What It's Like to Be a Brain Surgeon, from Dan Heath

Summary

---

Snap Judgment – “What It’s Like to Be a Brain Surgeon” (with Dr. Alfredo Quinones-Hinojosa, aka Dr. Q)

Air Date: June 16, 2026
Host: Dan Heath
Guest: Dr. Alfredo Quinones Hinojosa (Dr. Q), Chair of Neurosurgery, Mayo Clinic Florida

---

Overview

In this episode, Dan Heath brings listeners into the extraordinary world of brain surgery through a vibrant, personal conversation with Dr. Alfredo Quinones Hinojosa (Dr. Q). From the tense atmosphere of the operating room to the intensely human questions of trust, failure, and identity, the episode explores not just the technical feats of neurosurgery, but also the emotional, psychological, and social complexities that define the profession. Along the way, Dr. Q shares his own remarkable journey “from harvest to Harvard,” reflecting on what it really means to hold someone’s life in your hands.

---

Key Discussion Points & Insights

1. A Day in the Life of a Brain Surgeon

• Preparation Begins Early:
  • Dr. Q describes that surgery begins “the moment someone sends me a picture about their scan—their surgery begins to happen in my brain” (02:01).
  • “It’s like when a boxer walks into the ring. But the real training…happened in a dark gym, day after day…years of preparation.” (02:35)
• Morning Routine:
  • Comes in early, reviews films and patient notes, especially focusing on the family (02:16).
  • Mentally maps out potential risks and plans how to “dance around those dangers” (03:08).

2. Human Connection and Empathy

• Pre-Surgery Patient Meetings:
  • Dr. Q makes it a point to connect with patients before surgery:
    “I like to make sure they feel my pulse, the warm of my hand…I ask them what they had for dinner…stories I could use in the operating room.” (04:11)
  • Many surgeries are “awake” procedures; connecting with the patient makes the process less frightening and aids in monitoring key functions during surgery (04:36).

3. The Operating Room as an Orchestra

• Atmosphere in the OR:
  • Describes the surgical suite as “like an orchestra. It’s like a symphony…20 to 25 people…machines beeping…the sound is like the percussion…all that becomes the most beautiful music.” (06:24–07:34)
• Tools and Technology:
  • High-magnification “loupes,” a headlight, huge microscope controlled with his mouth:
    “I control the microscope with my mouth…with a small little handle…over a ton…and I can still talk.” (08:06–08:33)
  • Special chair with 16 foot controls, hands on highly delicate instruments under powerful magnification—“fully connected to the patient in such a way that…the microscope and myself were almost one person.” (09:01–09:18)
  • Stakes are high: “a small, little blood vessel…could mean the difference between memories or no memories, speech or no speech.” (09:46–10:01)

4. Why Brain Surgery Is Often Performed While the Patient Is Awake

• Direct Neuromonitoring:
  • “There’s no machine in the world that can monitor those functions better than the patient’s own brain.” (11:32)
  • Customizes tests to each patient:
    • One patient answered complex math questions (13:02).
    • Another played guitar throughout surgery because “I cannot not play music, I need to play my guitar.” (13:34)
    • An airport traffic controller simulated work, directing flights on a computer while on the table (14:08).
• Classic OR Tests:
  • Reading, complex instructions, answering questions—confirming function through repeated stimulation. “I go avenue by avenue, road by road…stimulate and put in numbers…minimum of three times to confirm” (15:23–16:21).
• Memorable Moments:
  • When stimulating certain brain areas: “I tell the patient, count from 1 to 40…when they’re at 10, I stimulate…and they pause. Take it away—they continue: 11, 12, 13…They don’t realize you have them stop time.” (16:31–17:33)
  • Triggering memories: “Stimulating a part of the brain and suddenly the patient will remember a memory of childhood…” (17:43)

5. The Physical Reality and Emotional Stakes

• The Mechanic Metaphor:
  • “I poke fun of myself…I’m nothing else but a highly regarded mechanic of the brain.” (19:05)
  • “You’ve got to roll your sleeves up…sometimes get little splashes of blood on your face…a little bit of that bone dust.” (19:30)
• Trust and Responsibility:
  • “The most remarkable thing for me…is the fact that a patient and their loved ones are willing to put their lives in the hands of a stranger. That speaks to the power of trust.” (20:14–20:30)

6. Success Rates, Difficult Choices, and the Emotional Toll

• Success Rates:
  • “Chances of complication for a healthy person are probably in the 1 to 2%” (21:21); remarkable given that it “used to be almost 100% mortality with brain surgery” a century ago (21:41).
  • Sometimes, “the best for the patient…is not to do anything.” (22:53)
• Edge of Diagnosis:
  • Tumors look “like a lightbulb” on MRI but real boundaries are unclear in the operating theater, especially at the edges where “important brain” may be invaded (23:11–23:39).
• When the Surgery Ends:
  • “The most stressful moment…is waiting until that patient is awake and moving.” (23:46)
  • “At that point, my heart was about to burst out of my chest…did I do something to that patient?” (24:58–25:04)
• What About When It Goes Wrong?
  • “The most difficult times…when surgery didn’t go the way I wanted…takes weeks, months, years to get over. I carry those scars in my heart.” (26:28–27:17)

