Cspan dr. Alfredo quinoneshinojosa, you write in your book, and that you were in illegal homeless immigrant. [laughter] illegal home less farmworker now you are a brain surgeon how long ago . Guest thank you brian is a comprehensive description. I came to United States 1987 and i talk about that with the recent book that we published just a little over 20 years ago. I was just coming to this country literally 63 in my pocket i spent 60 landed at lax with 3 then found my way up to Northern California where i had begun to work with the very same hands that now get to touch some human brain at one of the most prestigious institutions at the world which is Johns Hopkins. Cspan you remember the first time you saw the parade . Guest i remember. Brian, i was just the kids i started medical school when i was 26 years old and sometimes people have asked me did you know, you would be a doctor . Ice said no. Did you know, youd be a brain surgeon . No. How did i end up with this journey that i have lived the last two decades . Sometimes things happen for a reasoned and chants and good luck happens but it is not just that it comes to those who look for its. One day i was walking in all hallways of Harvard Medical School and a distinguished brain surgeon that looked at me on a friday night at 11 00 p. M. Where you going . I said to the library to study he said had you done brain surgery horsey net . No. He said would you like to see it and i said i would love to thinking this would happen in the future and i right in the book so the next thing i know i walked into the operating room. Imagine the magic i felt when i saw that beautiful bring to a patient that was awake now one of my specialities is doing brain surgery in taking help the tumors when they are awake and this is 1987. And it has a beautiful rhythm dancing with the heart it right there immediately i was captivated. The idea was born one day i may be able to do the same thing. Here i am. Cspan how many times have operated on the brave . Guest now i imagine after residency of six years with three or 400 cases freer now attending at john hopkins it is between 250 or 300 brain tumors per year and i have been there six years now thousands of times i have seen the brain. It doesnt matter how many times i see the abrasion i still go back to the same feeling every time i see a the brain with your brown or black or hispanic or muslim once you peel it back we all look the same. Cspan what is the toughest part about being a brain surgeon . Guest the toughest part is the challenges we face in the operating room sometimes the matter what you do you could do the most perfect brain surgery to remove all halt tumor at the end of the day we cannot defeat the Natural History of brain cancer. And hoping from the most devastating to see the effects of the body the diseased that affects the body know how much power or knowledge we still cannot defeat that disease. That is still frustrating to be happy with the surgery we have done. This is only a the first of many battles that we will fight. That feeling of no way in that how much of an expert i am, i cannot win that war. Indeed end the war will be fought by patients and families. Cspan what is said cancer called of senator kennedy . Guest gbm. Cspan you use that a lot where the percentages all lot today . Guest thankyou. Every time make go into the operating room to find myself with that dilemma no wing guy and in front of this massive killer because it kills thousands and thousands of people every year this type of cancer alone justice specifically this one i know i am the underdog when i fight that fight my patience trust me with my life i go with all the passion and the knowledge to the energy i take as much as i can safely i will wait to see i can take as much as i can. The odds are against me making an incredible difference at the end of the day because the bottom line the diseased is devastating it keeps growing but i never lose hope. Every patient every surgery for that type of cancer i always hope that this will be the patient that will defeat the deceased and from that patient we will learn and make history for a mother for many other patients to come and i have a feeling in my heart every single time i into that arena in the operating room. Hope is the last thing i hope i will ever lose. You write about being an illegal . Yes. How did you come to that country illegally . So through the country it was built from people who have immigrated to the country. In my case i came with no documentation or ability to get us a job or education so at first when i came to the United States and across the border between mexico and the United States come i came into this san lockean valley to work as a migrant farmworker it was no challenge to find a job there were not thousands of people to pull weeds with the very same hands that now do brain surgery if you can imagine pulling them from the land from the cauliflower or the corn to continuously be hurt people were not lining up so i ask for a job then i got it and eventually Ronald Reagan had Immigration Reform to gave the authorization and that specifically for people in the United States for a certain amount of years this legislation for people who came and worked as migrant farm workers that allows you to have the working authorization and then if you could not go back to your country but it allows you to work legally and eventually apply for the green card. So the country was welcoming people like me who work in the field and i felt i was given an opportunity to the the american and dreams. Times have changed that what i did back