“Show me two fingers” . . . “open your mouth” . . . “stick your tongue out” . . . “wiggle your toes” . . . were the words running through my brain as I sat, semi-asleep and dreaming, on a flight taking me from Baltimore to Los Angeles—the City of Angels.
Sometimes memories of failure haunt me, and this particular memory was of a young girl I treated after she had been in a terrible accident while sledding. Though I saved her life, in my view I had failed because she ended up in a coma for months and never regained the quality of life that had been hers before the accident.
Yet here I was on my way to LA to launch my first book. My psyche understood that I had mixed feelings.
Of course, I had high hopes for the book, Becoming Dr. Q., especially because I felt that I had honored my patients in it, however short or long their journeys. I also wanted to savor the moments of this new experience. After the plane landed, I remember the lights, the glamour, complete with the colors, the noises, the sights, and the smells that surrounded me on my way to downtown LA on that chilly Thursday night in October 2011. Up ahead, one of the most humbling yet gratifying experiences in my life— outside of the operating room (the OR)—was about to unfold.
The event was not long after this book’s original publication. When I’d first heard that my book tour would include an evening at LA’s Central Library—to be recorded for KPCC public radio with the award-winning poet and journalist Adolfo Guzman-Lopez—the news sparked a torrent of emotions. On one hand, I was humbled and delighted; on the other, I was frightened.
I was frightened because launching the book meant I was about to step onto a stage that was unfamiliar to me. It was not so many years earlier that I had landed in LA undocumented—with only dreams and audacious hope. During the ride to the Central Library, questions kept popping into my head about the remarks I had prepared. Was I overthinking what I was going to say? How would the audience receive me? Would they like what I had written in the book? Had I said too much? Too little? Was it too personal?
Thankfully, I knew that at the event, instead of me having to stand at a lectern and give a prepared speech, Adolfo and I would sit down in front of a small, friendly audience; the plan was that he’d ask me surprising and provocative questions, and I could simply respond by telling stories. It sounded like fun to me.
I had no idea how readers in general would receive so personal a retrospective as the one I had chosen to write. Granted, by this point, I was no stranger to academic publishing—from years as an author or co-author of hundreds of peer-reviewed scientific papers and from my role overseeing the most recent edition of the prestigious Schmidek and Sweet: Operative Neurosurgical Techniques, 2-Volume Set: Indications, Methods and Results. I had even written a brief personal essay for the New England Journal of Medicine and shared glimpses of my story in the Peabody Award–winning ABC TV documentary series Hopkins.
However, none of those experiences prepared me for how nervewracking it is to literally become an open book—no holds barred! Early on, I was pushed by the editors at a prestigious publishing house to focus more on the drama inside the OR, on the life-and-death, high-adrenaline moments of my profession, and less on my humble origins in a tiny village in Mexico where my elders raised me to shoot for the stars. Rather than take the publishers’ advice (we parted ways when we failed to find common ground), I decided to go in the opposite direction, to follow “my gut Introduct i o n ix instinct” (after all, the gut and the brain are well connected) and revisit lasting lessons from childhood—which included recalling my early heroes like Rocky Balboa and the Mexican comic book superhero Kaliman, whose gravity-defying maneuver is one I continue to attempt to this day.
What do those origin stories have to do with life and death in the OR? What do they have to do with brain surgery? Everything! Or so I hope you’ll come to conclude.
It was important to me to connect the dots of my journey, to share all the highs and lows along the way, from the crazy dreams and the even crazier realities to the mistakes and the sorrows, as well as the miracles and magic and unbelievable love and sacrifice of my family and colleagues. I wanted to pay tribute to the giants of my field, offer my gratitude to those who mentored me, and express my pride in those I have mentored. I especially wanted to honor the heroism of patients who put their lives in my hands: They are at the center of every medical breakthrough that my team and I have achieved, and they keep me going on days when the battle to find a cure for brain cancer feels overwhelming. I wanted my journey as an immigrant to be a reminder to all readers of the contribution and value we immigrants have to offer, no matter what our calling, background, or generation.
We all long to feel that our stories matter, that our stories can make a difference in our own lives and in the lives of others. So, as you may imagine, it was only natural for me to wonder: Would Becoming Dr. Q have that kind of positive impact? That question was very much on my mind on the drive to the radio interview at LA’s Central Library.
Because there was limited seating capacity for the event, I wasn’t expecting a large crowd at all—although the planners had asked that I arrive early to sign a few books ahead of the interview, and possibly to stay afterward if needed. When my driver pointed out the library coming into view up on our right, I noticed what appeared to be hundreds of people lining up near the entrance to the building—a line that stretched all the way down the hill for several blocks and seemed to double and triple in width. For a moment I had to wonder if there was something else happening at the library.
