Let's Ride w/ Paul Estrada

NICU Doctor: Navigating Our Daughter's First Fight

• Paul Estrada • Season 1 • Episode 24

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A quiet dinner turned into alarms, an emergency C-section, and a crash course in the NICU. When our daughter arrived five weeks early with her cord tightly wrapped and knotted, we met a calm, clear voice in the chaos: Dr. John Tran, a board-certified neonatologist at CHOC. He walked us through what was happening, what mattered right now, and how time and targeted temperature management could protect our baby’s brain after hypoxic-ischemic encephalopathy (HIE).

There’s a human side to the science. Dr. Tran shares how he chose neonatology, the resilience he sees in preemies, and the weight doctors carry home after difficult days. We explore mentorship, teamwork in a teaching hospital, and the support networks that keep clinicians steady through 24-hour shifts and unpredictable calls. We also touch on how AI can help parents ask better questions, bridging gaps when stress makes it hard to process information.

If you’re a parent, expect clear takeaways on fetal movement, advocacy, and what to ask when you hear words like HIE and NICU. If you’re just curious, you’ll hear a candid look at medicine where seconds count and empathy guides every decision. Our daughter’s story ends with relief and gratitude—and a renewed respect for teams who turn fear into focus.

If this conversation helped you, subscribe, share it with a friend who’s expecting, and leave a quick review. Your support helps more families find lifesaving clarity when every minute matters.

SPEAKER_02:

Check one two. Check one two. Are you recording, Dad? Why? Delete it.

SPEAKER_01:

Because your sister wants to be in the podcast.

SPEAKER_02:

Dad, delete it.

SPEAKER_01:

Why?

SPEAKER_02:

Because.

SPEAKER_01:

Because why?

SPEAKER_02:

Delete it and record again.

SPEAKER_01:

Alright. What did it feel like when you went to the hospital to visit your sister for the first time?

SPEAKER_02:

At first I was like, wow, I really have a sister now.

SPEAKER_01:

Yeah, so you're just like, that's crazy, huh? When you went in the room for the first time to meet your sister, like what how did you feel?

SPEAKER_02:

I felt excited to see her.

SPEAKER_01:

Yeah. And what else?

SPEAKER_02:

Did I feel? Yeah. I felt happy that she was a part of the family.

SPEAKER_01:

Yeah?

SPEAKER_02:

Yeah.

SPEAKER_01:

Me and mom and your sister had to stay there for a couple days, like almost two weeks. So how did you feel when we had to stay there for so long?

SPEAKER_02:

I felt sad.

SPEAKER_01:

Why'd you feel sad?

SPEAKER_02:

Because I wouldn't be around you that much.

SPEAKER_01:

Yeah, because basically you guys went on a trip and then we called and were like, oh, mom's gonna have the baby like right now. It was kind of like unexpected. And then before you know it, you had a sister. So, anyways, do you know that your your sister, like she they had to take extra special care of her because Yeah, I know. Do you know why?

SPEAKER_02:

She was born early. She was born early. Actually, one month.

SPEAKER_01:

Yeah, a little more than a month, right?

SPEAKER_02:

Like like one and a half.

SPEAKER_01:

Was it like scary to see that she had like some machines that were like helping her and stuff, or what did you think about that?

SPEAKER_02:

No.

SPEAKER_01:

No.

SPEAKER_02:

I was just happy that she was even alive.

SPEAKER_01:

That was good, right?

SPEAKER_02:

Yeah.

SPEAKER_01:

I think you could tell when you when you saw her for the first time and you like took your finger and you what did you do?

SPEAKER_02:

Grabbed it so hard.

SPEAKER_01:

Like when she was just born, she like grabbed your finger so hard, huh? And so did that does that like tell you that she was like doing pretty good?

SPEAKER_02:

Uh yeah.

SPEAKER_01:

She was pretty healthy.

SPEAKER_02:

Since me and Damien are are so strong, I think she was supposed to be like more like me, not like Damien.

SPEAKER_01:

And now that you have a sister and she's home at your house, what do you hope it will be like to be her big brother?

SPEAKER_02:

Dad. But when she has hair, like when she has more hair, I think she's gonna have straight here like me.

SPEAKER_01:

Yeah, maybe.

SPEAKER_02:

She does.

SPEAKER_01:

So now that your sister's home and she's doing well, like what are you most excited about being a a big brother to a sister?

SPEAKER_02:

I'm happy that I'm able to be with her more.

SPEAKER_01:

Yeah.

SPEAKER_02:

Like every day. Like she's my everyday life now.

SPEAKER_01:

Yeah. Hi, left ride listeners. It's your friend Paul Strada. If you've gotten any value out of any of the episodes, I'm here to ask you to pause this episode and take a moment to subscribe to the show wherever you're listening to this podcast. If you're a real go-getter, please take a moment to leave a review of the podcast. I'd be indebted to you forever. Thank you for supporting and listening to the show and for going on this journey with us. Pause, subscribe, and let's ride. Our guest today is a board-certified pediatric neonatologist who provides care for critically ill premature infants at Children's Hospital Orange County. Five weeks before our daughter was due, my wife told me something didn't feel right. By the next morning, her instincts proved correct, and we were rushed into an emergency C section, and we faced a fear every parent praised they never have to face. Our daughter entered the world under immense stress. In those moments when everything felt uncertain, and amongst a team of wonderful staff that took care of our family like their own, one person stepped forward to help us navigate it all. He explained what was happening in words we could understand, reassured us when we were overwhelmed, and most importantly, took action to give our daughter the best chance to survive and thrive. His calm, steady presence helps carry us through the scariest days of our lives, and his expertise change our family's story forever. Today, I'm grateful not just to introduce a doctor, but to honor the man responsible for helping my daughter through her earliest fight. Our guest today is Dr. John Tran.

