A Matter of Life and Death. Sue Armstrong
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 some ability to relate to patients and their families, and I liked 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