The Games Aetna Plays

(by Zuska) Jun 09 2017

I'm going to start by saying what I have to be thankful for. Thanks to the much-vilified ACA, my annual mammogram and my post-50 colonoscopy are provided at no cost to me, even if my spouse and I have not met his employer-provided insurance coverage deductible. Who knows how long that will last, thanks to the GOP-controlled Congress working day and night to repeal everything President Obama touched. But lucky for me I got to use these wonderful preventive care benefits as long as I did. My first colonoscopy found a few polyps, so I thank all who brought me the ACA, and all who have brought attention to the need for colon cancer screening, for possibly preventing and/or delaying the day when I may have ended up with colon cancer.

In the crazy world that is the U.S. health insurance system, I am probably better off than most people. Our employer-provided health insurance is a high deductible plan, but, oh well, chronic migraines go a long way in a short time to helping one meet that deductible. We are fortunate to be able to pay the deductible, so we can actually afford health care itself, beyond paying the premiums for health insurance. We have an HSA through Mr. Z's employer and that helps a bit as well - again, because we have enough money to spare to put into the HSA to begin with.

So I feel grateful for these things.

I also feel grateful for the Mental Health Parity and Addiction Equity Act provisions, which means that treatment for mental health has been covered the same as medical and surgical treatment. This is still not perfect, because most mental health providers one wants to see are not "in network" with any insurance company. So one must pay upfront, out of pocket, and submit a claim for reimbursement.

The parity provision has meant, in theory, that instead of being assessed a variety of coinsurances and copays separate from my regular coverage and then offered a reimbursement rate that works out to something like 15% of what I paid out of pocket, I get reimbursed for everything, if I have met my deductible.

In practice - only if I'm paying attention.

Because I receive SSDI, I am also automatically enrolled in Medicare Part A, which provides only hospitalization coverage. When I submit a claim to Aetna for out-of-network provider reimbursement, Aetna wants to know if I am covered by any other insurance. I always fill in the information on the form - Medicare Part A only. I always include a cover letter, stating that while I have Medicare, it is Part A only, and does not provide any coverage or reimbursement for the claims submitted.

Nine times out of ten, Aetna either refuses to process the claim because they are "waiting for [my] Medicare EOB" or because "member did not supply information on Medicare portion of this claim". I then call Aetna and say "see that form I sent with the claim? and the cover letter? where it says I have Medicare Part A only? so there is no Medicare portion of this claim?" And they say, oh, yes, just a processing mistake, we'll send this back for reprocessing, it will just be two to four weeks to reprocess.

Sometimes Aetna just flat out refuses to deal with it. I submitted one claim and heard nothing for weeks. I called Aetna: no, they never received it! Why did I submit the claim through the mail? Nobody sends claims through the mail! (Instructions on the form and on the back of the member card tell you to send the claim by mail, and give you the address where to send it.) I should have faxed my claim! Fax it to this number! I faxed it. Which cost me money, because I don't have a fax machine at home. And got...crickets. Called again. No, they never received anything. They don't know who gave me that fax number but it's not the right one to use. I should have submitted it online. I balked. They allowed as how maybe it could be mailed in, and promised to process it in two to four weeks... I said I felt harassed. I mailed it in again. This time miraculously it was received and processed.

Earlier this year, I submitted a claim in the usual way. Aetna received it - somehow, the mailroom does work! And they processed it, really rapidly, and sent me a check right quick. I was so happy I didn't realize the check was only 60% of what it should be. Today I was going over my records and trying to reconcile the check received with the documents I had submitted. (Pro-tip: keep copies of everything you ever send to a health insurance company, and keep an organized file system.) I studied the EOB for the claim, a multi-columned table studded with footnotes.

Here's the trick Aetna pulled. They separated the multiple dates of service, all submitted in one claim, into two groups, and listed them as two separate claims on one EOB. Then they sent me a check for one of the "two claims". They flagged the other as "member did not submit Medicare EOB information for this claim" and dumped it in the "do not pay" file.

Just like that, they wrote off 40% of a bill they owed me. Let us say there were ten dates of service from the same provider submitted together in one claim. Aetna grouped the first six dates of service together and said "these, we will pay". Aetna grouped the last four and said "these, identical services from same provider that we should also pay, tick this flag and don't pay."

I have to give them credit. It took me awhile to notice what they did and if I didn't keep good records and obsessively look them over every so often I might not have noticed it. If I were sicker, or more preoccupied with other things in life right now (like elder care) it might have slipped by me. And Aetna would have saved 40% of a bill they legit owed me with a simple trick that on the surface looks like human error. "Well, she does have Medicare, so one of our employees was just overcautious in not processing those claims in case the Medicare was outstanding." Never mind the six other identical services that went through just fine, and never mind they were all submitted on the same form.

After I called Aetna to "correct" this "processing error" (15 minutes on the phone, and was told "two to four weeks to reprocess") I said I wanted to submit a complaint. I got sent to a voice menu that asked me a bunch of questions about the person I interacted with, who was perfectly nice and helpful. At the end I was asked if I wanted to leave a comment. Did I ever.

I said that my spouse pays good money for our insurance premiums, that these premiums are supposed to purchase coverage for us; that every time I submit claims from this out of network provider, I get the same run around about "waiting for Medicare EOB" information, even though I have informed them there is no Medicare coverage; that I feel harassed by my insurance provider; that having to deal with this red tape and stalling and refusal to pay makes me sicker; that my health insurance company should be helping me with my health, not making me feel worse; that if we pay for coverage we should expect that it should be there when we use it.

