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