Case Study: A Pharmacist-Parent Eyes the Zebra Side Effect in a Field Full of Horses


How a mother's intutition, and a pharmacy background, proved important in identifying a medication-related side effect.

It’s uncanny how the rather vague concept of a side effect manifests so imminently, so concretely, when one experiences it first-hand.

My mother, a pharmacist who I imagine has seen her share of side effects related to medications, was the one who made this observation, when I experienced my first of several episodes of sudden vision loss. Rare (I’ve been told), this medication-induced side effect was a result of increased intracranial pressure, leading to increased intraocular pressure, which eventually inflated my optic nerve to the point of a cloud-like floater that would drift ominously in and out of my peripheral vision for the next several weeks.

To be candid, I wasn’t frightened of the “blackout” episodes, as they were short-lived and predictable (since the myriad of doctors who swarmed around me in the emergency room warned me of their arrival and, fortunately, of their passing).

As I look back at this time, with my vision ultimately intact, the remaining impression is how fortunate I was to have had a health care professional on my side nagging, (as only my mother can), the nurse and doctor about the unusual headaches that I was increasingly experiencing while on my medication.

Never mind that it happened to be spring, which is a prime headache season for me. Somehow my mother knew that these headaches were different, because (1) she’s my mother and (2) these headaches were indeed different, but in subtle ways. The pain was not unusually severe, but didn’t abate with my usual panacea of painkillers and sleep; the aches persisted daily, as did my mother’s phone calls to the doctor. Her complaints were initially dismissed, as my medical record included the telltale history of seasonal allergies, accompanied by headaches. I’m certain the doctor thought my mother to be ignorant, or at least nonlogical. I thought she was manning her usual parental helicopter (as headaches were not an unusual part of my spring).

The day I was reluctantly seen by my doctor was the blurriest in this entire misadventure. The light directed into my eyes was piercing and fleeting; moments later I was whisked to the nearest hospital emergency room, where, for the next 8 or so hours, I was seen by numerous impressive-sounding white coats.

The ones who were most impressed by the size of my bulging optic nerve were the neuro-ophthalmologists, who came to proclaim that, while they have seen this particular medication side effect, mine was the most severe, since that notorious optic nerve actually protruded into my field of vision.

I don’t want to oversimplify this experience by pointing out that I was lucky; yes, the complication was caught in time to prevent any permanent vision loss, ignoring the headaches for a bit longer might have forced me to delete the first half of this sentence, and sure, I was inclined to assume my doctor was the bad guy. The nonsimplified point of this story is, well, more complicated (as my mother explained).

In medicine, when we hear hooves, it’s generally acceptable to assume the arrival of a horse rather than a zebra (otherwise doctors would be practicing in a constant state of futile panic). As I mentioned earlier, my side effect was rare, while my spring headaches were common; in a statistical model of my experience, 8 out 10 “Madelines” would have been likely found to be suffering from allergy-related headaches rather than intracranial hypertension (so I’m told).

What I learned most about medicine (from my bird’s eye view of one of the many health care providers who practices it) is the degree of education and training that allows, say a pharmacist, to be able to almost instinctively distinguish a symptom as vague as a headache from the usual ache, to the unusual rare medication side effect.

Granted this health care professional happens to be my mother who know my aches and pains; but I suspect there were reasons (beyond motherhood) that governed her suspicions of this particular headache.

I’ve also come to realize that no one person in medicine has all the right answers, or all the wrong answers. My mother never blamed the doctor for ignoring my headaches. As I sat during one of my blackout moments, I realized that I wasn’t afraid of my treacherous optic nerve; I trusted that I would regain my vision (as I was reassured), since although there were a few wrong answers, the doctors, nurses, and pharmacists had more than a few right ones as well.

Madeline Beyzarov is a senior high school student and an aspiring health care provider.

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