7. Dr. Q’s Personal Journey: ‘Harvest to Harvard’

• Background:
  • Came to the US in 1987, undocumented, “from a very poor family in Mexico.” Worked in the fields of California as a teenager, matriculated at Harvard Medical School in 1994. (28:00–28:41)
• Reflections on Opportunity:
  • “This is the land of opportunities…can only happen here in the United States.” (29:00–29:15)
• Family & Roots:
  • “I was one of 54 grandchildren…my distinction was that I was the one who got in trouble the most.” (29:44)
  • Credits musical, adventurous grandfather and stern, respected grandmother (midwife and town healer) for shaping him (30:27–31:29).

8. How Being a Surgeon Shapes Everyday Life

• Hand Safety:
  • “I was a migrant farm worker…fixed a Chevy engine…here I am, have to be careful…one time, cut my hand and realized my actions could have downstream effects on patients.” (31:44–33:20)
  • “I love boxing…I wrap my hands…studied how to hit a bag without injuring fingers or wrist.” (33:20–34:08)

9. Lightning Round: Culture, Tools, and Sounds

• Insider Lingo:
  • “Show me two fingers”—a neurologic check in the OR (34:22–34:31).
  • Neuroanatomical term: “Where is the indusium griseum?” (34:44)
• The Unforgivable Insult:
  • Being mistaken for a neurologist—“insulting both ways…neurologists are extremely bright…they don’t put their hands on the brain.” (35:03–35:49)
• Favorite Tool:
  • “Bipolar coagulator…like tweezers…action zone as small as a hair” (36:00–36:18)
• Signature Sound:
  • “The sound of the anesthesia machine beeping…you want to hear that sound all the time.” (36:59–37:05); “If a note is off, you recognize it right away.” (37:27–37:29)
• Savoring Good News:
  • “What I savor…is walking into the room and telling the family, everything went well. They rush to hug me…those moments touch my heart…give me the energy to keep going.” (37:37–38:27)

---

Notable Quotes & Memorable Moments

• “The moment someone sends me a picture about their scan, their surgery begins to happen in my brain.” — Dr. Q (02:01)
• “The operating room for me is like an orchestra. It’s like a symphony…It becomes the most beautiful music you can possibly imagine.” — Dr. Q (06:24–07:34)
• “There is no machine in the world that can monitor those functions better than the patient’s own brain.” — Dr. Q (11:32)
• “You have them stop time. Isn’t that amazing? That’s how beautiful the brain is.” — Dr. Q (17:33)
• “I’m nothing else but a highly regarded mechanic of the brain.” — Dr. Q (19:05)
• “The most remarkable thing for me…is the fact that a patient and their loved ones are willing to put their lives in the hands of a stranger. That speaks to the power of trust.” — Dr. Q (20:08–20:30)
• “Chances of complication for a healthy person are probably in the 1 to 2%...100 years ago, it was almost a 100% mortality.” — Dr. Q (21:21–21:41)
• “The most difficult times…takes weeks, months, years to get over. I carry those scars in my heart.” — Dr. Q (26:58–27:17)
• “I came to this country in 1987 undocumented, from a very poor family in Mexico…by 1994, I was matriculating at Harvard Medical School.” — Dr. Q (28:00–28:41)
• “Show me two fingers.”—OR lore (34:22)
• “The sound of the anesthesia machine beeping…if a note is off, you recognize it right away.” — Dr. Q (36:59–37:29)
• “What I savor…is walking into the room and telling the family, everything went well.” — Dr. Q (37:37–38:27)

---

Key Timestamps

• 02:01 – Surgery begins in the mind
• 06:24–07:34 – The “orchestra” of the OR
• 08:06–09:18 – Controlling microscope with mouth and feet
• 10:47–14:40 – Awake surgery: why, and the breadth of patient-specific monitoring
• 16:31–17:33 – “Stopping time” by stimulating the brain
• 19:05–20:30 – Mechanic metaphor, trust, and responsibility
• 21:21–22:32 – Discussing odds of success and choices about operating
• 24:13–25:22 – The stress and relief at end of surgery
• 26:28–27:44 – When surgeries go wrong; emotional scars
• 28:00–29:15 – Harvest to Harvard: Dr. Q’s journey
• 34:22–36:18 – Lightning round: “Show me two fingers,” tools, and micro-instruments
• 36:59–38:27 – The OR’s music, savoring family relief

---

Conclusion

Dan Heath offers a moving portrait of Dr. Alfredo Quinones Hinojosa, whose life and work embody not only technical mastery but also resilience, empathy, and gratitude. The episode illuminates both the complexity and humanity of neurosurgery, from orchestrating a room full of experts and machines to connecting, sometimes wordlessly, with hopeful families at the threshold of relief or grief. It is a powerful meditation on the blend of science, art, grit, and heart at the high-wire edge of medicine.

