Oh, Diego, Oh How I Miss You

By Melanie Medina

This was originally published on the Texas Health Moms blog in April 2013

Man, I miss Diego. You know, Dora’s the Explorer’s primo? The one on Nick Jr. who talks to animals and swings from a vine? I want him back. And his stupid baby jaguar, too.

If you had told me three years ago that I’d be pining for Diego, I would have laughed in your face. My daughter, then 2, was addicted to “Gago” like a first-grader to frosting. Thanks to the wizardry of our DVR, we watched every episode of every season of “Go, Diego, Go” at least a dozen times.

On nights when I couldn’t sleep, it was because the mighty jungle drum beat of the Diego theme song looped on and on in my head. For Allie’s second birthday, my decidedly technology-averse 60-year-old mother – who actually learned how to operate our DVR via the universal remote control so she could play episodes of the show — made Diego cupcakes.

But then yesterday, my daughter, now 5, told me, “I just wish I could scratch my butt without getting jealous.” Between a half-guffaw and a half-snort/choke of my Diet Coke, I managed to ask her, “Where did you hear that?”

She doesn’t even know what that means. Heck, I don’t even know what that means. I just know it’s not the kind of thing I want her blurting out at Sunday school (never mind the fact that she once told her friends that her mommy only drinks wine).

“Fairly Odd Parents,” was her answer. That’s her new show. It’s airs on Nick Jr.’s older cousin, Nickelodeon. It’s about a buck-toothed fifth-grader who has two buffoons as human parents – and real parents who are actually fairies that grant his every wish.

It hit me then and there that Nick Jr., with its educational programming, innocent plots and multilingual characters who loudly and unnaturally OVer-EMphasize EVery SYllable, is waving at me in my rear-view mirror.

There was no transition period. Nothing to buffer the shock of crossing the bridge from good ol’ didactic Diego rescuing the rain forest animals to an obnoxious doofus whose repertoire of jokes is limited to bathroom humor and bodily functions.

Children’s TV programmers: You offer a zero-sum game. For all the early literacy skills you provide preschoolers with your itty-bitty-kid shows, you abruptly drain the instant a babysitter comes over and changes the channel to a slightly-older-kid show.

Diego, if you’re reading this, please know that I take back all the horrible things I said about you. I miss you, hombre. You, your Rescue Pack, and even the nasally Puerto Rican camera voiced by Rosie Perez, are welcome back to the Medina house any time.

A mother’s love

(This post was originally published on the Texas Health Moms blog on May 15, 2012.)

By Melanie Medina

On May 12, 2012, Herbert Marx turned 78 years old. Had it not been for his mother, Selma Marx, Herbert may not have lived past the age of 6.

That’s how old he was when German soldiers came to the house in Karlsruhe, Germany, where he lived with his mother, three aunts and grandmother. The soldiers took them from their home with only the clothes that they were wearing and packed them into a dark train compartment with other Jews.

He had always wanted to go on a train ride. Herbert stood there, squeezed among adults who were crying.

For two days, they stood in their own excrement while the train headed southwest through France. They were finally deposited at Gurs Internment Camp near the border between France and Spain – more than 850 miles from home. Herbert doesn’t remember many details of the train ride.

“All I knew was that I was held tightly by the hand by my mother,” Mr. Marx told me in a heavy German accent.

At the camp, he ran around with the five or six other children who were there. When trucks brought in food from outside the camp, the children would stand by the side of the vehicle and extend their arms to the soldiers and wait for baguettes. The children would take the bread back to their barracks, where it would be broken up and shared among the prisoners.

He doesn’t remember being beaten or whipped, although he did see a lot of other people get hurt, he said. He doesn’t remember whether his mother was forced to do hard labor. He does remember scrounging through trash cans outside the mess hall where the German soldiers ate, digging for anything that looked like food. He would take whatever he could find to his mother.

Other than this, Herbert doesn’t remember much about six months he spent in the concentration camp. Except that he slept on the same wooden bunk with his mother.