then nonetheless the American Dream has unchanged. Some peoples perception of how do i achieve the American Dream may evolve over time but it is the same foundation of hard work people come to the United States with the idea they can work as hard as they can to still put food on the table with their children to give them an education. It was that simple i just wanted to work hard enough to put food on the table for myself or my siblings and that was the journey and that is what i am today. Cspan you your nurse as saying from a patient, is it true the doctor is a dirty mexican . Isnt there another surgeon i can see . How often does that happen . Guest this happens very, very often when i first came to Johns Hopkins 2005. I was only there six years and i am so blessed i have risen in those academic rankings to now be nominated but when i first came in and people did not know my background they could see my skin color was different to detect an accent in to then with my trading but he could not get over the fact of was from a different country and i came from humble backgrounds. That happens a lot to be honest. Those that cater to see me not only to brain cancer but also the social disease which is discrimination to see people for how they talk than action say make. Not because they speak with the accent but my brain works with the accent and we know that. Dont worry. They will come around. And every single one always came around and after surgery i would talk to them and many times they would tell me how sorry they felt. Ive cheated that to the biological dealing with the brain cancer that makes you think in ways you cannot explain but it did happen often. I did not pay much attention i turn that negative energy into passive energy by doing research to make every single one of my patients parts of history. It is simple if you would be surprised how many Brain Surgeons to have not given up against brain cancer or who have decided they just cspan what is the point of operating on the brain to have the patientu9 awake . Guest gave wonderful question, brian. As i alluded to several people come into the operating room to see how maidus this surgery. But the principle is simple the majority of us have dominance for speech. About right here we have the ability to produce the speech the right here behind here to understand language. And between these two areas how the brain to interact. So imagine if you have the tumor in this vicinity with the malignant brain cancer you cannot tell the border between the tueber and the normal brain. The only way to map where the normal function lies. To take them all the way to that border. You can take as much of the two razz you cant to leave the braves for language. Cspan how does a patient not feel paid . Guest. [laughter] we have written about this. I have a wonderful patient die used to talk to you to be there awake to know that someone is on your brain the truce is the paid sensors are not in the braves surface. But there is no pain it is in the scalp and unless given and the bone and the paving is on the part that covers the of rain a small whereof tissue called duramatter. It is no different than dental work people tell me it is more painful to have dental work bet with the surgeon. But it is amazing a few weeks ago a young man 50 years old will be featured in the john hopkins newsletter. He was awake to the craniotomy with me. Talk about a true hero. Added to answer the questions to keep him awake and ask questions all this goes they work with me. To eradicated the disease. They do a beautiful job. Cspan how long can a patient stayed awake and have the braves open . Guest depends the surgery will range between one and three men hours depending on the timber or how precise so they can be a way. Sometimes a little anesthesia. Is crucial to keep them wray said relaxed. Cspan of the most difficult period surgeries how many people are involved . Guest imagine that. Yesterday morning i did a case that lasted 12 hours and i was the captive of this team and i had to ent surges into plastic surgeons and i was leading a team of neurosurgeons. In the patient that came from far away with the complex tueber we had to remove that the pace of the skull and edition to thats we have forces helping in the morning and four in the after news altogether as a team of 20 people. It very complex case. Cspan if someone had to pay out of pocket to you have any idea how to describe the cost . Guest every now and then that can happen is soap we have the International Reputation at hopkins we have people that come all over the overall. Those that have to pay cash with rage between 60,000 depending upon the complexity up at several hundred thousand dollars depending how long they are in the hospital. As you can imagine very well people come to the United States to have surgery. Not because they lead the team but i am surrounded by an incredible amount of smart is a dedicated physicians and nurses and every of buddy else. Cspan what is the most difficult . You probably hate this question i read about the face being pulled down but what is the most difficult situation . Guest the most difficult situation is those in which you are in the operating room like a complex brain tumor or a simple one. The difficulty is something unexpected happens. Three weeks ago and early may and a young man early 40s incredibly sick a very large brain tumor as soon as i opened the tumor, there were small but very significant breeders it is like you opened the casey of blood started to pour out uncontrollably the greatest challenge is you know, there is a fine line between life