SPEAKER_00:

Before we start though, how's your daughter doing? How's Camila doing?

SPEAKER_01:

She's great. I was she's actually napping right now. I was gonna see if she happens to wake up while we're on the phone. I'll bring her over and you can see her.

SPEAKER_00:

I'm still happy for you guys. I am still happy for you guys.

SPEAKER_01:

Nor normal baby stuff, you know, she's um, you know, waking us up every couple hours, but eating really well and can't ask for much more considering where we were coming from.

SPEAKER_00:

So yeah, no, it's great. It is absolutely amazing.

SPEAKER_01:

And and on that note, I wanted to say, you know, it's it's often when you see somebody's face, you go, man, it's great to see you. But in your case in particular, it's great not to see you. And I mean that in the most sincerious way possible. So but it I know in all seriousness, Doctor, it is great to see you. And you know, a lot of people don't know uh Christina and I's story uh what's kind of gone on in the last couple months. And in fact, just bringing our our families and friends up to speed. So for some of them, actually, it's gonna be their first time hearing about it. But yeah, I wanted to bring you on today, you know, just because of of that experience and what we went through and get a chance to learn more about you. And you know, obviously you took really great care of uh our daughter and our and our family, and just get to know a little bit more about you and and you know how you got to be, you know, Dr. John Trans. So with that, I want to start all the way at the beginning and just if you could tell us a little bit about how you were growing up, you know, the type of environment that you grew up in, and what were the expectations for you with regards to education and and maybe where you would end up career-wise?

SPEAKER_00:

Yeah, so um I am born and raised in Orange County, California. So born in Anaheim. Um, my family is actually really interesting. My parents are both immigrants from Vietnam. They're actually refugees from the Vietnam War.

SPEAKER_01:

Wow.

SPEAKER_00:

My mom, uh, she came here because my aunt worked for the US Embassy. And when Vietnamization happened and they were trying to get as many South Vietnamese to America, my my aunt, because of her connections with the US Embassy, got my mom's family here. They actually had to smuggle my youngest uncle in a uh in a refrigerator crate to get him to America.

SPEAKER_01:

Wow.

SPEAKER_00:

It was crazy because when my grandma died, when I was 10, in her dresser drawer was the article of their story of how they got to America. And it's my aunt who was already in America and my grandma hugging the airport as they were coming here.

SPEAKER_01:

That's incredible.

SPEAKER_00:

So yeah, it's pretty it's it's an amazing story. I mean, it you know, like you think about your accomplishments, and then my dad and my mom tell me about how they just survived a war, and you're like, there's not a lot that can beat that.

SPEAKER_01:

Yeah.

SPEAKER_00:

I get a lot of, I always say I get a lot of my street smarts from my mom, I get a lot of my academics from my dad. So with that comes a lot of typical immigrant parent kind of pressure to do well in school, right? To you know, be a doctor, a lawyer, an engineer, the you know, the big three. So and being the oldest and a son, kind of culturally, you you kind of get placed in that. So I had that burden and I was kind of, I wouldn't say brainwashed, but very young, always said, I'm gonna be a doctor. I'm gonna be a doctor.

SPEAKER_01:

And do you remember like age-wise, roughly what age that that was kind of set in your mind?

SPEAKER_00:

Yeah, like like I would say like five. Five. Yeah, like my some of my earliest memories. And I wow. And you and it's one of those things where you know, as a parent, you know this too. You always think your kid's like the smartest. Of course.

SPEAKER_01:

Yeah.

SPEAKER_00:

I was not that kid. I was, I was, I was the one that the babysitters would get would get upset with because you know, I'd be running around, I'd get bored easily. Yeah. So I was causing a little bit of mischief. So it was it was funny that my parents wanted me to be a doctor when I was causing so much trouble.

SPEAKER_01:

So did you feel you know a lot of pressure with that? Because like as I'm thinking, I'm the complete opposite of you, where I kind of wandered through high school and even honestly into college, still not quite knowing what I wanted to do. And then thankfully I was able to figure it out. But I mean, you're the complete opposite end of that spectrum where it's like you kind of have this, I don't know, let's call it a calling or the something way early on.

SPEAKER_00:

Yeah, but I think that pressure comes with the lack of identity, right? So you can't find your true identity, you know. So fortunately, you know, for me, I was always really good in the sciences. I was always really good with math. That that was like my the thing that I was really excelling at school in. And and I think being the oldest and being literally the oldest male in my whole family, including my extended family, you know, there was always this kind of, and when you're growing up, you know, from an immigrant family, you're poor, you don't have a lot of means. I mean, the family unit is so important. And even now, when we talked about like with Camilla and stuff like that, how important your social networks are, you know? And so I was always like we didn't have a lot of money growing up, but I was, I had a really happy childhood. I mean, my aunts and uncles were like my extended moms and dads, my mom and dad were working hard, but they were always there for me. My sisters and I are super close.

