It was not really the water level I was worrying about as I sat on the porch (once more half-listening to my husband pat himself on the back for having built our house 8 feet off the ground years ago) watching a record 30 inches of rain come down in one spot in less than 12 hours. No wading to the car while fighting with umbrellas and rain boots for me! No sailing sideways across I-4 while the car struggled through the river flowing down the middle of it; no peering through a windshield trying to see what the car in front of me was doing through an impenetrable sheet of water. If ever there was a perfect time to be an offsite MT this was darn sure probably it! Nope, what I was worrying about the most as I watched the yard, the path to the barn and the cow pastures disappear under a murky mud-colored covering of water were ants! Tiny critters that detest getting their teensy feet wet and who head for "high" ground every year during our Florida rainy season. Ants that I had spent most of the afternoon squashing and swatting off my computer, the monitor, the reference books on the shelf behind my desk. Ants that I was now watching march across my porch, aimed straight at my screen doors, in a wide, determined-looking swath.

Television newscasters are great at repeating (over and over and over, just in case someone out there may not have turned on the TV set in the last 72 hours or so) the list of hurricane preparedness actions people should be taking when those seasonal storms hit Florida, usually in the same sentence they use to tell us to stay off the roads. Check batteries, get gas for generators, pick up lawn furniture, stock up on canned goods, ice, and water. MTSOs send out "disaster" planning email memos chanting the mantra, "backup, make sure you have surge protectors, backup again." Occasionally we will hear newscasters talk about a snake that slithered up some steps in its search for a drier spot to sleep. They often show film footage of completely unruffled alligators ambling slowly down the middle of major highways. Sometimes we even get videos of bears up trees or deer and wild hogs in subdivision front yards. I have never had an MTSO discuss insect inundation issues, and I have never heard newscasters mention anything but mosquitoes. No one even utters the word "ants." Ants that, in Florida, have the most uncanny ability to find the most minuscule of cracks to infiltrate a home than any other insect I have ever come across. We have found them climbing out of the drain hole of the bath tub; marching down the hangers in the closet over the clothes and onto my rugs. That story about ants not liking the smell of moth balls is just that, a story. The ants at my house seem to get positively drunker than skunks on those musty-smelling things and come in even faster so they can all share in the banquet before it disappears. Nothing is more unsettling than dragging yourself, half-asleep, in the morning down the hallway to the pantry to start breakfast to find ants tippy-toeing delicately over the canned goods and infiltrating the only box of cereal that had not yet been opened! They do not really bite, are not dangerous to our health, they are just a plain old nuisance!

Sugar ants, so named by old-time Floridians because they were, most often, found infesting new bags of sugar in the pantry, are taken in stride by a lot of folks. I have watched my mother-in-law very seriously empty an entire bag of sugar into her flour sifter and carefully sift those ants out, then save that sugar for later use. I can only thank my luck stars I was not destined to live in the days of the Florida Crackers, back in the days with no air-conditioning when the beds, chairs, even bread boxes would be lifted off the floor and counter tops to be perched precariously in tin pans full of water ... supposedly the ants would not cross the water to get to the furniture. Not something practical for electronics of course, but I did, from sheer desperation, give that method a try with my bed the year we had 4 direct-hit hurricanes in less than 2 months ... all I can say is don't put all your faith in those Cracker tales. I can't think of a better to have your day go sour more quickly than waking up with ants in your hair and crawling over the pillows and sheets.

It's not like I can simply spray down the keyboard, monitor and the computer stack with pesticide and have done with it. Although I have to admit I did try that once when ants decided my keyboard and computer tower would make a dandy home. Not one of the brighter things I ever did for sure. My fingers smelled of chemicals for days and the monitor screen was ruined. It took me 2 containers of canned air to get all the dead ants out of the tower (believe me, those little critters most certainly do have a very distinctively odd "dead" smell when they are "en mass").  

So far we are relatively dry (compared to neighbors up the road who were forced to evacuate and are using canoes to get to their homes.) We use the field tractor to get back and forth to the hard road and we still have power and phone lines (at least for this moment), which with luck will hold through the next 2 hurricanes that are supposed to hit us this week in some way or another. I was able to boot up and work my normal early-morning shift on time.  There is, however, an odd ripple of movement across the living room floor that keeps catching the corner of my eye as I work. I am mentally willing it not to be another ant invasion, working on the theory there must be some truth in the "power of thought." I still have several hours to work today before I can stop. Then I will be dragging on my milking boots, wading out to the closest bay tree, picking whatever leaves the winds have left on it, grinding those up, mixing them with ground hot peppers and tobacco (easier said than done since none of us smoke and running to the store is not exactly an easy option). Then, according to the book I unearthed on natural gardening and organic pesticides, I will carefully scatter this concoction around the base of the monitor and computer tower. Supposedly the ants won't cross over that barrier, rather like piling garlic around your neck so the vampire won't bite ... at this point in the insect battle, and as it once again starts raining, I am willing to try almost anything!