and death. Luckily i remade called to keep my team call we could control the situation and the patient went home in todays. Imagine the pressure. I was home that night and i was still shocked after that adrenaline youre like the special forces to keep called and collected and those it is almost as if time slows down and everything moves around you and everything is quiet to try to save his life. I went home that night and said how did you dago . It was a tough day. I had a patient might kids already know the tumors already and i told them and they ask me a question. How much blood do you see q could afford to lose . Not much. Six leaders and we were giving him bledsoe we were this close to potentially losing him. Those were physically taxing for me. Cspan you have to go back the next day to do another operation . Guest yes. The same day i had to go back to do it again. With those we dont talk about the emotional weight i talk about this but i and the one to admit every day to get up in the morning to tell myself i can do this there is no one better. I have to believe every time i go into the operating room someones life is in my hand i am fully capable but then to walk that fine line between confidence and arrogance. Cspan back it up to what seems to be of metaphor of falling into the tanker. How long a Johns Hopkins . Guest six years and before that university of california said for cisco and before that Harvard Medical School. I did for years said with oneyear Howard Hughes doing research investigation. Cspan you are only 43. Guest so. Cspan where ever you before that . Guest at the university of california at ucberkeley and before that between 88 and 91 at a Small Community college at stockton california right before ucberkeley and before that i was in the fields. I were to there about a yearandahalf. Then simultaneously as i was working and studying english to Community College i worked on the real road. Cspan go back before he jumped the fence. When did you fall into the tank girl and why . Guest at this time that Community College and we have to set up the story is of metaphor to fight for your own life and what it is like to give up control. Right after a work in the fields i work with the Railroad Company doing the most menial job. I first started cleaning tanks that would carry fish oil with the larger to accumulate and then i had to clean the tanks that of liquid petroleum guest. I was thin and then to mention is the book i am in charge of the tank so they would not explode or release the gas. So with those 35,000gallon tanker and hold this big a big boat falls into the take keitel my coworker i will get it. That is exactly what happened and my coworker says are you crazy . We will vetted be progressive it will take me on it this is what i thought i was in the best physical shape of my life and i went down and i did not make it back out but i did try. As i landed at the bottom of the tank i realized there was no oxygen with all my equipment with big overalls and a lot of tools and start to drop everything i and 18 feet to the ceiling and started to go up and i relate in the book my whole life starts to flash like people talk about a neardeath experience. That i came to this country to fight so this is where i end up not without a fight. So to climb that rope little by little was no oxygen in my lungs and i made it to the top and i grabbed apollos he and he relates the story as to how bin he saw in my face that agony but i can almost crut crush his head he was asking for help but along that time my father working several road at the same place comes up and he lands right on top of pablo at the moment he could not hold me anymore because i completely lost consciousness and he says right before this i smiled then i went down and i fell all the way down completely unconscious. Then go whole incredible journey and the of work of the team led by a person mentioned in the book that subsequently died, he led the tea my brotherinlaw of wind in twice to save my life. And incredible story how they could get me out not only could have died but the way they got me with a rope and no resources we had nothing than the next thing i wake up i of the the small hospital in stock in california and vomiting isnt completely strapped with the yellow structure. My neck is protected now i know what traumatic brain injury and the doctor tries to examine me. How do do what made to relax . There was vomiting. I was completely sick to my stomach. My father relates the story there four minutes they thought i had a stroke i cannot feel my hand serve was side effects from the gas. I woke up a few hours later the father was trying then hours a bios my father i noticed there were young nurses taking care of me. My father knew i would be okay when i asked how does my hair looked . [laughter] but then is you can imagine the moment that i grabbed my coworker pablo i do i had given it all i had and at this point that was symbolic of me to trust that things would work out for be. Cspan when did you decide to tell the story . Guest i tell you bright, bright around 2008 abc did a beautiful show and how did i know of is in the First Episode in the last episode i had multiple interviews and people were asking me all ready because i was a medical student and a cover on the boston globe riders came to me to set up like to write your story if i was not ready mentally or physically yet mature. I was not ready yet at hopkins i needed to climb the ladder of academics and medicine to go from the assistant professor to full professor before i release my story which has happened now i have been nominated but around that time realized theres an incredible story to be told to imagine my story that my interaction with so many people that mentored me, i realize this was the American Dream to lose focus where it was all about. The American Dream comes back to the same principle of hard work to tell the underdog the United States who came with nothing bell with the opportunities given and me taking those i could show the world believe still have the American Dream and america is the most beautiful country in the world. Cspan four reid that some of your colleagues will thank you are showboating . Guest of course. [laughter] i always worry. You always do. It happens in an end to of wanted to move up the ladder they but not give me promotionsa . 