Doctor asks: How Well Does my (Non-Medical) Mom know NEONATOLOGY?

I have something a little bit different to do today. I'm going to be interviewing my mother and basically I'm going to be asking her random questions that we'll see if she knows or not in neonatology. She is not in medicine, but she is an extremely intelligent woman. She is an engineer, has her master's in engineering. Hers is mechanical. My father's a civil engineer. She has also gone very high in different educational systems. She's opened schools, SAT coaching schools. So a very intelligent, hardworking, well-read women, yet understands very little about medicine. The other day we were talking about pain receptors and even the word receptor didn't like ring a bell or anything. So the reason I really want to do this is I want you all to understand how little our families actually understand. And I always think about this when I'm in the unit. If my mother, who is a well-educated, intelligent person, doesn't understand what's going on, what are the chances that the majority of our mothers aren't going to understand it? I will also say that by definition that she was my mother and she graduated from high school a long time ago, let alone university or whatever. And so it is possible that some younger mothers have done their biology more recently and may have a slightly better understanding and remembering of it. But anyway, I'm going to meet, introduce you to my mommy. Hi. Hi Tala, thank you for inviting me on your channel. I'm honored. So, um, this is my mother, Yvonne Nasser. Uh, like I said, she's, um, an engineer by training. And so today, first of all, how much medicine would you say, you know, on a scale of one to 10? One? No, that's not true. So I'm one of four. I'm number two out of four kids. And obviously all mothers kind of become pediatricians. So did you feel like you had a good handle on like taking care of us as we were getting older? Like, you know, it's interesting. It was very much trial and error. I remember when, for me, I know, I'm sorry. I remember when, um, excuse me, when my number three, he got croup. I know it was number one, whatever. And I knew instinctively, I had to put him in the shower to have the humidity. And that's what I'm saying. It was all trial and error. So you were always a very, very healthy baby. Thank God. Okay. So I'm going to ask you some random things in neonatology and you just tell me whether, what you can about the subject. Okay. One, what is the difference between a hematocrit and a hemoglobin? And I'm bringing this up because I gave a lecture once that she turned up to where I literally discussed this for like an hour or just tell me what a hematocrit is. It's a reading in blood. Yes. What does it measure? Something to do with blood. The critics of, um, critics is a made up word. What does blood do? What does the, what does the oxygen? I'll give you that. We'll count that as a yay. We'll count that as a win. Is it the same thing or different? Hemoglobin is different. We don't have to discuss that now. Okay. What is the youngest gestational age that we are currently resuscitating in the U S? I think 22 weeks. Yes! 22 weeks! Two years? Yeah, two out of two, basically. What does intubation mean? It means sticking a tube in your throat, thorax, so the baby can breathe because there's some blockage in the throat. So are you, where, which tube are you sticking it into? The esophagus. Where does the esophagus go to? The lungs. The esophagus goes from the mouth to the stomach. Oh, really? Yes. The trachea goes from the mouth to the lungs. I mean the trachea. You do mean the trachea because you are trying to make the lungs breathe. Yes. But that is something that honestly, most people don't get. And, and you would be absolutely shocked by that. But really the majority of people don't understand that we have two tubes. One goes to the lungs, one goes to the stomach and we want the tube going towards the lungs. I mean, that's if you're intubating. Can I add something? Yes, please. My knowledge of intubation is confined to that really good doctor who's in an airport and somebody needs, can't breathe and he gets a straw and a knife. So basically my Mars medical knowledge is coming from TV shows. So this is great. This is amazing. In babies, we often need venous access, so we need to give medicines into the bloodstream. So we can put an IV, just like, you know, what a regular IV is, right? Yes. What other ways can we, which other veins or other forms of IV access can we do? Do you want me to guess? I have literally haven't a clue. I haven't a clue. Okay. Another vein, somewhere in the neck. I'll give you that. You can't, not really. We don't really use the neck veins in babies. Have you ever heard of like umbilical cord? So when you chop off the umbilical cord, the way that the mummies were feeding the babies in utero, you can put a catheter into the umbilicus and we can use that as an IV. I didn't know that. Okay. So the other thing, have you ever heard of a PICC line? I have, but I've no idea what it is. So it's like a really strong, long, skinny IV that you still put in the hand, um, or the legs, the arms or the legs, but instead of the inside of the catheter being that long, it's a much longer catheter and we thread it all the way up. Well, it solves two problems. When the babies move around, it's not going to fall out. And also because as the veins get bigger, closer to your heart, then we don't have to worry about it, like burning everything. So I'm teaching. So IV was, wasn't great. Okay. Tell me a couple of different diseases that babies may have when they're born that may affect their breathing. So a baby is born and they're breathing really fast or like, you feel like they're not getting enough oxygen. Can you name any disease the baby may have? For children, by the way. Jaundice? Nope. Jaundice is when