So, I said to the driver: “They must have someone important doing another event tonight. I am glad I am not the only speaker.”
The driver wasn’t sure what was on the schedule but agreed there were a lot of eager folks out there.
Whoever they had come to hear, I could tell by the excited, proud expressions on the faces of everyone in the crowd that they didn’t mind standing in this long line in the middle of downtown Los Angeles; whatever they were waiting for was about to be a big deal.
That’s when it hit me that almost everyone in the line was holding something in their hands with great tenderness and care. A jolt went up my spine when I realized that they were all cradling copies of Becoming Dr. Q and were patiently waiting in the chilly night air to have those copies signed.
I couldn’t believe it. There had been almost no publicity, but here they were, wanting to cheer me on, I suppose, and to maybe cheer themselves on? Maybe they wanted to revive that feeling of climbing the Rocky steps in Philly—victory! As soon as I leapt from the town car that delivered me to the entrance, I greeted a few of the folks in line, in English and in Spanish, before being whisked inside to a signing desk.
Wow, I thought, if only my wife, Anna, and our three kids could see me rolling like a rock star into the City of Angels! Fortunately, they would be there to hear about it when I returned and would remind me to keep my feet on the ground.
That night was in some ways a homecoming. Most of those in attendance, though not all, were Latino or were of immigrant descent, or worked in the medical field in some capacity, or were avid readers who had a devotion to the power of books and to stories that bridge even our widest differences. Many who came up to me to have their book signed wanted to share their reactions to having already read it. Many thanked me for telling stories that reminded them of their own journeys, of their own versions of hopping the fence, of the age-old odyssey of fleeing poverty and seeking a better life in the land of the American Dream. Families came up to me together to have their book signed to multiple family members; they described how their children and grandchildren were now inspired to pursue education in the sciences and in medicine.
Several medical students, nurses, and physicians at different stages in their careers thanked me for talking about the challenges of staying positive Introduct i o n xi on the job when faced with constant life-and-death demands and staffing shortages. They appreciated that I’d also written about the costs of always striving to be the best at what we do in the lifesaving business, especially the toll on family life, and about the importance of finding a balance.
At one point, I looked up and instantly recognized my friend Peter Dye from community college. We had not seen or heard from each other since 1998 when I had attended his graduation from George Washington Law School—a year before I graduated from Harvard Med. Peter had come to stand in that long line with a book in his hand for me to sign and to greet me. We laughed and quickly reminisced as I was immediately transported back to our days in community college where, though I’d had lots of dreams, an overall uncertainty and self-doubt had occupied my thoughts. Having Peter there that evening in LA provided the perfect set up for me to put things in perspective before the radio recording and interaction with the audience began. Peter’s appearance was so well-timed, almost mystical, that I had to ask myself—We are close to celebrating the Day of the Dead; is my late grandfather Juan sending me a message by putting Peter here today?
The message was heard in any case. My job was to trust the process. Leaving the library after a fantastic interview and more books signed, I was grateful, humbled, moved, and overwhelmed. And that more or less sums up how I have continued to feel whenever I’m fortunate enough to hear from far-flung readers in many diverse communities in this country and around the world.
Much has changed over the course of the decade since this book was first published. At the time, I was in my early forties; now, well, you can do the math. I’m just as young in terms of my energy but I like to think I’ve completed the journey of becoming and am in the process of being—which is very different from the proverbial assumption that we get to a certain age and are supposed to slow down or stop expanding our reach.
A handful of years ago I took the advice I’ve always given to my children— Gabriela, David, and Olivia, who are each on their own educational and professional paths. It’s the same advice I offer to my patients: never stop dreaming, growing, learning, loving, and seeking greater opportunities for reaching higher purposes. And to that end, at the age of forty-eight I decided xii Introduct i o n to pull up stakes and accepted an invitation to put down new roots at the Mayo Clinic in Jacksonville, Florida, as the William J. and Charles H. Mayo Professor and Chair of the Department of Neurologic Surgery.
Even though I had thrived in countless ways at Johns Hopkins in Baltimore, ranked as one of the top hospitals in the country and known as the mothership in my field, my decision to leave for the Mayo Clinic in Florida appealed to the adventurer in me. I had never forgotten a steering committee meeting at Hopkins where new goals were discussed. Everyone was talking about bringing in cutting-edge technology but then one of the professors on the committee said that, in fact, “we should aspire to be like the Mayo Clinic”—the global leader in patient care. That left a huge impression on me, so much so that when given the unexpected opportunity to go to the Mayo in Florida and be part of its effort to become the foremost destination medical center in the world, I heard the call to adventure and said “Yes!” without reservation—of course, that is, after making sure that Anna was on board (and luckily she was, so we made the move). Even better, I was able to bring with me almost thirty members of my team, and their families, along with the dream of changing the world.