SPEAKER_01:

Yeah.

SPEAKER_00:

So I've always had this great support network, and that allowed me to kind of I guess work hard. Like I'd never not known what not working hard was like because I would see it in the examples in my mom, my dad, and my aunts and uncles.

SPEAKER_01:

Yeah.

SPEAKER_00:

So it pushed me to kind of through example, just to work really hard. So, you know, through high school, through junior high, I just kind of grind.

SPEAKER_01:

So, John, I'm sorry, I want to mention to you as okay. So, academically, let's say I didn't do that great. And what I actually was explaining this to my mother-in-law the other day, which is I liked like I could get B pluses without trying very hard, but the incremental effort required to get that A to me wasn't worth it. And so I just didn't pursue it. And when I think about a doctor, for example, I just think about m studying and I'm like, I don't have a very good memory. And so a lot of these things, at least the perception was hey, this is out of reach for definitely for me, and probably most people feel that way. Um, so can you explain just I don't know, for those that maybe that you know that come from my pedigree or my shoes in terms of academics, that are still able to, if that's really what they want to do, that they can't actually find a way to carve out a career for themselves in that field?

SPEAKER_00:

I think there's so many different ways to learn, right? There's so many different ways that your brain works and how it works to its best, to its best, to its optimal level, you know? And granted, you see that in med school. You see the kids that are photographic memory. It comes with ease. You know, I I have a ton of friends like that. My wife tells me all the time, she goes, You always say that every time we meet a friend of med school or meet a friend at work, you always say they're so much how smart they are, how smarter they are than you. And I was like, Well, that's because I truly do think they're like that. But then you have people that grind. And honestly, motivation and commitment to your goal has a lot to do with it too. Because this is not a sprint. Natural ability will get you only so far, but this is your life and your career that you kind of go through, right? Right.

SPEAKER_01:

Well, I I would have loved this advice about 20 years ago. It's a little late for me, but for those that are still early on, you still have a chance, guys. All right, just work hard. And if you're not that book smart, you can still figure it out. So um, the last thing I want to touch on as it relates to your personal history is you became a neonatal neonatologist. And as I understand it, there's just, you know, once you get your doctorate, there's splinters off into, I'm sure, nearly infinite number of specializations that you could go into. How did you uh come acros come upon neonatology as the field that you wanted to pursue?

SPEAKER_00:

Yeah, that's a good one. So um, you know, I think I think when you go into med school, like everybody kind of gravitates toward kind of like the the sexier field. Like even I was the same way. I was like, surgery. I want to do surgery, you know? And and I graduate when I when I after first year, I was top, I think I was top five in my class in anatomy. So I was like, oh yeah, surgery, because anatomy is fun and surgery is fun.

SPEAKER_01:

And then and then By the way, that doesn't sound fun to me. Uh, the idea of blood and stuff, that's the other thing. So enough about me trying to be a doctor now, but yeah, that okay, continue. Sorry.

SPEAKER_00:

You know, my first rotation as a med student was pediatrics. And one of our brief encounters in pediatrics was neonatology. And I still remember the moment that I was like, this is the field that I think I want to do, is that we got called to go into an urgency section, and this baby pops out, and I'm sitting there, I'm like, oh my God, this is the miracle of life. This is amazing. There's nothing like that. There's nothing that you're gonna be able to witness that's gonna be this amazing. And then I realized as I found that field that, you know, I love ICU medicine. I love the acuity of it. I love that there's procedures, that there's things that you can do, and I love that you can make someone really sick into some into a baby that a baby or a person that's that can heal. I love that. And I realized that when I had to choose between pediatrics and adult, that you know, what I love about kids and even babies, and I don't think people realize this, there's resiliency. Babies, kids are incredibly resilient, and they're so inspiring because they don't know any better sometimes. You know, like they don't know when they get sick that that's not normal because they just don't know. They just continue to live their life, and that to me is incredibly inspiring.

SPEAKER_01:

You know, it's it just seems like it'd be so rewarding, obviously. I mean, uh for obvious reasons. You're literally impacting lives and and families. And I've just again I'm gonna give you kind of my perspective. I come from you know the corporate environment where I'm in supply chain, and my job effectively is to get a bottle of water from point A to point Z and all the steps in between, right? Sure, you know, you're hydrating people, you're giving them nourishment, I guess you want to say in that way. But and it's and it's it's a nut being in the supply chain, and if you think about like during COVID when there weren't products on the shelves, like, yeah, there are times where being a supply chain professional, you do see the impact that you're making, and you know, you're getting supplies that could be needed from point, yeah, you know, but so but this is very different, right? I mean, you're talking about you're actually interacting with the end user, quote unquote, right? The the families, you're seeing their emotions, you're seeing their faces, you're seeing the impact of your work. I mean, that's I I mean, I can't imagine what that's like. I mean, that that seems like that'd be pretty amazing. And I think for a lot of us, though, we struggle to find similar, I guess, meaning. Um, you know, we find it. I find it like where I find it is in coaching young professionals to get them to where they want to go professionally. And I find a lot of joy in that, right? And that's kind of how I look at it. But I mean, what you do is just so tangible, right?

