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Becoming Dr. Q My Journey from Migrant Farm Worker to Brain Surgeon

Read Chapter 1

Starry Nights

During the many minutes when I lay at the bottom of the tank without oxygen, struggling on the battlefield between life and death, there was something about the image of being on my back, enclosed in darkness and staring up at the light, that connected me powerfully to my childhood years. Indeed, whenever I travel back along memory's narrow pathways that lead to the furthest past, the familiar, starry night sky is the first image that rises to welcome me home.

There in the outskirts of the tiny village of Palaco where I was raised, in the northern part of Mexico's Baja peninsula, I spent many of the hotter nights of the year up on the roof of our little house. I would often lie awake for hours studying the infinite expanse of blackest outer space-everything lit by a glowing moon and millions of bright, sparkling, dancing stars. It was there, underneath the panoramic dome, that many of life's most pressing questions were first planted in my imagination-and where my high level of curiosity and hunger for adventure were cultivated. Under the stars, I could also find relief from the weight of daily concerns and from other worries whenever sadness or sudden misfortune struck.

Such was the nature of my earliest, clearest memory which took place when I was three years old. The trauma had to do with one of my siblings, my baby sister Maricela, whom I would always remember for her big brown laughing eyes and her round, chubby, smiling face. Suddenly, when I came home from playing one morning, she was nowhere to be found.

At the time, we lived in the two back rooms of my father's gas station. When I walked into the kitchen area of our living quarters that morning, I felt terrible sadness in the air. The day was gloomy, humid, and uncharacteristically cold. Unfamiliar yellow vinyl chairs had been arranged in the kitchen, where my mother, Flavia, was seated. A pretty, petite woman who was usually joyful, Mamá was sobbing as she cradled Maricela's twin, five-month-old Rosa, to breastfeed her. At her side was my little brother, two-year-old Gabriel. Gazing around with his large, thoughtful eyes, Gabriel sucked his thumb quietly as he leaned against our weeping mother. In front of the yellow chairs sat a tiny rectangular wooden box-a casket, I later learned-covered by a colorful handwoven blanket. Family members and neighbors filed into the room, many of them softly crying.

When I asked my aunt why Mamá was so sad, she explained that this was the funeral of my baby sister Maricela.

"Where is Maricela?" I whispered, unable to connect my happy, chubby baby sister with the casket.

"Maricela went to heaven," my mother said solemnly, wiping her tears.

Why was everyone so sad? After all, I had been told that heaven was a wonderful place where people could go to be with the angels. Shouldn't we feel good that she had gone to such a nice place?

Years later, I learned the tragic circumstances of Maricela's death-acute diarrhea and the accompanying dehydration, a common and curable condition, if the right medical resources are available. Initially, she wasn't taken to the hospital because we lived in the middle of nowhere with no accessible facilities nearby. The difficulty in obtaining medical attention was a function of the relative poverty in this rural area outside of Palaco, a small village of about five hundred families, some thirty miles from Mexicali-the border town that is split by a fence and is known as Calexico on the U.S. side. In our village and environs, we had no private doctors who made house calls, nor were there clinics close by. Many everyday medical needs were met in the boticas housed in local pharmacies. When Maricela's symptoms first appeared, my mother took her to the botica, and the pharmacist gave Mamá medicine to ease the baby's stomach problems and the pain later diagnosed as colitis.

That evening, when my father came home from work, Maricela began to laugh when he picked her up in his arms. Papá took her smiles as a sign that the medicine was working. But in the middle of the night, as her screams worsened from what was clearly horrible pain, my parents rushed Maricela over to my grandmother, Nana Maria, my father's mother, a curandera who specialized as a midwife and herbalist. My grandmother had delivered hundreds of babies through the years and was revered for her ability to know when a case required special attention. Nana knew at once that Maricela needed to be taken the hour's drive to the seguro social-the public hospital-without delay. My parents understood the gravity of the situation and raced to get there.

At the hospital, one of the physicians on duty knew my grandmother and heeded her concern, admitting my little sister immediately while reassuring my parents that she would improve by morning. With their hopes raised, Mamá and Papá then suffered the anguish of watching Maricela's convulsions increase over the next two days, and in the end, losing her. Though they did everything they could, their efforts weren't enough to combat her colitis, which had quickly reached an advanced state, nor to make up for the fact that the small, poor hospital didn't have the medicine or other forms of treatment that could have saved her. Tragically, in developing countries such as ours, diarrhea and resulting dehydration are still the main cause of death of little ones. But this aside, I know that my parents continued to ask themselves Why? and the question hung over the household for years.