they get the yellow skin. I know, I know you guys have jaundice, it's not strange. I haven't a clue, Tyler. Okay. Have you heard of RDS, respiratory distress syndrome? Have you heard of surfactant? No. Have you heard of like, if the baby still has a lot of fluid in it? Hang on a minute. Oh, something's, something's going on. Surfactant is when you put them in a liquid or something. No, but I know you send me those articles. If she ever reads articles about babies, about anything new in babies, then, uh, then obviously she sends it to me and a lot of recent excitement has been on putting babies in like the liquid nitrogen or liquid oxygen, whatever it is to try to kind of emulate what is happening in utero, but it has not been successful at all. So no, RDS is just really immature lungs and TTN is when they have a lot of fluid in their lungs. Okay. So I didn't know that. Okay. All right. This, this, this should be a big one. I can't wait to hear this one. Okay. We've talked about this a lot before. What does ECMO stand for? And what is ECMO? Look, I can tell you what ECMO is. You're taking all of the bloody out, blood out and putting it into a machine, cleaning it up and putting it back again. Cleaning it up for what? Impurities and stuff. What type of impurities? Germs? Okay. No. Well, no. ECMO literally, what, what are you trying to do? When do you put a patient on ECMO? When he can't breathe. So what are you trying to do to that blood? Oh, put more hematocrits in. Well, not more hematocrit. You need a lot of hematocrit. No. More what? What does the hematocrit carry? Oxygen. Right. So basically it's when the blood is, and you can't obviously drain all the blood out and then put it back in. So it's on a continuous system where the blood is getting drained and getting put back in. So the blood leaves the body. And then what do you, what do you have to, what are the lungs also doing? They're not just taking in oxygen. They're breathing out. What's the other gas that we breathe out that our bodies produce? Nitrogen? No. See, carbon dioxide. Carbon dioxide. Yeah. So that's what the ECMO machine is doing. You are breathing. It is basically taking the blood out. It's adding oxygen to it and it's removing the carbon dioxide, allowing the lungs to rest and heal until the lungs are better. And then you can take the baby off ECMO. So remember ECMO is just a short, like if you can't live on ECMO, obviously you're just doing it, hoping that the baby's lungs are going to get better. People say up to three weeks. Now, now, now like we've had CDHS on for if they have like structural problems with their lungs, but that obviously has changed a lot. So it really depends on the cause and everything else. Sometimes babies that do have germs or have sepsis are put on ECMO. Those kids don't do well. The ECMO machine doesn't get rid of the germs, but you're supporting the baby as we're fighting the germs. Okay. So really it's just purely oxygen and CO2. Out of 10, I'll give you like a two for that. I think I should have a three because I had heard of ECMO. You had heard of it. I know, but like you talk about ECMO. I know, but it doesn't mean I understand it, does it? I know, this is not good. Not good. Okay. Next question. What is the best way we have to feed a premature baby? Goodness. What would you say is the best nutrition? Oh, the best nutrition? Oh, breast milk. Yes! Ding, ding, ding, ding, ding, ding! I thought you meant do you use a bottle or do you put it through the alcohol cord? Well, you're not putting breast milk through the cord. I don't know, Tom. No, you, but you're right. At what developmental age, in weeks, can you put a bottle or a breast in a baby's mouth without worrying that some of the milk is going to go down into the lungs and they're very uncoordinated or some of it's going to... I saw quite late, 28, 29 weeks, 30, 31, 32, 33. About 33 weeks. Really? As late as that? Really, yes. Before that, they just don't have the coordination. They don't have to suck. They don't know, they can't coordinate it. Even the sucking reflex starts earlier than that. So they're like sucking on the endotracheal tube. But just the coordination with protecting their airway and everything does not happen until they're about 33, 34 weeks. So we don't really even try. And by the way, I always say this to parents. It is one of the most consistent developmental milestones in human behavior. So basically like kids may walk between like nine months and two years or whatever, and it's still considered, or nine months and 18 months, it's considered normal, but if a baby is able to eat with good coordination at 30 weeks, they're not 30 weeks. It's a lie. Like they got their dates wrong and we're wrong, you know, whatever. Sometimes, obviously they can't start eating till later than that because they do have illnesses or they're breathing hard. We don't want to put, or they're still on breathing support. But generally the earliest is about 33 weeks. Okay. We're not... I've learned so much. Billy Rubin? Oh yes. Billy Rubin's a good word. Why, you mentioned jaundice earlier when you're talking about lungs, don't want to let that go. Why do we, why do we care about jaundice? So what if babies go yellow? It's something to do with the liver. And I remember we used to have to put you guys under a light, a sunlight because... So you're saying, yes, because it gets rid of it. It's something to do with vitamin D. Uh, no, not really. Um, it is the blue light. Yes. It's a yellow pigment. The blood breaks down, releases the yellow pigment, which is called Billy Rubin and the Billy Rubin goes up. And the reason why it doesn't go up, like you said, you say all the words, you just can't put them together. So the liver is responsible for breaking down that Billy Rubin. But in babies, the liver is still immature. So it isn't able to break it down. So that level