I am grateful to the ACA for my having access to coverage for mental health providers at all, and I am aware that this coverage is precarious and about to be taken away from me and others. I am grateful that I have the resources to expend for mental health care while waiting months for my health insurance company to get around to deciding to pay what they owe me for coverage my spouse and his employer have already purchased. I am aware this is probably the best coverage for mental health care I've ever had in my life. With all its problems, my situation is no doubt enviable to many.

I grieve thinking that the GOP-controlled Congress doesn't see what I have as just barely adequate, as something worth building on, making better. I grieve that they don't see the problem as lying with insurance companies who use accounting tricks to withhold 40% on the dollar from disabled, chronically ill customers who paid for coverage. I grieve that they think the solution is just to take away what little we do have and give us "access" to high-risk pools. If insurance companies are playing dirty tricks to get out of providing coverage to people like me now, what will they do when unfettered by the ACA?

2 responses so far

Tree Wisdom

(by Zuska) Jun 05 2017

Happily, I've increased my Daily Minimum Intake of printed matter in the past few years in the form of books. I've been reading real books, not ebooks, though for a time I did do a lot of ebook reading too.

I liked a lot of things about ebooks. I liked the search feature of ebooks, allowing me to easily find a phrase - very helpful at book club discussions. While reading, if I came across something I wanted to understand a little more deeply, why, the googles were right there in my hands! (Though this often led me astray and away from the book itself.) I loved the immediacy of ebooks. Did the NYT Book Review develop in me a sudden hankering for Yu Hua's The Seventh Day?  Very well, I shall possess it in this moment of hot desire! Naturally this wanton pursuit of books resulted in reading three books at once, not finishing a book or three, and sometimes being quite shocked when the Visa bill arrived.*

But ultimately I found ebooks unsatisfying. I grew up with books made of trees, held in the hands, pages grasped between thumb and forefinger and turned one by one, the heft of a book in hands or on the lap a visceral sensation, the sense of where one was in the story seen and felt by the thickness of pages in the left hand versus the right. I have always had an ability to locate a remembered passage in a book because of this visual-tactile experience: it was on the upper right hand side of the page, in the middle of a large blocky paragraph, about a third of the way through the book... The search function of ebooks compensates in a technical way for the loss of this visual-tactile information and is no doubt more efficient but less emotionally satisfying than the thrill I experience each time I find what I want right there on the page, right there in the book, where my brain and body knows and feels it should be. There is no way to grab hold of an ebook they aren't even flat, they are dimensionless. You cannot use spatial or tactile information to remember anything about an ebook reading experience, and for me this ultimately diminishes the reading experience.

And I do not wish for any more of diminishment than that which life will bring to each of us in due course. (Each of us, that is, capable of registering growth between our selves at first grade and at adulthood.)

How we diminish, thankful for
comfort, unevent, kindness,
sunlight on October-orange maple leaves.
How we mature, tired of romancing pain.

                                   Jeff Mann, poet, essayist, teacher
  The Failed Romantic Seduces A Blueberry Bar
in A Romantic Mann, Lethe Press, 2013

Several of my books (e- or tree) in the past year have featured trees as a metaphor, main subject, or recurring topic. The Seventh Day, referenced above, is a fascinating fable of the afterlife of the world's poor featuring trees and tree imagery. What happens when you cannot afford cremation or burial, when you have no one to mourn you? In a particularly affecting section, a tree's broad leaves provide a resting place to babies who were abandoned as medical waste. This powerfully imaginative tale renders the interconnections between economic violence, sexual violence, and environmental devastation in a most unforgettable way that kept me reading late into the night.

I thoroughly enjoyed Lab Girl for many reasons. Hope Jahren speaks with passion about the life and love she has devoted to science, and what science has given back to her. She conveys the wonders of trees and the challenges of sciencing while female, using a direct and humorous manner that startled, shocked, and delighted this reader. Lab Girl is, of course, a memoir, not a novel, but it reads like a jolly picaresque tale. It is a kind of Wissenschaftlerroman, if I may be allowed to coin a new (usage) of a word. There is of course the bildungsroman (novel of formation), the Künstlerroman (artist's novel), and the Erziehungsroman (educational novel). But as far as I can tell, when the words "roman" and "Wissenschaftler" are linked in German, it means science fiction. I intend Wissenschaftlerroman here to mean the story of an individual's growth from childhood to maturity wherein she finds her calling in science, and develops mastery of her craft. It is true what she says - Hope Jahren sure can write.

Right now I am reading The Hidden Life of Trees, by Peter Wohlleben and Pilgrim at Tinker Creek, by Annie Dillard. The former was recommended to me by a friend, a great plants-woman. I picked it up during a delirious visit to Politics & Prose in DC, read a few pages, and was enthralled. It is a magical tale of the real life of trees. One is hardly prepared for such outlandish reports as are gathered in this book of science, unless one was raised on a diet of the very best unadulterated Grimm's and A Thousand and One Nights. Dillard asks, "What if I fell in a forest? Would a tree hear?" Wohlleben's book is in some ways an extended meditation on Dillard's reversal of the traditional koan. The scale of life for trees, so much radically longer than ours, makes of us mayflies. We cut down an old tree and walk away and in another lifetime someone else discovers that nearby trees are keeping the roots of that cut-down tree alive. Why? We are only beginning to know to ask the question.