My father and mother were not strangers to loss. My father had been one of eleven children, one of whom had died at the age of ten before my father was born and whose death left a lasting shadow in that household. My mother had been virtually orphaned at the age of six when her beloved mother had died in childbirth, leaving her essentially to raise the younger children, slaving under the abuses of her paternal aunts and trying to hold the family together while her father, my grandfather Jesus, struggled to find his footing after his wife's death.

Though my parents never spoke openly of their sorrow, it was a presence in our lives, an undercurrent of sadness that affected each of us differently. I suspect my sister's death had something to do with the added sense of responsibility I felt as the oldest of five children in our household, and with the recurring childhood nightmares in which I would find myself in the midst of disaster-fire, flood, or avalanche-and know that it was up to me to save my mother and siblings. In each of these dreams, part of the story was that I'd been given superpowers-able to walk through fire without being burned or swim through tidal waves without drowning (in reality I couldn't swim and would never be at ease in the water). The notion of having special powers must have come from my ambition in those years to follow in the footsteps of Kaliman, a Mexican superhero who could fight off the attacks of multiple demons in one move: the gravity-defying Kaliman maneuver that I was determined one day to master. In my waking hours, I was convinced that I could really do this. But in my nightmares, to my despair, before I could put my superpowers to work and save my loved ones, the dream would end and I would fail in my mission. Every time, I'd wake up crying in bewildered frustration.

The death of Maricela, my repeating nightmares, and the considerable amount of responsibility I felt from an early age may help explain why my most primal struggle was to understand and make sense of life and death. These experiences may also have planted the seed for my later interest in medicine. In the meantime, the idea that my sister had gone to a better place was comforting. It fueled my already active imagination and my curiosity to know more of the world beyond what I could see and observe in the everyday comings and goings in the outskirts of Palaco. Long before medicine was a remote possibility for me, I dreamed of a life of travel and adventure!

Then again, as I recall my nights of stargazing in the period when I was six and a half, almost seven years old, I was ready to settle for being an astronaut. I announced my plan one stiflingly hot night in the autumn of 1974 to my mother, my five-year-old brother Gabriel, and my three-year-old sister Rosa.

Everyone laughed. I was definitely the family dreamer!

There were many nights like this one when the suffocating heat made sleep impossible inside our two-bedroom house, where we had moved a year earlier. Just across the canal from the gas station, the adobe-style house-built of cinder blocks in one part and mud in the other-lacked air-conditioning and was like an oven, baking everything inside it! When the heat was unbearable, like this night, the four of us opted to climb up to the rooftop, first spreading blankets over the scratchy tar-paper surface, then settling into position. Rosa curled up on one side of Mamá, while I was on the other, in between her and Gabriel. Our flight to the roof was to escape not only from the heat but also from the ever-present threat of earthquakes known to collapse houses and create mudslides in this part of the Baja, where the San Andreas Fault trails down from the West Coast of the United States. Up on the roof, you were more likely to survive by avoiding having the house fall on you-as had happened recently in the area, killing hundreds. Yet those worries seemed to vanish under the stars-where all was safe and peaceful and fun!

Clasping my hands underneath my head, I made a pillow for myself, and with my legs crossed, I was at ease-happily engaged and ready to savor the show playing out in the sky above us and in our surroundings.

For a while, we were quiet. None of us said a word as our senses awakened to the sights, sounds, and smells of the night. I could hear the chirping of crickets and the buzzing of other insects, along with the loud croaking of the toads as they sang with a bravado that reminded me of the strolling mariachis who frequented the restaurants of Mexicali.

In these years, we were fortunate to be dining in restaurants every now and then, and to be part of the lower middle class in our village, slowly rising out of poverty-thanks to the modest earnings from my father's gas station. While our status was more precarious than we knew, I recognized that the steps up the ladder were many. I was aware too that not every family could afford to eat some meat once a week as we did and that none of our good fortune would have been possible if not for the family work ethic. I had been taught this fundamental lesson starting from the age of five, when I went to work at the gas station every day after school and on weekends, pumping gas, learning to fix cars and trucks, even driving them in and out of our mechanic's garage with the help of many cushions. I saw nothing unusual about being a five-year-old who could drive or climb up on hydraulic lifts to look under the hoods of cars and trucks to assess what needed repairing-all part of the job.

My family imparted the importance of hard work directly and by example. My father started his day at dawn at the gas station and didn't close down until nightfall, when he would go out to spend some of the day's earnings for food and other necessities for the family. For that reason, he wasn't usually up on the roof when we went up there to sleep. But I knew that when he returned home later, he would probably have something for all of us to eat in the morning-often my favorite, a loaf of pan dulce, sweet bread.

