- This is my friend, Dr.Heather Irobunda. She dances on TikTok,
she's an army veteran, and she's a board certified OB/GYN right here in New York. Basically, she's better than
I am in a lot of things. Especially the dancing. (shoes skidding) Today, I wanted to take a look at a really controversial
episode of "The Good Doctor," so I called my good friend
to get her perspective. And boy, I'm glad I did. These shows with the central lines (Heather laughs) Put a midline in, bro! (Mike makes a comical sound) - [Female Doctor] You have
two rambunctious boys. - I know, it's like a cage
match in here. (laughs) - Shaun, where's your first year resident? - I have two first year residents, but I don't want to teach them. They're very distracting. You have a dizygotic dichorionic
diamniotic pregnancy. (record scratch)
- How does he know that? - He's a magician. That's the thing, these shows
don't make any sense to me. - 'Cause like (laughs). Number one, he's a general surgery. Number two, he was like, how far away? And was like, "Those are (laughing) diamniotic dizygotic twins." - That he saw all of them. - Yeah, like- - All those parts without scanning. - Without scanning, without looking around,
- Not checking pockets. What if it was a bicornuate uterus? (bell dings) - [Dr. Irobunda] What? - [Dr. Mike] Look at that!
- [Dr. Irobunda] Look at that. - Family medicine, hitting
them with medical terms. (Dr. Irobunda makes popping noise) - Honestly, to know if it's like diamniotic, dizygotic, and depending on how far along she is, it may be hard. Her belly is pretty big, so it's harder sometimes
to know those things, unless you are able to see what we call the chorion, which is the separation
between the two sacs. - She has edema. - Not surprising for someone who's 26 weeks pregnant. - Pretty big belly for 26 weeks. - Yes.
- Would you agree? - Already did that. (machine beeps and hums) - What was her BP? - Is he going to
preeclampsia (indistinct)? - I feel like he's hinting to it, 'cause whenever, I feel like any of these shows, if they say edema, they're like- - Edema and he's rushing
for the blood pressure pump. - They're like, "What's
your blood pressure like?" Honestly, in terms of preeclampsia, that is not actually one of
the criteria to diagnose it. It used to be. - Visual. - Spots in the vision, blurry
vision, high blood pressure. So 140 over 90 or higher. Headaches that don't go away
with Tylenol or acetaminophen. If you have pain in your
right upper quadrant, so by your liver. There's also protein that
you'll see in the urine. We have to check your urine
in order to know that, so. - But he's going to know
it magically, right now. - I know he's going to
be like, preeclampsia. - BP is no longer normal.
She's hypertensive. - What does that mean, Dr. Murray? - Is your vision blurred? - A bit, I'm tired. - It sounds like preeclampsia. (Dr. Mike laughs) - It's always-
- We got it. That was a teamwork.
- It's always preeclampsia. (Dr. Irobunda laughs) - We need to start you
on antihypertensive meds, but your edema makes it
difficult to place an IV, so we need to run a central line. - These shows with the central lines. Put a midline in, bro!
(Dr. Irobunda laughs) - Oh man, that got really intense really quickly. - Since when do we expose patients to jugular vein lines?
- Exactly. - Exactly, because do you know how much we're exposing to bacteria and- - And they make mistakes. - And you can bleed out.
- You can cut the wrong thing and cut a carotid. - Oh good God. And they were talking about giving her antihypertensives and I'm like. I mean, you can do that, but you can also give
some oral medications for it too.
- Right? - And it depends on how hypertensive she is.
- Hypertensive she is. - And I don't think the number
was like through the roof. I mean, I didn't see it really. - I mean I didn't see it, but I don't feel like they showed us. - We'll see. - And he has an apple and
you know what apples do. - Dr. Jackson? - Keep doctors away.
- Keep doctors away. And why is he eating during this time? - And also why is he
eating in a patient's room. - Fetal heart rates dropping. - That's not how a fetal
heart rate would usually look if it was dropping. - I just want to say that. It was just like-- - I've never seen it that way either. - Yeah, if it was dropping, you would actually see it dropping. I feel like those were
not, you know, heart rates. That... - Yeah, they don't look legit. - Yeah. And baby's heart
rates are way faster. - Did you have another birth? - No.
- Any pregnancy? Miscarriage? Abortion, stillbirth?. - Had an abortion when I was 15. - ABO.