I'd known of Dillard's book for a long time but put off reading it. I had no idea how rapturous it is. I read small doses and meditate on it. People say "I'm not religious but I am spiritual." I envy them. Long ago I lost my childhood Roman Catholic belief; spiritualism never took its place. On high holy days at church we processed, and incense was burned, and I felt the presence of God; and when we were still allowed to have May Crowning we sang Glorious Mother, from high heaven/Down upon thy children gaze/Gathered in thy own loved season/Thee to bless and thee to praise!/See Sweet Mary, on thy altar/Bloom the fairest buds of May/O may we Earth's sons and daughters/Grow by grace as pure as they - then we were all part of the holy and the beauty and the grace.  Then came a cranky, vitriolic priest who disliked the flower-filled woman-centered Marian worship, declared it pagan and unfit for proper Catholics, and banned it shortly after arrival in our little coal-mining town.

I have found much solace in recent years in gardening. I have taken a Tree Tenders course, and become more active with my township's Shade Tree Commission. I have no illusions that caring for my tiny patch of soil, or planting trees in my local neighborhood, is anything but bailing a sinking ship with a teaspoon, and yet if we don't each wield our own teaspoon the best we can, what's the point of even being here. Annie Dillard reminds me that there is great joy in this world, she reminds me to be in the present, to face upstream in the creek at the great onrush of light and now, that there is a tree with the lights in it. " and grace are performed whether or not we will or sense them. The least we can do is try to be there." I am trying to be here. I did see the tree with the lights in it once. I try to remember to look close, look closer, look as closely as I can, pay attention to now, to remember that beauty and grace are being performed all around me, to at least do the least I can do.

O may we Earth's sons and daughters grow by grace as pure as they.

*To be honest, the fault lies not in our ebooks, but in myself. For when I walk into a bookstore, I walk out with a heavy bag, my TBR list unfurls  beyond my 127th year, and shock is duly feigned when the Visa bill arrives. If I had a House, my sigil would sport a book and the letters "TBR". Also, a tree.


4 responses so far

Annals of Elder Care: The Joy of Power

(by Zuska) Aug 31 2016

For five years I served as my mother's financial power of attorney. She had some complicated finances, and some very complicated health issues. Anyone who has done elder care for five minutes knows that "complicated health issues" = mounds of paperwork and hours of time per week dealing with it.

When mired in the thick of elder care paperwork muck, few people have time or energy to seek out others dealing with similar issues. It's not like everyone gets together at the elder care park, letting their loved ones frolic on the swingsets and seesaws so that serious information sharing and necessary venting can take place. There's really no place where people charged with caring for ill or elderly loved ones can regularly gather, except the internet.

That's why I thought it would be worth sharing some of my experiences.

Today's topic is the The Joy of Power.

If you are FPOA for a loved one, you may find yourself in what I call a unicorn family - everyone gets along, each person does what they can, and everyone's highest concern, ever and always, is the good of the loved one.

Or you may find yourself in a, shall we say, more realistic situation. In non-unicorn cases, the FPOA is understood by some or all family members to be controlling, conniving, and deceitful, and robbing the loved one blind. In short, their absolute power has corrupted them absolutely. Sadly, in far too many cases, something like this does happen. I have seen a son rob his mother of nearly everything, leaving her destitute and malnourished (while calling in bomb threats to the local school in his spare time).  I have seen cases where siblings are denied medical information about a parent by sibling(s) in control, who then feed the parent stories about how and why the denied siblings are evil. I have seen a child trash a parent's house, be evicted, and return to do it again. Money makes people crazy. The very wealthy are not exempt - Donald Trump, for example, once cut off health care for a sick child - his grandnephew - because the child's family contested Donald's daddy's will.

But in most cases, the FPOA is just a blindfolded donkey turning the millstone, taking the wheat of conflicting paperwork and grinding out the flour of financial stability, often as not with one or more family members pulling the cord tied to the mouth, the better to keep the FPOA turning in his or her tracks.* Jesus said of little children "But whoso shall offend one of these little ones which believe in me, it were better for him that a millstone were hanged about his neck, and that he were drowned in the depth of the sea." Taking to the waters with a millstone necklace often seems preferable to continuing in the traces. But escape leaves the loved one behind.

Here's a fun memory from my time in the traces that illustrates just how delightful it is to wield all that "power" of the FPOA.

In October of 2011, a collections agency sent a threatening letter demanding immediate payment for an overdue bill for my mom's visit to a doctor at a local clinic in June of 2011. Although the visit was for mom, the collections agency threatened me (and thus my credit rating).  I spent half an hour combing through old explanation of benefit forms, and two hours on the phone with Medicare and Blue Cross to determine that the bill had actually been paid and when it had been paid. The next day I spent half an hour on the phone with the collection agency who demanded physical proof in the form of faxed copies of documents from Medicare and Blue Cross stating that they had actually paid the bill. They demanded this proof by the next day.

A special sweet irony of the whole mess is that the person at the collections agency initially refused to talk to me because even though I was mom's POA, and even though the collections letter was addressed to me and even though it was my credit rating that was at stake, and even though they were trying to get the money out of me, the medical appointment was for mom and so they didn't want to discuss the issue with me because of "privacy issues".

I spent fifteen minutes trying to figure out how to get to speak to a person, not voice mail, at the clinic’s billing department to find out why they turned a paid bill over to collections and how to get this undone.  I finally got a helpful person who promised to undo the mistake and who caught another one that was about to be sent off to collections.  Someone submits a bill with incorrect coding, it comes back from insurance unpaid because of the error, and then someone in billing sees the bill is unpaid and sends it off to collections rather than fixing the error.  So it is probably more rather than less likely that you will be dealing with this scenario in the future, if you are so lucky as the be the donkey FPOA.  The person at the clinic offered to call collections and send them documentation and I planned to check in again later to see that things had been resolved, after I received copies of everything from the helpful clinic billing person. This all took another half hour to 45 minutes. At that point, I just assumed, till I knew for sure, that I was not yet done with the issue.

