Saturday, December 29, 2007

On becoming a doctor

I have to admit that I was really nervous to re-read the essay I wrote two years ago to get into medical school; I was anxious to look back at who I was then and to see how (if?) I had changed. In my essay, I wrote about how swimming was an activity I always loved and traced how I began to first identify as an athlete. I also described the struggle it was for me to take a break from swimming as a result of an injury. Ultimately, it was the encouragement of my father (an Olympic athlete) that I found the strength to realize that taking care of myself was part of being an athlete as well as part of learning how to become a doctor.

My first year of medical school was the best year of my life- meeting new friends, living on my own, feeling successful, managing classes, balancing life, and even learning how to be a puppy mama in my spare time- it really couldn’t have been better. Second year hit me as a stark contrast: I felt like I was never doing enough, I always felt behind in classes, my life was unbalanced, the pressure of boards was crushing, and I wasn’t healthy. I became a jaded negative medical student, someone who I never wanted to be. I forgot why I was working so hard and if it was worth it but remembered that I had too many loans and had invested too much time to give up just yet. Ultimately, it were my clinical experiences this year that helped inspire me to shake out of it and remind me of who I was and who I am now determined to be.

Exhausted, grumpy, and disgruntled that my afternoon of studies was interrupted, I arrived at the children’s hospital in Cleveland for a shadowing experience in neonatology. When I saw my first tiny patients, everything changed. The innocence of the kids- how could I resist smiling, even it was for the first time in too long? After finishing the shadowing experience, I stayed a few hours extra to talk to residents and, of course, to play with my patients. This clinical experience changed me by showing me that not everything in life was negative and instantly re-focused me. I’m not sure if it was the cuteness of the patients that woke the real me or if it was finding a possible specialty that may be my calling, but it changed me. Despite how packed I thought my schedule was, I started doing extra shadowing experiences at the children’s hospital. I found an amazing mentor who showed me that not all attending physicians are jerks, that medicine could be fun, and that you can really care about your patients even if you haven’t slept in three days.

I learned more about the doctor that I hope to be during a communications workshop. In this workshop, we have actors as patients so that we can practice delivering bad news and other challenging communications skills that a medical student must learn. As I told my “patient” that she had a sexually transmitted disease, I could have stopped at describing the treatment for her disease. Instead of judging, I asked this patient if she felt safe and why she did not use protection. Although I had already met all the requirements for this workshop, I continued talking to this woman, trying to inspire her to take better care of herself. I found myself empowering this woman and giving her resources for how she could be more healthy and more safe. Even though this situation was not a real one, I realized some traits of the kind of physician that I hope to become. My experience at an all-women’s college made me aware of the challenges of gender; even more, it inspired me to become an advocate for women. I hope to use my experiences to empower women and encourage the best kind of health. I hope to treat more than the disease: I hope that I can help my patients self-actualize their potential as individual women.

I was able to see the full circle of medical care- patient, physician, family member, medical student- a few weeks ago when I went with my father to a doctor’s appointment. Before the physician arrived, I found myself asking the same questions and in the same rhythm that the physician did later on; maybe I was learning something about being a doctor after all. As the physician spoke with my father, I was impressed by how much information she was able to attain from her patient as well as by how much concern she was able to convey. I was able to ask questions that I knew my father would want to know the answers to and I was able to explain things to him again and to the rest of the family after the appointment. This doctor’s appointment with my father was one of the proudest moments I’ve had in medicine so far. I was so impressed that I was learning how to become a doctor; even more, I was impressed that what little I knew about medicine was useful and that it already allowed me to help my family.

It was clinical experiences like these that ultimately helped re-inspire me during a tough year and provide me with the motivation to continue working hard. I understand now more than I did before just how grueling being in medicine will be: my final weeks of block six and cramming neuroanatomy, head and neck anatomy, ortho, and boards review will not be easy; once block six is over, it will only become more challenging as I’m faced with reviewing for boards everyday for five weeks. Although the next few months will challenge me more than I have been before, I hope that seeing the big picture of the kind of physician I want to become will help me ultimately persevere and do my best. As I wrote several years ago and before I knew medicine, I am reminded of the passion with which I hope to become a physician: “My experience has given me an insight that will continue my interest in fitness and provide me with the resolve for a medical career: the ability to view changes as opportunities gained.”

Friday, October 26, 2007

Something more positive

Sorry for the last post- I was in a real exhausted funk! I called it quits and went to sleep earlier than usual. I woke up and felt sooo much better. Sure it's going to be hard work but something is telling me that this will be worth it.

My new goal- only positive thoughts and only positive things to say! I even changed my desktop pic on my computer to something silly to remind myself of staying positive. (This is the first image that pops up when you google image "positive"... hhahahahhahah).

Thursday, October 25, 2007

A bit of negativity.

Me: "Mom I think I hate my life."
Mom: "Hunny you can't hate your life. You don't really have one."

After a grueling block 5 of relentless studying, I had 1.5 days off before getting thrown into my next block- the last block before I take the first part of the medical licensing exam. This block has a reputation of being the toughest one in medical school. Fall behind a day and you might as well do the year over, is the rumor. After only one week, I already feel overwhelmed, tired, and grumpy. For the first time really, I'm really starting to worry if I'm smart enough to get through medical school, let alone become a doctor. I'm really starting to doubt myself. Some classmates are managing to learn it all. Meanwhile, I'm so overwhelmed that I feel frozen in place. I study all the time but am worried that I'm not learning it well and convinced that despite my hard work, I'm not learning enough. What if I can't do this? What if I just am not tough enough to get through March?

I'm exhausted. I'm bitter. I'm filled with negativity. I know that I need to suck it up- each week is just going to get tougher. Residency will be tougher than anything I did in medical school. So what am I doing? If it's just going to keep getting harder, how do I know that it will be worth it and that I will be able to manage in the way that I want to? Today in a clinical rotation after class I was talking to an attending about a patient. Attendings are some of the most experienced physicians that can juggle it all effortlessly; despite this I looked into this physician's eyes and saw an exhaustion that I haven't even seen the likes of yet. If getting worse is almost a certainty, then how can I be motivated to get to what lies ahead?

Saturday, October 06, 2007

Getting fancy with Olive

We like dressing up

Olive in her new dress- maybe not her favorite


Olive's boyfriend comes for a visit


Olive + Oscar = 2 friends for life (At least until food is involved)

Almost time for the holidays

A video from Christmas in Poland last year... sorry it took me so long to figure out how to post this online!

Friday, September 14, 2007

I did it!




I finished a half marathon!!! 13.1 miles!!!! Wo hoo!

