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Dr. Quiíñones-Hinojosa: Q&A

On July 22, 2008, Dr. Alfredo Quiíñones-Hinojosa answered questions about his remarkable career trajectory from immigrant farmhand to brain surgeon, his advice for others, and brain cancer.


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Q: Dear Dr. Q.,
Your story and your work are truly inspiring! What advice would you give to young newcomers to the U.S. to encourage them to succeed? I work with Hispanic teenagers who are recent immigrants, and I am definitely going to share your story with my students, who love to hear about positive role models who share their background. Brenda D., New York, New York

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Alfredo Quíñones-Hinojosa: Dear Brenda,
Thank you very much for your kind e-mail. My main advice to young people, whether they are newcomers to the United States or living here in the United States for some time, whether they are from similar or different backgrounds to mine, is that the American dream is attainable. It is attainable if you believe in yourself-if you believe that beyond what your eyes can see and your heart can feel your brain can definitely achieve. My advice to young people is always to keep dreaming, but you have to back up your dreams with hard work, with determination, resilience, excitement for life, admiration for other people whose work you respect, as well as true mentorship.

Mentorship comes in many forms. A mentor does not have to necessarily be of the same religion, sex, race, or background as you. There are a lot of good people out there in the world who are willing to help you as long as you help yourself. And with a little bit of help and a lot of passion, dedication, determination, and hard work from you, you will be able to achieve those dreams.

Remember what Einstein once said, "This world is a dangerous place not because of people who do evil but because of those who look and do nothing." I believe that the American dream can only be obtained through hard work. We have to have patience and acceptance among one another, and you have to keep your mind clear, you have to remain focused, and you have to enjoy life as well. My joy comes directly from my passion for life.

Thank your for this wonderful question.

Q: My 50-year-old brother is a five-year brain cancer survivor with stage 4 glioblastoma multiforme. Have you ever met such a patient? We're in uncharted territory. What's the longest anyone has been a survivor? Anonymous

Quíñones-Hinojosa: Dear Anonymous,
It is wonderful news that your brother has survived five years. A stage 4 gioblastoma multiforme is a very dangerous disease and in many cases a fatal disease. The reality is 50 percent of patients survive less than a year and a half, and 50 percent survive more than a year and a half. However, there are cases-such as your brother's-of patients who are long-term survivors. And this is exactly why, when I counsel my patients and they ask me how long they have to survive, I always say every patient is different and there are no absolutes.

I do believe that our attitudes-the way we approach the disease-may have an impact on the way our bodies fight the disease. I tell my patients that our goal through surgery and treatment with radiation and chemotherapy is to help them to be long-term survivors.

It might seem like you are on uncharted territory, but there are case reports of patients who have survived much longer than five years after the diagnosis. This is one of the main objectives of the work that we do in our laboratory; we are trying to make this disease a chronic disease rather than a devastating and fatal disease. I am very thankful that your brother is doing well, and I sincerely hope that he continues to do well and enjoy life at its fullest.

Thank you very much!

Q: Dr. Quíñones-Hinojosa:

Your path from Mexicali and the fields to Berkeley, Harvard, UCSF, and now Hopkins is most impressive. What personality factors do you attribute to such success, i.e., what aspects of yourself do you feel were instrumental in getting through such tough academic environments and still remaining true to your ultimate goals?

Thanks, R. Eccles, Los Angeles, California

Quíñones-Hinojosa: Dear R. Eccles,
I am very thankful for you wonderful question. I think that the one key reason for my success is character. In regards to character, Albert Einstein said, "Most people think it is intellect that makes a good scientist. They are wrong, it is character." Character is a very important part of our personalities. It gives us the ability to see opportunity in the middle of chaos, to have an incredible amount of determination and courage, to fall down and get up and try again. I always tell my children and my students, it's ok to fail, for it is not failure that determines your ultimate success, it is your ability to deal with that failure- your ability get up and try again.

It's also important to have excitement and passion for life and enjoyment for everything you do. Admiration for other people and mentorship have been instrumental to my success; I am truly blessed to have had an incredible amount of mentorship, not only from people of my own race, but also from people of other races, other religions, other groups, because there are good people everywhere. The American dream has brought us all together. And what makes this is such a wonderful nation is that we work very hard and we stand on the shoulders of giants. My academic challenges were truly difficult, but I remained focused on my goals-to make this world a better place for all of us to live, as a surgeon, a scientist, a clinician, and a person. I strive to use neurosurgery and my research in cancer as a vehicle here for all of us.

