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Becoming Dr. Q
My Journey from Migrant Farm Worker to Brain Surgeon
By Alfredo Quiñones-Hinojosa, Mim Eichler Rivas
UNIVERSITY OF CALIFORNIA PRESS Copyright © 2011 Alfredo Quiñones-Hinojosa
All rights reserved.
During the many minutes when I lay at the bottom of the tank without oxygen, struggling on the battlefield between life and death, there was something about the image of being on my back, enclosed in darkness and staring up at the light, that connected me powerfully to my childhood years. Indeed, whenever I travel back along memory's narrow pathways that lead to the furthest past, the familiar, starry night sky is the first image that rises to welcome me home.
There in the outskirts of the tiny village of Palaco where I was raised, in the northern part of Mexico's Baja peninsula, I spent many of the hotter nights of the year up on the roof of our little house. I would often lie awake for hours studying the infinite expanse of blackest outer space—everything lit by a glowing moon and millions of bright, sparkling, dancing stars. It was there, underneath the panoramic dome, that many of life's most pressing questions were first planted in my imagination—and where my high level of curiosity and hunger for adventure were cultivated. Under the stars, I could also find relief from the weight of daily concerns and from other worries whenever sadness or sudden misfortune struck.
Such was the nature of my earliest, clearest memory, which was of an event that took place when I was three years old. The trauma had to do with one of my siblings, my baby sister Maricela, whom I would always remember for her big brown laughing eyes and her round, chubby, smiling face. Suddenly, when I came home from playing one morning, she was nowhere to be found.
At the time, we lived in the two back rooms of my father's gas station. When I walked into the kitchen area of our living quarters that morning, I felt terrible sadness in the air. The day was gloomy, humid, and uncharacteristically cold. Unfamiliar yellow vinyl chairs had been arranged in the kitchen, where my mother, Flavia, was seated. A pretty, petite woman who was usually joyful, Mamá was sobbing as she cradled Maricela's twin, five-month-old Rosa, to breastfeed her. At her side was my little brother, two-year-old Gabriel. Gazing around with his large, thoughtful eyes, Gabriel sucked his thumb quietly as he leaned against our weeping mother. In front of the yellow chairs sat a tiny rectangular wooden box—a casket, I later learned—covered by a colorful handwoven blanket. Family members and neighbors filed into the room, many of them softly crying.
When I asked my aunt why Mamá was so sad, she explained that this was the funeral of my baby sister Maricela.
"Where is Maricela?" I whispered, unable to connect my happy, chubby baby sister with the casket.
"Maricela went to heaven," my mother said solemnly, wiping her tears.
Why was everyone so sad? After all, I had been told that heaven was a wonderful place where people could go to be with the angels. Shouldn't we feel good that she had gone to such a nice place?
Years later, I learned the tragic circumstances of Maricela's death—acute diarrhea and the accompanying dehydration, a common and curable condition, if the right medical resources are available. Initially, she wasn't taken to the hospital because we lived in the middle of nowhere with no accessible facilities nearby. The difficulty in obtaining medical attention was a function of the relative poverty in this rural area outside of Palaco, a small village of about five hundred families, some thirty miles from Mexicali—the border town that is split by a fence and is known as Calexico on the U.S. side. In our village and environs, we had no private doctors who made house calls, nor were there clinics close by. Many everyday medical needs were met in the boticas housed in local pharmacies. When Maricela's symptoms first appeared, my mother took her to the botica, and the pharmacist gave Mamá medicine to ease the baby's stomach problems and the pain later diagnosed as colitis.
That evening, when my father came home from work, Maricela began to laugh when he picked her up in his arms. Papá took her smiles as a sign that the medicine was working. But in the middle of the night, as her screams worsened from what was clearly horrible pain, my parents rushed Maricela over to my grandmother, Nana Maria, my father's mother, a curandera who specialized as a midwife and herbalist. My grandmother had delivered hundreds of babies through the years and was revered for her ability to know when a case required special attention. Nana knew at once that Maricela needed to be taken the hour's drive to the seguro social—the public hospital—without delay. My parents understood the gravity of the situation and raced to get there.