My first 5-6 miles felt amazing- since I started towards the back I was passing people the entire time. It felt so good to learn that I was faster than someone! I felt very strong and even started thinking about training for another race. Unfortunately, mile 10 hit me... hard! I was so grateful that my family & David met me at this mile marker because I really needed a boost! David energized me and my Dad gave me such an encouraging and proud hi five! The last mile was definitely one of my most challenging to finish. At this point I was thinking, "What is wrong with walking? Why can't I just walk and enjoy the day?" My feet hurt, I was tired, other people were stopping... but somehow I crossed that finish line and boy did it feel amazing.

I still can't believe that I really did it. I've never been a runner before; in fact I'm pretty sure that I've hated it for most of my life. This time was different. With the goal of crossing that finish line, I pushed myself to run when I didn't feel like it and become an athlete again. In many ways, training for a half marathon was one of the most inspirational challenges I've had. It's easy to look at the 12 week training schedule and think that you can't do it- especially that one week when I ran about 30 miles! If you take things one day at a time, however, somehow you get through it. And on race day, even if you have some jitters, that training helps you cross the finish line. I think that I gained a lot of mental strength and discipline during these past 12 weeks. Even more, I think that I have some inspiration for the tough year that lays ahead. Studying for my medical board exam isn't going to be pretty. If I take a practice exam today, I will undoubtedly fail, just like I would if I tried to run 10 miles on day 1 of training. The point I have to keep in mind this year and the years to come is to be patient, have faith, and take things in long strides... eventually I will get there. Or at least I hope!

A huge part of why I crossed that finish line, was my support system. To all my friends who wished me luck. To all those volunteers who were cheering on race day. To David for not letting me take a day off. And most of all to my parents. To my parents, than you for encouraging me to take a day off when I was too tired and crabby but thank you for supporting me even when I didn't. Thank you for being there for me cheering me on just like all the hundreds of swim meets. Thank you for believing that I could cross that finish line. Thank you for being there for me on race day. I know that your support will carry me through these next tough months. Thank you.

Sunday, August 19, 2007

10 miles- I DID IT!

I finished my first double-digit run today!!!!!!! To make it more impressive, I ran it in a monsoon! Within the first 2 minutes of my run it started raining and never let up; I'm pretty sure the last half of my run was the worse rain that Cleveland has seen in awhile. I made it home and looked like I had been doing water aerobics in my clothes! I think that if I can complete a 10-mile run in a monsoon, I have a good chance of doing a half-marathon in better weather. :)

This past week has definitely been my hardest in training, both physically and mentally. It's really challenging to find the time for these long runs with school work, let alone to find the energy to finish the runs! With only three more weeks until race day, however, I feel like I have too much invested in training to give up now, despite how utterly exhausted I am. I'll make a compromise- if I'm very tired tomorrow from my 10 mile run, maybe I'll skip my 5 mile recover run to take a nice long bubble bath instead. :)

Keeping my fingers crossed that I will make it to Sept 9th!

Wednesday, August 15, 2007

olive + poison control

I just got off the phone with doggy poison control. Olive will be ok. Things this little troublemaker has ingested in the past 2 months: loestrin, caulking, paint, 409 cleaner, lots of toilet paper, her own poop (ew!), among many other things besides her dog food. What a troublemaker!! Luckily, she's doing just fine.

In other dramatic Olive news, she had surgery on Friday: total hysterectomy, ingrown thumbnail removal, and baby tooth removal. Eek. Luckily, despite her attempts to poison herself, she's doing just fine.

A few pics of Olive- she's getting so big (from 4.45lbs in April to 10.8lbs in August!)








A better update is on its way eventually:
1.) The new house
2.) How the summer went
3.) 2nd year so far (I'm in my second week already!)

Saturday, July 21, 2007

Half Marathon in September!!




It's official! I signed up for the Chicago Half Marathon on 9.09.2007. Now I am starting my 6th week of training- half way there! Overall, training has been great. I wanted to use this summer to get in shape. This summer is our last one ever so I figured that this would be a great time to start a 12 week training program. And more than the freedom of summer, I wanted to have the opportunity to prove myself as an athlete again. After 2 years+ of not being on a team, I wanted to feel the pride of training for something again. Plus I had something to prove- that I could be a real athlete this time around. Since developing asthma last year, I really struggled with keeping up a workout regime. How do you know if you are pushing too hard and that you will exacerbate your asthma if, after years of being a varsity athlete, you have learned to push through the pain? For the past year, I really struggled with finding a balance between taking care of myself and managing my asthma. I hope to find that balance somewhere among these 12 weeks. Although I'm still not sure if I will be able to cross the finish line in 6 weeks, I've already ran further than I ever have before and I'm already so proud. That said, it would be GREAT if I made it to the very end. Wish me luck!

If you want to learn more about the half, click here http://www.chicagohalfmarathon.com/

Thursday, June 21, 2007

Catchup pics

A pictorial mini catch up on my life since exams:

Olive knew something exciting happened- we were done with school! A celebratory dance/karate moves.

Our first weekend after exams and we headed out of Cleveland to relax at home in Michigan with my parents. Olive found a new best friend along the way and David caught his first salmon.


Survived one thing and rounds (life) continues

Ultimately, I survived my emotional and overwhelming shadowing experience in the ICU. Things got easier by the end of the week, but not by much. I guess I'm so used to that feeling of achieving and it was really hard for me to be put in a situation where I felt so worthless and useless: everyone knew infinitely more than me about everything. Instead of being humbling, it was initially incredibly crushing. For one of the first times, I realized just how much work awaits me in all the years to come and just how much more difficult each year will be compared to now. For the first time, I had thoughts of doubt: would I ever be able to manage the long road ahead, am I tough enough, am I smart enough?

I survived, without quiting medicine just yet, and met with my boss. When I told him how overwhelmed I felt after the ICU and how much doubt it put in my mind about medicine he showed genuine concern: "Natalia, you should be excited by how much the team knew, not intimidated. You will be just as smart if not smarter than them when you get to their year. Remember, medicine is an exponential learning process. Every project seems like too much when you try to take it all on at once. Same thing with medicine. Just focus on excelling now and the later will fall into place until you are the kind of physician that you are proud of." I have a great boss.

I look forward to going to the ICU in my clinical years of medical school when I will know a lot more than I did last week. I'm not giving up on medicine just yet because who am I kidding- I love this stuff.

