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!!

Olive!!

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

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! :)

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! :)

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!

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.

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.

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. :)

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!

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.

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."

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!

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! :)

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.

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!

Trip to Poland

I really really should get better at blogging more often. It's just hard to sit down and write when there are so many other things going on. That said, blogging more regularly is a new year's resolution for 2007. :)


Things with me are fantastic! I just finished my first week back from winter break. The first week back is always a little overwhelming, but especially so when you return jet-lagged and to biochemistry in full swing. I'll get through it, because it's not like I have a choice!

Break was really fantastic. I'm really glad that I got the opportunity to return to Poland at an older age because I could really appreciate things more than when I was younger. Poland has changed so much (for the better) since I last was there; it's really impressive! It's a very cool place now! It was a little challenging for me, however, to get used to seeing so many relatives that I don't see on a regular basis. All of the "advice" and "scoldings" that I got while I was there got on my nerves but there isn't much that you can say or should say back to an elder who just wishes you well, regardless of how unwanted the advice is. I can't tell you how many times I had to explain why or how I was vegetarian and how many "but you look so pale!" comments I got. It was hard for me to bite my lip and not say anything, given how independent and outspoken I am but I made it through the 2 weeks (horray!).



It was really fun to see my family, especially my cousins. It's nice to know that we can all get along and how much we have in common as we get older. And it's always nice to get to an age where we can make fun of our mutual relatives together. :)


It's good to be back in Cleveland, on my own terms, despite all the work that was waiting for me when I got back. :)

Cleveland Clinic

Wow! I just got back from my first visit from the Cleveland Clinic- one of the top hospitals in the world. I was so impressed by everything there! From classical music playing from the classy walkway between buildings to the open and inviting reception rooms for patients, this was the most impressive place I've ever been to. And all the restaurants inside! It was like it's own self-contained village!

The reason for my visit was to meet with a faculty member in pathobiology who specializes in asthma-related research in the clinic. I didn't expect to be so overwhelmingly welcomed and invited. Within a few hours of my email expressing interest, we had a meeting time set up. A busy physician scientist, the man I met with spent over 1.5 hours with me! I planned on 30 mins top so imagine my surprise!

It felt really nice to be so welcomed and accepted based on my prior research and current status as a med student. I didn't feel like I had to prove that I deserved to be there, quite a difference from med school interviews! I was really impressed by the clinic and lab. I would love to work there! I will have to consider how much time I can REALISTICALLY spend doing research while in med school, but time constraints aside there is nothing I would rather do (nerd alert!). :)

I am really excited to have the opportunity to do research in a subject matter that means so much to me. Being diagnosed with asthma really floored me; I hope that learning more about asthma will be a way to become empowered. :)

Skiing in Utah!

Aaah my first vacation since July! Horray! My parents were kind enough to invite me to go along on a ski trip to Snowbird, Utah for Thanksgiving. I mention that they were kind enough to invite me because last month they went to Mexico without me; still jealous! :) I'm really grateful that I can still go on occasional vacations with my parents. I think it's really special how well we can get along and how much fun we can still have on vacations together.

I'm also really proud of them for being adventurous and trying something new for Thanksgiving. For the past 24 years, my parents have used Thanksgiving as a time to look back at how far they have come since they first arrived in America. I always loved our traditional Thanksgivings because it was such a meaningful day in our family. That said, I'm proud that my parents are trying something new this year (and that they are letting me tag along!).

It's been four years since I've last been in the mountains. Gosh, I almost forgot how amazingly beautiful it is to be up so high. It's so exhilarating to be skiing down a steep slope again, admiring the mountains around, and contemplating the one below you. What a rush! Although I was worried it might take me awhile to get back to my technique, after the first few turns I felt like I'd been skiing last week. :)

I'm especially grateful to have a ski trip as my first vacation from med school. Ski trips are the anti-med school: working out all day, being outside, feeling athletic (and awake! and alive!), not studying anything more than a new novel, enjoying the hot springs, and going to bed by 9 exhausted from the day. It's such a nice break! Like the nerd that I am, I planned to do tons of work on vacation but I haven't felt like getting back into it just yet. Hopefully I will be more motivated later on in the week, otherwise I will have a tough week back in school!

Today is Thanksgiving. We are off to a nice breakfast, then the slopes, and we have reservations for a very fancy Thanksgiving dinner early tonight. Horray!

