Syllabus to Reality

One thing that excited me about medical school was being able to turn textbook (or syllabus) material into real, practical applications. Hypothetical scenarios in class are one thing, but being able to use the knowledge I gained in my first-year medical education at the Monday Clinic, UT Southwestern’s student-supported free clinic, was a refreshing reminder of how important our studies truly are.

I, along with other pre-clinical and clinical medical students, had the privilege of interviewing a young patient who had signs of hormone imbalances—she sometimes felt too hot or too cold and had an irregular menstrual cycle. She was also noticing some new difficulty in seeing. Given these two clues, I was now faced with coming up with a plausible explanation that could link them together.

From my physiology class in March, I knew that hormone dysregulation can sometimes come from tumors of the pituitary gland, commonly known as the master gland of the endocrine system. Pulling from my neuroscience class in April, I knew that overgrowth of the pituitary gland could compress on the optic chiasm running in front of it. And there I had it: Combining what I had learned in two different classes, I concluded that these were signs of a pituitary adenoma.

When I presented this to my attending, he reminded us that this was no small diagnosis and would need to be confirmed. He asked me, if a pituitary adenoma was true, what specifically I could expect to find about her vision. I didn’t expect to be put on the spot, so I had to think fast. I faintly recalled some colored nerve pathway diagrams I had known so well the night before my exam, and I remembered that the optic chiasm served the vision on the outer sides of each eye. Without any concrete medical vocabulary yet, I awkwardly demonstrated with my hands what my attending agreed would be bitemporal hemianopsia.

What amazed me was just how much more we have actually learned than we ever realize. I now know that seeing patients, far more than taking an exam, will bring forth knowledge we had no idea we gained. To be able to take care of patients makes the thousands of pages of our syllabi worth it.

In the end, it turned out my diagnosis was totally wrong. The attending performed a visual fields test and did not find any defects, and we concluded that her symptoms were due to a much more manageable case of diabetes. Although it was a little anti-climactic for me, I am extremely happy that our patient did not suffer something more threatening, and I am excited to be becoming closer to a doctor.