Up on the roof on this night in my memory, I imagined with pleasure what breakfast would bring even as I inhaled the green, wet, earthen smells of the night, savoring it all. Everything was fresh, present, and alive-like the smell of newly picked watermelon lifted from the wet soil, ripe and ready to be eaten. How well I knew these smells from recent outings to work in Palaco's cotton fields. Though our efforts weren't needed for the money at this point, my parents believed that we would use lessons from the fields in other ways. Papá also wanted to show me that working at the gas station was a much better job than standing out under the blazing sun all day and pulling cotton with my bare hands bleeding.

Out in the field, there was no use complaining. So I made the best of the situation by watching the process unfold-as we walked up and down the rows, picking the light fluffy pieces of cotton and putting them into long burlap sacks, and then watching how the filled-up sacks were weighed so that we could be paid by the kilogram. There was no shame in being a field worker. This was opportunity. Besides, I felt proud of what I could accomplish with my bare hands. And the moral of the story was twofold: first, every job in the entire operation counted-no job was meaningless; second, no matter how small and fluffy that piece of cotton felt, if we kept pushing ahead, all those bits of fluff would accumulate and have real weight-as much as twenty or thirty kilos that were worth their weight in pesos!

Such was the value of honest, rigorous work-bringing with it the pride of a job well done, some form of compensation, and sometimes opportunities to advance in the world. This was how I came to purchase the used bicycle I desperately wanted. Gabriel-a much more obedient child than I who also had more common sense-was unimpressed when I brought home the bike. "How can you ride it?" he laughed, pointing out that it had no pedals or brakes. To prove him wrong, I learned to ride it sideways and basically roll wherever the bicycle wanted to go.

However, Gabriel was considerably more enthusiastic when the two of us found a used black-and-white RCA television in a secondhand store and convinced our father to buy it-though he was careful to point out that we had only one line of power to the house and it was needed for the refrigerator and the two light bulbs that lit our home. Unfazed, we managed to build a makeshift outlet that gave us enough juice. Once we replaced the picture tube, magically the picture came on, thrilling us-at least during the few hours that Mexican televisions aired the two stations available.

Since the TV image was very grainy, we covered the windows with blankets to darken the rooms. With temperatures as high as 120 degrees outside, the insulation only made the interior more ovenlike. But we didn't care! The TV was a luxury item that connected us not just to the rest of the world but also to the fantastic possibilities of space travel to strange new worlds. We were hooked on the afternoon reruns of Star Trek, raptly following every move of Dr. Spock and Captain Kirk as they explored the galaxies-facing dangers, fighting battles, dodging asteroids, and venturing into unknown realms.

There was one huge problem. After being so industrious and using our ingenuity to fix the television set, I could seldom watch it because I had to work at the gas station after my father picked us up from school at midday. Sadly, that meant I could see Star Trek only on a catch-as-catch-can basis. I remember being desperate to watch an episode that was to air at four-thirty on a Thursday afternoon. When Papá picked me up at school and I asked if he could make an exception for this day, he firmly replied, "No, Alfredo, you have to work," and left it at that.

I was devastated. But I didn't cry. Instead, when we arrived at the gas station, I hopped out of the car, set my jaw, and went about my duties with greater purpose, hoping to forget all about the Star Trek episode I was doomed to miss. By the time four-thirty rolled around, I had almost succeeded in pushing it to the back of my mind. Papá then called me over and gestured toward home, telling me, "OK, son, you can go to the house," and before he could add "and watch your show," I was out of there as fast as my speeding little legs could carry me.

When I flew in the door, Gabriel informed me that I had missed only the opening credits, and we were able to watch in wonder together as the USS Enterprise journeyed into the unknown. The episode was everything that I'd anticipated and more! And on that hot autumn night in 1974, up on the rooftop with Gabriel, Mamá, and Rosa, I knew that I could land on a hostile planet some day, just like Captain Kirk did during that episode, and use my skills of diplomacy to keep the peace. Energized by the sounds of the wind in the brush of the foothills to the north of us, I basked in the main event already under way: the real star show. I loved the speedy stars-the ones that may have been the smallest but looked to me as if they were on a special mission, moving with purpose and power. Amazing! For the would-be astronaut in my six-year-old self, millions of stories and possibilities presented themselves on the giant blackboard above us.

In the second grade, I was beginning to have a sense of geography. I had heard that Palaco-which stood for Pacific Land Company-had been fostered by a long-gone American company that had come in around the 1930s to cultivate the various crops in the valley. I also knew that we were a satellite village like many others in the vicinity of Mexicali and that there were other, much bigger cities far from us in the huge country of Mexico of which I was a citizen. We had been taught about countries and continents, and the differences in their geographies. Whereas a few years earlier I had believed that the world was flat and that if I reached the end, I would fall off the edge, I now understood from school and from Star Trek that the earth was round-and was stationed much like a star in the universe. Aside from those basics, I had only questions: What was beyond the stars? What was between the stars and the blackness that separated them one from the other? Who created them? My mind couldn't conceive of where this expanse began or where it ended or how it could be measured relative to me, such a small being in the vast picture.