Horray!

BLOCK 2 IS DONE!! HORRAY!!!

I'm so relieved to be finished with exams for a few months. Overall, I think that things went well. I'm really impressed with how much I have learned about medicine so far in these few months. Despite the long hours of studying, especially the last three weeks before the exam, I really enjoyed learning for this block, as incredibly nerdy as that may be. Now that the block is done, I should "technically" "know" all there is to know about endocrinology, genetics, molecular biology, female and male reproductive tract histology and pathology, and pelvis anatomy. It's so weird to realize that my studies have a greater purpose and responsibility. I'm learning this information because it may help one of my patients in the future, regardless of the specialization that I choose. Wow! How weird!

The next block is exciting: Food to fuel. Biochemistry, anatomy of the abdomen, and nutrition. Should be very cool!

Exam on Friday :/

This week we had clinical immersion week and I got the opportunity to rotate in gynecological oncology. I spoke with a patient with ovarian cancer, saw a gruesome case of ovarian cancer in the OR, and then analyzed specimens for malignancies in the frozen specimen room for pathology. This was a great week for me. It was so important for me to take a step back from my studies and see just how much I had learned this block and how it really does apply to real patients. And as nerdy as it sounds, it was just so amazing to see a football size tumor being cut out of a patient and then looking at a slide and being able to classify it as a specific cancer. So cool!

Clinical immersion week gave a lot of meaning to my preparation for my exam: even though there are still tons more to learn, I HAVE learned quite a bit and it DOES have a profound patient application. That said, man I sure can't wait until this exam is over! I studied so much this week that I literally was eating tortilla chips towards the end because I didn't have time/energy to make a trip to the grocery store. Luckily today I was able to treat myself to a trip to stock up on food, after 8 hours of studying, that is. I planned ahead for the week and made a huge amount of soup and froze 4 containers; no tortilla chips this week unless it's a willing decision. :)

I feel really guilty about studying so much sometimes. Gosh, I'm sorry that I haven't been talking to my parents as much and that Mom's bday present didn't get there on time this year. And man, do I feel guilty for not being a better friend and keeping in better touch. Meredith, I'm sorry I haven't been calling more often! A lot of times it's not even that I'm studying continuously and pick up a phone, it's just that I am so focused on studying that I would have nothing to say if I called. I sure don't know how people go through medical school raising their own families!

I go through phases of feeling really prepared for the exam, realizing how much I've learned and then extreme phases of panic where I realize just how much I have left to learn. I hope that I can stay calm and collected with my studying: focus on important concepts and think logically; don't just memorize things that don't mean anything. Hopefully I can stick to the plan and do well! 4 hr exam on Thursday, 6 hours of exams on Friday... Friday at 5pm will feel amazing!

Hospice

I’ve been dreading my rotation at the hospice. I have a tendency to empathize a lot, maybe too much, with everyone that I meet so I was concerned that going to the hospice would be a really tough experience for me. I was worried that I wouldn’t be able to stay tough around so many terminally ill patients and that I would break down and cry in front of my peers. I expected the hallways to be filled with sobbing families and the rooms filled with patients dying painful deaths. I prepared myself for the very worse (and even stocked up on chocolate for when I returned from hospice).

The hospice that I saw was very different from what I expected. The center is situated on the lake, with beautiful landscaping, and gorgeous patient rooms. I felt that the place was very calming with open spaces and fresh flowers. I was impressed with the way that the staff dealt with death. I imagined that the “D-word” wouldn’t be mentioned, especially in front of patients. Instead, I was surprised to see how openly the patients and staff discussed death and dying.

As a physician in training, seeing a patient die is something that I’m not quite sure how I would be able to handle. So much of the medicine that I know is about learning about the problems of a patient and “fixing” them. A recommendation to stop trying and move on to hospice care seemed so much like giving up. Although I still don’t quite know how I would approach the subject of hospice care with my future patients or what point would have to be reached in order for me to make that recommendation, I discovered that hospice care was such a dignified way of approaching the end of life. Instead of ending their lives hooked up to countless burdensome machines and experiencing awful side effects, the patients at hospice seemed to live their final days to the fullest. Lifelong diabetic patients enjoy cookies while other patients learn how to sail for the first time. Although I recognize that it must be incredibly difficult to admit that a person’s life is really coming to a close, hospice care seems like a very empowering option for the patient.