If you are keeping track, that is nearly four hours of time (not counting time out for cursing and despair) on ONE issue, that may or may not have been resolved. (Luckily for me, that was the end of the story.) When I worked in pharma, at one company we tracked our time in 15 minute billable units. Alas, there was no billing code for my four hours of labor, and so my end of the week timesheet in that system would have shown ten percent unbillable hours, which is the same as not working in the business world, and I would have been on the edge of reprimand.

I do not know how people with full time jobs outside of being a FPOA manage to get all this sort of thing done. When feminists and economists talk about the unpaid labor of women, it is precisely this sort of thing they have in mind. Mind you, the 45 minutes the clinic billing person spent on the phone with me resolving this issue, plus whatever time she spent after we got off the phone, was paid but unproductive labor. No one’s unpaid bills got paid, no one’s health care status was advanced, nothing was achieved but once more subverting the malicious effects of an avaricious, antagonistic, and ill-designed health care system.

If you are FPOA donkey, turning in your traces, grinding the most illogical paperwork nightmares ever conceived into dust, day after day, I salute you.

*I thank Country Life (The Journal for All Interested in Country Life and Country Pursuits), Vol 24, Oct. 17, 1908 p. 515, for the anecdote that inspired my FPOA-donkey metaphor.

5 responses so far

It's Not The Same

(by Zuska) May 19 2016

It drives me nuts to read stuff like this and this about presidential candidate "likeability".

People don't like Trump because he is a racist, sexist, egomaniac who wants to Make America Great Again -Now With More Fascism! People don't like Clinton because she's a woman who doesn't give them a warm fuzzy feeling, and whose strong leadership qualities, which they would admire in any dude candidate, make them anxious and confused because they are attached to a Person Of Vagina.

People don't like Trump because they recognize him as the populist threat to democracy the Founding Fathers fretted over. People don't like Clinton because they are more comfortable with an old dude spouting fiery socialist rhetoric than a (less) old woman proposing thoughtful policies to advance the welfare of women and families.

People don't like Trump because he's tearing down an established party, running roughshod over that party's longstanding cherished policies and principles, and doing his level best to destroy any remaining shreds of respect not just for party leaders but for the concepts of experience, expertise, knowledge, logic, democracy, nonviolence, and civil rights. (Even if one can argue that Trump is merely reaping what the GOP has sown for years now, nothing says the sowers have to like the result any more than the rest of us.) People don't like Clinton because, you know, she's certainly qualified to be president, but, well, she's stiff, she's old, she's unattractive, she shouts/shrieks/cackles, she has that hair/those pantsuits/those cankles, her only qualification [besides the Senate and Secretary of State experience] is being married to Bill.

People like Trump because he's a filthy rich New Yorker who says he knows how Wall Street works and who disrespects women. People dislike Clinton because they suspect her of being filthy rich and hanging with people on Wall Street.  And people dislike Clinton despite her promotion of women-centric policy issues [either because they are anti-women or because "she doesn't speak for women". You know, the way Bernie does.]

When the press talks about Trump and Clinton being the two most unlikable presidential candidates ever in the recorded history of time, about how people are just having to choose between who they dislike the least, it obscures serious and meaningful differences. If Bernie's supporters can't bring themselves around to voting for Clinton in the fall, it doesn't mean they are standing true to their principles or trying to bring about a revolution. It means they would be more comfortable with American-style populist fascism than with a democratic leader who shares many but not all of their policy goals, but who happens to be female.

11 responses so far

The Story of Bread

(by Zuska) Apr 29 2016

My mother was the short-order cook of the Home Breakfast Diner. She made sure we children had a good breakfast before school each day – even if that meant a fried egg for this one, scrambled for that one, soft-boiled on toast for another, oatmeal or cereal for one more. For herself, though, breakfast was always a slice of toast and cup of coffee. On weekends, the diner became more of a self-serve counter, and my sisters and I would often emulate mom’s breakfast in lazy high style. Lounging about in our pajamas, we would toast slice after slice of Stroehmann’s white bread, slather it with Parkay margarine, and sprinkle it heavily with a cinnamon-sugar mix from a glass jar capped with a metal screwcap perforated lid. We sipped Salada tea with our toast, rather than coffee, and read the Tag Lines dangling from our cups to each other.

Our weekday breakfasts nourished our bodies, but those weekend toast-fests with tea and talk were for something else. We described our dreams to each other, talked about tv shows, movies, and books, gossiped and traded complaints about friends, enemies, school, marching band, our church group, and life in general. Verbal agility and wordplay were both practiced and admired in our house; Saturday toast and tea was often a fun time in that regard. “All sorrows are less with bread,” said Cervantes, and as well all conviviality was more with cinnamon toast.

I thought of that breakfast toast the other day, as I popped a slice of Whole Foods artisanal cranberry-walnut bread into my long-slice-accommodating toaster with defrost and bagel settings. My toaster resides in a corner of the countertop, not on the table as did my family’s. (It does, however, have the same propensity to burn on one side and not toast on the other. Little improvement in toaster technology over the ages, in my opinion.) I eat my toast alone, or at least in silence, as the cats are not much for conversational banter.

The bread I toast is upscale, not to say aspirational, and certainly much more expensive than those slices of Stroehmann’s. I buy it because I have learned to think disparagingly of the pre-sliced white loaves of my childhood, and because I have developed a taste for crusty artisanal loaves. Though I note that one can buy “artisanal” white bread loaves at Whole Foods. They will slice them for you, too.