The only other person who seemed to be considering such mysteries was my paternal grandfather, Tata Juan. In fact, he helped plant the seeds of these big questions in my mind, urging me on to ever-greater heights. "If you shoot high and aim for a star, you might just hit one," he would say.

Once, when I was about five years old, I took his advice literally. I took my slingshot and a handful of stones up to the roof one night and did exactly as he had recommended-shooting each one forcefully as far into the sky as I could muster. Although I didn't hit a star that night, I was certain that one day I would.

According to family accounts, from the moment of my birth on January 2, 1968, I kept everyone on their toes. First off, an unusual bump on my head raised concerns, interestingly enough, that I might have been born with a brain tumor. Today I understand that I had a cephalohematoma-nothing serious. But at the time, family members wondered how I managed to survive the fist-sized protrusion rising from my skull-composed of burst blood vessels-which looked like a second tiny head trying to push its way through the skin.

Relieved when they learned that the bump would disappear on its own, family members turned their attention to my hyperactive nature, worrying that I would hurt myself. Even before I could walk well, my parents were shocked at how fast I could toddle off. I also learned to speak expressively by my first birthday and soon thereafter taught myself to tie my shoelaces. Now the real trouble began. My vanishing acts usually required the entire extended family to go out and search for me-like the time when I was about three years old and everyone was afraid that I'd fallen into the reservoir. They eventually found me selling the tiny shrimp I'd discovered in the irrigation holes out in the fields. My many uncles thought these antics were hilarious, but my numerous aunts disagreed. They soon labeled me a hellion in need of better discipline. My parents did their best, but little worked. Nana Maria predicted that if they didn't set some kind of boundaries for me, I would be a danger to myself. The job then fell to Tata Juan, who took me under his wing and became my first true mentor.

Tall and lanky, with chiseled features and an eagle's nose, Tata was a towering figure for all of us. A self-made man who had never been to school, he nonetheless learned to read and write music while teaching himself to play multiple instruments. Tata also managed to make a few wise investments during his years toiling in agriculture (as we used to describe working in the fields), and throughout his life, he carried himself with such a regal bearing that he could have been mistaken for an aristocrat. A gentleman as well, he was never without his hat-a sign of dignity, I believed-and he never forgot to remove it in the presence of the ladies.

"How are you today, my ladies?" he would say with great courtesy, sweeping off his hat and bowing whenever he passed a group of women of any age. I mimicked this mannerism as a child, even though I didn't have a hat. I enjoyed the reaction whenever I bowed and said in my most proper five-year-old pronunciation, "How are you today, my ladies?" The move worked so well, I've done it ever since!

My fondest memories of my grandfather come from our outings to stay in a cabin in the Rumorosa Mountains. Everything about the region-from the giant, rocky mountain peaks to the mysterious series of caves with prehistoric wall paintings left by ancient human hands-filled me with wonder. Along the hiking trails that led up the mountains, Tata defied his age and ran like a gazelle. On purpose, he would sometimes sprint off into the woods and I would have to think fast and follow him into the brush. There were times when he would disappear, and just before I started to panic, Tata would reappear and we would continue up the steep mountain together, far from the main path.

On one occasion, he put the lesson of our hikes into words. Placing his hand on my shoulder as we climbed, he said, "Alfredo, whenever you have the choice, don't just follow where the path leads. Go instead where there is no path and then leave a trail." Whether Tata had ever heard the similar quote by Ralph Waldo Emerson, I'm not sure. But I wouldn't be surprised if he had.

Not until we reached the rocky peak would Tata Juan finally sit down to rest. Then he would watch in delight as I continued to run wildly, calling him at the top of my lungs, "Tataaaahhhh! Tataaaahhhh!" and loving the sound as it echoed down the mountainside.

Though my parents never said anything, they must have been relieved when the two of us returned from the outings in one piece. I know they were also pleased that we were so close. But not everybody shared their feeling. One of my father's sisters famously complained that out of his fifty-two grandchildren, some of whom were senior to me, Tata seemed to spend more time with me than with anyone else. Papá probably suggested that it was helpful to have someone in the family who could control me!

My mother often enlisted Tata to act as an intermediary when she had to explain to me why I had to accept the consequences of disobeying the rules. I would argue against the punishment, whether it was to sit in the corner or to give up television, telling Mamá she was too strict. Whatever my transgressions were-whether I skipped my chores or got into a fight-Tata would ask me to tell him the whole story and then pass judgment. That's what happened one day when my mother was upset with me for playing on the railroad tracks behind our house. (Coincidentally, these tracks were part of the line that carried freight trains and railway tankers from Northern California. The train cars that passed through my backyard were the same tankers that I would one day clean and refurbish-and put my life in jeopardy in the process.)