At the hospital, one of the physicians on duty knew my grandmother and heeded her concern, admitting my little sister immediately while reassuring my parents that she would improve by morning. With their hopes raised, Mamá and Papá then suffered the anguish of watching Maricela's convulsions increase over the next two days, and in the end, losing her. Though they did everything they could, their efforts weren't enough to combat her colitis, which had quickly reached an advanced state, nor to make up for the fact that the small, poor hospital didn't have the medicine or other forms of treatment that could have saved her. Tragically, in developing countries such as ours, diarrhea and resulting dehydration are still the main cause of death of little ones. But I know that my parents continued to ask themselves Why? and the question hung over the household for years.
My father and mother were not strangers to loss. My father had been one of eleven children, one of whom had died at the age of ten before my father was born and whose death left a lasting shadow in that household. My mother had been virtually orphaned at the age of six when her beloved mother had died in childbirth, essentially leaving her to raise the younger children, slaving under the abuses of her paternal aunts and trying to hold the family together while her father, my grandfather Jesus, struggled to find his footing after his wife's death.
Though my parents never spoke openly of their sorrow, it was a presence in our lives, an undercurrent of sadness that affected each of us differently. I suspect my sister's death had something to do with the added sense of responsibility I felt as the oldest of five children in our household, and with the recurring childhood nightmares in which I would find myself in the midst of disaster—fire, flood, or avalanche—and know that it was up to me to save my mother and siblings. In each of these dreams, part of the story was that I'd been given superpowers —able to walk through fire without being burned or swim through tidal waves without drowning (in reality I couldn't swim and would never be at ease in the water). The notion of having special powers must have come from my ambition in those years to follow in the footsteps of Kaliman, a Mexican comic-book superhero who could fight off the attacks of multiple demons in one move: the gravity-defying Kaliman maneuver that I was determined one day to master. In my waking hours, I was convinced that I could really do this. But in my nightmares, to my despair, before I could put my superpowers to work and save my loved ones, the dream would end and I would fail in my mission. Every time, I'd wake up crying in bewildered frustration.
The death of Maricela, my repeating nightmares, and the considerable amount of responsibility I felt from an early age may help explain why my most primal struggle was to understand and make sense of life and death. These experiences may also have planted the seed for my later interest in medicine. In the meantime, the idea that my sister had gone to a better place was comforting. It fueled my already active imagination and my curiosity to know more of the world beyond what I could see and observe in the everyday comings and goings in the outskirts of Palaco. Long before medicine was a remote possibility for me, I dreamed of a life of travel and adventure!
Then again, as I recall my nights of stargazing in the period when I was six and a half, almost seven years old, I was ready to settle for being an astronaut. I announced my plan one stiflingly hot night in the autumn of 1974 to my mother, my five-year-old brother Gabriel, and my three-year-old sister Rosa.
Everyone laughed. I was definitely the family dreamer!
There were many nights like this one when the suffocating heat made sleep impossible inside our two-bedroom house, where we had moved a year earlier. Just across the canal from the gas station, the adobe-style house—built of cinder blocks in one part and mud in the other—lacked air-conditioning and was like an oven, baking everything inside it! When the heat was unbearable, as on this night, the four of us opted to climb up to the rooftop, first spreading blankets over the scratchy tar-paper surface, then settling into position. Rosa curled up on one side of Mamá, while I was on the other, in between her and Gabriel. Our flight to the roof was to escape not only from the heat but also from the ever-present threat of earthquakes known to collapse houses and create mudslides in this part of the Baja, where the San Andreas Fault trails down from the west coast of the United States. Up on the roof, you were more likely to survive by avoiding having the house fall on you—as had happened recently in the area, killing hundreds. Yet those worries seemed to vanish under the stars—where all was safe and peaceful and fun!
Clasping my hands underneath my head, I made a pillow for myself, and with my legs crossed, I was at ease—happily engaged and ready to savor the show playing out in the sky above us and in our surroundings.
For a while, we were quiet. None of us said a word as our senses awakened to the sights, sounds, and smells of the night. I could hear the chirping of crickets and the buzzing of other insects, along with the loud croaking of the toads as they sang with a bravado that reminded me of the strolling mariachis who frequented the restaurants of Mexicali.
In these years, we were fortunate to be dining in restaurants every now and then, and to be part of the lower middle class in our village, slowly rising out of poverty—thanks to the modest earnings from my father's gas station. While our status was more precarious than we knew, I recognized that the steps up the ladder were many. I was aware too that not every family could afford to eat some meat once a week as we did and that none of our good fortune would have been possible if not for the family work ethic. I had been taught this fundamental lesson starting from the age of five, when I went to work at the gas station every day after school and on weekends, pumping gas, learning to fix cars and trucks, even driving them in and out of our mechanic's garage with the help of many cushions. I saw nothing unusual about being a five-year-old who could drive or climb up on hydraulic lifts to look under the hoods of cars and trucks to assess what needed repairing—all part of the job.