It is not all "mai-tai's and Yahtzee" on Sundays. For our primary clients Sunday has become the dumping ground for every dictator on staff who is behind ... often, as was the case last Sunday, a month or more behind and obviously driving the billing department into a frenzy because they cannot bill without the documentation; the wasteland for problem dictators, those who dictate 30-minute long consults resulting in a report that is only half a page long; 18 blanks in a 3-minute dictation because the dictator has never learned to use the dictation equipment properly and keeps cutting himself off; the dictator who speaks (and reads) so little English that I am often transcribing the report while hunched almost double over the keyboard, shoulders around my ears, straining to hear the voice of the interpreter who is standing behind him and repeating everything he says ... it sounds silly, but on Sundays I often find myself, like the Lone Ranger, shouting at my dog (named Willow, not Tonto ... sort of spoils the dramatic effect), "Hi ho Silver, away!" On Sunday, it is up to me to get the job done, no matter what. The ever present pressure of TAT must be met regardless of any issues that may occur to slow down production.

So there I was last Sunday, wading though a massive file of op notes, perched on a heating pad because the arthritis chose that day to make itself felt, and there they were, over 30 reports in a row, with same dictator ID number, and all with that distinct, liquidy sound; a wavering, sort of shimmering splintering of sound that is the tell-tale giveaway of a cell phone call. A surgeon who was a month behind documenting procedures already performed, upper GIs and colonoscopies, and dictating as fast as he could. The Olympics and children playing were clearly audible in the background, with not a single "canned phrase or normal template to be inserted" in the lot! If the Olympics had been in Australia the guy could have been dictating while snorkeling at the Great Barrier Reef with a trail of medical reports bobbing along behind him. It could have been a little mini-vacation for me, I would almost feel the warmth of the sun on the dictator's back through the voice file; the up and down motion as the waves pushed him on toward the next coral formation behind the school of parrot fish in front of him. Unfortunately, the Olympics are in China this year and, rather than a mini-vacation, these files that had the same sound quality of bad Chinese opera being warbled from the top of the Great Wall in a "whisper voice" were a far cry from those awe inspiring, jaw-dropping sound of the 2008 drummers of the opening ceremonies.

As an MT it always takes me back when a client blithely assures us that "our dictators are not allowed to use cell phones to call in dictation" It is impossible to disguise a cell phone call into the dictation system, although I have listened as some dictators attempted to disguise it by rattling x-rays into the speaker or slamming file cabinet drawers. Cell phone lines have a uniquely distinct sound, different from the everyday sort of tinny chatter and static that any MT who has worked offsite is used to hearing. After years on the job any MT can, with unerring accuracy, immediately identify a cell phone dictation ... despite vehement client denials to the contrary.

Poor sound quality slows down production, instead of passing through 1 or 2 sets of ears (the MT and a QA) it ends up going through 3 or 4 sets, resulting in late charting, multiple blanks and twice the cost in labor to produce a single report, yet clients passively allow their dictators to get away with it ... all the while patting the MTs on the shoulder and assuring them, "yes, yes, we know the sound is terrible, we will tell them not to do it again," or, (my personal favorite at the moment) "this will no longer be an issue once we have our new speech recognition system installed." The expectation that software will miraculously "hear" through poor sound quality any better than a human ear is something I often chuckle about while I am adjusting the ranger mask over my eyes in the vain hope that the eyes will somehow "see" what that dictator is burbling under the water better than the ears can "hear" it.    

The MTSO I work with once spent 6 full weeks documenting in every possible way the dictation habits of a dictator that were so utterly foul, coupled with his preference for using his cell phone to call in the reports while sitting at railroad crossings, she felt compelled to take several weeks of his routine daily dictation to the hospital's Risk Management Officer. They agreed that there "might" be a problem with the quality of his medical documentation habits. A meeting was set up with the physician, one of the hospital's lawyers, the MTSO. The physician walked in, sat down, punched "play" to relisten to the first of those dictations, irately announced that was not him dictating (even though every person sitting in that room clearly recognized the voice and the patients as his) got up and left the room ... the meeting was over. To this day he still dictates and has not made a single effort to change anything in the way he goes about the process of dictating.