As a child, I used to volunteer to help the switching guards and the engineers since they couldn't move as fast as me. My job was to wait by the side of the tracks until the last minute to identify whether the locomotive needed to have the track switched and, if so, leap over the track while flagging the guards and the engineers to pull the appropriate levers at the right moment. In my opinion, this was educational and excellent training in my quest to become either an astronaut or a superhero like Kaliman. My mother begged to differ.

On the day in question, Tata asked me to explain a particular incident and tell him why my job helping the switching guards required me to climb up on a tanker car that had only stopped temporarily-forcing me to jump when it suddenly got going again. After hearing me defend myself along with a few other details, he spoke slowly and sternly, "Your mother is absolutely correct, Alfredo. You could have been killed. You set a bad example for the other children. I think you should consider this as you go and sit in the corner." He had just repeated what my mother had already said-almost word for word! But when the words came from him, I agreed completely. The punishment was no longer unreasonable. In fact, I thought it was an honor to face my consequences at his request.

One reason I respected Tata was his ability to overcome the obstacles he had faced throughout his life. When he was growing up in Sonora, where he was born in 1907, his father was murdered by a band of pistoleros-lawless, thieving gangs who terrorized the countryside during the Mexican Revolution. His mother spiraled down into mental illness afterward-making life even tougher for my grandfather, who more or less raised himself.

Nana Maria had overcome much adversity too. Though I wasn't as close to her as I was to Tata, I was in awe of her role as a healer and pillar of the community. Through her work as a curandera, she taught me the most important lesson I would learn about the treatment and care of patients: in all matters, the life and the well-being of the patient must come first. Nana had a gift for connecting with her patients in an immediate, tactile way-looking into their eyes, studying their smallest of symptoms, putting her hands on their shoulders to be encouraging and to share her powerful healing energy. No one ever died in her care because she was so thorough that if she had any concern about whether someone required more than she could offer, she would refer the patient to a hospital or facility that could provide necessary services. Nana Maria never charged a single peso for her services. Her reward was being able to teach women how to take care of their reproductive health and their babies, and as a midwife, she considered it an honor to save lives and to lend a hand to new life coming into the world. That, to her, made for a richly rewarding existence. On call morning, noon, and night, she would remain awake and alert throughout protracted periods of labor and challenging deliveries, standing and working through the cold nights in the small unheated adobe homes of our area or through the stifling hot nights when everyone else fled to their roofs for relief.

After one very long delivery, when I was around six years old, on a blazing hot summer morning, I caught sight of Nana Maria on her front porch as I was playing outside my grandparents' house. Nana looked surprisingly fresh and renewed after a sleepless night as a midwife, though she was resting her legs and feet. She walked with a limp that my father said was caused by a deformity or illness like polio that had caused one foot to be much smaller than the other. Even in the days when she and Tata worked the fields, my grandmother never complained. Nana did believe, however, that too many of us took for granted the marvelous ability endowed to us through the power of our own two feet. And she never held back from admiring the beautiful gait of someone else or from expressing a wistful desire to have two normal feet and even to dance as others could. Perhaps this sense of her otherness made her all the more compassionate toward those in pain and in struggle. But that morning as I played with my cousin Cesar-a master at rock throwing who was helping me improve my technique-I noticed something magical about Nana Maria. Instead of appearing worn out, she was smiling and talking to Tata, as though invigorated. To have so much energy after going so long without eating or sleeping was incredible, and to achieve this while caring for others was a most noble act.

Just then, right on cue, a young couple walked down the road toward my grandparents' house. The young woman carried her newborn baby under a blanket while her husband cradled a live chicken in his arms. I was struck by the gratitude on the faces of the young mother and father as they offered my grandmother the chicken, the most valuable gift that they could find to express their thanks. Nana Maria was gracious, assuring them that their thoughtfulness would not go unappreciated in her humble home. Yet perhaps the gift she most valued was the chance to peek under the blanket and see the healthy tiny baby, knowing that she had done her job and had done it well.

The story had a twist that makes it stand out in my memory for another reason. After the young couple left and Nana went into the house, I decided to practice my new skills. The first rock left my hands with excellent speed. Unfortunately, my aim was terrible and I broke a window of my grandparents' house. Holy guacamole! But not giving up, I threw the next rock, carefully avoiding the house. Unfortunately, this time I wasn't careful enough to avoid hitting Cesar's head, causing a gash that bled profusely as his screams brought my grandparents running.

