The hot sun seared his skin as Alfredo Quiñones-Hinojosa (pictured) bent in the field to pick tomatoes. It was work few people would do for a pittance every week – and most of his fellow workers on this 4000 hectare farm were, like Quiñones, illegal immigrants. It was a grim existence: he lived in a decrepit caravan in the middle of a field.
One day the farm owner’s son came by. “He looked at us like we were less than dirt,” recalls Quiñones. Other workers were only too happy to be disdained by wealthy citizens who could have them deported, but not Quiñones. He carried an English dictionary in his pocket and studied it every day.
It had been a year since Quiñones, a Mexican, jumped the fence in Calexico, California. His cousin was supposed to be waiting for him on the other side. Instead he was met by the US Border Patrol. Half an hour later, Quiñones was back in Mexico.
Guessing that the border police would never expect the same man to cross in the same spot on the same night, he went over the fence again. This time, his cousin was there. Quiñones hopped into his car and the two roared off into the night. It was January 2, 1987, Quiñones’s 19th birthday.
The oldest of Sostenes Quiñones and Flavia Hinojosa’s five children, Alfredo began work aged five, pumping petrol at his father’s garage, where the family also lived, on a dusty road 60km south of the border town of Mexicali. It was hard work, but Quiñones didn’t mind. He also got to drive the cars every now and then, perching on a stack of pillows.
By Mexican standards, the Quiñones family was almost middle-class. But in 1976 the Mexican government devalued the peso, throwing the country into turmoil. “We lost everything, just like that,” Quiñones says with a snap of his fingers. “I remember going to the back of the house to find my father crying.”
Sostenes turned to his brothers, who were working in the US as migrant farm workers. They supplied the family with sacks of potatoes and beans. Quiñones helped bring in extra money by working at a taco stand.
Still, he kept up with school. “My father kept telling me, ‘You want to be like me? Just never go to school.’ And I was not going to follow the same path.” At 14, Quiñones qualified for an accelerated programme that prepared students for jobs as primary school teachers. Each morning, he rose at 4.30am to take a bus to the school in Mexicali. There was no bus home in the afternoon, so he hitchhiked – or walked – in the blistering heat.
He left near the top of his class. But because his family had no political connections, he says, he was assigned a teaching job at a remote school far down the Baja peninsula. “I wasn’t willing to put up with that injustice,” he says. Shortly after, he decided to leave Mexico in search of better options.
He had been to the US twice before, doing summer work. So on his arrival, Quiñones headed with his cousin for the San Joaquin Valley to work in the fields. “I picked tomatoes, cauliflower, broccoli, corn, grapes.” After a year, he had saved almost all of his meagre pay. “I ate what I was picking,” he says. “I wore the same pair of jeans the whole year.”
When Quiñones looked up from the dirt, the best job he could see was driving the big tractors. The drivers were skilled and they supervised crews. He was told it took ten years of fieldwork to land such a promotion, but Quiñones was soon behind the wheel of sophisticated ploughs and diggers. He learned how to service the engines and qualified for a temporary work permit. “I had that hunger in my gut,” he says.
A few months later, Quiñones told his cousin he was going to leave the farm. His response was, “What are you talking about? If you keep working here, one day you’ll be the foreman!”
“Sometimes you have to be willing to take a risk,” Quiñones said.
He moved further north to Stockton and took a job in a railway yard so he could attend night school and continue learning English. His first job, shovelling sulphur, was the worst of his life – smelly and filthy. Once again, he scrambled to acquire new skills, this time as a welder repairing valves on tanker wagons. Within a year, he’d become a foreman.
With his English steadily improving, Quiñones switched to the night shift and began full-time studies in science and maths. To make ends meet, he also tutored other students.
One day, outside the school cafeteria, he met Anna Peterson, an American student. “Alfredo was this fascinating guy, always in a hurry,” she says. “He had long, curly hair and earrings. I walked up and introduced myself. We became friends.”
After graduating with a foundation degree in 1991, Quiñones was accepted by the University of California, Berkeley. He moved to a seedy district, getting by on a combination of scholarships, loans, a small grant and, as always, work. He became a teacher’s assistant in three departments and also took a job at a men’s clothing shop. Peterson stopped by the shop one afternoon. The two had lost touch, but the reunion was fateful. Soon they fell in love.
Quiñones excelled in the competitive environment of Berkeley, getting straight As in advanced classes, writing his thesis on the role of drug receptors in the brain and teaching calculus on the side – not that he paid much attention to his standing. In the spring of 1993, his mentor Hugo Mora looked over his transcripts and told him he stood a good chance of getting into Harvard Medical School. “I thought,” recalls Quiñones, “firstly, this guy is very nice and secondly, he’s clearly living la vida loca [living the crazy life].” Quiñones had been to a doctor only once in his life. Then he thought some more. “My grandmother was a curandera, a town healer,” he says. “I saw the respect that she had. I decided to give it a shot.”
Harvard accepted him and Quiñones moved there in the autumn of 1994. Anna followed and they married in 1996. A year later, Quiñones became a US citizen. “I’m sitting there ten years after hopping the fence and it hits me how fast I came up.”