I spoke with two patients at the hospice. One of the patients really opened up to us. He seemed really grateful for the hospice option, despite how costly the stay is ($6000/month!). Although he seemed to accept why he was in the hospice he told us how much he struggled with his family’s reactions when they visited; he hated seeing how much it hurt them to have a terminal illness. Some of the advice he offered: “Live life like today’s your last day, learn like you are going to live forever,” “Don’t waste your time worrying about things like money; you never know what’s around the corner.”

Although “hospice” has a negative connotation, I wish that I had known more about it before my grandfather passed away. I wish that this had been an option for him. Like one of the patients that spoke with us, his health was fine until one day it wasn’t. Instead of being incapacitated in a hopsital, I think that my grandfather would have preferred to pass with more dignity and control. Hospice care addresses death as something that we all experience and gives the patient control over their final moments.

Exam coming up!

It's week 10 of our second block and an exam coming up in two weeks! Eek! This week is our last week of classes; next week we have clinical immersion exercises at the hospital. Although this week SHOULD give me extra time to study because I won't have classes to keep up with, I know that I will probably come back from my rotations pretty tired and overwhelmed. So basically these next two weeks are going to be a bit of a bear!

Despite how tired/crabby I might get during cram time, I want to take the time to be amazed at how much information I've learned so far, without really having to try too hard. I knew that I would learn a lot in medical school but seeing it first-hand is very impressive. Gosh it's all a bit amazing. The interactive discussions we have instead of many lectures allowed me to learn things without ever having to "memorize" information. I'm really grateful to be at a place like Case where there are numerous different learning opportunities to ingrain information.

That said, learning medicine is a bit of a firehose effect: the amount of information thrown at us each day is like water coming through a thick firehose; on most days I try and get as much in as possible but there is always ALWAYS so much more that I can known and understand. On that note, back to studying!

Time to shape up

A huge part of our new curriculum is self improvement. That said, I'm disappointed in some of the things that I've been doing and want to improve.

Fitness Goals: feel better about yourself
-stop snacking; empty calories--> fatty
-avoid carb-heavy meals
-dessert is not a staple!
-work is never going to end so make time for yourself: WORK OUT

Studying skills:
-Stay focused: organize your time about what NEEDS to be done vs indulging every little whim


That said, I doubt these goals will be actualization this week. I'm STILL sick and this week is probably one of the toughest weeks I've had in med school so far. I'm sure that I will look back at this list and smile because it will be super easy in comparison to what I'll be doing in the future, but STILL! To make things worse, my rock Mamacita is in Mexico so I can't call her for support. Looks like it will be a tough one! BTW, did I mention, I'm running in a marathon on Sunday? Hope I get better SOON!

Mom's here!

Unpublished post from last weekend:

Horray! My Mom is here for a visit! I have the best Mom in the world... driving up from Chicago for a day visit! :)

Mom honked the whole way down Mayfield. I was so excited that I ran out of the apartment to see her.

I feel so lucky to spend time with my Mom. I appreciated every minute of her short trip here! Come back soon!

Lazy but happy?

I've been feeling really happy lately. This surprises me I guess because I expected medical school to be the most challenging experience that I've been through so far. I feel like I'm finally doing what I want to be doing and somehow despite myself, I've been feeling relaxed!

At Smith I really pressured myself to be the best of the best. After all, if I wasn't then how would I get into med school, let alone an MD/PhD program? When I had the opportunity to join my dream school with an MD/PhD a few months ago, I realized that I wasn't excited by the idea of it anymore. My dreams had changed but what exactly caused the change is still unclear. Part of me thinks who cares what the reason is as long as I'm happy. But another part of me is worried that I'm losing my motivation, the drive that I used to define myself with.

This week I became concerned that these changes may be something more permanent and may affect lifelong decisions so I should probably think about these changes a bit more. In med school we have organizations like in college but they are more specialty-oriented like "future surgeons" or "dermatology interest group." I've been going to almost all of these meetings so far because 1.) I'm not sure what I might be interested in and 2.) there is free food at all of these meetings. The free food is definitely what convinced me to go to the family medicine interest group this week.