builds up in blood, which is why it then goes into the skin and babies look yellow. That's normal to have a little bit of yellowness. I mean, if you think about it, if you see any male, any adult that looks yellow, you know, they're sick, but we see yellow babies all the time and we know they're not sick. So it is normal to have a little bit of yellowness, but if that yellowness gets too high, which is why you put anybody under the lights, why would we be worried about that? Right? No, that was a question. Why, why would we listen? All I know about the liver is cirrhosis. It's not liver. It's not related to the liver. It's not, well, there's different types of high Billy, but this isn't the type of high Billy. It can cause brain damage if it's on really, really high levels. So we let it go, let it go, let it go. And then once it gets anywhere close to the number of needing brain damage, we're like, okay, it's getting too close and we'll put the baby on the lights. Oh, see, I didn't try that. So again, four kids, extremely well-educated. Are you beginning to realize what's happening with our families in the unit? Yeah, exactly. I think about this all the time. Okay. I hope that you all learned something from that. It really is a bit crazy, isn't it? Um, but now I just want to ask my mother, uh, for some advice. She has taught hundreds, if not thousands of kids, gotten them through college, into college, her own students, as well as us four, all doing jobs that we've all ended up loving. So I'm going to ask for some general advice of whatever field that you want to go into, not just medicine. What are the kind of phrases or the advice that you would give to all your students and that you gave to us? Really? It's very simple. You need to be passionate about what you want to do to succeed in it. You can be not passionate and do it, but it's not a, you can do an okay job, but to do an excellent job, you really have to care. Um, determination, uh, hard work as well. And I have to say what I have learned as a mother is it's so important to have compassion and empathy. And I imagine in a NICU unit dealing with stressed parents, sick babies, the empathetic side is as important. It can't be as important, but there is a place, a very strong place for it next to the medicine. So I do actually really agree with that. I think I always say this isn't rocket science. We can all learn this. We, if you study hard enough for long enough, you have good experience. You have good mentors. You never give up every single day. You try to learn something. You can learn all of it. A monkey could learn how to intubate or put in lines, right? Uh, I feel like a monkey could, some monkeys are like, they do really complicated things. Like I've seen them knit and stuff. Really? That's the same as saying, if you stick a monkey in front of a typewriting sheet, he'll type Shakespeare. But you know what? You need billions of years. It's not going to happen. Who says that if you stick a monkey in front of a typewriter? Well, I do. I do. I've never heard that. No. Yes. Okay, she's gone off, gone a little bit off here. Okay. But the point is, I think that all the stuff that we have to know as a neonatologist to pass the exams, to, that is all learnable. It's all the other stuff, which I think we have to put effort in and we do still have to like improve with it. So I do agree with that. And unfortunately, I think one of the ways that we learn is literally by making mistakes, by having bad interactions with other people on the team or with parents or saying the wrong thing, and, you know, it's just having a thick enough skin to be like, okay, I did, I messed up. I need to try harder next time. Right. Yes. Can I add something else? Honestly, having listened to this questioning, it's a miracle that you four guys grew up. Honestly, I don't know anything. Literally nothing. It's so humbling. But it's a very specific area of medicine. Like if I asked you more general pediatrics questions, I think you'd know this, right? Well, I hope so. This is a very, very specific. And the other thing about the NICU is it really is one of the few areas of medicine that if you don't have a child in the NICU, you will literally know nothing about it. Everybody will know a cardiologist eventually. Everybody will have to do surgery eventually. Everybody has an OB eventually, right? But literally a generalist, everybody knows somebody with an autoimmune disease. With the NICU, you really don't know details. You just know that a kid was in the NICU, but they're not going to start telling you the baby was intubated. The jaundice was this. We put under phototherapy. Obviously they're not telling you that. So it's a very different world in medicine that you don't need to know about. And I think people don't like to talk about it. I love the idea that if somebody pees on a pregnancy stick, they start imagining that nine months later, they are going to have a completely healthy baby and go home. It doesn't cross their mind that they might have a miscarriage, that the baby might have a fetal anomaly, that there might be an IUFD, that the baby may be born prematurely, that a million other things might happen. I love that the world has that innocence. Like childbirth is such a fantastic part of life that it's nice that like nobody could imagine these bad things happening. And also, as we all know, just to tell you, the majority of babies in the NICU do fantastically. Most of them go home to lead very happy, productive lives. So it is very different from other aspects of medicine. Okay. Any last words of advice? I think as a lay person, it is very humbling what doctors achieve. And I'm very grateful to my daughter for going into neonatology. I think she's wonderful. I think, can I say she's a saint? Slight bias. And I applaud the dedication of all doctors, really. Thank you. That's lovely.