Monday, June 11, 2007

ICU at the Clinic

This week, in addition to working on my research project at the Cleveland Clinic, I will be doing rounds in the ICU with the physician that I work under. It's only been two days and so much has happened so far. Maybe I have so much to reflect on because I've been removed from medical school for a month, or maybe I'm just seeing things that I haven't seen before. Regardless, it's worth quite a bit of reflection!

I go on rounds in the ICU, where my physician is treated like a mafia boss. The rest of us are below him: fellows, residents, interns, PharmDs, and lastly me. Each day, rounds happen in the morning to fill in the big physician with what has happened since he last left (and everyone else stayed up all night handling). On my first day, I was filled with excitement. I was going to be part of a medical team! Finally what I had been dreaming of this whole year: applying my knowledge to real patients! We started with a very ill patient, especially ill even for the ICU. I started to feel really comfortable and dare I say confident in my knowledge as I answered some of the questions that the big physician asked the team. I started thinking, "Hey I can do this! I actually know some of this!" I started answering questions about Fick's law, West zones, oxygen consumption, and hypoxic vasoconstriction; woa look at me was what I was thinking. As the physician started asking more challenging questions (that I felt less confident about answering), the lower levels of the team (interns, me) started to notice that the patients blood pressure (normal 120/80) had precariously dropped to 50/20 and was dropping despite pharmacological intervention. To my surprise, no one in the team was really surprised by this. Someone made a passing comment about how there was nothing else to be done, and ROUNDS CONTINUED AS THIS PATIENT DIED. I didn't know what to do with myself. Should I pretend that it's not a big deal that I was watching this woman pass away? Should I try and fit in with the more experienced team members by continuing to answer questions? Even though there was nothing that could have been done for this woman, I still struggled with how little care there was for this fact. THIS WOMAN IS DYING AND NO ONE IS DOING ANYTHING. No one was even holding her hand as she passed away. She died minutes later, without her family, and without anyone except for the nurse to record her passing. Rounds continued, we joked about the patient who tried to overdose on Viagra, and no one mentioned what had happened. I started thinking, how does one ever get used to this. Even more, how do you ever get to a point, where this patient's death doesn't affect anything? More so, is this something that I WANT to achieve through my training? We also met a patient who was under comfort care life support, there was nothing else to do to help him, because he wanted to wait for his son to fly in from Europe to see him before passing away. This was presented by one of the physicians as a matter of fact: son arriving today at 6pm, per patients wishes. Is it so wrong that I started thinking about this man's life, the son when get got the news that he would have to fly into the US to say goodbye? Am I too sensitive?


I survived the first day of rounds and looked up as much as I could before the next morning for rounds. Overnight four of the patients we had seen passed away. I couldn't even remember what they looked like. No thought was really paid, just a brief mention, and we moved on to the new patients admitted to the ICU. Although I didn't see anyone pass away this morning, two codes were called. These physicians really are "ON" all the time, making diagnoses then rushing off in an attempt to revive a crashing patient. A patient passed away before rounds began. The patient's daughters saw my big physician doing rounds and came up to him. In front of the entire team, these grieving patients attacked him telling him to "get that fat stupid smile off his face" and that "he should be ashamed to call himself a doctor." My physician, my boss, the mentor for the entire team just stood there and took the verbal abuse from these women who had lost their mother. All he said was "please do not raise your voice in the ICU." Even though I recognize that these women were searching for a way to deal with their grief, albeit through placing inappropriate blame, I was really taken back. My boss, one of the most decorated physicians in one of the world's best hospitals was being told off in front of HIS team of students and he didn't do anything. I was so uncomfortable to watch this happen. Once the women were removed from the ICU, rounds continued as usual as if nothing had happened. I couldn't help but wonder, what kind of profession IS THIS? Where the most successful physicians who have dedicated decades of their life to their career still get insulted? It must have taken so much humility and profesisonalism for my boss to handle the situation the way that he did. And yet, I doubt I would be able to do the same, even after all the years of training to come!

Goodness! And I still have the rest of the week to go in the ICU! Keep your fingers crossed!

Friday, June 08, 2007

Olive couldn't be cuter!

I know I haven't updated in a long time (sorry!) ; I am overwhelmed by how much I have to catch up on! I will start with an update on the lovely Ms. Olive, who is sleeping next to me now. :)

OLIVE IS SUCH A GIFT!! I got her a Cleveland Cavaliers jersey today and she loves wearing it! She was running around the apartment just like Lebron James (which explains why she is fast asleep now) ! She loves the attention!

I feel so lucky to have her in my life. I never was a dog person, so it came as such a surprise to me (maybe even more to my parents) when I started becoming obsessed with getting a puppy. Although I didn't really have many rational reasons for getting a puppy, especially during the last two months of my first year of medical school, it just felt right and I went with it. It was so nice to come home to Olive everyday after school and play with her during study breaks. Everyone in our med school fell in love with her and she is now the unofficial mascot for our med school class. :) She couldn't be more friendly and affectionate. I'm so proud to be a puppy mama!!

I hope to upload more recent pictures of her soon (especially in her Cavs jersey!). If you haven't already, I hope that you can meet Olive soon!



Thursday, April 26, 2007

I am the luckiest!


Yesterday was my birthday and it was one of my best ones ever! Horray 23! Early in the morning I woke up to walk Olive who was very well behaved and excited. Before class, David took me to Starbucks so that I could treat myself to my favorite coffee and a scone. Class went well... my small group embarrassed me by singing happy birthday when I came in! I spent the next 6 hours or so doing good quality work. I know it sounds silly that I would like to do that for my birthday, but with all the taking care of Olive, I just wanted an afternoon to myself so that I could start reviewing for exams. David went home and took care of our adorable Olive and kept sending me messages about the cute things they were doing at home together. I was jealous and missed her already!

When I came back home, I played a bit with Olive and took her on a nice walk. That girl gets so much attention! I started taking side streets because so many people want to stop and meet her. :) David told me that he was going to take me out to dinner but that we were going to get a few drinks first. On our way to the restaurant near Legacy Village, he asked me which place I wanted to stop at for a drink, even gave me choices, and we ended up at a surprise birthday dinner with all of my closest friends from medical school waiting for me there! I was so overwhelmed I didn't know what to do! I love talking to all the people that were there and now I was at a huge table surrounded by all of them! It was so overwhelming!

Because I was still so dumbfounded by the moment, David got up and gave a speech to thank everyone for coming. Apparently many people had to rearrange their clinical schedules to make it there. THANK YOU! It meant so much. David's speech was amazing, and I was so proud to look up at him talking. :) So many people were there and it meant so much to meant. So thank you to everyone who made my birthday just so special. I'm the luckiest!!

Tuesday, April 24, 2007

Olive!!







