The Beautiful Jim Key.”
I mean, she has done and incredible amount of work. And the moment that I met her, the moment that we talked and you know obviously the publishers they all gather you know a lot of resources to be able to do this because she is a incredibly accomplished writer, she came in and spent time with me personally, right here.
She’d run around with me in the hospital, in my laboratory, with my patients and then she had multiple interviews with me, we worked through multiple drafts. I mean it took us about three years to complete this project of going back and forth all the time.
LAMB: The name of the book is Becoming Dr. Q, My Journey from Migrant Farm Worker to Brain Surgeon. Alfredo Quiñones-Hinojosa, brain surgeon at Johns Hopkins and this is published by the University of California press. We thank you for joining us.
QUIÑONES-HINOJOSA: Thank you Brian for having me. My pleasure.