- 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.
- 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)