---

Recommended for listeners interested in:

• Medicine and the brain
• Human stories of resilience and transformation
• Precision, teamwork, and emotional stakes in high-pressure professions
• The interface between personal identity and professional calling

---

Transcript

[Marriage Therapist]

Foreign.

[Podcast Host Dan Heath]

I'm sharing something special this week. It's an episode of the podcast what it's like to Be from author Dan Heath. And every episode, Dan speaks to someone from a different profession. A veterinarian, an aircraft carrier commander, a Christmas tree Florentine asks what it's like to do what they do you like. How does the lineman know it's safe to grab wire carrying thousands of volts? What does the diplomat do when an entire embassy has to evacuate overnight? Or how does an aerospace Engineer Handle the 7 minutes of terror that decide whether a Mars rover lands safely? If you've ever met someone whose work you were curious about, this is the show for you. Here, Dan asks a brain surgeon about the most harrowing part of a brain surgery, why he operates on people's brains while they're awake, and his remarkable path to the operating room. If you dig it, find more episodes of what it's like to Be wherever you get your podcast.

[Interviewer]

How should I refer to you? What do you prefer?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

You know, I can go for almost anything. My full name is Alfredo Quinones Hinojosa. Some people can pronounce it, some people cannot. And this is why people began to call me Dr. Q. Dr. Q is

[Narrator Dan Heath]

a brain surgeon and chair of neurosurgery at the Mayo Clinic's Florida campus. He's got an absolutely astonishing life story,

[Interviewer]

which we'll get to later, but first

[Narrator Dan Heath]

I want to zoom in on one of his surgical days. He says his work begins long before he steps into the operating room.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

So the moment someone sends me a

picture about their scan, their surgery begins

to happen in my brain.

The potential complications, the potential dangers, the issues that can become catastrophic.

[Narrator Dan Heath]

On every surgery day, he follows a careful routine.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

I like to come in early in the morning. I like to review all the films, review my notes about the patient and family.

[Narrator Dan Heath]

Most of Dr. Q's surgeries involve removing brain tumors. And in the morning, as he studies the images, he's mapping out the challenges ahead.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

It's like when a boxer walks into the ring. It's when the lights are above them. But the real training, the real fight happened in a dark room, in a dark gym, day after day, for many, many days before the surgery. Months, in my case. It's many years of preparation.

But that morning, when I'm looking at the films, I am cementing all those years of training into one specific moment where I know exactly what I need to do. And I have an idea about the

potential dangers and how to dance around those potential dangers.

[Narrator Dan Heath]

I'm Dan Heath. And this is what it's like be. In every episode, we walk in the shoes of someone from a different profession. A hairstylist, a turnaround consultant, an archaeologist. We want to know what they do all day at work. Today we'll ask Dr. Alfredo Quinones Hinojosa what it's like to be a brain surgeon. We'll talk about how he knows where to cut and not cut, what it's like when the operation does not go as planned, and his own remarkable path to the operating room. Stay with us. On the day of his surgery, after Dr. Q has reviewed images of the patient's brain, he visits them before they're

[Interviewer]

wheeled away to get anesthesia.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

We already spoke about the dangers of brain surgery. And I like to keep it positive. I like to make sure that they feel my pulse, the warm of my hand. I like to sit right next to them. I like to ask them what they had for dinner the day before. And I like to ask them about some stories that I could potentially use in the operating room, because the majority of my surgeries are with the patients awake, and I have to monitor their speech and their function. So the more connections I have with them, the easier it is for them to overcome the fears and anxieties they have.

[Narrator Dan Heath]

And do you still get nervous before surgery?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

Oh, my goodness. And every time I am about to walk into the operating room, I get nervous. Is that fine line between life and death that gives you the pause, the

preoccupation, the adrenaline to make sure that

all your senses are hyper, not just

acute, but are hyper acute. So time slows down, your ability to

see, hear, multitask, it gets super enhanced.

And it's that adrenaline, in my opinion,

that allows you to do things that are sometimes considered to be very challenging.

For instance, the moment that something goes wrong, which has happened to me. After you've done 5,000 surgeries, you know,

there's been moments where suddenly something changes quite rapidly. A blood vessel explodes, the vitals change, a patient has a heart attack, the

heart stops, you name it, anything. And at those moments, your adrenaline goes through the roof. Your heart goes to 180 beats per minute.

And yet you have to remain calm.