I'm a puppy Mama! Meet Ms. Olive, my 10 week old pug!!

Sunday, April 15, 2007

Check below for new pics!

Finally updated the blog and added pics from spring break. Look below!

My summer plans

Ok so I'm definitely procrastinating this morning. Instead of doing work, I'm catching up on writing in my blog! :)

Below is what I'm doing this summer at the Cleveland Clinic. I initially contacted this physician because I wanted to start feeling more empowered by my newly diagnosed asthma. By learning absolutely everything I can about asthma, I'm starting to feel better about having asthma.

Use of exhaled breath condensate to monitor nitric oxide metabolites before and after allergen challenge in asthma patients

Natalia M. Grob

Department of Pulmonary, Allergy, and Critical Care Medicine and Pathobiology, Lerner Research Institute and Cleveland Clinic, Cleveland, OH

Asthma affects more than 20 million people (ALA, 2005). Despite continued research and advances in treatment, the incidence of asthma is rising and asthma-related mortality continues to increase at astonishing rates. Asthma is a disease characterized by bronchial hyperresponsiveness, airway obstruction, and inflammation. The exaggerated narrowing of airways that occurs in asthma occurs after inhalation of a myriad of stimuli including common allergens, microbes, and pollution.

Asthma exists as two forms: allergic and non-allergic asthma. In allergic asthmatics, the presence of an allergen stimulates an inflammatory process that leads to airway obstruction. The antigen cross-links to a specific IgE on mast cells present in the bronchial mucosa or submucosa, leading to the degranulation and release of leukotrienes, prostaglandins, and other inflammatory mediators. Together, these mediators stimulate the inflammation and smooth muscle contraction that lead to the air flow obstruction present in asthma.

The presence of these mediators and their end-products can illustrate an augmentation of the inflammatory response and be used to predict lung function. For example, nitric oxide (NO) has been used as a surrogate marker for airway inflammation because of its role in the regulation of smooth muscle tone of pulmonary blood vessels and bronchi as well as a role in the mediation of vasodilation. Khatri, et al. (2001) and other have shown increased NO during asthmatic response following an allergen challenge. Smith, et al. (2005) further demonstrated that exhaled NO measurements could be used to guide treatment in chronic asthma: NO levels increased in proportion to bronchial wall inflammation and airway hyperresponsiveness. NO acts as a free radical and is quickly oxidized to nitrite and nitrate by macrophage activation. By monitoring NO, Smith, et al. (2005) demonstrated the potential for using mediators to assess and predict lung function.

Although NO levels have been useful in predicting airway inflammation in asthma, exhaled NO levels in the gas phase may not tell the complete story. NO levels in the exhaled gas at any point in time are the result of a complex biology and biochemistry in the airway that is dependent on the other substances in the airway milieu. NO quickly reacts with oxygen, superoxide, water, thiols, amides, and lipids to produce several endproducts of NO metabolism with varying and sometimes opposing biological effects. Thus, NO levels in the gas phase in the asthmatic airway need to be interpreted in the context of other products of NO metabolism. Monitoring these metabolites in exhaled breath may offer a method to evaluate perturbances in airway chemistry before this is reflected in exhaled NO levels. This has been clearly demonstrated by measuring NO metabolite levels in bronchoalveolar lavage specimens (Dweik et al., 2001). The bronchioalveolar lavage procedure, however, is an invasive method which limits its usefulness to the research setting. For NO metabolite measurement to be clinically useful, a non-invasive method is needed to collect lower airway lining fluid to measure these metabolites. One such method that has become available in the past few years is exhaled breath condensate (EBC) (Horvath et al., 2005). Exhaling through a cooling system generates EBC. The condensate contains the metabolites present in the exhaled tidal breath, including mediators of the NO pathway including markers of inflammation and oxidative stress released from an asthmatic lung (Liu & Thomas, 2005). This procedure is a non-invasive and safe with substantially reduced risk for influencing airway function or inflammation in contrast to bronchoalveolar lavage (Liu & Thomas, 2005).

This summer, I plan on using EBC to monitor levels of NO metabolites and how they change after an allergen challenge (which induces a mild controlled asthma attack) in patients with asthma. Our hypothesis is that in addition to exhaled NO levels, NO metabolites in exhaled breath condensate can provide a better and more accurate method to predict the occurrence of an asthma attack and its resolution. Collection of EBC will be preformed immediately before and after the challenge while still in the clinic. Specimens will also be collected at 8, 24, and 48 hours after the challenge. The non-invasive nature of this procedure allows for the repeated collection without a significant risk to research participants. This project will be performed as part of a much larger NIH-funded Program Project studying the pathobiology of asthma. The subjects of this study will be categorized into four groups: allergic asthma, non-allergic asthma, allergic without asthma, and non-allergic without asthma. Atopy will be detected by skin test reactivity to a panel of common environmental allergens, as described in Khatri, et al. (2001). Other specimens to be collected on the same individuals in the project include exhaled breath, blood, and urine. All individuals will also have pulmonary function tests. My role in the project will be to collect the exhaled breath condensate samples and help run the NO metabolites assay.

Reference:

American Lung Association. Epidemiology & statistics Unit, Research and Program Services. Trends in Asthma Morbidity and Mortality May 2005.

Dweik, R.A., Comhair, S.A., Gaston, B., Thunnissen, F.B.J.M., Farver, C., Thomassen, M.J., Kavuru, M., Hammel, J., Abu-Soud, H.M., & S.C. Erzurum (2001). NO chemical events in the human airway immediate and late antigen-induced asthmatic response. Proceedings of the National Academy of Sciences of the United States of America, 98(5): 2633-2627.

Horvath, I., Hunt, J., Barnes, P.J., Alving, K., Antczak, A., Baraldi, E., Becher, G., van Beurden, W.J., Corradi, M., Dekhijzen, R., Dweik, R.A., Dwyer, T., Effros, R., Erzurum, S., Gaston, B., Gessner, C., Greening, A., Ho, L.P., Hohlfeld, J., Jobsis, Q., Laskowski, D., Loukides, S., Marlin, D., Montuschi, P., Olin, A.C., Redington, A.E., Reinhold, P., van Rensen, E.L., Rubinstein, I., Silkoff, P., Toren, K., Vass, G., Vogelberg, C., Wirtz, H., & ATS/ERS Task Force on Exhaled Breath Condensate (2005). Exhaled breath condensate: methodological recommendations and unresolved questions. European Respiratory Journal, 26(3): 523-548.