SPEAKER_00:

I think to your point though, Paul, I think there's so many aspects to it that I love about being a doctor. I mean, the immediate aspect clinically is to see the results in our patients and to see them do well. I mean, you're right. It's an incredible satisfaction that you feel that's just amazing. You there's nothing that can describe that. But then there's the flip side too, right? The the ones that that don't make it and the ones that don't do well. And your job then is to almost guide a family to making a decision that they're gonna be able to live with. You know, that is not easy. And I can tell you, even with here within our hospital, not every doctor is really good at it and comfortable in doing it, you know. So the ends of the spectrum that can make this job pretty difficult. And then there's the things that you enjoy. I think I always feel like every job provides a service. And you have to realize in the grand scheme, it's kind of culturally thinking it, but in the grand scheme of life, you are providing a service to somebody. Do the best you can because you know, we all benefit, you know? And I think, like to your point, the other thing that is incredibly satisfying for me is that I work in a teaching hospital. So I deal with high school students, college students, med students, and residents and fellows. And I've been able to mentor those kids to find their path in life, whether it's doc being a doctor, a nurse, a physician assistant, something in the medical field if that's their interest. So I've been very fortunate enough to still do what I kind of wanted to do going into medicine, which is to still be a teacher, but then get to do the clinical aspect, which is which is something that honestly you don't know how great it is until you actually experience it. Yeah.

SPEAKER_01:

Well, I'm so I'm gonna take a step back because you said a lot of really important things there that I want to touch on, but I want to do it in the context of the experience that um my family had. And so what I'm gonna do is I'm gonna just take a moment for those that don't know the story, very, very briefly explain what happened. But basically, we it just so happened that my two, our two younger kids, our two older boys at this point, were happened to be away from the house. And Christina and I were able to go out and have a nice dinner uh together, knowing it would be one of the last um, you know, or five weeks out from delivery. So yeah, this will be really nice to have the house to ourselves and just kind of enjoy some final moments of peace and quiet before, you know, the madness begins. And so, you know, that evening she said, you know what, I'm just not, I'm not feeling the same movement that I would normally feel. And she's like, I'm gonna really keep a close eye on this. And because it's her third pregnancy, like I feel like, you know, you're pretty in tune with your body at that point. And so we wake up the next morning, same level of concern, and starting to think about, hey, I, you know, I don't want to be that mom that says, like, man, I get overly nervous, and you go to the hospital and they just send you home like an hour or two later. And so, you know, we're kind of like thinking about it. To be honest with you, I chat GPT, we chat GPT'd it a little bit and say, like, what is it telling us to do? Uh, believe it or not, it actually said, Hey, you should probably go get checked out. So, and again, with this being her third one, she knows her body really well. So, we go in and you know, we got monitored, they get set up, everything's looking great. They said, Hey, you know what, we're just gonna keep you here for about an hour and just make sure everything's looking good. 20 minutes in, thumbs up, everything's looking good. All of a sudden, we start hearing a bunch of beeps and buzzers, and about five people come flooding into the room. And that's when you kind of know, okay, so I don't know what's happening, but something not good is potentially happening. And fast forward a little bit, but um, they said, Hey, look, that the baby's under a lot of uh pressure and stress right now. Like, we need to get this baby out immediately. So we're in for emergency C-section. We go into the operating room, literally, and I'm not exaggerating, maybe 15 people in this room. She had had the first two births by, you know, normally. Um, so this was a very new experience for us to be in an operating room and all these sorts of things. And then, you know, the baby comes out and we don't hear it breathing. And uh, you know, you're I'm trying, she's asking me what's going on. I'm like, no one's saying anything, but I'm I think everything's going okay, right? And so, anyways, we end up getting rushed over to the NICU, and kind of that's where you and your team um start to take over. I do want to read something. I have this sheet of paper here uh that we got from our insurance. Thankfully, we have not had experiences where we've had to go in hospitals very often. We've had very healthy family members, and we just haven't had to be in hospitals, other than for births, which is a great reason to be in a hospital. But so you go in there and you know, you start hearing things, and again, I don't know nothing. We're not medical people, we know nothing about these things, but you start hearing things like I'm gonna read two sentences just so people get an idea. Rupture of membrane at delivery, amniotic fluid, presentation, vertex, delivery, emergent cesarean suction, fetal distress, uh, operating room, then it gets into oxygen stimulation, oral suctioning, tracheal suctioning, intubation, and endotracheal tube ventilation. So, my point is a lot of words that you're just like, I am so confused on what's happening right now. And once everything kind of settled down, you and I ended up in an elevator together. And I know you're doing your best to explain things to a lay person that has does not have the decade plus of education that you have. And what I explained to you is like, Doctor, like I don't really know what you're saying. I'm trying to follow along with what you're saying, but I I don't quite get it. And at the sake of spending three hours with what I'm doing right now is I'm reading your facial expressions to get a sense of the severity of this issue. And I think I don't know if you've ever heard that before. I'm sure as a human, I'm sure that's kind of what we have to lean on. Um, but just curious to get your thought. I know I said a lot of things there, but just like what are your initial thoughts? Like just getting that parental perspective. Yeah. Like what are your thoughts on that? Right. Just how you have to communicate information.