The leadership at the Mayo has been nothing short of visionary. In a short amount of time, it has made possible extraordinary advances in the work we are doing to better understand, treat, and ultimately cure the ravages of brain cancer. The global reach of the Mayo’s multiple modes of communication has been particularly effective in creating a sea change of awareness about the need to create better practices for optimizing the health of the brain.
Not long ago, while exploring possibilities for modes of communication outside the established medical/scientific sphere, Mayo’s brilliant powers that be came up with a wildly innovative plan to launch the Mayo Clinic Press. Before I had a chance to process all the possibilities, I heard from the executives at this new publishing entity. Much to my delight, they proposed the re-release of Becoming Dr. Q as the first in a new series of books featuring innovators and innovations at Mayo.
The decision was not a difficult one, but perhaps not for the reasons you might suspect. Of course, I said “Yes!” and did so with great pride, and am thrilled to know that the book will find an even larger audience and will continue to inspire readers toward seemingly impossible goals and dreams. Even more than that, I am grateful for the timing and the opportunity to speak out against what I consider a current escalation of hateful and increasingly violent rhetoric aimed at immigrants, especially darker-skinned or “other”-looking refugees.
A decade ago, I believed that things were going to get better—with the values of diversity and inclusion seen as core strengths for our democracy. Today, my impression is that those values are under fire, under attack, and that there has been a surge in racism and xenophobia. It infuriates me when I hear political leaders and news commentators using the most demeaning phrases to describe immigrants from Mexico, from other countries in South America, from Africa, the Middle East, and across Asia (including India and China) and so on. After hearing news of the election in 2016 of the candidate who compared my decent, hardworking parents, citizens of this country, to drug-dealers, murderers, and rapists, I was thoroughly disheartened.
I will never forget Gabbie, my first-born child, then in her early twenties, asking me, “Dad, did you speak out? Did you do anything to work toward another outcome?” She told me, “You know you have a voice.”
Gabbie was right. The passion I express for the work I do uses only part of my voice. We can’t just assume that because we have made progress in the past that this progress will go on. It is up to each of us to advocate for one another and, yes, to continue to prove our worth. Thanks to Gabbie’s insight, I decided to be louder, and become better-versed in my Mexican heritage—which led to new explorations into the language of the Aztecs and the role of the Incas in shaping civilization. Who knew? As a people we have an amazing origin story to tell.
But I didn’t stop there. With the support of the Mayo Clinic, I launched a series of webinars that I give in Spanish—sharing the wealth of knowledge I’ve gained in my field with others who are giving so much of themselves to communities in need. Not stopping there, I escalated my dream of providing patient care to underserved populations around the world by co-founding mission:brain, a nonprofit that provides life-saving surgical services and connects health care providers to a global network that can accelerate discoveries that benefit all of us.
If you take only one message from the journey that I’ve travelled in becoming who I am today, it is that we need each other to survive on our small planet. xiv Introduct i o n The paradox of being human is something I discovered in my early days as a neurosurgeon when peering for the first time at the human brain—the most beautiful organ of all. Underneath our skulls, there is no way to distinguish one brain from another in terms of ethnicity or nationality or socioeconomic background. That tells us that we are a lot alike in the most profound way.
And yet, what I have also learned about the brain shows how unique each of us truly is. In each of our brains there are about 100 billion neurons, and, even crazier, no two neurons are exactly the same. Can you believe what a masterpiece your brain is—just in its constitution? But it gets better! For our brains to work, synapses are created through the interaction of neurons, and thought is produced by neurons firing across these synapses. The most staggering number of all is that at this very moment, as you are reading this introduction, you are registering info that results from no less than 160 trillion synapses—more than there are stars in the galaxy. And no two synapses are the same.
Our paradox is that, as a species, we are so very much alike, so much more than we usually accept, and yet each one of us is completely, radically unique. And the same goes for our journeys. The more we share our stories with each other, the more we can connect and value each other, in all our diversity, and the more we can create powerful synapses for making life better and more inclusive for all who inhabit this earth.
As I look back on that flight to LA recalling the loss of my patient’s future, I realize that if I look strictly at lives or futures saved, I have failed more times than I have succeeded. But I have gained a different insight, thanks to my patients and their families, and have begun to understand that I was meant to go through the journey of their disease with them, in partnership, by their side, giving them hope and dignity.
Thank you for the privilege of sharing my journey with you in this second incarnation. I could not have become me without the family members, friends, colleagues, staff, mentors, students, patients, and loved ones whom you will soon meet. Each one of them is woven into the fabric of who I am. And this story wouldn’t be worth telling if not for Anna and our three children—who have inspired me to take this journey of hope and imagination with you now.
Becoming Dr. Q
The inspiring story of a young Mexican immigrant who became a renowned neurosurgeon.Shop Now