For the last 3 weeks the afternoon storms have played havoc with scheduling and TAT as the MTs who work in Central Florida seem to spend more time plugging and unplugging than they do sitting in the chair.

Later, after the storm passed, as I was sending through that last set of transcripts I could hear a television newscaster from the set in the living room gravely announcing a "special weather bulletin" (it is hard to miss those here in Florida; they have a really obnoxious siren sort of thingy that simply cannot be tuned out). He was reporting that we had just had a dramatic lightning strike in Sanford (Sanford? That is where I live! So that is why I was desk diving this afternoon!). The bolt had hit a 75-foot tall oak tree, literally shattering it into fist-sized bits, and sending those bits flying through five different houses ... not even a quarter mile from where my farm is situated! By the time I made it to the living room the newscast was showing pictures of a house door with roughly 2-inch wide fragments of wood that had pierced entirely through it resulting in a nifty pincushion-like look! The homeowner was planning to cut that part of the door out with a chain saw and frame it to hang in his hallway as art.  

Lightning is probably one of my worst MT fears. Despite all the money I have spent on surge protectors, heavy-duty UPCs and the "easy-jerk" network of twist-tied together wires under the desk, I have lost three different computers, a telestaffing unit and a portable hard drive to lightning strikes ... three indirect hits and one direct hit that threw the computer monitor and external drive across the room and into my kitchen while I watched with my mouth sort of unattractively hanging open. The rebuilding process is never fun, even with all sorts of backups on disk, reloading all the various client-specific proprietary software programs, downtime to reload and rework macro expanders, templates ... it is time-consuming and costly. After third time I invested in a laptop, as well as the new computer I had to have built. Granted, I rarely use the laptop (I detest the dinky little standard keyboard, having used a split board for years), but it is fully loaded with everything I need to work, and, I hope, will take at least some the ability-to-work delay (and frustration) out of once again having a bolt flash through or near my house.

I know many people think MTs are not at risk physically from anything they do in their line of work.

I believe MTs rank right up there with those crab fishermen ... I cannot think of anything more physically risky than lightning through a headset, in one ear and out the other! Or worse, trauma to the head and back from rolling out of chairs and wallowing around on the floor attempting to disconnect from electrical sockets. I think any MT who struggles to work each day during the Florida thunderstorm season and manages, despite the weather, to make that TAT, fully deserves some sort of hazard pay for being brave enough to ride that "steel horse" each day.

Transcribing sexual content in a patient's medical record is a part of the transcription process that rarely gets talked about publicly. While many MTs would not openly admit it, over the years I have come to think that for some the vicarious frisson that inevitably accompanies learning "secrets" as we sit here transcribing is as much a part of what we do as reaching for the Dorland's to research a new medical word. And, though some would deny it, reality is that those tawdry, trashy, at times emotionally draining feelings (sort of like those we get from watching soap operas and reading tabloid gossip magazines) are feelings all MTs have had to struggle with. Certainly there have been times I found myself staring at my dog, squirming around in my chair, attempting to suppress that feeling of "knowing" something I cannot share with anyone at all ... virtuously hugging that secret to myself. The temptation not to share those "secrets" is one of hardest hurdles every MT I have ever known has had to learn to overcome, doubly so when the subject is related in any way whatsoever to sex. As the recent hoo-haw with Britney Spears' medical records has shown us, some folks in health care jobs never do make it over that hurdle. When something "Brangelina" passes through the headset, something only a few people on earth are privy to ... ohhh the temptation to hint, to wink, to try disguising the particulars, to let just a little bit of that "slip" out somewhere, especially online where it is so easy to pretend anonymity. I think transcribing anything sex related is one of the most important lessons in self-restraint that an MT learns. It is, undeniably, a very real part of our working reality.

**agra, the big "V" ... and the many other permutations of the spelling of the name has a way of attracting attention. I am sure the reporter knew that, saw it as a way to set herself apart from the crowd. It is a drug name that, no matter how often transcribed in medical records (and it is transcribed a lot), those who post in online message forums purposely misspell in order to avoid waking up in the morning to e-mail boxes overflowing with offers from spam bots for "deep discounts," yet here was a reporter unafraid to spit that word out on national television, boldly asking a question many females in this country would dearly love an answer to ... what cojones! While I had a moment of justifiable intrigue watching the politician fumble about for an answer, I have to say I did kind of feel sorry for the guy--I am sure he would much rather have been discussing world peace instead of erectile dysfunction issues. Another thing that was intriguing about that press conference was that the reporters in the room must not listen to their own news casts because in that same week that the "V" question was asked scientists had announced that watermelon had been found to contain the same chemical properties as the drug. It had been a leading news item on every television station one turned to, but not a single one of those reporters volunteered that information to sort of help that politician out.

