A Matter of Life and Death. Sue Armstrong

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СКАЧАТЬ that experience. Even now I sometimes go to the wards and look at patients myself when I have specific questions to answer. Pathology is not only research; it’s not only looking at microscopes and glass slides. I never forget that behind everything we do there is a patient. So I am a doctor: I consider myself a physician with a particular subspeciality.

      After working with Dr Pérez-Tamayo, how did your career develop?

      I continued my medical school studies. I finished the four years of basic learning and then I did one year of practice, the internship, and then one year of social service. This is when you pay back society that has been generous enough to provide you with a free medical education. I worked at the National Institute of Pediatrics in Mexico City, and because it was one of the largest and busiest paediatric hospitals in the whole of Latin America, I rapidly began to develop some knowledge of pathology, in particular paediatric pathology. After my social service year I started my residence in pathology, and the director of the programme was again Dr Pérez-Tamayo, so I went back to him. I eventually went to the General Hospital of Mexico, the largest in my country, where I finished my specialist training.

      Then there was another significant event in my life, in all our lives: the big earthquake in Mexico City in 1985. I lost seven of the residents in my department, including my room-mate, in that earthquake. Together with other people, I pulled him from the rubble of the collapsed building. Forty-nine residents just in my hospital were dead … Many people died.

       Where were you when it happened?

      It happened at 7.19 a.m. on 19 September 1985. I was kissing my small son, and we both fell to the ground with the first shake. Mexico is an area with high earthquake activity, and I have many memories of my father sitting on the bed looking at his watch and counting the seconds, and my mother praying. I’d had that experience many times, and I was never very scared. But I was a little surprised that this one was so strong.

      I was living with my three children at the time – I had separated from my wife, and I kept my children; I raised them. So I asked the nanny to take my son to kindergarten, and I took my two daughters to school. I could see people running along the streets, but I didn’t see collapsed buildings – until I got to my hospital. Then I began to realise the magnitude of the problem. Two buildings within my hospital collapsed – one was the building where residents lived, the other was the gynaecology/obstetrics building where the nursery was. There were 302 people killed in my hospital alone. The official death toll varied tremendously, but probably about 20,000 people died in that earthquake.

      The army took over the hospital and the city in general, and we organised groups to identify people pulled from the rubble, and tried to help the injured. We would spend hours trying to remove rocks and material. There would be 50 or 60 people working in an area, and someone would suddenly yell, ‘Hey, silence!’ and you would hear someone asking for help. There were people, including newborn babies, pulled out several days later still alive. It was a terrifying experience.

       What effect did the earthquake have on you?

      It changed my life in many ways. First of all I am terrified of earthquakes now; I learnt my lesson. Secondly I switched my decisions. I was going to be chief resident in the General Hospital of Mexico that year. But after the earthquake there was talk about closing the hospital because of the damage. I switched and took a job in the National Institute of Pediatrics [NIP], where I’d done my social service. And instead of being a chief resident for a year, I began, in 1986, as a fully fledged junior staff pathologist in a very big hospital.

       What sort of cases were you seeing?

      NIP was a tertiary level centre with the ability to perform renal transplants and cardiac surgery and stuff. But also we had a very large caseload of run-of-the-mill infections, and the pathology of poverty – malnutrition, tremendously advanced cancers, all kinds of things. It’s a hospital that covers the full spectrum of human pathology, from zero to 18 years of age, so I was exposed to a massive amount of paediatric human pathology in the four years that I spent there.

      How did you manage the two things – your career and bringing up a family?

      Well, my ex-wife had some psychological problems. We decided to split and I kept my three children. I was in the second year of my residency training when the divorce happened, so it was tough. Usually I would take the children to school in the morning, and I would take an hour off to eat with them around 2 p.m. At 3.15 p.m. I would run back to the hospital and continue my activities, and then in the evening I would go back to the university to teach. So it was crazy: I didn’t have much time to be with my children, so I had to spend what is now called ‘quality time’ with them. And eating is an opportunity to exchange a lot of things; it’s a very important time of the day, and an educational experience for children.

       And did you remain close to them?

      Oh yes; they lived with me until they all left home. They are married now, and I have one granddaughter.

      When I divorced I met my second wife, who was a medical student. It was tough, because she came from a very conservative family that wanted her to marry someone without a lot of baggage, and I had three children, but she finally married me. After four years together in Mexico we decided to try to come for one year to the United States.

      I went to speak with Dr Pérez-Tamayo and he mentioned González-Crussí, who was a huge figure for me. He was a fantastic paediatric pathologist, a famous Mexican, and he had written Notes of an Anatomist. So it couldn’t get better. Dr Pérez-Tamayo wrote a letter and a week later I got a phone call from Dr González-Crussí inviting me to visit Chicago. He said, ‘If Dr Pérez-Tamayo recommends you, you’re accepted’!

      Your intention was to come and do some learning here and then go back home?

      Absolutely. I never even took the United States Medical Licensing Examinations [USMLE], so I wasn’t officially allowed to take part in any medical procedure because I had no credentials. I was a research associate doing projects, and I was just learning pathology on the side with Dr González-Crussí and his team. But then things got complicated with my ex-wife and it was very difficult. I sent my children on vacation to Mexico and they were kept there against their will. Finally I recovered my children in a complicated transaction that took all my little savings. My wife was pregnant at that time, and we decided to stay in the United States and cut our ties with Mexico at that moment.

      Dr González-Crussí told me, ‘If you can take the USMLE, get your credentials in time to be appointed fellow, I will keep the position for you.’ I got my licence just a week before the deadline and I stayed on in Chicago as his fellow in paediatric pathology.

      This was already my fourth year in Chicago, and then I saw that Yale University was looking for a paediatric pathologist. That was in 1994, and I was there for fourteen years.

      Tell me about your time with González-Crussí. You had started reading his essays before you met him, had you?

      I have read every book he has published to date. Dr González-Crussí is a vastly cultured man. He speaks many languages. But my first impression was that he was a fantastic pathologist. Pathology is a difficult trade; you need to be special in certain ways. It’s like, to do basketball you need to be tall. Well, to be a good pathologist there has to be something in your brain that allows you to orient yourself in the visual, spatial field, and he had a particular talent with that. But also massive medical information – he knew everything, and I was very impressed with that. Then I started reading his contributions to medical literature, and saw that he was able to jump from one topic to another in paediatric pathology, always as if he was an СКАЧАТЬ