SPEAKER_00:

Two things that I want to say before we answer that question. When you bring up that story, right? You give the medical team a lot of credit, and we'll and we'll take some of that credit, but it starts even before you went to the hospital, right? Advocating for yourself, knowing your body, knowing something's not right. The true heroes of why your daughter is doing so well right now is because you guys went to the hospital when you did, you know? Because if you waited too long, we might be talking about a different story, you know. So I don't think people realize that medicine, especially in the pediatric world and in NICU, it's a team sport, right? And I always say that I'm just a team member of this game, right? The real important members are you and mom, right? And it's because of the fact that you guys are the voice of your baby, right? You are her advocate, right? And again, if you guys didn't make that decision, we might be talking about different situations. So the true heroes to even begin end of this whole story is the fact that you guys realized something was not right and went to the hospital. That's a big deal, right?

SPEAKER_01:

Well, I think just on that point, I've heard stories now, having gone through this, that a lot of people are like us where you don't want to be that person that just like goes in at the faintest sign of like distress. Yeah. And I hear that like in my wife talking to her friends a lot about similar situations. So that's kind of interesting, right? It's like you don't want to like, I don't know, almost like be a burden on somebody if there's not like a real issue going on. And that seems like it's kind of a common thought, which I th I found interesting.

SPEAKER_00:

I think this there's this weird notion that you're burdening us, but remember, it's our job. So you're not burning anybody, right?

SPEAKER_01:

Right.

SPEAKER_00:

When I come in and sit to you side by side, you know, you're not burdening me. And if we're talking about this for the 10th time or the 11th time or the hundredth time, it's not a burden because the important thing is that I'm conveying information again, because in the end, when you leave the NICU, who's Camilla's advocate? It's you guys. And if you guys don't understand what's going on, then then I'm not doing my job right. So I think it's one of those things for patients and for your listeners to realize that you know what, you know your body best. And if your body is saying that something's not right, you should listen to your body. Yeah. I think when it comes to communicating with parents, you know, one, I have a tendency to talk as fast as I think. So I talk really fast.

SPEAKER_01:

That's I can confirm.

SPEAKER_00:

And two, you know, I try to take medical jargon out as much as I can. But, you know, I've done this for so long now. And I work in a children's hospital and I've seen a lot, things that I wouldn't be able to describe, you know.

SPEAKER_01:

Right.

SPEAKER_00:

I stay humbled because the field humbles you, right? But there's not a lot that I haven't seen at after doing this for over 10 years where it's gonna scare me, scare me, you know, especially when it comes to what Camila went through, because I'm the neurodirector of of this NICU. So I've seen all the kids that go through. I don't know if you want to share what what Camila went through, but so what she went through, I I always it's called HIE, hypoxic, ischemic, encephalopathy, hypoxic meaning um lack of oxygen, ischemia usually meaning some kind of injury, and cephalopathy meaning to your brain. And essentially, so essentially, babies, their oxygen from mom, from mom's blood, from mom's lungs, through her uterus to the placenta, umbilical cord to the baby. Any of that tract is compromised, that's compromised blood to your baby. And in this case, we realized that what happened was unfortunately, the umbilical cord does what it wants to do in the amniotic fluid, and if it wants to make a knot, it makes a knot. If it wants to wrap around your neck, it wraps around your neck. In Camila's case, I think it did bull. Yeah.

SPEAKER_01:

Four times around the neck and a knot. Yeah.

SPEAKER_00:

So it compromised her blood flow to the point where she was not getting adequate oxygen. That's why your wife wasn't feeling so well. That's why Camila was telling your wife something's going on here.

SPEAKER_01:

Right.

SPEAKER_00:

So I played HIE to like getting punched in the arm. I don't know if you remember that analogy.

SPEAKER_01:

Of course. That was like the simplest form of explaining something. So thank you.

SPEAKER_00:

Yeah, well, we're guys, so we understand about getting punched in the arm. That's right.

SPEAKER_01:

Yeah, sure.

SPEAKER_00:

So it's like getting punched in the arm. If I was to punch in the arm, what do you do? Right? Well, there's nothing about getting punched, right, that you can take back. I hit you, there's no take backs. Right. Too bad, right? But what you can do is you put ice on that arm. And what does ice do? Well, ice again doesn't take care of the initial injury, but it takes care of the secondary injury, the swelling, the inflammation, things that can happen from get from the initial hit. So that's why I always say, when I always talk about HIE, I always say hits, right? Because Camila took a few hits. She took a cord around her neck and a knot, and that compromised a lot and caused potentially inflammation. Now, the milical cord gives blood to your whole body. So it's technically inflammation to their whole body, but we're trying to protect the brain. Right. So what we do for that is we put a baby under cooling. We put them on a blanket, we cool them down, and we're trying to prevent the secondary injury that can potentially cause worsening brain injury. So that's what Camila had to go through. And fortunately for her, and again, the bigger the hit, so like we used an analogy if I was hit you with the baseball bat, ice is not going to do a lot for a baseball bat, right?