Quiñones says he understands why people might resent him for entering the country illegally. His only excuse is that he was a brash and desperate teenager. “The last thing I was thinking was that I was going to break the law,” he says. Once he arrived, Quiñones says, the US “opened its doors to me” – a welcome, he adds, that would be unlikely today given the heated immigration debate. He offers no solution, but suggests it will not come from higher walls. “As long as there is poverty in our neighbouring countries, there will continue to be this influx.”
Quiñones continued his training, in neurosurgery, at the University of California, San Francisco, after graduating from Harvard. It was an exciting but daunting prospect. Could an illegal Mexican farm worker become a brain surgeon? It didn’t seem possible.
This period turned out to be a low point in Quiñones’s American journey. “Neurosurgery has been reserved for people who come from a long pedigree of medicine,” he says carefully. “It’s rare that you have someone like me go into this highly demanding field, where lots of patients die.” He’d experienced prejudice before – the farm owner’s son who looked right through him, a former girlfriend whose mother disdained him for his nationality. “They ignited my fire even more,” he says.
He admits there were times, working 130 hours a week for the equivalent of A$40,000 a year, when he considered giving up. “I felt what my father felt, not being able to put food on the table,” he says. “But I had a dream.”
“Are we ready to rock and roll?” Dr Quiñones, now 40, sits on the edge of a patient’s bed. It’s a Friday morning at Johns Hopkins Bayview Medical Centre in Baltimore and this will be Quiñones’s second brain surgery patient of the day.
The woman, who’s in her sixties, has two tumours; one is in the highly sensitive part of the cortex that controls motor movements. Quiñones holds her hand and looks into her eyes. “I walk a fine line every day between good and bad outcomes, and bad outcomes can mean life or death,” he tells her frankly. “Also, there is a chance that you will be paralysed on the right side.” She nods. Dr Q, as everyone calls him, believes patients deserve both compassion and honesty. “That is the risk,” he concludes. “So we’re set. You and I have a date.”
An hour later, in operating theatre five, surrounded by six attendants and an anaesthetist, Dr Q cuts through the woman’s scalp to expose her skull. Using a whirring tool, he carves out a 5cm section of bone and pops it off like a manhole cover. He carefully cuts back the dura, a leathery layer of tissue under the skull, and the brain is exposed.
Dr Q specialises in a high-tech form of brain surgery called motor mapping, in which an electrical stimulator is used to locate sensitive areas. “Let’s have complete silence, please,” he says and the room falls quiet. He touches the stimulator to the brain surface and the woman’s arm twitches – a spot to avoid. Eventually he determines a safe path to the tumour, which he painstakingly removes, piece by piece, with an electrical forceps that cauterises as it dissects.
The four-and-a-half-hour procedure goes well – the patient comes to with no loss of motor function – and Dr Q is ecstatic. “Holy guacamole, that was a great day!” he says, shedding surgical garb as he heads to a meeting with the family of a man who recently suffered a massive brain haemorrhage.
Although Dr Quiñones is a relatively young doctor, his colleagues are impressed. “Not only is he a talented and conscientious surgeon, but he’s very sensitive to the needs of patients,” says Dr Henry Brem, director of neurosurgery at Johns Hopkins. “And he’s a joyous person – full of enthusiasm and the mission to do good for the world.”
It’s now after seven and Dr Q has been working for 12 hours. Other surgeons are going home for the weekend, but he’s heading to his research labo- ratory in the centre of town. The lab is an extension of his operating theatre: cancerous tissue that he removes in surgery is studied with the goal of finding new therapies. “One hope is that we can make brain cancer a bit more chronic, such as diabetes, instead of a devastating lethal disease,” he explains.
Dr Q joins more than a dozen medical students from round the world at a table with a projector. Over Chinese food cartons, they present and discuss studies with titles such as “A Functional Role for EGFR Signalling in Myelination and Remyelination”. The work is serious, but after a full day of surgery, the meetings give Dr Q a chance to unwind.
The following afternoon, many of the students show up at Dr Q’s home for a barbeque. The suburban house is spacious but hardly palatial; several rooms have no furniture, though toys are everywhere. The doctor’s hectic schedule means little time relaxing with his three children – Gabriella, eight, David, six, and Olivia, two – so today he dotes on them.
Work is never far from home. Recently, Dr Q removed a chest tumour from Gabriella’s pet hamster Theodore. “It was very aggressive and I wanted to give him a chance,” he says. Meanwhile, his BlackBerry chirps constantly with updates from the hospital and laboratory. Anna, 35, smiles. “I’m not one of those clingy, needy wives who have to talk to their husbands 50 times a day,” she says. “I run the house completely.” Except the grill on the back porch, where Dr Q is cooking tortillas. “I think my background allows me to interact with my patients in a more humanistic way,” he says. “When they’re scared, I’m one of them. I’m just lucky that patients allow me to touch their brains, their lives. When I go in, I see these incredible blood vessels. And it always brings me back to the time I used to pick those huge, beautiful tomatoes with my own hands.
Now I am here, looking at the same colour – that bright red that just fills the brain with nutrition and wonder. I’m right there in the field and I’m just doing it.”.