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!

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!)

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/

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.

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!

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!

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!