SPEAKER_01:

Right.

SPEAKER_00:

The bigger the hit, the harder cooling is going to benefit a child. So, like I said before we even talked about this, is that the biggest heroes really is you and your wife for coming in earlier. Because if you waited longer, we don't know how compromised Camila would have been during that process, right? So you guys probably came in in the right time, got monitored properly, saw the initial insult quick enough to get her out so that she can use her own lungs to oxygenate to get rid of all that compromised blood flow, you know? And then we just kind of kind of like when you study, right? We just took her from a B plus to an A, right? Yeah. Where where we kind of just helped her along in the in the healing process of it. Right. And the work was done by her, right? She was the one that did all the work. She healed, she did well. And and now we can have this conversation where there's smiles on our face because we have the healthy baby girl.

SPEAKER_01:

So let's talk about just the communication. I want to go a little bit more in depth into that part. So like I was saying earlier, you're probably interacting with a lot of people, again, that don't don't have the same foundation to be able to understand these things. I know you did, like you said, do it as layman's terms as you as you possibly could. Do you kind of notice though, what I'm going back to what I was saying about like, hey, look, especially in the moment, like your brain's kind of all over the place. So you're kind of not able to completely focus because you're thinking about the world of possibilities. And I, like I said, I had mentioned to you in that elevator, like, hey, I'm just trying to read your face to see like how serious this actually is. Because I think the other thing too is as a doctor, like you don't want to overpromise and underdeliver too, right? Like you're not gonna go in there and say, like, hey, it looks really good, and then just something turn worse, and you're like, but doctor, you told me everything was gonna be great, and now everything's not great. So you kind of have to take like a more, I don't want to say pessimistic approach, but you try not to be overly optimistic, let's say, right?

SPEAKER_00:

Yeah.

SPEAKER_01:

Um, so can you just talk about like that balance of just like, I know as a parent, you really want me to tell, hey guys, there's a 90 because what I wanted you to tell me was, Paul, there's a 95% chance that everything's gonna be great and don't worry about it, but you can't do that, and I know you can't do that, but like, so if you could just talk about that part of it, because I'm sure in the back of your mind, are you thinking, like, I wish I could tell these people what I really want to tell them, but I can't talk about that.

SPEAKER_00:

I think part of it is just the fact that I don't know, right? And I'm okay with saying I don't know. And I'm also okay in saying I don't mind being wrong, right? I'm happy if when I'm wrong, usually. So in the initial phase of things, honestly, like I think I told you this too, Paul, is like it's too early to tell a lot of things, right? There's things that are promising. Remember what we're talking about, that we can already see improvement in her that's promising because a lot of babies we know that are sicker don't improve so quickly.

SPEAKER_01:

Right.

SPEAKER_00:

But a lot of it is information gathering. And and the more I and more information I get, whether it's through blood work or through imaging or just through how how a patient is looking, you know, that's more telling. That phase, remember what I told you, growth in time. That phase, just giving time and letting it kind of breathe a little bit, you know, that is actually really important. And sometimes what I'm trying to tell parents is that, you know, it's hard because we're doing something you've never heard of.

SPEAKER_01:

Right.

SPEAKER_00:

You went from a normal day to something incredibly scary. We're not part of the birth plan. You never heard of what neonatology was, you know.

SPEAKER_01:

Right.

SPEAKER_00:

And I'm trying to tell you we have to let it settle a little bit. We have to let time tell us more, you know. I think that's the biggest thing that I try to do when the when I first meet a family is to say, hey, we might not have all the answers, but we're gonna get those answers. We need a little bit more time, but the most important thing we need to do right now is stabilize your baby. That's kind of where I am when I initially meet a family, you know. And like I said, I there's not a lot of scaring me. So it's so it's hard to read my facial expression to see how scared I really am because there's some scary situations, but I, you know, it's one of those things where it's like, okay, we've seen this. We can we know what we need to do. Yeah, but the baby is incredibly sick, you know.

SPEAKER_01:

So for a parent that hasn't experienced that, that has no, like I said, foundation. Uh and I'm gonna I'm gonna tell you now what happened. So we would talk to, you know, you or we talked to another doctor, I would kind of like memorialize what was being said and just say, okay, uh, it's a little bit embarrassing. I don't know if it's embarrassing, but I would then take that information and go put it in chat GPT and say, like, give me more answers, like give me pre because I I'm not like a numbers guy, right? So I'm like, yeah, what so I'd put it on like what are the odds of permanent brain damage based on these factors? And it would actually spit out a number. Whether it was accurate or not, I don't know. But for me, and to get through that experience, like it was helpful, right or wrong, that it was like, hey, there's like a 90% chance that your daughter's gonna be perfectly fine. And so like I would do, I don't know what I would have done before. I guess Google searched it, but I was like looking for things to put my mind and Christina's mind at ease when I couldn't get that from you know, be again, because you can't offer it because you just genuinely don't know. Um, I don't know what do you have to say about that, if anything.