Khatri, S.B., Ozkan, M., McCarthy, K., Laskowski, D., Hammel, J., Dweik, R.A., & S.C Erzurum (2001). Alterations in exhaled gas profile during allergen-induced asthmatic response. American Journal of Respiratory and Critical Care Medicine, 164: 1844-1848.

Liu, J. & P.S. Thomas (2005). Exhaled breath condensate as a method of sampling airway nitric oxide and other markers of inflammation. Medical Science Monitor, 11(8): MT53-62.

Smith, A.D., Cowan, J.O., Brasset, K.P., Herbison, G.P., & D.R. Taylor (2005). Use of exhaled nitric oxide measurements to guide treatment in chronic asthma. The New England Journal of Medicine, 352(21): 2163-2174.

Struggling to find a balance

What an appropriate title to this post during this block: homeostasis. Our bodies use homeostasis to regulate everything: acid-base, CO2 vs O2, high blood pressure low blood volume, drug action vs excretion. Similarly, I have been trying to achieve that right balance between learning to become a doctor and having fun while I can. Lately, I worry that my balance has been a bit skewed. On the one hand, I look back at all the sacrifices I made in college to get to medical school: staying up late, deciding not to go out with friends on a weekend, choosing to not go abroad to Spain for a semester. Were these worth it? Hind site is always 20/20 and yet I find myself regretting all the fun I passed up in college. Now I can see that nothing that I learned in college was really that important, at least compared to the pace that I work at now.

So taking that perspective, I am struggling to decide how to manage my time appropriately. I want to have a good balance in life so that I can still do well in school but have fun. Lately, I've been having a lot of fun. Is this too much fun? Maybe it's just attributable to the end of the year and summer plans, but gosh I have been having a hard time buckling down and doing motivated work. Instead, I have been going grocery shopping for fun, planting herbs, making big dinners, sleeping in, going out. I worry that I may be losing grip on what's really important: I'm here to become a doctor. All of this fun won't be worth it if I don't get to become a doctor. I guess I'm worried that I am losing site of what a privilege it is to be in medicine. I want to make sure that I give it the attention that it deserves.

That said, I can't study all the time. And if you don't pick and choose your battles, you will lose them all, in medicine. Take for example our cardiology unit. It would have been absolutely worthless if I had stayed up late every night in a frantic attempt to memorize every anti-arrhythmic agent. First, I won't understand the clinical application so it will be meaningless to me. Second, I will be taking away from other things that I have to be learning that week, whether it is the Frank Starling mechanism for contractility or pharmacokinetics. It's important for me to not freak out and try to learn everything everyday. It's important for me to have breaks so that I really learn things, instead of just frantically skim.

I guess the only conclusion that I can take from this entry is that there still is a lot more for me to learn about homeostasis.

On being intrusive

When I first started meeting “real” patients, I felt really intrusive: I’m supposed to ask them what? And they are going to answer? I ask them questions about bowel movements to how many times they wake up at night to urinate to “men, women, or both.” I feel especially awkward asking patients these questions when they are close to me in age. I feel like they can better sense how little I know.

The more times I ask these questions, however, the more comfortable I start becoming. At first, I struggled to maintain eye contact with patients during these uncomfortable questions. Now I think that I am treating these questions as my job and present them with an indifferent non-judgmental tone that helps me seem more professional, at least in my mind.

My experiences in CPCP at the internal medicine clinic at Metro have really helped me advance my ability to ask these questions as well as start to really learn review of systems, physical examination, and differential diagnosis. One of the other key things that my weekly experience has taught me is the unpredictability of patient care. I may have arranged to have dinner with a friend at 7:30pm, but if a few of the patients come in with complicated cases (i.e. three borderline patients in one day!), my other plans don’t matter. I’ve learned that there really is no way for you to predict how the day will go and you really have no chance in planning what time you get out. A few weeks ago we had a “light” schedule and the last patient was scheduled for 3:40pm for a 20 minute appointment. I got out past 6:30pm. This was early for me. I think that I really struggle to learn that you can’t plan your day as well as I would like. The physician that I shadow is usually running late and although I’m sure it’s because of her other commitments, I struggle to understand why she checks her emails between patients if she is already an hour late for some appointments. I guess that I still have a lot more to learn about becoming a doctor! :)

Monday, April 09, 2007

Easter weekend

Handsome man-some :)

Starting the weekend right with my cousin Rysio:
My charming uncle, caught in the act of being a bit of a nerd. :)
The most beautiful ladies in the world.


I was really lucky and got to come back to Chicago for the weekend! I was even luckier that my family from Canada (minus my favorite Londonian) and my family from Hoffman Estates came to visit, too. :) It was so nice to see a more normal pace of life. I didn't do any work, caught up on sleep, had fun discussions, ate great food (slowly!), and took naps. Life was great. I will post pictures once I get back home today from a long day of catching up on work. I was especially impressed that Rysio spent so much time with us, considering that he had an insane number of finals that start on Tuesday. Thanks Rysio and best of luck!

I know that I should focus on the positive: I got to come home! It's still really hard, however, to come back to Cleveland and have a ton of work waiting for me as well as a ton of slow (in April! 18 inches!). I'm lucky that I was able to come home this weekend and that I got to spend so much time with my family, but it only makes it that much more difficult to get back to work on Monday morning. Oh well.... luckily the library is always 70F and sunny. :)

This week is going to be busy for me. Besides catching up from this weekend, I will be away on Thursday and Friday for all day conferences at the Cleveland Clinic. Hopefully when I'm there I can focus on what a great opportunity the conference is for me to learn more about asthma and other chronic pulmonary diseases. And pulmonary is part of this block, right? So it won't all be extracurricular. :) I'm very eager to see how much of the talks I can follow bc pulmonary is a tough subject. I'm even more eager for my pulmonary, renal, cardio, and pharm block to be over... because then it will be summer!

Stay tuned for pics later on tonight or this week. And a special hello to Jacek, Gigi, Gabe, and Peter who I saw this weekend and said they read my blog! Horray! :)

Sunday, April 01, 2007

Happy birthday Peter!


Today is my nephew's birthday! Happy birthday Peter! I can't wait to see him this weekend when I come home for Easter!

To one of my coolest nephews... happy birthday! Eat tons of cake!

Thursday, March 29, 2007

Oh the power of the white coat

I had two similar situations occur in the past two days and reacted to them very differently. On my walk back from Walgreens one day, a unkempt male approached me with a loud rude voice. Because I was by myself and in a not so safe area (walking, too!), I thought it would be best to ignore him and keep walking. Sure, he could have been harmless but I sure wasn't going to take the chance while I was by myself.