- Stop preeclampsia. - ABO. Fetus is RH positive. - It's not (Dr. Irobunda laughs). - I knew it. RH incompatibility. - With antibodies, antibodies. She could only have, if she
had an earlier pregnancy. - My body is trying to
kill one of my babies? - Wow.
- Don't they check this? - Like, 26 Weeks, we are definitely checking. So part of the initial prenatal visit, we do a whole bunch of lab work. So we're checking to see if
there's any infectious disease, you know, to make sure you're not anemic. And we also check to see the RH factor. So RH positive or negative because we're concerned
about things like this, where if you are RH negative
and you do have antibodies, we can start monitoring way sooner than 26 weeks for this. - The only time that this could happen is if she wasn't getting prenatal care, which does happen. - Which does happen, yeah. And that's why we push patients to go earlier and start the process earlier. So we can be proactive. - Dr. Jackson, what's our next step? - Oh. - Oh, what's happening? - What's going on here is this pregnancy has twin to twin Transfusion Syndrome. They have the same placenta and they're sharing blood flow. And so typically what happens is that they need to actually ligate or cauterize some of the vessels, blocks some of the vessels that are in between the two so that it doesn't shut blood
to one twin over the other. Because what we usually see
is one twin is thriving. One is bigger, one is smaller. - Why would they do that for RH and compatibility? - That's why this is all very confusing because usually it's not due to RH. (both laughing) Usually this is just a whole
thing happening on its own. So we went from preeclampsia to RH incompatibility to Twin-Twin Transfusion Syndrome. This is very confusing. - Okay, interesting. Let's see where this goes. - One of the amniotic sacs ruptured, the strong twins'. - Dr. I need help. (Dr. Irobunda laughs) - I need a console. - I used to, I have no idea why the amniotic sacs ruptured. - By helping the weak, we hurt the strong. C-section? - If. we do a C-section
to save the strong baby, there's a 90% chance
that weak baby will die. But if we do an IMU infusion to save the week baby, there's an 85% chance
that strong baby will die. - I definitely would not recommend doing an amnioinfusion. We wouldn't want to do it in this case because it can increase
the risk of infection. Basically, if the amniotic
sac already broke, that means there's a hole in it. And that means that all kinds
of bacteria can come into it. So if we put more amniotic fluid and we're just creating this like... - Breeding ground.
- Yeah. - If there's a strong
baby and a weak baby, it's pretty clear which one we save. - Survival of the fittest. - Sorry, it's just, it's not really what we're about. Is it as a civilization aren't the strong morally
obligated to help the weak? - This got really deep, man. - Is this going to turn political? Like what's about to happen? - I mean, I see where the,
where the discussion's going, we are faced with these types of things all the time in medicine, where it's like, we're picking like the
lesser of two evils, where trying to figure out what the best mode of action is. - What do you do in a situation where there's twins like that, one is threatened, one is not. - It's a group decision. And I mean, ultimately it's always
the patient, the mom, dad, everybody who's involved
decisions about it because it's a really big deal. And so a lot of times
we have the discussion. We give people the options, we give them the risk associated with it, all the data. And then they give us their answer. - Delayed interval delivery. We induce labor, deliver the strong twin, then stop the labor to
keep the weak twin in utero until his lungs mature. - I don't know anything about this. I'm going to ask you something. Can you do a C-section, get one baby out and leave the other baby in? - Not for a C-section, but I actually saw this
one case in residency that was like the most crazy thing that I've ever seen. And it actually was a set of twins where one twin delivered and it was maybe like 30 weeks or so. And then they did a high ligation, the umbilical cord for that one and left the second twin in. And that one stayed in utero - No, don't tell me--
- 35 Weeks. - Oh, my god. - And then they delivered that one. - Wow. - It was like the craziest slash
coolest thing ever. Doctor Thiel! I remember you did that (claps) - Once she hears there's a slightest chance
of saving both babies, she won't listen to any alternatives. - Statistically, it's a terrible option, but it is an option. - Present all the options. - Yes. And see, she has to make the choice. - No, you can't seriously
be asking me this. - I know that this is something no mother should ever have to decide. - Good statement. What do you do if a patient says, what would you do if I
was your family member? - I mean, I usually give
them my honest answer, but I always say that like my family may be different than yours. My situation may be different than yours, but it's really hard because you don't know where
people's actual values stand. And you're only seeing them in that one particular situation. You're seeing them in
that one particular time in their lives. What about you? - I usually give full on as if I'm giving my
family's recommendation, but then afterwards say like, that doesn't mean you should do this. (they laugh) Don't use that as the
reason why you should do it. Unless I really feel like for whatever reason, they really should be doing this or like avoiding something. - Exactly, usually... Exactly, it depends on the decision. Cause like this one is hard. - Yeah, it's life or death. It's like big deal.