[Interviewer]

Paint us a picture of what the operating room is like for you. Like, is it. Is it quiet? Are you playing music? How many people are in the room?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

I tell you, this is the operating

room for me, is like an orchestra. It's like a symphony.

Because if you listen to the sounds of about 20 to 25 people moving

around the operating room, Quietly, the anesthesiologists, the machine beeping, the machine breathing for the patient. Sometimes, if you then go on and you look at the neurologists that are helping me monitor the brain function with electrophysiology, and you listen to their keyboards as they're entering information, or the squiggly lines that are beeping also, it sort of makes some music. And then you listen to the scrap text, the circulating nurses, moving equipment. And that sound is like the percussion,

you know, in a band. And if you listen to the steps, you know, of the people moving around

quietly in the upper room, when you listen to the scrubs rubbing, you can listen to all that. It becomes the most beautiful music you can possibly imagine.

[Interviewer]

What are the tools that you have at your disposal? Like what are you holding or wearing as you operate?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

Well, several things.

I have high magnification glasses, they're called

loupes, you know, and a headlight. And once I get deeper into the brain, I bring a microscope that it is more expensive than my house, you

know, gets in there and gives me amazing light and a microscope that I can control with my mouth.

[Interviewer]

Wait, say that again. You control.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

I control the microscope with my mouth.

[Interviewer]

You control the microscope with your. How.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

Yes, usually I grab. I have a small little handle that is in my mouth that control this piece of equipment that is, you know, over a ton. And I can move it and it's all the technology then isn't that amazing? And I can still talk because I usually use my teeth a little bit. And I can still talk the way that you hear me talking as I'm moving the microscope.

[Interviewer]

So you're sort of like chomp down on something and you move your head to turn it, or you're using like breath in and out or what's the.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

I use my head. I imagine you just, you just put, put a pen on your mouth and you just move in your pen. That's it.

[Interviewer]

That is crazy.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

Then on top of that, I'm not done yet. Then I use a special chair that

has all kinds of controls, you know,

in my feet, in one foot, I have about 16 controls that allow me

to do things with the chair and

the microscope that suddenly I am fully connected to the patient in such a way that the patient, the brain, the

microscope and myself were almost one person.

So when one foot, 16 controls, with the other foot, about eight controls, and both of my hands are underneath the microscope under high level of magnification, and you have instruments that are finer than the finest pain you can possibly imagine

doing microscopic Movements to separate a small,

little blood vessel that is the size of a hair. But you know that that little blood

vessel could potentially mean the difference between

memories or no memories, speech or no

speech, motor function or no motor function. So that's how. And you take your time and your

patience, and you're listening to the orchestra,

the symphony of the operating room, and you're handing your.

You're moving your hands, and your nurse

predicts the instrument that you're going to need. A small, little, microscopic scissors. Small, little, microscopic, very sharp instruments that may look like a little scoop. Small, little instrument that may look like a little spatula that moves a blood vessel the brain. Or sometimes you use small, little devices that cauterize small, little vessels. They look like tweezers. And your getting together and you're moving around.

[Interviewer]

One of the most striking things about

[Narrator Dan Heath]

brain surgery is, as you said, that

[Interviewer]

the patient is often awake. Why is that important?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

Well, Dan, the reason why being awake

is important for me in my specialty,

because I do brain surgery.

There are brain surgeons who do epilepsy. There are brain surgeons.

I do vascular neurosurgery.

I do brain brain tumors.

And the majority of the brain tumors that I do are intricately related and adjacent or sometimes invading and penetrating parts

of the brain where speech function is important, where motor function is important, where sensory function is important, where vision is

important or memory is important.

And there's no machine then in the world that can monitor those functions better than the patient's own brain.

So what I tell patients when they

ask me, why do we need to do this surgery awake?

I said, because your brain is the

best neuromonitoring technique that I have available in the world to be able to do do the best surgery for you.

[Interviewer]

So is the idea that as you're inspecting the site of the tumor, that you can, you know, deliver little electrical zaps to different part of the brain, and you're kind of monitoring to see, okay, when we zap that, does anything bad happen? Is that the idea?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

100%.

I zap this little area, and suddenly the patient stops talking. And I know, oh, my gosh, I should not take that out.

[Interviewer]

But how? I mean, there's like a thousand different things that your brain does. I mean, how do you sort of monitor for all those things in real time?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

So over the years, what we began to realize is that the brain has

function, is organized, has eloquence, has parts

of the brain that are like oceans, where we have no idea what kind

of function is there.

So the way I I deal with my patients. I ask the question, you know, I recently had a patient that mathematics, accounting was very important for him.

And we needed to make sure that we preserve that function to the max.

So we forgot to the operating room, we did maximum amount of testing to maximize the test that we could do in the OR that will maximize that function preservation. And that's what we do.

