Books and Essays by Doctor Frank Boehm

(August 26, 2006)

      I have practiced medicine for 41 years and during this time I have often been asked why doctors "practice" medicine? While there are several ways to define the word practice, a common understanding of what practice means is "to do repeatedly in order to learn or become proficient". But the question always remains the same, "Shouldn't we already be proficient when we become doctors and no longer need to practice"?

      The truth is that doctors practice all the time. We are in a constant mode of learning to do it better, to become more proficient. We can never learn it all. In that sense, the practice of medicine is quite humbling. In our ever changing world of medical advances and new technology a truly good doctor is always practicing.

      We practice by reading medical journals each month, attending lectures and post graduate courses each year to learn what is new and effective, undergoing re-certification exams to prove to others that we still have what it takes to be proficient and, most importantly, by looking at each patient as a challenge that needs careful scrutiny and attention so as to wind up with a good result. I was reminded of this recently when I was on call at the hospital last month.

      Melinda was 34 years old and 26 weeks pregnant when we met. She was in our care because she had insulin dependent diabetes, a blood clotting disorder and, tragically, because she had lost all of her six pregnancies, three by miscarriage and three stillborn babies. The three babies that died in Melinda's uterus prior to birth were at 30, 28 and 26 weeks gestation (a normal pregnancy is usually around 40 weeks). What was particularly worrisome was the fact that no one knew for sure why her babies died inside her uterus at those times or what could be done to avoid this current pregnancy ending the same way.

      During her last pregnancy we had attempted tight control of her diabetes and testing her baby twice a week to ascertain its oxygen reserves. Despite all this, Melinda came to us a few days after all tests looked reassuring with a baby that had died in her uterus at 26 weeks.

      So, here she was once again pregnant at 26 weeks gestation with no answers from our medical team of high risk doctors how to assure this pregnancy would have a different outcome. We felt we had given her the best available medical care possible during her last pregnancy and didn't know what more we could do.

      I explained this to Melinda and her family. But I also told her that since we did not know what was causing her babies to die, we would try something different. We admitted her to our hospital and tested her baby every day, in every way we could. We took nothing for granted. Melinda accepted our plan as we began a rigorous course of testing her fetus in multiple ways each day for its ability to remain alive inside her uterus.

      As we made our rounds each day, we carefully reviewed each test that was performed for any changes or signs of problems. As long as everything remained the same we were reassured. While Melinda's child was not growing as fast as expected, her diabetes was in good control, her blood was properly thinned and daily heart rate monitoring and ultrasound testing of her unborn child did not reveal any problems.

      Then quite suddenly after three weeks of hospitalization and at 29 weeks gestation, my resident called me. "Dr. Boehm, I need you to look at Melinda's tests". I quickly went to Melinda's room and looked at a fetal heart rate pattern that looked troubling and an ultrasound exam of a baby that was not moving, a potentially ominous finding. A mere 24 hours earlier, Melinda's baby appeared healthy, but now things were very different. A quick decision to perform a Cesarean Section was made and within minutes we delivered Chelcie, a two pound six ounce baby girl who seemed dazed but healthy.

      Later, while talking to a very happy mother and family, I still could not understand what had happened. What I do know, however, is that all of us at the hospital that day were thankful for the delivery of a live and healthy baby. I also knew that we had all been reminded of the important fact that practicing medicine was a continuous learning process, and that while we do not always understand the complexity of the human body, we can respect and learn from that complexity. That's why I love the practice of medicine. ( PS: Chelcie now weighs over 3 pounds and is doing well)