Family medicine? Um yeah right. That sounded like such a "cop-out" in terms of medical professions. The common cold? Gosh give me a break. I went to the meeting thinking that I would get some free food and have an hour to check my email. I was really surprised to hear the faculty mentor speaking about how she choose family medicine and what she actually does on a daily basis. From preventing an MI, to a gyno exam, to teaching a family how they can start reading to an infant, her profession sounded so much more rewarding than I imagined it could be. And the variety of cases and teamwork approach to her daily work really interested me. That said, I was surprised to find myself interested in this profession but let myself feel that way.

The next day was a surgery interest group. Surgery is the "gunner" profession of medicine. Known for its ridiculous hours and tremendous pressure, only the most dedicated professionals can make it through the profession. After my experience at the heart hospital in Phoenix, I saw just how hard surgery was but thought that I would be able to manage it. After all, I always thought of myself as a gunner and an athlete... someone who could definitely give surgery a run for its money. When I went to the meeting I was really disturbed by what I heard the surgery residents telling us. Referring to themselves as "angry" and "tired" as well as calling themselves "the ones that everyone else depends on" really bothered me. Besides the blatant cockiness, I was disgusted that the one male resident spoke over and even for the other two female residents during the panel discussion, going as far as describing their research!! Why the female residents thought that this was ok infuriated me and I ended up leaving the meeting early.

What is going on with me? Am I giving up on working hard and being a gunner because I am intimidated by the challenge? Or am I just listening to what I think will make me happy, really happy even if it's not the things that I always imagined it to be?

Learning about how to mess up a fetus!

I definitely haven't been keeping things updated as much as I would like. With all the info that gets thrown at us in everyday in med school, it's hard for me to justify time to write about my thoughts. Thinking? When do I have time for that?? Haha

Actually things aren't that bad. Luckily, I really enjoy the material. Phew it would be super rough if I found out that I didn't like medicine after all. I feel like I've had a pretty good balance with everything so far. I've been doing tons of work but not too much. I've definitely been having fun living life too and I think that's important too because I have a looong way ahead of me!

These past few weeks we have been learning about embryology and fetal developing. Wow, with all the grotesque things that can go wrong at every point in development, it's a miracle that there are over a billion normal people walking around! And learning about pregnancy and labor has left me with one thought: 10 cm?! Honestly??

Luckily I still have a long time to consider 10cm. I'm feel a little lazy tonight and I'm going to run with it. I'm sure that I will be overwhelmed with work soon enough and focus again soon. In the meantime, I want to take time to be grateful. I feel so lucky that I'm doing something that I really enjoy doing and have so many wonderful people in my life... what a blessing!

One block down!

So my first block of medical school is completed... horray! :) We had SSEQs on Thursday (Summary synthesis essay questions) and a CAT multiple choice exam (cumulative achievement test) on Friday that has questions similar to the National Board Exam so we can track our progress in relation to the rest of the class and the rest of the nation. I was a little concerned about my first exam in medical school, but I think it went well. Just like at Smith, no matter how much work you do to prepare for an exam, there are always a bunch of crazys who try to out-do you with the amount of work they do. I felt pretty confident going into the exam and am happy that I found a good way to study by the end of this block.

So this weekend is my last really guilty-free lazy weekend. On Monday we start the next block and it looks tough! Tons of work and the pace looks slightly insane. I hope that I remember to enjoy things as much as possible and to stay excited about it all. I don't want to lose enthusiasm for the material or be a complainer; remember, this is such a gift to be here! So hang in there and do the best that you can! :)

I went for a run today and it felt so great. Like my swim coach would always remind me, "If we perform well on the days that we don't feel great, think of the things that we can do when we feel good." During my cooldown I had one of those endorphin-inspired moments of being grateful: for my new life, my new neighborhood, my new friends, my family, for everything falling into place. I feel really lucky and hope that I can remember feeling this way when the tough times that inevitably await me arrive.

BTW, shout out my cousin Ola.... it was great talking to you. I'm so proud of you and everything that you are doing. I'm especially proud/excited that Steven has a blog that I can use to stalk your adventures. Love you!

Can't sleep

3am and I can't sleep. Awesome. Did I make the right decision? I hope so and I think so. I'm worried that now that I've made up my mind I'm not being responsible about my decision. Seriously, it's such a gift to be here in med school. Am I wasting it by skimming through readings to finish early enough to go out to much? Or is it ok that I'm trying to enjoy the "summer" of Block 1 before "real" med school starts??