[Interviewer]

Wait, so you were giving him like math questions during the surgery?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

Questions during the surgery. Absolutely. Very complex math questions to which I had no idea what the answer was.

[Interviewer]

So you had to refer back to his own answers to see if he was getting it right?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

Well, we, I had a neuropsychologist, we had a mathematician, you name it. And then imagine I had another patient who was a patient that was a music, a classical guitar expert. And he did an amazing job. He had, he had a two hour concerto that he put together for me. So during my entire surgery, he was serenading me with music from my own country, from Mexico, from the 40s and 50s, you know, music from the United States from the 60s and 70s. So he had a whole two hours because I had to make sure that I preserve. He says, I'm okay if I cannot talk, but I cannot not play music. I need to play my guitar, you know, I had another patient recently that he was important for him. He works at an airport and he directs traffic, so air control. So we set up our computer to simulate what work would be like. And during the surgery, he was monitoring flights, directing flight, doing all kinds of

[Interviewer]

stuff that is so interesting. So it's actually different for different patients. I didn't expect that.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

That's exactly. For someone like you, it would have to be probably depend. Just listen to you, which make sure that we preserve your voice, your ability to ask all these probing questions in an interview, and you name it.

[Interviewer]

So what are the kinds of classic tests that you're administering as you work? You're looking for speech comprehension, I assume. What else?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

Well, there are some baseline things that

we have sort of utilized for decades.

The ability to read sentences, the ability

to understand complex instructions, you know, the

ability to produce speech that complements being asked a question and then being able

to answer that question. What does the cow do?

Will they move?

You know, what does the, you know, tiger do?

And so on and so forth. So there's a lot of questions that are baseline, you know, functions. And I follow the best way that I can describe it. The brain has sulci and gyra. The best way that I can describe it, it has roads, avenues And I go avenue by avenue, road by road, and I begin to stimulate and put in numbers. And when I find an area that has a question, I pause, I keep going. And then I go back to that area a few minutes later and find out, is that area important? Was that just a mistake, or was it real? And then I do it at a minimum of three times to confirm that it was not just an oversight, because we all made mistakes.

[Interviewer]

So when you hit a part of the brain that clearly is responsible for some core function and you realize it,

[Narrator Dan Heath]

how do you realize it?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

Sometimes it's so abrupt. You know, let's say that I have a patient, and I tell the patient, I want you to count from 1 to 40. And they start 1, 2, 3, 4, 5. And I'm waiting until they get a rhythm. And then when they're, like, around 10, I go ahead and stimulate a part of the brain, and there is no function. They keep counting like, nothing. If it is a part of the brain where I can literally stop language, the patient stops as the moment I touch the brain with my stimulator. They stop at 10, and they pause. And I got my stimulator on the brain for 1 second, 2 seconds, 3

seconds, making sure that I don't give any seizures.

And then suddenly, I take the stimulator away from the brain, and the patient continues. 11, 12, 13. And then you ask them what happened, and they'll be like, what do you mean, what happened? I was counting. They don't realize that you have them stop time. Isn't that amazing?

That's how beautiful the brain is.

[Interviewer]

That is completely insane. What is the strangest response you've ever gotten from one of those tests?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

Well, the stranger response is eliciting memory. The strangest and at the same time, more beautiful. You know, we're stimulating a part of

the brain, and suddenly the patient will remember a memory of childhood, a beautiful memory of their parents, a beautiful memory of their pet, or something very powerful. And they get either very ecstatic, happy if it's a happy memory, or they get very sad if it's a sad memory. And that, to me, is the beauty of how little we know about the brain and how much more we need to learn.

[Interviewer]

This is absolutely fascinating. I mean, what is so striking is that, I mean, here, brain surgery is surely one of the pinnacles of human achievement. I mean, the sophistication of the people in the room and the tools and the monitoring, and then adjacent to that is the actual mechanics of the surgery are you're going around poking Parts of the brain to see if they're safe to cut out with a knife, you

[Patient or Assistant]

know what I mean?

[Interviewer]

It's like this incredible blend of complexity and almost like plumbing behaviors.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

100%, I agree with you.

And I poke fun of myself. I tell people that I'm nothing else

but a highly regarded mechanic of the brain.

That's it. That's how I see myself. And of course, I do recognize it,

that it is very complex, it's very

sophisticated, and it took many, many years to get to where I am.

Of course, I've been doing this for over 25 years. But the reality is that there's some

level of simplicity that you very eloquently illustrate.

You gotta roll your sleeves up and you gotta get in there and you have to have sometimes little splashes of blood on your face. You gotta get a little bit of that bone dust that comes along when you are removing this skull, or sometimes a little bit of the. Of the muscle, as is being, you know, cauterized with electricity and the little

smoke that comes out.

That's 95% of my work.