“A lot of times she held me in her arms,” he said.

One day, Selma told her son, “The nice German soldiers are going to take you for a ride.” He was hidden on a truck among the soldiers, who dropped him off at a Catholic orphanage in Toulouse, France. He never saw his mother again.

As a 34-year-old woman who was born and raised in what is arguably the most prosperous country in the most prosperous time in history—who’s never seen war outside the comfort of a movie theater—I have no frame of reference to help me comprehend what this must have been like.

But I am a mother. And I know what it feels like to hold my 2-year-old son and 4-year-old daughter while they sleep.

Nearly every morning when I take them out of their beds to get ready for the day, I let them sleep on me for a few minutes. These are the most sacred minutes of my day.

I carry my groggy girl down the stairs and smell her sweet morning breath as she breathes on my neck. I hold her for a while, then lay her on the couch while I get my son out of his baby bed.

I hold him with his arms around my neck and legs around my waist. I sit with them in our dark living room before the sun comes up, wishing I could stay there with them on the couch and hold them forever, because I know that faster than I can blink my eyes, I’ll have to let them go.

And then I think of Selma. I cannot speak for her or even fully tell her story. Herbert doesn’t remember how tall she was or the color of her eyes. He believes she was a cook at the Jewish kindergarten he attended, but he’s not certain.

When they were together in the concentration camp, I imagine that Selma’s only source of comfort in that horrifying place was the rise and fall of her son’s chest against hers as she held him in the bunk they shared.

I try to imagine what she must have been thinking, knowing that at his young age, she was the only one who could protect him (Herbert’s father, a gentile, was not married to Selma and did not live with them). And knowing, too, that the only way he would be able to grow up would be by her sacrificing her desire to cling to him and let him go. And not just let him go, but send him away.

Herbert spent four years at the Catholic orphanage in Toulouse, France, before he had to be sent away again – to escape from German soldiers looking for any Jewish (circumcised) children. He spent some time in a Jewish orphanage in Switzerland before the Red Cross relocated him with an aunt and uncle in New Jersey.

He learned English and graduated from high school. He became a citizen while serving in the U.S. Army (occupying Germany). He earned a bachelor’s degree in business.  He married a Catholic woman, Ida, with whom he had seven children. “The Magnificent Seven,” they called them.

He now has 15 grandchildren and one great grandchild. He referees soccer games – soccer is his passion – near his home in Denver, Colorado. He works out at a nearby gym and travels with his new wife (Ida died of ovarian cancer several years ago) to attend his grandchildren’s special events. In 2011, Herbert got to see one of his grandsons walk across the stage to get his high school diploma. The young man just finished his freshman year at the University of Colorado, where he earned a 10-year scholarship that will take him all the way through medical school.

I asked Herbert if, when he looks at how well his family is doing now, he ever thinks about the sacrifices his mother made for his freedom.

“I think about that I wish the mother would have seen what had become of me. When I say me, I mean the family.”

I believe that she sees.

Herbert says that despite everything that happened to his mother (relatives told him that she was gassed at Auschwitz), he still believes that love prevails over hate.

Selma’s family is living, breathing proof that this must be true.

Melanie Medina is a senior communications specialist at Texas Health Resources, where Edward Marx, the youngest of The Magnificent Seven, was Chief Information Officer.

Listen to your mothers

By Melanie Medina

(This was originally published on the Texas Health Moms blog in 2012).

I’m not a big fan of help — never have been. I’ve been pouring my own milk in my cereal since I was about 3 years old, thank you very much. And if something’s wrong with the TV or any one of the half-dozen gaming and/or sound systems connected to it, don’t call my husband to fix it. I’ve got it under control.

Until it comes to being a mom. Then I need all the help I can get.

There is nothing like the joy, the challenge, the exasperation of preparing two tiny human beings to be contributing members of society. The longer I contemplate this, the more I realize that it truly does take a village. And (no surprise here) the villagers who’ve provided me the most help are mothers who have a few more years’ experience on me.