Q: Being an illegal immigrant and economically disadvantaged, how did you overcome the financial adversities of college and medical school? Dennis, Rochester, New York

Quíñones-Hinojosa: Dear Dennis,
Thank you very much for this wonderful question. One of the things that I look back to is my time working at the railroad. I was an immigrant with documentation, but I made very little money. I knew I needed to get an education to find a better life. But the community college where I eventually went to school was very expensive. Fully realizing the value of this education, I worked nights and weekends and went to school during the day. Essentially, I worked 24/7. By the time I went to U.C., Berkeley, the education I received in community college made me qualified to earn money tutoring students in physics, chemistry, and mathematics and working as a teacher's assistant. I also applied for special loans, some of them were low-interest and some of them were high-interest. I never thought that this country had any responsibility to me as an immigrant to provide me with a free education, so I have paid and continue to pay through loans and have acquired education-related debt through the years in excess of several hundred thousand dollars. But regardless of this debt, I am very thankful that I have been given an opportunity to fulfill the American dream. I never thought that I was owed anything. I always thought that I had to pay my way, and I continue to pay my way.

I know it seems like an insurmountable task, but with dedication and with hard work you can get through. I always tell my students, it's difficult to imagine that by the time you finish medical school and residency you can have a several-hundred-thousand-dollar debt, but in my case the alternative would have been to not have been given the privilege to care for patients with brain cancer who are threatened with death. My contribution goes beyond just medicine; it is my contribution to society, to humanity. My own difficult times, economic situations, they seem so little and so vain when compared to the hardships of people who are dying from brain cancer.

Q: What is the greatest lesson you have learned from being a doctor? Anonymous

Quíñones-Hinojosa: Dear Anonymous,
I think that the greatest lesson that I have learned from being a doctor and a physician/scientist is that humanity is just absolutely wonderful; we have an incredible power as humans to deal with a disease and deal with it graciously. I am truly inspired when I see my own patients dealing with brain cancer, going into the operating room and allowing me to touch their lives, touch their brains, having faith and trust in me, putting their lives in my hands, literally, as we walk the fine line between life and death. It always reminds me how much capacity we have as humans to trust one another.

To be confronted with difficult situations and find a way to rise to the occasions and overcome them is one of the biggest challenges that we face as a society. How can we work with one another, how can we trust each other in daily activities, how can we make this world a better place for all of us to live? That is the question that I still try to answer every day, and my way of answering it is through hard work, by providing excellent healthcare to my patients and excellent research in our laboratory. I have learned numerous lessons from my own patients; they teach me every day the power of love, the power of humans to deal with adversities, the power of working with one another. Those are the lessons I have learned as a doctor, and I am very glad that I have the privilege of sharing those lessons every day with my patients, with my students, with my post-doctoral fellows, with the work that we do in the laboratory.

Thank you very much for this question.

Q: Who inspired you to become a neurosurgeon? L.J. Main, North Douglas High School, Oregon

Quíñones-Hinojosa: Dear L.J. Main,
What inspired me to become a neurosurgeon is a question that I have asked myself many times. Is it that I found neurosurgery, or is it that neurosurgery found me? I think it's difficult to answer that question, but I do remember the passion and the excitement I felt the first time I actually saw the human brain exposed. When I walked into the operating room/theater and I saw the beautiful organ, I was fascinated by the concept that this wonderful and fascinating organ is what allows us to be who we are. It allows us to interact and understand each other, and it also has the capability to destroy. This organ gave me the chance to have a much better quality of life, it gave me the ability to work with my hands, it gave me my knowledge and my vision of what I wanted to do in the future, which is exactly what I am doing today. It allowed me to pursue my dreams. When I saw it for the first time, I just completely fell in love, and I have been in love with my profession ever since. I am very lucky to be able to shed some light on what we do as brain surgeons/scientists.

Thank you.

Q: Can someone who had a stroke six years ago and who is paralyzed on the left side have any type of brain surgery to help regain some left-side usage back? Despina Lalas, Pensacola, Florida

Quíñones-Hinojosa: Dear Despina Lalas,
Thank you very much for your question. It is important to stress that each case is unique, and each patient needs to be evaluated by a professional before anyone can make any conclusions about their condition or hope of recovery. However, in general, I am not aware of any neurosurgical procedures available presently in the United States that could recover some of the function in the brain after a massive stroke.

The work that we are doing in our laboratory with stem cells may one day in the future be beneficial for this type of brain injury, but at the present we are very much at the early stages of using this kind of technology. There are some preliminary experiments in animal models that might someday help stroke sufferers regain some brain function after a massive stroke. In terms of what is available today, there are physical exercises and other programs that can potentially help patients regain some function. (Dr. John McDonald at Johns Hopkins and The Kennedy Krieger Institute is an expert in this field.) I encourage you to look at other alternatives, but at the present brain surgery is not something we have routinely used in humans for this type of condition.