1 at hopkins based on of book you have to peter review and scientific papers. Lolgkbq article featuring on Nature Magazine in grants from the government. In to multimilliondollar grants that is how you get promoted and i would do that before i release the story. Cspan i think Johns Hopkins has 1. 6 billion grants that they get every year the number one hospital according to u. S. News and world reports. Guest over 20 years. Cspan what do they do with all that money . Guest i always welcome people to come see. In all goes back to research. That is what makes this place incredibly special that we constantly strive to make history with their patients. And we use all the resources to find new cures and specifically for me for that black monday that my patients donate through philanthropy, it goes back to fight. So 20 years from now we can say we are going to defeat your disease that is affecting not only you but a future generation. While laboratory alone is 20 people you can imagine a have to pay their salaries and experiments they do every day that money is put back into the economy to find cures for a disease. Cspan go back to the basics of brain surgery. Go back to the average or so regular story you hear of the patient that leads to brain surgery . Guest beautiful question. This is what i hear from my patients. One of the reasons why practice has been so successful they have all access to everything with my team and my personal cellphone number if they have been emergency but i commonly hear that the moment they got their diagnosis it is like the whole world collapses. One patient and beautifully describes it as if imagineer drivein california highway five which is a beautiful drive straight and nice and quiet with Classical Music and you drive comfortably and something hits you from this side and your whole world collapses there are many that are not but that the diagnosis all they know is they have a brain tumor and that by itself it is a life changing experience. Cspan use in there 600,000 americans living with primary brain or nervous system tubers that there are 130 different types of brain cancer and 124,000 that are malignant. But nowadays get a much better to treat other cancers in the body Breast Cancer and lung cancer some tumors when they grow to make get up and of brain is like a sanctuary a privilege Jordan Jordan that is so well into the brain so we can cure cancers year but many times they make it to the brainy and it is a devastating problem. But is why we have so many patients that have to rescind their brain cancerous not just those that are born in the brain like senator kennedy but then many others. Cspan what is the usual way you know, you have a problem . Guest this is the way. Their life has changed many times they were sent with a convulsion or a seizure. Never sick in their life but then they start to have a convulsion by of not talking about a small little head and many patients are getting worse and worse. But then they have a seizure or a convulsion and drop on the floor like a fair shot of water then they have a scanner. That is how they end up many of my patients. Cspan let say somebody watching this has a compulsion and they applied to get to you . What are the chances they can get to you . Guest it is very high anyone in the world. I have a web page dedicated to find my information there is information in my book and anybody can send email from anywhere in the world i will make sure we will take care of them. I can give up what i do today to go to a different job to make a lot more money but i can assure you that well make the same amount of money in the job offer is i have gotten many but i want to be a part of history ive led to live the American Dream and i am thankful for the things this country has done for me. Cspan your parents . Guest san diego. Cspan how to live today compared to the early days . Guest much better my brother and i helped them to buy a house. It is interesting you mention my parents because theyre beginning to realize what i do. With the book coming there are requests for interviews especially Spanish Television wednesday what to talk to humble background. Said they begin to realize what my life is all about and for many years they could understand why after a graduate from harvard i would work 120 hours for we can never hold they did not know i was training to be who i am today but they have the wonderful life than they are very proud of not just me but the others that are working hard to fulfill the American Dream. Cspan the book is dedicated to your deceased sister how many are there . Guest six total five left. Theyre all in the United States said diego and las vegas area. Cspan where teeeight you beat your wife . Guest i talk about that. A wonderful story. She comes of a swedish family her name is Anna Peterson she is brilliant since march in beautiful. When