Miguel Reyes-Múgica - Transcript Summary

Miguel Reyes-MúgicaChief of Pathology and Head of Laboratories, Children’s Hospital, Pittsburgh; Professor of Pathology, and Marjory J Harmer Chair in Pediatric Pathology, University of Pittsburgh, USA*

* At the time of this interview, Miguel Reyes-Múgica was Director of the Program in Pediatric and Developmental Pathology at the Yale School of Medicine

Interview location: Paediatric hospital in New Haven, Connecticut
Interview date: 24th November, 2007

Key themes: Autopsy, Children, History of Pathology, International Perspective, Legislation and Regulation, Life, death and the hereafter, Mentors and Influences, Motivation

 

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Section 1

  • Describes growing up in a small town in Mexico where both his parents were doctors.  From an early age accompanied his father on his rounds:  “I saw my first Caesarean when I was about 11.”
  • Partly by temperament and partly from growing up in an unequal society, he developed a “social conscience” at an early age. “Seeing these people who could not pay, might even die because they couldn’t afford treatments.  It was not a very easy thing to see and to live with.”
  • Describes a short period of youthful rebellion when his father sent him to live with his grandparents who ran a butchery, which he says taught him valuable dissection skills!  “In retrospect I recognise that experience as a very important influence.”  This was followed by a spell at military school which he says taught him the value of self-discipline.
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Section 2

  • Explains having married at 18, he had a daughter by the time he started medical school and therefore had to work as well as study.  In his second year managed to get a job in the medical school teaching histology to first year students.  “Under the microscope, I discovered a different universe.  And I started learning very fast, because I had to teach.  The best way to learn something is to teach it.”
  • Describes meeting his most important mentor, the renowned Dr Ruy Perez-Tamayo. “I immediately knew that I was going to be a pathologist.  I wanted to be just like him.”
  • Discovered he had an aptitude for microscopy.  “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.”
  • Describes how Perez-Tamayo invited him to work in his laboratory where he learnt cutting edge technology.   “In the process I learnt many other little lessons in science -- experimental design, and to be very sceptical, never to believe the first time you see something etc.”
  • Comments however that he never lost the desire to work with patients.   “When I started with my father I discovered that I had some ability to relate to patients and to patients’ families, and I liked that experience.”  And, he says, “I never forget that behind everything that we do there is a patient, or group of patients... Even if you understand molecular issues, that doesn’t necessarily mean that you are removed from the medical perspective.”
  • As an example of the way he likes to interact with both patients and clinicians, he describes the relatively rare condition Beckwith-Wiedemann syndrome, and the phenomenon of genetic imprinting.
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Section 3

  • Returns to the story of his medical training.  Describes his various posts before entering “the General Hospital of Mexico, the largest in my country, where I finished my specialist training.”
  • Then came the Mexican Earthquake of 1985: “It had a very significant impact -- it changed my life in many ways.”  He lost many colleagues and the hospital was virtually destroyed.  Moved to the National Institute of Pediatrics, where “I began in 1986 as a fully-fledged junior staff pathologist in a very big hospital.”
  • He had a huge caseload, most of which, he explains, was “the pathology of poverty”. The work was fascinating but demanding, and at the same time he had become a lone parent to his three children.
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Section 4

  • Again Perez-Tamayo is instrumental in his next career move, and puts him in touch with another highly influential figure and fellow Mexican, Francisco Gonzales-Crussi, at the Children's Memorial Hospital, Chicago. 
  • Explains that he and his second wife went for a year, but for personal reasons they felt they had to cut their ties with Mexico and stay in the US.  Describes the “unfair bureaucratic barriers” he had to go through to practise medicine in the US.  “I got my licence just a week before the deadline and Dr Gonzales-Crussi gave me the fellowship in paediatric pathology.”
  • A year later, in 1994, he was offered an assistant professorship at Yale.
  • Talks about Gonzáles-Crussí, whom he admires as an essayist as well as a great pathologist.
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Section 5

  • Turns to his own thoughts about death, and relates a moving anecdote about an autopsy he performed that exemplified the idea that “death teaches or helps those that are still alive”.
  • Leads on to discussion about the role of the autopsy, which he sees “as the most exhaustive, and final, medical exam that a doctor can provide for a patient”.
  • Expresses concern that the practice of medicine today is fragmented into so many “different specialities and little fields and tasks, that we as doctors lose track of the patient”.  Comments that there may be so many different interventions that “frequently it is only the pathologist that can try to bring all these little loose ends together”.
  • However, he says, this is certainly not an argument “against the application of advanced technology to sustain life...but it should be done in a respectful way”.
  • Expresses real irritation about what he sees as over-regulation. “We have created a monster in overseeing the activity of medical research, and I think we have forgotten what ‘good faith' is."
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Section 6

  • Goes into considerable detail about his own research interest, which is neural crest disorders.  Describes some of the different manifestations, including the bowel condition Hirschprung disease. “It is very difficult to make the diagnosis, because it is based on the absence of neurons, and absence of proof doesn’t mean proof of absence.”
  • The manifestation on which he has focused most of his research attention is neurocutaneous melanocytosis, characterised by giant moles, or naevi, a “very complex disorder in terms of genetics.”   He points out that “the deeper tissues are also abnormal, and can develop malignant tumours.”

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Section 7

  • Turns to the history behind the development of paediatric pathology as a specialism in its own right.  “In paediatrics the key is development... Things are in continuous growth.”
  • Talks about his family and despite his passion for his work, he says, “I think that is what defines me.  I am a father.”
  • Concludes by musing on the immigrant experience, and his desire to give back to Mexico as much as he can.

 

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