Here are a few words of wisdom I’ve learned from other moms so far:

1.    “You fall in and out of love.” This was my grandmother’s answer to someone who’d asked her how she and my grandfather stayed married for 53 years, when my grandfather passed away. I was 16 when I heard this. Married couples may not always be the picture of bliss, but two people who support each other, regardless of what season their relationship is in, can model a healthy relationship for their children.

2.    “If you can get through the first 12 weeks, you’ll be OK.” This is from a down-to-earth friend who wasn’t afraid to be honest about the difficult first few weeks after a baby is born. She told me this about three weeks after I became a mother for the first time. She recommended I read “Operating Instructions: A Journal of My Son’s First Year” by Anne Lamott. My friend (and Anne Lamott) helped me see that I wasn’t alone in having trouble getting through that fourth trimester.

3.    “I’m just not one of those cupcake-baking moms.” This declaration is from my own mom. As a younger kid, I thought it’d be cool to have her as a room mother or to chaperone my class on field trips. As I got older, I saw how hard she worked and the sacrifices she made so that my sister and I could wear Guess Jeans like the other kids in our affluent neighborhood. She may not have handed down any killer cupcake recipes. But she did give me a killer work ethic. And the phone number to a great bakery.

4.    “Love and logic work hand-in-hand.” My former boss, a mom of two grown kids—one who’s special needs, and the other who’s working on her master’s degree—pointed me to a book called “Parenting with Love and Logic: Teaching Children Responsibility.” The authors’ main idea is that children should learn from the natural consequences of their actions – not by mommy and daddy dictating orders to them or hovering over them and catering to their every need. There are plenty of parenting books out there with sound advice; the ideas in this book are ones that my husband and I agree work well for our family.

5.    “Let God’s hand be evident every step of the way.” Another former boss, a mother of three girls, sent me this in a text message when I was diagnosed with cancer. Out of all the prayers that people so graciously prayed for me, this sentence sticks with me. And although her message was tied to my illness, the thought applies to many areas of life. Parenting is the hardest job in the world – and how we love our children unconditionally – is evidence of God’s love for us. My boss’s words help me remember this through the roughest and best of parenting seasons. 

Thank you, moms, for all your help. Now all I have to do is figure out how to operate the DVD player.

How patient generated health data impacts interoperability

By Melanie Medina

This originally appeared on the Lyniate blog on August 1, 2019

Healthcare organizations are swimming in it. Patients are becoming increasingly empowered with it. And investors are pouring millions of dollars into medical devices and apps that will generate even more of it. It is patient generated health data (PGHD), and it has huge potential in enhancing patient care and lowering healthcare costs — if implemented in a way that brings value to clinicians, patients, payers, and health systems.

That’s where health IT leaders come in, because the responsibility of developing and maintaining the technical infrastructure and tools to capture, use, and share PGHD will fall on their shoulders. Health IT leaders will need to be strategic in their approach with PGHD, because this is about much more than data exchange; PGHD also has major implications for business processes, clinical workflows, and patient care.

What is patient generated health data, and why is the amount of it skyrocketing?

The Office of the National Coordinator for Health Information Technology (ONC) defines PGHD as “health-related data created, recorded, or gathered by or from patients (or family members or other caregivers) to help address a health concern.”

While PGHD is nothing new — patients have been telling their physicians about their symptoms and outcomes since time immemorial — what’s different is how the data is generated, collected, and shared. PGHD is now coming from:

  • Remote monitoring devices that help physicians monitor and treat chronic illnesses such as diabetes, cardiovascular disease, and asthma
  • Wearables such as insulin monitors
  • Online questionnaires that allow for patient-reported outcomes
  • Mobile apps such as AliveCor, a device that clips onto an iPhone and can measure a person’s heart rhythms, and Diabetes Manager by WellDoc, which monitors blood glucose information


Virtually every stakeholder in a particular healthcare setting can benefit from PGHD.