Today, for the first time I had a transcript with the physician earnestly detailing his discussion with a patient about just how much watermelon one should probably eat as an alternative to taking the drug, and, as I finished creating a macro expander for that word (I reckon I will have to transcribe it at least as much as the "V" word once farmers figure out they should be marketing watermelon as heavily as the drug reps have pushed the "V" pill since the day it was created) I found myself rethinking my plan to expand my beds of heirloom tomatoes and put in some more watermelons instead.

I do vividly recall that my cows, unlike the literate bovines of the cheese commercials, did not seem a bit impressed as I related this magnificent achievement to them later in the day. In fact those cows were all giving me the same blank look I would come to know well, the look my husband and even my best friend would give me when I attempted to explain to them what had happened and how I just "knew" I was now a real MT. That was the day I learned, painfully slowly, that unless someone is already an MT there is simply no hope they will ever truly understand how special the feeling of having finally arrived at full-fledged MT status really is.

If the 2007 Survey of Medical Transcriptionists (by Gary David, PhD, of Bentley College) is to be believed, the bulk of working MTs are middle-aged women who have, undoubtedly, been sitting in their chairs for many years, and no matter how much the advertising folks for the newly revamped AHDI try to gussy it up, those working MTs spend most of their working day repeatedly transcribing the same surgical procedures, discharge summaries, office visits, history and physicals until most of them, upon simply hearing the dictator's name or ID number, will know 95 percent of what is going to be dictated before the first sounds are even uttered. While it is true that there is always something unique, something new about each patient encounter, repetition and routine from the majority of what any MT encounters when transcribing daily, and it is that mind numbingly normal routine that made me sit down to think about that "real MT feeling" while reading through the MySpace web site for AHDI's "I Love My Career" video contest.

Although on the day I visited only one video had been entered, I admit that I am looking forward to seeing the ideas others will have for making the work of MT sound enticing to the 30-second sound-bite generation of today's work force ... how they will portray MT as something exciting ... sexy even. I don't mind telling y'all that I have spent some time thinking about what sort of video I would like to do myself.

My video would be pretty simple ... low budget, low tech ... 3 sets of bare legs, slowly strolling down a beach, waves barely washing over the toes and erasing those footprints as the camera pans toward the horizon. Sea gulls would be calling in the distance and a line of pelicans swooping across the waves. Then 3 sets of legs would stretch out on lounge chairs with laptops propped neatly on rolled-up beach towels. A Dorland's medical dictionary and a copy of the Saunders Pharmaceutical Word Book tossed casually at the end of one chair. The sound of the clickety-click-click of 3 keyboards racketing along. A camera shot of a cell phone held to an ear while a calm MT voice assures the client that she has just, minutes ago, uploaded the H&P that the surgeon was waiting on before the patient was prepped for the OR. A masculine arm extends a tray on which sit 3 tall glasses of lemonade (with little pink umbrellas for a bit of color contrast against the yellow drink) and a voice asking ... "why would anybody bring their job to the beach?" Then, as the camera pans slowly toward the distance showing the backside of the cabana boy walking away to sound of ZZ Top's "Legs" ... 3 voices answer at once, "because we can take this job anywhere we go, and, every now and then, there are benefits!"

The filming would have to be done on a cell phone and would be a bit shaky, but I think the light, tongue-in-cheek, touch would be a nice departure from the serious work MTs do without dwelling on the routine of transcribing the same words for the same dictator day after day. Perhaps it would appeal to a younger demographic than the one recruiters of MTs have traditionally recruited from.

Now all I have to do is successfully convince my daughter and my son's girlfriend (tanned, young legs look far better on camera than the varicose veins of middle age) into taking a ride to the beach with me, and somehow shanghai my son into performing the cabana boy duties (he is the only male around here with a firm tush). There may be a slight hitch to this plan once he figures out that his derriere is going to be immortalized for all sorts of MTs to look at, but perhaps I can dazzle him with assorted baked goods that incorporate chocolate and slip the picture release form to him while he is sitting there in a chocolate-induced haze.

Nae