- This is hard. - (indistinct) for an amnioinfusion. - Have you named them? - Dr. Allen? - Is that typical? People name babies in utero? - Yeah. People name babies
in utero all the time, No. No, I can't do this. - Oh. - You have to see both of them. - OB/GYN is so tough sometimes. - But, I don't think
these are OB/GYN doctors. - They're not.
- They're not. - But OB/GYN is hard sometimes. The reason why I did OB/GYN was very much self serving because I was like, I
don't like that outcomes. - That's not self-serving, that's the opposite of self-serving. - Personally, I don't know how I would be if I saw like so many, like people dealing with really, really bad medical problems. And so OB we deliver babies all the time. - Oh, I see what you mean. You mean that like you're seeing mostly healthy patients.
- Mostly healthy patient. - As opposed to like seeing pathologies. - Right. - Got it. Okay. Makes sense. - And then like even GYN side, it's usually like, oh, you have an itch? I can fix that. Oh, you're bleeding too much? I can fix that! - And you can prevent stuff. - Exactly.
- Cervical cancer, HPV vaccines. - Yeah. HPV vaccines. Gardasil, word. - Insert a 16 gauge IV. - 16 gauge, that's thick. - You need big, in OB. That's when you need to put that fluid and you got to run it fast. - And they're inducing a pregnancy here. To be delivered. - Yeah. And it's twins. (woman moaning) - His lungs are also under developed. He needs to be placed on a ventilator. (eerie music) - She's having another contraction. - (indistinct) Calcium channel blockers. - Am I going to lose both of them? - I don't know. - Good answer. - Good answer. - Kenzie. We need to do a C-section. No. No, if he comes out, he'll die. - If he doesn't you both will. - No! - 69 over 40. - Why would she die? Well, that's a really low blood pressure. Why is she...? - Well I think, because at this point now she's hypovolemic she probably lost a lot of blood. Her uterus is still distend because it has the other baby in there. But then, you know, part of maybe the placenta for the first baby is like, you know, maybe an issue with that. And so she's bleeding. If they don't basically get
everything out of the uterus and let the uterus kind of
clamp down and stop bleeding, they both are not going to do well. - You know, I had scary moment one time I delivered a baby, vaginal delivery, it seemed like a totally normal, like nothing happened, and all of a sudden I'm like doing my check and I feel like something's not right. - Uh-oh! - And I didn't know what's going on because I was like, something just doesn't feel right. So I was like, I think
we need to call the OB and she says "no, we don't." Like, no, we really need to. Inverted uterus. - Oh, man. - And he came in - And he go... - And it was the most painful, most excruciating thing
I've ever witnessed live. Have you, have you had that happen? - Oh, yeah.
- Yeah? Well, I got called into a room once to a quick vaginal exam and I'm like, yup, that would be the endometrium. So that's the inner lining of the uterus, that I'm staring at. As soon as I opened her vagina, I tried to do it first and it wasn't going in because it had contracted a little bit. So we had to give her something. - To relax her first? Because she was probably bleeding a lot. - She was bleeding a lot and so we had to give
her something to relax it and back up. - We're doing a C-section, let's prep and drape her. - No! My kid. - Whether you're doing it right there, I've never seen an in room C-section, have you?
- Yeah. But usually the patient's not with us anymore. It usually is post mortem.
- Oh, okay. - Try it. Breathe. Good. They're not going to give her a drape? - 100 over 65. - Contractions are stopping. (peaceful music) - I mean, you're not out of the woods yet. - No.
- So the peaceful music shouldn't start just yet. - Not yet. - It's 26 week--
- It's super high risk. - And the other baby too. (gentle music) - I, judge this. Does this looks like a 26 week preemie? - Looks, pretty young. Also, usually they don't
bring the baby to you. - Yeah. You go to the nursery or the NICU in this case. We got through one episode. Yay. All right, guys, so
check out more episodes of "The Good Doctor" reviews. Click here to check that out. As always stay happy and healthy. And follow Dr. Heather
Irobunda on her channels. Linking down below. TikTok? Where you want them? - IG and TikTok - IG and TIkTok! - Both, I'm greedy. (hip hop music)