  • Patients can play a more active role in their health and engage in shared-decision making with their physician
  • Clinicians can gain real-time insights into a patient’s health outside of what they observe in occasional office visits
  • Payers can reimburse clinicians for better health outcomes resulting from incorporating PGHD into a patient’s care
  • Researchers can more closely monitor patients enrolled in clinical trials

While there’s not a ton of evidence (yet) that PGHD can lower healthcare costs and improve care, a number of small case studies show promising results.

One pilot program (PDF) at a Flagstaff, Arizona, hospital involved connecting PGHD from patients with congestive heart failure to their clinicians who would monitor it and intervene in the patient’s care when needed. When the program’s organizers compared data from the six months following enrollment to the six months prior, they found:

  • A 44% reduction in emergency department readmissions
  • A 64% decrease in the average number of days in the hospital
  • Hospital charges per patient were $92,000 less on average
  • The program proved so effective for the hospital that it has been expanded to patients with other chronic conditions

And according to IQVIA Institute for Human Data Science:

The use of Digital Health apps in just five patient populations where they have proven reductions in acute care utilization (diabetes prevention, diabetes, asthma, cardiac rehabilitation and pulmonary rehabilitation) could save the U.S. healthcare system an estimated $7 billion per year. This represents about 1.4% of total costs in these patient populations. If this level of savings could be achieved across all disease areas, annual cost savings of $46 billion could be achieved.

With the growing number of health apps, wearables, and remote monitoring devices, we can only expect to see more data like this in the coming years. Consider these statistics, also from IQVIA:

  • More than 318,000 health apps and 340 consumer wearable devices are now available worldwide
  • General wellness apps still account for the majority of health apps available to consumers, but those focused on health condition management — often associated with patient care — are growing and now account for 40% of all apps
  • More than 860 clinical trials worldwide now incorporate digital health tools, including 540 in the U.S., with two-thirds of these focused on apps and text message interventions to smartphones

If your health system isn’t already incorporating PGHD with your EHR, it’s only a matter of time before it will begin doing so.

Interoperability and PGHD

In theory, capturing, sharing, and using PGHD is straightforward.

In practice, given the growing number of sources of PGHD, this data exchange will increase in complexity and require a savvy team of IT experts to handle it.

And integrating PGHD into EHRs in a way that is useful for clinicians, patients, and healthcare organizations involves far more than creating interfaces. For instance:

  • How do we capture charges related to PGHD-related interactions?
  • How will PGHD-related interactions interface with payers so providers are reimbursed?
  • What standards need to be developed for capturing and integrating PGHD?
  • How do we get the right data to the right people at the right time?
  • How do we store massive amounts of PGHD?
  • What privacy and security measures need to be in place?
  • How will we protect data at rest as well as data in motion?
  • These are just a few of the issues that health IT leaders need to address as PGHD becomes more pervasive in our healthcare system. They’ll also need to consider whether they have the right talent and expertise on their teams to interact with the influx of new data trading partners.

This might require health IT leaders to look beyond their current in-house technical resources to outside vendors who can help them manage these complexities.

‘It seemed like the right thing to do’

By Melanie Medina

The most vivid memory I have of my Uncle Jim was when my cousin Katy and I were in the back seat of his car singing, Little Bunny Foo Foo, I don’t wanna see you pickin’ up the field mice and boppin’ ‘em on the head.

We were doing the hand motions and everything. Scoop-and-hold motion with the left hand, boppin’ the pretend field mouse with the right.

Uncle Jim made us stop singing the song because it was such a cruel way to treat a field mouse.

I can’t say that I knew my Uncle Jim very well. It seemed to me that he got grumpy easily and would then want to be by himself. Besides that, what I remember about my uncle: he loved animals, and he had enormous amounts of empathy for anyone who was hurting.