Nana pointed out that I had once again shown that I needed to be more mindful of my actions. Tata was greatly displeased. Of course, I felt terrible about my cousin and the window. But most of all, I didn't want my grandparents to be mad at me. And, in truth, they weren't, although they did worry. My grandmother spoke to my parents, I later learned, telling them I would go far in life only if appropriate boundaries were set. Tata Juan warned Papá, "Alfredo is unusually bright. But you must watch him. Otherwise, he will miss out on many opportunities." My parents were in full agreement. Their solution, rather than being overly critical, was to make sure that through education and the discipline of the classroom, I would settle down. The need for me and my siblings to go to school, work hard in the classroom and on homework, and make the most of our education was all the more important to my parents because neither of them had much formal schooling.

Before my maternal grandmother had died, she had taught my mother to read and write at home. In fact, one of the only memories my mother retained from this time was seeing my grandmother's loving smile of approval as they read together. But after being orphaned and made into a servant by her aunts, my mother had no option but to teach herself. Considering these limitations, Mamá did very well and was able to apply the basics in qualifying for a training program to become a nurse, her dream. Sadly, her father, my grandfather Jesus, refused to help her pay for nursing school. Still, Mamá continued to educate herself, developing skills she put to use when she later went into business, buying used items that she would refurbish and then sell. My father was thirteen when his family moved close enough to a school for him to attend for the first time. But as the oldest student in the classroom, already with facial hair, he felt like a swarthy giant sitting there. Though he managed to learn enough to later teach himself to read and write, he lasted only three months in class before quitting. No one was more disappointed than he was. Later, expressing regret that he hadn't been able to accomplish everything he wanted in life, Papá would tell us, "If you want to grow up and be like me, don't go to school."

After my parents married in 1967, they had considered continuing their education in some form, but with babies to feed and a gas station to run, they never had time. My father had taken on the business in his late teens when Tata Juan came to him and said, "Sostenes, I have been thinking about buying the Garcia Gas Station that is for sale. Would you like to be my partner?" Then, as a wedding present, Tata took my father aside and announced, "The gas station has always been yours, son. I knew that you would need it when you started your family."

Papá wanted nothing more than to make his father proud-to prove himself worthy. That task turned out to be more challenging than he expected. But in keeping with Tata's expectations, my father devoted himself to making the business a monumental success, soon transforming the ordinary gas station into a colorful, eye-catching enterprise. With his fondness for vibrant colors, he painted it a fluorescent mustard yellow with bright lime green trim. You couldn't miss it!

My father bequeathed his love of color to me. But his most important legacy was his oft-repeated phrase, which he would deliver either with a smile or with tears in his eyes: "Every man is the architect of his own destiny."

Tata Juan was of the strong opinion that charm and charisma could carry a person a very long way, and if you added hard work, honesty, and a good heart, you would go "a long way and back." He also believed that out of small efforts, great results could come. To prove it, he gave me my first marble, explaining, "If you use this well, in time you will have more marbles than you can count." How right Tata was. I soon became the king of marbles, setting up tournaments that I managed to oversee while working at the gas station. Thus began my training in multitasking-an indispensable skill for the future clinician, surgeon, and scientist in me. Soon, untold numbers of jars filled with marbles of every color lined the nooks and crannies of our little house.

At the age of six, however, my ambition to win all the marbles-a competitive streak that would get me into trouble later-worked against me when I was lured into a contest with a nine-year-old challenger. While he let me win, his older sidekick snuck into the entrance of the station and stole fifty pesos! Faced with such cold-blooded dishonesty, I had to avenge myself. But having tried before and gotten my ass kicked by bigger kids, I concluded that it was time to cultivate an entourage-a lasting tradition. My team was made up of former bullies I had befriended. They brought the muscle; I brought the brain.

I did not stand back from the fight, however. At the age of six, I was still in training as Kaliman, still certain that I could perfect the maneuver he used to fight off several adversaries at once. Studying the comic book version carefully, I analyzed the components of the maneuver and understood that to pull it off successfully I would need to embody the green-eyed, pantherlike agility of Kaliman by jumping five feet into the air while extending my arms and legs. The goal was to knock out four foes-two by punching them with my fists and the other two by kicking my feet. With lightning speed, I would not only disarm them but then land back on my feet-again, like a panther. It was also important, I decided, to make sure that my eyes blazed with defiance-just as Kaliman's eyes turned a more intense shade of green whenever he fought off demons.

As I explained to Gabriel and three of my cousins, "I am going to practice the Kaliman maneuver and I need your help. Do exactly as I say and you won't be hurt too much."

Seeing some concern in their faces, I reminded them about the problem we had been having with local bullies who were roaming the area and shooting their BB guns at us. We had to practice the maneuver ahead of time in case of attack.