i was thin Community College i was real value rating while life i had so much energy i cannot tell you like to go for days without sleeping were working all the time then to track and field and i had an injury one day. I go to the Swimming Pool in the morning and when i come out there is a young woman who says hello to be. I thought she was talking to someone else. I was so shy people would not believe this bill lacy and this woman before the two weeks prior i was having lunch in the middle of the Community College they sat next to me in my english was so terrible that i bolted and ran out it was disabled woman. We denied state until ucberkeley the year before harvard. She saw me but i had nothing working at school with my steel toe boots and a genes smelling like sulfur she has been my life partner as you can imagine. Cspan how old are your children . Guest and daddy is 12 bin david is 10 in bolivia is six years old. You have a picture there from a few years back but this is about the time im very proud of our children and i give full credit to my wife was did a beautiful job to raise them with the principles and values of the American Dream. Cspan how close did you come to getting aids . In the Second Period of my life trading to become a brain surgeon it is an incredible experience and very humbling. With the big collection of fluid dying of aids and another physician with the attempt to help this patient rehab the big needle to get the fluid so it was an Orthopedic Surgeon and myself doing general rotation you had to do a lot before you became a brain surgeon. So we do this and she has a big deal then she loses control and we both get stuck with blood and fluid. You can imagine how i related the story of brain tumors my whole life collapse because we knew there was a case reported at University CaliforniaSan FranciscoGeneral Hospital have the first war for aids patients in the United States and there was a patient that had converted from negative to positive and it was a Health Care Provider that also got stuck y day and patients relate similar stories when they take chemotherapy specifically. That is why have the incredible amount of respect for what they do because i only did it for a month but imagine those doing it for years at a time. Luckily everything went well. That is when there is a gap between david and bolivia we had to protect ourselves and every time i ever get the results of their wusses nerve wracking to cents those moments that my wife and i will read through. Cspan was there another time your operating and blood squirted . Guest . [laughter] that was on television. Taking care of a beautiful young woman, a lovely family of traumatic brain injury i am trying to reconstruct the of brain and i have protection as special goggles with back defying glasses and completely protected but somehow i hit a small little artery that was sent a blood perfectly located right above my i bypass my protection right into my eye and she had received a lot of blood transfusions. Paris so beautiful the first thing that came out when i told the bomb she heard the first thing she wanted to make sure i was falling. That was so touching that i had her daughters life in my hands and she was still concerned for the two of us. Everything was fine if she had a risk because of transfusion but we were in good shape. Cspan what is the worst thing a family or a patient does to dr. . Guest i think it is a difficult question. I had experiences where it is a relationship you build with your patients and expectations that you will save their loved ones from brain cancer. I had a few. The worst thing a family can do that personally i cannot speak for more but one of the most devastating experiences is i of the old ways the last one to give hope the you reach a point but once we reached the end of life and the disease continues to progress what i had experienced from the patient is the inability to realize the matter what we do things are not going to change in their willingness to see the loved ones continue to suffer rather than deal with their own and abilities to cope that their loved ones will die and that breaks my heart. I struggle and we talked with them. Please. This will not change reedy to help the patient put them into hospice. Cspan where have you said i dont want to ever to fly see that doctor doing . Guest if your location is obviously. You learn at places like hopkins with the most brilliant positions in the world or as a resident not only in my discipline but to do things that i consider for the welfare of a patient making decisions to stop a treatment and give the false expectation to the family is something that i feel strongly against. I told myself id never do that my goal is always with patients the first thing i say is this is what happened this is what we know and this is what we will do you know, what is in my brain. Cspan one of the things that has changed is the patient go bonkers gates to have a relationship with their primary care doctor yugo around that rather than waste the time . One they that has made by relationships strong is sometimes the specialty is we tried to come as the special force to think about taking back a note the tumor and sometimes we think that is its twin is when with reality with my team we take that issue to work in the laboratory to try to find a cure and i get the patients involved not only in their own care but apart of history that comes strictly from the institutional review boards so they feel a part of history in my relationship continues to revolve the arent taking care of their tumor. That is devil to fill