But a lot of the attention is in the 5% because it is absolutely remarkable. I got to tell you that the

most remarkable thing for me is not what I do as a brain surgeon,

is not the technology, but to me is the fact that a patient and

their loved ones are one willing to put their lives on the hands of a stranger.

And that, to me, speaks about the

power of trust and the power of believing, which is all in the brain.

And that, to me, is remarkable.

[Narrator Dan Heath]

After a quick break, what's the most

[Interviewer]

stressful part of a brain operation?

[Narrator Dan Heath]

Stay with us.

[Interviewer]

What is the track record for the kind of brain surgery that you do? Is it relatively high percentage chance of success, or are the situations so precarious that any chance of success is worth

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

trying or likely nowadays is extraordinarily high. The chances of complication for a healthy person are probably in the 1 to 2% complication.

[Podcast Host Dan Heath]

Wow. Yes.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

Think about this. Then. 100 years ago, it was almost a

100% mortality with brain surgery. So we have come a long, long

[Interviewer]

way when they brought the leeches out.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

Yes. Remember, they used to. So I think the chances of success are very high. Now, having said that, there's still a percentage, 5 to 10%, that you may have an issue, that you may have

a deficit, whether it's motor function, inability to move the hand, leg, face, or some sort of a speech deficit.

And at one, you don't know exactly

if it was done by the surgery or exacerbated by the surgery?

Or was it just the fact that the air hit the brain and you mobilized things?

Or the disease is moving so rapidly

that it's affecting other parts of the

brain, but nonetheless, likely the chances of success are so, so high.

Now, every now and then you will have a patient where you look at

the scans and you realize, no matter what I do to this patient, all I am going to is do a brain surgery. And they're going to spend the last few months of their life in and

out of the hospital. So I want to do what is best for this patient and their family.

And sometimes what is best is not to do anything.

[Interviewer]

What do tumors look like?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

You know, in the mri, tumors look

most of the time like a light bulb. And people say, oh, there is the tumor.

It should be no problem taking it out.

Once you walk into the operating room many times, there is no clear distinction between what is tumor and what is normal. And most especially at the edges of the tumor, when the tumor begins to

invade the brain and we know there are cancerous cells right there and very likely important brain at those edges, but

you can tell the difference.

[Interviewer]

What does it feel like when the surgery is over?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

Well, first of all, I tell you

that for me, the most stressful moment, if everything went well with the surgery as I expect that it will go,

I finish the surgery, I wait around

until that patient is awake and moving.

[Narrator Dan Heath]

In 2008, ABC's documentary series Hopkins followed Dr. Q at Johns Hopkins Hospital in Baltimore. Cameras rolled as he performed brain surgery.

[Patient or Assistant]

What do you think we have here?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

It's fairly straightforward. Meningioma.

[Patient or Assistant]

Wonderful news. Thank you.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

And the patient is getting extubated at

the end of the surgery.

And then the anesthesiology is going, show

me two fingers, no function.

Squeeze my hand, no functions. And then I'm looking at this and I'm getting worried. All right? Cuz I know what that potentially means. So I come in and I say,

[Patient or Assistant]

michael, squeeze my hand. Squeeze my hand, Michael, squeeze.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

And you're literally yelling because remember, they're coming out of anesthesia.

[Patient or Assistant]

Squeeze my can, bud. Squeeze my can.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

At that point, my heart was about

to burst out of my chest.

I was thinking, did I do something to that patient?

That that patient is not going to be able to wake up.

[Patient or Assistant]

Wiggle your toes. Can you wiggle your toes?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

There you go.

[Patient or Assistant]

Good job. Very good. Yes. It's just great.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

Just great. This is what keeps me going every day. You know, I mean, I deal with very bad disease, you know, Brain cancer. It's tough, but every now and then we just have this nice, very good news. It's just exciting. Everything went great. So he'll be Mike again? I think so.

[Patient or Assistant]

Very good. Okay.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

I tell people we are not better doctors than many other doctors. We are not better surgeons than many other surgeons. I think that what makes us special and different, why society has put us where we are, is because we have this amazing ability to emotionally deal with so much uncertainty and where the outcomes and the stakes are so high every single day between life and death in

[Interviewer]

the operating room, what is it like when the surgery just doesn't end in a success?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

I would say that the most difficult times in my life, the moments where I have landed and got down in my knees, where life just puts you down and you feel like there's a fine line between not wanting to do this again and quitting had been those moments where the surgery didn't go the way that I didn't want it to go.

And I cannot tell you that it's

never happened to me. Unfortunately, when you have done this for more than 5,000 times, it has happened to me. I think those are the moments that have taken years of my life, Dan. And those moments, I gotta tell you, they're not easy for me to get over. It takes weeks, months, years. And I always tell people I carry those scars in my heart. I have never forgotten the patience that have passed through this life where I have wondered, did I do something to accelerate that demise?