Q: Hi, Dr. Quíñones-Hinojosa,
You give me lots of hope for our people. How do you think we should address students who are graduating from U.S. universities and are not citizens? Many of these students risk deportation and are not able to contribute to our society once they have graduated. You have worked hard to get where you are-how can we help others do this? Danielle Medina, Corona, California

Quíñones-Hinojosa: Dear Danielle Medina,
This is a very important question, and I am not an expert on these issues. I can only speak from my own experience as an immigrant to this country. No matter how dark my future appeared and how little I could predict my future, I always thought that through hard work, dedication, determination, resilience, mentorship, passion for everything I did, and admiration for other people's work, I could fulfill my dreams. My advice is to never let go of your dreams, to always keep working hard and moving forward in spite of how difficult it might seem. We should never take for granted the wonderful things we have been given, the things we can achieve, and the fact that no matter what our station in life, we all play a significant role in society and have many opportunities to contribute in many ways.

Q: I am the director of an organization that I created five years ago to combat hunger and chronic food insecurity among impoverished children living hidden in the shadows of my affluent suburban hometown. These are the children of hardworking parents who landscape the lawns, clean the homes, wash the cars, bus the tables, and bag the groceries of their prosperous neighbors. Some of these children, and virtually all of their parents, are undocumented, and as I have come to know them and have had the opportunity to talk with them about their hopes and their dreams for their futures, I have come to understand how deeply they hunger for much more than food.

My greatest desire is to help these children believe in themselves and in the viability of their dreams, but I feel that I'm fighting a losing battle against the barrage of negative messages they receive from all directions in this era of heightened hostility toward immigrants, and especially the undocumented. Do you have any suggestions on how I might most effectively combat those messages so that I can fuel the type of fire in these children that carried you through your journey? Laura Distelheim, Illinois

Quíñones-Hinojosa: Dear Laura Distelheim,
Thank you very much. This is a noble program and a very noble thing that you are doing. I think that I have benefited in my life from people who, like you, believe in the American dream. Many of us have encountered situations in our lives in which we feel that there is absolutely no hope. I have encountered moments like those in my life, and the only thing that carried me through was faith in people and faith in my ability to succeed. It didn't matter how dark it was, it didn't matter how difficult it looked, I just believed that if you give the world your best, the best will come back to you. The biggest forces that carried me through my difficult times were the belief that I could make a difference in this world and the belief that no matter how insurmountable a challenge seemed, if I tried hard enough, I could overcome it through patience, dedication, and hard work.

No matter how difficult it may seem for these children to be dealing with negative situations and negative messages from many different sources, no matter how much hostility they face every day, they need to be told that they have an important contribution to make to our society. The only way that people have fulfilled their dreams is by keeping those dreams alive, and they need to keep those dreams alive.

Thank you very much!

Q: Dear Dr. Q,
My friend Nancy is a 25-year-old second grade teacher who is getting married in November. Recently she was diagnosed with a brain tumor. Nancy's tumor is in a bad location, so her doctors have been reluctant to operate knowing that the chances are high of causing severe disabilities like loss of speech or worse. They were hoping that medicine to curb her seizures would give her more time, but the medicine makes her sick. The doctors may need to operate soon.

After watching the program about you on NOVA, we know you are the best doctor to help her. Can my friend get an appointment to see you? If not, could you recommend a doctor for her? We'd appreciate any help you can give.

Sincerely, Liz Meggitt, Princeton, New Jersey

Quíñones-Hinojosa: Dear Liz Meggitt,
Thank you very much for your kind question. Brain tumors are devastating; not all of them are necessarily malignant in nature as far as their invasiveness, but all tumors in my opinion carry a degree of risk once we go into the brain to try to get them out. Sometimes it is not necessarily the pathology that is dangerous but it is rather the location. Without seeing the films and without examining your friend, Nancy, it is difficult for me to make a complete opinion about the situation on this particular case. I have confronted situations myself in which tumors in certain parts of the brain are quite dangerous to take out, and we are required to use a very aggressive medical management but not necessarily a surgical intervention. In your friend's case, I would have to see the films, evaluate, and examine her. We would be delighted to be of any assistance at Johns Hopkins, and my office can be reached at any point at 410-550-3367 for any questions or issues. Please don't hesitate to contact us, and we would be delighted to see your dear friend.

Thank you very much!