SPEAKER_00:

I mean, I think what helps you get through helps you get through, right? I mean, it is an incredibly stressful environment. I mean, I tell I tell parents all the time too, it's like what you're going through, not a lot of your friends and family have gone through. It's hard to convey kind of how you're feeling because it's hard to find people that can actually empathize and have similar experiences. So I think in that sense, I mean, I'm not a big fan of people looking up things on the online, but if it helps you, if it helps you get through, you know, through a really stressful situation, I'm okay with that. And sometimes it also means that, hey, if it helps with conversation, had you just come up to me and it's like, hey, Dr. Tran, you know, Chat GPT says, you know, that Camila has a 30% chance that she's gonna be okay. Is that true? I would, I would probably say, no, most likely not.

SPEAKER_01:

You know what's crazy is it it would give me a synopsis of of the answer, and then it would say, Would you like me to generate questions for you to ask your doctor? I was like, I didn't I didn't use it, just to be honest. I didn't use really I didn't, but because you know, you'd go in there and you'd say to a bunch of things, and then it's like the last thing you would always say is what do you have any questions? I don't know if I have questions because I don't really kind of fully understand what you're saying. And so, like through Chat GPT, it actually kind of like directed you on like, hey, well, maybe ask about these areas. So I just think it's fat we're kind of meeting this intersection now of like where technology's at versus where you know just medicine and all those sorts of things are at. And so I think everyone's talking about AI and Chat GPT. So I just I thought it was kind of fascinating that at least I wanted to share my experience of how I try to use it to get through that.

SPEAKER_00:

I think if I remember right when ChatGPT first came out and they kind of compared a Chat B GPT doctor ChatGPT to a doctor, they found out that ChatGPT was more empathetic. So I think it's one of those things where you know there's a lot of technical stuff that goes in and on our field. And I think because of that, I don't mind having technology be the bridge for communication, especially if there's especially if there's a gap in communication. Because I've like I said, in the world of pediatrics and neonatology, it's so important that the parents understand what's going on. And because Camila can't talk and she won't be able to talk until she's one and two. And even then she can't really express herself that well. So when we need to educate somebody, we're educating parents to be champions and advocates for their kids. So it's incredibly important for me to make sure that you guys understand what's going on through the whole process. And if there's gaps, you know, if Chat GPT is helping you kind of say, hey, these are my knowledge gaps, these are the questions I should be asking. Yeah, I I don't feel like that's offensive at all. You know, I feel like that is more helpful in the communication of trying to fill those gaps so that when you lead the NIC, you you know what's going on with your daughter. So you know what know what know how to advocate for her properly.

SPEAKER_01:

Our story has a has a happy ending. You know, we're we're home, healthy, everyone's doing great. And you briefly touch on this, but I want to spend a little bit more time here. And that is just, you know, part of your job is meeting families at a very challenging moment in their life. They don't we don't, you're a stranger to us. You've obviously very quickly become somebody that we rely on very heavily um to take care of a very important, you know, meaningful person in our life. When you are communicating, like when you get to communicate good news, uh, how is it when you you know have to, you know, maybe I don't know, sit in your office and and deliver, prepare yourself mentally for delivering bad news? Like what what how does that work for a doctor?

SPEAKER_00:

So I think good news is always easy, right? I mean, honestly, tell you the truth, we fight over good news, right? So so you met the neurology team, and and when there's a good MRI, it's always a race, who's gonna give the good news first? You know, so good news is easy, right? I mean, you'll you'll see smiles on our faces, and I love, I think I love giving good news and I love seeing that relief that comes with good news. That's the easy part of the job, right? That's the that's what gets you going. I think with bad news, that's a different, that's a different beast. And I think there's a technique to that. It depends on who you are, you know, and how you are to deliver it. I'm pretty transparent. And I think, again, I always am under the belief that to empower a family to make a difficult decision, they need to know what's going on, which means that I'm not gonna hide the words death. I'm not gonna hide the words, you know, brain injury, I'm not gonna sugarcoat certain things because families need to know. You know, it's unfair for them to make a such a life-altering decision for not their child's life, but their life too and their other kids' life, you know, and not be transparent for them to make that decision. So I am pretty transparent about that. And then my job after that really is to really, once I feel like a family understands what's going on, is to honor their wishes. You know, I'm not the decision maker in that one. I think as a family, you are the beliefs of your child, you're gonna convey to them, right? And whatever a family wishes, if they are truly informed well, then my job is not to cast judgment, but to support that family. Because I know no one's gonna love that baby or that patient more than that family. Right. You know? So I think doing what we do, unfortunately, we give a lot of bad news. I had had given a lot of bad news in my life. And, you know, sometimes, and I'm okay, and I think I've become okay, a little effort to not be like, you know, I'm okay. Oh, go ahead.

SPEAKER_01:

Yeah, I was gonna say, so uh, this is reminding me a lot of actually. So my dad was 30-year veteran LA sheriff's department, he was a police officer. Um, kind of similar in a lot of ways, right? You're meeting people sometimes in very poor moments, you don't want the person to be there. It's it's a low point potentially in your life. Um, he's seen death and injury and you know everything. Yeah. And one thing he talked about was that, and that's prevalent throughout the police forces, some people are able to compartmentalize that and go home and be able to enjoy their family and things like that. And then I and the other part, unfortunately, like the the suicide rates for police officers is really high and like they they carry this massive burden with them that some of them just are not capable of overcoming. I feel like there's a lot of similarities in that sense. Like, do you feel like when you go home to your family, like are you able to compartmentalize and disconnect? Is that how do other doctors deal with that too?