very well as prenet searches a specialty. I dont take away the of rule but i tried to make it easier for their primary care physician who feels frustrated didnt have the knowledge to do with patients with brain cancer. I tried to surround myself by people who do this all the time to know how to talk to patients or deal with the families that are upset and frustrated because their loved ones are dying. I tried to take the role of the primarycare physician into a sub specialty beds surround myself with a lot of people. Cspan when do people stop questioning you got into these places because of affirmative action . I thought that happened. Guest of course, it will never end and people will wonder why it is my son not there . He took a spot from someone else. End why is it that i can publish my story because i had to be ready when the show came out i got Death Threats and emails and people who hated and loved me and missed the message. They think i have taken someone elses bought in medical school someone else born and raised should be the brain surgeon. So that will never end. That is a love makes the country the most beautiful country to express their opinions. I dont agree but i respect as long as it is not affect my life for the life of my patients are my family. Words come and go but it is what you do for people. Cspan how often is race issue . Guest every day i get a request for an interview interview, people say we want to have this guy because he is famous. I say this is my agenda. I want to talk about my story so there are things i can to put the plays double every single day of my life. I dont shy away i realized what i was in medical school that what i thought was a weakness monday, as a poor immigrant it turned out to be the greatest event of my life. The true definition of the American Dream. Cspan take list from the very beginning to the end. Guest i get up at 5 00 in the morning. I do this every day. My alarm goes off at 4 50 a. M. And i take 10 minutes to gather my thoughts. For a run for trading for a Half Marathon in honor of a patients battling brain cancer. I will not lie imi in perfect shape to do that but i will give it my best. Then i tried to rent office see if you patience and come to washington d. C. Where he will go back to the operating room bentonite get home at 8 00 p. M. Have dinner with my kids for about 30 minutes and tell them the story and go back to office then spend half an hour with my wife and watch the news then go to bet around midnight and i get calls overnight i will receive four or five calls i am always on call for any patient that wants to get ahold of me. Sometimes they called off hospital because they know i get best bet theyd do that every single day seven days of week for 365 days a year since i remember. That is my level of energy. Cspan how much fatigue . Guest i am human. Of course, and get tired and every morning when i get up my body aches and i am sore because theyve training and tired. I think of the patients better struggling every day than the world starts and i love to watch the sun coming up every morning. I the of trading days like this as well. It is the cycle of life. Cspan 10 years from now based on what you have watched happening with medicine, what do you think will be different about the art of brain surgery . Guest i would say we will see more personalized medicine. Right now forebrain to retake is much as he scanned ink give chemotherapy and radiation. In 10 years but thanks to the work people around the world including a laboratory is doing we can take the tumor to save this patient specifically responds to this treatment we will give a personalized but is said to that patient in that will revolutionize our system. We can allow our country not to. That is why i feel so strongly and to be able to support the Creative Minds to help us to live a long and healthy life. Cspan over all your education harvard harvard, university of california berkeley but was the toughest time during your medical training . Guest medical trading was undoubtedly a around the time of was stabbed with the needle working 120 hours a week. San francisco question. Coming as a young attending then have to face the issues like racism and establishing your practice but back then working as a resident to train to become the special forces with a lot of short, little sleep, a little money, the resources, not seeing my children that was undoubtedly the most challenging times i had to survive. And having the problem with hiv and to deal with the fact so it was excruciatingly painful because of how expensive it was this was that the peak of the. Com companies that was a challenging time and i talk about that in the book but i have incredible memories but those are the times when i would wake up and my kids were in my face, the little ones trying to play with me and i was completely spent. Cspan you have a coauthor how did you relate to her . Did she interview you . Guest yes. She is incredible and has written several successful books and part of the team that wrote the pursuit of happiness with Kris Kirchner and has done an incredible amount of work. The moment her because she is the incredibly accomplished writer, she spent time with me personally. In by a laboratory with my patients and then she had multiple interviews with the through multiple drafts it took about three years to complete the project to go back and forth all the time. Cspan then theyve of the book is called that becoming dr. Q teeeighteen brings surgeons at john hopkins published by California University press. Thank you for joining us. Guest mycu r tkh pleasure