A Matter of Life and Death. Sue Armstrong

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      I was very close to my parents, and particularly to my father. He was more of a friend than a parent at times. He was a well-read man and, although not very religious, we would speak about life and death, and he helped me to discover my own path in medicine. At that time there were no structured programmes of specialisation in Mexico, so he was a generalist, but a very knowledgeable generalist who would take on any kind of case. My mother was more surgically oriented, so they complemented each other. Her hospital was at San Cristóbal de las Casas in Chiapas, where the Zapatista Revolution started in 1990. I grew up mostly in that small town, although I was born in Mexico City.

       What sort of social environment was it?

      There are many indigenous people there, and the relationship between the more Spanish-looking people and the indigenous natives has never been easy. But my mother and father would see patients from all strata, from the well-off to the very poor people – frequently, you know, payments were in the form of a chicken, a bag of eggs, fruits or things like that. My father labelled me a communist when I was about 11! I guess I developed a little social conscience when I saw the differences in the standards of living.

      I was expelled from my high school for rebelling when I was 15, and my father put me to work with his parents, who ran some butcheries in the local market. I used to go with my grandfather to buy cattle, and we would slaughter them, and then we would do a complete post-mortem. So my first contact with cutting and looking at flesh really was there.

      You say ‘post-mortem’, but, I mean, butchery is a lot different, surely?

      Oh, a post-mortem in a human, an ‘autopsy’, is absolutely different from butchery. But it was an animal: it was muscle, it was viscera, it was handling a knife, it was knowing the different types of tissues from a macroscopic, naked eye, perspective, and recognising when something is not how you expect it to be. I recognise that experience as a very important influence on my personal development in pathology, and I can tell you that when I cut an organ, not only in autopsy but also in surgical pathology – which, by the way, is what we do most of the time; we are not ‘death doctors’ – the residents usually express surprise at the way I handle the knife.

       And then you tell them, ‘Well, I learnt on cattle’!

      Yes, exactly. Even though I am a paediatric pathologist and usually handle smaller organs, I use a longer knife, and I can cut very thin slices without injuring myself. I am a very neat pathologist.

       So how did you not end up becoming a master butcher?!

      Well, I had to go back to school. So my father and I made a deal and I went to a military school in Mexico City, where I spent a year fighting my way out of little troubles every day. After a year I left and went to a more normal high school, and then I entered medical school. But I learnt discipline in the military school, and it was a useful exercise. For a youngster from a relatively privileged family it was a good moment to realise that things can get really tough, and if you want to make it you really need self-discipline.

      Because things happened very fast in my life. First I got married, aged 18, and the same day that my first daughter was born I was accepted at medical school – in the largest university on earth, which is the National Autonomous University of Mexico. The first day of class was interesting: I was the only one with family responsibilities. I was very fortunate because I had four or five wonderful classmates, all of them very intelligent, and I became part of this group that would get together to study. I had much less time than they did, because I had to earn a living as well. The first year of medical school I was assistant to a producer of a TV programme on cultural matters, so I had to read a lot in addition to reading my medical school books. It was fun, it was a lot of work, but when you are young you can afford not to sleep much!

      But television started to take second place pretty fast. After the first year I realised I had to concentrate on medicine, so I looked for a position in the medical school as an assistant. They opened a competition for people that had finished some first-year courses to start teaching those courses to the following class. So I took the competition and I won two places. The competition was very tough because my class was tremendously big, about 5,000 students. They selected the best 100 students and, out of those, six won positions to teach – and that’s when I discovered histology.

      The first histologist was a Frenchman, François Bichat, in the 1700s. He never used a microscope, but he described 20 different kinds of tissue just with his naked eye. He was the ‘father of histology’. When I started looking down the microscope, I discovered a different universe. Those years were very important in my life, because I had such a need to make money, to concentrate on my career, and I discovered that teaching something that was part of my own academic learning was the best combination possible. In the mornings I would teach histology, and in the afternoons learn my own subjects in medical school.

      Then I discovered several mentors, but one of them, Dr Ruy Pérez-Tamayo, is the most important person in my academic life. He was professor of pathology, and when I took that course in my second year I immediately knew I was going to be a pathologist. I wanted to be just like him in many respects. He’s now in his eighties. He has shaped the discipline of pathology in Latin America, but he has also made tremendous contributions to pathology worldwide.

      You say that when you first looked down a microscope it was a different universe – what was the thrill?

      Well, the first time our lecturer told us, ‘Look at these cells on the screen’ – they used to project these slides – I couldn’t really understand it: what were cells, what were nuclei? So it was a challenge, and I like to be challenged: there were a whole lot of things I wanted to know. But then I discovered I had some ability to distinguish things under the microscope, and I liked that. It gives you immediate gratification to be able to diagnose something under the microscope, be it normal as in histology, or abnormal as in pathology. Pathology is just ordinary life in abnormal conditions, right? So when you know your ‘normal’, you are able to recognise when something is not normal, therefore pathological. And microscopy is magnificently beautiful! I still now can spend more time than I should just looking at something under the microscope because of the beauty of it.

      So Dr Pérez-Tamayo was your mentor at that time? And did he take you under his wing?

      Well, I took his course and he was aware of my presence relatively fast because I asked questions and things. Every year he would select one student to go and visit his lab, and that year he invited me. This was a completely different universe again. Here it was not a matter of looking down the microscope; it was doing all kinds of strange things that scientists do in labs. He was an expert on collagen, which is the most abundant protein in our bodies. I started working with his group on extracting collagen, and trying to identify an enzyme that would degrade the protein in order to explore the biology of certain diseases such as liver cirrhosis.

      I spent about 18 months learning electrophoresis, protein extraction and things like that. And in the process I learnt many other little lessons in science – experimental design, and to be sceptical, never to believe the first time you see something.

      So did you decide then that the academic side of things was more beguiling to you than actually seeing patients?

      Well, yes, but I never gave up my intention of seeing patients, because when I started with my father I discovered I had СКАЧАТЬ