SPEAKER_00:

Yeah, you know, it every doctor is different. I think what makes it harder for us, honestly, is to be parents as parents and having kids of our own and to see parents go through this with their own children. It was much easier to do when I was younger. It's become harder as I've gotten older and have three of my own. I feel this this is the reason why I chose NICU over pediatric ICU. Is when I did rotation in pediatric ICU as a resident, you don't forget when kids die. Not babies, when kids die, because they developed friends, they become social networks, they had a life, you know, and to watch them die and to watch them die due to usually some accident or some disorder like disease, it's hard to watch. Cancer kids passing away is one of the hardest things to watch for me. I'm not strong enough to do that, you know. And why I chose the NICU is that I always felt that without the NICU, these kids don't have a shot. So if you cannot make it out of the NICU, you know, it's not because we didn't try, you know, and it's not because the family didn't try, and it's not because definitely not because the baby didn't try. We tried our best. And I think that has allowed me to be okay when I lose a baby in the NICU, whether it's something as tragic as a complication of birth or something as a genetic disorder that's just not compatible with life, that with me, that still allows me to go home knowing that we did the best we could, that that family and that baby did the best they could. And it was just not meant to be. Now, doesn't don't get me wrong, I'm still a human being. I still hug my kids a little bit harder. But that's how I can move on. And that's how my mentors have taught me, multiple mentors, not just one, but multiple mentors have said, you gotta move on. The reason why we have to move on is because the next kid needs you, the next family needs you. And if you if you hold on to it too long, yeah, right, the next family is not getting the best version of you, you know.

SPEAKER_01:

So that leads me to something else, which is you know, you can't have an off day, right? Like sometimes people, you had a you had a rough week, you're just mentally not, you're not there, and you kind of go into work and you maybe just you know check it in for the day. You you you cannot do that. I mean, there's literally lives on the line. So I just um imagine like this massive uh mental burden um that on you. And then you know, the other thing I didn't even talk about was I think one of the times I talked to you, you're going on at the end of a 24-hour shift of like little to no sleep, and then you're like, oh, I'm gonna go home and my sister decided to come over and have a pool party, and so I don't even know if I'm gonna get sleep then, right? And so just like the physical and mental wear and tear, like how do you how do you manage that so that you're able to I mean you're smiling right now, you look like you're you've got some sleep today, like you're functioning, you seem like you're functioning really well. So, like, I mean, just how do you how do you put your body through that sort of stuff?

SPEAKER_00:

Yeah, I think part of it's training. And that I that where I I come from I'm at that kind of middle ground where training, I was in the middle of like the end of the old school way of training where you just work your tail off to kind of this newer age where there's work hour restrictions and whatnot. So I think I've been kind of bred and trained to to take 24 hours like I'm used to it. But just like anybody else, though, I'm a human being. And I think what gets what helps you through the day and get through the day is your own social network. And I've been very blessed to have an incredibly strong social network, whether that's my colleagues at work that if they know I'm having a bad day, will say, We got you, we'll cover, we'll cover your patients, don't worry about it. Or whether it's at home, like you said, my sisters, they still, my sisters, my parents, we still live a mile away from each other. You know, my aunts and uncles are still around. I met my wife when I was a resident. So she knew me before I became an attending, but she knew me when I was in training. And she's been with me since then, and she's always had my back. And honestly, we've been married for over what, 13, 14 years now. And it's getting to the point where like she knows when I'm having a bad day. She knows when, you know, that she'll she'll take the kids to go somewhere just for a break, you know, just so I can take a nap. You're only as strong as your support network. I've been very fortunate and blessed to just have a great group of friends, colleagues, family that help me kind of get through potentially bad days, you know. And you know this too, it just in life, you just don't know when you're gonna have a bad day, you know, and to have just a strong network to be able to support me during that kind of unpredictableness of my career on top of just the unpredictableness of life, you know, has been really beneficial for me. It's a tough run. I'm not gonna get, I'm not gonna lie, I'm not gonna sugarcoat it, but it's been an enjoyable one.

SPEAKER_01:

Well, Doctor, you know, we're we're so thankful for having come across you again. I wish I would have never met you, and I mean that in the nicest way possible. Uh, but but since I did, we felt very fortunate uh to be in the hands of of your caring hands as well as the rest of the team over at um the Orange Chalk. Uh Nick, you we felt just amazingly taken care of. And like I said, family's thriving and doing well. And so um it's it's nice to talk to you and personally thank you again for for what you did for us and our family.

SPEAKER_00:

So thank you. No, it's my pleasure. I think I say this to every family. I always thank my families that I work with because you're allowing us to be a part of your life and putting trust in us. So thank you for just allowing us to take care of your child and your baby and trusting us through a really difficult time. And I'm so glad that you guys, that we are together sitting in this room, smiling, sharing good news.

SPEAKER_01:

All right, go save some babies.

SPEAKER_00:

All right, thank you.