Dr. Heather Irobunda is a board-certified OBGYN in New York and the perfect person to have join me for a reaction to The Good ...

doctors-react-to-controversial-good-doctor-episode

Doctors React To Controversial Good Doctor Episode

this is my friend dr heather irobonda 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 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 put a midline in bro you have two rambunctious boys i know it's like a cage mansion here sean was 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 dicorionic die amniotic pregnancy how does he know that um he's a magician that's a thing these shows don't make any sense like number one he's a general surgery number two he was like how far away and was like those are die amniotic die psychotic that he saw all of them yeah like all those parts without scanning without standing without checking your pockets what if it's a bicornuate uterus what look at that look at that family medicine hitting them with medical terms honestly to know if it's like diametric dizygotic like and depending on how far along she is it may be hard her belly's pretty big so it's harder sometimes to know those things unless you are able to see what we call like the chorion which is like the separation between the two sacks she has edema not surprising for someone who's 26 weeks pregnant pretty big belly for 26 weeks did you agree i already did that what was her bp is he going to preeclampsia route i feel like he he he's hinting to it because whenever i feel like any of these shows if they say edema yeah they're like a d when he's rushing for the blood pressure 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 visuals spots and divisions 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 gonna know it magically right now i know he's gonna 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 we got it we need to start you on anti-hypertensive meds but your edema makes it difficult to place an iv so we need to run a central line these shows with essential lines put a midline in bro oh man that got really intense really quickly since when do we expose patients to jugular vein lines exactly because do you know how much we're exposing them to bacteria and they make mistakes and you can you can cut the wrong thing and cut a carotid like oh good god and they were talking about doing it um giving her anti-hypertensives and i'm like i mean you can do that but you can also give some oral medications for it too and it depends on how hypertensive she is and i don't think the number was like through the roof i mean i didn't see it i mean i didn't see it but i don't feel it but no show it out yeah we'll see and he has an apple and you know what apples do doctor jackson keep doctors keep doctors away and why is he eating during a thorough procedure and also why is he eating in a patient's room fetal heart rate's dropping that's not how a fetal heart rate would usually look if it was dropping i just want to say that i've never seen it that way either yeah if it was dropping you would actually actually see it dropping i feel like those were not fetal heart rates that would be yeah they look legit yeah and babies heart rates are way faster did you have another birth no any pregnancy miscarriage abortion still birth i had an abortion when i was 15. eclampsia fetus is rh positive it's not father is rh negative i do it and 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 by 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 like 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 what's happening what's going on here is this pregnancy has twin the 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 block some of the vessels that are in between the two so that it doesn't shunt 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 um rh incompatibility that's why this is all very confusing because usually it's not due to rhs yeah usually this is just a whole thing happening on its own so we went from pre-eclampsia to our age incompatibility to twin twin transfusion syndrome it's very confusing to me interesting let's see where this goes one of the amniotic sex ruptured the strong twins doctor i need help i need a console i just i have no idea why the enemy hunting sucks 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 mu infusion to save the week baby there's an 85 chance that strong baby will die i definitely would not recommend doing an amnio infusion 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 in we're just creating this like breeding ground yep 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 i know is this gonna turn political like what is about to happen right now i mean i see where the where the discussion's going we we were faced with these types of things all the time in medicine where it's like we're picking like the lesser of two evils we're 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 the one is not it's a group decision and i mean ultimately it's always the patient the mom dad everybody who's involved decision 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 gonna ask you something can you do a c-section get one baby out and leave the other baby in um not for a c-section but i actually saw this one case in residency that was cr 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 of the umbilical cord for that one and left the second twin in and that one stayed in utero and then they delivered that one it was like the craziest slash coolest thing ever dr thiel i remember you did that once she hears there's the 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 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 don't use that as the reason why you should do it right 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 because like this one is hard yeah it's life or death this is a card but for an amnio infusion 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 save 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 it's very hard the reason why i did ob gyn was very much self-serving because i was like i don't like bad 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 happens you mean that like you're seeing mostly healthy patients mostly healthy as opposed to like i'm seeing pathologies right got it okay makes sense and then like even gyn sign it's usually like oh you have a niche i can fix that oh you're bleeding too much i can fix that and you can prevent stuff exactly squares cervical cancer hpv vaccines yeah hpv vaccine scarcely word insert a 16 gauge iv 16 gauge that's thick you need big you know b so when you need to put that fluid in you got to run it fast and they're inducing a pregnancy here to be delivered yeah and it's twins [Music] his lungs are also underdeveloped he needs to be placed on a ventilator she's having another contraction adding tubulin and calcium channel bluff am i gonna 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 chad'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 distended because it has that other baby in there but then you know part of maybe the placenta for the first baby is like you know there may be 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 much you know i had a 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 he's like no we don't like no we really need to inverted uterus oh man and he came in and you go and it was the most painful most excruciating thing i've ever witnessed live have you have you had that oh yeah yeah well i got called into a room once do a quick vaginal exam and i'm like yep that would be the endometrium so that's the inner lining of the uterus that i'm staring at as soon as i open 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 yeah relax yeah yeah 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 i can't hear this lady wait they're doing it right there i've never seen an in-room c-section have you yeah but usually the patient's not look at me with us anymore usually it's post-mortem oh okay try it breathe good you're not gonna give her a drape 100 over 65. contractions are stopping i mean you're not out of the woods yet no so the peaceful music shouldn't start just yet not yet she's 26 hi and the other baby too [Music] all right judge this does this look 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 nicu in this case we got through one episode yay all right guys to 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 tick-tock where you want them ig and six times ign tick-tock both i'm greedy [Music] you

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