I hate Northwestern

So there has been quite a bit of drama this past week and I wish that I had started to use this blog to figure things out sooner. Last week I got an email from Northwestern MSTP offering me a spot. Northwestern, the program that was my top choice for such a long time. Northwestern, the school that everyone kept hoping I would get into.

What kind of cruel irony is it that I get into Northwestern now that I am really starting to get used to life at Case (after being here a month already)?! I was really shocked when I first received the email of acceptance; I didn't know what I should. I have to admit that I even considered not telling anyone. I am really happy here and that email threatened everything that I had done so far to assimilate to Case.

So obviously the email brought up a lot more questions. Do I want to do MSTP now that my top program accepted me? Can I picture my life as an MSTP student after living a month as an MD only student? What about all the money that I will get as an MSTP? But will it be worth it? Did I even like Northwestern? Or did I just say it was my top choice because it was in Chicago?

After thinking about this long and hard, the thing that I struggled with the most was the thought of leaving everyone that I've met here and the life that I started to make for myself here. I decided that I wanted to stay at Case. I love the personalized education here at Case: group discussions rather than lectures and an emphasis on life-long learning, not memorization really attracted me to the school in the first place. Plus, I really like the fact that I'm starting to prove that I CAN make it here on my own. It was so exciting to meet new people, be in a brand new place, and prove that I can do it... but I don't think I would want to do it all again to go to Northwestern.

Besides the fact that I'm passing up an opportunity for a "free" MD, my decision had consequences with my relationship with Jarek. He, rightly so, pointed out that if I wanted it to work out between us, I would have chosen to move to Northwestern; but I didn't. Things were so perfect with him before I left for school. I guess I really didn't take into consideration how difficult it would be to maintain a relationship long distance while trying to make a life for myself here in Cleveland. And now that I'm staying here in Cleveland, 4years just seems a little crazy to wait on a relationship. Plus, being around all these older med students made me question my own maturity. Jarek and I had talked (and even planned) on marriage for a long time but now that I'm in med school, I really started to wonder whether I was realistic about it all. I'm 22, he's 28. He's waaay more ready than I am. And as I get ready to start to create my own career, I'm not sure if I want to be limited in my choices. As selfish and awful as that sounds, I want to focus on myself for awhile. I feel like he can make more serious decisions because he already has a career whereas I'm still figuring out who I want to be and what I want to do. The very fact that I was having these thoughts convinced me that I should have "the talk" with Jarek. Once we started talking, I knew that we needed to end it because I had already accepted the idea of it. I feel so awful for hurting him, because he didn't do anything wrong. I feel awful that I ruined the relationship and that I brought about the end through my decision to stay at Case. But somehow, for some reason that I don't really understand, it feels like something that I have to do right now. Maybe in a few months I will end up regretting my decision to pass up a free MD and my decision to end something that once was really special, but I can only make my decision based on what I feel right now. And right now, even if I don't know why, it just doesn't feel right to do MSTP and it doesn't feel right to stay with Jarek.

It's so hard for me to realize that my decision had repercussions on so many different people. Besides absolutely crushing Jarek (I feel like the worst person in the world), my parents took my decision very hard. They just couldn't understand why I would give up on something that I had fought for so long to achieve. But the more that I think about it, the more that I realize that I wasn't really realistic about MSTP. I guess I COULD do it (I'm qualified, after all) but do I WANT to do it?? It's hard for my parents to understand that I would rather start my life off with 1000s of dollars in debt than take this prestigious position. I'm not sure if I even understand why I'm doing this. I'm just doing what feels right right now. Gosh, I sure hope that I'm doing the right thing.

Still alive!

Although I had originally planned on posting almost daily for my blog, itÂ’s been three weeks since my last post (as my cousin Ola complained to me in an email; sorry Ola!). Things got crazy real fast at med school. The biggest problem was getting my computer set up. Even though it was a new computer, the Case ITS people were "fixing" my computer for 20+ days- insane! They were on such a power trip!

I finally have my computer back and life here has been picking up really quickly. It's a little exhausting to get back in the grind of things and get to know tons of new people, but it's been fun overall. I've been going out a lot, more than usual, because I keep thinking that this might be one of the last times that I have time to go out and enjoy myself.