People still say of some new thing “that’s the greatest thing since sliced bread!” Don’t they? They should. When sliced “store-bought” bread appeared on the scene, my mother told us, she and her siblings longed to have it. To them its taste was deliciously novel and desirable. Their mother baked bread three times a week. Rarely did they get to partake of the heavenly delight that was store-bought, sliced white bread. Only at times when the coal miner’s wife and mother of seven ran out of time for one of the thrice-weekly bakings would she send a child down to the company store to purchase the savory goodness. Julia Child’s bread-that-tastes-like-Kleenex was the desiderata for my mother and her siblings.

When our mother described this to us, her longing as a child for store-bought bread, and sadness at “having” to eat her mother’s homemade bread, we hooted and hollered and cried out in disbelief. You should know, dear reader, that this story was told to us many, many times, and each time we would react with the same level of dismay. We were a family that repeated stories as if no written record could exist. The only way to preserve family lore was to repeat the stories. The telling of stories to each other was to say “this is who you are, you belong to this and it belongs to you.”  I belong to the story of bread, and it belongs to me.

We were the eaters of Stroehman’s, who longed for the few times a year when our mother would make homemade bread. At Easter time she made a special kind of bread called paska, which we ate with the other “blessed foods” that went into the Easter basket. This basket of delights was taken to the church on Easter Saturday for the priest’s blessing – kielbasa, Easter eggs, pickled eggs, horseradish & beets, ham, and an egg cheese that my mother called “cedetz” or sirecz. We loved paska, and while a sandwich of ham and egg cheese on paska was divine, just a plain slice of paska with butter was itself an eagerly anticipated treat.

I have baked bread maybe five times in my whole life. I buy flour in a one-pound sack, store it in a small Tupperware canister, use it mostly to make desserts for Mr. Z, and struggle to use it up before it goes bad.  I skip the bread aisle in my regular grocery store and buy bread at Whole Foods, or at the farmer’s market, or at the little bakery in the next town over, because I have learned to be a bread snob, and because I can afford it.

My mother baked bread a few times a year in an electric oven, along with cakes and cookies for our family. She bought flower in five or ten pound sacks and stored it first in a metal canister, later in a large Tupperware canister. Still later she had a bread machine, rarely used. Late in life, she began to favor “Tuscany bread” from her local grocery store, as the artisanal bread craze washed up on her shores.

Her mother, the grandmother I never knew, baked bread three times a week on a coal stove. She bought flower in twenty-five pound sacks and stored it in a compartment of a Hoosier-type cabinet designed especially for that purpose.

My great-grandmother baked bread in an outdoor communal brick oven in the small coal town of Beatty, PA.  I am fairly certain she bought her flour, though I don’t know in what quantities or how it was stored.

Zuska's great-grandma, near Beatty, PA

Zuska's great-grandma, near Beatty, PA

My great-great-grandmother, back in Slovakia, most likely ground her own grain or went to the local mill to get her flour.

I never learned from my mother the skill of baking the breads she knew how to make, the skill she learned from her mother and her aunts who lived next door. I would gladly pay to have the bread my grandmother baked because she could not afford the store-bought sliced stuff.  Even in the ethnic enclaves that survive in urban Philadelphia, I have not found a bakery that makes paska.

Last year at Easter time I assayed an attempt at paska. The results were mixed. It looked alright, had the wonderful aroma I remembered, and the taste was not all that bad. But it was way too dense, not the light, delicate, somewhere-between-bread-and-cake bread of my childhood.

Paska made by Zuska - loaves and burnt rolls

Paska made by Zuska - loaves and burnt rolls

This year I had an opportunity to learn to make paska at my in-laws’ Hungarian church “kitchen club”, but I had a month-long lung plague instead. They sent me the recipe and directions with pictures, so maybe I will give it another try.

Breadmaking is a science and an art – the right mix of dry and wet ingredients, the right amount of kneading, the right rise time, the quality of your yeast and the way you handle it, the evenness of your oven’s heat. My mother swore that her bread, as much as we loved it, never baked as well in her electric stove as it had in her old coal stove. She used to let the bread rise on the back of the coal stove, which always had some residual heat. Not so with an electric stove. She also used cake yeast, which is nearly impossible to find today. The dry yeast packets, to my mind, have a different rise effect and lend a different flavor to the bread. I have one of my mother's old bread pans, and the bread bakes differently in it that dark battered pan that it does in my shiny new one, i.e., better.

I don’t have a large family to bake for. I have my Whole Foods cranberry-walnut bread, and the cats and Mr. Z.  I could probably learn to bake bread, but I tell myself it’s not the best use of my time when it’s so easy to buy good bread (not paska, but good bread nonetheless).  I suspect if my grandmother were here with me today, she would not be sorry to leave off the chore of needing to bake bread three times a week in a coal stove. If she could afford it, she would no doubt be pleased to purchase tasty bread at a nearby store. I don’t have false nostalgia for a past where women’s work was constant and hard, and women’s opportunities were circumscribed by law as well as prejudice. My great-grandmother left Slovakia in part so her descendants could experience a life with cranberry walnut bread they didn’t have to bake for themselves. So all-in-all my story of bread has worked out okay.

It’s much harder today to be in the situation my grandmother had to negotiate, a family to feed and not able to afford the fancy store-bought sliced bread. My grandfather was able to support the family financially, more or less, on his coal miner’s wages even in the days of struggling to establish the union, while my grandmother ran the household, raised the kids, preserved food from the garden, and baked bread. Today’s poor families are unlikely to have someone at home full time, with the energy and time to bake bread. They are unlikely to have the capital to invest in bread-baking supplies and tools, or perhaps even to have a stable home address where said supplies can be stored. (As can happen, for example, when people are subjected to shameful evictions following on the heels of predatory lending practices.)