[Interviewer]

There's a great Netflix episode about you and your work. We'll put the link in the show notes. But at one point, you have this quote where you said you went from harvest to Harvard in less than seven years. Tell our listeners what you meant by that.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

It was amazing. You're talking about the surgeon's cut. That is a quote that most people don't realize. I came to this country in 1987 undocumented, from a very poor family in Mexico. My parents had no education. I was undocumented. I was poor. I came to this country undocumented and poor, to work on the fields of California in 1987. And by 1994, I was matriculating at Harvard Medical School.

[Interviewer]

That is absolutely crazy. I mean, what. What do you attribute that to?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

You know, I gotta tell you that I wish I can give you the recipe for many is now, now.

It made me reflect about the miracle.

And I attribute. This is. I'm going to say it.

I attribute this to how amazing this country is. This is the country this is the land of opportunities. Now, don't take me wrong. We still can do a lot for

humanity, for our country.

But I cannot conceive stories like this happening in too many places around the world. And I still believe they can only happen here in the United States.

[Interviewer]

Another point in the episode that I appreciated, and correct me if these facts are wrong, but at one point, I think you said that you're one of 50 grandkids for your grandfather and that you were the worst behaved of the lot.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

I was one of 54 in my father's side. In my. I was not the oldest, I was not the youngest, I was not the smartest, I was not the hard worker. My distinction was that I was the one who got in trouble the most all the time. I had such an inquisitive mind in a curious personality. And when people say no to me, I want to do it even more. So my grandmother and my grandfather played an important role.

My grandfather, he was an extraordinarily gifted man in music. And even though he never went to school, he learned how to play many instruments. And he had a wandering spirit. He would allow me to go and explore, and I could do no wrong in his eyes.

And my grandmother, she was the opposite.

She was the one who was also,

by the way, a town healer and a midwife.

And I saw the amount of respect

that people had for her, the love that people had for her.

But she had also a very strong personality. And she was a disciplinary towards me.

And nowadays, then, if you look at me, if you look at my picture and you look at a picture of my grandmother, imagine that you see me. The more I age, the more I look like my grandmother, physically, spiritually, and

also in my personality.

[Interviewer]

How much does being a brain surgeon affect the choices you make in your daily life? Like, are there things you won't do because it might injure your hands, which are, of course, precious for surgery?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

You have alluded to something, that I had to think about it because, remember, I was a migrant farm worker in 1987. I fixed a 351v6 Chevrolet engine and so on and so forth. I was working in the fields, picking cotton, tomato, driving all these machines. And suddenly, here I am, years later, after Harvard and after my residency and being at Hopkins, now here at Mayo, where, you know, I have to be careful with what I do. And that came clear to me when I finished Harvard and I went back

to California, to the University of California,

San Francisco, and I had my pickup truck. It was a 1987, you know, Nissan pickup truck. And the alternator needed to be exchanged. And I proceeded to bring my tools out and exchange it.

And it was a little bit rusty

and I was struggling and suddenly one of the wrenches slipped and I ended up cutting my hand. And it was for the first time, and I was already a resident in neurosurgery. It was for the first time that I realized it was that what I did had consequences, but not just on myself, but on the people that I care for in such a way that I couldn't scrub my hands for a

few weeks until that wound healed, so

that therefore my actions could have a downstream effect on other people that I care for. So, yes, there are things that I think about, you know, and you'd be surprised. So, you know the Netflix, you saw it. You know that I love boxing. I don't get into the ring anymore. The last time is when I was 17 years old. But I love having my punching bag and exercising. What do I do? I wrap my hands and my wrist in ways that you could never imagine. I also study for many, many years the way in which I should hit a bag without prompting any injury on my fingers, my wrist, or anything else.

[Interviewer]

So, Dr. Q, we always end our episodes with a lightning round of questions. Let me fire away here. What is a word or phrase that only someone from your profession would be likely to know and what does it mean?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

Show me two fingers.

[Interviewer]

That's the diagnostic that things are okay, right?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

That's exactly right. Show me two fingers. But I also have some other connotations, as you know.

[Interviewer]

I thought you were going to give me some obscure neuroanatomical term or something.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

Well, yes, I will do that, too. Where is the indusium griseum?

[Interviewer]

Above the neck.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

Above the neck, that's right.

[Interviewer]

What is the most insulting thing you could say about a brain surgeon's work?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

This is so funny that you asked that I would say that the most

insulting thing that you can say is

it's not so much about my work, but the profession. When someone. Because it's actually insulting to the opposite profession. When someone says to you, oh, you're a neurologist. And the neurologist gets offended and the neurosurgeon gets offended. The neurosurgeon gets offended because we're not neurologists. We know a little bit of neurologists. We like to think we're not as smart as the neurologist. And the neurologist gets offended because they know that they're extremely bright and they don't put Their hands on the brain. They work through diagnosis and medications and everything else. So I would say that that's probably insulting both ways to a neurosurgeon, a brain surgeon and a neurologist.