We all took our places, bracing for the blows to come. I focused, inhaled deeply, bent my knees, and leapt into the air, rising two feet at the most. At the same time, I extended my arms and legs to simultaneously punch and kick but managed instead to miss my target entirely and land face down in the dirt-knocking the air out of my chest. Talk about eating dust! When I sat up on my haunches, the four of them stared at me in horror and shame that I had failed so miserably. Then they began to laugh uproariously.

My conclusion? Clearly, the comic book had exaggerated Kaliman's powers! From then on, as the tougher kids continued to make trouble for the rest of us, I looked for other ways to disarm the bullies.

Incredibly, even as an alleged hellion, I managed to survive childhood with only one visit to a doctor. On this occasion, the pain and infection in my bicep became so acute that I had to confess that I had fallen on one of the drumsticks I'd made to go along with the drum setup I'd put together. The wooden point of the drumstick, as sharp as an arrowhead, had pierced my arm, breaking off in the right bicep. It was amazing to me that the doctor could examine my infected injury and, like a wizard, remove the piece of wood from my bicep and give me the correct medicine to make it all better. Magic!

Although it crossed my mind that being a doctor would be a noble undertaking, my first true role model was Mexico's beloved Benito Pablo Juárez García. After starting kindergarten, I was introduced to his story when my teacher learned that I already knew how to read and selected me to recite a poem about him in front of a gathering of hundreds of students. This was my first public-speaking opportunity, and I was terrified! I had to stand up on a chair to speak, and the microphone had to be lowered and turned sideways so that I could reach it. From my perch, I could see a quote by Benito Juárez high above me on the stone wall: "Among individuals, as among nations, respect for the rights of others is peace." This got me going, and when I started to speak, I forgot about the crowd and poured my passion into paying homage to Juárez-a poor young man of native heritage who grew up to become the president of Mexico. He embodied real-life heroism, fighting on behalf of everyday people.

From the beginning, as my parents hoped, school offered me structure with defined boundaries, in which I could excel. At home, I could break the rules with my experiments and explorations, giving free rein to my curiosity. School was a different kind of fun, with challenges and excitement. There I learned how to be still and focused, thus becoming the most obedient, disciplined student.

My father loved telling about the day he came to pick me up from kindergarten, and my teacher told him, "I think that Alfredo is ready for elementary school. You should go see my sister, and then see what she says."

Lucky for me that her sister, Señorita Jauregui, my teacher for first and second grades, not only decided that I was ready for elementary school but took me under her wing at the start of my academic experience. She had faith that I could go far in my education and in the world. Soon, I became the teacher's pet-a mantle that stayed with me and was alternately an honor and an invitation for other kids to beat me up on the playground and after school. Being younger and smaller than the other students in my grade was bad enough. On top of that, I was from outside of town-a country bumpkin in the eyes of the city dwellers who lived in Palaco. If not for my street-smart best friend, Niki, my large sidekick, I would have been in real trouble. Soon my would-be attackers figured out that if they messed with me, they'd have to mess with him or some of the other, tougher kids I befriended. But despite my defenders, I continued to think of myself as the underdog and to identify with others who got picked on-especially the ones who couldn't defend themselves.

There was an instance that caused me to become particularly upset one day when a little boy in my second-grade class, also named Alfredo, raised his hand to ask to go to the bathroom. The teacher asked him to wait until class was over. Unfortunately, he wasn't able to contain himself and pooped in his pants. Alfredo was mortified. I felt so bad for him and was mortified for his sake when the rest of the kids started to tease him. As soon as we got out to the schoolyard, I decided to tease those kids for their various shortcomings, hurling sharp-tongued remarks that came easily to me. Championing his cause wasn't going to solve everything for the other Alfredo, but at least I hoped it would cheer him up.

I also would never forget a young girl in the area who was born with a disfiguring cleft palate that made her appear to have two faces-like a little monster, some said. A few family members, being very poor, charged admission for others to come and stare at her, even to shriek over her deformities and taunt her. There was no way I could stand by and allow such cruelty-even if it meant a fight with kids who were bigger than I was. Most of the time, I didn't win those fights. But I hoped that somehow the little girl knew that someone was sticking up for her.

Some of my happiest memories of childhood exist not in story form but in scattered images or recollections of smells and tastes. I can vividly recall waking up to the smell of my mother's tamales on Christmas morning. Just the memory floods me with warmth and contentment, along with the happiness I felt on one Christmas in particular when I received a surprise gift. It was a racing car set that my mother had refurbished after buying it on one of her excursions across the border. In those days, it was possible to obtain an official identification card that allowed Mexican citizens to travel to the United States as tourists to shop or visit friends and relatives. My entrepreneurial mother would go over the border to Calexico on such shopping trips, usually with my father, and after rummaging through garage sales and picking up discarded items, would return and fix them up for sale. I knew that the racing set would have sold for a tidy sum of money. But instead she had decided that I was to be the lucky recipient. Just as I recall my own joy in receiving the gift, I can still see the smile on my mother's face as she watched my delighted reaction.