My good-fortune story of bread gives me an opportunity to lend a hand in other peoples’ stories. I am always happy to support food pantries. One of my favorite programs is Philabundance, and I recently discovered that my county’s community college has a food pantry program for its students, developed by faculty and staff. Maybe there’s something similar at a community college near you, or maybe you could help establish something like it. There is also a program at Community College of Philadelphia, helping students keep their grades up and graduate.

If you’re lucky enough to enjoy artisanal toast in the morning, think about sharing some of your good fortune with people in your area who are not so fortunate. The story of bread should belong to all of us.

4 responses so far

View From The Taker-Zone

(by Zuska) Mar 23 2016

Paul Ryan is rethinking that whole "makers and takers" rhetoric, so I hear. He has had an insight. People who are "accepting government benefits" don't actually "want to be dependent". [We won't argue about whether it is accurate to characterize a social safety net as a "benefit". I think of "benefits" as things like "free chocolate at lunch!" or "my job provides me a leased automobile!" or "zillions of dollars worth of stock options even though I ran the company into the ground!" Not, you know "here's $300 worth of food stamps, go feed your kids for a month!" But I digress.] However:

It should be noted that there are two separate ingredients that make up “makers and takers” doctrine. The first is the idea that those who are relying on government want to be dependent on it, because it’s an easier life. The second is the idea that those who are relying on government are stuck in a plight, perhaps against their will, that is counter-productive for them, in that it increases dependence and saps individual initiative.

While Paul Ryan has had the amazing insight that people do not want to be dependent, he is less sure that they are not somehow stuck against their will. Not in a safety net - in a hammock! A hammock that has lulled them into dependency! Against their will!

I thought it would be of use to Mr. Ryan if I were to give him just a tiny glimpse of life here rocking sweetly in the hammock of SSDI, lulled to dependency on the government largess.

Last night Mr. Z and I began the ever-so-fun process of preparing our 2015 taxes. TurboTax was happy to let me know that my SSDI income for 2015 is GREATER THAN that of 2014 - by a total of $408! COLA raises are the breeze that make the hammock swing! TurboTax also cheerfully informed us that, although last year we had received a modest refund of about $200, this year we owed a payment in an amount just under...$400.

The extra $10 or so of the difference between my SSDI COLA and the federal tax owed is, of course, a lavish extravagance that has lulled me into remaining disabled by chronic migraines and dependent on SSDI, against my true will. Which, of course, is to remain disabled by chronic migraines and NOT "accept government benefits".

One "government benefit" that you may see people who are homeowners "accepting" around tax time is the federal deduction for mortgage interest paid. Unlike the rhetoric around the social safety net, this is a true benefit. It is a pure bonus of buying a house, that the federal government says "good news for you! You can deduct all that interest if you itemize your taxes! Aren't you glad you're a homeowner?" No one ever calls a homeowner a "taker" for accepting this clear, outright government benefit. Homeowners have done nothing special to deserve it. They will not go hungry, or unclothed, or unhoused, or fail to receive needed medical treatment, if this tax break is not extended to them. It. Is. A. Benefit.

Many homeowners even put up actual hammocks in their backyards, rocking contentedly in them after taking their tax break, knowing that the federal government - and Paul Ryan - is somewhere smiling beneficently upon them.

I am the farthest thing from a Trumpist you could find in this U.S. of A., but Paul Ryan's half-way non-pology for "makers and takers" rhetoric is the best the GOP can muster, no wonder The Orange Man is a hit among the disaffected middle class Republicans.

2 responses so far

Anti-Vaxxers Gave Me Whooping Cough

(by Zuska) Mar 11 2016

This is the story of my trip to the hospital.

While the good people of Nevada were busy rejecting their native son a few weeks ago, and helping the nation choose a loose cannon Republican nominee that will make us all say "remember when we used to think Dubya was as bad as it could get?" I was otherwise occupied coughing out my lungs. What had started as some mild sinus congestion and a little cough had led to this - me, on my hands and knees, gasping for breath between paroxysms of coughing.

We went to the ER, where they promptly gave me a little mask to wear once they called me in for triage (but only after I had coughed up a storm in the waiting area. I did cough into my elbow, as one is supposed to do.) Once settled in a curtained-off bed, the kindly physician's assistant listened to my story, listened to my cough, listened to my lungs and then told me:  you may have whooping cough. Yes. Whaaaat? I was just thinking super-bad bronchitis. Although, there was that coughing-so-hard-I-could-barely-breath thing.

They gave me a one hour albuterol breathing treatment which, if you are ever coughing your lungs out, do ask for one, because it is like the balm of Gilead to inflamed bronchial tubes in spasm.  The chest x-ray in the ER showed "lower left lobe infiltrate" which is fancy doctor talk for "you have walking pneumonia" which is also fancy doctor talk for "you have the kind of pneumonia that doesn't give a fever and that is sneaky and hides" and also "you will feel like crap for another week or so, but we should be able to get the coughing under some control" and "you are not going to die, and can go home with your spouse".

The breathing treatment, plus a massive dose of prednisone, plus a horse pill of Levaquin, plus cough syrup with codeine, took me from "I am going to crack a rib if I keep coughing like this, which maybe if the broken rib punctures my lung, it will let some air in" to "Jesu Christi! I can draw a breath of air without breaking into spasms of coughing!" You don't realize how nice it is to breath easy until you can't.