During my weekly rotation at Metro Hospital in inner city Cleveland, a similar situation occurred. I was doing my usual sprinting around the hospital when someone approached me in a similar way. "'Scuse me." This time, however, I stopped, approached, and listened. It's really unbelievable how in two similar situations, I can have such different responses. Once I put my white coat on I feel that I have a responsibility to turn, approach, and listen.

Saturday, March 17, 2007

Spring break 2007!

My last spring break- ever! It’s crazy to think that this time next year I will be done with step 1 of the medical school boards! It’s even crazier to think that at this point I only have about half a year of classes left and then I’m off to rotate and be responsible for knowing things at the hospital. (!!)

Spring break 2007 started off with a drive down to Columbus, OH where we met up with Emily’s parents and they took the group of 5 of us (the last person met us in Atlanta, GA) to the airport. It was a rare beautiful sunny day when we left and we were all so excited that we were going someplace even sunnier. :) During our layover in Atlanta we had lunch and watched the start of the NCAA Basketball Games- we officially started our spring break!

We landed around 6:30pm in Miami and it was still very warm and balmy. We arrived at our hotel, had a quick outfit change, and headed out for South Beach Miami. Our first night was very fun and exciting- we had lots of (unintentional) matching outfits. We had drinks and a late dinner on Ocean Drive. People watching on that street cannot be topped! After dinner we headed to one of the bars that I frequented with the girls last spring break. I couldn’t remember the name of it but instantly recognized it when I saw it: The Clevelander. The bar was a great choice and I smiled thinking that I had gone there so many times last year without ever knowing that I would end up in Cleveland, Ohio for medical school.

Our hotel was close to the port of Miami so when we woke up the next morning, we had breakfast at a Cuban restaurant overlooking the port. We headed out to our cruise ship as soon as we could and we were on the boat by 11:30am. We spent the rest of the afternoon on the docked cruise ship lying out by the pool, ordering tropical drinks, and EATING. My goodness! That first day I must have had more than three lunches! Thank goodness for all you can eat cruise ships! We left the port of Miami around 6pm and passed by South Beach only to see the sunset a few hours later. I was already in heaven!

The boat was huge! My first impression of the boat was disbelief that it really was a boat- a grand scale hotel-like lobby, climbing wall, gym, theater, casino, and more! And there were so many activities, even on the first day. It was all a bit overwhelming at first.

Every night our group of friends had a nice fancy dinner together. We ordered wine, we ordered too much food, we took our time- it was fantastic! I have to admit, however, that I rarely made it very late past dinner. After enjoying wine, appetizers, salads, entrees (sometimes even trying two), and dessert, it was quite challenging for me to fight my food coma impulse. Luckily, I didn’t feel bad about it and didn’t resist my strong urge to go to bed early every night. Thank goodness.

On the cruise we went to Nassau in the Bahamas, then the privately owned island of our cruise line (Cococay, Bahamas), Key West, and finally back to Miami. In Nassau we went to the beach and Atlantis. The hotel was unbelievable! They had shark tanks and a water slide (enclosed in glass) went through it! Amazing. Apparently the rooms on the bridge between the two buildings cost $25,000/night with a four night minimum stay: not this year for us. ;) In the afternoon, David and I went on a catamaran with another couple (Tai and Julie) and then went snorkeling. I was very lucky to have David at my side: he is a certified underwater naturalist so I learned so much about what I was seeing. We even found a turtle and followed it through the water.

The next day at Cococay was very windy but David and I still managed to have fun. There were miles of nature trails and beautiful beach fronts. Check out some pics from our walk!



In Key West we spent most of the day walking around the main street. It was very touristy, but still very fun. We made it to the closest point to Cuba and walked by Jimmy Buffet’s Margaritaville. Most importantly, I got to try some conch fritters and key lime pie!

The next morning we had to leave the cruise ship around 8am. We were all a little sad that vacation was almost over. For the record, this was the first vacation that I can remember NOT DOING WORK. Ok so I did a bit of work on the airplane but I RESISTED doing work this week. I didn't even get more than 50 pages into my fun novel. Mmm I feel so relaxed and rejuvenated! This spring break was definitely one to remember!

I'm glad that I wrote this post on the plane returning from Miami! I'm back in Cleveland now, adding pics and as they were loading up realized that I have to learn renal, pharm, and pulmonary this week on top of writing a grant this week. Awesome. And did I mention it snowed here? Welcome back, Natalia.



Saturday, March 10, 2007

Spring break here I come!

I'm leaving for Miami tomorrow! I'm going on spring break with David and two other couples from our med school. I can't wait! We arrive on Sunday night and will be going out to dinner and drinks with David's friends from home. Our cruise leaves Miami on Monday. From Miami we are going to the Bahamas and then Key West for a total of 5 days. I'm so excited! I can't wait to lay back and relax in the sun. I will be posting pictures here once I return. Can't wait to be tan! (Until then, I'm frivolously applying self-tanner)

And of course, I'll be bringing work with me... and I don't mind- I'm starting to get used to this. :)

Sunday, March 04, 2007

My heroes


Mom & Dad visit!

:) :) :)

Today was a wonderful day! My parents drove from Chicago today so that they could visit. And they brought so many goodies! Polish deli meats, 10 packages of pirogies, a new blender, and a new bed! Horray! I was so happy to see them! I feel very lucky to have such supportive and caring parents. Really, they couldn't get any better.

After unpacking a bit, David came over and helped put together my new bed. I was very proud of how well everyone got along. I have to admit that it's always a little nerve-wracking at first! Luckily, things turned out amazingly well. I took my parents to their hotel to check in and then Mom & I went on a frantic bathing suit shopping extravaganza. At least 13 suits later, we found two perfect ones. Horray- new suits for my cruise next week! Leave it to my mamacita to always pull through during a stressful time.

After shopping, we met up with my Dad and David. We went to dinner at Blue Point Grille downtown. It was unbelievable. I couldn't have picked a better restaurant for us! Dad loved the seafood and Mom loved the mini tour of downtown Cleveland. We drank champagne, enjoyed unbelievable seafood, and the waiter even brought over a surprise treat to wish my parents a happy 25th anniversary. It was a flawless night and I couldn't have been more pleased.

It took a few years but I really feel like I'm starting to come to my own. I looked at my parents as they chatted with David and was so PROUD of them. I was so proud that they were MY parents. I felt so LUCKY to say, "Them! These are my parents! Aren't they perfect?!" After all the years of battling (especially with my dad), I finally felt at peace. I didn't feel like I had anything to prove, I relaxed and had one of the best times with my family that I've ever had. I'm the luckiest... :) :)

Pics of the happy couple to come!