When I was going through some orthodontic work as a teenager, he showed me that if I clenched my jaw together and put some pressure on my molars—not too hard—it would give me a bit of relief, or rather it would change the type of pain that I felt, which in a way is relieving, I suppose.

Also—and this is pretty important—he introduced my dad to my mother in the 1970s, so if it weren’t for him, I wouldn’t be writing this.

I also know that when the Gulf War started, he began to suffer flashbacks to his time in the Vietnam War.

He was inducted into the Army in January 1967 at just barely 19 years old.

He was stationed somewhere in the central highland region of South Vietnam. His combat tour ended at about 9:30 a.m. October 19, 1967, when his helicopter came under enemy fire, which caused it to crash.

“I was one of several soldiers on that craft that was seriously injured and was sent back to The States for medical treatment,” he wrote in a letter to his grandson, which Katy shared with me.

In that letter, he also described a picture that someone had taken of him in a Vietnam village off the coast of the South China Sea.

“I am giving this woman some antibiotic ointment to rub on some sores on her baby’s head,” my uncle wrote. “We had found the ointment in a stash of supplies we came across when we destroyed a Viet Cong bunker a couple of days before.

“I don’t know if it helped the baby but it just seemed like the right thing to do.”

I imagine that destroying a bunker—when it’s not in your nature to fathom even a field mouse being hurt—does something to you. It did something to my Uncle Jim.

He came back home with his jaw in pieces. He hid his scars under a beard until the day he died.

When one of the nurses who took care of him in his last days told me she was going to shave his beard, I asked her if she wouldn’t mind just trimming it instead. When she let me Facetime with him two days before he died, I was so happy to see his clean and neatly trimmed beard.

The beard was good for hiding most of his scars, except for the one on his cheek that I had always believed to be a dimple. It wasn’t.

The beard did a terrible job of hiding his emotional scars. Everyone close to him could see he was fighting internal demons. They seemed ruthless and relentless. Even a kid could sense his pain.

My uncle is finally at peace. He died on Sunday, March 28, 2021, of cancer. He so kept to himself that, according to what the doctors tell us, once he learned he had some type of cancer, he did not go back to find out what type. At one time, we heard it was mesothelioma. But he used to smoke a pipe, so maybe it was smoking-related lung cancer.

My cousin had him cremated. Last weekend she arranged a military service for him at Texas State Veterans Cemetery at Abilene, and it was absolutely beautiful.

I’m humbled by his service and sacrifice. He deserved the honor of a veteran’s service.

At the end of it, a woman who worked at the cemetery poured out some of his ashes over the scattering garden.

When it was over, Katy and I and our families drove to Seymour. It’s a tiny town halfway between Dallas and Lubbock where my dad and Uncle Jim lived from the time they were 10 and 8 years old, respectively, until my dad left for college at University of North Texas in Denton, with Jim following behind him two years later.

Based on what family have told me, my uncle joined the Army as a form of rebellion against my grandparents.

Katy and I went to the Seymour rodeo and watched barrel racers and bull riders, just like our dads did in the 1950s and ’60s.

We fed our kids Frito pie and nachos and watched the sun set behind the bull pens.

As we walked back to our cars, we cut over to one side in the grass. Out of my purse, I pulled a tiny urn that held some of my dad’s ashes. She opened a black box and pulled out a bag of the ashes she’d saved from her dad’s service. We poured them out and let the breeze mix the ashes of our dads together. We watched them settle in a little field in the town where they grew up.

I don’t know if resting in peace forever in the grass near the Seymour rodeo is what they would have wanted but it just seemed like the right thing to do.

Surviving Breast Cancer, Cynicism Intact

By Melanie Medina

Originally appeared in Live Happy, September 30, 2017

THE DISEASE TAUGHT ME TO EMBRACE WHAT I CANNOT CHANGE.

I never planned to write about breast cancer—partly because I told myself it wasn’t that big of a deal, but mostly I didn’t want to be a pink-ribboned poster girl for the disease, trotting out my story and cheapening it with every retelling.