An inept male nurse swabbed me to test for whooping cough, which means he injected my nostrils with saline and then tried to suction "boogies" (his word) out of them for lab culture, while Mr. Z gagged in the chair next to the bed. This was a bad evening for Mr. Z, as he had already had to deal with the cat litter earlier (normally my duty).

Do not ever let anyone swab you for whooping cough, if you can help it. It is not a pleasant experience. Imagine that you have been coughing and choking to death for days on end. Now imagine someone shoots saline up your nostrils, which runs down your throat, and then they stick a thin plastic suction tube up your nostril probing for your brains. Imagine you burst into a spasm of coughing and the torturer nurse says "ready for the other nostril?" and between gasps you say "no" and he says "whenever you are ready!" in a chipper voice and all this is interrupting your balm of Gilead breathing treatment. Bastard. And also, fuck you to all the anti-vaxxers who aren't vaccinating their kids and thus creating outbreaks of whooping cough that lead to innocent bystanders like me getting swabbed for whooping cough because maybe that's what caused my pneumonia. Fucking whooping cough. Fucking anti-vaxxers.

After a five-hour visit, we left the hospital around 2:15 a.m. with a sheaf of prescriptions. We headed for the 24 hr CVS, about a 10 minute drive from the hospital...only to find that the 24 hr CVS is no longer the 24 hr CVS "not since December!" The new 24 CVS is now the CVS that is...down the road from the hospital and on the way home. So, right back to where we started and on to the New Improved 24 Hr CVS, where we waited for the scripts while the slightly crazed looking, probably sleep deprived, but very nice pharmacist called out questions and directions to me in brazen disregard for HIPPA as I sat next to one other pathetic late night prescription seeker. We bought two bottles of Gatorade, a pack of Ensure for Mr. Z to have some breakfast nutriment, and a Kit Kat candy bar for the little girl who had been so brave at the doctor's. And then we went home.

When we were waiting at the ER exit for the valet to bring the car back (you can't park at the ER except by valet) I said to Mr. Z, "I've got the walking pneumonia and the boogie woogie blues" (through my little face mask). And he said, "You surely do." Then: "Boogies! He kept saying it, over and over! Boogies! Over and over! Why did he have to say it!" It was funny, but we were too tired and traumatized to laugh.

He was so angry when the old 24 hr CVS turned out not to be the 24 hr CVS. And then, just as we were almost home we got one last red light, and he was just furious about the wait. And I felt so bad, because I knew he had to get up in about 4 hours and go to work. I felt so awful for being this person who just has one strange illness after another (in the past year I've developed unusual allergic reactions to food and now have an epi-pen; I've had a problem with my eyes; all this on top of the migraine stuff.) I thought he is just going to hate me. We got home, and I crawled into bed and started making a little mound of pillows, because the PA told me to sleep sitting up some if I could, and he said "I love you, but I have to get to sleep".

The next morning, I woke before him, with a little coughing - so I coughed into my pillow as quiet as I could and I slipped out of the room to use my inhaler. After Mr. Z got out of the shower, I said "I know last night was terrible but I'm feeling a lot better" and before I could even finish he said "you sound way better than you did even when we got home last night. I didn't think they were going to let you leave with me." And then he bent over Kitteh #1 laying at the foot of the bed, and petted and kissed him and said "Mommy's getting better, Kitteh! Everything's going to be okay again!" And before he left, he planted three soft, long kisses on top of my head. And I knew he did not hate me, and had not been mad at me for being sick.  And then I took a bunch of meds and made tea.

And that is the story of my trip to the hospital. The End.*

*It was not, however, the end of the story. Eventually had to get a nebulizer for home use, every four hours. And I have to see a pulmonologist. And I've got my fingers crossed that I don't end up with asthma out of all this. So, once again: fuck you, anti-vaxxers. Your irrational, unfounded superstitions about vaccines have real-life, harmful consequences for people.

14 responses so far

That Rescue Thing

(by Zuska) Mar 11 2016

Drugmonkey went old-school with a blog meme recently.

The question is, from the teevee (or movies) you've been watching recently, name the top five characters you'd want coming to rescue you from a bad situation.

Although I was not tagged, I took it as an opportunity to write something on this blog again in the least painful way possible. So thanks, DM!

My rescue team would be:

  1. Archer & Lana
  2. Summer. Or Ghost, or Nymeria. Whoever's available.
  3. Emma Swan
  4. Maneet Chauhan
  5. Stimpy

Secret agents, direwolves, magic (light, dark, whatevs), good cooking, and Happy Happy Joy Joy - that should about cover it.

4 responses so far

Shredding Event

(by Zuska) Dec 23 2015

Some few weeks ago my township held a semi-annual "shredding event", an occasion for citizens to bring forth their accumulated piles of dossiers and documents to be fed into a giant communal shredder, lest our identities be filched and/or days of our lives given over to feeding two sheets of paper at a time into our home shredders.

This was my pile:

To be shredded...

To be shredded...

It might have been much bigger but that was all I could part with at the time.

The pile contained all the Medicare statements and Blue Cross EOB forms I had received for my mother during the time I was her power of attorney. I held on to these until her estate was closed and we were sure all outstanding issues and bills were resolved. It has been many months since the estate closed and I have no further legal need of these documents. But I found it surprisingly hard to let them go.