My family imparted the importance of hard work directly and by example. My father started his day at dawn at the gas station and didn't close down until nightfall, when he would go out to spend some of the day's earnings for food and other necessities for the family. For that reason, he wasn't usually up on the roof when we went up there to sleep. But I knew that when he returned home later, he would probably have something for all of us to eat in the morning—often my favorite, a loaf of pan dulce, sweet bread.
Up on the roof on this night in my memory, I imagined with pleasure what breakfast would bring even as I inhaled the green, wet, earthen smells of the night, savoring it all. Everything was fresh, present, and alive—like the smell of newly picked watermelon lifted from the wet soil, ripe and ready to be eaten. How well I knew these smells from recent outings to work in Palaco's cotton fields. Though our efforts weren't needed for the money at this point, my parents believed that we would use lessons from the fields in other ways. Papá also wanted to show me that working at the gas station was a much better job than standing out under the blazing sun all day and picking cotton, my bare hands bleeding.
Out in the field, there was no use complaining. So I made the best of the situation by watching the process unfold—as we walked up and down the rows, picking the light fluffy pieces of cotton and putting them into long burlap sacks, and then watching how the filled-up sacks were weighed so that we could be paid by the kilogram. There was no shame in being a field worker. This was opportunity. Besides, I felt proud of what I could accomplish with my bare hands. And the moral of the story was twofold: first, every job in the entire operation counted—no job was meaningless; second, no matter how small and fluffy that piece of cotton felt, if we kept pushing ahead, all those bits of fluff would accumulate and have real weight—as much as twenty or thirty kilos that were worth their weight in pesos!
Such was the value of honest, rigorous work—bringing with it the pride of a job well done, some form of compensation, and sometimes opportunities to advance in the world. This was how I came to purchase the used bicycle I desperately wanted. Gabriel—a much more obedient child than I, who also had more common sense—was unimpressed when I brought home the bike. "How can you ride it?" he laughed, pointing out that it had no pedals or brakes. To prove him wrong, I learned to ride it sideways and basically roll wherever the bicycle wanted to go.
However, Gabriel was considerably more enthusiastic when the two of us found a used black-and-white RCA television in a secondhand store and convinced our father to buy it—though he was careful to point out that we had only one line of power to the house and it was needed for the refrigerator and the two light bulbs that lit our home. Unfazed, we managed to build a makeshift outlet that gave us enough juice. Once we replaced the picture tube, magically the picture came on, thrilling us—at least during the few hours that Mexican television aired the two stations available.
Since the TV image was very grainy, we covered the windows with blankets to darken the rooms. With temperatures as high as 120 degrees outside, the insulation only made the interior more ovenlike. But we didn't care! The TV was a luxury item that connected us not just to the rest of the world but also to the fantastic possibilities of space travel to strange new worlds. We were hooked on the afternoon reruns of Star Trek, raptly following every move of Dr. Spock and Captain Kirk as they explored the galaxies—facing dangers, fighting battles, dodging asteroids, and venturing into unknown realms.
There was one huge problem. After being so industrious and using our ingenuity to fix the television set, I could seldom watch it because I had to work at the gas station after my father picked us up from school at midday. Sadly, that meant I could see Star Trek only on a catch-as-catch-can basis. I remember being desperate to watch an episode that was to air at four-thirty on a Thursday afternoon. When Papá picked me up at school and I asked if he could make an exception for this day, he firmly replied, "No, Alfredo, you have to work," and left it at that.
I was devastated. But I didn't cry. Instead, when we arrived at the gas station, I hopped out of the car, set my jaw, and went about my duties with greater purpose, hoping to forget all about the Star Trek episode I was doomed to miss. By the time four-thirty rolled around, I had almost succeeded in pushing it to the back of my mind. Papá then called me over and gestured toward home, telling me, "OK, son, you can go to the house," and before he could add "and watch your show," I was out of there as fast as my speeding little legs could carry me.
Excerpted from Becoming Dr. Q by Alfredo Quiñones-Hinojosa, Mim Eichler Rivas. Copyright © 2011 Alfredo Quiñones-Hinojosa. Excerpted by permission of UNIVERSITY OF CALIFORNIA PRESS.
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