Buck up and deal with it, I told myself. Get the surgery. Take the chemo. What else was I going to do? If I wanted to live to see my 11-month-old son grow out of his baby bed, and watch my 3-year-old daughter start kindergarten, my path was clear. Whatever pain I might have after surgery, however sick I felt after chemo, I would get through it.

REALITY BITES

I recently heard an interview with a veteran Marine who talked about a motto that’s often used in the military: Embrace the suck. I’m not in the military, but I know what she was talking about. Hearing this phrase was the first time I had words to nail down exactly how I got through breast cancer.

Deep down inside, I knew this wasn’t the flu. The fact is, women die from breast cancer every single day—even in 2017. Doctors staged my cancer at 2b. Had it been stage 4, the statistics say I probably wouldn’t be here writing about it.

So I embraced the suck, because it did suck, and there was no use pretending otherwise. I couldn’t Pollyanna my way through it. I had no other options beyond accepting my reality and reacting to each minute as it unfolded.

If anything could be construed as “positivity,” I suppose it was my acceptance of the situation. For the 33 years until my diagnosis, I’d been living in a universe where everything just worked out.

Then I blinked.

And when I opened my eyes, I realized that I’d actually been in a parallel universe my whole life. One where I had a BRCA2 gene mutation that meant when some cells in my right breast started growing out of control, this mutated gene couldn’t go in and stop the nonsense like a healthy BRCA2 gene would do. When I accepted this universe, life with cancer was manageable. It was a kind of suck that I had to embrace.

FINDING THE GOODNESS

For example, I embraced the distressing news from my aunt Margie, who told me that my grandmother wasn’t the only one in our family who’d had breast cancer. My grandmother’s sister had died of breast cancer at age 35. Had Margie not told me this, I never would’ve started doing self-exams in the shower. (Lesson: Know your family history and check your breasts.)

I embraced the fact that it was our neighbor and friend Miss Beth who had to read The Monster at the End of This Book to my curly haired daughter when I couldn’t.

My husband and I embraced Miss Beth’s husband, Mike, when he brought his homemade, Mickey Mouse-shaped pancakes to our kids one Saturday morning.

I embraced my mother for staying with me when, after my nine-hour bilateral mastectomy, my plastic surgeon had to wheel me back into the operating room to take care of a hematoma that had developed. I can’t imagine what a mother feels like after everyone else goes home for the night, and her daughter has to go back into surgery.

I embraced my stepmother for doing my family’s laundry, and my dad for being a good sport and dancing when my daughter commanded him to, and for helping my husband get two tiny kids out of the bathtub because I couldn’t.

Woman in robe watching TV

I embraced TLC for creating the reality show My Big Fat Gypsy Wedding so that I had something to binge-watch while trying to ignore the nausea from chemo.

I embraced my husband for his humor, and his guidance in helping me choose the right implants for my reconstruction. And for going with me to every single infusion, even though I told him he didn’t have to.

I embraced my co-workers who taped three-dozen tiny pink ribbons on the walls of our conference room—and left them there until I was done with my treatments.

LOOKING FOR SILVER LININGS

I embraced modern medicine. Despite the nausea and utter disgust I felt after each round of chemo, I still thanked God that these medications (and some pretty powerful antiemetics) exist.

I embraced the fact that, early in my diagnosis, we learned that a gene mutation runs on my mother’s side of the family. This explained my great-aunt’s premature death, and the fact that my own grandmother was diagnosed with breast cancer not just once, but twice. Knowing this mutation runs in our family taught us all to be more proactive in taking care of our health.

And today I embrace the fact that I can sit here and write about cancer. Because you know what? It was a big deal. And because not everyone’s fortunate enough to live through it.

And because writing about my own unique perspective—one where the patient doesn’t wear a pink tutu in the O.R. or hang gaudy pink metallic wreaths on her door but instead finds her own begrudging path through this thing—might be helpful after all. Maybe as much for me as for anyone reading this.