I have equally happy memories of time spent with my father and my brother Gabriel, particularly our periodic trips to the Sea of Cortez. Even though Papá traveled there to set up his stand and sell refurbished items-frequently trading them for food-to me these exciting expeditions felt like vacations. The drive down to San Felipe required us to journey south and through the desert. Our three-hour trek through the desert was made not just in any automobile; it was in my father's one-of-a-kind, custom-painted, custom-built flatbed truck.

To visualize the shade of green that my father had painted this truck, you might want to imagine a neon green parrot. An ugly green. The always-colorful Sostenes Quiñones, of course, would have disagreed. He was equally proud of the multicolored spiraling stripes he had painted on the truck bed-twenty colors in the pattern of a barbershop pole. A true work of art! If the exterior was outrageous, the interior was likewise laughable. The springs poked out of the seats and made for a sore behind for all occupants. The floorboard was apparently added as an afterthought, leaving cracks over the engine. The stick shift and the knob atop it would come out of place if we shifted too forcefully, causing the truck to slide around the road in between gears as the driver held a knobless stick in his hand while trying to deal with the jammed axle. The truck wouldn't go much faster than thirty miles an hour. The drive was always a journey-a fantastic, unforgettable adventure.

The road was full of dips and dives, winding over crests and around curves, so the only thing we could see as we made our way around the side of a hill and approached the town of San Felipe was desert. But all at once, we would come over a rise and see a spectacular panoramic view of the Sea of Cortez. In the morning sun, the shade of blue was deep and pure, incomparable, like an ocean of shining, rippling sapphires.

It felt as if we might drop right down into the sea itself. I loved the vantage point from the top of the hill that let me look down on the horizon rather than view it at sea level. It seemed to open up to infinite possibilities in the world beyond, somehow bringing me closer to the stars. Each time we headed off to the Sea of Cortez, I would anticipate this sight, becoming more excited with every mile. And the image would stay with me long after the excursion was over-symbolizing hope for my future and firing me up with the spirit of navigation that applied as much to the sea as it did to outer space.

One of our more memorable trips took place in 1977, when Mexico's economic downturn was starting to send tremors across the country before becoming a full-blown earthquake and forcing the catastrophic devaluation of the peso. On this trip, as soon as Papá parked the truck, he sent me and Gabriel off to play for many hours on our own. On a weekend day like this, we were usually at work at the gas station, so this truly was a holiday. We spent most of the morning building an elaborate sandcastle-a fortress fit for a king-until it was time to comb the beach for the small shiny rocks and shells that we determined were gold and pearls.

Then it was time for our feast! My father had exchanged goods for so much fresh fish that he had enough to cook us dinner before we made the journey back home. He cut the fish open, cleaned them of bones before stuffing them with vegetables and spices, and then baked them in tin foil over a fire that he made on the beach. The smell of the baked fish when my father first peeled back the foil was so intoxicatingly fragrant that I could almost taste it with my nose. The lens of memory captured it all: the red embers of the wood heating the package of tin foil, the seductive peeling back of the foil, and the vapor rising from the fish, just caught by local fisherman, waiting to be eaten. A feast to be remembered, savored again and again, and always appreciated.

Upon our return from the Sea of Cortez, even as leaner times began to seriously encroach on our lives, I refused to be robbed of childhood and constantly sought creative ways to hold onto the magic of life. The prime opportunity to challenge darker days occurred whenever it rained and a lake would form outside and then flood the lower part of our house, where everything was already made of mud. To my mother, this was a housekeeping nightmare: a messy, salty, sticky, disgusting ordeal that would take weeks to clean up after the rains were over and we were no longer wading through water up to our knees. But to me, it was our very own Sea of Cortez-inside our house! By a wonderful stroke of luck, my father had purchased a wreck of an old fishing boat, basically a wooden board with sides that he insisted on keeping in the yard. Obviously, it was a pirate ship begging to be put to use!

You should have seen the surprised faces of the adults when I created a contest to determine who could command the old boat in the waters filling up the lower part of the front yard. Of course, I didn't wait for the sea to form. The minute the rain began to fall, it was rock 'n' roll time! Gabriel and I would rally our younger cousins, I'd assign roles, and then we'd let the games begin.

No matter how hungry, wet, or sticky with mud we might have been, we didn't care. We were having fun, and it didn't cost a peso. We could create the magic with the superpower of our beautiful brains! How much did I learn from my trips to the Sea of Cortez and from my other research in the laboratory of childhood about how to use mental resources to withstand the tests to come? Everything.