Saturday, March 03, 2007

Thoughts about the white coat

Being in medical school is such a gift: everyday you are immersed in a world of intelligent individuals, individuals who are passionate about the things that you have always cared about. It's really special to see a case and have so many people, just like you, interested in exploring the nature of the case. We throw out diagnoses, etiologies, long term sequelae... it's such a high to be in this driven and interested environment. We delve into patient presentations with the same attention and passion as detectives in a murder case. What we talk about and what we do each day immerses us in an exciting learning environment.

Although I feel like I am thriving in this environment, it has been a struggle for me to adapt to situations where I am no longer in this safe haven of discussion. It's challenging for me to hear a woman in the grocery store describing symptoms of an illness and not shout out, "It's CML! Or maybe it's pernicious anemia!" Similarly, it's challenging to see friends or family members who I have learned have increased risk for developing certain diseases, and not freak out trying to explain to them all of the reasons why they might develop something like CHF in the next minute. I struggle to separate my learning environment at school and my "real" life. It's hard not to ask questions and shout out diagnoses at the store or on the phone when I think that way at school for hours.

I've also realized that as I learn more about medicine, it becomes more difficult to explain what I do everyday to people who aren't in medicine. How can you explain how exciting it was to realize the clinical significance of elevated ESV and hypertension? How can you explain to people outside of medicine that 4 weeks before the exam is "last minute" studying?

That said, I've also found an unbelievable camaraderie and acceptance to go along with my white coat. Physicians talk to me when they see me in the hallway just because I have a white coat on too. I don't walk by myself in the hospital: I get nods of acknowledgment as I walk by. I've found myself surprised by how much acceptance I get for my white coat. The people that nod at me are encouraging me along because they too once went through this short-white coat era.

Saturday, February 24, 2007

The end of Block 3: Food to Fuel!

First things first: an apology for not posting for more than a month! I got so involved in studying, I didn't even realize that so much time has gone by. How is it almost March?

The block 3 exam went well and I felt very well prepared. It took a lot of work to start feeling prepared though. 2 weeks before I started panicking when I realized I only had 14 days left to study... in college I wouldn't even start studying then! Hahaha. Again, med school is constantly re-defining my norms. Although I studied longer and more intensely for this exam than I had for any other in my life, I got used to studying and adapted to my bookworm lifestyle the past few months. What came next I was not prepared for... BLOCK 4!

We finished Block 3 on Friday afternoon. I celebrated with friends at Benihana (yumsters!), then treated myself to a massage and haircut at Aveda to de-stress (courtesy of a gift certificate from David), took a nap at home, and then went out to dinner with friends for Korean food downtown. Before I go any further I would like to note that the massage and haircut were desperately needed- I left that salon human again after all those weeks of studying; it felt nice. :) Saturday was a busy day of catching up on emails, phone calls, and errands (food! clean the apt!); David and I treated ourselves to a fancy dinner at Fire restaurant in Cleveland that night. It was so nice to go on a date and dress up! And then came Sunday... the realization that not only did Block 4 start but also that we had hours of reading and assignments due on Monday. Yes Monday, the first day of classes after our exam. My soul rebelled against learning and I only did an hours worth of work and then watched the Oscars with friends.

Although the Oscars were a great way to spend my Sunday evening (after all, wasn't this weekend my one "free" weekend from work), I realized how much work I could have (should have?) done over the weekend when I arrived at school on Monday. ESVs, EDVs, cardiac output, LV dilations... so many new words all on the first day. There would be no easing into the new block today! And no time to fully recover from studying for all those weeks before. Instead, it was me and cardiac physiology (+ pharmacology) on a rough Monday. I have a feeling this will, yet again, be a time where I re-define how hard I can work. As my Mamacita told me on the phone a few minutes ago: "this isn't your first and this won't be the last time you have ups& downs in med school."

Wednesday, January 24, 2007

First CPCP

Today was a crazy busy day: leader in small group discussion, class (crazy biochem), 2 min lunch, drive to metro, CPCP until 5ish, back home, quick dinner, and then off to my healer's art elective until 9:30. By the time I got back home (and started writing this) it was past 10pm! Despite how busy today was (no checking the gossip columns every 5 mins today), it was one of my best days. Plus, I'm sure that looking back at today a week from now I will chuckle to myself about how "busy" I thought I was this week. Med school is constantly re-defining me: what I think is "busy", what I think it is possible for me to learn and understand... they change on a daily basis. Today was still a great day though and I hope that no matter how many times I "redefine" myself that I always find time to appreciate a good day.

I wasn't sure what to expect at a CPCP rotation at Metro. Metro, being the hospital that serves inner city Cleveland, sees the most diverse range of patients. Would people with GSWs walk into the internal medicine clinic? Haha. Needless to say, I was very excited about starting my rotation there. Although I didn't get to meet my preceptor, the person that I am "officially" supposed to follow all day, I shadowed another doctor and numerous other doctors welcomed me. I was really impressed by how everyone wanted to meet me and how welcomed I felt. For the first time as a med student, I didn't feel like I was a burden the whole time. I loved it!

Friday, January 19, 2007

Snow day!

Yes, I'm posting on my blog at 11:30pm on a Friday night. Yes, I'm not even sure if anyone reads this. However, I have an excellent excuse to be staying in (besides the fact that people are anxiously awaiting my next post).... it's snowing! The way this "winter" (65F last week!) was going I was worried that it would never get here! And now it's snowing and I can blame my laziness on the weather. Horray!

I spent the night catching up on emails. The below post was edited shamelessly from an email I wrote to a good friend a few minutes ago. :)

I've been dating a guy from our med school for 6 months now. I really hesitated to date him because I was so concerned that I would hurt another guy after Jarek and because dating colleagues can't be a good idea. That said, it really has been going well. I think that I treated it the complete opposite way that I treated my past relationship and took things very light-heartedly. Def no wed planning a few months in! I haven't talked about him in my blog because I didn't want to jinx things and because I didn't want to admit to myself how well things were going. That said, despite all my efforts to keep things light-hearted, we've become a really great couple. Being an only child, I always thought that being with someone 24/7 (studying, cooking, same friends, etc) would be way too tough and that I would end up hating the other person. I guess I had to grow into it a bit or I just had to find someone that I wouldn't kill after a few days. He balances me really well- I'm always laughing and joking around. It feels great. :)