One of the things that struck me the most about med school is how I feel that I got waaay older the day that I started. All of a sudden, my classmates are married, have families, and have PhDs. Awesome. Did I mention that I'm 22? Haha. Being around so many mature and accomplished people definitely made me feel a little insecure. So although I feel older now that I'm surrounded by mature people and now that I am (successfully!) living on my own, I can't help feel like I am pretty immature and young compared to everyone else.

I try to remind myself that despite other people being older (and having PhDs already!), I AM qualified to be here. The work is picking up but I'm excited that all of the work is pretty enjoyable. Medicine is definitely the thing for me to do. I hope that I don't get overwhelmed with the work. I want to remember to take advantage of the fact that school is PASS/FAIL and not drive myself crazy. I hope that I can really take good care of myself and get enough sleep. So far, I've been taking pretty good care of myself living on my own, but definitely not getting the ideal amount of sleep. (That's what the weekends are for, right?)

About to become a medical student!

I'm sitting at a Starbucks near my apartment early on Monday morning. Who was I kidding? I won't be able to sleep in on a day like today! I'm going to start medical school today!! The move into my apartment went very smoothly; I'm getting to be a pro at moving myself back and forth across the country! I'm sitting here in disbelief. Did I really graduate from Smith? Am I really not going to be living in the quad anymore? Is my summer vacation really over? Dude, am I REALLY living on my own in a sweet apartment? AND MOST IMPORTANTLY, am I REALLY about to start medical school today? Ohhhh my goodness!!

I want to remember all the crazy things going through my head today because, quite honestly, I don't think that I have a very good idea of what is waiting for me these next 4 years. Regardless of what happens over the next few weeks, months, and years I want to make SURE that I stay excited and enthusiastic. Dude, I'm FINALLY studying the things that interest me most: the body! When I get frustrated or tired, I want to remember that it is such a privilege to be in medical school starting to learn about how the human body works. How exciting!!

I also want to promise myself that I will not get too carried away with my excitement for learning about the human body. I promise to take time to take good care of myself too. I want to make sure that I work out everyday (night time routine with abs, legs, pushups) and try to do cardio 5x a week. I feel better about myself when I work out: I feel confident, am optimistic, and energetic. I want to make sure that I take good care of myself physically because it translates to good emotional and mental health. So Natalia, it makes sense to sacrifice time to work out and take good care of myself.

I also want to make sure that I eat well. This is my first time cooking on my own. Now that I have the choice to eat any way that I want, I want to make sure that I make good choices. This is not Smith anymore, so there is no reason for dessert splurges! I feel better when I eat food that is good for me. Things like ruffles sour cream & onion chips are a temporary pleasure but they make me feel heavy and fat after so let's keep those to a minimum. Plus I don't have my Smith friends with me to snack late at night; just not as fun without them!

So besides taking good care of myself, I hope that I really enjoy my experience in medical school. I hope that besides being a good student and enthusiastically learning about the human body, I hope that I can make great friends and have fun. OK more updates later as an official medical student. Wish me luck on my first day! :)

Excited and nervous!

Gosh, can you believe that my summer ends THIS WEEK?! Ohhh my goodness! Tomorrow I pack up the cars (let's keep our fingers crossed that all of my stuff fits!) and start the move to Cleveland. I really can't believe that it's time to leave already!

I think the thing that is keeping me from getting sad about leaving my family and Jarek (again!) to start school is the fact that I have a really hot apartment. Haha. Hey it's the little things that add up. :) I'm excited to get myself settled in my first apartment and organize (yay!) my new life. My parents helped me find/fund some really cool furniture. It looks like I will have a really f.King. hot apartment; hopefully I will be able to enjoy it at least a little bit this year! (On a side note, I just realized that not many people would pick up on the "f.King" stuff; I miss Smith sooo much, especially Franklin King house!!)

Like the title of this post indicates, I am feeling a little excited AND (a lot) nervous. Things that I am concerned about: my amazing group of Smith friends won't be there!!, living on my own all by myself, making new friends, getting lonely in a new place, not liking Cleveland, missing home and everyone there. Things that I am excited about: becoming a doctor(!!!!!), meeting new people, the opportunity to start fresh and new, overcoming challenges, organizing my hot apartment, proving to myself that I can be a functional adult. :)