I browsed through them and their listings of date of service, provider, and service provided. I remembered many of these "services provided", some quite vividly. There were routine doctor visits on which I had accompanied her. There were the "pain shots", the epidural steroids to relieve the pain of her spinal stenosis. Organizing those was like planning the invasion of Normandy, given the astonishing difficulty in communicating with the doctor's office; the need to coordinate scheduling with availability of someone to take her there; and the trickiness of managing all this for someone taking coumadin.  There were the ER visits for falls and other minor emergencies. There was the mountainous paper trail generated near the end, when she bounced from assisted living to hospital to rehab hospital to nursing home and back around till the final bounce home to die. Sometimes I looked at dates and events in disbelief: did that really happen then? so close to the time she died? did all those things really happen so close to one another? Or, oh my god I totally forgot about THAT! How strange, I thought, that these impersonal medical records hold memories of my mother I'm struggling to piece together.

When my father died (young, in his fifties), my mother was devastated. She could not bear the idea that he would go underground. When my brother died, eight months before my mother, we helped her to her feet beside his coffin in the funeral home for the "last goodbye". Though she could barely stand she kind of launched herself at him, weeping over his dead form and declaring "oh Paul, it won't be long, I'll be coming after you." She did not want him to go underground, either.

When she lay dying at home, mostly robbed of speech, she communicated to me one day with great difficulty: "I'm afraid to go in the ground." I don't remember what I said to comfort her beyond "I know" and "I'm sorry" and maybe the pitiful "it will be okay".  I don't know why I didn't ask her why this fear was so strong. Lifelong devout Catholic, each Sunday at Mass she recited "I believe in...the resurrection of the body and life everlasting" and yet in the face of death it appeared this was cold comfort. When her youngest brother, the one she raised from age seven, died before her and was cremated, she did not like that any better. She fretted over how his body would be resurrected at the end of the world. I tried to assure her that if God could do anything, He could surely put her brother's ashes back together in the form of his body. She remained unconvinced.

When she died it was some time before I could leave her side. This parting, unlike every one before it, would not be followed by seeing her smile yet one more time.

I believed I was relatively blasé about the subject of corpses and what should be done with them; I often told Mr. Z he should have mine turned into compost for my garden. At the funeral home, it did not seem to me as if it were her lying there. In the bustle at the house the morning after her death, we could not find her glasses. Lying there without them, that face could have been a wax doll.

And then at the cemetery, the graveside service ended, I wept the tears of a motherless child. I did not want to leave. I knew they would put her in the ground when we left. And she did not want that. It did not matter that she was beyond wanting. Finally, my younger sister said through her sobs and tears, "We have to let her go. Come on. We have to let her go." It was like breaking a spell; her words gave me permission to leave. I let her go, I let her go underground.

A week or so after the funeral my younger sister and I both had the same experience. It was a physical sensation of lightening, as if someone had just removed a very heavy backback from our shoulders. It was not just a mental uplift; we were both still very sad, and actually perplexed by the physical sensation. It was very distinct, and strong. I can only describe it thus: it felt as if I had been literally carrying something on my shoulders, and someone had lifted it off of me. Not that I had set it down, but that the weight had been lifted off me. I had a constant feeling of that sudden lightening for about two weeks. My sister, the same.

I also quit having migraines for three months. My doctors thought that it was the reduction in stress that allowed me to stop having migraines, but I didn't think so. (For one thing, I still had all my worries about my in-laws, and while I no longer had power-of-attorney duties, I now had executor duties for the estate.) I felt that my body chemistry had been altered by grief. I felt that my body was so physically preoccupied with the sensations of grief and loss, that it had no resources, so to speak, to devote to experiencing migraines. In this way, it was similar to the period just after I had my stroke, when I was almost completely blind. I had no migraines then, either. They did not come back until my sight recovered to the point where the place in my visual field where auras formed was functioning again. After my mother's death, my migraines did not come back until I was no longer completely blinded by grief to the world around me.

Time heals all wounds, as they say, whether you want it to or not. Eventually grief lessens, the sharpness of pain dulls, the loved one recedes into memory, which is unreliable, and must be pieced together through written records and conversations with others. Sending the medical records to the shredder was sending a pile of recorded memory to oblivion. If memory is all that is left, how can we bear to part with even one tiny morsel, no matter how bitter its taste? And yet doctor's appointments and ER visits are memories perhaps not worth savoring. There are so many, they dull the taste of anything sweeter.

I gave my folders to the township for shredding. I let them go. Death is cold, the ground dark and silent, but I remember warm evenings at dinner with mom, in the summer at Apple Annie's in Point Marion, the two of us talking, and her smile.

mom apple annies [640x480]

3 responses so far

The Changing Seasons

(by Zuska) Dec 23 2015

It's a balmy 59 degrees today as I write, here in eastern Pennsylvania. Forecast for Christmas Eve and Christmas Day is 72 and 68, respectively. These kinds of temperatures may perhaps seem unusual for December in eastern PA. Nevertheless they are quite normal if one attends to the changing of the seasons. In 2015, we had:
Winter With A Vengeance (Jan-Feb-March)
Spring Thank God Spring! (April-May)
Summer (June-July)
Hell (August)
Summer (Sept)
Fall (Oct-Nov)
and now Springish Falmmer (December).
We can expect Winterish and Winter to come and go over the next two to three months (some say Winter Is Coming, but not till April 2016), to be followed by Spring lasting anywhere from two weeks to 2 months, leading into Jesus It's Summer Already! followed inevitably by Hell once again, etc.

When I see the following in my front yard in December

December bloom of black-eyed Susan

December bloom of black-eyed Susan

I think of my mother. Once, driving her to a doctor appointment in early February, I pointed out a tree that had budded and begun to leaf. "That tree doesn't know what it's supposed to be doing," she said. The flora around me are feverishly cogitating over Springish Falmmer. Who among them knows what to make of it, we shall see when actual Spring gets here.




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