I've also never dated anyone with similar interests to me. I was worried that I would get really competitive or really intimidated but I haven't. Despite being together all day in school and living together at home, we have still managed to get along. We help each other with our work sometimes and really complement each other. I've finally learned how to have a better balance in my life- live and enjoy life, THEN study. :) I'm so jealous that guys have always been so much more low-key about studying and how much easier it seems to come to them! David is super smart and things come to him very easily. I was jealous for awhile and maybe even a little intimidated, but I got over it and now that we have moved on to biochem (my domain) things have evened out, at least in my mind. :)

One of my favorite things to do is cook with David. He worked as a chef for a few years during college and before returning to school. I've always been a decent cook and definitely very creative, but he has techniques that I never learned. Together we make *amazing* meals. I look forward to cooking all the time! It's such a treat to come home after studying to talk and cook. I guess it's my creative outlet. Lame. :)

Although I feel like I've never been happier, I realized that I may be ignoring/forgetting times of struggle and difficulty. One of the things that I have been struggling with is having an emotional outlet while in school. I didn't realize how lucky I was to live with so many of my close friends while at college. We spent so much time together during meals, study breaks, late night snacks, trips to the gym, watching the newest America's Next Top Model, and we always analyzed every little detail about our lives. It's really hard NOT to talk about your feelings when you are at an all-women's college! At school, everyone pretends that they don't do as much work as they do. Although everyone is really helpful and its a conducive environment to learning, even more than at Smith, it's still a competitive environment. I have tons of friends here and go out a lot but I don't feel like I can ever really open up to any of them and talk the way that I did to my friends at Smith. I feel like we all have to hide our insecurities from each other.

I guess I didn't realize how much I missed that part of my life and being able to do that until this week. I'm taking an elective course called "The Healer's Art" where we talk about things that don't quite get into the curriculum, like grieving, etc. One of our exercises was to visualize what part of us has been pushed back since starting school and draw a picture that represents it. Most people talked about things like keeping up with friends or hobbies like environmental activism. When I was asked to share, I ended up crying in front of a small group! I was so embarrassed and yet relieved at the same point. Although my first instinct was to run away, hide, and never come back, I think it was good for me to acknowledge that I'm not perfect and that I am human. I have to find a good way to have healthy releases without feeling guilty about having emotion. I feel another New Years Resolution coming on! :)

Wednesday, January 17, 2007

Take care of myself

A reoccurring theme. Recently, I haven't felt like I have been doing a good job. I feel like I have been eating a lot of junk food, not working out as much as I would have liked, and don't feel like I look the way I want. I don't feel good after eating chips and greasy bar food. I want to feel better. I hope that during the rest of this week I can work on finding (and restoring!) a healthy balance.

I felt ok last week about everything and I know that I cannot look very different physically this week than last week. I guess it builds up... especially at times of stress. Why is it that I always pick on myself when I'm stressed out? I hope I can also spend the rest of this week doing less work, but more quality work, AND in the process, start feeling better about myself.

Saturday, January 13, 2007

Family stories

It was really great for me to see my dad's sisters at an older age. I appreciated what they could offer me a lot more now that I'm older. The things that my dad's family went through were really remarkable and the stories that were told were incredible.



1.) My aunts and their mom hid in the basement of a church while Warsaw was being bombed. Their mother (my grandmother) took off her shirt and cut it into little pieces. She wrote each one's names and date of birth on each piece and tied them to her children. The girls thought that it was a game but really their mom was sure that they wouldn't make it through the night.

2.) My grandmother would walk by the Jewish ghetto in Poland and see really starved children. Even though her own children didn't have enough to eat and they barely were making it by, she would sneak out in the night past the army-enforced curfew, ride the trolley hidden under the seats to not be seen, and drop off food packages to these children. Something that my family reminded me: there were so many Jews in Poland because they were always welcome there and had a good life. The high numbers of Jewish deaths were NOT a result of Polish killings, but rather the Nazi's rule. It angers me that there were countless Polish families who risked their lives to protect Jewish families and yet Poland is blamed in many textbooks for the Holocaust.

3.) One night, my grandmother's mother came down the stairs at 2am. She woke up my grandmother and told her that she had a bad dream and had to leave the apartment. Without hesitating, my grandmother took her young children and carried the children (past curfew) for 2 hours to get to her sister's home outside of the city. The next morning she went back to the apartment and saw the front window broken. At night, shrapno had flown into the apartment and landed in the closet, right above the bed where the girls slept. Incredible.

Christmas Eve--> NYE 2007

I was in Chicago for a day or two before leaving for Poland. I was really excited to see my parents- they look great! We had a good time doing lots of nothing (mmm) at home and then we headed over to my Mom's best friend's house for Christmas Eve dinner. My mamacita looked super hot because she was rocking a new outfit we picked out for her at Old Orchard-pants! We had a good time catching up with them and it was really nice to see how things have been going. (Ciocia Malgosia quit smoking- Horray!) It was also nice to see my cousin Tina doing well in college and very happy. :)

The next day we headed out for Poland. There was quite a bit of drama at the airport, mostly my fault and I really regret losing it. The drama started because the flight was overbooked so I volunteered our family to take the next flight out to Poland (and fly first class in return!). When Tata found out he got really panicky and angry because he wanted to leave at the time we had scheduled. I shouldn't have lost my temper with him. I guess it's really hard for me to realize that he is getting older and that I have to interact with him differently. It's especially hard for me to see the man who expected perfection from me, to be making irrational decisions. I was fuming the whole flight that we didn't get to take the next flight out (first class!!) but luckily, the flight attendants separated us by nearly 10 rows on the airplane; 10 hours later, I had calmed down a little. When we landed, I realized how vulnerable my dad looked- like a little kid- and I felt bad for him and was angry at myself. I realize he is getting older, but I'm struggling to accept it and adapt. I don't want to have strain between us, especially as we both get older, because I know that we both value each other and love each other... we just but heads a lot. That said, it's hard not to get annoyed by a 64+ year old when you see him 24/7 for two weeks!


Once we got to Poland, it was shocking to see my grandma. She looked so healthy and fresh when we last saw her over the summer. Since she moved back to Poland, she looks unhealthy, much older, swollen, and just plain bad. I was really frustrated by the medical care she had been receiving here in Poland and how malnourished she looked. I don't know a lot of medicine, but the little that I know would have really helped her out. She started to look better after she calmed down a bit later on in the week. I hope that she comes to visit us again in the US.

We spent the next week or so visiting from one family to the next. I'll post more about visiting my dad's sisters later!

For NYE, my cousins and I stayed in the city and went to a house party "impreza." It was a casino night and we had so much fun! Rysio won the most money! I really love seeing my cousins. We always get along well and catch up quickly. I love em!