[Interviewer]

I love that. It's a rare two way insult.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

That's right.

[Interviewer]

What is a tool specific to your profession that you really like using?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

I personally like to use a bipolar

coagulator, which is like a little tweezers that allows you to coagulate a small little blood vessels.

[Interviewer]

Like how small would the action zone on this thing be?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

All this would be as small as. Imagine trying to grab a small little hair.

[Narrator Dan Heath]

Wow.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

With this little tweezers, you know, and

sometimes the only way you can see that little hair is with the microscope. That's why you use the highest level

[Interviewer]

of magnification that you're controlling with your mouth.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

That you're controlling with your mouth.

[Podcast Host Dan Heath]

Yeah.

[Interviewer]

Is normal life just boring for you after spending hours in that kind of.

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

Just never, never, never know. On the other hand, it allows me

to see life with such an enthusiasm and such a love and not take anything for granted.

[Interviewer]

What is a sound specific to your profession that you're likely to hear?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

The sound of the anesthesia machine beeping,

the beep, beep, beep, beep, which is the heart beating. And you want to hear that sound all the time.

[Interviewer]

And I imagine you're so accustomed to that that you immediately process any deviations from the rhythm. If it speeds up or slows down

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

100% and you're attuned and you remember what I was telling you, because you're listening to the music, you listen to

the orchestra, the symphony, and if a

note is off, you recognize it right away.

[Interviewer]

What's an aspect of your work that you consistently savor?

[Dr. Alfredo Quinones Hinojosa (Dr. Q)]

Oh, I savor every time I finish a surgery and everything goes well. It's likely it's most of the time. And I put families on the room, and I walk into the room and the first thing that I like to tell the family, everything went well. And they all stand up, and before I even get close to them, they're rushing to hug me. And those moments are so private and they're so beautiful. And they are. They touch my heart, they fill me with hope, and they give me the energy to keep going, even in those moments of darkness that we talked about earlier.

[Narrator Dan Heath]

Doctor Alfredo Quinones Hinojosa is a brain surgeon and chair of the Department of Neurologic Surgery at the Mayo Clinic's campus in Jacksonville, Florida. He wrote about his remarkable journey to the operating room in the book Becoming Doctor My Journey from Migrant Farm Worker to Brain Surgeon. You'll find a link to that book in the show Notes, along with his featured episode in the Netflix documentary series the Surgeon's Cut, which is brilliant. I can't stop thinking about harvest to Harvard in seven years.

[Interviewer]

Incredible.

[Narrator Dan Heath]

As I see it, it's a story with two, two distinct sides. On one side is Dr. Q's vast potential and talent and drive to have the ability to vault himself upward like that. And on the other side is the ecosystem that allowed that potential and drive to manifest. So if you think about someone you manage, or your kid for that matter, you can ponder that same two sided story. Are they capable of thriving? And one side is about their personal capacity and drive and the other is about their environment. Are they in a place that permits them to thrive? It's kind of like a plant and the soil that it grows in. There are no universals with either. Some plants are delighted in a hanging planter and some plants manage to grow 10ft tall in the desert. How can we find the right soil for the people we care about? Dr. Q found a place to thrive and thousands of families are lucky to have received his care. Identifying the talents that a patient could not stand to lose. Probing the brain to distinguish invader from host. Performing in the symphony of the operating room. And sharing the news with desperate relatives that their loved ones came through. Okay, folks, that's what it's like to be a brain surgeon.

[Interviewer]

I hope you enjoyed my conversation with Dr. Q in every episode of this show. What it's like to be. I talked to someone from a different, different profession. If you're interested in more healthcare professions, check out my conversation from last year with a hospice nurse. That's episode 45.

[Hospice Nurse]

So we have to sort of negotiate food. And what does it mean to respect the patient's right to not want to eat or I want to eat. I don't care if I'm diabetic, I want a milkshake or I want to eat the slice of cake and to say, just let him eat. Let her eat, let her enjoy.

[Interviewer]

If you want a doctor, but for animals, we've got an episode featuring a veterinarian who is great.

[Veterinarian]

It was a really pivotal moment for me in my life and I've never stopped. You know, again, asterisks. Not mosquitoes or roaches or ants or insects, but other living creatures. I've never stopped caring about them and really wanting the best for them.

[Interviewer]

And if you want something outside the medical field completely. We've got lots of those. Start with episode two, featuring a couples therapist.

[Marriage Therapist]

You know, inevitably, somewhere I get cornered on long runs, long rides, anytime on, like, an airplane, someone finds out that I'm a marriage therapist, and it is immediately just like a loss of the next two hours of my life and not getting paid for it.

[Interviewer]

So this episode was produced by Matt Purdy. I'm Dan Heath.

[Patient or Assistant]

Thanks for listening, Sam.